Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up

Background Silent atrial fibrillation (AF), assessed by continuous ECG monitoring (CEM), has recently been shown to be common in acute myocardial infarction (AMI), and associated with higher hospital mortality. However, the long-term prognosis is still unknown. We aimed to assess 1-year prognosis in...

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Bibliographic Details
Published in:Heart (British Cardiac Society) Vol. 101; no. 11; pp. 864 - 869
Main Authors: Stamboul, Karim, Zeller, Marianne, Fauchier, Laurent, Gudjoncik, Aurélie, Buffet, Philippe, Garnier, Fabien, Guenancia, Charles, Lorgis, Luc, Beer, Jean Claude, Touzery, Claude, Cottin, Yves
Format: Journal Article
Language:English
Published: England BMJ Publishing Group LTD 01.06.2015
BMJ Publishing Group
Subjects:
Acute coronary syndromes
Age
Aged
Aged, 80 and over
Atrial Fibrillation - diagnosis
Atrial Fibrillation - drug therapy
Atrial Fibrillation - mortality
Cardiac arrhythmia
Electrocardiography
Epidemiologic Methods
Female
Heart attacks
Heart failure
Hospitalization
Humanities and Social Sciences
Humans
Male
Medical prognosis
Middle Aged
Mortality
Myocardial Infarction - mortality
Population
Prognosis
Risk factors
Stroke - mortality
Studies
Variance analysis
ISSN:1355-6037, 1468-201X
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Summary:Background Silent atrial fibrillation (AF), assessed by continuous ECG monitoring (CEM), has recently been shown to be common in acute myocardial infarction (AMI), and associated with higher hospital mortality. However, the long-term prognosis is still unknown. We aimed to assess 1-year prognosis in patients experiencing silent AF in AMI. Methods All consecutive patients with AMI who were prospectively analysed by CEM during the first 48 h after admission and who survived at hospital discharge were included. Silent AF was defined as asymptomatic episodes lasting at least 30 s. Patients were followed up at 1 year for cardiovascular (CV) outcomes. Results Among the 737 patients analysed, 106 (14%) developed silent AF and 32 (4%) symptomatic AF. Compared with the no-AF group, patients with silent AF were markedly older (79 vs 62 years, p<0.001), more frequently hypertensive (71% vs 49%, p<0.001) and less likely to be smokers (23% vs 37%, p<0.001). Also, they were more likely to have impaired LVEF (50% vs 55%, p<0.001). Risk factors in patients with silent AF were similar to those in patients with symptomatic AF. However, a history of stroke or AF was less frequent in silent AF than in symptomatic-AF patients (10% vs 25% and 10% vs 38%, respectively). At 1 year, CV events including hospitalisation for heart failure (HF) and CV mortality were markedly higher in silent-AF patients than in no-AF patients (6.6% vs 1.3% and 5.7% vs 2.0%, p<0.001, respectively). Conclusions Our large prospective study showed for the first time that silent AF is associated with worse 1-year prognosis after AMI. Systematic screening and specific management should be investigated in order to improve outcomes of patients after AMI.
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ISSN:1355-6037
1468-201X
DOI:10.1136/heartjnl-2014-307253