Aortic dissection presenting with new onset atrial fibrillation: a very unusual presentation

Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

OBJECTIVE

To explore the link between aortic dissection (AD) and atrial fibrillation (AF).

METHODS

Using the National Health Insurance Research Database (NHIRD), cohorts were constructed for evaluating the incidence of AF in patients with AD (study 1) and the incident AD among AF patients (study 2) based on propensity matching analysis. Cox proportion hazard regression models were used to examine the effect of AD on the risk of AF, shown as hazard ratios (HRs) with 95% confidence intervals (CIs). Similar statistical procedures were used for study 2.

RESULTS

The study 1 consisted of 11 813 patients in the AD cohort and 11 813 controls in the non-AD cohort and the study 2 consisted of 190 494 patients in the AF cohort and 190 494 controls in the non-AF cohort. The overall incidence density of AF was 1.32-fold higher in the AD cohort than in the non-AD cohort (11.1 and 8.3 per 1000 person-years), with an adjusted HR (aHR) of 1.74 (95% CI = 1.53-1.98). The AF cohort had 1.18-fold higher incidence of AD than the non-AF cohort (0.55 vs 0.47 per 1000 person-years), with an aHR of 1.24 (95% CI = 1.07-1.44).

CONCLUSIONS

Bidirectional association between AD and AF was shown for the first time in this study.

Ruptured aortic dissection presenting with new onset atrial fibrillation

We report this type A aortic dissection in both ascending and descending thoracic aorta presenting with new onset atrial fibrillation. CT images confirmed the final diagnosis. The mechanism may be due to compression of the left atrium by a large haematoma.