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Prognostic Impact of the Atrial Fibrillation Burden in Patients With Pulmonary Embolism

Zhijun Lei1, Chuanzhen Hao2, Jiaxin Zhang3

  • 1Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.

Pacing and Clinical Electrophysiology : PACE
|March 13, 2026
PubMed
Abstract

Insights

High atrial fibrillation (AF) burden significantly increases 1-year mortality risk in pulmonary embolism (PE) patients. Low AF burden did not show a significant association, indicating AF burden

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Epidemiology

Background:

  • The prognostic impact of atrial fibrillation (AF) burden in pulmonary embolism (PE) patients is not well-established.
  • Understanding this relationship is crucial for effective risk stratification and management of PE.

Purpose of the Study:

  • To investigate the association between atrial fibrillation (AF) burden and prognosis in patients diagnosed with pulmonary embolism (PE).
  • To determine if AF burden can serve as a predictor of mortality in PE patients.

Main Methods:

  • Retrospective cohort study utilizing the MIMIC-IV v2.0 database.
  • AF burden quantified as the percentage of total AF duration from continuous electronic monitoring records.
  • Patients categorized into sinus rhythm, low-burden AF (≤12.0%), and high-burden AF (>12.0%) groups.
  • Multivariable Cox proportional hazards models analyzed 1-year all-cause mortality risk.

Main Results:

  • Out of 1,175 PE patients, 246 (20.9%) had AF (84 low-burden, 162 high-burden).
  • 1-year all-cause mortality rates were 22.1% (SR), 26.2% (low-burden AF), and 40.7% (high-burden AF).
  • High-burden AF independently predicted increased 1-year mortality (aHR: 1.67, p=0.001), while low-burden AF did not (aHR: 0.97, p=0.906).
  • Restricted cubic spline analysis revealed a nonlinear, inverted U-shaped relationship between AF burden and mortality risk.

Conclusions:

  • High atrial fibrillation (AF) burden is an independent predictor of 1-year all-cause mortality in pulmonary embolism (PE) patients.
  • AF burden, particularly high burden, holds clinical utility for risk stratification in PE management.
Keywords:
atrial fibrillationatrial fibrillation burdenprognostic impactpulmonary embolismrisk stratification

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