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Dong Z, Du X, Hou XX, He L, Dong JZ, Ma CS. Effect of electrical cardioversion on 1-year outcomes in patients with early recurrence after catheter ablation for atrial fibrillation. Clin Cardiol 2021; 44:1128-1138. [PMID: 34101841 PMCID: PMC8364725 DOI: 10.1002/clc.23663] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Abstract
Background Atrial fibrillation (AF) recurrence is common in the 3‐month blanking‐period after catheter ablation, during which electrical cardioversion (ECV) is usually performed to restore sinus rhythm. Whether ECV can affect the clinical outcome of post‐ablation AF patients is inconsistent, however. We aimed to explore the 1‐year effect of ECV on AF recurrence and rehospitalization in patients experienced recurrence within 3‐month after AF catheter ablation. Methods Patients who experienced recurrence within 3‐month after AF catheter ablation procedure were enrolled from the China Atrial Fibrillation Registry (China‐AF). A 1:3 Propensity score matching (PSM) method was applying to adjust the confounders between patients who had been treated by ECV or not. Logistic regression models were conducted to evaluate the association of ECV with 1‐year AF recurrence and rehospitalization. Results In this study, 2961 patients experienced AF recurrence within 3‐month after the procedure, and 282 of them underwent successful ECV, 2155 patients did not undergo ECV. One‐year AF recurrence rates were 56.4% in ECV group versus 65.4% in non‐ECV group (p = .003), and were 55.9% versus 65.9%, respectively, after PSM (adjusted odds ratio [OR] 0.66; 95% confidence interval (CI): 0.49–0.88, p = .005). However, the difference of 1‐year rehospitalization rates between two groups were not statistically significant before (ECV group: 23.7% vs. non‐ECV group: 22.3%, p = .595) and after PSM (ECV group: 24.4% vs. non‐ECV group: 21.6%, adjusted OR1.14; 95% CI 0.81–1.62, p = .451). Conclusions Successful ECV was associated with lower rate of one‐year recurrence in patients with early recurrent AF after catheter ablation.
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Affiliation(s)
- Zheng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.,Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiao-Xia Hou
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.,Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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Reinhardt SW, Chouairi F, Miller PE, Clark KAA, Kay B, Fuery M, Guha A, Freeman JV, Ahmad T, Desai NR, Friedman DJ. National Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure. J Am Heart Assoc 2021; 10:e019412. [PMID: 34013736 PMCID: PMC8483517 DOI: 10.1161/jaha.120.019412] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Heart failure (HF) and atrial fibrillation (AF) frequently coexist and may be associated with worse HF outcomes, but there is limited contemporary evidence describing their combined prevalence. We examined current trends in AF among hospitalizations for HF with preserved (HFpEF) ejection fraction or HF with reduced ejection fraction (HFrEF) in the United States, including outcomes and costs. Methods and Results Using the National Inpatient Sample, we identified 10 392 189 hospitalizations for HF between 2008 and 2017, including 4 250 698 with comorbid AF (40.9%). HF hospitalizations with AF involved patients who were older (average age, 76.9 versus 68.8 years) and more likely White individuals (77.8% versus 59.1%; P<0.001 for both). HF with preserved ejection fraction hospitalizations had more comorbid AF than HF with reduced ejection fraction (44.9% versus 40.8%). Over time, the proportion of comorbid AF increased from 35.4% in 2008 to 45.4% in 2017, and patients were younger, more commonly men, and Black or Hispanic individuals. Comorbid hypertension, diabetes mellitus, and vascular disease all increased over time. HF hospitalizations with AF had higher in‐hospital mortality than those without AF (3.6% versus 2.6%); mortality decreased over time for all HF (from 3.6% to 3.4%) but increased for HF with reduced ejection fraction (from 3.0% to 3.7%; P<0.001 for all). Median hospital charges were higher for HF admissions with AF and increased 40% over time (from $22 204 to $31 145; P<0.001). Conclusions AF is increasingly common among hospitalizations for HF and is associated with higher costs and in‐hospital mortality. Over time, patients with HF and AF were younger, less likely to be White individuals, and had more comorbidities; in‐hospital mortality decreased. Future research will need to address unique aspects of changing patient demographics and rising costs.
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Affiliation(s)
| | | | - P Elliott Miller
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | | | - Bradley Kay
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Michael Fuery
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Avirup Guha
- Harrington Heart and Vascular InstituteCase Western Reserve University Cleveland OH
| | - James V Freeman
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Tariq Ahmad
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Nihar R Desai
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation New Haven CT
| | - Daniel J Friedman
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
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Use of Web-Based Patient Portals in Patients With Atrial Fibrillation Is Associated With Higher Readmissions. Ochsner J 2021; 21:25-29. [PMID: 33828423 PMCID: PMC7993436 DOI: 10.31486/toj.19.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The impact of web-based patient portals on patient outcomes-specifically hospital readmissions in patients with atrial fibrillation (AF)-remains understudied. Methods: This single-center retrospective cohort study investigated the use of an online portal system (MyChart) by patients hospitalized from January 1, 2014 to June 30, 2017 for AF. During the study period, 11,334 unique AF admissions were identified; 50.3% were MyChart users and 49.7% were non-MyChart users. Patients who experienced inpatient mortality were excluded. The study groups were analyzed for demographic variables, comorbidities, readmission rates, and the frequency of MyChart use during the 3.5-year time frame. Results: MyChart users were younger (median age, 74 years, interquartile range [IQR] 66-82 vs 77 years, IQR 68-85; P<0.0001) and more likely to be white (91.9% vs 84.6%; P<0.0001), but the sex distribution was similar between groups, with 51.8% males in the MyChart group vs 53.2% in the non-MyChart group. MyChart users had a significantly higher rate of readmission compared to non-MyChart users at 1 year (43.0% vs 32.0%, respectively; P<0.0001). MyChart users who were readmitted had a higher median number of logins to MyChart (121 [IQR 32-270.5]) than MyChart users who were not readmitted (91 [IQR 26-205]; P<0.0001). Multivariable regression analysis demonstrated that MyChart use was associated with readmission (odds ratio 1.57, 95% CI 1.49-1.70; P<0.0001). Conclusion: Among patients with AF, MyChart use was associated with higher readmissions in this single-center cohort. Use and benefit of bespoke portals require further study.
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Mohammed M, Ramirez R, Steinhaus DA, Yousuf OK, Giocondo MJ, Ramza BM, Wimmer AP, Gupta SK. Comparative outcomes of vascular access closure methods following atrial fibrillation/flutter catheter ablation: insights from VAscular Closure for Cardiac Ablation Registry. J Interv Card Electrophysiol 2021; 64:301-310. [PMID: 33796968 DOI: 10.1007/s10840-021-00981-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This registry compared the safety and efficacy of vascular closure device Perclose (PC) with figure-of-eight stitch (Fo8) and manual compression (MC) following catheter ablation of atrial fibrillation/flutter. METHODS VAscular Closure for Cardiac Ablation Registry (VACCAR) is a prospective, observational registry that assessed the time to hemostasis (TTH), time to ambulation (TTA), length of stay (LOS), complications, patient-reported outcomes, and pain medication use. RESULTS A total of 434 patients (mean age 64.0±11.0 years; 38% female; 94.9% white) were enrolled between October 2017 and May 2019: 156 in MC, 203 in Fo8, and 75 in the PC group. Median TTH was significantly reduced in the PC and Fo8 group at 7 and 9 min respectively vs. the MC group at 20 min (p<0.001). Median TTA was significantly reduced in both the PC and Fo8 group at 2.2 h vs. the MC group at 6.5 h (p<0.001 for both). Median LOS for the PC group was significantly reduced at 27.5 h compared to the MC and Fo8 group at 29 h (p<0.01). A higher proportion of same-day discharges were noted in the PC and Fo8 groups at 14 (18.7%) and 25 (12.3%), respectively, compared to 5 (3.2%) in the MC group (p<0.01 for all). There was no significant difference in complications between the three groups. CONCLUSIONS Both PC and Fo8 are safe with improved TTH, TTA, LOS, and a higher number of same-day discharges compared to MC.
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Affiliation(s)
- Moghniuddin Mohammed
- Department of Medicine, Saint Luke's Health System, Kansas City, MO, USA
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City, MO, USA
| | - Rigoberto Ramirez
- Division of Cardiology, The University of Kansas Hospital, Kansas City, KS, USA
| | - Daniel A Steinhaus
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Omair K Yousuf
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Michael J Giocondo
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Brian M Ramza
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Alan P Wimmer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Sanjaya K Gupta
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA.
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Gallagher C, Middeldorp ME, Hendriks JM, Lau DH, Sanders P. Lifestyle as a Risk Factor for Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:263-272. [PMID: 33516405 DOI: 10.1016/j.ccep.2020.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The growing burden of atrial fibrillation health care resource utlization has created an urgent need to develop preventative strategies and opportunities to improve outcomes in the prevalent population. Modifiable risk factors contribute to both disease development and progression. In the prevalent atrial fibrillation population, modifying cardiovascular risk factors has decreased disease burden and progression. However, further research is required to determine the role of comprehensive cardiovascular risk factor modification programs in primary prevention. An understanding of strategies required to facilitate health behavior change is crucial to the effective implementation of cardiovascular risk factor management programs.
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Affiliation(s)
- Celine Gallagher
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia
| | - Melissa E Middeldorp
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia
| | - Jeroen M Hendriks
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia; College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042 Australia
| | - Dennis H Lau
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia.
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3101] [Impact Index Per Article: 1033.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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57
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Khera R, Kondamudi N, Zhong L, Vaduganathan M, Parker J, Das SR, Grodin JL, Halm EA, Berry JD, Pandey A. Temporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016. JAMA Netw Open 2020; 3:e2022190. [PMID: 33095250 PMCID: PMC7584929 DOI: 10.1001/jamanetworkopen.2020.22190] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Heart failure (HF) incidence is declining among Medicare beneficiaries. However, the epidemiological mechanisms underlying this decline are not well understood. OBJECTIVE To evaluate trends in HF incidence across risk factor strata. DESIGN, SETTING, AND PARTICIPANTS Retrospective, national cohort study of 5% of all fee-for-service Medicare beneficiaries with no prior HF followed up from 2011 to 2016. The study examined annual trends in HF incidence among groups with and without primary HF risk factors (hypertension, diabetes, and obesity) and predisposing cardiovascular conditions (acute myocardial infarction [MI] and atrial fibrillation [AF]). EXPOSURES The presence of comorbid HF risk factors including hypertension, diabetes, obesity, acute MI, and AF identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. MAIN OUTCOMES AND MEASURES Incident HF, defined using at least 1 inpatient HF claim or at least 2 outpatient HF claims among those without a previous diagnosis of HF. RESULTS Of 1 799 027 unique Medicare beneficiaries at risk for HF (median age, 73 years [interquartile range, 68-79 years]; 56% female [805 060-796 253 participants during the study period]), 249 832 had a new diagnosis of HF. The prevalence of all 5 risk factors increased over time (0.8% mean increase in hypertension per year, 1.9% increase in diabetes, 2.9% increase in obesity, 0.2% increase in acute MI, and 0.4% increase in AF). Heart failure incidence declined from 35.7 cases per 1000 beneficiaries in 2011 to 26.5 cases per 1000 beneficiaries in 2016, consistent across subgroups based on sex and race/ethnicity. A greater decline in HF incidence was observed among patients with prevalent hypertension (relative excess decline, 12%), diabetes (relative excess decline, 3%), and obesity (relative excess decline, 16%) compared with those without corresponding risk factors. In contrast, there was a relative increase in HF incidence among individuals with acute MI (26% vs no acute MI) and AF (22% vs no AF). CONCLUSIONS AND RELEVANCE Findings of this study suggest that the temporal decline in HF incidence among Medicare beneficiaries reflects a decrease in HF incidence among those with primary HF risk factors. The increase in HF incidence among those with acute MI and those with AF highlights potential targets for future HF prevention strategies.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Lin Zhong
- Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas
| | - Muthiah Vaduganathan
- Brigham and Women’s Hospital Heart and Vascular Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Joshua Parker
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sandeep R. Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Justin L. Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ethan A. Halm
- Division of General Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jarett D. Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Trends in ablation procedures in Greece over the 2008-2018 period: Results from the Hellenic Cardiology Society Ablation Registry. Hellenic J Cardiol 2020; 62:48-54. [PMID: 32956809 DOI: 10.1016/j.hjc.2020.09.005] [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] [Received: 05/31/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In 2008, the radiofrequency ablation (RFA) procedures registry of the Hellenic Society of Cardiology was created. This online database allowed electrophysiologists around the country to input data for all performed ablation procedures. The aim of this study is to provide a thorough report and interpretation of the data submitted to the registry between 2008 and 2018. METHODS In 2008, a total of 27 centers/medical teams in 24 hospitals were licensed to perform RFA in Greece. By 2018, the number had risen to 31. Each center was tasked with inserting their own data into the registry, which included patient demographics (anonymized), type of procedure and technique, complications, and outcomes. RESULTS A total of 18587 procedures in 17900 patients were recorded in the period of 2008-2018. By 2018, slightly more than 70% of procedures were performed in 7 high-volume centers (>100 cases/year). The most common procedure since 2014 was atrial fibrillation ablation, followed by atrioventricular nodal reentry tachycardia ablation. Complication rates were low, and success rates remained high, whereas the 6-month relapse rates declined steadily. CONCLUSION This online RFA registry has proved that ablation procedures in Greece have reached a very high standard, with results and complication rates comparable to European and American standards. Ablation procedures for atrial fibrillation are increasing constantly, with it being the most common intervention over the last 6-year period, although the absolute number of procedures still remains low, compared to other European countries.
