51
|
Gatti G, Fiorica I, Dell'Angela L, Morosin M, Faganello G, Cappelletto C, Pagura L, Ceschia A, Piazza R, Pappalardo A. Isolated left atrial cryoablation of atrial fibrillation in conventional mitral valve surgery. IJC HEART & VASCULATURE 2020; 31:100652. [PMID: 33102684 PMCID: PMC7575890 DOI: 10.1016/j.ijcha.2020.100652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/23/2020] [Accepted: 09/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent trends of surgery for atrial fibrillation (AF) are towards more safe and effective energy sources, as well as to simplified sets of atrial lesions. METHODS One hundred eighteen (mean age, 67.4 ± 9.2 years) selected patients with paroxysmal/persistent AF and mitral valve (MV) disease underwent cryoablation of AF combined with conventional (not via mini-thoracotomy) MV surgery; the lesion set was limited to only the left atrium. Multivariable analyses identified predictors of cardiac rhythm at hospital discharge and follow-up. RESULTS There were 7 (5.9%) hospital deaths; 33 (28%) patients were discharged on AF. Higher values of preoperative left atrial volume index (odds ratio [OR] = 1.07, 95% confidence interval [95%CI]: 1.01-1.13) and mixed etiology of MV disease (OR = 4.19, 95%CI: 1.23-14.2) were predictors of hospital discharge on AF. Seventy-four (66.7%) patients were on stable sinus rhythm at follow-up (median period, 6.6 years); the 1, 5, and 10-year nonparametric estimates of adjusted freedom from AF were 98.1%, 89.2% and 45.6%, respectively. Higher values of preoperative systolic pulmonary artery pressure (hazard ratio [HR] = HR = 1.04, 95%CI: 1.01-1.08) and AF at hospital discharge (HR = 4.14, 95%CI: 1.50-11.4) were predictors of AF at follow-up. CONCLUSIONS During conventional MV surgery, a cryo-lesion set limited to only the left atrium may give good, immediate and long-term results. Left atrial dilation and mixed etiology of MV disease were predictors of hospital discharge on AF. Preoperative pulmonary hypertension and AF at discharge combined with an increased risk of AF at follow-up.
Collapse
Affiliation(s)
- Giuseppe Gatti
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Ilaria Fiorica
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Luca Dell'Angela
- Division of Cardiology, Gorizia & Monfalcone Hospital, Gorizia, Italy
| | - Marco Morosin
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Giorgio Faganello
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Chiara Cappelletto
- Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Linda Pagura
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Alessandro Ceschia
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Rita Piazza
- Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Aniello Pappalardo
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| |
Collapse
|
52
|
Hu Y, Zhao Y, Liu J, Pang J, Zhang C, Li P. An effective frequency-domain feature of atrial fibrillation based on time-frequency analysis. BMC Med Inform Decis Mak 2020; 20:308. [PMID: 33239025 PMCID: PMC7690088 DOI: 10.1186/s12911-020-01337-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/17/2020] [Indexed: 01/02/2023] Open
Abstract
Background Atrial fibrillation is a type of persistent arrhythmia that can lead to serious complications. Therefore, accurate and quick detection of atrial fibrillation by surface electrocardiogram has great importance on further treatment. The practical electrocardiogram signals contain various interferences in different frequencies, such as myoelectricity interference, power interference and so on. Detection speed and accuracy largely depend on the atrial fibrillation signal features extracted by the algorithm. But some of the discovered atrial fibrillation features are not well distinguishable, resulting in poor classification effect. Methods This paper proposed a high distinguishable frequency feature—the frequency corresponding to the maximum amplitude in the frequency spectrum. We used the R–R interval detection method optimized with the mathematical morphology method and combined with the wavelet transform method for analysis. According to the two features—the maximum amplitude in the frequency spectrum and R–R interval irregular, we could recognize atrial fibrillation signals in electrocardiogram signals by decision tree classification algorithm. Results The data used in the experiment come from the MIT-BIH database, which is publicly accessible via the web and with ethical approval and consent. Based on the input of time-domain and frequency-domain features, we classified sinus rhythm signals and AF signals using the decision tree generated by classification and regression tree (CART) algorithm. From the confusion matrix, we got the accuracy was 98.9%, sensitivity was 97.93% and specificity was 99.63%. Conclusions The experimental results can prove the validity of the maximum amplitude in the frequency spectrum and the practicability and accuracy of the detection method, which applied this frequency-domain feature. Through the detection method, we obtained good accuracy of classifying sinus rhythm signals and atrial fibrillation signals. And the sensitivity and specificity of our method were pretty good by comparison with other studies.
Collapse
Affiliation(s)
- Yusong Hu
- College of Information Science and Engineering, Northeastern University, Shenyang, Liaoning, China
| | - Yantao Zhao
- College of Information Science and Engineering, Northeastern University, Shenyang, Liaoning, China
| | - Jihong Liu
- College of Information Science and Engineering, Northeastern University, Shenyang, Liaoning, China.
| | - Jin Pang
- College of Information Science and Engineering, Northeastern University, Shenyang, Liaoning, China
| | - Chen Zhang
- College of Information Science and Engineering, Northeastern University, Shenyang, Liaoning, China
| | - Peizhe Li
- College of Information Science and Engineering, Northeastern University, Shenyang, Liaoning, China
| |
Collapse
|
53
|
Liu Y, Lv H, Tan R, An X, Niu XH, Liu YJ, Yang X, Yin X, Xia YL. Platelets Promote Ang II (Angiotensin II)-Induced Atrial Fibrillation by Releasing TGF-β1 (Transforming Growth Factor-β1) and Interacting With Fibroblasts. Hypertension 2020; 76:1856-1867. [PMID: 33175633 DOI: 10.1161/hypertensionaha.120.15016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hypertension is a risk factor of atrial fibrillation (AF), and a certain number of patients with hypertension were found with an enlarged left atrium. Platelet activation is found in patients with hypertension or pressure overload/Ang II (angiotensin II)-induced hypertensive animal models and contribute to ventricular fibrosis. Whether hypertension-induced atrial fibrosis is mediated by platelets remains unknown. Our previous experimental data showed that platelet-derived TGF-β1 (transforming growth factor-β1) was reduced in patients with hypertensive AF. The present study is to investigate whether platelet-derived TGF-β1 promotes Ang II-induced atrial fibrosis and AF. Platelet activation and atrial platelet accumulation were measured in sinus rhythm controls, normotensive AF, and patients with hypertensive AF. Ang II (1500 ng/kg per minute, 3 weeks) infused mice with pharmacological (clopidogrel) and genetic platelet inhibition (TGF-β1 deletion in platelets) were used. Platelet activation, atrial structural remodeling, atrial electrical transmission, AF inducibility, inflammation, and fibrosis were measured in mice. We found that circulating platelets were activated in patients with hypertensive AF. A large amount of platelet was accumulated in the atriums of patients with hypertensive AF. Both clopidogrel treatment and platelet-specific deletion of TGF-β1 attenuated Ang II-induced structural remodeling, atrial electrical transmission, AF inducibility, as well as atrial inflammation and fibrosis than mice without interventions. Furthermore, clopidogrel blocked atrial platelet accumulation and platelet-fibroblast conjugation. Platelets promoted atrial fibroblast differentiation in cell culture. Profibrotic actions of platelets are largely via activation of atrial fibroblasts by releasing TGF-β1 and inducing platelet-fibroblast conjugation, and platelet inhibition is sufficient to inhibit atrial fibrosis and AF inducibility.
Collapse
Affiliation(s)
- Yang Liu
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Haichen Lv
- Department of Cardiology (H.L., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Ruopeng Tan
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Xiangbo An
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Xiao-Hui Niu
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China.,Yixing People's Hospital, the Affiliated Hospital of Jiangsu University, China (X.N.)
| | - Yue-Jian Liu
- Central Laboratory (Y.-J.L.), the First Affiliated Hospital of Dalian Medical University, China
| | - Xiaolei Yang
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Xiaomeng Yin
- Department of Cardiology (H.L., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| | - Yun-Long Xia
- From the Institute of Heart and Vascular Diseases (Y.L., R.T., X.A., X.N., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China.,Department of Cardiology (H.L., X.Y., Y.-L.X.), the First Affiliated Hospital of Dalian Medical University, China
| |
Collapse
|
54
|
Abstract
Pharmacologic management of atrial fibrillation (AF) is a pressing problem. This arrhythmia afflicts >5 million individuals in the United States and prevalence is estimated to rise to 12 million by 2050. Although the pill-in-the-pocket regimen for self-administered AF cardioversion introduced over a decade ago has proven useful, significant drawbacks exist. Among these are the relatively long latency of effects in the range of hours along with potential for hypotension and other adverse effects. This experience prompted development of a new strategy for increasing plasma concentrations of antiarrhythmic drugs rapidly and for a limited time, namely, pulmonary delivery. In preclinical studies in Yorkshire pigs, intratracheal administration of flecainide was shown to cause a rapid, reproducible increase in plasma drug levels. Moreover, pulmonary delivery of flecainide converted AF to normal sinus rhythm by prolonging atrial depolarization, which slows intra-atrial conduction and seems to be directly correlated with efficacy in converting AF. The rapid rise in plasma flecainide levels optimizes its anti-AF effects while minimizing adverse influences on ventricular depolarization and contractility. A more concentrated and soluble formulation of flecainide using a novel cyclodextrin complex excipient reduced net drug delivery for AF conversion when compared to the acetate formulation. Inhalation of the beta-adrenergic blocking agent metoprolol slows ventricular rate and can also terminate AF. In human subjects, oral inhalation of flecainide acetate with a hand-held, breath-actuated nebulizer results in signature prolongation of the QRS complex without serious adverse events. Thus, pulmonary delivery is a promising advance in pharmacologic approach to management of AF.
Collapse
|
55
|
Pearman CM, Redfern J, Williams EA, Snowdon RL, Modi P, Hall MCS, Modi S, Waktare JEP, Mahida S, Todd DM, Mediratta N, Gupta D. Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation. Europace 2020; 21:738-745. [PMID: 30753411 PMCID: PMC6479510 DOI: 10.1093/europace/euy303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022] Open
Abstract
Aims Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods and results Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA (P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P = 0.32). Conclusion During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.
Collapse
Affiliation(s)
- Charles M Pearman
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, 3.14 Core Technology Facility, University of Manchester, Manchester, UK
| | - James Redfern
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Emmanuel A Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Richard L Snowdon
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Paul Modi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mark C S Hall
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Simon Modi
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Johan E P Waktare
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Derick M Todd
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Neeraj Mediratta
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| |
Collapse
|
56
|
Hayashi H, Naka Y, Sanchez J, Takayama H, Kurlansky P, Ning Y, Topkara VK, Yuzefpolskaya M, Colombo PC, Sayer GT, Uriel N, Takeda K. Consequences of functional mitral regurgitation and atrial fibrillation in patients with left ventricular assist devices. J Heart Lung Transplant 2020; 39:1398-1407. [PMID: 32994093 DOI: 10.1016/j.healun.2020.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/15/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Functional mitral regurgitation (MR) (FMR) and atrial fibrillation (AF) are common in patients undergoing left ventricular assist device (LVAD) implantation. However, the impact of FMR and AF on clinical outcomes is uncertain. This study aimed to investigate the characteristics and prognostic significance of FMR and AF in patients with LVADs. METHODS We retrospectively reviewed all patients who underwent LVAD implantation at our center between January 2010 and December 2017. We defined significant FMR as the ratio of MR color jet area to left atrial area of >20% and persistent or permanent AF (PeAF) as persistent or permanent AF at LVAD implantation. RESULTS A total of 380 patients were included in this analysis. Patients were divided into 6 groups: patients with no PeAF and no significant FMR (Group 1), patients with no PeAF but with significant FMR (Group 2), patients with PeAF but no significant FMR (Group 3), patients with PeAF and significant FMR (Group 4), patients with concomitant mitral valve surgery (MVS) at LVAD implantation and without PeAF (Group 5), and patients with concomitant MVS and with PeAF (Group 6). A total of 56 patients (15%) died within 2 years. Kaplan-Meier curve analysis demonstrated a 2-year survival of 81% in Group 1, 89% in Group 2, 87% in Group 3, 47% in Group 4, 87% in Group 5, and 79 % in Group 6 (log-rank test, p < 0.001). The multivariable Cox proportional-hazards model showed that classification in Group 4 was an independent predictor of mortality (hazard ratio, 4.31; 95% CI: 2.19-8.46; p < 0.001). CONCLUSIONS The coexistence of significant FMR and PeAF may represent a poor prognostic marker in patients undergoing LVAD implantation.
