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Atrial Fibrillation Post-myocardial Infarction is Associated with Ventricular Fibrillation and Poor Long Term Outcomes
Abstracts
Conclusions: AS lead placement was feasible, durable and exhibited comparable outcomes to RAA placement. AS pacing did not reduce the development or burden of AF compared with RAA pacing, although further research is required to determine whether particular subgroups may benefit from AS pacing.
S97
doi:10.1016/j.hlc.2010.06.893
Results: From 1998 to 2008, a total of 373,197 patients were hospitalised for a principal diagnosis of AF. 54.8% of these were for men. Hospitalisations increased from 27,245 to 47,164, or by an average of 6.8% per annum. AF as a percentage of all hospitalisations also increased from 0.48 to 0.60%. Overall, the proportion of individuals hospitalised with AF > 75 years rose from 24 to 27% in men and from 47 to 51% in women during this period. The average length of stay fell for men from 2.8 to 2.7days and from 4.0 to 3.5days in women. Despite this decrease in length of stay, the increase in AF hospitalisations resulted in a 74 and 73% increase in the total number of hospitalisation days for AF respectively for both sexes. Conclusions: The number of hospitalisations for AF has increased significant in Australia from 1998 to 2008. This enormous public health burden has important implications for health care planning and primary prevention strategies.
227
doi:10.1016/j.hlc.2010.06.894
Parameter
Right AS (n = 129)
RAA (n = 73)
p-Value
Age (years, mean ± SD) Gender (M/F) History of atrial fibrillation n (%) Coronary artery disease n (%)
74 ± 10 78/51 36 (28) 28 (22)
75 ± 8 44/29 30 (37) 25 (34)
0.3 1 0.2 0.04
Indication n (%) Sick sinus syndrome Complete heart block Second degree heart block Other
56 (43) 30 (23) 21 (16) 22 (18)
37 (51) 12 (16) 8 (11) 14 (22)
0.5
Fluoroscopy time (min, mean ± SD)
46 ± 27
48 ± 25
0.7
Atrial Fibrillation Hospitalisations in Australia: Increasing Nation-Wide Trends (1998–2008) C. Wong ∗ ,
Y. Cheng, M. Sun, D. Lau, A. Brooks, D. Leong, N. Shipp, M. Alasady, H. Lim, H. Abed, K. RobertsThomson, P. Sanders Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and the Discipline of Medicine, University of Adelaide, Adelaide, Australia Background: The prevalence of atrial fibrillation (AF) is believed to be increasing in developed countries. Despite the substantial public health burden, there is a paucity of epidemiological data on AF in recent years, and very little on AF in Australia. We thus sought to determine recent nationwide trends in hospitalisation for AF as a principal diagnosis in Australia from 1998 to 2008. Methods: We identified all hospitalisations for AF in Australia as a principal diagnosis by ICD-10 coding from the Australian Institute of Health and Welfare. Population data was obtained from the Australian Bureau of Statistics.
228 Atrial Fibrillation Post-myocardial Infarction is Associated with Ventricular Fibrillation and Poor Long Term Outcomes M. Alasady 1,∗ , D. Chew 2 , D. Barlow 1 , H. Lim 1 , D. Leong 1 , A. Brooks 1 , K. Roberts-Thomson 1 , W. Abhayaratna 3 , P. Sanders 1 1 Cardiovascular Research Centre, Royal Adelaide Hospital and
Discipline of Medicine, Australia Department, Finders Medical Centre, Australia 3 College of Medicine, Biology and Environment, Australian National University, Canberra, Australia 2 Cardiology
Introduction: Atrial fibrillation (AF) confers poor outcomes in patients with acute myocardial infarction (AMI) and is associated with increased risk of death. In patients with implantable defibrillators, AF is associated with ventricular arrhythmias requiring device therapy. Our aim was to investigate the interaction between AF occurring after AMI and VF.
