Abstract 11270: Liver Disease as a Novel Risk Factor for Atrial Fibrillation

Abstract

Background: End-stage liver disease can significantly affect circulating inflammatory peptides, creating a pro-arrhythmic substrate. However, liver disease as a risk factor for atrial fibrillation (AF) has not been previously studied and few studies have evaluated the incidence of AF in this population. Objective: The purpose of this study was to examine incidence of AF in patients with cirrhosis and assess liver disease severity as a risk factor for AF. Methods: A single center retrospective chart review of adult patients evaluated for orthotopic liver transplantation between 1/2006 and 12/2015 was performed. Model for End-stage Liver Disease (MELD) severity scores were calculated and presence of AF assessed from chart review and billing codes. Incidence of AF for MELD score severity was quantified and Cox proportional hazard models used to analyze effect of risk factors, including quartiles of MELD score, for AF occurrence. Results: Data from 1694 subjects (age 55±12 years, LVEF 61±7.4%) was analyzed. Mean MELD score was 16±8.5 and AF prevalence was 11.2%. Median follow up was 10.8 months (range 0.5-25). Hypertension was present in 12%, diabetes mellitus in 13%, sleep apnea in 0.7%, coronary artery disease (CAD) in 0.9%, valvular heart disease (VHD) 0.5%, and left ventricular hypertrophy (LVH) in 0.8%. After adjusting for age, gender, VHD, sleep apnea, diabetes, hypertension, LVEF, left atrial enlargement, and LVH, the highest quartile (MELD >30) had a HR of 12 (CI 5.3-29) with decreasing hazard ratios for the third (MELD = 21 to 30, HR of 6.8 (CI 3.8-12)) and second (MELD = 11 to 20, HR of 2.9 (CI 1.8-4.8)) compared to the lowest quartile (MELD = 1 to 10). Older age, sleep apnea, hemodynamic instability, VHD and lower LVEF also proved statistically significant. Conclusion: Patient with cirrhosis have a notable prevalence of AF. Severity of liver disease proved to be an independent risk factor for AF, even after accounting for other traditional risk factors.