Incidence and Predictors of Atrial Fibrillation in Cardiac Sarcoidosis,JACC: Cardiovascular Imaging

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Incidence and Predictors of Atrial Fibrillation in Cardiac Sarcoidosis
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2022-05-11 , DOI: 10.1016/j.jcmg.2022.02.025
Meri Niemelä ₁ , Valtteri Uusitalo ₂ , Pauli Pöyhönen ₃ , Jukka Schildt ₄ , Jukka Lehtonen ₁ , Markku Kupari ₁

Affiliation

Background

In cardiac sarcoidosis (CS), the risk and predictors of new-onset atrial fibrillation (AF) are poorly known.

Objectives

The authors evaluated the incidence and characteristics of AF in newly diagnosed CS.

Methods

The authors studied 118 patients (78 women, mean age 50 years) with AF-naive CS having undergone cardiac ¹⁸F-fluorodexoyglucose positron emission tomography (¹⁸F-FDG PET) at the time of diagnosis. Details of patient characteristics and medical or device therapy were collected from hospital charts. The PET scans were re-analyzed for presence of atrial and ventricular inflammation, and coincident cardiac magnetic resonance (CMR) studies and single-photon emission computed tomography (SPECT) perfusions were analyzed for cardiac structure and function, including the presence and extent of myocardial scarring. Detection of AF was based on interrogation of intracardiac devices and on ambulatory or 12-lead electrocardiograms.

Results

Altogether 34 patients (29%) suffered paroxysms of AF during follow-up (median, 3 years) with persistent AF developing in 7 patients and permanent AF in 4. The estimated 5-year incidence of AF was 55% (95% CI: 34%-72%) in the 39 patients with atrial ¹⁸F-FDG uptake at the time of diagnosis vs 18% (95% CI: 10%-28%) in the 79 patients without atrial uptake (P < 0.001). In cause-specific Cox regression analysis, atrial uptake was an independent predictor of AF (P < 0.001) with HR of 6.01 (95% CI: 2.64-13.66). Other independent predictors were an increased left atrial maximum volume (P < 0.01) and history of sleep apnea (P < 0.01). Ventricular involvement by PET, SPECT, or CMR was nonpredictive. Symptoms of AF prompted electrical cardioversion in 12 patients (35%). Three of the 34 patients (9%) experiencing AF suffered a stroke versus none of those remaining free of AF.

Conclusions

In newly diagnosed CS, future AF is relatively common and associated with atrial inflammation and enlargement on multimodality cardiac imaging.

中文翻译：

心脏结节病心房颤动的发生率和预测因素

背景

在心脏结节病 (CS) 中，新发心房颤动 (AF) 的风险和预测因子知之甚少。

目标

作者评估了新诊断 CS 中 AF 的发生率和特征。

方法

作者研究了 118 名 AF 初治 CS 患者（78 名女性，平均年龄 50 岁），这些患者在诊断时接受了心脏¹⁸ F-氟葡萄糖正电子发射断层扫描 ( ^{18 F-FDG PET)。}从医院图表中收集了患者特征和医疗或设备治疗的详细信息。重新分析 PET 扫描是否存在心房和心室炎症，同时对心脏磁共振 (CMR) 研究和单光子发射计算机断层扫描 (SPECT) 灌注分析心脏结构和功能，包括心肌梗死的存在和程度疤痕。AF 的检测基于对心内装置的询问和动态或 12 导联心电图。

结果

共有 34 名患者 (29%) 在随访期间（中位数，3 年）出现阵发性房颤，其中 7 名患者发展为持续性房颤，4 名患者发展为永久性房颤。估计 5 年房颤发生率为 55%（95% CI：诊断时39 名心房^{18F -FDG 摄取的患者为 34%-72%，而 79 名无心房摄取的患者为 18%（95% CI：10%-28%）（}P < 0.001）。在病因特异性 Cox 回归分析中，心房摄取是 AF 的独立预测因子 ( P < 0.001)，HR 为 6.01 (95% CI：2.64-13.66)。其他独立预测因素是左心房最大容积增加 ( P < 0.01) 和睡眠呼吸暂停病史 ( P <0.01）。PET、SPECT 或 CMR 检测的心室受累是不可预测的。AF 症状促使 12 名患者 (35%) 进行电复律。经历 AF 的 34 名患者中有 3 名 (9%) 中风，而没有 AF 患者。