Is atrial fibrillation associated with pulmonary embolism?
BACKGROUND
A pulmonary embolism (PE) is thought to be associated with atrial fibrillation (AF). Nevertheless, this association is based on weak data.


OBJECTIVE
To assess whether the presence of AF influences the clinical probability of PE in a cohort of patients with suspected PE and to confirm the association between PE and AF.


METHODS
We retrospectively analyzed the data from two trials that included 2449 consecutive patients admitted for a clinically suspected PE. An electrocardiography (ECG) was systematically performed and a PE was diagnosed by computer tomography (CT). The prevalence of AF among patients with or without a PE was compared in a multivariate logistic regression model.


RESULTS
The prevalence of PE was 22.8% (519/2272) in patients without AF and 18.8% (25/133) in patients with AF (P = 0.28). After adjustment for confounding factors, AF did not significantly modify the probability of PE (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.42-1.11). However, when PE suspicion was based on new-onset dyspnea, AF significantly decreased the probability of PE (OR 0.47, 95% CI 0.26-0.84). If isolated chest pain without dyspnea was the presenting complaint, AF tended to increase the probability of PE (OR 2.42, 95% CI 0.97-6.07).


CONCLUSIONS
Overall, the presence of AF does not increase the probability of PE when this diagnosis is suspected. Nevertheless, when PE suspicion is based on new-onset dyspnea, AF significantly decreases the probability of PE, as AF may mimic its clinical presentation. However, in patients with chest pain alone, AF tends to increase PE probability.
Division of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland. gregoire.gex@hcuge.ch
G
G
Gex
E
E
Gerstel
M
M
Righini
G
G
LE Gal
D
D
Aujesky
P-M
PM
Roy
O
O
Sanchez
F
F
Verschuren
O T
OT
Rutschmann
T
T
Perneger
A
A
Perrier
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D002637:Chest Pain / Q000453:epidemiology; D016009:Chi-Square Distribution; D004417:Dyspnea / Q000453:epidemiology; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed