ABSTRACT

Background: Acute coronary syndrome (ACS) is a fatal entity and can be even more deadly if they develops concomitant complications in the form of arrhythmias like atrial fibrillation. Coronary artery disease is thought to be more severe in cases with ACS and atrial fibrillation.

Objective: To determine the angiographic findings in patients presenting with acute coronary syndrome and atrial fibrillation and

To find the involvement of more common circulation (right or left coronary circulation) leading to atrial fibrillation in acute coronary syndrome.

Materials and Methods: This 6 month case series study conducted at department of Cardiology, Sheikh Zayed Hospital, Rahim Yar Khan from14-01-20 to 14-09-20.  A total of 198 cases aged 30-60 years of both gender were included in the study through non-probability consecutive sampling. Patients suffering with ACS and has atrial fibrillation on presentation or develops within 24 hours of admission were included. They underwent coronary angiography to look for number of vessels involved, severity of coronary artery disease and culprit vessel involved.

Results: In this study there were total 198 cases. Mean age of the participants was 50.09±5.88 years and mean duration of atrial fibrillation was 14.91± 4.51 hours. There were 70 (35.35%) cases with DM, 78 (39.39%) with HTN and 61 (30.81%) smokers. STEMI was found in 35 (17.68%) and NSTEMI in 152 (76.77%) of cases as in figure 05. One vessel disease was observed in 26 (13.13%), two vessel disease in 147 (74.24%) and three vessel disease in 25 (12.63%) of cases. Mild disease on angiography was seen in 45 (22.73%), moderate in 132 (66.67%) and severe in 21 (10.61%) of the cases.it was found that out of 198 patients ,   146 ( 74 %) had right coronary artery culprit lesion and     51 ( 26 %) has left sided coronary circulation culprit lesion and from left coronary circulation, left circumflex  was most commonly involved :  41  ( 21 % ) of patients as compared to only  10 ( 5 %) patients had culprit in left anterior descending artery.

Conclusion: AF in patients with ACS is most commonly associated with right coronary artery lesionsand right type of coronary circulation. In terms of number and severity of disease the most common pattern observed was two vessel disease comprising almost 3/4^th of all cases and moderate disease was in most of the vesselsrespectively.