title: Incidence and prognostic significance of silent atrial fibrillation in acute myocardial infarction.
abstract: BACKGROUND
  Silent atrial fibrillation (AF) has been suggested to be frequent after acute myocardial infarction (MI). Continuous ECG monitoring (CEM) has been shown to improve AF screening in patients at risk of stroke.
  
  
  OBJECTIVE
  We aimed to assess the incidence and prognosis of silent AF in patients with acute MI.
  
  
  METHODS
  All the consecutive patients with acute MI were prospectively analyzed by CEM ≥ 48 h after admission. Silent AF was defined as asymptomatic episodes lasting at least 30s. The population was divided into three groups: no-AF, silent AF and symptomatic AF.
  
  
  RESULTS
  Among the 849 patients, 135 (16%) developed silent AF and 45 (5%) symptomatic AF. Compared with the no-AF group, patients with silent AF were markedly older (80 vs. 62 y, p<0.001), more frequently women (43% vs. 30%, p=0.006) and less likely to be smokers (20% vs. 36%, p<0.001). They had impaired left ventricular ejection fraction (LVEF) and left atrial (LA) enlargement. By multivariate analysis, age, history of AF, indexed LA area and LVEF were identified as independent predictors of silent AF. In-hospital heart failure and death rates were markedly higher in silent AF group when compared with no-AF patients (41.8% vs 21.0% and 10.4% vs. 1.3%, respectively).
  
  
  CONCLUSIONS
  Our large prospective study showed for the first time that silent AF is more frequent than symptomatic AF after MI. Our work suggests that indexed LA area could help to predict the risk of developing silent AF. Moreover, the onset of silent AF is associated with worse hospital prognosis.
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Stamboul
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France. Electronic address: Marianne.zeller@u-bourgogne.fr.
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.affiliation: Cardiology Department, Trousseau University Hospital and François Rabelais University, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gudjoncik
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Buffet
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Garnier
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Guenancia
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Beer
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Touzery
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology
keywords: Acute myocardial infarction; Atrial fibrillation; Continuous ECG monitoring