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268
S98
Heart, Lung and Circulation 2010;19S:S1–S268
Abstracts
ABSTRACTS
Method: 96 patients with new onset AF associated with AMI were matched with 96 patients with AMI without AF by ejection fraction (EF) and gender. The incidence of VF during hospital admission was recorded. Mortality data was collected for an average of 5.5 ± 2 years. All data was collected prospectively on formulated database registry in which a wide range of variables were recorded including past medical history, co-morbidities, electrolyte disturbances, and drugs therapies. Results: Baseline characteristic for AF group vs control were as follows: age (73 ± 9 vs. 68 ± 12, P = 0.012), male (56% vs. 56%, P = 1) and EF (48 ± 13 vs. 49 ± 14, P = 0.6). There was no difference between the groups in other cardiovascular risk factors. Incidence of in hospital VF in the AF group was higher than the control group (12.5% vs. 2%, P = 0.03). On univariate analysis AF (OR 5.45, 95% CI: 1.16–25, P = 0.03), cardiogenic shock (P = 0.002), and ST segment elevation MI (P = 0.05) were predictor’s of in-hospital VF. On multivariate analysis AF remained an independently significant predictor of VF (OR 7.34, 95% CI: 1.31–41, P = 0.024). Longterm mortality was higher in the AF group compared to the non AF group (29% vs. 12.5%, P = 0.04). However, there was no difference in-hospital mortality between the groups (7% vs 4%, P = 0.5). Conclusion: New onset AF post AMI is associated with increased risk of in-hospital VF and long-term mortality independent of LVEF.
size (P < 0.001), LV filling pressure E/E (P < 0.001), atrial branch disease and left main (LM) disease (P = 0.02). In multivariate analysis, lesions in the LA branch of the circumflex artery (P < 0.01) and RA branches (sinoatrial, right intermediate and atrionodal; P < 0.006) were predictors of AF after adjusting for LM-disease, and E/E . A composite of major cardiovascular outcome (MACE) of death, stroke and bleeding were worse in the AF group compared to controls (P = 0.02). Conclusion: The presence of Atrial ischemia as evident by compromised atrial branches is an important determinant for the development of AF after MI. This finding was independent of age, gender, pressure load or LV systolic dysfunction. AF was strongly associated with MACE in the 7 days post-MI.
doi:10.1016/j.hlc.2010.06.895
A. Tay ∗ , B. Walker, H. Lim, R. Subbiah, D. Kuchar, C. Thorburn
229 Atrial Ischemia is an Important Determinant of Atrial Fibrillation After Myocardial Infarction Alasady 1,∗ ,
Abhayaratna 2 ,
Lim 1 ,
M. W. H. D. Roberts-Thomson 1 , D. Chew 3 , P. Sanders 1
Leong 1 ,
K.
1 Cardiovascular
Research Centre, Cardiac Electrophysiology, Royal Adelaide Hospital and Discipline of Physiology, Faculty of Health Science, University of Adelaide, Australia 2 College of Medicine, Biology and Environment, Australian National University, Australia 3 Cardiology Department, Flinders Medical Centre and Discipline of Medicine, Flinders University, Australia Background: Myocardial infarction can be associated with the development of AF (up to 20%). In a prospectively collected clinical cohort, we evaluated the characteristics associated with the development of new onset-AF. Methods: In a cohort of 3200 pts with acute MI, 149 (4.6%) were identified as having new onset-AF within 7 days of MI. After excluding pts with previous AF, severe valvular heart disease, LVH or CCF, using a nested case–control studies design, we assessed coronary anatomy by angiography, and cardiac structure and function by echocardiography in 42 AF cases and 42 controls (AMI but no AF). Result: The groups were matched for age, gender, LVEF, and cardiovascular risk factors. AF pts more often had inferior MI (P = 0.002) but less STEMI (P = 0.02). Univariate factors associated with AF included increased in LA