Collapse
Affiliation(s)
| | | | | | | | | | - Yuming Ning
- Center for Innovation and Outcomes Research, Department of Surgery
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | | |
Collapse
|
57
|
Uysal D, Aksoy F, Ibrişim E. The Validation of the ATRIA and CHA2DS2-Vasc Scores in Predicting Atrial Fibrillation after Coronary Artery Bypass Surgery. Braz J Cardiovasc Surg 2020; 35:619-625. [PMID: 33118725 PMCID: PMC7598961 DOI: 10.21470/1678-9741-2019-0274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective The aim of this study was to evaluate the value of CHA2DS2-VASc and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) risk scores for prediction of postoperative atrial fibrillation (AF) development in patients undergoing coronary artery bypass grafting (CABG) operation. Methods The population of this observational study consisted of 370 patients undergoing CABG operation. CHA2DS2-VASc and ATRIA risk scores were calculated for all patients and their association with postoperative AF (AF episode lasting > 5 min) were evaluated. Predictors of postoperative AF were determined by multiple logistic regression analysis. Results During follow-up, 110 patients (29.7%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: ATRIA risk score (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.11-1.36; P<0.001), fasting glucose level (OR 1.006; 95% CI 1.004-1.009; P<0.001), and 24-hour drainage amount (OR 1.002; 95% CI; 1.001-1.004; P<0.001). Receiver operating characteristic curve analyses showed that CHA2DS2-VASc and ATRIA risk scores were significant predictors for new-onset AF (C-statistic 0.648; 95% CI 0.59-0.69; P<0.001; and C-statistic 0.664; 95% CI 0.61-0.71; P<0.001, respectively). Conclusion CHA2DS2-VASc and ATRIA risk scores predict new AF in patients undergoing CABG.
Collapse
Affiliation(s)
- Dinçer Uysal
- Suleyman Demirel University Medical School Department of Cardiovascular Surgery Isparta Turkey Department of Cardiovascular Surgery, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Fatih Aksoy
- Suleyman Demirel University Medical School Department of Cardiology Isparta Turkey Department of Cardiology, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Erdogan Ibrişim
- Suleyman Demirel University Medical School Department of Cardiovascular Surgery Isparta Turkey Department of Cardiovascular Surgery, Medical School, Suleyman Demirel University, Isparta, Turkey
| |
Collapse
|
58
|
The Predictive Value of Growth Differentiation Factor-15 in Recurrence of Atrial Fibrillation after Catheter Ablation. Mediators Inflamm 2020; 2020:8360936. [PMID: 32904560 PMCID: PMC7456492 DOI: 10.1155/2020/8360936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022] Open
Abstract
The mechanisms underlying the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are not well concerned. The study sought to explore the association between growth differentiation factor-15 (GDF-15) and the incidence of recurrent events among AF patients after the ablation procedure. We prospectively included 150 consecutive AF patients who underwent RFCA. Clinical information about the patients was collected. Blood samples on the second morning of hospital admission and three months after RFCA were collected, and enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of GDF-15. All participants were followed up at specific times (1st/3rd/6th/12th/18th/24th months) after RFCA to record recurrences events. During a median follow-up of 14.0 months, AF recurrence occurred in 37(24.7%) patients. Baseline serum GDF-15 level in the persistent AF group was significantly higher than the paroxysmal AF group [1140(854~1701)ng/L vs. 1062(651~1374)ng/L, P = 0.039]. Baseline serum GDF-15 level in the recurrence group was significantly higher than the nonrecurrence group [1287(889~1768) ng/L vs. 1062(694~1373)ng/L, P = 0.022]. Serum GDF-15 level at three months after RFCA was significantly lower than the baseline [870 (579~1270) ng/L vs. 1155 (735~1632)ng/L, P < 0.001]. The baseline GDF-15 correlated significantly with LAP (r = 0.296, P < 0.001) and LAAV(r = −0.235, P = 0.003). Kaplan-Meier analysis showed a significantly lower event-free survival time in the high baseline GDF-15 (≥1287.3 ng/L) group than the low baseline GDF-15 (<1287.3 ng/L) group (17.1 months vs. 20.4 months, Log Rank P = 0.017). In the multivariate Cox regression, baseline GDF-15(HR 1.053, 95% CI 1.007-1.100, P = 0.022) and LAD (HR 1.124, 95% CI 1.011-1.250, P = 0.030) were independent predictors of AF recurrence after RFCA. Our study indicated increased preprocedural GDF-15 is associated with left atrial remodeling and acts as a predictor of AF recurrence after ablation.
Collapse
|
59
|
Xu HX, Zhu YM, Hua Y, Huang YH, Lu Q. Association between atrial fibrillation and heart failure with different ejection fraction categories and its influence on outcomes. Acta Cardiol 2020; 75:423-432. [PMID: 31141463 DOI: 10.1080/00015385.2019.1610834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The important role of atrial fibrillation (AF) in different types of heart failure (HF) according to ejection fraction (EF) is much less explored. In this study, we compared AF in HF with preserved (HFpEF), mid-range (HFmrEF) and reduced (HFrEF) EF with regard to prevalence, association, and prognostic role.Methods and results: A total of 405 inpatients with HF between February 2014 and June 2016 were prospectively analysed in this study. Patients were divided into three groups: HFrEF group (n = 109, 26.9%), HFmrEF group (n = 94, 23.2%), and HFpEF group (n = 202, 49.8%). There was a higher prevalence of AF in patients in the HFpEF and HFmrEF groups than in patients in the HFrEF. Several baseline variables were found to be independently associated with AF, including age, coronary heart disease, heart rate, left atrial diameter, and left ventricular (LV) end-diastolic diameter, regardless of EF category after multivariable adjustment. In addition, AF was found to be a more powerful predictor of all-cause mortality, HF rehospitalisation, and the composite event of all-cause mortality or rehospitalisation in HFpEF and HFmrEF patients, but not in HFrEF patients.Conclusions: HFmrEF resembled HFpEF rather than HFrEF with regard to both a higher prevalence of AF and a greater risk of all-cause mortality, HF rehospitalisation, and the composite event of all-cause mortality or rehospitalisation.
Collapse
Affiliation(s)
- Hai-Xia Xu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| | - Yan-Min- Zhu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| | - Ying Hua
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| | - Yin-Hao Huang
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| | - Qi Lu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| |
Collapse
|
60
|
Does the mean 24-h pulse rate from ambulatory blood pressure monitoring reflect the mean 24-h ventricular rate from Holter electrocardiogram in atrial fibrillation patients? Blood Press Monit 2020; 25:332-337. [PMID: 32815920 DOI: 10.1097/mbp.0000000000000481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ambulatory blood pressure monitoring (ABPM) on the oscillometric method is applicable in patients with atrial fibrillation, but the mean pulse rate is or not similar to the ventricular rate from the Holter in atrial fibrillation patients remains unknown. METHODS This study included 228 persistent atrial fibrillation patients who received simultaneous 24-h ABPM and 24-h Holter. The mean 24-h pulse rate and the mean 24-h ventricular rate were calculated, and mVR-mPR was used to reflect the difference between them. The SD of 24-h pulse rate values was calculated as SD-pulse rate. Furthermore, according to the SD-pulse rate, the patients were divided into ≤5, 6-10, 11-15 and >15 bpm subgroups. RESULTS For the total population, the mean 24-h pulse rate is positively correlated with the mean 24-h ventricular rate, and the Bland-Altman plot showed quite wide 95% limits. As the SD-pulse rate increased, the 24-h mVR-mPR also increased. The mean 24-h mVR-mPR was 0.5 bpm when SD-pulse rate ≤5, 3.5 bpm when SD-pulse rate of 6-10, 7.6 bpm when SD-pulse rate of 11-15, and 12.5 bpm when SD-pulse rate >15 bpm, respectively. Meanwhile, in the SD-pulse rate 0-10 subgroup, the 95% limits were only from -13.8 to 19.7 bpm, while in the >10 subgroup, these values were from -19.5 to 36.5 bpm. CONCLUSION The mean 24-h pulse rate should not be used to represent the true ventricular rate for all atrial fibrillation patients. However, when lower the SD-pulse rate, the mVR-mPR becomes smaller.
Collapse
|
61
|
Daily Exposure to Air Pollution Particulate Matter Is Associated with Atrial Fibrillation in High-Risk Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176017. [PMID: 32824908 PMCID: PMC7504134 DOI: 10.3390/ijerph17176017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/31/2022]
Abstract
Several epidemiological studies found an association between acute exposure to fine particulate matter of less than 2.5 μm and 10 μm in aerodynamic diameter (PM2.5 and PM10) and cardiovascular diseases, ventricular fibrillation incidence and mortality. The effects of pollution on atrial fibrillation (AF) beyond the first several hours of exposure remain controversial. A total of 145 patients with implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy defibrillators (ICD-CRT), or pacemakers were enrolled in this multicentric prospective study. Daily levels of PM2.5 and PM10 were collected from monitoring stations within 20 km of the patient’s residence. A Firth Logistic Regression model was used to evaluate the association between AF and daily exposure to PM2.5 and PM10. Exposure levels to PM2.5 and PM10 were moderate, being above the World Health Organization (WHO) PM2.5 and PM10 thresholds of 25 μg/m3 and 50 μg/m3, respectively, on 26% and 18% of the follow-up days. An association was found between daily levels of PM2.5 and PM10 and AF (95% confidence intervals (CIs) of 1.34–2.40 and 1.44–4.28, respectively) for an increase of 50 µg/m3 above the WHO threshold. Daily exposure to moderate PM2.5 and PM10 levels is associated with AF in patients who are not prone to AF.
Collapse
|
62
|
Akkuş M, Öner E. Can local infiltration of lidocaine reduce the postoperative atrial fibrillation rate in patients undergoing lobectomy for lung cancer? Acta Chir Belg 2020; 120:265-270. [PMID: 31010387 DOI: 10.1080/00015458.2019.1610259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Postoperative atrial fibrillation (POAF) occurs frequently after lung cancer surgery. Unfortunately, owing to the multifactorial etiology of POAF, no single drug or intervention can prevent POAF in all cases. The effects of local interventions after lung cancer surgery are unknown. This study investigated the effects of local infiltration of an anesthetic (lidocaine) on the post-lobectomy POAF rate.Methods: This non-randomized study included 81 patients who underwent lobectomy for lung cancer. Patients were divided into a lidocaine-infiltration group comprising patients who received lidocaine infiltration around the pulmonary veins and a no-intervention group. Patients were monitored for the development of POAF during hospitalization. Pre- and postoperative demographic and clinical data were analyzed.Results: AF occurred in 3 (7.5%) of 40 patients in the lidocaine-infiltration group and in 10 (24.39%) of 41 patients in the standard surgical resection group. Overall, it was observed that intraoperative lidocaine infiltration resulted in a lower POAF rate (p < .05).Conclusion: Local infiltration of lidocaine around the pulmonary veins in patients undergoing lobectomy for lung cancer was associated with a lower incidence of POAF, which is attributable to the local anesthetic and autonomic effects of lidocaine.
Collapse
Affiliation(s)
- Murat Akkuş
- Department of Thoracic Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ender Öner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
63
|
Hu WS, Lin CL. Comparison of CHA2DS2-VASc and C2HEST scores for predicting the incidence of atrial fibrillation among patients with end-stage renal disease. Perfusion 2020; 35:842-846. [PMID: 32666900 DOI: 10.1177/0267659120930931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE The authors have studied assessment of CHA2DS2-VASc score versus C2HEST score in atrial fibrillation risk prediction in end-stage renal disease patients. METHODS The authors conducted this study by Longitudinal Health Insurance Database 2000. The authors totally enrolled 4,601 end-stage renal disease patients. The predictive capability of atrial fibrillation by using CHA2DS2-VASc and C2HEST score was estimated by area under the receiver operating characteristic curve (AUROC). RESULTS The AUROC for CHA2DS2-VASc score in predicting atrial fibrillation events was 0.5786, and AUROC for C2HEST score for atrial fibrillation prediction was 0.5983. CONCLUSION Both scores yield almost identical AUROC values implying no difference in predictive power. Further work is warranted to verify the prognostic value of the current scores.
