0294: Symptomatic AF but no silent AF is associated with an increased occurrence of ventricular arrhythmias after acute myocardial infarction

ObjectivesThe aims of our study were to assess ventricular tachycardia or fibrillation (VT or VF) occurrence after AMI and to analyse the relationship with either symptomatic or silent AF occurrence.BackgroundSilent or symptomatic AF are known to be common after AMI and to impair patients prognosis. But the reasons of this worse prognosis remain discussed.Methods849 consecutive AMI were prospectively analyzed by continuous ECG monitoring (CEM) during the first 48 hours after admission. All AF, VT or VF episodes were confirm by standard ECG and sytematically reviewed by two investigators. The population was studied into three groups: No AF, Silent AF, and symptomatic AF after AMI.ResultsForty five patients (5%) developed symptomatic AF and one hundred and thirty five developed silent AF (15.9%). Compared with the no AF group, patients with AF were markedly older 80 (67-85) and 81(71-88) vs. 62 (53-75) years; with p<0.001), more likely to have hypertension (96(72%) and (35(80%) vs 332(50%); with p<0.001) and less smoker (26 (20%) and 3(7%) vs. 242 (36%); with p<0.001). Comparing these three groups at day 1 and day 2, patients with symptomatic AF had higher heart rate (maximum, median or minimum) than patients with silent or no AF. Thus, at day 1 there was trend to a higher rate of VT or VF occurrence in symptomatic AF group, that was confirm at day 2 with 11(24.4%) vs 7(5.2%) in silent AF group and 29(4.3%)in no AF group, with p<0.001. Moreover, in-hospital mortality was higher in symptomatic AF group (8 (17.8%)) than in silent AF group (14 (10.4%)) and in no AF group (9 (1.3%)) with p