Device-detected atrial fibrillation before and after acute cardiac events: insights from ASSERT
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AbstractFunding AcknowledgementsType of funding sources: None.BackgroundAtrial fibrillation (AF) that is first detected concurrently with or shortly after another cardiac event is often thought to be caused by acute cardiac injury, and therefore reversible.MethodsASSERT enrolled patients >65 years old with hypertension and a pacemaker, but without known AF. We evaluated participants who had a cardiac event [angina/myocardial infarction (MI), cardiac catheterization/percutaneous coronary intervention (PCI), cardiac surgery or other (e.g. pericarditis, hypertensive crisis)] and compared the prevalence of device-detected AF before and after these events.ResultsAmong 2580 participants, 178 (6.9%) had at least one cardiac event over a mean 2.5 years of follow-up. In the 30 days following a first cardiac event, the prevalence of device-detected AF >6 min was 12.4% (95% confidence interval [CI] 7.9%-18.1%), which was higher than in the 30 days before the event (12.4% versus 4.5%, P = 0.004) (Figure 1). The prevalence of device-detected AF following the event was comparable across event subtypes (MI: 13.8%, 95%CI 7.9-18.1%; PCI: 6.9%, 95%CI 1.9-16.7%; Surgery: 20.0%, 95%CI 5.7-43.7%; Other: 18.5%, 95%CI 6.3-38.1%).There was a significant association between device-detected AF in the 6 months before a cardiac event and device-detected AF in the 30 days after a cardiac event: odds ratio (OR, adjusted for CHA2DS2-VASc score) for episodes >6 min 7.07 (95%CI 2.07-24.19; P = 0.002); adjusted OR for episodes >24 hours: 11.41 (95%CI 1.47-88.43; p = 0.020).ConclusionsAcute cardiac events are associated with an increase in the prevalence of device-detected AF. These episodes are associated with a prior history of device-detected AF. Abstract Figure 1
