title: Restrictive left ventricular filling pattern and risk of new-onset atrial fibrillation after acute myocardial infarction.
abstract: Mechanisms for atrial arrhythmias that occur in the context of acute myocardial infarction (AMI) have not been well characterized. AMI often leads to alterations in left ventricular (LV) filling dynamics, which may result in advanced diastolic dysfunction. Diastolic dysfunction may produce increased left atrial (LA) pressure and initiate LA remodeling, promoting the progression to atrial fibrillation (AF). We studied 1,169 patients admitted with AMI. Advanced diastolic dysfunction was defined as a restrictive filling pattern (RFP), defined as ratio of early to late transmitral velocity of mitral inflow >1.5 or deceleration time <130 ms. The relation between RFP and the primary end point of new-onset AF occurring within 6 months was analyzed using multivariable Cox models. Of 1,169 patients (70% men, mean ± SD 64 ± 10 years of age), 110 (9.4%) developed new-onset AF (19.6% and 7.5% in patients with and without RFP, respectively, p <0.0001). RFP was associated with a hazard ratio of 2.72 for AF (95% confidence interval 1.83 to 4.05, p <0.0001). After multivariable adjustments for clinical variables, LV ejection fraction (EF) and LA size, RFP remained an independent predictor of AF (hazard ratio 2.17, 95% confidence interval 1.42 to 3.32, p <0.0001). Risk of AF was higher in patients with RFP for preserved (≥45%, hazard ratio 2.14, 95% confidence interval 1.09 to 4.20, p = 0.03) or decreased (hazard ratio 2.80, 95% confidence interval 1.63 to 4.82, p <0.0001) LVEF. In contrast, decreased LVEF in the absence of RFP was similar to that of patients with preserved LVEF and without RFP. In conclusion, in patients with AMI, presence of advanced diastolic dysfunction was independently associated with new-onset AF, suggesting that increased filling pressures may contribute to the development of AF after AMI.
authors.affiliation: Department of Cardiology, Rambam Medical Center, and Rappaport Faculty of Medicine and Research Institute, Technion, Israel Institute of Technology, Haifa, Israel. daronson@tx.technion.ac.il
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.forename: Diab
authors.initials: D
authors.lastname: Mutlak
authors.forename: Fadel
authors.initials: F
authors.lastname: Bahouth
authors.forename: Rema
authors.initials: R
authors.lastname: Bishara
authors.forename: Haim
authors.initials: H
authors.lastname: Hammerman
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lessick
authors.forename: Shemy
authors.initials: S
authors.lastname: Carasso
authors.forename: Saleem
authors.initials: S
authors.lastname: Dabbah
authors.forename: Shimon
authors.initials: S
authors.lastname: Reisner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Agmon
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012307:Risk Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D016277:Ventricular Function, Left