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Incidence and prognostic significance of new onset atrial fibrillation/flutter in acute pericarditis
  1. Massimo Imazio1,
  2. George Lazaros2,
  3. Elisa Picardi3,
  4. Panagiotis Vasileiou2,
  5. Fabrizio Orlando1,
  6. Mara Carraro1,
  7. Dimitris Tsiachris2,
  8. Charalambos Vlachopoulos2,
  9. George Georgiopoulos2,
  10. Dimitrios Tousoulis2,
  11. Riccardo Belli1,
  12. Fiorenzo Gaita3
  1. 1Cardiology Department, Maria Vittoria Hospital, and Department of Public Health and Pediatrics, University of Torino, Torino, Italy
  2. 21st Department of Cardiology, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
  3. 3University Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
  1. Correspondence to Massimo Imazio, MD, FESC, Cardiology Department, Maria Vittoria Hospital and Department of Public Health and Pediatrics, University of Torino, Torino, Italy. Via Luigi Cibrario 72, 10141 Torino, Italy, massimo_imazio{at}yahoo.it, massimo.imazio{at}unito.it

Abstract

Objective Data on the incidence of new onset atrial fibrillation and flutter (AF/f) in patients with acute pericarditis are limited. We sought to determine the incidence and prognostic significance of AF/f in this setting.

Methods 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 AF/f defined as episodes lasting ≥30 s were recorded. Events considered during follow-up consisted of AF/f and pericarditis recurrence, cardiac tamponade, pericardial constriction and death.

Results 822 consecutive new cases of acute pericarditis (mean age 53±15 years, 444 men) were analysed. AF/f was detected in 35 patients (4.3%, mean age 66.5±11.3 years, 18 men). Patients with AF/f were significantly older (p=0.017) and presented more frequently with pericardial effusion (p<0.001). Arrhythmias developed within 24 h of pericarditis onset in 91.4% of cases, lasted >24 h in 25.7% and spontaneously converted in 74.3% of patients. Underlying structural heart disease was present in 17% of AF/f cases. In a 30-month follow-up, patients with history of AF/f at the initial episode had a higher rate of arrhythmia occurrence (34.3% vs 0.9%, p<0.001), mostly (75%) within 3 months. No other differences were detected in additional clinical events including haemorrhagic complications in patients receiving oral anticoagulation.

Conclusions The occurrence of AF/f in acute pericarditis identifies a predisposed population to AF/f 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.

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