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Singh SM, Abdel-Qadir H, Pang A, Fang J, Koh M, Dorian P, Wijeysundera HC, Ko DT. Population Trends in All-Cause Mortality and Cause Specific-Death With Incident Atrial Fibrillation. J Am Heart Assoc 2020; 9:e016810. [PMID: 32924719 PMCID: PMC7792395 DOI: 10.1161/jaha.120.016810] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Limited studies have evaluated population‐level temporal trends in mortality and cause of death in patients with contemporary managed atrial fibrillation. This study reports the temporal trends in 1‐year overall and cause‐specific mortality in patients with incident atrial fibrillation. METHODS AND RESULTS Patients with incident atrial fibrillation presenting to an emergency department or hospitalized in Ontario, Canada, were identified in population‐level linked administrative databases that included data on vital statistics and cause of death. Temporal trends in 1‐year all‐cause and cause‐specific mortality was determined for individuals identified between April 1, 2007 (fiscal year [FY] 2007) and March 31, 2016 (FY 2015). The study cohort consisted of 110 302 individuals, 69±15 years of age with a median congestive heart failure, hypertension, age (≥75 years), diabetes mellitus, stroke (2 points), vascular disease, age (≥65 years), sex category (female) score of 2.8. There was no significant decline in the adjusted 1‐year all‐cause mortality between the first and last years of the study period (adjusted mortality: FY 2007, 8.0%; FY 2015, 7.8%; P for trend=0.68). Noncardiovascular death accounted for 61% of all deaths; the adjusted 1‐year noncardiovascular mortality rate rose from 4.5% in FY 2007 to 5.2% in FY 2015 (P for trend=0.007). In contrast, the 1‐year cardiovascular mortality rate decreased from 3.5% in FY 2007 to 2.6% in FY 2015 (P for trend=0.01). CONCLUSIONS Overall 1‐year all‐cause mortality in individuals with incident atrial fibrillation has not improved despite a significant reduction in the rate of cardiovascular death. These findings highlight the importance of recognizing and managing concomitant noncardiovascular conditions in patients with atrial fibrillation.
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Affiliation(s)
- Sheldon M Singh
- Schulich Heart Center Sunnybrook Health Sciences Center Toronto Canada.,Department of Medicine Faculty of Medicine University of Toronto Canada
| | - Husam Abdel-Qadir
- Department of Medicine Faculty of Medicine University of Toronto Canada.,ICES Toronto Canada.,Institute of Health Policy, Management and Evaluation University of Toronto Canada.,Women's College Hospital Toronto Canada
| | | | | | | | - Paul Dorian
- Department of Medicine Faculty of Medicine University of Toronto Canada.,St. Michael's Hospital University of Toronto Canada
| | - Harindra C Wijeysundera
- Schulich Heart Center Sunnybrook Health Sciences Center Toronto Canada.,Department of Medicine Faculty of Medicine University of Toronto Canada.,ICES Toronto Canada.,Institute of Health Policy, Management and Evaluation University of Toronto Canada
| | - Dennis T Ko
- Schulich Heart Center Sunnybrook Health Sciences Center Toronto Canada.,Department of Medicine Faculty of Medicine University of Toronto Canada.,ICES Toronto Canada.,Institute of Health Policy, Management and Evaluation University of Toronto Canada
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60
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Loring Z, Holmes DN, Matsouaka RA, Curtis AB, Day JD, Desai N, Ellenbogen KA, Feld GK, Fonarow GC, Frankel DS, Hurwitz JL, Knight BP, Joglar JA, Russo AM, Sidhu MS, Turakhia MP, Lewis WR, Piccini JP. Procedural Patterns and Safety of Atrial Fibrillation Ablation: Findings From Get With The Guidelines-Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e007944. [PMID: 32703018 PMCID: PMC7502261 DOI: 10.1161/circep.119.007944] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Catheter ablation is an increasingly used treatment for symptomatic atrial fibrillation (AF). However, there are limited prospective, nationwide data on patient selection and procedural characteristics. This study describes patient characteristics, techniques, treatment patterns, and safety outcomes of patients undergoing AF ablation. METHODS A total of 3139 patients undergoing AF ablation between 2016 and 2018 in the Get With The Guidelines-Atrial Fibrillation registry from 24 US centers were included. Patient demographics, medical history, procedural details, and complications were abstracted. Differences between paroxysmal and patients with persistent AF were compared using Pearson χ2 and Wilcoxon rank-sum tests. RESULTS Patients undergoing AF ablation were predominantly male (63.9%) and White (93.2%) with a median age of 65. Hypertension was the most common comorbidity (67.6%), and patients with persistent AF had more comorbidities than patients with paroxysmal AF. Drug refractory, paroxysmal AF was the most common ablation indication (class I, 53.6%) followed by drug refractory, persistent AF (class I, 41.8%). Radiofrequency ablation with contact force sensing was the most common ablation modality (70.5%); 23.7% of patients underwent cryoballoon ablation. Pulmonary vein isolation was performed in 94.6% of de novo ablations; the most common adjunctive lesions included left atrial roof or posterior/inferior lines, and cavotricuspid isthmus ablation. Complications were uncommon (5.1%) and were life-threatening in 0.7% of cases. CONCLUSIONS More than 98% of AF ablations among participating sites are performed for class I or class IIA indications. Contact force-guided radiofrequency ablation is the dominant technique and pulmonary vein isolation the principal lesion set. In-hospital complications are uncommon and rarely life-threatening.
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Affiliation(s)
- Zak Loring
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | | | - Roland A. Matsouaka
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Anne B. Curtis
- Department of Medicine, University at Buffalo, Buffalo, NY
| | - John D. Day
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Nihar Desai
- Cardiovascular Medicine Section, Yale University, New Haven, CT
| | | | - Gregory K. Feld
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Gregg C. Fonarow
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - David S. Frankel
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Jose A. Joglar
- Department of Cardiology, University of Texas, Southwestern Medical Center, Dallas, TX
| | | | | | - Mintu P. Turakhia
- VA Palo Alto Health Care System, Palo Alto, CA; Center for Digital Health, Stanford University, Stanford, CA
| | - William R. Lewis
- MetroHealth System Campus, Case Western Reserve University, Cleveland, OH
| | - Jonathan P. Piccini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Division of Cardiology, Duke University Medical Center, Durham, NC
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Vinter N, Huang Q, Fenger-Grøn M, Frost L, Benjamin EJ, Trinquart L. Trends in excess mortality associated with atrial fibrillation over 45 years (Framingham Heart Study): community based cohort study. BMJ 2020; 370:m2724. [PMID: 32784208 PMCID: PMC7418071 DOI: 10.1136/bmj.m2724] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess temporal trends in the association between newly diagnosed atrial fibrillation and death. DESIGN Community based cohort study. SETTING Framingham Heart Study cohort, in 1972-85, 1986-2000, and 2001-15 (periods 1-3, respectively), in Framingham, MA, USA. PARTICIPANTS Participants with no atrial fibrillation, aged 45-95 in each time period, and identified with newly diagnosed atrial fibrillation (or atrial flutter) during each time period. MAIN OUTCOME MEASURES The main outcome was all cause mortality. Hazard ratios for the association between time varying atrial fibrillation and all cause mortality were calculated with adjustment for time varying confounding factors. The difference in restricted mean survival times, adjusted for confounders, between participants with atrial fibrillation and matched referents at 10 years after a diagnosis of atrial fibrillation was estimated. Meta-regression was used to test for linear trends in hazard ratios and restricted mean survival times over the different time periods. RESULTS 5671 participants were selected in time period 1, 6177 in period 2, and 6174 in period 3. Adjusted hazard ratios for all cause mortality between participants with and without atrial fibrillation were 1.9 (95% confidence interval 1.7 to 2.2) in time period 1, 1.4 (1.3 to 1.6) in period 2, and 1.7 (1.5 to 2.0) in period 3 (Ptrend=0.70). Ten years after diagnosis of atrial fibrillation, the adjusted difference in restricted mean survival times between participants with atrial fibrillation and matched referents decreased by 31%, from -2.9 years (95% confidence interval -3.2 to -2.5) in period 1, to -2.1 years (-2.4 to -1.8) in period 2, to -2.0 years (-2.3 to -1.7) in period 3 (Ptrend=0.03). CONCLUSIONS No evidence of a temporal trend in hazard ratios for the association between atrial fibrillation and all cause mortality was found. The mean number of life years lost to atrial fibrillation at 10 years had improved significantly, but a two year gap compared with individuals without atrial fibrillation still remained.
