Impact of Atrial Fibrillation on Clinical Outcome in Patients with Peripartum Cardiomyopathy

Background The relationship between Atrial fibrillation (AF) and peripartum cardiomyopathy (PPCM) is not well characterized. Both are independently associated with increased risk of morbidity and mortality; however, the effect of the coexistence of AF and PPCM on clinical outcome is not clear. Objective We aimed to determine the impact of AF on long-term survival in patients with PPCM. Methods This retrospective cohort study included all patients with diagnosis of PPCM at the University of Chicago from 2006 to 2025. Data were collected from Electronic Medical Records, and analyzed by using Kaplan-Meier, logistic and Cox regression models. Results A total of 420 patients were identified with PPCM (predominantly Black or African Americans, 75.5%) at a mean maternity age of 34.2 years. Mortality was high among PPCM (6.4%) during a mean follow-up of 9.7±6 years. AF was documented in 91 patients (21.7%). Mortality was markedly higher in patients with AF versus without AF (22% vs 2%, p < 0.001). Multivariate analysis showed AF is an independent predictor of mortality in PPCM. Kaplan–Meier analysis showed significantly reduced long-term survival in PPCM patients with AF versus those without AF (p < 0.001). Predictors of AF and mortality in patients with PPCM include lower BMI, poor LVEF recovery, heart failure, and other heart rhythm disorders. Conclusion AF is highly prevalent in patients with PPCM and strongly associated with higher mortality. AF is a significant prognostic marker for poor long-term survival in PPCM. Early detection and management of AF in PPCM is critical for clinical outcomes.