Retrospective cohort study of new-onset atrial fibrillation in acute pulmonary embolism on prognosis

Abstract

ObjectivesTo investigate the characteristics of new-onset atrial fibrillation (AF) and its impact on prognosis in acute pulmonary embolism (aPE).DesignA retrospective cohort studySettingThe study cohort included patients diagnosed with aPE who were admitted to the Renmin Hospital of Wuhan University from January 2017 to January 2019.ParticipantsPatients were ≥18 years of age and hospitalised for aPE.Outcome measuresAF was diagnosed based on an ECG recording or a Holter monitor during hospitalisation. aPE was diagnosed by CT pulmonary angiography. The prescription was determined from the discharge medication list. All-cause mortality was observed after 6-month follow-up. The logistic regression model and Cox proportional hazards model were used to study the risk factor of the new-onset AF and the predictor of all-cause mortality, respectively.ResultsA total of 590 patients with aPE were enrolled, 23 (3.9%) in the new-onset paroxysmal AF group, 31 (5.3%) in the new-onset persistent AF group and 536 (90.8%) in the sinus rhythm (SR) group. The incidence of the new-onset AF was 9.2% (54/590). A significant difference in age, heart rate, cardiac troponin I ultra, amino-terminal pro-brain natriuretic peptide, D-dimer, left atrial diameter, left ventricular ejection fraction, pulmonary infection, venous thromboembolism, congestive heart failure, chronic cor pulmonale and ischaemic heart disease was found among the three groups (p<0.05). Risk factors for the new-onset AF were massive PE, ischaemic heart disease and congestive heart failure. The survival rate of the paroxysmal and persistent AF group was significantly lower than that of the SR group within 6 months (60.9% and 51.6% vs 88.8%, p<0.001). New-onset persistent AF (OR 2.73; 95% CI 1.28 to 5.81; p=0.009) was an independent predictor affecting the 6-month survival in aPE patients.ConclusionsMassive PE, ischaemic heart disease and congestive heart failure are high-risk factors which were related to new-onset AF in aPE. New-onset persistent AF was an independent predictor for 6-month all-cause mortality in PE patients.

Ischemic Stroke Temporally Associated With New-Onset Atrial Fibrillation: A Population-Based Registry-Linkage Study

“…22 The effects carried by new-onset AF may also partly explain the higher mortality in patients with ISTAF, as increased mortality with new-onset AF has been shown also in other acute vascular conditions, such as myocardial infarction and pulmonary embolism. 23,24 As a favorable trend, we showed improved survival rates over time, especially for patients with ISTAF, which supports our previous findings in the same cohort demonstrating a decrease in mortality in all patients with AF 25 and large epidemiological studies showing improved stroke survival rates during the past decade. 26 As risk factor burden and age of patients with ISTAF did not reduce over the years, potential explanations for the improved survival include better access to stroke unit care, higher utilization of recanalization therapies (intravenous thrombolysis and mechanical thrombectomy), and better control of cardiovascular risk factors.…”

“… 22 The effects carried by new-onset AF may also partly explain the higher mortality in patients with ISTAF, as increased mortality with new-onset AF has been shown also in other acute vascular conditions, such as myocardial infarction and pulmonary embolism. 23 , 24 …”

Pulmonary embolism and atrial fibrillation: analysis of data from the SIRENA Russian registry

“…человек [6]. Доказательства двунаправленной связи между возникновением ФП и ВТЭО получены в когортных исследованиях [6][7][8][9][10][11][12]. Оба состояния включают общие факторы риска, такие как пожилой возраст, ожирение, сердечную недостаточность [7,[12][13][14].…”

“…Интересно отметить, что имеются данные о более низкой частоте тромбозов глубоких вен у пациентов ФП [7,11], эти результаты согласуются с представлением о том, что тромбы могут возникать не только в системе глубоких вен, но, возможно, и в правых отделах сердца или образовываться de novo в крупных артериях легких. Однако в нашей работе различий по частоте тромбоза глубоких вен в группах в зависимости от наличия/отсутствия ФП не выявлено.…”

“…Однако в нашей работе различий по частоте тромбоза глубоких вен в группах в зависимости от наличия/отсутствия ФП не выявлено. Другим заслуживающим внимания предположением, требующим дополнительного исследования, является то, что система оценки CHA 2 DS 2 -VASc может быть более чувствительной для прогнозирования риска и стратификации ВТЭО у пациентов с ФП [11], а риск ТЭЛА следует учитывать у пациентов с впервые возникшей ФП или с ФП в анамнезе.…”