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Affiliation(s)
- Nicklas Vinter
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Qiuxi Huang
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | | | - Lars Frost
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Emelia J Benjamin
- Department of Medicine, School of Medicine and Department of Epidemiology School of Public Health, Boston University, Boston, MA, USA
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
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Gore MO, Ayers CR, Khera A, deFilippi CR, Wang TJ, Seliger SL, Nambi V, Selvin E, Berry JD, Hundley WG, Budoff M, Greenland P, Drazner MH, Ballantyne CM, Levine BD, de Lemos JA. Combining Biomarkers and Imaging for Short-Term Assessment of Cardiovascular Disease Risk in Apparently Healthy Adults. J Am Heart Assoc 2020; 9:e015410. [PMID: 32698652 PMCID: PMC7792258 DOI: 10.1161/jaha.119.015410] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022]
Abstract
Background Current strategies for cardiovascular disease (CVD) risk assessment focus on 10-year or longer timeframes. Shorter-term CVD risk is also clinically relevant, particularly for high-risk occupations, but is under-investigated. Methods and Results We pooled data from participants in the ARIC (Atherosclerosis Risk in Communities study), MESA (Multi-Ethnic Study of Atherosclerosis), and DHS (Dallas Heart Study), free from CVD at baseline (N=16 581). Measurements included N-terminal pro-B-type natriuretic peptide (>100 pg/mL prospectively defined as abnormal); high-sensitivity cardiac troponin T (abnormal >5 ng/L); high-sensitivity C-reactive protein (abnormal >3 mg/L); left ventricular hypertrophy by ECG (abnormal if present); carotid intima-media thickness, and plaque (abnormal >75th percentile for age and sex or presence of plaque); and coronary artery calcium (abnormal >10 Agatston U). Each abnormal test result except left ventricular hypertrophy by ECG was independently associated with increased 3-year risk of global CVD (myocardial infarction, stroke, coronary revascularization, incident heart failure, or atrial fibrillation), even after adjustment for traditional CVD risk factors and the other test results. When a simple integer score counting the number of abnormal tests was used, 3-year multivariable-adjusted global CVD risk was increased among participants with integer scores of 1, 2, 3, and 4, by ≈2-, 3-, 4.5- and 8-fold, respectively, when compared with those with a score of 0. Qualitatively similar results were obtained for atherosclerotic CVD (fatal or non-fatal myocardial infarction or stroke). Conclusions A strategy incorporating multiple biomarkers and atherosclerosis imaging improved assessment of 3-year global and atherosclerotic CVD risk compared with a standard approach using traditional risk factors.
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Affiliation(s)
- Maria Odette Gore
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
- Department of MedicineDenver Health and Hospital AuthorityDenverCO
- Community Health DepartmentColorado Prevention CenterAuroraCO
| | - Colby R. Ayers
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Amit Khera
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | | | - Thomas J. Wang
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Stephen L. Seliger
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - Vijay Nambi
- Department of MedicineBaylor College of MedicineHoustonTX
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
- Department of MedicineMichael E. DeBakey Veterans Affairs HospitalHoustonTX
| | - Elizabeth Selvin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Jarett D. Berry
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - W. Gregory Hundley
- Departments of Medicine and Radiological SciencesWake Forest Health SciencesWinston‐SalemNC
| | | | - Philip Greenland
- Department of Preventive MedicineFeinberg School of Medicine, Northwestern UniversityChicagoIL
| | - Mark H. Drazner
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Christie M. Ballantyne
- Department of MedicineBaylor College of MedicineHoustonTX
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | - Benjamin D. Levine
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - James A. de Lemos
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
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Zeng C, Tan H. Gut Microbiota and Heart, Vascular Injury. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1238:107-141. [PMID: 32323183 DOI: 10.1007/978-981-15-2385-4_8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The gut microbiota plays an important role in maintaining human health. Accumulating evidence has indicated an intimate relationship between gut microbiota and cardiovascular diseases (CVD) which has become the leading cause of death worldwide. The alteration of gut microbial composition (gut dysbiosis) has been proven to contribute to atherosclerosis, the basic pathological process of CVD. In addition, the metabolites of gut microbiota have been found to be closely related to the development of CVD. For example, short-chain fatty acids are widely acclaimed beneficial effect against CVD, whereas trimethylamine-N-oxide is considered as a contributing factor in the development of CVD. In this chapter, we mainly discuss the gut microbial metabolite-involved mechanisms of CVD focusing on atherosclerosis, hypertension, diabetes, obesity, and heart failure. Targeting gut microbiota and related metabolites are novel and promising strategies for the treatment of CVD.
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Affiliation(s)
- Cheng Zeng
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Hongmei Tan
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.
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Martignani C, Massaro G, Biffi M, Ziacchi M, Diemberger I. Atrial fibrillation: an arrhythmia that makes healthcare systems tremble. J Med Econ 2020; 23:667-669. [PMID: 32255385 DOI: 10.1080/13696998.2020.1752220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Cristian Martignani
- Cardio-Thoracic and Vascular Building, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola Hospital, Bologna, Italy
| | - Giulia Massaro
- Cardio-Thoracic and Vascular Building, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola Hospital, Bologna, Italy
| | - Mauro Biffi
- Cardio-Thoracic and Vascular Building, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola Hospital, Bologna, Italy
| | - Matteo Ziacchi
- Cardio-Thoracic and Vascular Building, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola Hospital, Bologna, Italy
| | - Igor Diemberger
- Cardio-Thoracic and Vascular Building, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola Hospital, Bologna, Italy
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Deitelzweig S, Baker CL, Dhamane AD, Mardekian J, Dina O, Rosenblatt L, Russ C, Poretta T, Lingohr-Smith M, Lin J. Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States. J Drug Assess 2020; 9:87-96. [PMID: 32489717 PMCID: PMC7241468 DOI: 10.1080/21556660.2020.1750418] [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: 09/04/2019] [Accepted: 03/30/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives To compare the risks of 1-month all-cause, major bleeding (MB)-related and stroke-related readmissions and the associated hospital resource use and costs among patients previously hospitalized for nonvalvular atrial fibrillation (NVAF) and treated with warfarin, rivaroxaban, and dabigatran vs apixaban. Methods Adult patients hospitalized with NVAF (any discharge diagnosis position) who received apixaban, warfarin, rivaroxaban, or dabigatran during hospitalization were identified from the Premier database (1 January 2013–30 June 2017) and grouped into respective cohorts. Propensity score matching was used to generate cohorts with similar characteristics. In regression analyses the risk of readmissions that occurred within 1 month of discharge were evaluated and the associated length of stay (LOS) and costs compared. Results NVAF patients treated with warfarin vs apixaban had significantly greater risk of all-cause (odds ratio [OR] = 1.05; confidence interval [CI] = 1.02–1.08; p < .001), MB-related (OR: 1.28; CI: 1.16–1.42; p < .001), and stroke-related (OR: 1.33; CI: 1.11–1.58; p = .002) readmissions; for all readmission categories, average LOS was significantly longer and costs significantly higher for warfarin treated patients. NVAF patients treated with rivaroxaban versus apixaban had significantly greater risk of all-cause (OR: 1.06; CI: 1.02–1.09; p = .001) and MB-related (OR = 1.62; CI = 1.44–1.83; p < .001) readmissions, but not stroke-related readmission; for MB-related readmissions average LOS and costs were higher for rivaroxaban treated patients. Significant differences in risks of all-cause, MB-related, and stroke-related readmissions were not observed between the apixaban and dabigatran cohorts. Conclusion In this retrospective real-world analysis of NVAF patients, apixaban treatment was associated with better clinical outcomes than warfarin or rivaroxaban and lower hospital resource burden.
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Affiliation(s)
- Steven Deitelzweig
- Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.,Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | | | | | | | | | | | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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66
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Mao YJ, Wang H, Huang PF. Meta-analysis of the safety and efficacy of using minimally interrupted novel oral anticoagulants in patients undergoing catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2020; 60:407-417. [PMID: 32361948 DOI: 10.1007/s10840-020-00754-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The ideal periprocedural anticoagulation strategy for patients being treated with a novel oral anticoagulant (NOAC) during catheter ablation (CA) for atrial fibrillation (AF) is unclear. We evaluated the safety and efficacy of using a minimally interrupted NOAC strategy versus an uninterrupted NOAC or vitamin K antagonist (VKA) strategy during AF ablation. METHODS The Cochrane Library, PubMed, and EMBASE databases were searched for randomized controlled or prospective observational studies that compared a minimally interrupted NOAC strategy with an uninterrupted NOAC or VKA strategy from the time of database establishment up to December 2019. The primary endpoints were major bleeding, minor bleeding, and symptomatic thromboembolism. The secondary endpoint was silent cerebral infarction (SCI) as detected by post-ablation brain magnetic resonance imaging (MRI). A measurement of treatment effect for the endpoint was reported as pooled odds ratio (OR) with 95% confidence interval (CI). RESULTS A total of 18 studies (6 randomized, 11 observational, and 1 randomized registry) with 6203 patients were included in the final analysis (47% of the patients received minimally interrupted NOAC). There was no significant difference between treatment groups regarding the risk for major bleeding (OR 1.04, 95% CI 0.69-1.57, P = 0.86, I2 = 27%). Different stratification methods did not yield significant difference regarding the risk for major bleeding. There was no difference between groups regarding the risk for minor bleeding (P = 1.00) or symptomatic thromboembolism (P = 0.26). Brain MRI results showed that both uninterrupted NOAC (OR 0.44, 95% CI 0.23-0.83, P = 0.01, I2 = 72%) and uninterrupted VKA (OR 0.48, 95% CI 0.24-0.97, P = 0.04, I2 = 36%) produced a significant reduction in the rate of SCI when compared with minimally interrupted NOAC. CONCLUSIONS A periprocedural anticoagulation strategy of minimally interrupted NOAC is not superior to uninterrupted NOAC or VKA when used during AF ablation. There is evidence favoring the use of uninterrupted NOAC or VKA in terms of the risk for SCI.
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Affiliation(s)
- Yin-Jun Mao
- Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Chazhong Road No. 20, Fuzhou, Fujian, China
| | - Hang Wang
- Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Chazhong Road No. 20, Fuzhou, Fujian, China
| | - Pin-Fang Huang
- Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Chazhong Road No. 20, Fuzhou, Fujian, China.
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67
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Isaac E, Cooper SM, Jones SA, Loubani M. Do age-associated changes of voltage-gated sodium channel isoforms expressed in the mammalian heart predispose the elderly to atrial fibrillation? World J Cardiol 2020; 12:123-135. [PMID: 32431783 PMCID: PMC7215965 DOI: 10.4330/wjc.v12.i4.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/18/2020] [Accepted: 03/15/2020] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. The prevalence of the disease increases with age, strongly implying an age-related process underlying the pathology. At a time when people are living longer than ever before, an exponential increase in disease prevalence is predicted worldwide. Hence unraveling the underlying mechanics of the disease is paramount for the development of innovative treatment and prevention strategies. The role of voltage-gated sodium channels is fundamental in cardiac electrophysiology and may provide novel insights into the arrhythmogenesis of AF. Nav1.5 is the predominant cardiac isoform, responsible for the action potential upstroke. Recent studies have demonstrated that Nav1.8 (an isoform predominantly expressed within the peripheral nervous system) is responsible for cellular arrhythmogenesis through the enhancement of pro-arrhythmogenic currents. Animal studies have shown a decline in Nav1.5 leading to a diminished action potential upstroke during phase 0. Furthermore, the study of human tissue demonstrates an inverse expression of sodium channel isoforms; reduction of Nav1.5 and increase of Nav1.8 in both heart failure and ventricular hypertrophy. This strongly suggests that the expression of voltage-gated sodium channels play a crucial role in the development of arrhythmias in the diseased heart. Targeting aberrant sodium currents has led to novel therapeutic approaches in tackling AF and continues to be an area of emerging research. This review will explore how voltage-gated sodium channels may predispose the elderly heart to AF through the examination of laboratory and clinical based evidence.
