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Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

Jorg L; Osswald S; Kato K; Rajan L; Fischer TA; Widimsky P; Meyer P; Poglajen G; Galuszka J; Cuneo A; Maier LS; Kaiser C; Sarcon A; Pfister R; Horowitz JD; Michels G; Wischnewsky M; Crea F; Ghadri JR; Ukena C; Bauersachs J; Prasad A; Rihal CS; Pestana G; Kozel M; Akin I; Rossi A; Schulze PC; Pinto FJ; Bianco M; Pieske BM; Kherad B; Noutsias M; Katus HA; Paolini C; El-Battrawy I; Winchester DE; Felix SB; Koenig W; Lairez O; Szawan KA; Opolski G; Arroja JD; Bridgman P; Liu K; Beug D; Kobayashi Y; Bax JJ; D'Ascenzo F; Ruschitzka F; Jaguszewski M; Gilyarova E; Schunkert H; Budnik M; Carrilho-Ferreira P; Galiuto L; Templin C; Bilato C; Kobza R; Borggrefe M; Cuculi F; Munzel T; Hermes-Laufer J; Bohm M; Shinbane J; Rickli H; Knorr M; Shilova A; Airaksinen KEJ; Rottbauer W; Tschope C; Napp LC; Gili S; Heiner S; Citro R; Banning A; Gilyarov M; Hauck C; Delmas C; Dichtl W; MacCarthy P; Jacobshagen C; Burgdorf C; Vasankari T; Neuhaus M; Tousek P; Chan C; Bossone E; Franke J; Nguyen TH; Dworakowski R; Cammann VL; Hasenfuss G; Thiele H; Luscher TF; Braun-Dullaeus RC; Duru F; Meder B; Di Vece D; Karakas M; Di Mario C; Pott A

Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

Jorg L
Osswald S
Kato K
Rajan L
Fischer TA
Widimsky P
Meyer P
Poglajen G
Galuszka J
Cuneo A
Maier LS
Kaiser C
Sarcon A
Pfister R
Horowitz JD
Michels G
Wischnewsky M
Crea F
Ghadri JR
Ukena C
Bauersachs J
Prasad A
Rihal CS
Pestana G
Kozel M
Akin I
Rossi A
Schulze PC
Pinto FJ
Bianco M
Pieske BM
Kherad B
Noutsias M
Katus HA
Paolini C
El-Battrawy I
Winchester DE
Felix SB
Koenig W
Lairez O
Szawan KA
Opolski G
Arroja JD
Bridgman P
Liu K
Beug D
Kobayashi Y
Bax JJ
D'Ascenzo F
Ruschitzka F
Jaguszewski M
Gilyarova E
Schunkert H
Budnik M
Carrilho-Ferreira P
Galiuto L
Templin C
Bilato C
Kobza R
Borggrefe M
Cuculi F
Munzel T
Hermes-Laufer J
Bohm M
Shinbane J
Rickli H
Knorr M
Shilova A
Airaksinen KEJ
Rottbauer W
Tschope C
Napp LC
Gili S
Heiner S
Citro R
Banning A
Gilyarov M
Hauck C
Delmas C
Dichtl W
MacCarthy P
Jacobshagen C
Burgdorf C
Vasankari T
Neuhaus M
Tousek P
Chan C
Bossone E
Franke J
Nguyen TH
Dworakowski R
Cammann VL
Hasenfuss G
Thiele H
Luscher TF
Braun-Dullaeus RC
Duru F
Meder B
Di Vece D
Karakas M
Di Mario C
Pott A
Katso/Avaa
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Lataukset: 

WILEY
doi:10.1161/JAHA.119.014059
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Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2021102752679
Tiivistelmä

Background
Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS.

Methods and Results
Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in‐hospital (P<0.001) and long‐term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF.

Conclusions
In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial.


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