Incidentally Induced Atrial Fibrillation During Programmed Electrical Stimulation in Patients With Depressed Left Ventricular Systolic Function After an Acute Myocardial Infarction

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2024-09-03 DOI:10.1111/anec.70011

Tharsika Sakthivel, Niels Risum, Henning Bundgaard, Rikke Moerch Joergensen, Uffe G. Jacobsen, Heikki V. Huikuri, Poul Erik Bloch Thomsen, Christian Jons, Anna F. Thomsen

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引用次数: 0

Abstract

Background

The aim of this study was to investigate the clinical implication of incidentally induced atrial fibrillation (AF) during programmed electrical stimulation (PES) in patients with left ventricular systolic dysfunction (≤40%) after an acute myocardial infarction (MI).

Methods

In this study, we included 231 patients from the Cardiac Arrhythmias and RIsk Stratification after Myocardial InfArction (CARISMA) study with left ventricular ejection fraction ≤40% and no prior history of AF. These patients underwent PES 6 weeks post-MI as part of the study protocol. Patients all received an implantable cardiac monitor (ICM) 3–21 days post-MI and were continuously monitored for cardiac arrhythmias for 2 years. Induction of AF was unwanted but reported if this incidentally occurred.

Results

A total of 61 patients (26%) developed AF within 2 years of follow-up, in which n = 10 (29%) had incidental AF during PES at baseline. The overall risk of AF was not significantly increased in patients with incidental AF (n = 34) during PES compared to patients without incidental AF (n = 197) (HR 1.6 [0.9–3.0], p = 0.14). The risk of bradyarrhythmia (HR = 0.2 [0.0–1.2], p = 0.07), ventricular arrhythmias (HR = 0.7 [0.1–5.8], p = 0.77), and major cardiovascular events (MACE) (HR 0.5 [0.2–1.7], p = 0.28) was not significantly different in patients with versus without incidental AF.

Conclusions

Incidentally induced AF during PES in post-MI patients with reduced LVEF was not significantly associated with a higher risk of long-term atrial fibrillation, other cardiac arrhythmias, or major cardiac events.

Trial Registration

NCT00145119

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急性心肌梗死后左心室收缩功能减退的患者在接受程序性电刺激时意外诱发心房颤动

研究背景本研究旨在探讨急性心肌梗死（MI）后左室收缩功能障碍（≤40%）患者在程序性电刺激（PES）过程中偶然诱发心房颤动（AF）的临床意义：在这项研究中，我们纳入了心肌梗死后心律失常和 RIsk 分层（CARISMA）研究中的 231 名左心室射血分数≤40%、既往无房颤病史的患者。作为研究方案的一部分，这些患者在心肌梗死后 6 周接受了 PES 治疗。所有患者都在心肌梗死后 3-21 天接受了植入式心脏监护仪 (ICM)，并在两年内持续接受心律失常监测。研究人员并不希望诱发房颤，但如果偶然发生房颤，也会进行报告：共有 61 名患者（26%）在随访 2 年内出现房颤，其中 10 人（29%）在基线 PES 期间偶发房颤。与无偶发房颤的患者（n = 197）相比，PES 期间偶发房颤的患者（n = 34）发生房颤的总体风险并无明显增加（HR 1.6 [0.9-3.0]，p = 0.14）。偶发性房颤患者与无偶发性房颤患者发生缓慢性心律失常（HR = 0.2 [0.0-1.2]，p = 0.07）、室性心律失常（HR = 0.7 [0.1-5.8]，p = 0.77）和重大心血管事件（MACE）（HR 0.5 [0.2-1.7]，p = 0.28）的风险无显著差异：LVEF降低的MI后患者在PES期间偶然诱发房颤与长期房颤、其他心律失常或重大心脏事件的较高风险无明显关联：NCT00145119。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.