Collapse
Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung.,Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung
| |
Collapse
|
64
|
Imamura T, Kinugawa K. Novel rate control strategy with landiolol in patients with cardiac dysfunction and atrial fibrillation. ESC Heart Fail 2020; 7:2208-2213. [PMID: 32666693 PMCID: PMC7524084 DOI: 10.1002/ehf2.12879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 01/15/2023] Open
Abstract
While patients with acute heart failure often have tachycardia with atrial fibrillation, there have been no established medical tools that control tachycardia safely and definitely. Digoxin has been recommended as a first choice in the former guidelines, but it takes time to affect and has a risk of adverse events particularly for those with chronic kidney disease. Landiolol is a recently innovated ultra‐short‐acting beta‐blocker with 251‐fold β1/β2 selectivity, which was originally indicated only to control peri‐operative supra‐ventricular tachyarrhythmia by 2013 in Japan. We aimed to review how to use landiolol in patients with cardiac dysfunction and tachycardia due to atrial fibrillation. We reviewed recently conducted randomized control trials using landiolol, recently updated guidelines, as well as current practical use of landiolol. Japan landiolol vs. Digoxin (J‐Land) study demonstrated that landiolol was more effective to control tachycardia than digoxin in atrial fibrillation patients with left ventricular dysfunction in 2013. Given the result, the revised Japanese heart failure guideline recommends landiolol for rate control during atrial fibrillation in acute heart failure patients as Class IIa with evidence level B. Currently in Japan, landiolol is used for rate control, even in patients with advanced heart failure receiving continuous infusion of inotropes. The clinical use of landiolol in patients with cardiac dysfunction and tachycardia due to atrial fibrillation is increasing. Further studies are warranted to investigate the implication of faster and safer rate control using landiolol.
Collapse
Affiliation(s)
- Teruhiko Imamura
- Second Department of Internal Medicine, Toyama University, Toyama, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Toyama University, Toyama, Japan
| |
Collapse
|
65
|
Liu F, Xin Z, Bin Waleed K, Lin Y, Tse G, Luhanga A, Sun Y, Gao L, Yin X, Xia Y. CHA 2DS 2-VASc Score as a Predictor of New-Onset Atrial Fibrillation After Catheter Ablation of Typical Atrial Flutter. Front Physiol 2020; 11:558. [PMID: 32587524 PMCID: PMC7298125 DOI: 10.3389/fphys.2020.00558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose Cavotricuspid isthmus (CTI) ablation is an effective procedure for typical atrial flutter (AFL), but patients remain at an elevated risk for developing new atrial fibrillation (AF). Currently, there are limited data on the utility of CHA2DS2-VASc score to predict new-onset AF after typical AFL ablation. In this study, we assessed whether the CHA2DS2-VASc score is a useful predictor of new-onset AF after CTI ablation in typical AFL patients without a prior history of AF. Methods This was a retrospective study of 103 typical AFL patients with no prior history of AF, who underwent successful CTI ablation. The endpoint was occurrence of new-onset AF during follow-up. Results During a mean follow-up period of 24.6 ± 16.9 months, at least one episode of AF occurred in 33 (32%) patients. Multivariate Cox regression analysis revealed that CHA2DS2-VASc score (hazard ratio = 1.736; 95% confidence interval = 1.370–2.201; P < 0.001) was significantly associated with postablation new-onset AF (area under the curve = 0.797). A cutoff value of three stratified these patients into two groups with different incidences of postablation new-onset AF (67.9 vs. 18.7%, P < 0.001). Conclusion The CHA2DS2-VASc score is a useful tool for the prediction of new-onset AF after ablation of typical AFL. Patients with CHA2DS2-VASc score ≥3 are more likely to develop new-onset AF and should be monitored more closely.
Collapse
Affiliation(s)
- Fei Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zechang Xin
- Faculty of Medicine, Dalian Medical University, Dalian, China
| | - Khalid Bin Waleed
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Yajuan Lin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Andrew Luhanga
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuanjun Sun
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianjun Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
66
|
Jurin I, Hadžibegović I, Durlen I, Jakšić Jurinjak S, Mišković D, Ajduk M, Jerkić H, Letilović T. Left atrium size and red cell distribution width predict atrial fibrillation progression from paroxysmal or persistent to permanent. Acta Clin Belg 2020; 75:205-211. [PMID: 30950766 DOI: 10.1080/17843286.2019.1599173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Stratifying patients with paroxysmal or short-term persistent atrial fibrillation (AF) who are at greater risk of developing permanent AF is challenging. Aim of our prospective study was to evaluate association of laboratory parameters (biochemistry and complete blood count (CBC)) together with standard demographic, clinical and echocardiography parameters, with AF progression.Methods: We prospectively recruited 579 patients with AF and divided them into two groups at index hospitalization: paroxysmal or persistent (non-permanent AF), and long-term persistent or permanent AF patients (permanent AF). Clinical, echocardiographic, and relevant CBC parameters were collected. Non-permanent AF patients were selected for follow-up, with a median follow-up time of 21 months. Endpoint was progression to permanent AF.Results: Out of 409 patients with non-permanent AF, 109 (26.6%) progressed within follow-up. In a multivariate Cox regression model only increased left atrium (LA) diameter (HR 2.16, 95% CI 1.20-3.87, p = 0.010), and increased red cell distribution width (RDW; HR 1.19, 95% CI 1.03-1.39, p = 0.022) showed significant independent association with progression. There were 221/409 patients with both LA ≤45 mm and RDW level ≤14.5% who progressed at a rate of only 17.6%, and showed relative risk of AF progression of 0.47 (95% CI 0.34-0.67; p < 0,001).Conclusion: Together with LA size, RDW was independently associated with AF progression. Patients with both LA size ≤45 mm and RDW level ≤14.5% are most probably the best candidates for rhythm control strategies.
Collapse
Affiliation(s)
- Ivana Jurin
- Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Irzal Hadžibegović
- Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Ivan Durlen
- Department of Dialysis, University Hospital Dubrava, Zagreb, Croatia
| | - Sandra Jakšić Jurinjak
- Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Domagoj Mišković
- Department of Cardiology, General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
| | - Marko Ajduk
- Department of Vascular surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Helena Jerkić
- Department of Cardiology, University Hospital Merkur, Zagreb, Croatia
| | | |
Collapse
|
67
|
Chen Y, Liu F, Han F, Lv L, Tang CE, Xie Z, Luo F. Omentin-1 is associated with atrial fibrillation in patients with cardiac valve disease. BMC Cardiovasc Disord 2020; 20:214. [PMID: 32375640 PMCID: PMC7203903 DOI: 10.1186/s12872-020-01478-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) remodeling and adipocytokines are associated with structural remodeling in atrial fibrillation (AF). However, the role of omentin-1, a novel adipocytokine, in structural remodeling remains unknown. METHODS Hematoxylin and eosin (H&E) and Masson's trichrome stains were used to investigate the histology of EAT and right atrial appendages. The expression levels of adipocytokines in these human samples were determined by immunohistochemical assay and western blotting. Models of transforming growth factor (TGF)-β1-induced activation of cardiac fibroblasts (CFs) and TGF-β1-induced endothelial-mesenchymal transition (EndMT) of human umbilical vein endothelial cell (HUVEC) were established to explore roles of omentin-1 in these processes. To determine changes in adipocytokines secretion under hypoxia conditions, adipocytes were treated with 5% O2 and 95% N2, and then CFs and HUVECs were co-cultured with the conditioned medium of adipocytes to determine the effects of hypoxia-treated adipocytes on these cells. RESULTS Expression of omentin-1 was downregulated in the EAT and right atrial appendages from patients with AF compared to samples from patients without AF, while the TGF-β1 level was upregulated in EAT from patients with AF. EAT from patients with AF exhibited adipocyte hypertrophy and severe interstitial fibrosis. Omentin-1 inhibited TGF-β1-induced CF activation and reversed TGF-β1-induced HUVEC EndMT. Adipocytes treated with hypoxia exhibited downregulation of omentin-1 and partly activated CFs. CONCLUSIONS This study demonstrated that omentin-1 was an antifibrotic adipocytokine and was downregulated in patients with AF, which was partly mediated by hypoxia.
Collapse
Affiliation(s)
- Yubin Chen
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Fen Liu
- The Institute of Medical Science Research, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Fei Han
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lizhi Lv
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Can-E Tang
- The Institute of Medical Science Research, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Zhongshang Xie
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Fanyan Luo
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| |
Collapse
|
68
|
Cho HJ, Lee CH, Hwang J, Park HS, Choi SW, Kim IC, Cho YK, Yoon HJ, Kim H, Nam CW, Hur SH, Jung BC, Kim YN, Han S. Accuracy of implantable loop recorders for detecting atrial tachyarrhythmias after atrial fibrillation catheter ablation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-020-00013-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Implantable loop recorders (ILRs) can provide an enhanced possibility to detect atrial fibrillation (AF), but the accuracy, especially the positive predictive value (PPV), is controversial. This study aimed to evaluate the accuracy of ILRs for detecting AF through a comparison with Holter.
Method and results
Thirteen patients who underwent AF ablation were enrolled. ILRs were implanted in all patients, who were scheduled to have Holter monitorings after the procedure. The incidence of AF was compared between the two modalities and analyzed for any correlations. A total of 51 Holters (67,985.5 min) and concomitant ILRs were available for the comparison. The judgment of the presence of AF did not perfectly correlate between the ILR and Holter (Kappa = 0.866, P < 0.001). In the ILR data, the sensitivity of detecting AF on the Holter was 81.6% (95% confidence interval [CI] 0.812–0.820; P < 0.001). The specificity was 99.9% (95% CI 0.998–0.999; P < 0.001). When the ILR detected AF, the PPV was 99.5% (95% CI 0.994–0.995), but the ILR did not detect AF, and the negative predictive value was 94.2% (95% CI 0.941–0.944). A separate analysis of AF/atrial tachycardia (AT) showed that the AT detection rate of the ILR was 2.3%.
Conclusion
The ILR had a low false positive value and high PPV for AF events. However, it was limited in identifying AT.
Collapse
|
69
|
Li LYF, Lou Q, Liu GZ, Lv JC, Yun FX, Li TK, Yang W, Zhao HY, Zhang L, Bai N, Zhan CC, Yu J, Zang YX, Li WM. Sacubitril/valsartan attenuates atrial electrical and structural remodelling in a rabbit model of atrial fibrillation. Eur J Pharmacol 2020; 881:173120. [PMID: 32325147 DOI: 10.1016/j.ejphar.2020.173120] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 01/09/2023]
Abstract
Atrial structural and electrical remodelling play important roles in atrial fibrillation (AF). Sacubitril/valsartan attenuates cardiac remodelling in heart failure. However, the effect of sacubitril/valsartan on AF is unclear. The aim of this study was to evaluate the effect of sacubitril/valsartan on atrial electrical and structural remodelling in AF and investigate the underlying mechanism of action. Thirty-three rabbits were randomized into sham, RAP, and sac/val groups. HL-1 cells were subjected to control treatment or rapid pacing with or without LBQ657 and valsartan. Echocardiography, atrial electrophysiology, and histological examination were performed. The concentration of Ca2+ and expression levels of calcineurin, NFAT, p-NFAT, Cav1.2, collagen Ⅰ and Ⅲ, ANP, BNP, CNP, NT-proBNP, and ST2 in HL-1 cells, and IcaL in left atrial cells, were determined. We observed that compared to that in the sham group, the atrium and right ventricle were enlarged, myocardial fibrosis was markedly higher, AF inducibility was significantly elevated, and atrial effective refractory periods were shortened in the RAP group. These effects were significantly reversed by sacubitril/valsartan. Compared to that in the sham group, collagen Ⅰ and Ⅲ, NT-proBNP, ST2, calcineurin, and NFAT were significantly up-regulated, while p-NFAT and Cav1.2 were down-regulated in the RAP group, and sacubitril/valsartan inhibited these changes. Ca2+ concentration increased and ICaL density decreased in in vivo and in vitro AF models, reversed by sacubitril/valsartan. Sacubitril/valsartan attenuates atrial electrical remodelling and ameliorates structure remodelling in AF. This study paves the way for the possibility of clinical use of sacubitril/valsartan in AF patients.
