Atrial fibrillation in dobutamine stress echocardiography.
OBJECTIVE
To describe the incidence of atrial fibrillation induced by dobutamine stress echocardiography and characterize patients at risk of developing atrial fibrillation, by constructing a simple validated risk score index.


METHODS
An observational study using prospectively collected data.


METHODS
3800 consecutive patients in sinus rhythm undergoing dobutamine stress echocardiography were randomly divided to a case (2/3) and test group (1/3). Associations of predetermined demographic, clinical, electrocardiographic and echocardiographic variables were calculated in patients with and without atrial fibrillation induced by dobutamine stress echocardiography in the case group. Logistic regression analysis determined significant independent risk predictors, a scoring index was constructed and validated on the test group.


RESULTS
There was a 2% incidence of dobutamine stress echocardiography-induced atrial fibrillation in the study population. Risk predictors of atrial fibrillation included: a history of atrial fibrillation (2 points), increased left atrial diameter, right bundle branch block, decreased rest heart rate and hypertension (1 point each). The case subgroup low-risk patients (score 0-2) had a 1% risk, moderate-risk patients (score 3) a 2.7% and high-risk patients (score 4-6) a 14.5% risk of developing atrial fibrillation during dobutamine stress echocardiography. The rates in the test subgroup were 1%, 3.8% and 15.3%, respectively.


CONCLUSIONS
Atrial fibrillation during dobutamine stress echocardiography is not common, the risk of developing atrial fibrillation during dobutamine stress echocardiography can be predicted by using a simple risk score system comprised of clinical, electrocardiographic and rest echocardiographic variables, which may be of help when planning a dobutamine stress echocardiography test in selected cases.
Carasso
Shemy
S
The Heart Institute, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel AVIV, Israel.
Sandach
Amir
A
Kuperstein
Rafael
R
Schwammenthal
Ehud
E
Glikson
Michael
M
Luria
David
D
Guetta
Victor
V
Shechter
Michael
M
Eldar
Michael
M
Feinberg
Micha S
MS
D000368:Aged; D001281:Atrial Fibrillation / Q000139:chemically induced* / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000009:adverse effects*; D004280:Dobutamine / Q000009:adverse effects*; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
D002316:Cardiotonic Agents; D004280:Dobutamine