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28/07/2023 - Press release

Patients with arrhythmia are at greater risk of suffering atrial fibrillation

A study by cardiologists at Hospital del Mar and researchers at the Hospital del Mar Medical Research Institute reveals that more than half of the people treated for the arrhythmia known as atrial flutter will suffer an episode of atrial fibrillation in less than a year. The risk of atrial fibrillation reaches 86% in those patients who score higher on a risk scale designed by the team, prompting the need for more accurate monitoring of these patients because of the likelihood that they could suffer other cardiovascular problems, such as a stroke. The study, published in the Journal of Cardiology, was funded by the 2014 La Marató de TV3, dedicated to heart disease.

According to a study by researchers from the Hospital del Mar Medical Research Institute and doctors from the Cardiology Service of the Hospital del Mar, published in the Journal of Cardiology, more than half of the people treated for the arrhythmia known as atrial flutter will suffer at least one episode of atrial fibrillation afterwards. Specifically, 56%. The study also indicates the collective within this group that is most at risk of suffering from heart disease and who, therefore, should be monitored more closely in order to avoid the negative consequences of this situation. The study was financed with funds from the 2014 La Marató de TV3, which was dedicated to heart disease.

The researchers were able to exhaustively monitor their patients thanks to an implantable heart rhythm monitoring device, known as a subcutaneous Holter, which Hospital del Mar is pioneering in Catalonia. This device transmits data in real time via the patient's mobile phone, allowing specialists to continuously monitor their progress. The device is implanted during the procedure to treat atrial flutter, an ablation, which consists of eliminating the electrical circuit that causes the arrhythmia via catheterisation. This is one of the most common and most easily treated arrhythmias.

An analysis of the data from 48 patients treated at the hospital between 2017 and 2019 for this type of arrhythmia revealed that more than half of them, 56%, suffered an episode of atrial fibrillation, another more serious type of arrhythmia, within the first year after undergoing treatment for atrial flutter. This figure far exceeds previous estimates of 30-40% within two to three years. The researchers then studied patients who might be at higher risk, and found that those with a higher PACE score had an 86% higher chance of developing atrial fibrillation. This scale is a tool designed by the same researchers to predict the risk of atrial fibrillation in a healthy population. To do this, it takes into account the electrocardiogram, age and whether the patient has underlying heart disease.  

"We have observed that one of the factors predicting the likelihood of suffering an episode of atrial fibrillation is a higher score on the PACE scale", explains Dr. Ermengol Vallès, a researcher in the Biomedical Research Group on Heart Diseases at the IMIM-Hospital del Mar and head of the Arrhythmia Unit within Hospital del Mar's Cardiology Service. A score of 29 points or more on this scale indicates a high-risk patient.

This leads the authors of the study to recommend "closer monitoring of these patients, as they should probably never stop taking anticoagulants, since most of them will eventually develop atrial fibrillation. We could even consider early treatment of this pathology when it appears for the first time", says Dr Vallès. Anticoagulant drugs are prescribed to patients with arrhythmia to prevent the appearance of clots that could lead to other conditions such as stroke, but these are discontinued once the condition has been treated. For this group, the researchers believe that this action should be reconsidered and that the prescription should be maintained in view of the high risk of an episode of atrial fibrillation that could trigger clots.

From left to right: Carlos González, Jesús Jiménez, Ermengol Vallès and Fatima Zaraket.

Reference article

Vallès E, Martí-Almor J, Grau N, Casteigt B, Benito B, Cabrera S, Alcalde O, Benito E, Bas D, Conejos J, Cabero P, Soler C, Duran X, Fan R, Jimenez J. Influence of PACE score and conduction disturbances in the incidence of early new onset atrial fibrillation after typical atrial flutter ablation. J Cardiol. 2022 Mar;79(3):417-422. doi: 10.1016/j.jjcc.2021.10.012. Epub 2021 Nov 10. PMID: 34774385.

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