Collapse
Affiliation(s)
- Lu-Yi-Fei Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Qi Lou
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Guang-Zhong Liu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jia-Chen Lv
- Department of Colorectal Surgery, The Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Feng-Xiang Yun
- Department of Internal Critic Care, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Tian-Kai Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Wen Yang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Hong-Yan Zhao
- Department of Cardiology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Li Zhang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Nan Bai
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Cheng-Chuang Zhan
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jia Yu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yan-Xiang Zang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Wei-Min Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
| |
Collapse
|
70
|
Patients with atrial fibrillation and mid-range ejection fraction differ in anticoagulation pattern, thrombotic and mortality risk independently of CHA2DS2-VASC score. Heart Vessels 2020; 35:1243-1249. [DOI: 10.1007/s00380-020-01603-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/27/2020] [Indexed: 12/28/2022]
|
71
|
Randhawa MS, Vishwanath R, Rai MP, Wang L, Randhawa AK, Abela G, Dhar G. Association Between Use of Warfarin for Atrial Fibrillation and Outcomes Among Patients With End-Stage Renal Disease: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e202175. [PMID: 32250434 PMCID: PMC7136833 DOI: 10.1001/jamanetworkopen.2020.2175] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Several studies have examined the role of warfarin in preventing strokes in patients with atrial fibrillation and end-stage renal disease; however, the results remain inconclusive. OBJECTIVE To assess recently published studies to examine the outcomes of the use of warfarin among patients with atrial fibrillation and end-stage renal disease. DATA SOURCES A literature search was performed using the terms warfarin and atrial fibrillation and end-stage renal disease and warfarin and atrial fibrillation and dialysis in the MEDLINE, Embase, and Google Scholar databases from January 1, 2008, to February 28, 2019. STUDY SELECTION The studies included were those with patients with end-stage renal disease and atrial fibrillation who were receiving warfarin and with hazard ratios (HRs) of at least 1 primary outcome. The studies excluded were those with a lack of information on outcomes and unreliable 95% CIs of the results. DATA EXTRACTION AND SYNTHESIS The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed in selecting studies. Collected data were also scrutinized for reliable 95% CIs. Finally, studies were examined for perceived biases, their limitations, and the definitions of the outcomes. MAIN OUTCOMES AND MEASURES The HRs and 95% CIs were calculated for the incidence of ischemic stroke, hemorrhagic stroke, major bleeding, and mortality among patients receiving anticoagulants and those not receiving anticoagulants. RESULTS Study selection yielded 15 studies with a total of 47 480 patients with atrial fibrillation and end-stage renal disease. Of these patients, 10 445 (22.0%) were taking warfarin. With a mean (SD) follow-up period of 2.6 (1.4) years, warfarin use was associated with no significant change for the risk of ischemic stroke (HR, 0.96; 95% CI, 0.82-1.13), with a significantly higher risk of hemorrhagic stroke (HR, 1.49; 95% CI, 1.03-1.94), with no significant difference in the risk of major bleeding (HR, 1.20; 95% CI, 0.99-1.47), and with no change in overall mortality (HR, 0.95; 95% CI, 0.83-1.09). CONCLUSIONS AND RELEVANCE In the studies reviewed, warfarin use appears to have been associated with no change in the incidence of ischemic stroke in patients with atrial fibrillation and end-stage renal disease. However, from the studies reviewed, it does appear to be associated with a significantly higher risk of hemorrhagic stroke, with no significant difference in the risk of major bleeding, and with no change in mortality.
Collapse
Affiliation(s)
- Mandeep S. Randhawa
- Division of Cardiology, Michigan State University, Kalamazoo
- Sparrow Clinical Research Institute, Sparrow Healthcare, Lansing, Michigan
| | | | - Manoj P. Rai
- Department of Medicine, Michigan State University, East Lansing
| | - Ling Wang
- Division of Occupational and Environment Medicine, Michigan State University, East Lansing
| | | | - George Abela
- Division of Cardiology, Michigan State University, Kalamazoo
| | - Gaurav Dhar
- Division of Cardiology, Michigan State University, Kalamazoo
- Sparrow Clinical Research Institute, Sparrow Healthcare, Lansing, Michigan
| |
Collapse
|
72
|
Atrial Fibrillation and Surgical Patients with Peripheral Arterial Disease. Ann Vasc Surg 2020; 67:411-416. [PMID: 32209417 DOI: 10.1016/j.avsg.2020.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and its prevalence rate significantly increases with age. The prognostic implication of AF in surgical patients with peripheral arterial disease (PAD) has not been analyzed. The aims of this study were to analyze the prevalence of AF among patients operated on with symptomatic PAD, and to determine whether these patients are at a higher risk of death or amputation. METHODS We designed a retrospective cohort study, from January 2013 to December 2017, in which we analyzed the medical records of all consecutive patients with symptomatic PAD admitted to our hospital and underwent a vascular procedure. We compared the outcomes of patients with and without AF. All statistically significant demographic variables that underwent a univariate analysis were inserted in the stepwise multivariate model along with AF. A survival analysis was performed to evaluate the factors associated with mortality through a Cox regression model. P-value of 0.05 was considered statistically significant. RESULTS Four hundred three patients were admitted in-hospital with symptomatic PAD and they underwent a vascular intervention. The mean follow-up was 2 years. Seventy-six patients (18.8%) had AF. These patients were older (78 ± 9.1 years) than the 327 patients without AF (68 ± 12.37 years) (P < 0.0001), and more likely to undergo emergency surgery (18.42% vs. 7.34%, P = 0.0029). Age and emergency admission were dependent associates of AF. The patients with AF were frequently men (69.7%) with previous hypertension (96% %). The presence of AF was associated with higher rate of all-cause mortality (55.26%, P < 0.0001, hazard ratio 2.24, confidence interval 1.55-3.25), but the multivariate analysis adjusted for risk factors showed that the mortality was only associated with age because these patients were older and with many comorbidities. The majority of this population with AF showed some tissue lesion when they were admitted in-hospital (Rutherford V-VI, AF 80.2%, P = 0.0004), and this fact justified that a 22.36% underwent a major amputation affecting the ischemic lower limb in admission (P = 0.018). During the follow-up the free amputation rate was similar between groups (60.5% AF vs. 78.3% non-AF). CONCLUSIONS This study showed the high prevalence of AF in patients with symptomatic PAD that required surgical admission in-hospital. The presence of AF was related with a greater and serious risk of mortality, but this was independently associated to age, because patients with AF were older and frailer. Clearly, this group of patients had a high risk of amputation when they arrived to the hospital and they needed emergency surgery.
Collapse
|
73
|
Oster J, Hopewell JC, Ziberna K, Wijesurendra R, Camm CF, Casadei B, Tarassenko L. Identification of patients with atrial fibrillation: a big data exploratory analysis of the UK Biobank. Physiol Meas 2020; 41:025001. [PMID: 31978903 DOI: 10.1088/1361-6579/ab6f9a] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an estimated prevalence of around 1.6% in the adult population. The analysis of the electrocardiogram (ECG) data acquired in the UK Biobank represents an opportunity to screen for AF in a large sub-population in the UK. The main objective of this paper is to assess ten machine-learning methods for automated detection of subjects with AF in the UK Biobank dataset. APPROACH Six classical machine-learning methods based on support vector machines are proposed and compared with state-of-the-art techniques (including a deep-learning algorithm), and finally a combination of a classical machine-learning and deep learning approaches. Evaluation is carried out on a subset of the UK Biobank dataset, manually annotated by human experts. MAIN RESULTS The combined classical machine-learning and deep learning method achieved an F1 score of 84.8% on the test subset, and a Cohen's kappa coefficient of 0.83, which is similar to the inter-observer agreement of two human experts. SIGNIFICANCE The level of performance indicates that the automated detection of AF in patients whose data have been stored in a large database, such as the UK Biobank, is possible. Such automated identification of AF patients would enable further investigations aimed at identifying the different phenotypes associated with AF.
Collapse
Affiliation(s)
- Julien Oster
- IADI, U1254, INSERM, Université de Lorraine, Nancy, France
| | | | | | | | | | | | | |
Collapse
|
74
|
Left atrial thrombus in patients with atrial fibrillation and under oral anticoagulant therapy; 3-D transesophageal echocardiographic study. Int J Cardiovasc Imaging 2020; 36:1097-1103. [DOI: 10.1007/s10554-020-01811-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
|
75
|
Wang EY, Hulme OL, Khurshid S, Weng LC, Choi SH, Walkey AJ, Ashburner JM, McManus DD, Singer DE, Atlas SJ, Benjamin EJ, Ellinor PT, Trinquart L, Lubitz SA. Initial Precipitants and Recurrence of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e007716. [PMID: 32078361 DOI: 10.1161/circep.119.007716] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) may occur after an acute precipitant and subsequently resolve. Management guidelines for AF in these settings are unclear as the risk of recurrent AF and related morbidity is poorly understood. We examined the relations between acute precipitants of AF and long-term recurrence of AF in a clinical setting. METHODS From a multi-institutional longitudinal electronic medical record database, we identified patients with newly diagnosed AF between 2000 and 2014. We developed algorithms to identify acute AF precipitants (surgery, sepsis, pneumonia, pneumothorax, respiratory failure, myocardial infarction, thyrotoxicosis, alcohol, pericarditis, pulmonary embolism, and myocarditis). We assessed risks of AF recurrence in individuals with and without a precipitant and the relations between AF recurrence and heart failure, stroke, and mortality. RESULTS Among 10 723 patients with newly diagnosed AF (67.9±9.9 years, 41% women), 19% had an acute AF precipitant, the most common of which were cardiac surgery (22%), pneumonia (20%), and noncardiothoracic surgery (15%). The cumulative incidence of AF recurrence at 5 years was 41% among individuals with a precipitant compared with 52% in those without a precipitant (adjusted hazard ratio [HR], 0.75 [95% CI, 0.69-0.81]; P<0.001). The lowest risk of recurrence among those with precipitants occurred with postoperative AF (5-year incidence 32% in cardiac surgery and 39% in noncardiothoracic surgery). Regardless of the presence of an initial precipitant, recurrent AF was associated with increased adjusted risks of heart failure (hazard ratio, 2.74 [95% CI, 2.39-3.15]; P<0.001), stroke (hazard ratio, 1.57 [95% CI, 1.30-1.90]; P<0.001), and mortality (hazard ratio, 2.96 [95% CI, 2.70-3.24]; P<0.001). CONCLUSIONS AF after an acute precipitant frequently recurs, although the risk of recurrence is lower than among individuals without an acute precipitant. Recurrence is associated with substantial long-term morbidity and mortality. Future studies should address surveillance and management after newly diagnosed AF in the setting of an acute precipitant.
Collapse
Affiliation(s)
- Elizabeth Y Wang
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine, Columbia University Medical Center, New York, NY (E.Y.W.)
| | - Olivia L Hulme
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
| | - Shaan Khurshid
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Division of Cardiology (S.K., S.A.L.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Lu-Chen Weng
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Allan J Walkey
- Boston University School of Medicine (A.J.W.), Harvard Medical School, MA
| | - Jeffrey M Ashburner
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester (D.D.M.)
| | - Daniel E Singer
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - Steven J Atlas
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - Emelia J Benjamin
- Department of Medicine, Sections of Preventive Medicine and Cardiovascular Medicine (E.J.B.), Harvard Medical School, MA.,Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study (E.J.B.), Boston University School of Public Health, MA.,Department of Epidemiology (E.J.B.), Boston University School of Public Health, MA
| | - Patrick T Ellinor
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Ludovic Trinquart
- Department of Biostatistics (L.T.), Boston University School of Public Health, MA
| | - Steven A Lubitz
- Division of Cardiology (S.K., S.A.L.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| |
Collapse
|
76
|
Kotadia ID, Williams SE, O'Neill M. High-power, Short-duration Radiofrequency Ablation for the Treatment of AF. Arrhythm Electrophysiol Rev 2020; 8:265-272. [PMID: 32685157 PMCID: PMC7358956 DOI: 10.15420/aer.2019.09] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
High-power, short-duration (HPSD) ablation for the treatment of AF is emerging as an alternative to ablation using conventional ablation generator settings characterised by lower power and longer duration. Although the reported potential advantages of HPSD ablation include less tissue oedema and collateral tissue damage, a reduction in procedural time and superior ablation lesion formation, clinical studies of HPSD ablation validating these observations are limited. One of the main challenges for HPSD ablation has been the inability to adequately assess temperature and lesion formation in real time. Novel catheter designs may improve the accuracy of intra-ablation temperature recording and correspondingly may improve the safety profile of HPSD ablation. Clinical studies of HPSD ablation are on-going and interpretation of the data from these and other studies will be required to ascertain the clinical value of HPSD ablation.
