***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background We examined the incidence of new-onset atrial fibrillation in patients with left ventricular dysfunction . Patients either had a recent myocardial infa rct ion ( with or without clinical heart failure ) or symptomatic heart failure ( without a recent MI ) . Patients were with and without treatment with the class III antiarrhythmic drug dofetilide over 36 months . Methods The Danish Investigations of Arrhythmia and Mortality ON Dofetilide ( DIAMOND ) studies included 2627 patients without atrial fibrillation at baseline , who were r and omised to treatment with either dofetilide or placebo .  Results The competing risk analyses estimated the cumulative incidences of atrial fibrillation during the 42 months of follow-up to be 9.6 % in the placebo-treated heart failure-group , and 2.9 % in the placebo-treated myocardial infa rct ion-group . Cox proportional hazard regression found a 42 % significant reduction in the incidence of new-onset AF when assigned to dofetilide compared to placebo ( hazard ratio 0.58 , 95 % confidence interval 0.40 - 0.82 ) and there was no interaction with study ( p = 0.89).In the heart failure-group , the incidence of atrial fibrillation was significantly reduced to 5.6 % in the dofetilide-treated patients ( hazard ratio 0.57 , 95 % confidence interval 0.38 - 0.86).In the myocardial infa rct ion-group the incidence of atrial fibrillation was reduced to 1.7 % with the administration of dofetilide . This reduction was however not significant ( hazard ratio 0.61 , 95 % confidence interval 0.30 - 1.24 ) . Conclusion In patients with left ventricular dysfunction the incidence of AF in 42 months was 9.6 % in patients with heart failure and 2.9 % in patients with a recent MI . Dofetilide significantly reduced the risk of developing atrial fibrillation compared to placebo in the entire study group and in the subgroup of patients with heart failure . The reduction in the subgroup with recent MI was not statistically significant , but the hazard ratio was similar to the hazard ratio for the heart failure patients , and there was no difference between the effect in the two studies ( p = 0.89 for interaction ) BACKGROUND Atrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infa rct ion . Recent advances in pharmacological treatment of myocardial infa rct ion may have changed the impact of this arrhythmia . OBJECTIVE To assess the incidence and prognosis of atrial fibrillation complicating myocardial infa rct ion in a large population of patients receiving optimal treatment , including angiotensin converting enzyme ( ACE ) inhibitors .  METHODS Data were derived from the GISSI-3 trial , which included 17 944 patients within the first 24 hours after acute myocardial infa rct ion . Atrial fibrillation was recorded during the hospital stay , and follow up visits were planned at six weeks and six months . Survival of the patients at four years was assessed through census offices . RESULTS The incidence of in-hospital atrial fibrillation or flutter was 7.8 % . Atrial fibrillation was associated with indicators of a worse prognosis ( age > 70 years , female sex , higher Killip class , previous myocardial infa rct ion , treated hypertension , high systolic blood pressure at entry , insulin dependent diabetes , signs or symptoms of heart failure ) and with some adverse clinical events ( reinfa rct ion , sustained ventricular tachycardia , ventricular fibrillation ) . After adjustment for other prognostic factors , atrial fibrillation remained an independent predictor of increased in-hospital mortality : 12.6%v 5 % , adjusted relative risk ( RR ) 1.98 , 95 % confidence interval ( CI ) 1.67 to 2.34 . Data on long term mortality ( four years after acute myocardial infa rct ion ) confirmed the persistent negative influence of atrial fibrillation ( RR 1.78 , 95 % CI 1.60 to 1.99 ) . CONCLUSIONS Atrial fibrillation is an indicator of worse prognosis after acute myocardial infa rct ion , both in the short term and in the long term , even in an unselected population BACKGROUND Paroxysmal atrial fibrillation ( PAF ) is considered a frequent complication of acute myocardial infa rct ion ( AMI ) , associated with increased in-hospital and long-term mortality rates . This notion is based on data collected before thrombolysis and additional modern methods of treatment became widely available , and no information is available on the significance of PAF in the general population with AMI in the thrombolytic era . The aim of the present study was to define the incidence , associated clinical parameters , and short- and long-term prognostic significance of PAF in patients with AMI in the thrombolytic era . METHODS AND RESULTS A prospect i ve , nationwide survey was conducted of 2866 consecutive patients admitted with AMI in all 25 coronary care units in Israel during January/February 1992 , 1994 , and 1996 ( thrombolytic era [ TE ] ) . The data were compared with a previous Israeli study of 5803 patients with AMI hospitalized in 1981 through 1983 ( prethrombolytic era [ PTE ] ) . Patients in the TE with PAF were older and had a worse risk profile than those without PAF . PAF in the TE was independently associated with increased 30-day ( odds ratio , 1.32 ; 95 % confidence interval , 0.92 to 1.87 ) and 1-year ( relative risk , 1.33 ; 95 % confidence interval , 1.05 to 1.68 ) mortality rates . The incidence of PAF ( 8.9 % and 9.9 % ) and the 30-day ( 25.1 % and 27.6 % ) and 1-year ( 38.4 % and 42.5 % ) mortality rates of patients with PAF were similar in the TE and PTE , although PAF in the TE occurred in older and sicker patients than those in the PTE . After adjustment for conventional risk factors , PAF was associated with significantly lower 30-day ( odds ratio , 0.64 ; 95 % confidence interval , 0.44 to 0.94 ) and 1-year ( relative risk , 0.69 ; 95 % confidence