No AF (n = 42) Left Main disease, n (%) Three vessels disease, n (%) Right CA disease, n (%) Left CX, n (%) Right atrial branches, n (%) Left atrial branches, n (%)
AF (n = 42)
3 (7.3) 8 (19) 9 (21.4) 17 (40.5) 8 (19%) 7 (16.7)
11 (26.6) 14 (33.3) 30 (71.4) 25 (59.5) 28 (66.7) 18 (42.9)
P-value 0.02 0.14 0.009 0.10 0.006 0.01
doi:10.1016/j.hlc.2010.06.896 230 Cardiac Device and Lead Displacement Secondary to Significant Weight Loss in the Obese Patient
St Vincent’s Hospital, Australia Introduction: Obese patients who require implantable cardiac devices have higher complication rates. We present three cases of obese patients presenting with generator and lead displacement secondary to significant weight loss. Results: Patient A and B achieved weight loss over a 2year period by lifestyle modification and gastric banding respectively. Patient C weight loss occurred over 10 months with lifestyle modification. Patient A’s atrial threshold increased from 1.5 V @ 0.4 ms to 2.25 V @ 0.4 ms and the R wave amplitude decreased from 11 mV to 5.6 mV. Patient C ventricular threshold increased from 0.75 V @ 0.4 ms to 3.5 V @ 0.4 ms. Patient B had no change in lead parameters. Each patient had substantial inferior migration of the generator associated with increased discomfort and hypermobility. Potential mechanisms of lead and generator displacement include inappropriate anchoring of device and lead to adipose tissue instead of pectoral muscle, increased physical activity, and loss of lead redundancy. Particular attention should be made to surgical technique in obese patients to minimize the risk of future lead and generator displacement. .
Sex
Age
Device
Implant weight (BMI)
Weight loss (BMI)
Patient A Patient B Patient C
F M M
44 42 37
PPM (DDD) PPM (VVI) ICD (VVI)
95 kg (34.5 kg/m2 ) 160 kg (52.2 kg/m2 ) 152 kg (42.1 kg/m2 )
28 kg (24.3 kg/m2 ) 62 kg (32 kg/m2 ) 12 kg (38.8 kg/m2 )
Conclusions: AS lead placement was feasible, durable and exhibited comparable outcomes to RAA placement. AS pacing did not reduce the development or burden of AF compared with RAA pacing, although further research is required to determine whether particular subgroups may benefit from AS pacing.
S97
doi:10.1016/j.hlc.2010.06.893
Results: From 1998 to 2008, a total of 373,197 patients were hospitalised for a principal diagnosis of AF. 54.8% of these were for men. Hospitalisations increased from 27,245 to 47,164, or by an average of 6.8% per annum. AF as a percentage of all hospitalisations also increased from 0.48 to 0.60%. Overall, the proportion of individuals hospitalised with AF > 75 years rose from 24 to 27% in men and from 47 to 51% in women during this period. The average length of stay fell for men from 2.8 to 2.7days and from 4.0 to 3.5days in women. Despite this decrease in length of stay, the increase in AF hospitalisations resulted in a 74 and 73% increase in the total number of hospitalisation days for AF respectively for both sexes. Conclusions: The number of hospitalisations for AF has increased significant in Australia from 1998 to 2008. This enormous public health burden has important implications for health care planning and primary prevention strategies.