Collapse
Affiliation(s)
| | | | - Mark O'Neill
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
77
|
Newman RA, Hameed AB. Matters of the Heart: Cardiovascular Health in Women Throughout Their Lifetimes. Obstet Gynecol Clin North Am 2020; 46:515-525. [PMID: 31378292 DOI: 10.1016/j.ogc.2019.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The authors' goal is to review the current recommendations for optimizing cardiovascular health beginning in adolescent years to adulthood, and to expand on the role that pregnancy complications may have as implications for future cardiovascular health. Attention to cardiac health begins in adolescence; however, most young patients are not screened. Pregnancy, with its increased cardiovascular demands and host of antepartum cardiopulmonary complications, may provide a window into future cardiac health. The distinct shift in cardiac risk that occurs once a woman enters menopause is largely ignored in routine screening guidelines.
Collapse
Affiliation(s)
- Rachel A Newman
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, 333 City Boulevard West, 14th Floor, Suite 1400, Orange, CA 92868, USA
| | - Afshan B Hameed
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of California, Irvine Medical Center, 333 City Boulevard West, 14th Floor, Suite 1400, Orange, CA 92868, USA.
| |
Collapse
|
78
|
Bai B, Li X, Yang C, Chen X, Wang X, Wu Z. Prediction of atrial fibrillation using the recurrence complex network of body surface potential mapping signals. Technol Health Care 2020; 27:287-300. [PMID: 31045547 PMCID: PMC6598016 DOI: 10.3233/thc-199027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE: Atrial fibrillation (AF) is the most common type of persistent arrhythmia. Early diagnosis and intervention of AF is essential to avert the further fatality. The technique of noninvasive electrical mapping, especially the body surface potential mapping (BSPM), has a more practical application in the study of predicting AF, when compared with the invasive electrical mapping methods such as the epicardial mapping and interventional catheter mapping. However, the prediction of AF with noninvasive signals has been inadequately studied. Thus, the aim of this paper was to analyze the properties of atrial dynamic system based on the noninvasive BSPM signals (BSPMs), using the recurrence complex network, and consequently to evaluate its role in predicting the recurrence of AF in clinical aspect. METHOD: Twelve patients with persistent AF were included in this study. Their preoperative and postoperative BSPMs were recorded. Initially, the preoperative BSPMs were transformed into the recurrence complex network to characterize the complexity property of the atria. Subsequently, the parameters of recurrence ratio (REC), determinism (DET), entropy of the diagonal structure distribution (ENTR), and laminarity (LAM) were calculated. Furthermore, the difference in the parameters in the four regions of the body and the difference obtained from the dominant frequency (DF) method were compared. Finally, the results obtained for the atrial dynamic system complexity from a 12-lead electrocardiogram (ECG) from the BSPMs were discussed. RESULTS: Our study revealed that the patients whose REC is greater than an average threshold, and with a lower LAM presented a much higher possibility of AF recurrence, after the AF surgery. CONCLUSIONS: The recurrence complex network is a useful and convenient way to evaluate the nonlinear properties of the BSPMs in patients with AF. It has good immunity to the lead position and has a potential role in the understanding of predicting the recurrence of AF.
Collapse
Affiliation(s)
- Baodan Bai
- School of Medical Instruments, Shanghai University of Medicine and Health Sciences, Shanghai 200433, China.,Engineering Research Center of Universities of Shanghai for Wearable Medical Technology and Instrument, Shanghai 200433, China
| | - Xiaoou Li
- School of Medical Instruments, Shanghai University of Medicine and Health Sciences, Shanghai 200433, China.,Engineering Research Center of Universities of Shanghai for Wearable Medical Technology and Instrument, Shanghai 200433, China
| | - Cuiwei Yang
- Department of Electronic Engineering, Fudan University, Shanghai 200433, China
| | - Xinrong Chen
- Digital Medical Research Center of School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.,Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai 200032, China.,Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich 52425, Germany
| | - Xuan Wang
- School of Medical Instruments, Shanghai University of Medicine and Health Sciences, Shanghai 200433, China.,Engineering Research Center of Universities of Shanghai for Wearable Medical Technology and Instrument, Shanghai 200433, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| |
Collapse
|
79
|
|
80
|
Zhou D, Chen Y, Wu J, Shen J, Shang Y, Zheng L, Xie X. Association between chymase gene polymorphisms and atrial fibrillation in Chinese Han population. BMC Cardiovasc Disord 2019; 19:321. [PMID: 31888494 PMCID: PMC6936049 DOI: 10.1186/s12872-019-01300-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/05/2019] [Indexed: 12/18/2022] Open
Abstract
Background Chymase is the major angiotensin II (Ang II)-forming enzyme in cardiovascular tissue, with an important role in atrial remodeling. This study aimed to examine the association between chymase 1 gene (CMA1) polymorphisms and atrial fibrillation (AF) in a Chinese Han population. Methods This case-control study enrolled 126 patients with lone AF and 120 age- and sex-matched healthy controls, all from a Chinese Han population. Five CMA1 polymorphisms were genotyped. Results The CMA1 polymorphism rs1800875 (G-1903A) was associated with AF. The frequency of the GG genotype was significantly higher in AF patients compared with controls (p = 0.009). Haplotype analysis further demonstrated an increased risk of AF associated with the rs1800875-G haplotype (Hap8 TGTTG, odds ratio (OR) = 1.668, 95% CI 1.132–2.458, p = 0.009), and a decreased risk for the rs1800875-A haplotype (Hap5 TATTG, OR = 0.178, 95% CI 0.042–0.749, p = 0.008). Conclusions CMA1 polymorphisms may be associated with AF, and the rs1800875 GG genotype might be a susceptibility factor for AF in the Chinese Han population.
Collapse
Affiliation(s)
- Dongchen Zhou
- Department of Cardiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuewei Chen
- Department of Cardiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiaxin Wu
- Department of Cardiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiabo Shen
- Department of Cardiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yushan Shang
- Department of Cardiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liangrong Zheng
- Department of Cardiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xudong Xie
- Department of Cardiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| |
Collapse
|
81
|
Sejr MH, May O, Damgaard D, Bruun NH, Nielsen JC. Burden of Premature Atrial Complexes and Risk of Recurrent Stroke and Death in Patients with Mild to Moderate Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 29:104490. [PMID: 31839547 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Premature atrial complexes (PACs) meet increased attention as a potential intermediary between sinus rhythm and atrial fibrillation (AF). Patients with even high numbers of PACs do not fulfill current guidelines for oral anticoagulation treatment though an associated stroke risk is suspected. OBJECTIVE We aimed to determine whether a high number of PACs or runs of AF less than 30 seconds in 2-day continuous electrocardiogram (ECG) recording was associated with risk of recurrent ischemic stroke/transient ischemic attack (TIA) or death in a large cohort of patients with acute ischemic stroke or TIA and no prior AF. METHODS We performed 48 hours continuous ECG recording within 1 week after ischemic stroke/TIA. PACs were reported as mean number of PACs per hour. Patients were followed in Danish Stroke Registry, Danish Civil Registration System, and Danish National Patient Registry. Cox Regression analysis was used to calculate hazard ratios. RESULTS We included 1507 patients with TIA (40%) or ischemic stroke (60%), of which 98.7% had mild to moderate strokes. Mean age was 72.9 (7.8) years, 43.4% were females. Follow-up was 2.3 (1.3) years. Hazard ratio for recurrent stroke/TIA or death did not differ between quartiles of PAC burden, nor did any of the 2 components of this composite endpoint. Nonsustained AF less than 30 seconds was not associated with higher risk of recurrent stroke/TIA or death. CONCLUSIONS In a large cohort of patients with recent ischemic stroke or TIA, burden of PACs or nonsustained AF less than 30 seconds were not associated to higher risk of recurrent stroke/TIA or death.
Collapse
Affiliation(s)
- Michala Herskind Sejr
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| | - Ole May
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Henrik Bruun
- Department of Public Health, Biostatistical Advisory Service (BIAS), Aarhus University, Aarhus, Denmark
| | | |
Collapse
|
82
|
Cordes F, Ellermann C, Ehrchen J, Ullerich H, Eckardt L. Diagnosis and management of cold urticaria in cryoablation of atrial fibrillation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-5. [PMID: 31912003 PMCID: PMC6939821 DOI: 10.1093/ehjcr/ytz221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/20/2019] [Accepted: 11/19/2019] [Indexed: 11/13/2022]
Abstract
Background Cold-induced urticaria is triggered by exposure to local or environmental cold and manifests as localized or systemic pruritic papules, sometimes accompanied by angio-oedema and anaphylaxis representing a life-threatening condition. Therapy options of atrial fibrillation (AF) include catheter ablation with different energy sources, of which cryoenergy may be superior to other energy sources regarding safety and efficacy. Case summary We report the case of a 60-year-old man suffering from symptomatic paroxysmal AF. The patient had a history of cold-induced urticaria without occurrence of systemic reactions to date. After successful pulmonary vein isolation (PVI) using cryoenergy, post-interventional oesophagogastroduodenoscopy and endosonography revealed newly occurred oedema in the middle oesophagus with inclusion of all oesophageal wall layers. Due to missing peri-atrial lesions, activation of cold urticaria during cryoablation rather than procedure-associated alterations was diagnosed. The patient reported no systemic or gastrointestinal symptoms after PVI. Discussion We could demonstrate that cold urticaria can manifest as oesophageal angio-oedema in AF patients undergoing cryoablation. Therefore, these patients should be carefully considered for an alternative energy source for PVI or premedication with antihistamines when using cryoenergy.
Collapse
Affiliation(s)
- Friederike Cordes
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
| | - Jan Ehrchen
- Department of Dermatology, University Hospital Münster, Von-Esmarch-Strasse 58, D-48149 Münster, Germany
| | - Hansjoerg Ullerich
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
| |
Collapse
|
83
|
Goldenthal IL, Sciacca RR, Riga T, Bakken S, Baumeister M, Biviano AB, Dizon JM, Wang D, Wang KC, Whang W, Hickey KT, Garan H. Recurrent atrial fibrillation/flutter detection after ablation or cardioversion using the AliveCor KardiaMobile device: iHEART results. J Cardiovasc Electrophysiol 2019; 30:2220-2228. [PMID: 31507001 PMCID: PMC6819233 DOI: 10.1111/jce.14160] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/15/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study evaluated the impact of daily ECG (electrocardiogram) self-recordings on time to documented recurrent atrial fibrillation (AF) or atrial flutter (AFL) and time to treatment of recurrent arrhythmia in patients undergoing catheter radiofrequency ablation (RFA) or direct current cardioversion (DCCV) for AF/AFL. BACKGROUND AF recurrence rates after RFA and DCCV are 20% to 45% and 60% to 80%, respectively. Randomized trials comparing mobile ECG devices to standard of care have not been performed in an AF/AFL population after treatment. METHODS Of 262 patients consented, 238 were randomized to either standard of care (123) or to receive the iHEART intervention (115). Patients in the intervention group were provided with and trained to use an AliveCor KardiaMobile ECG monitor, and were instructed to take and transmit daily ECG recordings. Data were collected from transmitted ECG recordings and patients' electronic health records. RESULTS In a multivariate Cox model, the likelihood of recurrence detection was greater in the intervention group (hazard ratio = 1.56, 95% confidence interval [CI]: 1.06-2.30, P = .024). Hazard ratios did not differ significantly for RFA and DCCV procedures. Recurrence during the first month after ablation strongly predicted later recurrence (hazard ratio = 4.53, 95% CI: 2.05-10.00, P = .0006). Time from detection to treatment was shorter for the control group (hazard ratio = 0.33, 95% CI: 0.57-2.92, P < .0001). CONCLUSIONS The use of mobile ECG self-recording devices allows for earlier detection of AF/AFL recurrence and may empower patients to engage in shared health decision-making.
