Occurrence of atrial fibrillation and flutter in acute pericarditis identifies a predisposed population to atrial fibrillation and flutter with a high recurrence risk


Data on the incidence of new onset atrial fibrillation and flutter ( AF/f ) in patients with acute pericarditis are limited. A gol of a study was to determine the incidence and prognostic significance of atrial fibrillation and flutter in this setting.

Between January 2006 and June 2014, consecutive new cases of acute pericarditis were included in two urban referral centres for pericardial diseases.
All new cases of atrial fibrillation and flutter defined as episodes lasting greater than or equal to 30 s were recorded.
Events considered during follow-up consisted of atrial fibrillation and flutter and pericarditis recurrence, cardiac tamponade, pericardial constriction and death.

822 consecutive new cases of acute pericarditis ( mean age 53±15 years, 444 men ) were analysed.

Atrial fibrillation and flutter was detected in 35 patients ( 4.3%, mean age 66.5±11.3 years, 18 men ). Patients with atrial fibrillation and flutter were significantly older ( p=0.017 ) and presented more frequently with pericardial effusion ( p less than 0.001 ).

Arrhythmias developed within 24 h of pericarditis onset in 91.4% of cases, lasted more than 24 h in 25.7% and spontaneously converted in 74.3% of patients.

Underlying structural heart disease was present in 17% of atrial fibrillation and flutter cases.

In a 30-month follow-up, patients with history of atrial fibrillation and flutter at the initial episode had a higher rate of arrhythmia occurrence ( 34.3% vs 0.9%, p less than 0.001 ), mostly ( 75% ) within 3 months.

No other differences were detected in additional clinical events including haemorrhagic complications in patients receiving oral anticoagulation.

In conclusion, the occurrence of atrial fibrillation and flutter in acute pericarditis identifies a predisposed population to atrial fibrillation and flutter with a high recurrence risk ( about 35% ): in these patients, pericarditis may act as an arrhythmic trigger and oral anticoagulation should be seriously considered according to guidelines. ( Xagena )

Imazio M et al, Heart 2015;101:1463-1467

XagenaMedicine_2015



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