Predictors and prognostic significance of atrial fibrillation developed during dobutamine stress echocardiography: A propensity score-matched comparison.

AIMS: Atrial fibrillation (AF) uncommonly occurs during dobutamine stress echocardiography (DSE). We aimed to characterize the predictors and long-term prognostic significance of AF during DSE. METHODS: The clinical, echocardiographic, and outcome data of patients in sinus rhythm who developed AF during DSE were reviewed and compared to a propensity score-matched group of controls. RESULTS: Atrial fibrillation developed in 73 (1% of 7026) patients (age 70±10 years, 58% men). Compared to 144 propensity score-matched controls without AF during DSE, those with AF were more likely to have had history of prior AF (23% vs 8%, P=.002), known coronary artery disease (CAD; 22% vs 10%, P=.037), enlarged left ventricle (LV; 27% vs 9%, P=.002), LV wall-motion abnormality (33% vs 12%, P<.0001), enlarged aortic root (22% vs 8%, P=.009), or dilated left atrium (52% vs 30%, P=.002). Multivariate logistic regression analysis identified prior history of AF (OR=3.7, 95% CI 1.5-9.0, P=.005), larger LV size (OR=3.1, 95% CI 1.3-7.3, P=.009), and lower LV ejection fraction (OR=-0.95, 95% CI -0.92 to -0.99, P=.02) as independent predictors of AF during DSE. At a mean follow-up period of 3.4 (0.5-7.3) years, those with AF during DSE were more likely to develop new coronary events (22% vs 10%, P=.0372), new-onset heart failure (19% vs 4%, P=.0003), or die from any cause (27% vs 6%, P<.0001). Kaplan-Meier curves demonstrated significantly lower event-free survival in patients compared to controls (P by log-rank test=.001) over the follow-up period. CONCLUSION: Dobutamine-induced AF occurs more commonly in those with prior history of AF and remodeled LV and is associated with unfavorable outcomes.

Woman with Brugada syndrome and epilepsy: a unifying diagnosis?

A woman with a past medical history of epilepsy was transferred to our hospital for episodic changes in mental status, jerking movements, and decreased hearing that were thought to represent seizure activity. While in the hospital, she was diagnosed with Brugada syndrome. Her antiepileptic medications were adjusted while she was monitored on constant electroencephalography, video, and cardiac telemetry. It was found that the patient's seizures were not caused by hypoperfusion of her brain secondary to cardiac arrhythmia. Instead, we theorize that she had an underlying systemic, genetic sodium ion channel dysfunction.