New-onset atrial fibrillation as a prognostic marker in Takotsubo cardiomyopathy

Although recent studies suggest that atrial fibrillation (AF) is a poor outcome predictor in Takotsubo Syndrome (TTS), the association between new-onset AF during hospitalization and adverse events in TTS remains unclear.

This study aims to investigate the prevalence, clinical correlates, and prognostic impact of new-onset AF in TTS patients.

Consecutive patients admitted in our centre with TTS in the last 15 years were retrospectively evaluated. Patients with previous history of AF were excluded. Patients were categorized based on the presence or absence of new-onset AF during hospitalization. Baseline characteristics, clinical management and outcomes were compared between the two groups. Association between new-onset AF in TTS patients and major adverse cardiovascular and cerebrovascular events (MACCE), including death, cerebrovascular events, myocardial infarction, heart failure and recurrency, was analyzed using multivariate Cox regression model.

Of the 109 included patients, 12 (11.1%) developed new-onset AF. Patients with AF were less frequently female (66.7% vs 88.5%, p=0.039). There were no significant differences in age (76±10 vs 70±12, p=0.083) and preexisting comorbidities, except for arterial hypertension (91.7% vs 59.4%, p=0.03) between the 2 groups. Incidence of physical triggers (p=0,997) and typical form (p=0.686) were also similar and LVEF at admission was not significantly lower in AF group (38.4±11.3 vs 41.2±10.5%, p=0.401).

Patients with AF had longer hospital stays (5±4 vs 8±5 days, p=0.004), but there were no significant differences in in-hospital mortality (8.3% vs 2.1%, p=0.300) and complications between the 2 groups, including cerebrovascular events (8.3% vs 2.1% p=0.300). Prescribed medication during hospitalization and at discharge was similar, except for anticoagulant agents.

At discharge, LVEF showed no significant difference between groups (47.7+13.5% vs 52.6+10.9% p=0.068), but non-AF patients exhibited a higher incidence of LVEF recovery (59.5% vs 27.3%, p=0.044).

In a multivariate regression analysis, after adjusting for possible confounders, new-onset AF was an independent predictor of MACCE (HR 2.97, 95% CI 1.124-7.861, p=0.028).