Collapse
Affiliation(s)
- Isaac L. Goldenthal
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | | | - Teresa Riga
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | | | - Maurita Baumeister
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | - Angelo B. Biviano
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | - Jose M. Dizon
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| | - Daniel Wang
- Department of Medicine ‐ CardiologyWhite Plains HospitalNew YorkNew York
| | - Ketty C Wang
- Columbia University School of NursingNew YorkNew York
| | - William Whang
- Department of Medicine ‐ CardiologyIcahn School of MedicineNew YorkNew York
| | | | - Hasan Garan
- Department of Medicine ‐ CardiologyColumbia University Irving Medical CenterNew YorkNew York
| |
Collapse
|
84
|
Yamagami F, Tajiri K, Yumino D, Ieda M. Uremic Toxins and Atrial Fibrillation: Mechanisms and Therapeutic Implications. Toxins (Basel) 2019; 11:E597. [PMID: 31614923 PMCID: PMC6832954 DOI: 10.3390/toxins11100597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation (AF) is the most prevalent arrhythmia in the general population. There is a close association between chronic kidney disease (CKD) and AF. In recent years, attention has been focused on the relationship between AF and uremic toxins, including indoxyl sulfate (IS). Several animal studies have shown that IS promotes the development and progression of AF. IS has been shown to cause fibrosis and inflammation in the myocardium and exacerbate AF by causing oxidative stress and reducing antioxidative defense. Administration of AST-120, an absorbent of uremic toxins, decreases uremic toxin-induced AF in rodents. We have recently reported that patients with a higher serum IS level exhibit a higher rate of AF recurrence after catheter ablation, with serum IS being a significant predictor of AF recurrence. In this review, we discuss the possible mechanisms behind the AF-promoting effects of uremic toxins and summarize the reported clinical studies of uremic toxin-induced AF.
Collapse
Affiliation(s)
- Fumi Yamagami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
- YUMINO Heart Clinic, Toshima-ku, Tokyo 171-0033, Japan.
| | - Kazuko Tajiri
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
| | - Dai Yumino
- YUMINO Heart Clinic, Toshima-ku, Tokyo 171-0033, Japan.
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
| |
Collapse
|
85
|
|
86
|
Ptaszek LM, Baugh CW, Lubitz SA, Ruskin JN, Ha G, Forsch M, DeOliveira SA, Baig S, Heist EK, Wasfy JH, Brown DF, Biddinger PD, Raja AS, Scirica B, White BA, Mansour M. Impact of a Multidisciplinary Treatment Pathway for Atrial Fibrillation in the Emergency Department on Hospital Admissions and Length of Stay: Results of a Multi-Center Study. J Am Heart Assoc 2019; 8:e012656. [PMID: 31510841 PMCID: PMC6818017 DOI: 10.1161/jaha.119.012656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Variability in the management of atrial fibrillation (AF) in the emergency department (ED) leads to avoidable hospital admissions and prolonged length of stay (LOS). In a retrospective single‐center study, a multidisciplinary AF treatment pathway was associated with a reduced hospital admission rate and reduced LOS. To assess the applicability of the AF pathway across institutions, we conducted a 2‐center study. Methods and Results We performed a prospective, 2‐stage study at 2 tertiary care hospitals. During the first stage, AF patients in the ED received routine care. During the second stage, AF patients received care according to the AF pathway. The primary study outcome was hospital admission rate. Secondary outcomes included ED LOS and inpatient LOS. We enrolled 104 consecutive patients in each stage. Patients treated using the AF pathway were admitted to the hospital less frequently than patients who received routine care (15% versus 55%; P<0.001). For admitted patients, average hospital LOS was shorter in the AF pathway cohort than in the routine care cohort (64 versus 105 hours, respectively; P=0.01). There was no significant difference in the average ED LOS between AF pathway and routine care cohorts (14 versus 12 hours, respectively; P=0.32). Conclusions In this prospective 2‐stage, 2‐center study, utilization of a multidisciplinary AF treatment pathway resulted in a 3.7‐fold reduction in admission rate and a 1.6‐fold reduction in average hospital LOS for admitted patients. Utilization of the AF pathway was not associated with a significant change in ED LOS.
Collapse
Affiliation(s)
- Leon M Ptaszek
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | | | - Steven A Lubitz
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Grace Ha
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Margaux Forsch
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | | | - Samia Baig
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - E Kevin Heist
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Jason H Wasfy
- Cardiology Division Massachusetts General Hospital Boston MA
| | - David F Brown
- Department of Emergency Medicine Massachusetts General Hospital Boston MA
| | - Paul D Biddinger
- Department of Emergency Medicine Massachusetts General Hospital Boston MA
| | - Ali S Raja
- Department of Emergency Medicine Massachusetts General Hospital Boston MA
| | - Benjamin Scirica
- Heart and Vascular Center Brigham and Women's Hospital Boston MA
| | - Benjamin A White
- Department of Emergency Medicine Massachusetts General Hospital Boston MA
| | - Moussa Mansour
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| |
Collapse
|
87
|
Enginoev S, Koz'min D, Magomedov G, Makeev S, Chernov I, Ilov N, Tarasov D, Zhigalov K, Weymann A. Ligation of Left Atrial Appendage during Off-Pump Coronary Surgery. Thorac Cardiovasc Surg 2019; 68:695-699. [PMID: 31505691 DOI: 10.1055/s-0039-1695758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The main purpose of this article is to evaluate an impact of epicardial ligation of the left atrial appendage (LAA) in patients with atrial fibrillation (AF) undergoing off-pump coronary artery bypass grafting (OPCAB) on the development of ischemic stroke and mortality. METHODS From 2009 to 2013, a total of 125 patients (86.4% men, mean age 64 ± 7 years, 95% confidence interval: 61-65 years) received a combined OPCAB and LAA ligation because of coronary artery disease and AF. All the subjects were divided into two groups: group 1 (n = 57)-LAA ligation during OPCAB, group 2 (n = 68) without LAA ligation during OPCAB. Primary endpoints were postoperative incidence of ischemic stroke and mortality. RESULTS No difference in the number of ischemic stroke (0 vs. 5.9%) and death (0 vs. 4.4%) in both groups during the hospital period (p > 0.05). Median overall follow-up was 41 (22-61) months: without difference for groups (p > 0.05). During follow-up, there was a difference in the number of ischemic stroke (0 vs. 17.6%, p < 0.001), while there was no difference in mortality in two study groups (5.3 vs. 16.2%, p > 0.05). CONCLUSION Epicardial ligation of LAA during OPCAB in patients with AF may reduce the risk of ischemic stroke in long-term follow-up and does not affect the mortality.
Collapse
Affiliation(s)
- Soslan Enginoev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia.,Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia
| | - Dmitry Koz'min
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Gasan Magomedov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Sergey Makeev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Igor Chernov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Nikolay Ilov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia.,Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia
| | - Dmiry Tarasov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia.,Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia
| | - Konstantin Zhigalov
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| |
Collapse
|
88
|
Comparative transcriptome analysis to elucidate the therapeutic mechanism of colchicine against atrial fibrillation. Biomed Pharmacother 2019; 119:109422. [PMID: 31514070 DOI: 10.1016/j.biopha.2019.109422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/17/2019] [Accepted: 08/30/2019] [Indexed: 02/05/2023] Open
Abstract
In recent years, colchicine has been used to reduce the risk of cardiovascular events; in particular, it has been effectively used for the treatment of atrial fibrillation (AF). We first discovered that colchicine can treat AF in a rat model and that it can reverse the effects of atrial fibrosis. To illustrate the potential therapeutic mechanism of colchicine against AF, we performed comparative transcriptome analyses; our aim was to elucidate the therapeutic effects of colchicine so as to improve treatment and prognoses of AF. Genomics and bioinformatics analyses revealed that the IL-17 signaling pathway, and renin secretion pathway are involved in the mechanism of action of colchicine. Furthermore, there was a significant correlation between overlapping genes in the two groups of differentially expressed genes. The genes encoding Akap4, Pcdha9, Gp2, Cd177, Krt15, Aqp3, Chia, and Bpifb1 were pivotal and possible action sites for the therapeutic mechanisms of colchicine. We conclude that AF involves a multifactorial pathological process. The mechanisms underlying the action of colchicine in the treatment of AF warrant further studies.
Collapse
|
89
|
Moreno-Ruiz LA, Madrid-Miller A, Martínez-Flores JE, González-Hermosillo JA, Arenas-Fonseca J, Zamorano-Velázquez N, Mendoza-Pérez B. Left atrial longitudinal strain by speckle tracking as independent predictor of recurrence after electrical cardioversion in persistent and long standing persistent non-valvular atrial fibrillation. Int J Cardiovasc Imaging 2019; 35:1587-1596. [PMID: 30993507 PMCID: PMC6700045 DOI: 10.1007/s10554-019-01597-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/03/2019] [Indexed: 11/01/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in humans. After successful cardioversion, there is a recurrence of 60% due to atrial remodeling, and it has been shown that the global peak atrial longitudinal strain (GPALS) is decreased in these subjects. The aim of this study was to evaluate the predictive value of GPALS for AF recurrence. A prospective cohort of patients with persistent (PnVAF) and long standing persistent non-valvular AF (LSPnVAF) which underwent electrical cardioversion was evaluated with standard echocardiographic variables and GPALS quantification. The primary endpoint was AF recurrence at 6 months. We included PnVAF (n = 50, aged 68.4 ± 10.2 years, female 46%, lasted AF 6 months) and LSPnVAF (n = 81, aged 66.5 ± 13.1 years, female 36%, lasted AF 18 months). At 6 months there were a 68% of recurrence of AF in PnVAF and 53% in LSPnVAF group. GPALS was lower in recurrence 7.8 ± 2.0% versus 21.2 ± 8.9% (p < 0.001) for PnVAF and 7.3 ± 2.7% versus 20.7 ± 7.6% (p < 0.001) in LSPnVAF. GPALS ≤ 10.75% discriminates recurrence at 6 months with a sensitivity of 85%, specificity 99%, PPV 85%, NPV 90%, LR + 8.5 and LR- 0.17. The independent predictors of recurrence in PnVAF were GPALS ≤ 10.75% HR 8.89 [(2.2-35.7), p < 0.01] meanwhile in LSPnVAF were age HR 1.039 [(1.007-1.071), p = 0.01], and GPALS ≤ 10.75% HR 28.1 [(7.2-109.1), p < 0.001]. In subjects with PnVAF and LSPnVAF with successful electrical cardioversion, GPALS ≤ 10.75% predicts arrhythmia recurrence at 6-month follow-up.
Collapse
Affiliation(s)
- Luis Antonio Moreno-Ruiz
- Division of Cardiology, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico.
| | - Alejandra Madrid-Miller
- Direction of Education and Research, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Jerónimo Enrique Martínez-Flores
- Department of Electrophysiology, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Jesús Antonio González-Hermosillo
- Medical Subadrees of Innovation and Development Project, Instituto Nacional de Cardiología "Ignacio Chávez", 1 Juan Badiano, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Jorge Arenas-Fonseca
- Department of Echocardiography, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Noé Zamorano-Velázquez
- Department of Echocardiography, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Beatriz Mendoza-Pérez
- Division of Cardiology, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| |
Collapse
|
90
|
Scheuermeyer FX, Andolfatto G, Christenson J, Villa‐Roel C, Rowe B. A Multicenter Randomized Trial to Evaluate a Chemical-first or Electrical-first Cardioversion Strategy for Patients With Uncomplicated Acute Atrial Fibrillation. Acad Emerg Med 2019; 26:969-981. [PMID: 31423687 DOI: 10.1111/acem.13669] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 10/05/2018] [Accepted: 10/23/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emergency department (ED) patients with uncomplicated atrial fibrillation (AF) of less than 48 hours may be safely managed with rhythm control. Although both chemical-first and electrical-first strategies have been advocated, there are no comparative effectiveness data to guide clinicians. METHODS At six urban Canadian centers, ED patients ages 18 to 75 with uncomplicated symptomatic AF of less than 48 hours and CHADS2 score of 0 or 1 were randomized using concealed allocation in a 1:1 ratio to one of the following strategies: 1) chemical cardioversion with procainamide infusion, followed by electrical countershock if unsuccessful; or 2) electrical cardioversion, followed by procainamide infusion if unsuccessful. The primary outcome was the proportion of patients discharged within 4 hours of arrival. Secondary outcomes included ED length-of-stay (LOS); prespecified ED-based adverse events; and 30-day ED revisits, hospitalizations, strokes, deaths, and quality of life (QoL). RESULTS Eighty-four patients were analyzed: 41 in the chemical-first group and 43 in the electrical-first group. Groups were balanced in terms of age, sex, vital signs, and CHADS2 scores. All patients were discharged home, with 83 (99%) in sinus rhythm. In the chemical-first group, 13 of 41 patients (32%) were discharged within 4 hours compared to 29 of 43 patients (67%) in the electrical-first group (p = 0.001). In the chemical-first group, the median ED LOS was 5.1 hours (interquartile range [IQR] = 3.5 to 5.9 hours) compared to 3.5 hours (IQR = 2.4 to 4.6 hours) in the electrical-first group, for a median difference of 1.2 hours (95% confidence interval = 0.4 to 2.0 hours, p < 0.001). No patients experienced stroke or death. All other outcomes, including adverse events, ED revisits, and QoL, were similar. CONCLUSION In uncomplicated ED AF patients managed with rhythm control, chemical-first and electrical-first strategies both appear to be successful and well tolerated; however, an electrical-first strategy results in a significantly shorter ED LOS.