227
doi:10.1016/j.hlc.2010.06.894
Parameter
Right AS (n = 129)
RAA (n = 73)
p-Value
Age (years, mean ± SD) Gender (M/F) History of atrial fibrillation n (%) Coronary artery disease n (%)
74 ± 10 78/51 36 (28) 28 (22)
75 ± 8 44/29 30 (37) 25 (34)
0.3 1 0.2 0.04
Indication n (%) Sick sinus syndrome Complete heart block Second degree heart block Other
56 (43) 30 (23) 21 (16) 22 (18)
37 (51) 12 (16) 8 (11) 14 (22)
0.5
Fluoroscopy time (min, mean ± SD)
46 ± 27
48 ± 25
0.7
Atrial Fibrillation Hospitalisations in Australia: Increasing Nation-Wide Trends (1998–2008) C. Wong ∗ ,
Y. Cheng, M. Sun, D. Lau, A. Brooks, D. Leong, N. Shipp, M. Alasady, H. Lim, H. Abed, K. RobertsThomson, P. Sanders Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and the Discipline of Medicine, University of Adelaide, Adelaide, Australia Background: The prevalence of atrial fibrillation (AF) is believed to be increasing in developed countries. Despite the substantial public health burden, there is a paucity of epidemiological data on AF in recent years, and very little on AF in Australia. We thus sought to determine recent nationwide trends in hospitalisation for AF as a principal diagnosis in Australia from 1998 to 2008. Methods: We identified all hospitalisations for AF in Australia as a principal diagnosis by ICD-10 coding from the Australian Institute of Health and Welfare. Population data was obtained from the Australian Bureau of Statistics.
228 Atrial Fibrillation Post-myocardial Infarction is Associated with Ventricular Fibrillation and Poor Long Term Outcomes M. Alasady 1,∗ , D. Chew 2 , D. Barlow 1 , H. Lim 1 , D. Leong 1 , A. Brooks 1 , K. Roberts-Thomson 1 , W. Abhayaratna 3 , P. Sanders 1 1 Cardiovascular Research Centre, Royal Adelaide Hospital and
Discipline of Medicine, Australia Department, Finders Medical Centre, Australia 3 College of Medicine, Biology and Environment, Australian National University, Canberra, Australia 2 Cardiology
Introduction: Atrial fibrillation (AF) confers poor outcomes in patients with acute myocardial infarction (AMI) and is associated with increased risk of death. In patients with implantable defibrillators, AF is associated with ventricular arrhythmias requiring device therapy. Our aim was to investigate the interaction between AF occurring after AMI and VF.
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268
S98
Heart, Lung and Circulation 2010;19S:S1–S268
Abstracts
ABSTRACTS
Method: 96 patients with new onset AF associated with AMI were matched with 96 patients with AMI without AF by ejection fraction (EF) and gender. The incidence of VF during hospital admission was recorded. Mortality data was collected for an average of 5.5 ± 2 years. All data was collected prospectively on formulated database registry in which a wide range of variables were recorded including past medical history, co-morbidities, electrolyte disturbances, and drugs therapies. Results: Baseline characteristic for AF group vs control were as follows: age (73 ± 9 vs. 68 ± 12, P = 0.012), male (56% vs. 56%, P = 1) and EF (48 ± 13 vs. 49 ± 14, P = 0.6). There was no difference between the groups in other cardiovascular risk factors. Incidence of in hospital VF in the AF group was higher than the control group (12.5% vs. 2%, P = 0.03). On univariate analysis AF (OR 5.45, 95% CI: 1.16–25, P = 0.03), cardiogenic shock (P = 0.002), and ST segment elevation MI (P = 0.05) were predictor’s of in-hospital VF. On multivariate analysis AF remained an independently significant predictor of VF (OR 7.34, 95% CI: 1.31–41, P = 0.024). Longterm mortality was higher in the AF group compared to the non AF group (29% vs. 12.5%, P = 0.04). However, there was no difference in-hospital mortality between the groups (7% vs 4%, P = 0.5). Conclusion: New onset AF post AMI is associated with increased risk of in-hospital VF and long-term mortality independent of LVEF.
size (P < 0.001), LV filling pressure E/E (P < 0.001), atrial branch disease and left main (LM) disease (P = 0.02). In multivariate analysis, lesions in the LA branch of the circumflex artery (P < 0.01) and RA branches (sinoatrial, right intermediate and atrionodal; P < 0.006) were predictors of AF after adjusting for LM-disease, and E/E . A composite of major cardiovascular outcome (MACE) of death, stroke and bleeding were worse in the AF group compared to controls (P = 0.02). Conclusion: The presence of Atrial ischemia as evident by compromised atrial branches is an important determinant for the development of AF after MI. This finding was independent of age, gender, pressure load or LV systolic dysfunction. AF was strongly associated with MACE in the 7 days post-MI.