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Affiliation(s)
- Emmanuel Isaac
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals, Cottingham HU16 5JQ, United Kingdom
| | - Stephanie M Cooper
- Department of Biomedical Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| | - Sandra A Jones
- Department of Biomedical Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals, Cottingham HU16 5JQ, United Kingdom
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68
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Bumpus S, Krallman R, McMahon C, Gupta A, Montgomery D, Kline-Rogers E, Vaishnava P. Insights into hospital readmission patterns of atrial fibrillation patients. Eur J Cardiovasc Nurs 2020; 19:545-550. [PMID: 32148075 DOI: 10.1177/1474515120911607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients admitted to the hospital with atrial fibrillation have associated morbidity and mortality and incur significant costs. Data characterizing atrial fibrillation patients at high risk for readmission are scarce. We sought to inform this area by characterizing and categorizing unplanned readmissions of atrial fibrillation patients. METHODS Retrospective data were abstracted from the charts of patients discharged from 2008 to 2012 after an index hospitalization for atrial fibrillation and referred to the nurse practitioner-led transitional care program, Bridging the Discharge Gap Effectively. Unplanned readmissions were dichotomized as early (⩽30 days) or late (31-180 days) and further classified as either "atrial fibrillation/atrial fibrillation-related" (AF/AF-related), "Cardiac; not AF/AF-related," or "Not cardiac-related." Case classifications were adjudicated by a senior cardiologist. Patient demographics and readmission characteristics were then compared. RESULTS Of 255 patients, 97 (38.0%) had unplanned readmissions within 180 days of discharge; 45 (46.4%) were early and 52 (53.6%) were late. Atrial fibrillation and cardiac causes accounted for 68.9% (n=31) of early readmissions and 65.4% (n=34) of late. Patients with late readmissions were more likely to have diabetes (32.7% vs. 17.7%, p=.022) and higher CHA2DS2VASc scores (3.63 vs. 2.98, p=0.026) than those not readmitted. No other differences in baseline characteristics were seen within or between groups. The 30-day all-cause readmission rate in this sample was 17.6% (n=45). CONCLUSION Readmissions following hospital discharge for atrial fibrillation are common; approximately 50% of these readmissions are for reasons unrelated to atrial fibrillation. In order to reduce atrial fibrillation-related readmissions, further research is needed to characterize predictors of readmission and to develop effective transitional care interventions.
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Affiliation(s)
- Sherry Bumpus
- Eastern Michigan University, Ypsilanti, USA.,Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Rachel Krallman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Colin McMahon
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Ashwin Gupta
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan Health System, Ann Arbor, USA.,Veterans Administration Ann Arbor Health Care Center, USA
| | - Daniel Montgomery
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Eva Kline-Rogers
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Prashant Vaishnava
- Mount Sinai Hospital, Department of Internal Medicine, Division of Cardiology, New York City, USA
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4871] [Impact Index Per Article: 1217.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Staerk L, Preis SR, Lin H, Lubitz SA, Ellinor PT, Levy D, Benjamin EJ, Trinquart L. Protein Biomarkers and Risk of Atrial Fibrillation: The FHS. Circ Arrhythm Electrophysiol 2020; 13:e007607. [PMID: 31941368 DOI: 10.1161/circep.119.007607] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Identification of protein biomarkers associated with incident atrial fibrillation (AF) may improve the understanding of the pathophysiology, risk prediction, and development of new therapeutics for AF. We examined the associations between 85 protein biomarkers and incident AF. METHODS We included participants ≥50 years of age from the FHS (Framingham Heart Study) Offspring and Third Generation cohorts, who had 85 fasting plasma proteins measured using Luminex xMAP platform. Hazard ratios (per 1 SD increment of rank-normalized biomarker [hazard ratio]) and 95% CIs for incident AF were calculated using Cox regression models adjusted for age, sex, height, weight, current smoking, systolic blood pressure, diastolic blood pressure, hypertension treatment, diabetes mellitus, valvular heart disease, prevalent myocardial infarction, and prevalent heart failure. We used the false discovery rate to account for multiple testing. RESULTS The study sample comprised 3378 participants (54% women) with mean (SD) age of 61.5 (8.4) years. In total, 401 developed AF over a mean follow-up of 12.3±3.8 years. We observed lower hazard of incident AF associated with higher mean levels of IGF1 (insulin-like growth factor 1; hazard ratio per 1 SD increment in protein level, 0.84 [95% CI, 0.76-0.93]), and higher hazard of incident AF associated with higher mean levels of both IGFBP1 (insulin-like growth factor-binding protein 1; hazard ratio, 1.24 [95% CI, 1.1-1.39]) and NT-proBNP (N-terminal pro-B-type natriuretic peptide; hazard ratio, 1.73 [95% CI, 1.52-1.96]). CONCLUSIONS Decreased levels of IGF1 and increased levels of IGFBP1 and NT-proBNP were associated with higher risk of incident AF.
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Affiliation(s)
- Laila Staerk
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (L.S., H.L., D.L., E.J.B., L.T.).,Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Helleup, Denmark (L.S.)
| | - Sarah R Preis
- Department of Biostatistics (S.R.P., L.T.), Boston University School of Public Health, MA
| | - Honghuang Lin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (L.S., H.L., D.L., E.J.B., L.T.).,Section of Computational Biomedicine (H.L.), Department of Medicine, Boston University School of Medicine, MA
| | - Steven A Lubitz
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Patrick T Ellinor
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Daniel Levy
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (L.S., H.L., D.L., E.J.B., L.T.)
| | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (L.S., H.L., D.L., E.J.B., L.T.).,Department of Epidemiology (E.J.B.), Boston University School of Public Health, MA.,Cardiology and Preventive Medicine Sections (E.J.B.), Department of Medicine, Boston University School of Medicine, MA.,Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (E.J.B.)
| | - Ludovic Trinquart
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (L.S., H.L., D.L., E.J.B., L.T.).,Department of Biostatistics (S.R.P., L.T.), Boston University School of Public Health, MA
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Wingerter R, Steiger N, Burrows A, Estes NAM. Impact of Lifestyle Modification on Atrial Fibrillation. Am J Cardiol 2020; 125:289-297. [PMID: 31761147 DOI: 10.1016/j.amjcard.2019.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Atrial Fibrillation (AF) is the most common arrhythmia in adults, and the rapid increase in AF prevalence has been classified by experts as an epidemic. The mechanisms of AF are complex and incompletely understood. While many aspects of management are now based on high quality evidence, other clinical decisions are based on experience and judgment. This article provides an up to date review relating to lifestyle modification and its effect on AF to inform clinical treatment. This comprehensive review used PubMed and Google Scholar to perform keyword searches of articles published between 1998 and the present, with the exception of the 1978 "Holiday Heart" article. Robust data has emerged identifying multiple risk factors for development of AF, including age, sex, hypertension, diabetes mellitus, obesity, alcohol consumption, exercise, and obstructive sleep apnea. Recent evidence indicates that lifestyle modification has a significant role in mitigating the risk and burden of AF. In conclusion, based on the available evidence, an interdisciplinary approach to lifestyle modification will likely reduce risk and/or symptom burden of AF.
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Affiliation(s)
- Rebecca Wingerter
- College of Medicine at University of Central Florida, Orlando, Florida
| | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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72
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Coppini R, Santini L, Palandri C, Sartiani L, Cerbai E, Raimondi L. Pharmacological Inhibition of Serine Proteases to Reduce Cardiac Inflammation and Fibrosis in Atrial Fibrillation. Front Pharmacol 2019; 10:1420. [PMID: 31956307 PMCID: PMC6951407 DOI: 10.3389/fphar.2019.01420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022] Open
Abstract
Systemic inflammation correlates with an increased risk of atrial fibrillation (AF) and thrombogenesis. Systemic inflammation alters vessel permeability, allowing inflammatory and immune cell migration toward target organs, including the heart. Among inflammatory cells infiltrating the atria, macrophages and mast cell have recently attracted the interest of basic researchers due to the pathogenic mechanisms triggered by their activation. This chemotactic invasion is likely implicated in short- and long-term changes in cardiac cell-to-cell communication and in triggering fibrous tissue accumulation in the atrial myocardium and electrophysiological re-arrangements of atrial cardiomyocytes, thus favoring the onset and progression of AF. Serine proteases are a large and heterogeneous class of proteases involved in several processes that are important for cardiac function and are involved in cardiac diseases, such as (i) coagulation, (ii) fibrinolysis, (iii) extracellular matrix degradation, (iv) activation of receptors (i.e., protease-activated receptors [PPARs]), and (v) modulation of the activity of endogenous signals. The recognition of serine proteases substrates and their involvement in inflammatory/profibrotic mechanisms allowed the identification of novel cardio-protective mechanisms for commonly used drugs that inhibit serine proteases. The aim of this review is to summarize knowledge on the role of inflammation and fibrosis as determinants of AF. Moreover, we will recapitulate current findings on the role of serine proteases in the pathogenesis of AF and the possible beneficial effects of drugs inhibiting serine proteases in reducing the risk of AF through decrease of cardiac inflammation and fibrosis. These drugs include thrombin and factor Xa inhibitors (used as oral anticoagulants), dipeptidyl-peptidase 4 (DPP4) inhibitors, used for type-2 diabetes, as well as novel experimental inhibitors of mast cell chymases.
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Affiliation(s)
- Raffaele Coppini
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Lorenzo Santini
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Chiara Palandri
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Laura Sartiani
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Elisabetta Cerbai
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Laura Raimondi
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
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73
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Kelly JP, DeVore AD, Wu J, Hammill BG, Sharma A, Cooper LB, Felker GM, Piccini JP, Allen LA, Heidenreich PA, Peterson ED, Yancy CW, Fonarow GC, Hernandez AF. Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines-Heart Failure. J Am Heart Assoc 2019; 8:e011560. [PMID: 31818219 PMCID: PMC6951063 DOI: 10.1161/jaha.118.011560] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Limited data exist to guide treatment for patients with heart failure with preserved ejection fraction and atrial fibrillation, including the important decision regarding rate versus rhythm control. Methods and Results We analyzed the Get With The Guidelines—Heart Failure (GWTG‐HF) registry linked to Medicare claims data from 2008 to 2014 to describe current treatments for rate versus rhythm control and subsequent outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation using inverse probability weighted analysis. Rhythm control was defined as use of an antiarrhythmic medication, cardioversion, or AF ablation or surgery. Rate control was defined as use of any combination of β‐blocker, calcium channel blocker, and digoxin without evidence of rhythm control. Among 15 682 fee‐for‐service Medicare patients, at the time of discharge, 1857 were treated with rhythm control and 13 825 with rate control, with minimal differences in baseline characteristics between groups. There was higher all‐cause death at 1 year in the rate control compared with the rhythm control group (37.5% and 30.8%, respectively, P<0.01). The lower 1‐year all‐cause death in the rhythm control group remained after risk adjustment (adjusted hazard ratio, 0.86; 95% CI, 0.75–0.98; P=0.02). Conclusions Rhythm control in patients aged 65 and older with heart failure with preserved ejection fraction and AF was associated with a lower risk of 1 year all‐cause mortality. Future prospective randomized studies are needed to explore this potential benefit.
