Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

Abstract

The relationship and clinical implications of atrial fibrillation (AF) in acute pulmonary embolism (PE) are poorly investigated. We aimed to analyze clinical characteristics and prognosis in PE patients with paroxysmal AF episode. Methods. From the 391 patients with PE 31 subjects with paroxysmal AF were selected. This group was compared with patients with PE and sinus rhythm (SR) and 32 patients with PE and permanent AF. Results. Paroxysmal AF patients were the oldest. Concomitant DVT varies between groups: paroxysmal AF 32.3%, SR 49.5%, and permanent AF 28.1% (p = 0.02). The stroke history frequency was 4.6% SR, 12.9% paroxysmal AF, and 21.9% permanent AF (p < 0.001). Paroxysmal AF comparing to permanent AF and SR individuals had higher estimated SPAP (56 versus 48 versus 47 mmHg, p = 0.01) and shorter ACT (58 versus 65 versus 70 ms, p = 0.04). Patients with AF were more often classified into high-risk group according to revised Geneva score and sPESI than SR patients. In-hospital mortality was lower in SR (5%) and paroxysmal AF (6.5%) compared to permanent AF group (25%) (p < 0.001). Conclusions. Patients with PE-associated paroxysmal AF constitute a separate population. More severe impairment of the parameters reflecting RV afterload may indicate relation between PE severity and paroxysmal AF episode. Paroxysmal AF has no impact on short-term mortality.

Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

“…In a study by Kukla et al [26], RHT was found in 5% of the whole study group, in 8% of patients with paroxysmal AF, and in 7% of patients with nonparoxysmal AF [26]. In a study by Krajewska et al [3], the presence of RHT was confirmed in 5.9% of patients in sinus rhythm, with a tendency to a higher prevalence in the groups with paroxysmal AF and permanent AF (10% and 14.3%, respectively). The differences did not reach significance, mainly because of a small population size in both studies.…”

“…Large-scale population-based studies have provided a considerable body of evidence on the involvement of PE in the onset of subsequent AF [3, 9, 30]. The increased risk of late-onset AF has been observed in patients after acute PE during long-term follow-up [24].…”

“…The involvement of AF in the pathomechanism of PE has not been fully elucidated, and scientific evidence is indirect and based on retrospective observational studies [1, 3, 4]. Also, the impact of AF on prognosis in PE has not been well explained [4].…”

Pulmonary embolism causing atrial fibrillation with slow ventricular response: a case report

“…The association of causation between PE and AF with slow ventricular response remains to be vague in the literature in which the exact pathophysiology and causal mechanism is yet to be fully understood [2, 3]. On a pathophysiological level that might demonstrate AF, Flegel concluded that a PE may trigger AF by causing acute right ventricular dilatation with strain, something that was evident in our case [4].…”

“…One of these rare complications are arrythmias such as atrial fibrillation (AF) [1]. Although rare, the ensuing presentation of AF secondary to PE is evident in the literature, however there has been no report of PE causing AF with slow ventricular response requiring a pacemaker [1–3]. We present a case of AF with slow ventricular response caused by a bilateral PE, with a conceivable pathophysiological hypothesis.…”