BACKGROUND: The reported incidence of atrial fibrillation (AF) occurring during dobutamine stress echocardiography (DSE) ranges from 0.5% to 4%. The aim of this study was to characterize the incidence, risk factors, and outcomes of AF precipitated during DSE. METHODS: The clinical and echocardiographic data of consecutive patients over a 50-month period who were in sinus rhythm and underwent DSE were retrospectively reviewed. RESULTS: A total of 11,806 consecutive patients underwent DSE and met all inclusion criteria. AF developed during DSE in 122 patients (1%), 71 of whom had histories of AF. The duration of AF was <1 hour in 74 patients (61%) and<24 hours in 117 patients (96%). Of the 47 patients who were still in AF when dismissed from the echocardiography laboratory, 21 had outpatient follow-up within 24 hours, eight were already inpatients, and 18 were triaged to the emergency department or hospital. Spontaneous cardioversion occurred in 114 patients (93%). There were no reported complications. The clinical characteristic most strongly associated with the development of AF during DSE was a history of AF (odds ratio, 18.4 if no history of congestive heart failure; P<.001). The presence or extent of stress-induced myocardial ischemia was not predictive of the development of AF. CONCLUSIONS: AF is an infrequent complication of DSE. Most patients return to sinus rhythm spontaneously within 1 hour. Patients with persistent AF can be safely dismissed from the echocardiography laboratory to have outpatient follow-up within 24 hours unless they have suboptimal heart rate control, hypotension, significant symptoms, or markedly abnormal findings on DSE.
BACKGROUND: The reported incidence of atrial fibrillation (AF) occurring during dobutamine stress echocardiography (DSE) ranges from 0.5% to 4%. The aim of this study was to characterize the incidence, risk factors, and outcomes of AF precipitated during DSE. METHODS: The clinical and echocardiographic data of consecutive patients over a 50-month period who were in sinus rhythm and underwent DSE were retrospectively reviewed. RESULTS: A total of 11,806 consecutive patients underwent DSE and met all inclusion criteria. AF developed during DSE in 122 patients (1%), 71 of whom had histories of AF. The duration of AF was <1 hour in 74 patients (61%) and<24 hours in 117 patients (96%). Of the 47 patients who were still in AF when dismissed from the echocardiography laboratory, 21 had outpatient follow-up within 24 hours, eight were already inpatients, and 18 were triaged to the emergency department or hospital. Spontaneous cardioversion occurred in 114 patients (93%). There were no reported complications. The clinical characteristic most strongly associated with the development of AF during DSE was a history of AF (odds ratio, 18.4 if no history of congestive heart failure; P<.001). The presence or extent of stress-induced myocardial ischemia was not predictive of the development of AF. CONCLUSIONS:AF is an infrequent complication of DSE. Most patients return to sinus rhythm spontaneously within 1 hour. Patients with persistent AF can be safely dismissed from the echocardiography laboratory to have outpatient follow-up within 24 hours unless they have suboptimal heart rate control, hypotension, significant symptoms, or markedly abnormal findings on DSE.
Authors: Vasken Dilsizian; Henry Gewirtz; Nicholas Paivanas; Anastasia N Kitsiou; Fadi G Hage; Nathan E Crone; Ronald G Schwartz Journal: J Nucl Cardiol Date: 2015-05-15 Impact factor: 5.952