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Affiliation(s)
- Jacob P Kelly
- Duke Clinical Research Institute and Duke University Medical Center Durham NC
| | - Adam D DeVore
- Duke Clinical Research Institute and Duke University Medical Center Durham NC
| | - JingJing Wu
- Duke Clinical Research Institute and Duke University Medical Center Durham NC
| | - Bradley G Hammill
- Duke Clinical Research Institute and Duke University Medical Center Durham NC
| | - Abhinav Sharma
- Duke Clinical Research Institute and Duke University Medical Center Durham NC.,Mazankowski Alberta Heart Institute University of Alberta Edmonton Alberta Canada
| | - Lauren B Cooper
- Duke Clinical Research Institute and Duke University Medical Center Durham NC.,Inova Heart & Vascular Institute Falls Church VA
| | - G Michael Felker
- Duke Clinical Research Institute and Duke University Medical Center Durham NC
| | - Jonathan P Piccini
- Duke Clinical Research Institute and Duke University Medical Center Durham NC
| | | | | | - Eric D Peterson
- Duke Clinical Research Institute and Duke University Medical Center Durham NC
| | - Clyde W Yancy
- Northwestern University, Feinberg School of Medicine Chicago IL
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center University of California Los Angeles Medical Center Los Angeles CA
| | - Adrian F Hernandez
- Duke Clinical Research Institute and Duke University Medical Center Durham NC
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74
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Woods TJ, Speck P, Kaambwa B. A systematic review protocol for examining 30-day readmission costs for atrial fibrillation patients. BMJ Open 2019; 9:e032101. [PMID: 31601601 PMCID: PMC6797277 DOI: 10.1136/bmjopen-2019-032101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and readmissions of AF patients place a huge burden on the healthcare system, including economically. With an increasing prevalence, the burden of AF will continue evolving. To illuminate the readmission-specific economic burden, we aim to provide quality evidence on the cost of readmissions within 30 days where AF has been the primary diagnosis at the index admission. METHODS AND ANALYSIS We will conduct a systematic review of all peer-reviewed articles examining readmission costs for AF patients. We will search MedLine, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Library for articles written in English, published in peer-reviewed journals from inception to 2019. Reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist. Studies will be included if patients were aged 18 years and over, AF was the primary diagnosis of index admission and costs of readmission within 30 days were reported. Quality assessment of studies will be done using a modified Evers checklist. Study results will be summarised in a Forest plot and heterogeneity tested for using the Cochran's Q and I2 statistic. A random-effects model will be applied for meta-analysis if studies are sufficiently homogeneous. The cost of readmission to hospital within 30 days for AF patients is the main outcome of interest while additional outcomes are 30-day readmission rate, predictors of readmission and predictors of readmission costs. ETHICS AND DISSEMINATION Formal ethical approval is not required as no patients will be involved. Dissemination of results will be through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42019132017.
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Affiliation(s)
- Taylor-Jade Woods
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter Speck
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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75
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Gallagher C, Rowett D, Nyfort-Hansen K, Simmons S, Brooks AG, Moss JR, Middeldorp ME, Hendriks JM, Jones T, Mahajan R, Lau DH, Sanders P. Patient-Centered Educational Resources for Atrial Fibrillation. JACC Clin Electrophysiol 2019; 5:1101-1114. [DOI: 10.1016/j.jacep.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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76
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Tripathi B, Atti V, Kumar V, Naraparaju V, Sharma P, Arora S, Wojtaszek E, Gopalan R, Siontis KC, Gersh BJ, Deshmukh A. Outcomes and Resource Utilization Associated With Readmissions After Atrial Fibrillation Hospitalizations. J Am Heart Assoc 2019; 8:e013026. [PMID: 31533511 PMCID: PMC6806041 DOI: 10.1161/jaha.119.013026] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atrial fibrillation is the most common arrhythmia worldwide. Data regarding 30‐day readmission rates after discharge for atrial fibrillation remain poorly reported. Methods and Results The Nationwide Readmission Database (2010–2014) was queried using the International Classification of Diseases, Ninth Revision (ICD‐9) codes to identify study population. Incidence, etiologies of 30‐day readmission and predictors of 30‐day readmissions, and cost of care were analyzed. Among 1 723 378 patients who survived to discharge, 249 343 (14.4%) patients were readmitted within 30 days. Compared with the readmitted group, the nonreadmitted group had higher utilization of electrical cardioversion and catheter ablation. Atrial fibrillation was the most common cause of readmission (24.1%). Median time to 30‐day readmission was 13 days. Advancing age, female sex, and longer stay during index hospitalization predicted higher 30‐day readmissions, whereas private insurance, electrical cardioversion, catheter ablation, higher income, and elective admissions correlated with lower 30‐day readmission. Comorbidities such as heart failure, neurological disorder, chronic obstructive pulmonary disease, diabetes mellitus, chronic kidney disease, chronic liver failure, coagulopathy, anemia, peripheral vascular disease, and electrolyte disturbance, correlated with increased 30‐day readmissions and cost burden. Trend analysis showed a progressive decline in 30‐day readmission rates from 14.7% in 2010 to 14.3% in 2014 (P trend, <0.001). Conclusions Approximately 1 in 7 patients were readmitted within 30 days of discharge, with symptomatic atrial fibrillation being the most common cause. We identified a predictive model for increased risk of readmissions and treatment expense. Electrical cardioversion during index admission was associated with a significant reduction in 30‐day readmissions and service charges. The 30‐day readmissions correlated with a substantial rise in the cost of care.
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Affiliation(s)
| | - Varunsiri Atti
- Department of Medicine Michigan State University East Lansing MI
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77
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Chang TIH, Liu S, Airy M, Niu J, Turakhia MP, Flythe JE, Montez-Rath ME, Winkelmayer WC. Blood Pressure and Incident Atrial Fibrillation in Older Patients Initiating Hemodialysis. Clin J Am Soc Nephrol 2019; 14:1029-1038. [PMID: 31175104 PMCID: PMC6625626 DOI: 10.2215/cjn.13511118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/06/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES We examined the association of predialysis systolic and diastolic BP and intradialytic hypotension with incident atrial fibrillation in older patients initiating hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used the US Renal Data System linked to the records of a large dialysis provider to identify patients aged ≥67 years initiating hemodialysis between January 2006 and October 2011. We examined quarterly average predialysis systolic BP, diastolic BP, and proportion of sessions with intradialytic hypotension (i.e., nadir systolic BP <90 mm Hg). We applied an extended Cox model to compute adjusted hazard ratios (HRs) of each exposure with incident atrial fibrillation. RESULTS Among 17,003 patients, 3785 developed atrial fibrillation. When comparing predialysis systolic BP to a fixed reference of 140 mm Hg, lower predialysis systolic BP was associated with a higher hazard of atrial fibrillation, whereas higher systolic BP was associated with a lower hazard of atrial fibrillation. When comparing across a range of systolic BP for two hypothetical patients with similar measured covariates, the association varied by mean systolic BP: at systolic BP 190 mm Hg, each 10 mm Hg lower systolic BP was associated with lower atrial fibrillation hazard (HR, 0.94; 95% confidence interval, 0.90 to 1.00), whereas at systolic BP 140 mm Hg, a 10 mm Hg lower systolic BP was associated with a higher atrial fibrillation hazard (HR, 1.12; 95% confidence interval, 1.10 to 1.14). Lower diastolic BP was associated with higher atrial fibrillation hazards. Intradialytic hypotension was weakly associated with atrial fibrillation. CONCLUSIONS In this observational study of older patients initiating hemodialysis, lower predialysis systolic BP and diastolic BP were associated with higher incidence of atrial fibrillation.
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Affiliation(s)
| | | | - Medha Airy
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
| | - Jingbo Niu
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
| | - Mintu P Turakhia
- Cardiovascular Medicine, Stanford University, Stanford, California.,Division of Cardiovascular Medicine, Palo Alto Veterans Affairs Medical Center, Palo Alto, California; and
| | - Jennifer E Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
| | | | - Wolfgang C Winkelmayer
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas;
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78
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Tsao PA, Estes JP, Griggs JJ, Smith DC, Caram ME. Cardiovascular and Metabolic Toxicity of Abiraterone in Castration-resistant Prostate Cancer: Post-marketing Experience. Clin Genitourin Cancer 2019; 17:e592-e601. [DOI: 10.1016/j.clgc.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/28/2019] [Accepted: 03/01/2019] [Indexed: 12/29/2022]
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79
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Zeng C, Wang R, Tan H. Role of Pyroptosis in Cardiovascular Diseases and its Therapeutic Implications. Int J Biol Sci 2019; 15:1345-1357. [PMID: 31337966 PMCID: PMC6643148 DOI: 10.7150/ijbs.33568] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022] Open
Abstract
Pyroptotic cell death or pyroptosis is characterized by caspase-1-dependent formation of plasma membrane pores, leading to the release of pro-inflammatory cytokines and cell lysis. Pyroptosis tightly controls the inflammatory responses and coordinates antimicrobial host defenses by releasing pro-inflammatory cellular contents, such as interleukin (IL)-1β and IL-18, and consequently expands or sustains inflammation. It is recognized as an important innate immune effector mechanism against intracellular pathogens. The induction of pyroptosis is closely associated with the activation of the NOD-like receptor 3 (NLRP3) inflammasome which has been linked to key cardiovascular risk factors including hyperlipidemia, diabetes, hypertension, obesity, and hyperhomocysteinemia. Emerging evidence has indicated pyroptosis as an important trigger and endogenous regulator of cardiovascular inflammation. Thus, pyroptosis may play an important role in the pathogenesis of cardiovascular diseases. Design of therapeutic strategies targeting the activation of NLRP3 inflammasome and pyroptosis holds promise for the treatment of cardiovascular diseases.
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Affiliation(s)
- Cheng Zeng
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Renqing Wang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.,Department of pathology, the Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing 21008, China
| | - Hongmei Tan
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
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80
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Loring Z, Sun AY. Should His Bundle Pacing Be Preferred over Cardiac Resynchronization Therapy Following Atrioventricular Junction Ablation? Cardiol Clin 2019; 37:231-240. [PMID: 30926024 PMCID: PMC6442941 DOI: 10.1016/j.ccl.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are associated with high morbidity and mortality, which is particularly detrimental when patients develop rapid ventricular rates (RVR). Atrioventricular junction (AVJ) ablation with pacemaker implantation has been used as a method of achieving rate control in patients with incessant AF with RVR. Right ventricular only pacing is known to be harmful in the setting of HF. His bundle pacing (HBP) and biventricular (BiV) pacing both offer durable pacing solutions that offer more physiologic activation. This review describes the benefits and drawbacks of HBP and BiV pacing in HF patients after AVJ ablation.
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Affiliation(s)
- Zak Loring
- Division of Cardiology, Section of Electrophysiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Clinical Research Institute, 200 Morris St, Durham, NC 27701, USA.
| | - Albert Y Sun
- Division of Cardiology, Section of Electrophysiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Division of Cardiology, Section of Electrophysiology, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA
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81
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Gallagher C, Hendriks JM, Giles L, Karnon J, Pham C, Elliott AD, Middeldorp ME, Mahajan R, Lau DH, Sanders P, Wong CX. Increasing trends in hospitalisations due to atrial fibrillation in Australia from 1993 to 2013. Heart 2019; 105:1358-1363. [PMID: 30936408 DOI: 10.1136/heartjnl-2018-314471] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of this study is to characterise hospitalisations due to atrial fibrillation (AF) compared with two other common cardiovascular conditions, myocardial infarction (MI) and heart failure (HF), in addition to the associated economic burden of these hospitalisations and contribution of AF-related procedures. METHODS The primary outcome measure was the rate of increase of AF, MI and HF hospitalisations from 1993 to 2013. The rate of increase of AF-related procedures including cardioversion and ablation were also collected, in addition to direct costs associated with hospitalisations for each of these three conditions. RESULTS AF hospitalisations increased 295% over the 21-year period to a total of 61 424 in 2013. In comparison, MI and HF hospitalisations increased by only 73% and 39%, respectively, over the same period. Considering population changes, there was an annual increase in AF hospitalisations of 5.2% (incidence rate ratio [IRR] 1.052; 95% CI 1.046 to 1.059; p<0.001). In contrast, there was a 2.2% increase per annum for MI (IRR 1.022; 95% CI 1.017 to 1.027; p<0.001) and negligible annual change for HF hospitalisations (IRR 1.000; 95% CI 0.997 to 1.002; p=0.78). Cardioversion and AF ablation increased by 10% and 26% annually, respectively. AF hospitalisation costs rose by 479% over the 21-year period, an increase that was more than double that of MI and HF. CONCLUSIONS The burden of AF hospitalisations continues to rise unabated. AF has now surpassed both MI and HF hospitalisations and represents a growing cost burden. New models of healthcare delivery are required to stem this growing healthcare burden.
