- 作者：Anne-Christine Huth Ruwald ; Poul Erik Bloch Thomsen ; Uffe Gang ; Rikke M酶rch J酶rgensen ; Heikki V. Huikuri ; Christian Jons
- 刊名：American Heart Journal
- 出版年：November, 2013
- 年：2013
- 卷：166
- 期：5
- 页码：855-863.e3
- 全文大小：1177 K
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 鈮?0%, 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 鈮I 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.