Abstract 3694: Should All Patients Presenting With Shortlasting New Onset Atrial Fibrillation Receive Anticoagulation?
Background: Risk of thromboembolism (TE) in patients with a single short lasting episode of atrial fibrillation (AF) is not clear. The AHA/ACC/ESC guidelines suggest to tailor antithrombotic treatment (ATT) to the intrinsic risk of TE. We evaluated ATT patterns and major cardiovascular and cerebrovascular events (MACCE) in patients successfully cardioverted for 1st time AF shorter than 24 hours.
Hypothesis: Appropriate ATT is low in 1st time AF patients, while MACCE rates are higher than expected.
Methods: We identified 267 consecutive patients with a successful cardioversion of AF <24 hours between 1997 and 2002. The incidence of MACCE - including any TE (stroke/TIA/peripheral), acute coronary syndrome, and all-cause mortality - was retrieved. Oral anticoagulation (OAC) use was recorded and patients were categorized according to CHADS2 score.
Results: Patients were 64 ± 12 years old, 57% were male. Hypertension, coronary artery disease, previous stroke, and diabetes were present in 36%, 24%, 12%, and 3%, respectively. Fifty-four % of all patients were considered at high risk for stroke and were eligible for OAC treatment. CHADS2 score and MACCE rates are depicted in the table⇓. There were no MACCE within the first month after cardioversion. Patients with CHADS2 score ≥1 were more at risk for MACCE (corrected for ATT, p<0.001) compared to patients with CHADS2 score of 0.
Conclusions: MACCE rates are extremely high in patients successfully cardioverted for 1st time AF shorter than 24 hours. OAC use is not influenced by the CHADS2 score. Strongly increasing MACCE rates are associated with increase in CHADS2 score. Unlike recommendations in AF guidelines, improvement in antithrombotic and non- antithrombotic treatment is mandatory in patients with first time AF. The unexpectedly high MACCE rate in patients admitted with AF for the first time suggests active concomitant cardiovascular disease as a cause for AF, which should be managed aggressively.