title: Occurrence of atrial fibrillation during dobutamine stress echocardiography: incidence, risk factors, and outcomes.
abstract: BACKGROUND
  The reported incidence of atrial fibrillation (AF) occurring during dobutamine stress echocardiography (DSE) ranges from 0.5% to 4%. The aim of this study was to characterize the incidence, risk factors, and outcomes of AF precipitated during DSE.
  
  
  METHODS
  The clinical and echocardiographic data of consecutive patients over a 50-month period who were in sinus rhythm and underwent DSE were retrospectively reviewed.
  
  
  RESULTS
  A total of 11,806 consecutive patients underwent DSE and met all inclusion criteria. AF developed during DSE in 122 patients (1%), 71 of whom had histories of AF. The duration of AF was <1 hour in 74 patients (61%) and<24 hours in 117 patients (96%). Of the 47 patients who were still in AF when dismissed from the echocardiography laboratory, 21 had outpatient follow-up within 24 hours, eight were already inpatients, and 18 were triaged to the emergency department or hospital. Spontaneous cardioversion occurred in 114 patients (93%). There were no reported complications. The clinical characteristic most strongly associated with the development of AF during DSE was a history of AF (odds ratio, 18.4 if no history of congestive heart failure; P<.001). The presence or extent of stress-induced myocardial ischemia was not predictive of the development of AF.
  
  
  CONCLUSIONS
  AF is an infrequent complication of DSE. Most patients return to sinus rhythm spontaneously within 1 hour. Patients with persistent AF can be safely dismissed from the echocardiography laboratory to have outpatient follow-up within 24 hours unless they have suboptimal heart rate control, hypotension, significant symptoms, or markedly abnormal findings on DSE.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Seth H
authors.initials: SH
authors.lastname: Sheldon
authors.forename: J Wells
authors.initials: JW
authors.lastname: Askew
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Klarich
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Robert B
authors.initials: RB
authors.lastname: McCully
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004280:Dobutamine; D064420:Drug-Related Side Effects and Adverse Reactions / Q000000981:diagnostic imaging / Q000453:epidemiology; D004452:Echocardiography / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004280:Dobutamine