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Traumatic Injury and Atrial Fibrillation Among Deployed Service Members
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  • Karl Christian Alcover,
  • Shiva Ambardar,
  • Eduard Poltavskiy,
  • Javed Nasir,
  • Jud Janak,
  • Jeffrey Howard,
  • Lauren Walker,
  • Mark Haigney,
  • Ian Stewart
Karl Christian Alcover
Uniformed Services University of the Health Sciences
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Shiva Ambardar
Uniformed Services University of the Health Sciences
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Eduard Poltavskiy
David Grant Medical Center
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Javed Nasir
Stanford University School of Medicine
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Jud Janak
Bexar Data Limited
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Jeffrey Howard
The University of Texas at San Antonio
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Lauren Walker
David Grant Medical Center
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Mark Haigney
Uniformed Services University of the Health Sciences
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Ian Stewart
Uniformed Services University of the Health Sciences
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Abstract

Introduction. Atrial Fibrillation and Atrial Flutter (AF/AFL), the most common atrial arrhythmias, have never been examined in combat casualties. In this study, we investigated the impact of traumatic injury on AF/AFL among service members with deployment history. Methods. Sampled from the Department of Defense (DoD) Trauma Registry (n=10,000), each injured patient in this retrospective cohort study was matched with a non-injured service member drawn from the Veterans Affairs/DoD Identity Repository. The primary outcome was AF/AFL diagnosis identified using ICD-9-CM and ICD-10-CM codes. Competing risk regressions based on Fine and Gray subdistribution hazards model with were utilized to assess the association between injury and AF/AFL. Results. There were 130 reported AF/AFL cases, 90 of whom were injured and 40 were non-injured. The estimated cumulative incidence rates of AF/AFL for injured was higher compared to non-injured patients (HR = 2.04; 95% CI = 1.44, 2.87). After adjustment demographics and tobacco use, the association did not appreciably decrease (HR = 1.90; 95% CI = 1.23, 2.93). Additional adjustment for obesity, hypertension, diabetes, and vascular disorders, the association between injury and AF/AFL was no longer statistically significant (HR: 1.51; 95% CI = 0.99, 2.52). Conclusion. Higher AF/AFL incidence rate was observed among deployed service members with combat injury compared to servicemembers without injury. The association did not remain significant after adjustment for cardiovascular-related covariates. These findings highlight the need for combat casualties surveillance to further understand the AF/AFL risk within the military population and to elucidate the potential underlying pathophysiologic mechanisms.

Peer review status:UNDER REVIEW

28 Apr 2021Submitted to Journal of Cardiovascular Electrophysiology
28 Apr 2021Submission Checks Completed
28 Apr 2021Assigned to Editor
29 Apr 2021Reviewer(s) Assigned
09 May 2021Review(s) Completed, Editorial Evaluation Pending
09 May 2021Editorial Decision: Revise Minor
26 May 20211st Revision Received
01 Jun 2021Submission Checks Completed
01 Jun 2021Assigned to Editor
02 Jun 2021Reviewer(s) Assigned