Older patients at increased risk for AFib during dobutamine stress echo

Atrial fibrillation (AF) is rare during dobutamine stress echocardiography (DSE), a routine exam for assessing coronary ischemia, but elderly patients and those with a history of paroxysmal AF are at an increased risk for arrhythmia during the test, a team of researchers from Boulogne, France, reported.

“Despite its wide use, several complications or side effects of DSE have been reported: myocardial infarction, supraventricular or ventricular arrhythmias, hypotension, coronary spasm and death,” first author Nicolas Mansencal, MD, PhD, and colleagues at Hôpital Universitaire Ambroise Paré wrote in the American Journal of Cardiology. “Thus, AF may occur during DSE, but studies for the incidence of this specific side effect remain rare.”

The condition is still worth studying, the authors said, since dobutamine acts directly through beta-adrenergic receptor activation, leading to the possibility of an increased AF risk through the enhancement of adenosine monophosphate.

Mansencal and his co-authors reviewed all patients referred for DSE at their center between 2001 and 2017, systematically analyzing all ECGs performed during DSE to detect any AF during the exam. DSE was performed completely in 4,818 patients, 40 of whom showed symptoms of AF during the procedure.

The researchers said that in meta-analysis, the combined incidence of AF was just 0.86 percent, making it a rarity among the thousands of patients they evaluated. Of the 40 who did develop the condition, 31 were men, and on average the patients were around 80 years old.

“We found that the main factor associated with AF occurrence during DSE is age,” Mansencal et al. wrote. “The incidence of AF significantly increased with age (0 percent in patients under 60 years old versus 4 percent in patients greater than 80 years old). Physicians should be aware of these interactions between AF and elderly patients and previous history of AF, should discuss the utility of this specific examination and could eventually propose another ischemic test with less risk of AF.”

A previous history of paroxysmal AF was also a predictive factor for AF in the study—patients with the diagnosis saw a 1.5-fold increased risk for AF during DSE. Age remained the strongest predictor, with older patients seeing a more than twofold increased risk of experiencing AF during the exam.

Mansencal and co-authors said their study was limited because only 40 patients experienced AF during DSE, but noted the population was in sinus rhythm and AF-free at baseline.

“Thus, we were clearly able to identify AF occurrence during DSE,” they wrote. “This side effect of high-level dobutamine infusion remains uncommon and we demonstrate that elderly patients and patients with previous history of paroxysmal AF are at risk of AF during DSE.”