Incidence and burden of new-onset atrial fibrillation after STEMI detected by 14-day ECG patch monitoring
C Moser, A Bettelini, J Bruegger, F Jordan, S Knecht, R Stump, J Boeddinghaus, G Leibundgut, B Schaer, P Krisai, N Schaerli, F Mahfoud, C Sticherling, M Kuehne, P BadertscherAbstract
Introduction
Reported new-onset atrial fibrillation (NOAF) incidence following ST-segment elevation myocardial infarction (STEMI) varies widely, likely reflecting disease severity and differences in monitoring intensity. Robust data on post-STEMI AF burden is needed to guide therapeutic decisions, such as initiation of anticoagulants.
Purpose
We therefore aimed to assess the incidence, timing, and burden of NOAF after STEMI using systematic 14-day continuous ECG patch monitoring.
Methods
Consecutive patients presenting with STEMI at a Swiss tertiary center were prospectively enrolled and prescribed a 14-day single-lead ECG patch. Patients with known AF prior to STEMI or implanted cardiac devices with an atrial lead were excluded.
Results
Among 265 STEMI admissions, 182 patients (69%; median age 66 years; 26% female) underwent patch monitoring. Median analyzable monitoring duration was 13.6 days [IQR 13.2–13.8]. NOAF was detected in 11/182 patients (6.0%; median age 76 years; 27% female). Ten patients (91%) had paroxysmal AF and one (9%) persistent AF. Median AF burden was 2.72% [0.79–10.86], corresponding to a mean AF duration of 39 minutes per day. First AF detection occurred after a median of 44 hours [1.4 - 95] of monitoring. Patients with NOAF were older than those without AF (76 vs 65 years; p=0.004). Median CHA₂DS₂-VA score in NOAF patients was 4 [4–5]. Oral anticoagulation in addition to antiplatelet therapy was initiated in 9 of 11 patients (82%).
Conclusion
In this prospective cohort of STEMI patients, 14-day ECG patch monitoring identified NOAF in 6.0% of patients, mainly within the first two days. Despite a high thromboembolic risk profile, AF burden was generally low, highlighting the unresolved question of whether oral anticoagulation benefits outweigh bleeding risk in low-burden NOAF detected after STEMI. Further studies are warranted to define burden-informed anticoagulation strategies in this population.Graphical Abstract