title: Incidence of atrial fibrillation detected by continuous rhythm monitoring after acute myocardial infarction in patients with preserved left ventricular ejection fraction: results of the ARREST study.
abstract: Cardiac arrhythmias following acute myocardial infarction (AMI) can be associated with major adverse cardiovascular events. Data on the "real incidence" of post-MI arrhythmias are limited. We aimed to determine the rate and burden of cardiac arrhythmias by the use of insertable cardiac monitors (ICM) in patients with preserved left ventricular ejection fraction (LVEF) after AMI.
  
  
  
  In this prospective observational study, patients with LVEF ≥40% who underwent PCI within 7 days following AMI were enrolled to receive an ICM. Primary outcome was the incidence of new-onset atrial fibrillation (AF) measured by the ICM during a follow-up of 2 years; results: Of 165 consecutive patients with AMI, 50 (30.3%) eligible patients were recruited (mean age 57.8 ± 8.3, 88% male). During follow-up, AF was the most frequently detected arrhythmia. Twenty-nine (58%, 95% CI: 42-70%) patients developed new-onset AF, with a cumulative rate of all detected arrhythmias of 65%. Median time to the first detected AF episode was 4.8 months and the peak cumulative AF burden was detected between 3 and 6 months. Twenty-seven (93%) out of 29 patients with AF were asymptomatic. Cox regression analysis found that baseline troponin level (hazard ratio [HR] for 1 ng/mL increment: 1.03, 95% CI: 1.01-1.06, P = 0.01) and CHA2DS2-VASc score of 4 (HR: 11.42, 95% CI: 1.01-129.06, P = 0.04) were independent risk factors of new-onset AF post-AMI.
  
  
  
  AF is a frequent but largely underestimated cardiac arrhythmia after AMI. More rigorous monitoring strategies resulting in crucial medical interventions (e.g. implementation of oral anti-coagulation) are needed.
  
  
  
  http://www.clinicaltrials.gov. Unique identifier: NCT02492243.
authors.affiliation: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Romanov
authors.affiliation: Department of Cardiology, Elisabethinen University Teaching Hospital, Linz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Martinek
authors.affiliation: Department of Cardiology, Elisabethinen University Teaching Hospital, Linz, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Pürerfellner
authors.affiliation: Department of Cardiology, Elisabethinen University Teaching Hospital, Linz, Austria.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.affiliation: Medtronic BRC, Maastricht, The Netherlands.
authors.forename: Mirko
authors.initials: M
authors.lastname: De Melis
authors.affiliation: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Igor
authors.initials: I
authors.lastname: Grazhdankin
authors.affiliation: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Ponomarev
authors.affiliation: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Denis
authors.initials: D
authors.lastname: Losik
authors.affiliation: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Artem
authors.initials: A
authors.lastname: Strelnikov
authors.affiliation: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Vitaliy
authors.initials: V
authors.lastname: Shabanov
authors.affiliation: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Karaskov
authors.affiliation: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Pokushalov
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
keywords: Atrial fibrillation; Cardiac rhythm; Continuous monitoring; Implantable rhythm monitor; Myocardial infarction