Collapse
Affiliation(s)
- Frank X. Scheuermeyer
- Department of Emergency Medicine St Paul's Hospital and the University of British Columbia Vancouver BC
- Department of Emergency Medicine South Health Campus and the University of Calgary Calgary AB
| | - Gary Andolfatto
- Department of Emergency Medicine Lions Gate Hospital the University of British Columbia Vancouver BC
| | - Jim Christenson
- Department of Emergency Medicine St Paul's Hospital and the University of British Columbia Vancouver BC
| | - Cristina Villa‐Roel
- Department of Emergency Medicine University of Alberta Hospital and the University of Alberta Edmonton AB Canada
| | - Brian Rowe
- Department of Emergency Medicine University of Alberta Hospital and the University of Alberta Edmonton AB Canada
| |
Collapse
|
91
|
Hickey KT, Wan E, Garan H, Biviano AB, Morrow JP, Sciacca RR, Reading M, Koleck TA, Caceres B, Zhang Y, Goldenthal I, Riga TC, Masterson Creber R. A Nurse-led Approach to Improving Cardiac Lifestyle Modification in an Atrial Fibrillation Population. J Innov Card Rhythm Manag 2019; 10:3826-3835. [PMID: 32494426 PMCID: PMC7252822 DOI: 10.19102/icrm.2019.100902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/01/2018] [Indexed: 02/01/2023] Open
Abstract
Atrial fibrillation (AF) is a major public health problem and the most common cardiac arrhythmia encountered in clinical practice at this time. AF is associated with numerous symptoms such as palpitations, shortness of breath, and fatigue, which can significantly reduce health-related quality of life and result in serious adverse cardiac outcomes. In light of this, the aim of the present pilot study was to test the feasibility of implementing a mobile health (mHealth) lifestyle intervention titled "Atrial Fibrillation and Cardiac Health: Targeting Improving Outcomes via a Nurse-Led Intervention (ACTION)," with the goal of improving cardiac health measures, AF symptom recognition, and self-management. As part of this study, participants self-identified cardiac health goals at enrollment. The nurse used web-based resources from the American Heart Association (Dallas, TX, USA), which included the Life's Simple 7® My Life Check® assessment, to quantify current lifestyle behavior change needs. Furthermore, on the My AFib Experience™ website (American Heart Association, Dallas, TX, USA), the patient used a symptom tracker tool to capture the date, time, frequency, and type of AF symptoms, and these data were subsequently reviewed by the cardiac nurse. Throughout the six-month intervention period, the cardiac nurse used a motivational interviewing approach to support participants' cardiac health goals. Ultimately, the ACTION intervention was tested in 53 individuals with AF (mean age: 59 ± 11 years; 76% male). Participants were predominantly overweight/obese (79%), had a history of hypertension (62%) or hyperlipidemia (61%), and reported being physically inactive/not preforming any type of regular exercise (52%). The majority (88%) of the participants had one or more Life's Simple 7® measures that could be improved. Most of the participants (98%) liked having a dedicated nurse to work with them on a biweekly basis via the mHealth portal. The most commonly self-reported symptoms were palpitations, fatigue/exercise intolerance, and dyspnea. Seventy percent of the participants had an improvement in their weight and blood pressure as documented within the electronic health record as well as a corresponding improvement in their Life's Simple 7® score at six months. On average, there was a three-pound (1.36-kg) decrease in weight and a 5-mmHg decrease in systolic blood pressure between baseline and at six months. In conclusion, this pilot work provides initial evidence regarding the feasibility of implementing the ACTION intervention and supports testing the ACTION intervention in a larger cohort of AF patients to inform existing AF guidelines and build an evidence base for reducing AF burden through lifestyle modification.
Collapse
Affiliation(s)
- Kathleen T. Hickey
- Department of Medicine, Columbia University, New York, NY, USA
- Department of Nursing, Columbia University, New York, NY, USA
| | - Elaine Wan
- Department of Medicine, Columbia University, New York, NY, USA
| | - Hasan Garan
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - John P. Morrow
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - Meghan Reading
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | | | - Billy Caceres
- Department of Nursing, Columbia University, New York, NY, USA
| | - Yiyi Zhang
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - Teresa C. Riga
- Department of Medicine, Columbia University, New York, NY, USA
| | - Ruth Masterson Creber
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
92
|
Peng H, Sun Z, Chen H, Zhang Y, Ding X, Zhao XQ, Li H. Usefulness of the CHA 2DS 2-VASc Score to Predict Adverse Outcomes in Acute Coronary Syndrome Patients Without Atrial Fibrillation Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2019; 124:476-484. [PMID: 31235063 DOI: 10.1016/j.amjcard.2019.05.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022]
Abstract
The prognostic value of the CHA2DS2-VASc score in acute coronary syndrome (ACS) patients without atrial fibrillation (AF) who underwent percutaneous coronary intervention remains uncertain. We examine the association of the CHA2DS2-VASc score and major adverse cardiovascular events (MACE) in this population and compared its risk prediction with 2 other commonly used risk scores (Global Registry of Acute Coronary Events [GRACE] and thrombolysis in myocardial infarction [TIMI]). A total of 3,745 consecutive ACS patients without AF who underwent percutaneous coronary intervention during 2013 to 2017 were classified into 4 groups according to the CHA2DS2-VASc score: low (0 to 1), moderate (2 to 3), high (4 to 5), and very high (>5). Incidences of MACE including cardiovascular death, nonfatal myocardial infarction, or stroke in-hospital and during a median follow-up of 33 months were compared among the 4 groups. Receiver-operating characteristic curves were generated to compare CHA2DS2-VASc with GRACE and TIMI for risk prediction. The incidences of in-hospital MACE (3.5%, 6.6%, 7.6%, and 9.1%, p <0.001) and mid-term follow-up MACE (4.5%, 7.1%, 13.1%, and 16.1%, p <0.001) were significantly higher as the CHA2DS2-VASc score increased. The CHA2DS2-VASc score was an independent predictor of subsequent MACE (hazard ratio = 1.31, 95% CI 1.24 to 1.39, p <0.001), and the very high-risk score group showed 3.8-fold increased risk of MACE than the low-risk score group. Receiver-operating characteristic curves showed that the CHA2DS2-VASc score was comparable to the GRACE score and to TIMI-STEMI, but, better than the TIMI-NSTEMI/unstable angina pectoris score in terms of predicting MACE. In conclusion, higher CHA2DS2-VASc score was independently associated with increased risk of MACE in the ACS patients without AF who underwent PCI.
Collapse
|
93
|
Abstract
With the growing obesity epidemic, the global burden of AF and obstructive sleep apnoea (OSA) is increasing at an alarming rate. Obesity, age, male gender, alcohol consumption, smoking and heart failure are common risk factors for both AF and OSA and they are independently associated with adverse cardiovascular outcomes. Weak evidence from observational studies link OSA to the development of AF. Hypoxia/hypercapnia, systemic inflammation and autonomic nervous system modulation are biological mechanisms that link OSA to AF. Patients with OSA have a poor response to catheter ablation of AF and often suffer recurrences. Observational data shows that continuous positive airway pressure is associated with a reduction in AF burden and a better response to catheter ablation of AF. However, prospective randomised studies are needed to confirm the usefulness of continuous positive airway pressure in the treatment of AF in patients with OSA.
Collapse
Affiliation(s)
- Ghanshyam Shantha
- Clinical Cardiac Electrophysiology, University of Michigan Ann Arbor, MI, US
| | - Frank Pelosi
- Clinical Cardiac Electrophysiology, University of Michigan Ann Arbor, MI, US
| | - Fred Morady
- Clinical Cardiac Electrophysiology, University of Michigan Ann Arbor, MI, US
| |
Collapse
|
94
|
Li XH, Hu YM, Yin GL, Wu P. Correlation between HCN4 gene polymorphisms and lone atrial fibrillation risk. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:2989-2993. [PMID: 31315459 DOI: 10.1080/21691401.2019.1637885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background and objective: Atrial electrical remodelling (AER) was significantly associated with atrial fibrillation (AF) development. Polymorphisms in hyperpolarization activated cyclic nucleotide gated potassium channel 4 (HCN4) gene might be correlated with AER. In the present study, we explored the association of HCN4 polymorphisms (rs498005 and rs7164883) with lone AF risk in a Chinese Han population. Methods: In this case-control study, the Sanger sequencing method was utilized to genotype the HCN4 polymorphisms. Relative risk of AF was assessed by the χ2 test, and presented by odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Logistic regression analysis was performed for multivariate analysis. The effects of HCN4 polymorphisms on AF clinical features were analyzed by the Mann-Whitney U test and adjusted by the Bonferroni method. Results: C allele of rs498005 was significantly correlated with increased risk of AF (OR = 1.412, 95%CI = 1.012-1.970), and the association still exited after adjustment by age, gender, the status of smoking and drinking, histories of diabetes, hyperlipidaemia and myocardial infarction (adjusted OR = 1.473, 95%CI = 1.043-2.081). G allele of rs7164883 SNP was marginally associated with enhanced AF risk after adjustment by the above clinical parameters (adjusted OR = 1.742, 95%CI = 1.019-2.980). Atrial late potential (ALP), including TP (P wave duration after filtering) and LP20 (the amplitude of superimposed potential in the final 20 ms of P wave) were significantly associated with rs498005 genotype (p < .001). Conclusion: HCN4 rs498005 and rs7164883 polymorphisms are significantly associated with AF risk.
Collapse
Affiliation(s)
- Xiao-Hong Li
- a Department of Cardiology, Cangzhou City Central Hospital , Cangzhou , China
| | - Ya-Min Hu
- a Department of Cardiology, Cangzhou City Central Hospital , Cangzhou , China
| | - Guang-Li Yin
- b Department of Cardiology, Hebei Provincial Hospital of Integrative Chinese and Western Medicine , Cangzhou , China
| | - Ping Wu
- a Department of Cardiology, Cangzhou City Central Hospital , Cangzhou , China
| |
Collapse
|
95
|
Toale C, Fitzmaurice GJ, Eaton D, Lyne J, Redmond KC. Outcomes of left atrial appendage occlusion using the AtriClip device: a systematic review. Interact Cardiovasc Thorac Surg 2019; 29:655-662. [DOI: 10.1093/icvts/ivz156] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/07/2019] [Accepted: 05/19/2019] [Indexed: 12/16/2022] Open
Abstract
AbstractAtrial fibrillation increases lifetime stroke risk. The left atrial appendage (LAA) is thought to be the source of embolic strokes in up to 90% of cases, and occlusion of the LAA may be safer than the alternative of oral anticoagulation. Occlusion devices, such as the AtriClipTM (AtriCure, Mason, OH, USA) enable safe and reproducible epicardial clipping of the LAA. A systematic review was performed in May 2018, based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, using the keyword ‘AtriClip’. A total of 68 papers were identified and reviewed; 11 studies were included. Data including demographics, medical history intervention(s) performed, periprocedural outcomes and follow-up were assessed and analysed. A total of 922 patients were identified. LAA occlusion was achieved in 902 out of 922 patients (97.8%). No device-related adverse events were reported across the studies. The reported incidence of stroke or transient ischaemic attack post-clip placement ranged from 0.2 to 1.5/100 patient-years. Four hundred and seventy-seven of 798 patients (59.7%) had ceased anticoagulation on follow-up. The AtriClip device is safe and effective in the management of patients with atrial fibrillation, either as an adjunct in patients undergoing cardiac surgery or as a stand-alone thoracoscopic procedure.