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Affiliation(s)
- Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jeroen Ml Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lynne Giles
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Clarabelle Pham
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Traykov V, Kirova G, Karagyozov P, Marchov D, Kaninski G, Gelev V. Massive air embolism caused by an atrioesophageal fistula following isolation of the pulmonary veins for atrial fibrillation. HeartRhythm Case Rep 2019; 5:101-104. [PMID: 30820407 PMCID: PMC6379520 DOI: 10.1016/j.hrcr.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Vassil Traykov
- Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Galina Kirova
- Department of Imaging, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Petko Karagyozov
- Department of Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Daniel Marchov
- Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Genadi Kaninski
- Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Valeri Gelev
- Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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Zou R, Zhang D, Lv L, Shi W, Song Z, Yi B, Lai B, Chen Q, Yang S, Hua P. Bioinformatic gene analysis for potential biomarkers and therapeutic targets of atrial fibrillation-related stroke. J Transl Med 2019; 17:45. [PMID: 30760287 PMCID: PMC6375208 DOI: 10.1186/s12967-019-1790-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most prevalent sustained arrhythmias, however, epidemiological data may understate its actual prevalence. Meanwhile, AF is considered to be a major cause of ischemic strokes due to irregular heart-rhythm, coexisting chronic vascular inflammation, and renal insufficiency, and blood stasis. We studied co-expressed genes to understand relationships between atrial fibrillation (AF) and stroke and reveal potential biomarkers and therapeutic targets of AF-related stroke. METHODS AF-and stroke-related differentially expressed genes (DEGs) were identified via bioinformatic analysis Gene Expression Omnibus (GEO) datasets GSE79768 and GSE58294, respectively. Subsequently, extensive target prediction and network analyses methods were used to assess protein-protein interaction (PPI) networks, Gene Ontology (GO) terms and pathway enrichment for DEGs, and co-expressed DEGs coupled with corresponding predicted miRNAs involved in AF and stroke were assessed as well. RESULTS We identified 489, 265, 518, and 592 DEGs in left atrial specimens and cardioembolic stroke blood samples at < 3, 5, and 24 h, respectively. LRRK2, CALM1, CXCR4, TLR4, CTNNB1, and CXCR2 may be implicated in AF and the hub-genes of CD19, FGF9, SOX9, GNGT1, and NOG may be associated with stroke. Finally, co-expressed DEGs of ZNF566, PDZK1IP1, ZFHX3, and PITX2 coupled with corresponding predicted miRNAs, especially miR-27a-3p, miR-27b-3p, and miR-494-3p may be significantly associated with AF-related stroke. CONCLUSION AF and stroke are related and ZNF566, PDZK1IP1, ZFHX3, and PITX2 genes are significantly associated with novel biomarkers involved in AF-related stroke.
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Affiliation(s)
- Rongjun Zou
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Dingwen Zhang
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Lei Lv
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Wanting Shi
- Department of Gastroenterology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000, China
| | - Zijiao Song
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Bin Yi
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Bingjia Lai
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Qian Chen
- The Second Department of Orthopedics, Affiliated Hospital of Beihua University, Jilin, 132011, China
| | - Songran Yang
- The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China. .,Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Ping Hua
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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84
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Drivers of hospitalisation trends for non-valvular atrial fibrillation in Western Australia, 2000–2013. Int J Cardiol 2019; 276:273-277. [DOI: 10.1016/j.ijcard.2018.09.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022]
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Garg J, Patel B, Chaudhary R, Shah M, Gupta R, Gunda S, Padala SK, Ellenbogen KA. Predictors of 30-day readmissions after catheter ablation for atrial fibrillation in the USA. J Interv Card Electrophysiol 2019; 55:243-250. [PMID: 30612212 DOI: 10.1007/s10840-018-0503-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Catheter ablation is considered as the mainstay treatment for patients with symptomatic atrial fibrillation (AF). We aimed to determine the predictors of 30-day readmission after catheter ablation for AF. METHODS The study cohort consisted of patients who underwent AF catheter ablation (International Classification of Diseases, Ninth Revision 427.31 and procedure code 37.34) in 2014, identified from the National Readmission Database. RESULTS Our final cohort consisted of 5322 unweighted cases, of which 4736 (89%) constituted the no-readmission group and 586 patients (11%) the readmission group. Female gender (OR 1.62, 95% CI 1.35-1.95), CAD (OR 1.36, 95% CI 1.08-1.71), peripheral vascular disease (OR 1.45, 95% CI 1.07-1.98), acute renal failure (OR 1.46, 95% CI 1.09-1.97), fluid and electrolyte disorders (OR 1.32, 95% CI 1.03-1.67), chronic pulmonary disease (OR 1.25, 95% CI 1.01-1.53), ablation on the day of admission (OR 0.74, 95% CI 0.61-0.91), and fourth quartile of hospital AF catheter ablation volume (OR 0.60, 95% CI 0.45-0.80) were independent predictors of 30-day readmission. Arrhythmias and heart failure were the most common cardiac etiologies for readmission. The most common ablation-related complications were hemorrhage (11%) and vascular (7%) complications. CONCLUSIONS Several patient- and hospital-related factors were identified as predictors of 30-day readmission, the knowledge of which can potentially improve healthcare delivery.
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Affiliation(s)
- Jalaj Garg
- Division of Electrophysiology, Mount Sinai Medical Center, Icahn School of Medicine, New York, NY, USA.
| | - Brijesh Patel
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Rahul Chaudhary
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Mahek Shah
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Rahul Gupta
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Sampath Gunda
- Department of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Santosh K Padala
- Department of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Department of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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86
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Kalesan B, Kundu A, Vaze A, Pino E, Walkey AJ, Vasan RS, McManus DD. Sex-differences in post-discharge outcomes among patients hospitalized for atrial fibrillation. Clin Cardiol 2018; 42:84-92. [PMID: 30421445 DOI: 10.1002/clc.23111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) are at risk for both thromboembolic and bleeding complications. While the risk for thromboembolism is higher among women with AF than men, the sex-related differences in post-discharge outcomes after hospitalization is not clearly understood. HYPOTHESIS Compared to men, women hospitalized for AF are at a higher risk of both thromboembolic and bleeding complications. METHODS We conducted a retrospective cohort study using data from the 2013 to 2014 Nationwide Readmission Database (NRD), to compare outcomes among men and women, ≥50 years of age after hospitalization for AF. The primary patient outcome was all-cause rehospitalization at 90-days after initial hospitalization. Survey-weighted Cox proportional hazard regression models were used to estimate the hazard ratios (HR) and their 95% confidence intervals (CI) for bleeding events at 30, 60, 90, and 270 days after hospitalization. RESULTS From the 28 million patients in the NRD, we identified 522 521 individuals with an index hospitalization for AF. Compared to men, women hospitalized for AF accounted for 53.3% of the cohort and had higher rates of thrombotic (1.7%, 1.4%) and bleeding complications (1.4%, 1.1%). After adjustment, the 90-day risk among women vs men was significantly greater; all-cause rehospitalization (24.2%, 17.0%; HR = 1.07, 95% CI = 1.05-1.09), rehospitalization related to ischemic stroke (0.6%, 0.3%; HR 1.31, 95% CI = 1.14-1.51), pulmonary embolism (0.4%, 0.2%; HR 1.21, 95% CI = 1.01-1.45), and any thrombotic event (1.3%, 0.7%; HR 1.20, 95% CI = 1.09-1.32). CONCLUSIONS Hospitalization for AF is common and frequently associated with both in-hospital complications and readmission, which were more commonly observed among women with AF. Further research into epidemiological factors and treatment differences between men and women with AF is warranted.
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Affiliation(s)
- Bindu Kalesan
- Center for Translational Epidemiology and Comparative Effectiveness Research and Department of Community Health Sciences, Boston University School of Medicine and Public Health, Boston, Massachusetts
| | - Amartya Kundu
- Department of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Aditya Vaze
- Department of Cardiology, University of California Irvine School of Medicine, Irvine, California
| | - Elizabeth Pino
- Center for Translational Epidemiology and Comparative Effectiveness Research and Department of Community Health Sciences, Boston University School of Medicine and Public Health, Boston, Massachusetts
| | - Allan J Walkey
- Division of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University Medical School, Boston, Massachusetts
| | - Ramachandran S Vasan
- Division of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University Medical School, Boston, Massachusetts
| | - David D McManus
- Department of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts
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König S, Ueberham L, Schuler E, Wiedemann M, Reithmann C, Seyfarth M, Sause A, Tebbenjohanns J, Schade A, Shin DI, Staudt A, Zacharzowsky U, Andrié R, Wetzel U, Neuser H, Wunderlich C, Kuhlen R, Tijssen JGP, Hindricks G, Bollmann A. In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures. Eur Heart J 2018; 39:3947-3957. [PMID: 30165430 DOI: 10.1093/eurheartj/ehy528] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/11/2018] [Indexed: 01/17/2024] Open
Abstract
Aims Atrial fibrillation (AFib) and atrial flutter (AFlut) are common arrhythmias with increased use of invasive procedures. A steady re-evaluation of relevant safety endpoints is recommended and both quality management and pay-for-performance programs are evolving. Therefore, the aims of this study were (i) to investigate and report overall in-hospital mortality and mortality of invasive arrhythmia-related procedures and (ii) to identify mortality predictors in a German-wide hospital network. Methods and results Administrative data provided by 78 Helios hospitals between 2010 and 2017 were examined using International Statistical Classification of Diseases and Related Health Problems- and Operations and Procedures-codes to identify patients with AFib or AFlut as main discharge diagnosis or secondary diagnosis combined with invasive arrhythmia-related interventions. In 161 502 patients, in-hospital mortality was 0.6% with a significant decrease from 0.75% to 0.5% (P < 0.01) during the observational period. In multivariable analysis, age [odds ratio (OR) 2.69, 95% confidence interval (CI) 2.36-3.05; P < 0.01], high centre volume (OR 0.57, 95% CI 0.50-0.65; P < 0.01), emergency hospital admission (OR 1.57, 95% CI 1.38-1.79; P < 0.01), and Charlson Comorbidity Index (CCI, OR 4.95, 95% CI 4.50-5.44; P < 0.01) were found as independent predictors of in-hospital mortality. Mortality rates were 0.05% for left atrial catheter ablation (CA, n = 21 744), 0.3% for right atrial CA (n = 9972), and 0.56% for implantation of a left atrial appendage occluder (n = 2309), respectively. Conclusion We analysed for the first time in-hospital mortality rates of patients with atrial arrhythmias in a German-wide, multi-centre administrative dataset. This allows feasible, comparable, and up-to-date performance measurement of clinically important endpoints in a real-world setting which may contribute to quality management programs and towards value-based healthcare.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Ekkehard Schuler
- Helios Kliniken GmbH, Friedrichstraße 136, 10117 Berlin, Germany
| | - Michael Wiedemann
- Department of Cardiology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Christopher Reithmann
- Department of Internal Medicine I, Helios Hospital München West, Steinerweg 5, 81241 München, Germany
| | - Melchior Seyfarth
- Department of Cardiology, Helios University Hospital Wuppertal, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Armin Sause
- Department of Cardiology, Helios University Hospital Wuppertal, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Jürgen Tebbenjohanns
- Department of Cardiology, Helios Hospital Hildesheim, Senator-Braun-Allee 33, 31135 Hildesheim, Germany
| | - Anja Schade
- Department of Cardiology, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089 Erfurt, Germany
| | - Dong-In Shin
- Department of Cardiology, Helios Hospital Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Alexander Staudt
- Department of Cardiology and Angiology, Helios Hospital Schwerin, Wismarische Straße 393-397, 19053 Schwerin, Germany
| | - Udo Zacharzowsky
- Department of Cardiology, Helios Hospital Bad Saarow, Pieskower Straße 33, 15526 Bad Saarow, Germany
| | - René Andrié
- Department of Cardiology, Helios Hospital Siegburg, Ringstraße 49, 53721 Siegburg, Germany
| | - Ulrike Wetzel
- Department of Cardiology, Helios Hospital Aue, Gartenstraße 6, 08280 Aue, Germany
| | - Hans Neuser
