Liver international : official journal of the International Association for the Study of the Liver 2017 04 22() doi 10.1111/liv.13459
BACKGROUND & AIMS
Information is lacking regarding whether liver cirrhosis (LC) is associated with atrial fibrillation (AF) development. We aimed to investigate the incidence and clinical significance of AF in cirrhotic patients.
LC patients (n = 3,596; mean age, 54.7 ± 12.3 years; male, 72.5%) without previous AF were selected from the Korean National Health Insurance Service National Sample Cohort database between 2004 and 2008. Age- and sex-matched controls (n=17,980) were randomly sampled in a 5:1 ratio from non-LC individuals. Both cohorts were followed-up for incident AF and death until 2013.
During 9 years of follow-up, AF was newly detected in 113 (3.1%) LC patients and 385 (2.1%) controls (incidence: 3.48 and 2.16 per 1,000 person-years, respectively). LC patients were at higher risk for AF development compared to controls (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.18-1.80) after multivariate adjustment. On subgroup analysis, LC increased the risk for AF, especially in younger (age younger than 65 years) men without comorbidities (CHA2 DS2 -VASc score, 0). LC patients showed increased overall mortality compared to controls (HR, 4.80; 95% CI, 4.47-5.15) as well as increased cardiovascular mortality (HR, 1.37; 95% CI, 1.07-1.75). However, there was no significant association between development of AF and increased mortality in LC patients (p = 0.188 and 0.260).
LC was an independent risk factor for AF development, especially in younger, otherwise healthy men, stressing the importance of cardiac assessment in cirrhotic patients. Meanwhile, AF development in LC patients was not associated with increased mortality. This article is protected by copyright. All rights reserved.