New-Onset AF Predicts Malignant Arrhythmias in Post-MI Patients
New-Onset AF Predicts Malignant Arrhythmias in Post-MI Patients
Background After myocardial infarction (MI) the risk of sudden cardiac death due to arrhythmias is substantial.
Objective The purpose of this study was to investigate if new-onset atrial fibrillation (AF) is associated with development of potential malignant brady- and tachyarrhythmias after an acute MI.
Methods The study included 277 post-MI patients from the CARISMA study with left ventricular ejection fraction ≤40%, New York Heart Association class I, II, or III and no history of AF. All patients were implanted with an implantable cardiac monitor within 4 to 27 days after an acute MI and followed every 3 months for 2 years. Time-dependent association between new-onset AF >30 s and the development of bradyarrhythmias and/or ventricular tachyarrhythmias were investigated using Cox proportional hazard regressions.
Results New-onset AF was associated with an increased risk of bradyarrhythmias when adjusting for male gender and baseline age, left ventricular ejection fraction and QRS width (HR = 2.8 [1.3–5.8], P = .006). Similarly, new-onset AF predicted ventricular tachyarrhythmias when adjusting for New York Heart Association class ≥II and baseline QRS width (HR = 2.3 [1.2–4.4], P = .019). After dividing ventricular tachyarrhythmias into subgroups of non-sustained ventricular tachycardia (VT), sustained VT and ventricular fibrillation (VF), new-onset AF was significantly associated with an increased risk of non-sustained- and sustained VT but not VF (non-sustained VT: HR = 3.5 [1.7–7.2], P < .001, sustained VT: HR = 4.2 [1.1–15.7], P = .035, VF: HR = 1.1 [0.2–5.8], P = .877).
Conclusion In patients surviving a MI with reduced left ventricular systolic function, new-onset AF is associated with a significantly increased risk of developing ventricular brady- and tachyarrhythmias.
Abstract
Background After myocardial infarction (MI) the risk of sudden cardiac death due to arrhythmias is substantial.
Objective The purpose of this study was to investigate if new-onset atrial fibrillation (AF) is associated with development of potential malignant brady- and tachyarrhythmias after an acute MI.
Methods The study included 277 post-MI patients from the CARISMA study with left ventricular ejection fraction ≤40%, New York Heart Association class I, II, or III and no history of AF. All patients were implanted with an implantable cardiac monitor within 4 to 27 days after an acute MI and followed every 3 months for 2 years. Time-dependent association between new-onset AF >30 s and the development of bradyarrhythmias and/or ventricular tachyarrhythmias were investigated using Cox proportional hazard regressions.
Results New-onset AF was associated with an increased risk of bradyarrhythmias when adjusting for male gender and baseline age, left ventricular ejection fraction and QRS width (HR = 2.8 [1.3–5.8], P = .006). Similarly, new-onset AF predicted ventricular tachyarrhythmias when adjusting for New York Heart Association class ≥II and baseline QRS width (HR = 2.3 [1.2–4.4], P = .019). After dividing ventricular tachyarrhythmias into subgroups of non-sustained ventricular tachycardia (VT), sustained VT and ventricular fibrillation (VF), new-onset AF was significantly associated with an increased risk of non-sustained- and sustained VT but not VF (non-sustained VT: HR = 3.5 [1.7–7.2], P < .001, sustained VT: HR = 4.2 [1.1–15.7], P = .035, VF: HR = 1.1 [0.2–5.8], P = .877).
Conclusion In patients surviving a MI with reduced left ventricular systolic function, new-onset AF is associated with a significantly increased risk of developing ventricular brady- and tachyarrhythmias.
