Background: Pectus excavatum is a skeletal abnormality that may have cardiac manifestations.
Objective: To determine whether pectus excavatum is associated with lone atrial fibrillation (AF).
Methods: The pectus severity index (PSI) is the ratio of the lateral diameter of the chest to the distance between the sternum and the spine on computed tomography scan. A normal PSI is ≤2.5 whereas patients with severe pectus excavatum have a PSI >3.25. We calculated the PSI of 220 consecutive patients with AF who underwent radiofrequency catheter ablation from September 2008 to 2012 and compared this to the PSI of 225 controls without a history of AF undergoing chest computed tomography.
Results: Mean PSI was higher in patients with lone AF (2.72 ± 0.07) compared to patients with nonlone AF (2.25 ± 0.03) or controls (2.26 ± 0.03) (P < .001). The likelihood of mild, moderate, or severe pectus excavatum was higher in patients with lone AF compared to patients with nonlone AF and controls (P < .001). Patients with lone AF were more than 5 times as likely to have severe pectus excavatum compared to patients with nonlone AF or controls (P < .001) even after adjustment for potential confounders.
Conclusions: Nearly two-thirds of the patients with lone AF have at least mild pectus excavatum and 17% have severe pectus, which is significantly higher than in patients with nonlone AF or controls. This association suggests a potential genetic or mechanical abnormality may be common to the 2 disorders. Our study may provide insight into the pathogenesis of lone AF.
Keywords: AF; Atrial fibrillation; CABG; CT; PCI; PSI; Pectus excavatum; SMART; Symptom Mitigation in Atrial Fibrillation; UNC; University of North Carolina; atrial fibrillation; computed tomography; coronary artery bypass grafting; pectus severity index; percutaneous coronary intervention.
Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.