- Department of Internal Medicine II, Helios Hospital Plauen, Röntgenstraße 2, 08529 Plauen, Germany
| | - Carsten Wunderlich
- Department of Internal Medicine II, Helios Hospital Pirna, Struppener Straße 13, 01796 Pirna, Germany
| | - Ralf Kuhlen
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
- Helios Kliniken GmbH, Friedrichstraße 136, 10117 Berlin, Germany
| | - Jan G P Tijssen
- Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
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88
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Yao C, Veleva T, Scott L, Cao S, Li L, Chen G, Jeyabal P, Pan X, Alsina KM, Abu-Taha I, Ghezelbash S, Reynolds CL, Shen YH, LeMaire SA, Schmitz W, Müller FU, El-Armouche A, Eissa NT, Beeton C, Nattel S, Wehrens XH, Dobrev D, Li N. Enhanced Cardiomyocyte NLRP3 Inflammasome Signaling Promotes Atrial Fibrillation. Circulation 2018; 138:2227-2242. [PMID: 29802206 PMCID: PMC6252285 DOI: 10.1161/circulationaha.118.035202] [Citation(s) in RCA: 388] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/14/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is frequently associated with enhanced inflammatory response. The NLRP3 (NACHT, LRR, and PYD domain containing protein 3) inflammasome mediates caspase-1 activation and interleukin-1β release in immune cells but is not known to play a role in cardiomyocytes (CMs). Here, we assessed the role of CM NLRP3 inflammasome in AF. METHODS NLRP3 inflammasome activation was assessed by immunoblot in atrial whole-tissue lysates and CMs from patients with paroxysmal AF or long-standing persistent (chronic) AF. To determine whether CM-specific activation of NLPR3 is sufficient to promote AF, a CM-specific knockin mouse model expressing constitutively active NLRP3 (CM-KI) was established. In vivo electrophysiology was used to assess atrial arrhythmia vulnerability. To evaluate the mechanism of AF, electric activation pattern, Ca2+ spark frequency, atrial effective refractory period, and morphology of atria were evaluated in CM-KI mice and wild-type littermates. RESULTS NLRP3 inflammasome activity was increased in the atrial CMs of patients with paroxysmal AF and chronic AF. CM-KI mice developed spontaneous premature atrial contractions and inducible AF, which was attenuated by a specific NLRP3 inflammasome inhibitor, MCC950. CM-KI mice exhibited ectopic activity, abnormal sarcoplasmic reticulum Ca2+ release, atrial effective refractory period shortening, and atrial hypertrophy. Adeno-associated virus subtype-9-mediated CM-specific knockdown of Nlrp3 suppressed AF development in CM-KI mice. Finally, genetic inhibition of Nlrp3 prevented AF development in CREM transgenic mice, a well-characterized mouse model of spontaneous AF. CONCLUSIONS Our study establishes a novel pathophysiological role for CM NLRP3 inflammasome signaling, with a mechanistic link to the pathogenesis of AF, and establishes the inhibition of NLRP3 as a potential novel AF therapy approach.
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Affiliation(s)
- Chunxia Yao
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine (Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
- Affiliated Hospital, College of Medicine, Hebei University of Engineering, Handan, Hebei Province, China
| | - Tina Veleva
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Larry Scott
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine (Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Shuyi Cao
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Luge Li
- Department of Medicine (Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
| | - Gong Chen
- Department of Medicine (Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
| | - Prince Jeyabal
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine (Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
| | - Xiaolu Pan
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Katherina M. Alsina
- Integrative Molecular and Biomedical Sciences Program, Baylor College of Medicine, Houston, TX, USA
| | - Issam Abu-Taha
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Shokoufeh Ghezelbash
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Corey L. Reynolds
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
- Mouse Phenotyping Core, Baylor College of Medicine, Houston, TX, USA
| | - Ying H. Shen
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Scott A. LeMaire
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Wilhelm Schmitz
- Department of Pharmacology and Toxicology, University of Münster, Münster, Germany
| | - Frank U. Müller
- Department of Pharmacology and Toxicology, University of Münster, Münster, Germany
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany
| | - N. Tony Eissa
- Department of Medicine (Pulmonary), Baylor College of Medicine, Houston, TX, USA
| | - Christine Beeton
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Stanley Nattel
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Xander H.T. Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine (Cardiology), Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Na Li
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine (Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
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89
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Shangguan W, Liang X, Shi W, Liu T, Wang M, Li G. Identification and characterization of circular RNAs in rapid atrial pacing dog atrial tissue. Biochem Biophys Res Commun 2018; 506:1-6. [PMID: 29772236 DOI: 10.1016/j.bbrc.2018.05.082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/13/2018] [Indexed: 12/11/2022]
Abstract
Circular RNAs (circRNAs) have emerged as novel molecules of interest in gene regulation as other noncoding RNAs, and participating in the process of many diseases. However, the expression and functions of circRNAs in Rapid atrial pacing (RAP) dog atrial tissue still unknown. 12 canines were randomly assigned to control and pacing group. RAP at 500 beats per minute was maintained 14 days in the pacing group. The expression characterization of circRNAs were revealed by high-throughput sequencing. We totally predicted 15,990 circRNAs in dog atrial tissues. Moreover, we found 146 differentially expressed circRNAs between control and RAP dogs. Five circRNAs were selected for subsequent RT-PCR validation, and four circRNAs confirmed with the high throughput sequencing analysis. GO analysis showed that the differentially expressed circRNAs might involve in the process of "structural constituent of cytoskeleton, ion channel activity". We explored the circRNA-miRNA interaction network, and found extensive interaction among differentially expressed circRNAs and AF related miRNAs and mRNAs. Our work firstly identified the characterization of circRNAs in the dog atrial, and revealed the differentially expressed circRNAs in the RAP dog, this might lay a solid foundation on the function of circRNA in the mechanisms of AF.
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Affiliation(s)
- Wenfeng Shangguan
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Xue Liang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Wen Shi
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Manman Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
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90
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Proietti M, Laroche C, Nieuwlaat R, Crijns HJGM, Maggioni AP, Lane DA, Boriani G, Lip GYH. Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries. Eur J Intern Med 2018; 55:28-34. [PMID: 29778588 DOI: 10.1016/j.ejim.2018.05.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/13/2018] [Accepted: 05/09/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND In 2002, the European Society of Cardiology conducted the Euro Heart Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry. METHODS We analysed differences in clinical profiles, therapeutic approaches and outcomes between these two cohorts after propensity score matching (PSM). RESULTS After PSM, 5206 patients were analysed. In EORP-AF there were more elderly patients than EHS (p < .001). EORP-AF patients were more burdened with cardiovascular (CV) and non-CV comorbidities, with a higher proportion of patients with high thromboembolic risk. EORP-AF patients used more oral-anticoagulant (OAC) (p < .001). At 1-year follow-up EORP-AF patients had lower risk for thromboembolic and CV events, readmission for AF and other CV reasons (all p < .001), showing conversely a higher risk for CV death (p = .015). Kaplan-Meier curves showed that EORP-AF patients had higher risk for CV death (p < .0001) and all-cause death (p = .0019). Cox regression confirmed that EORP-AF patients were at higher risk for CV death (p = .021). CONCLUSIONS We found significant changes in AF epidemiology over a decade in Europe, with older patients, more burdened with comorbidities. A greater use of OAC was found. Despite a reduction in risk for thromboembolic events, a high risk of CV-related death was still evident.
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Affiliation(s)
- Marco Proietti
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Cécile Laroche
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France
| | - Robby Nieuwlaat
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Aldo P Maggioni
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France; ANMCO Research Center, Firenze, Italy
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy; Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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91
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Chen G, Chelu MG, Dobrev D, Li N. Cardiomyocyte Inflammasome Signaling in Cardiomyopathies and Atrial Fibrillation: Mechanisms and Potential Therapeutic Implications. Front Physiol 2018; 9:1115. [PMID: 30150941 PMCID: PMC6100656 DOI: 10.3389/fphys.2018.01115] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/25/2018] [Indexed: 12/28/2022] Open
Abstract
Inflammasomes are high molecular weight protein complexes in the cytosol of immune and other cells that play a critical role in the innate immune system in response to cellular stress. NLRP3 inflammasome, the best-understood inflammasome, is known to mediate the maturation (activation) of caspase-1 from pro-caspase-1, causing the maturation and release of cytokines (e.g., interleukin-1β) and potentially leading to a form of inflammatory programmed cell death called pyroptosis. Previous work has shown that the NLRP3 components are expressed in cardiomyocytes and cardiac fibroblasts and recent studies have identified the NLRP3 inflammasome as a key nodal point in the pathogenesis of cardiomyopathies and atrial fibrillation, which may create an opportunity for the development of new therapeutic agents. Here we review the recent evidence for a role of NLRP3 inflammasome in the cardiomyocytes and discuss its potential role in the evolution of cardiac remodeling and arrhythmias and new opportunities created by these very recent developments.
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Affiliation(s)
- Gong Chen
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Mihail G Chelu
- Comprehensive Arrhythmia Research and Management Center, School of Medicine, University of Utah, Salt Lake City, UT, United States.,Cardiovascular Medicine Division, Section of Cardiac Electrophysiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Na Li
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.,Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, United States.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, United States
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92
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Continuous and minimally-interrupted direct oral anticoagulant are both safe compared with vitamin K antagonist for atrial fibrillation ablation: An updated meta-analysis. Int J Cardiol 2018; 262:51-56. [DOI: 10.1016/j.ijcard.2018.03.095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 11/21/2022]
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93
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Srivatsa UN, Xing G, Amsterdam E, Chiamvimonvat N, Pezeshkian N, Fan D, White RH. California Study of Ablation for Atrial Fibrillation:Re-hospitalization for Cardiac Events (CAABL-CE). J Atr Fibrillation 2018; 11:2036. [PMID: 30455838 DOI: 10.4022/jafib.2036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/19/2018] [Accepted: 04/14/2018] [Indexed: 01/17/2023]
Abstract
Background Catheter ablation (ABL) for non-valvular (NV) atrial fibrillation (AF) improves rhythm control. Our aim was to compare re-hospitalization for heart failure (HF), acute coronary syndrome (ACS), or recurrent AF among patients with NVAF who underwent ABL versus controls. Methods From the Office of Statewide Planning and Development (OSHPD) database, we identified all patients who had at least one hospitalization for AF between 2005-2013. Patients who subsequently underwent ABL were compared to controls (up to fivematched controls by age, sex and duration of AF between diagnosis and time of ABL). Cases with valve disease, open maze, other arrhythmias, or implanted cardiac devices were excluded. Pre-specified clinical outcomes including readmission for HF, ACS, severe or simple AF (severe = with HF or ACS; simple= without HF or ACS)were assessed using a weighted proportional hazard model adjusting for number of hospital admissions with AF before the ABL, calendar year of ABL, and presence of chronic comorbidities. Results The study population constituted 8338 cases and controls, with mean 3.5+ 1 patient-year follow up. In the ABL cohort, there was lower risk of re-hospitalizations for HF, HR=0.55(95%CI: 0.43-0.69,); ACS,HR=0.5(95%CI: 0.35-0.72,); severe AF [HR=0.86 (CI:0.74-0.99), and higher for simple AF, HR=1.25 (CI:1.18-1.33). Conclusions In patients with NVAF,although ABL is associated with increased risk of re-hospitalization for simple AF, ABL was associated with a significant reduction in the risk of re-hospitalization for HF, ACS and severe AF. These findingsrequireconfirmation in a prospective clinical trial.