Collapse
Affiliation(s)
- Conor Toale
- Department of Thoracic Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gerard J Fitzmaurice
- Department of Thoracic Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Donna Eaton
- Department of Thoracic Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jonathan Lyne
- Department of Cardiology, Blackrock Clinic, Dublin, Ireland
| | - Karen C Redmond
- Department of Thoracic Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
96
|
Jin MN, Kim TH, Kang KW, Yu HT, Uhm JS, Joung B, Lee MH, Kim E, Pak HN. Atrial Fibrillation Catheter Ablation Improves 1-Year Follow-Up Cognitive Function, Especially in Patients With Impaired Cognitive Function. Circ Arrhythm Electrophysiol 2019; 12:e007197. [PMID: 31442075 DOI: 10.1161/circep.119.007197] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although atrial fibrillation (AF) has a risk of cognitive dysfunction, it is not clear whether AF catheter ablation improves or worsens cognitive function. This prospective case-control study sought to assess the 1-year serial changes in the cognitive function with or without AF catheter ablation. METHODS We evaluated the Montreal Cognitive Assessment score in 308 patients (71.4% male, 60.6±9.1 years of age, 34.1% persistent AF) who underwent AF ablation (ablation group) and 50 AF patients on medical therapy who met the same indication for AF ablation (control group), at baseline and 3 and 12 months after enrollment. Cognitive impairment was defined as a published cutoff score of <23 points. To exclude any learning effects, we used the practice-adjusted reliable change index for assessing the cognitive changes. RESULTS Preablation cognitive impairment was detected in 18.5% (57/308). The Montreal Cognitive Assessment score significantly improved 1 year after radiofrequency catheter ablation in both overall ablation group (24.9±2.9-26.4±2.5; P<0.001) and the propensity-matched ablation group (25.4±2.4-26.5±2.3; P<0.001), but not in the control group (25.4±2.5-24.8±2.5; P=0.012). Preablation cognitive impairment (odds ratio, 13.70; 95% CI, 4.83-38.87; P<0.001) was independently associated with an improvement in the 1-year post-ablation cognitive function. In the reliable change index analyses, 94.7% of propensity-matched ablation group showed an improved/stable cognitive function at the 1-year follow-up. CONCLUSIONS Catheter ablation of AF, at least, does not deteriorate the cognitive function, but rather improves the performance on 1-year follow-up neurocognitive tests, especially in patients with a preablation cognitive impairment.
Collapse
Affiliation(s)
- Moo-Nyun Jin
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon (K.-W.K.)
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Eosu Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.)
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| |
Collapse
|
97
|
Hersi AS, Osenenko KM, Kherraf SA, Aziz AA, Sambrook RJ. Cost-effectiveness of apixaban for stroke prevention in non-valvular atrial fibrillation in Saudi Arabia. Ann Saudi Med 2019; 39:265-278. [PMID: 31381381 PMCID: PMC6838647 DOI: 10.5144/0256-4947.2019.265] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Apixaban, an oral anticoagulant for stroke and systemic embolism prevention in non-valvular atrial fibrillation (NVAF), was superior to warfarin in prevention of stroke and systemic embolism, bleeding outcomes and mortality (ARISTOTLE trial), and substantially reduced stroke risk, with no significant increase in major or intracranial bleeding risk versus aspirin (AVERROES trial). OBJECTIVE Estimate cost-effectiveness of apixaban versus other anticoagulants for NVAF treatment in Saudi Arabia. DESIGN Lifetime Markov model. SETTING A published model was adapted from the United Kingdom (UK) to the Saudi Arabia setting. PATIENTS AND METHODS The model enabled pairwise comparisons of apixaban against other anticoagulants, aspirin, and aspirin+clopidogrel. Apart from warfarin and aspirin, comparisons were indirect. Subpopulations included vitamin K antagonist (VKA) suitable and unsuitable patients. Medication and physician visit costs were from published lists. A cost ratio (0.533), from comparison of UK and Saudi physician visit costs, was applied to UK model inputs to estimate local event costs. Background life expectancy was from Saudi life tables. Model structure, treatment comparators, patient characteristics, event rates, and utilities were unchanged. Costs and health benefits were discounted by 3.5% annually. MAIN OUTCOME MEASURE Incremental cost-effectiveness ratio of cost per quality-adjusted life-year (QALY) gained. SAMPLE SIZE Model cohort of 1000 NVAF patients, for VKA suitable and VKA unsuitable populations. RESULTS Apixaban was dominant versus warfarin (VKA suitable) and rivaroxaban (VKA suitable and unsuitable). Compared against dabigatran (110mg, 150 mg, 110/150mg), the cost/QALY gained for apixaban was $5166, $11 143, $10 849 (VKA suitable) and $5 157, $14 424, $14 134 (VKA unsuitable), respectively. Cost/QALY for apixaban versus aspirin and aspirin+clopidogrel was $14 805 and $5784 (VKA suitable); and $10 564 and $4203 (VKA unsuitable), respectively. Sensitivity analyses demonstrated consistency of findings across varying inputs. CONCLUSIONS Apixaban was found to be cost-effective for stroke prevention among Saudi NVAF patients, when assessed using a US$20 000 willingness-to-pay threshold. LIMITATIONS Lack of robust local clinical, cost and utility data for model inputs. Lack of head-to-head clinical trial data for rivaroxaban, dabigatran, and clopidogrel plus aspirin comparators. CONFLICT OF INTEREST Study was funded by Pfizer Inc. and Bristol Myers-Squibb. KO, RS, SAK and AAA received salaries from their respective employers, but did not receive direct financial compensation for participation in or authorship of this study.
Collapse
Affiliation(s)
- Ahmad S Hersi
- From the Department of Cardiac Science, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | |
Collapse
|
98
|
Prediction of acute coronary syndrome, ischemic stroke, and mortality in patients with heart failure: a comparison of CHA 2DS 2-VASc and AHEAD scores. J Interv Card Electrophysiol 2019; 55:225-231. [PMID: 31201591 DOI: 10.1007/s10840-019-00552-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the predictive capacity of the CHA2DS2-VASc and AHEAD scores in predicting acute coronary syndrome (ACS), ischemic stroke (IS), and mortality in patients with heart failure (HF). METHODS A total of 404,635 patients hospitalized for HF between 2000 and 2011 were recruited from a large national database in Taiwan. The predictive value of both scores was evaluated by analysis of the area under the receiver operating characteristic curve (AUROC), and the difference in their discriminative capacity was assessed using the DeLong test. RESULTS The AUROC for the CHA2DS2-VASc score was significantly higher than that for the AHEAD score in predicting ACS and IS: 0.53 (95% CI = 0.53-0.54) versus 0.51 (95% CI = 0.51-0.52) for ACS, and 0.57 (95% CI = 0.56-0.57) versus 0.52 (95% CI = 0.51-0.52) for IS, respectively (all DeLong tests p < 0.001). By contrast, for mortality risk, the AUROC was significantly lower for the CHA2DS2-VASc score (0.56, 95% CI = 0.55-0.56) than the AHEAD score (0.60, 95% CI = 0.59-0.60; DeLong test p < 0.001). CONCLUSIONS The ability of the CHA2DS2-VASc score to predict macrovascular complications (ACS and IS) in HF patients was higher than that of AHEAD.
Collapse
|
99
|
Seifert MB, Olesen MS, Christophersen IE, Nielsen JB, Carlson J, Holmqvist F, Tveit A, Haunsø S, Svendsen JH, Platonov PG. Genetic variants on chromosomes 7p31 and 12p12 are associated with abnormal atrial electrical activation in patients with early-onset lone atrial fibrillation. Ann Noninvasive Electrocardiol 2019; 24:e12661. [PMID: 31152482 DOI: 10.1111/anec.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/04/2019] [Accepted: 05/05/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Abnormal P-wave morphology (PWM) has been associated with a history of atrial fibrillation (AF) in earlier studies. Although lone AF is believed to have substantial genetic basis, studies on associations between single nucleotide polymorphisms (SNP) linked to lone AF and PWM have not been reported. We aimed to assess whether SNPs previously associated with lone AF (rs2200733, rs13376333, rs3807989, and rs11047543) are also linked to P-wave abnormalities. METHODS Four SNPs were studied in 176 unrelated individuals with early-onset lone AF (age at onset <50 years), median age 38 years (19-63 years), 149 men. Using sinus rhythm ECG, orthogonal PWM was classified as Type 1-positive in leads X and Y and negative in lead Z, Type 2-positive in leads X and Y and biphasic (-/+) in lead Z, Type 3-positive in lead X and biphasic in lead Y (+/-), and the remaining as atypical. RESULTS Two SNPs were found to be significantly associated with altered P-wave morphology distribution: rs3807989 near the gene CAV1/CAV2 and rs11047543 near the gene SOX5. Both SNPs were associated with a higher risk of non-Type 1 P-wave morphology (rs3807989: OR = 4.8, 95% CI = 2.3-10.2, p < 0.001; rs11047543: OR = 4.7, 95% CI = 1.1-20.5, p = 0.04). No association was observed for rs2200733 and rs13376333. CONCLUSION In this study, the two variants rs3807989 and rs11047543, previously associated with PR interval and lone AF, were associated with altered P-wave morphology distribution in patients with early-onset lone AF. These findings suggest that common genetic variants may modify atrial conduction properties.
Collapse
Affiliation(s)
- Mariam B Seifert
- The Center for Integrative Electrocardiology, Arrhythmia Clinic Skåne University Hospital, Lund University (CIEL), Lund, Sweden.,Department of Cardiology, Frederiksberg Hospital, Copenhagen, Denmark
| | - Morten S Olesen
- Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid E Christophersen
- The Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Rud, Norway
| | - Jonas B Nielsen
- Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Carlson
- The Center for Integrative Electrocardiology, Arrhythmia Clinic Skåne University Hospital, Lund University (CIEL), Lund, Sweden
| | - Fredrik Holmqvist
- The Center for Integrative Electrocardiology, Arrhythmia Clinic Skåne University Hospital, Lund University (CIEL), Lund, Sweden
| | - Arnljot Tveit
- Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Rud, Norway
| | - Stig Haunsø
- Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper H Svendsen
- Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pyotr G Platonov
- The Center for Integrative Electrocardiology, Arrhythmia Clinic Skåne University Hospital, Lund University (CIEL), Lund, Sweden
| |
Collapse
|
100
|
Rakhshan M, Najafi H, Valizadeh GA. Lifestyle of Patients with Atrial Fibrillation Following Self-Management Interventions: a Randomized Clinical Trial. J Caring Sci 2019; 8:83-88. [PMID: 31249817 PMCID: PMC6589479 DOI: 10.15171/jcs.2019.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 07/21/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction: Cardiovascular diseases are the most common cause of death in most countries, such as Iran. Cardiac arrhythmias, including Atrial Fibrillation (AF) comprise an important category of these diseases. During recent years, AF has become a serious medical condition. This study aimed to investigate the effect of self-management interventions on the lifestyle of patients with AF. Methods: In this Randomized Clinical Trial study, 88 patients were selected and randomly assigned to intervention and control groups. The intervention group received self-management interventions, including education and telephone follow-ups. The data were collected using a demographic questionnaire and Walker's health-promoting lifestyle profile II, before the intervention and four and twelve weeks after the intervention. The significance level was considered to be 0.05. Results: The results showed a significant increase in the intervention group's lifestyle mean score, four and twelve weeks after the intervention as compared with control group However, this increase was not similar in all the lifestyle dimensions. Conclusion: In conclusion, implementation of self-management interventions could improve the lifestyle of the patients with Atrial Fibrillation. The results can help nurses to conduct self-management interventions into such patients' care plan and prevent many physical, psychological, and social problems that negatively affect patients and their lifestyle.
Collapse
Affiliation(s)
- Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hojatolah Najafi
- Department of Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical sciences, Shiraz, Iran
| | - Gholam Abbas Valizadeh
- Department of Cardiovascular, Faculty of Medicine, Fasa University of Medical sciences, Fasa, Iran
| |
Collapse
|