doi:10.1016/j.hlc.2010.06.895
A. Tay ∗ , B. Walker, H. Lim, R. Subbiah, D. Kuchar, C. Thorburn
229 Atrial Ischemia is an Important Determinant of Atrial Fibrillation After Myocardial Infarction Alasady 1,∗ ,
Abhayaratna 2 ,
Lim 1 ,
M. W. H. D. Roberts-Thomson 1 , D. Chew 3 , P. Sanders 1
Leong 1 ,
K.
1 Cardiovascular
Research Centre, Cardiac Electrophysiology, Royal Adelaide Hospital and Discipline of Physiology, Faculty of Health Science, University of Adelaide, Australia 2 College of Medicine, Biology and Environment, Australian National University, Australia 3 Cardiology Department, Flinders Medical Centre and Discipline of Medicine, Flinders University, Australia Background: Myocardial infarction can be associated with the development of AF (up to 20%). In a prospectively collected clinical cohort, we evaluated the characteristics associated with the development of new onset-AF. Methods: In a cohort of 3200 pts with acute MI, 149 (4.6%) were identified as having new onset-AF within 7 days of MI. After excluding pts with previous AF, severe valvular heart disease, LVH or CCF, using a nested case–control studies design, we assessed coronary anatomy by angiography, and cardiac structure and function by echocardiography in 42 AF cases and 42 controls (AMI but no AF). Result: The groups were matched for age, gender, LVEF, and cardiovascular risk factors. AF pts more often had inferior MI (P = 0.002) but less STEMI (P = 0.02). Univariate factors associated with AF included increased in LA
No AF (n = 42) Left Main disease, n (%) Three vessels disease, n (%) Right CA disease, n (%) Left CX, n (%) Right atrial branches, n (%) Left atrial branches, n (%)
AF (n = 42)
3 (7.3) 8 (19) 9 (21.4) 17 (40.5) 8 (19%) 7 (16.7)
11 (26.6) 14 (33.3) 30 (71.4) 25 (59.5) 28 (66.7) 18 (42.9)
P-value 0.02 0.14 0.009 0.10 0.006 0.01
doi:10.1016/j.hlc.2010.06.896 230 Cardiac Device and Lead Displacement Secondary to Significant Weight Loss in the Obese Patient
St Vincent’s Hospital, Australia Introduction: Obese patients who require implantable cardiac devices have higher complication rates. We present three cases of obese patients presenting with generator and lead displacement secondary to significant weight loss. Results: Patient A and B achieved weight loss over a 2year period by lifestyle modification and gastric banding respectively. Patient C weight loss occurred over 10 months with lifestyle modification. Patient A’s atrial threshold increased from 1.5 V @ 0.4 ms to 2.25 V @ 0.4 ms and the R wave amplitude decreased from 11 mV to 5.6 mV. Patient C ventricular threshold increased from 0.75 V @ 0.4 ms to 3.5 V @ 0.4 ms. Patient B had no change in lead parameters. Each patient had substantial inferior migration of the generator associated with increased discomfort and hypermobility. Potential mechanisms of lead and generator displacement include inappropriate anchoring of device and lead to adipose tissue instead of pectoral muscle, increased physical activity, and loss of lead redundancy. Particular attention should be made to surgical technique in obese patients to minimize the risk of future lead and generator displacement. .
Sex
Age
Device
Implant weight (BMI)
Weight loss (BMI)
Patient A Patient B Patient C
F M M
44 42 37
PPM (DDD) PPM (VVI) ICD (VVI)
95 kg (34.5 kg/m2 ) 160 kg (52.2 kg/m2 ) 152 kg (42.1 kg/m2 )
28 kg (24.3 kg/m2 ) 62 kg (32 kg/m2 ) 12 kg (38.8 kg/m2 )