Clinical Characteristics and Influencing Factors of New-Onset Atrial Fibrillation in Patients with Acute Pulmonary Embolism: A Case-Control Study

BackgroundAtrial fibrillation (AF) after acute pulmonary embolism (PE) may lead to a poor prognosis. We conducted this study to explore influencing factors of new-onset AF in patients after acute PE.MethodsPatients with objectively confirmed acute PE at the China-Japan Friendship Hospital from first January 2015 to 31st May 2022 were retrospectively included in the study, and patients with new-onset AF confirmed by electrocardiography were defined as the case group. The control group was obtained from the above PE patients without new-onset AF in age matching. Patients with a history of AF, pulmonary hypertension, acute myocardial infarction, valvular heart disease and hyperthyroidism were excluded. Logistic regression was conducted to identify potential influencing factors for the development of new-onset AF in patients with acute PE. To assess the prediction value of potential variables, receiver operating characteristic curves were plotted.ResultsAmong 853 patients diagnosed with acute PE, 732 patients met the including criteria, and 29 patients with new-onset AF were identified. The median age of all patients was 74 years, with 77.6% being male. No statistically significant differences were observed between the case and control groups regarding demographic characteristics. Patients with new-onset AF had significantly enlarged right atrium, right ventricle and left atrium in echocardiography compared with control group, but no significant differences were observed in the diameter of the left ventricle and the proportion of left ventricular ejection fraction (LVEF) ≤ 40%. Right atrial enlargement (OR, 4.19; 95%CI, 1.24-15.09; P = 0.023), left atrial enlargement (OR, 14.76; 95%CI, 4.79-57.28; P < 0.001) and the simplified pulmonary embolism severity index (sPESI) (OR, 2.04; 95%CI, 1.19-3.67; P = 0.012) were associated with increased risk of new-onset AF.ConclusionsBoth severity of acute PE and enlargement of left and right atrium were associated with an increased risk of new-onset AF in patients with acute PE. In patients with high-risk acute PE, greater vigilance is needed for the occurrence of new-onset AF.