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Affiliation(s)
| | | | | | | | | | - Dali Fan
- Division of Cardiovascular Medicine
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Arora S, Lahewala S, Tripathi B, Mehta V, Kumar V, Chandramohan D, Lemor A, Dave M, Patel N, Patel NV, Palamaner Subash Shantha G, Viles-Gonzalez J, Deshmukh A. Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population-Based Cohort Study. J Am Heart Assoc 2018; 7:e009294. [PMID: 29907655 PMCID: PMC6220533 DOI: 10.1161/jaha.118.009294] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/07/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Reducing readmission after catheter ablation (CA) in atrial fibrillation (AF) is important. METHODS AND RESULTS We utilized National Readmission Data (NRD) 2010-2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD-9-procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30- and 90-day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3%) underwent CA. Patients aged ≥65 years and female sex were less likely to receive CA for AF. Overall, 10.9% and 16.5% of CA patients were readmitted within 30 and 90 days post-CA, respectively. Most common causes of readmissions were arrhythmia (AF, atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease (CAD), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30- and 90-day readmissions post-CA. Predictors of increase in AF recurrence post-CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90-day readmission and AF recurrence were found to improve over the study period. CONCLUSIONS We identified several demographic and clinical factors associated with the use of CA in AF, and short-term outcomes of the same, which could potentially help in the patient selection and improve outcomes.
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Affiliation(s)
| | - Sopan Lahewala
- RWJ Barnabas Health/Jersey City Medical Center, Jersey City, NJ
| | | | - Varshil Mehta
- Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, NY
| | - Varun Kumar
- Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, NY
| | | | - Alejandro Lemor
- Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, NY
| | - Mihir Dave
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Nilay V Patel
- University of Kansas Medical Center, Kansas City, KS
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Ziakas PD, Kourbeti IS, Poulou LS, Vlachogeorgos GS, Mylonakis E. Medicare part D prescribing for direct oral anticoagulants in the United States: Cost, use and the "rubber effect". PLoS One 2018; 13:e0198674. [PMID: 29879194 PMCID: PMC5991647 DOI: 10.1371/journal.pone.0198674] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Direct oral anticoagulants (DOAC) have gained an increased share over warfarin for prevention and treatment of thromboembolic disease. We studied DOAC adoption across providers and medical specialties. METHODS Retrospective, cross-sectional analysis of Medicare Part D public use files (PUF), 2013 to 2015. We summarized prescription data for claims and drug payment, stratified by drug class, specialty and calendar year. We treated DOAC claims as a count outcome and explored patterns of expansion across prescribers via a truncated negative binomial regression. We described dispersion and spread in DOAC prescribing, across hospital referral regions (HRRs), including the p90/p10 ratios, and the median absolute deviation from the median. RESULTS In 2015 part D PUF, oral anticoagulant claims have climbed to approximately 24.4 million with a payment cost of approximately $3.3 billion. DOAC claims comprised 31.0% of oral anticoagulant claims, showing a relative increase of approximately 127% compared to 2013. The upper decile of prescribers accounted for half of the oral anticoagulant prescriptions and the resulting cost. The median cost per DOAC claim in 2015 was $367.4 (interquartile range 323.9 to 445.9), as opposed to $12.3 (interquartile range 9.2 to 16.5) for warfarin. The median cost per standardized (30-day supply) prescription was $317.0 (interquartile range 303.8 to 324.3) and $8.0 (6.7 to 9.8) for DOACs and warfarin, respectively. DOAC adoption differs by specialty. Cardiologists, cardiac electrophysiologists and orthopedics had the highest predicted DOAC share per 100 claims (53.8, 72.9 and 71.5, respectively in 2015); nephrologists, family practitioners and geriatricians the lowest (22.3, 21.5 and 20.7, respectively in 2015). The p90/p10 ratio and the median absolute deviation from the median varied across HRRs and correlated positively with the prevalence of stroke and atrial fibrillation in the Medicare population. CONCLUSIONS DOACs have been increasing their share year-over-year, but adoption varies across specialties. In prevalent areas for stroke and atrial fibrillation, prescription dispersion magnifies, and this may signify a rapid adoption by top providers.
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Affiliation(s)
- Panayiotis D. Ziakas
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Irene S. Kourbeti
- First Department of Internal Medicine, Medical School, University of Athens, Greece
| | - Loukia S. Poulou
- Division of Medical Imaging & Interventional Radiology, “IASO” Maternity Clinic, Athens, Greece
| | | | - Eleftherios Mylonakis
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
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Staerk L, Wang B, Preis SR, Larson MG, Lubitz SA, Ellinor PT, McManus DD, Ko D, Weng LC, Lunetta KL, Frost L, Benjamin EJ, Trinquart L. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. BMJ 2018; 361:k1453. [PMID: 29699974 PMCID: PMC5917175 DOI: 10.1136/bmj.k1453] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the association between risk factor burdens-categorized as optimal, borderline, or elevated-and the lifetime risk of atrial fibrillation. DESIGN Community based cohort study. SETTING Longitudinal data from the Framingham Heart Study. PARTICIPANTS Individuals free of atrial fibrillation at index ages 55, 65, and 75 years were assessed. Smoking, alcohol consumption, body mass index, blood pressure, diabetes, and history of heart failure or myocardial infarction were assessed as being optimal (that is, all risk factors were optimal), borderline (presence of borderline risk factors and absence of any elevated risk factor), or elevated (presence of at least one elevated risk factor) at index age. MAIN OUTCOME MEASURE Lifetime risk of atrial fibrillation at index age up to 95 years, accounting for the competing risk of death. RESULTS At index age 55 years, the study sample comprised 5338 participants (2531 (47.4%) men). In this group, 247 (4.6%) had an optimal risk profile, 1415 (26.5%) had a borderline risk profile, and 3676 (68.9%) an elevated risk profile. The prevalence of elevated risk factors increased gradually when the index ages rose. For index age of 55 years, the lifetime risk of atrial fibrillation was 37.0% (95% confidence interval 34.3% to 39.6%). The lifetime risk of atrial fibrillation was 23.4% (12.8% to 34.5%) with an optimal risk profile, 33.4% (27.9% to 38.9%) with a borderline risk profile, and 38.4% (35.5% to 41.4%) with an elevated risk profile. Overall, participants with at least one elevated risk factor were associated with at least 37.8% lifetime risk of atrial fibrillation. The gradient in lifetime risk across risk factor burden was similar at index ages 65 and 75 years. CONCLUSIONS Regardless of index ages at 55, 65, or 75 years, an optimal risk factor profile was associated with a lifetime risk of atrial fibrillation of about one in five; this risk rose to more than one in three a third in individuals with at least one elevated risk factor.
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Affiliation(s)
- Laila Staerk
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, USA
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Biqi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Sarah R Preis
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Martin G Larson
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Steven A Lubitz
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, USA
| | - Patrick T Ellinor
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, USA
| | - David D McManus
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Darae Ko
- Sections of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, USA
| | - Lu-Chen Weng
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, USA
| | - Kathryn L Lunetta
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lars Frost
- Silkeborg Hospital, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, USA
- Sections of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
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Leitz P, Mönnig G, Güner F, Dechering DG, Wasmer K, Reinke F, Lange PS, Eckardt L, Frommeyer G. Comparing learning curves of two established "single-shot" devices for ablation of atrial fibrillation. J Interv Card Electrophysiol 2018; 53:317-322. [PMID: 29679185 DOI: 10.1007/s10840-018-0361-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE We compared the contour of learning curves of two "single-shot" devices used for pulmonary vein isolation (PVI) for safety and procedural data. METHODS We performed a retrospective analysis comparing the first 60 PVI performed at our center using a pulmonary vein ablation catheter (PVAC) array (39 male, mean age 57 years, 42 paroxysmal AF) to the first 60 first PVI using the Cryoballoon (44 male, mean age 59 years, 22 paroxysmal AF). Both groups were further divided into tertiles, where T1 regroups the first 20 ablations, T2 the following 20, and T3 the last 20 ablations. RESULTS The mean total procedure time was reduced by 24 min between T1 and T3 for the PVAC and 15 min for the Cryoballoon (p = 0.01). Fluoroscopy increased by 5 min, total ablation time was reduced by 7 min for PVAC (p = 0.02), and both times decreased respectively by 7 and 1 min for the Cryoballoon (p = ns). In the PVAC group, a mean rate of 0.16 (T1: n = 5; T2: n = 2; T3: n = 3) complications was observed while a rate of 0.16 (T1: n = 2; T2: n = 3; T3: n = 4) occurred in the CRYO group (p = ns). Severe complications defined as stroke, pericardial tamponade with need of pericardiocentesis and phrenic nerve palsy occurred in n = 4 in both groups (6.6%). CONCLUSIONS With either of the systems, no significant differences in the effect of the learning curve on the occurrence of adverse events were observed. However, the PVAC array seemed to have a steeper learning curve for procedure, as well as fluoroscopy time.
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Affiliation(s)
- Patrick Leitz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
| | - G Mönnig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - F Güner
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - D G Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - K Wasmer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - F Reinke
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Philipp S Lange
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - L Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - G Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
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Effect of Electrophysiology Assessment on Mortality and Hospitalizations in Patients With New-Onset Atrial Fibrillation. Am J Cardiol 2018; 121:830-835. [PMID: 29397105 DOI: 10.1016/j.amjcard.2017.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/03/2017] [Accepted: 12/27/2017] [Indexed: 11/22/2022]
Abstract
Few patients with atrial fibrillation (AF) receive care by cardiac electrophysiologists. Although previous work has highlighted differential care for patients with AF treated by electrophysiologists, it is unclear whether this is associated with improved clinical outcomes. This retrospective population-level propensity score-matched cohort study included patients aged 20 to 80 years with new-onset AF presenting to an emergency department (ED) in Ontario, Canada, between 2010 and 2012. Patients were followed until March 31, 2015. Patients who saw an electrophysiologist within 1 year of the index ED visit were matched to patients who did not see an electrophysiologist. Linked administrative databases were used for cohort construction and allow 1-year follow-up to assess for the clinical end points of all-cause mortality and hospitalization for AF, heart failure, bleeding, and stroke. A total of 5,221 unique pairs of patients were matched. One hundred seventeen patients (2.2%) in the electrophysiologist cohort underwent an AF ablation procedure during the 1-year follow-up period. All-cause mortality (hazard ratio [HR] = 1.1, p = 0.17) and stroke (HR = 1.4, p = 0.09) were not significantly different between the 2 groups. Hospitalization for AF (HR = 1.4, p <0.001), bleeding (HR = 1.5, p = 0.0001), and congestive heart failure (HR = 1.5, p <0.0001) was increased in the group that saw an electrophysiologist. In conclusion, electrophysiologist care was not associated with improved clinical outcomes in patients with new-onset AF.
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4525] [Impact Index Per Article: 754.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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