interval , 0.54 to 0.88 ) mortality rates compared with the PTE . CONCLUSIONS Patients with AMI who develop PAF in the TE have significantly worse short- and long-term prognoses than patients without PAF , mostly due to their worse risk profile . After adjustment for confounding factors , patients with PAF in the TE have a better overall outcome than counterparts in the PTE , probably reflecting the better management of patients with AMI in the TE OBJECTIVES We examined the clinical predictors and angiographic and clinical outcomes associated with  atrial fibrillation in the setting of acute myocardial infa rct ion ( MI ) . BACKGROUND This condition has been studied primarily in prethrombolytic era small trials . METHODS We compared baseline clinical characteristics , short-term clinical and angiographic outcomes and 1-year mortality of patients enrolled in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries ( GUSTO-I ) trial with atrial fibrillation on admission electrocardiography ( n = 1,026 [ 2.5 % ] ) or after enrollment ( n = 3,254 [ 7.9 % ] ) and those without atrial fibrillation ( n = 36,611 [ 89.6 % ] ) . Univariable and multivariable analyses were used to assess relations between baseline factors and the development of atrial fibrillation . RESULTS Patients with any atrial fibrillation more often had three-vessel coronary artery disease and initial Thrombolysis in Myocardial Infa rct ion ( TIMI ) grade < 3 flow than those without the arrhythmia . In-hospital stroke was increased in patients with atrial fibrillation ( 3.1 % vs. 1.3 % , p = 0.0001 ) , mainly ischemic stroke ( 1.8 % vs. 0.5 % , p = 0.0001 ) . Significant multivariable predictors of later atrial fibrillation included advanced age , higher peak creatine kinase levels , worse Killip class and increased heart rate . The unadjusted mortality rate was significantly higher at 30 days ( 14.3 % vs. 6.2 % , p = 0.0001 ) and at 1 year ( 21.5 % vs. 8.6 % , p < 0.0001 ) in patients with atrial fibrillation . The adjusted 30-day mortality rate remained significantly higher with any ( odds ratio [ OR ] 1.3 , 95 % confidence interval [ CI ] 1.2 to 1.4 ) or later ( OR 1.4 , 95 % CI 1.3 to 1.5 ) atrial fibrillation but not with baseline atrial fibrillation ( OR 1.1 , 95 % CI 0.88 to 1.3 ) . CONCLUSIONS Atrial fibrillation in the setting of acute MI independently predicts stroke and 30-day mortality . More aggressive treatment strategies in this subgroup may be warranted and deserve further study AIMS Atrial fibrillation ( AF ) is a common complication in patients with acute myocardial infa rct ion and is associated with an increase in the risk of death . The excess mortality associated with AF complicating acute myocardial infa rct ion has not been studied in detail . Observations indicate that AF facilitates induction of ventricular arrhythmias , which may increase the risk of sudden cardiovascular death ( SCD ) . A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments . METHODS AND RESULTS We analysed the relation between AF/atrial flutter ( AFL )  and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infa rct ion screened in the TR And olapril Cardiac Evaluation registry . This cohort of patients with an enzyme-verified acute myocardial infa rct ion was admitted to 27 centres in 1990 - 92 .  Survival status was obtained 2 years after screening of the last patient . An independent endpoint committee assessed the modes of death . Left ventricular ejection fraction was determined in all the screened patients and information about presence or absence of AF/AFL was prospect ively collected . Sustained or paroxysmal AF/AFL was observed in 1149 patients ( 19 % ) during hospitalization . During follow-up , 1659 patients ( 34 % ) died : 482 ( 50 % ) patients with AF/AFL and 1177 ( 30 % ) patients without AF/AFL , P<0.001 . SCD occurred in 536 , non-SCD occurred in 725 , and 398 died of non-cardiovascular causes ( includes 142 unclassifiable cases ) . The adjusted risk ratio of AF/AFL for total mortality was 1.33 ( 95 % CI : 1.19 - 1.49 ; P<0.0001 ) and the risk ratio for SCD was 1.31 ( 95 % CI : 1.07 - 1.60 ; P<0.009 ) . The adjusted risk ratio of AF/AFL for non-SCD was 1.43 ( 95 % CI : 1.21 - 1.70 ; P<0.0001 ) . CONCLUSION The excess mortality observed in patients with AF/AFL following acute myocardial infa rct ion is due to a significant increase in both SCD and non-SCD Background : Atrial fibrillation ( AF ) is a common complication of acute myocardial infa rct ion ( AMI ) with a reported incidence of 7–18 % . Recently ,  P‐wave signal‐averaged electrocardiogram ( P‐SAECG )  has been used to assess the risk of paroxysmal AF attacks in some diseases . The aim of this study was to determine prospect ively whether patients with AMI at risk for paroxysmal AF would be identified by P‐SAECG and other clinical variables Atrial fibrillation ( AF ) is common during the course of acute myocardial infa rct ion and is associated with left atrial ( LA ) dilatation . However , the role of LA depolarization abnormality on the  electrocardiogram ( ECG ) in the setting of LA dilatation was not studied in this context . Patients admitted with non-ST-segment elevation myocardial infa rct ion ( NSTEMI ) who developed new-onset AF ( International Classification of Diseases , Ninth Revision code 427.31 ) were prospect ively identified . Baseline ECGs and echocardiograms before the admission event were review ed . Follow-up was directed toward pertinent cardiovascular events , atrial tachyarrhythmias , and death as end points . Of 101 patients with NSTEMI who had new-onset AF , 88 had current echocardiograms and 69 had LA dilatation ( 78 % ) . Total follow-up was 24 months ( mean 21.4 ) . Prolonged P-wave duration ( > or = 110 ms ) and decre 
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Conclusions Our meta- analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI