101
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Himmelreich JCL, Lucassen WAM, Heugen M, Bossuyt PMM, Tan HL, Harskamp RE, van Etten-Jamaludin FS, van Weert HCPM. Frequent premature atrial contractions are associated with atrial fibrillation, brain ischaemia, and mortality: a systematic review and meta-analysis. Europace 2018; 21:698-707. [DOI: 10.1093/europace/euy276] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Martijn Heugen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Amsterdam UMC, University of Amsterdam, Biostatistics and Bioinformatics, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Hanno L Tan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Faridi S van Etten-Jamaludin
- Medical Library, Amsterdam UMC, University of Amsterdam, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
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102
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Killu AM, Granger CB, Gersh BJ. Risk stratification for stroke in atrial fibrillation: a critique. Eur Heart J 2018; 40:1294-1302. [DOI: 10.1093/eurheartj/ehy731] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/03/2018] [Accepted: 11/10/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Ammar M Killu
- Division of Heart Rhythm Services, Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Christopher B Granger
- Division of Cardiovascular Medicine, Department of Internal Medicine, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA
| | - Bernard J Gersh
- Division of Heart Rhythm Services, Department of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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103
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Oesterle A, Ermakov S, Goldschlager N. Does prematurity unmask disease? J Electrocardiol 2018; 51:1117-1119. [DOI: 10.1016/j.jelectrocard.2018.10.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/06/2018] [Accepted: 10/07/2018] [Indexed: 01/09/2023]
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104
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Fredriksson T, Frykman V, Friberg L, Al-Khalili F, Engdahl J, Svennberg E. Usefulness of Short-Lasting Episodes of Supraventricular Arrhythmia (Micro-Atrial Fibrillation) as a Risk Factor for Atrial Fibrillation. Am J Cardiol 2018; 122:1179-1184. [PMID: 30064858 DOI: 10.1016/j.amjcard.2018.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
According to the present European Society of Cardiology's guidelines for atrial fibrillation (AF), the definition of AF contains a 30-second time criterion, based on consensus. The aim of this cohort study is to evaluate whether very short-lasting episodes of AF, micro-AF, are risk factors for developing AF and to compare AF detection between continuous and intermittent ECG recordings applied in parallel. All participants, n = 102, were identified from the STROKESTOP study, a Swedish mass-screening study for AF. Participants were divided into 2 groups depending on results in the STROKESTOP study: a micro-AF group (with abrupt onset episodes of ≥4 consecutive supraventricular beats, irregular rate-to-rate intervals, absence of regular p waves, lasting for <30 seconds), n = 54, and a control group, n = 48. After a follow-up period participants who were clinically free of AF were invited to undergo repeat AF screening during a 2-week period, using continuous ECG recording and 30 seconds intermittent recordings simultaneously. After 2.3years of follow-up, significantly more participants in the micro-AF group had developed AF, 27 of 54 (50%), compared with the control group, 5 of 48 (10%), p < 0.001. Among the 94 participants not already diagnosed with AF who underwent AF-screening, 25 of 25 (100%) AF cases were detected with help of continuous monitoring whereas 10 of 25 (40%) AF cases were found with intermittent ECGs. In conclusion, micro-AF seems to be an important risk factor for the development of AF in an elderly population. The detection of AF was significantly higher using 2 weeks of continuous ECG monitoring compared with intermittent 30-second ECG recordings twice daily for 2 weeks.
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105
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106
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Rho R, Vossler M, Blancher S, Poole JE. Comparison of 2 ambulatory patch ECG monitors: The benefit of the P-wave and signal clarity. Am Heart J 2018; 203:109-117. [PMID: 30072027 DOI: 10.1016/j.ahj.2018.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/19/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Robert Rho
- Overlake Hospital and Medical Clinics, Bellevue, WA.
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107
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Jolobe OM. What Constitutes Truly Low Risk of Stroke? J Emerg Med 2018; 55:419-420. [PMID: 30057007 DOI: 10.1016/j.jemermed.2018.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Oscar M Jolobe
- Manchester Medical Society, Medical Division, Manchester, Lancashire, United Kingdom
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108
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Lip GYH, Coca A, Kahan T, Boriani G, Manolis AS, Olsen MH, Oto A, Potpara TS, Steffel J, Marín F, de Oliveira Figueiredo MJ, de Simone G, Tzou WS, Chiang CE, Williams B, Dan GA, Gorenek B, Fauchier L, Savelieva I, Hatala R, van Gelder I, Brguljan-Hitij J, Erdine S, Lovic D, Kim YH, Salinas-Arce J, Field M. Hypertension and cardiac arrhythmias: a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2018; 19:891-911. [PMID: 28881872 DOI: 10.1093/europace/eux091] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 12/23/2022] Open
Abstract
Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both supraventricular and ventricular arrhythmias may occur in hypertensive patients, especially in those with left ventricular hypertrophy (LVH) or HF. Also, some of the antihypertensive drugs commonly used to reduce blood pressure, such as thiazide diuretics, may result in electrolyte abnormalities (e.g. hypokalaemia, hypomagnesemia), further contributing to arrhythmias, whereas effective control of blood pressure may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between hypertension and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit to comprehensively review the available evidence to publish a joint consensus document on hypertension and cardiac arrhythmias, and to provide up-to-date consensus recommendations for use in clinical practice. The ultimate judgment regarding care of a particular patient must be made by the healthcare provider and the patient in light of all of the circumstances presented by that patient.
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Affiliation(s)
- Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Thomas Kahan
- Karolinska Institutet Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Heart and Health Foundation of Turkey, Ankara, Turkey
| | - Tatjana S Potpara
- School of Medicine, Cardiology Clinic, Clinical Centre of Serbia, Belgrade University, Belgrade, Serbia
| | - Jan Steffel
- Electrophysiology and Cardiac Devices, Department of Cardiology, University Heart Center Zurich; Zurich, Switzerland
| | - Francisco Marín
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | | | - Giovanni de Simone
- Department of Translational Medical Sciences, Federico II University Hospital, via S. Pansini 5, bld # 1, Napoli 80131, Italy
| | - Wendy S Tzou
- Cardiac Electrophysiology, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chern-En Chiang
- Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, UK
| | | | - Gheorghe-Andrei Dan
- Colentina University Hospital, Medicine Faculty, University of Medicine "Carol Davila"-Bucharest Romania
| | | | | | | | - Robert Hatala
- National Cardiovascular Institute, NUSCH, Bratislava, Slovak Republic
| | - Isabelle van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jana Brguljan-Hitij
- University Medical Centre, Hypertension Department, Hospital Dr. Peter Drzaja, Ljubljana, Slovenia
| | - Serap Erdine
- Istanbul University Cerrahpasa Medical School, Head of Hypertension Department, Istanbul, Turkey
| | - Dragan Lovic
- Clinic for internal disease Intermedica, Cardiology department-Hypertension centere, Serbia
| | | | | | - Michael Field
- University of Wisconsin, Clinical Science Center, Madison, USA
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109
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Sampaio RF, Gomes IC, Sternick EB. Cryptogenic Acute Ischemic Stroke: Assessment of the Performance of a New Continuous Long-Term Monitoring System in the Detection of Atrial Fibrillation. Arq Bras Cardiol 2018; 111:122-131. [PMID: 29972414 PMCID: PMC6122902 DOI: 10.5935/abc.20180112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 04/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background Long-term monitoring has been advocated to enhance the detection of atrial
fibrillation (AF) in patients with stroke. Objective To evaluate the performance of a new ambulatory monitoring system with mobile
data transmission (PoIP) compared with 24-hour Holter. We also aimed to
evaluate the incidence of arrhythmias in patients with and without stroke or
transient ischemic attack. Methods Consecutive patients with and without stroke or TIA, without AF, were matched
by propensity score. Participants underwent 24-hour Holter and 7-day PoIP
monitoring. Results We selected 52 of 84 patients (26 with stroke or TIA and 26 controls).
Connection and recording times were 156.5 ± 22.5 and 148.8 ±
20.8 hours, with a signal loss of 6,8% and 11,4%, respectively. Connection
time was longer in ambulatory (164.3 ± 15.8 h) than in hospitalized
patients (148.8 ± 25.6 h) (p = 0.02), while recording time did not
differ between them (153.7 ± 16.9 and 143.0 ± 23.3 h). AF
episodes were detected in 1 patient with stroke by Holter, and in 7
individuals (1 control and 6 strokes) by PoIP. There was no difference in
the incidence of arrhythmias between the groups. Conclusions Holter and PoIP performed equally well in the first 24 hours. Data
transmission loss (4.5%) occurred by a mismatch between signal transmission
(2.5G) and signal reception (3G) protocols in cell phone towers (3G). The
incidence of arrhythmias was not different between stroke/TIA and control
groups.
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110
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Kollias A, Destounis A, Kalogeropoulos P, Kyriakoulis KG, Ntineri A, Stergiou GS. Atrial Fibrillation Detection During 24-Hour Ambulatory Blood Pressure Monitoring. Hypertension 2018; 72:110-115. [DOI: 10.1161/hypertensionaha.117.10797] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/12/2018] [Accepted: 04/07/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Anastasios Kollias
- From the Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Antonios Destounis
- From the Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Petros Kalogeropoulos
- From the Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Konstantinos G. Kyriakoulis
- From the Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Angeliki Ntineri
- From the Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - George S. Stergiou
- From the Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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112
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Dan GA, Martinez-Rubio A, Agewall S, Boriani G, Borggrefe M, Gaita F, van Gelder I, Gorenek B, Kaski JC, Kjeldsen K, Lip GYH, Merkely B, Okumura K, Piccini JP, Potpara T, Poulsen BK, Saba M, Savelieva I, Tamargo JL, Wolpert C, Sticherling C, Ehrlich JR, Schilling R, Pavlovic N, De Potter T, Lubinski A, Svendsen JH, Ching K, Sapp JL, Chen-Scarabelli C, Martinez F. Antiarrhythmic drugs–clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP). Europace 2018; 20:731-732an. [DOI: 10.1093/europace/eux373] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Gheorghe-Andrei Dan
- Colentina University Hospital, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Antoni Martinez-Rubio
- University Hospital of Sabadell (University Autonoma of Barcelona), Plaça Cívica, Campus de la UAB, Barcelona, Spain
| | - Stefan Agewall
- Oslo University Hospital Ullevål, Norway
- Institute of Clinical Sciences, University of Oslo, Søsterhjemmet, Oslo, Norway
| | - Giuseppe Boriani
- Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Martin Borggrefe
- Universitaetsmedizin Mannheim, Medizinische Klinik, Mannheim, Germany
| | - Fiorenzo Gaita
- Department of Medical Sciences, University of Turin, Citta' della Salute e della Scienza Hospital, Turin, Italy
| | - Isabelle van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bulent Gorenek
- Department of Cardiology, Eskisehir Osmangazi University, Büyükdere Mahallesi, Odunpazarı/Eskişehir, Turkey
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Keld Kjeldsen
- Copenhagen University Hospital (Holbæk Hospital), Holbæk, Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Centre For Cardiovascular Sciences, City Hospital, Birmingham, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ken Okumura
- Saiseikai Akumamoto Hospital, Kumamoto, Japan
| | | | - Tatjana Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Magdi Saba
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Irina Savelieva
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Juan L Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense Madrid, Madrid, Spain
| | - Christian Wolpert
- Department of Medicine - Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Joachim R Ehrlich
- Medizinische Klinik I-Kardiologie, Angiologie, Pneumologie, Wiesbaden, Germany
| | - Richard Schilling
- Barts Heart Centre, Trustee Arrhythmia Alliance and Atrial Fibrillation Association, London, UK
| | - Nikola Pavlovic
- Department of Cardiology, University Hospital Centre Sestre milosrdnice, Croatia
| | | | - Andrzej Lubinski
- Uniwersytet Medyczny w Łodzi, Kierownik Kliniki Kardiologii Interwencyjnej, i Zaburzeń Rytmu Serca, Kierownik Katedry Chorób Wewnętrznych i Kardiologii, Uniwersytecki Szpital Kliniczny im WAM-Centralny Szpital Weteranów, Poland
| | | | - Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Felipe Martinez
- Instituto DAMIC/Fundacion Rusculleda, Universidad Nacional de Córdoba, Córdoba, Argentina
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113
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Parreira L, Marinheiro R. “Excessive” atrial ectopy is worse than “frequent” atrial ectopy. Int J Cardiol 2018; 251:54. [DOI: 10.1016/j.ijcard.2017.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
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114
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Qin F, Liu N, Liu C, Bai F, Sun C, Li B, Liu Q, Liu Z. Could excessive atrial ectopic activity be an independent risk factor for ischemic stroke? Int J Cardiol 2018; 251:53. [DOI: 10.1016/j.ijcard.2017.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/26/2022]
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115
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Aizawa Y, Watanabe H, Okumura K. Electrocardiogram (ECG) for the Prediction of Incident Atrial Fibrillation: An Overview. J Atr Fibrillation 2017; 10:1724. [PMID: 29487684 DOI: 10.4022/jafib.1724] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/19/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022]
Abstract
Electrocardiograms (ECGs) have been employed to medically evaluate participants in population-based studies, and ECG-derived predictors have been reported for incident atrial fibrillation (AF). Here, we reviewed the status of ECG in predicting new-onset AF. We surveyed population-based studies and revealed ECG variables to be risk factors for incident AF. When available, the predictive values of each ECG risk marker were calculated. Both the atrium-related and ventricle-related ECG variables were risk factors for incident AF, with significant hazard risks (HRs) even after multivariate adjustments. The risk factors included P-wave indices (maximum P-wave duration, its dispersion or variation and P-wave morphology) and premature atrial contractions (PACs) or runs. In addition, left ventricular hypertrophy (LVH), ST-T abnormalities, intraventricular conduction delay, QTc interval and premature ventricular contractions (PVCs) or runs were a risk of incident AF. An HR of greater than 2.0 was observed in the upper 5th percentile of the P-wave durations, P-wave durations greater than 130 ms, P-wave morpholyg, PACs (PVCs) or runs, LVH, QTc and left anterior fascicular blocks. The sensitivity , specificity and the positive and negative predictive values were 3.6-53.8%, 61.7-97.9%, 2.9-61.7% and 77.4-97.7%, respectively. ECG variables are risk factors for incident AF. The correlation between the ECG-derived AF predictors, especially P-wave indices, and underlying diseases and the effects of the reversal of the ECG-derived predictors on incident AF by treatment of comorbidities require further study.
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Affiliation(s)
- Yoshifusa Aizawa
- Research and Development, Tachikawa Medical Center and Niigata University,Nagaoka and Niigata,Japan
| | - Hiroshi Watanabe
- Department of Cardiology, Graduate School of Medical and Dental Science,Niigata University, Niigata, Japan
| | - Ken Okumura
- Arrhythmia Center,Saiseikai Hospital Kumamoto, Kumamoto, Japan
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116
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Marinheiro R, Parreira L, Amador P, Sá C, Duarte T, Caria R. Excessive atrial ectopic activity as an independent risk factor for ischemic stroke. Int J Cardiol 2017; 249:226-230. [DOI: 10.1016/j.ijcard.2017.08.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/08/2017] [Accepted: 08/21/2017] [Indexed: 11/28/2022]
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117
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Christensen MA, Nguyen KT, Stein PK, Fohtung RB, Soliman EZ, Dewland TA, Vittinghoff E, Psaty BM, Heckbert SR, Marcus GM. Atrial ectopy as a mediator of the association between race and atrial fibrillation. Heart Rhythm 2017; 14:1856-1861. [PMID: 29110996 PMCID: PMC5712237 DOI: 10.1016/j.hrthm.2017.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Blacks have a lower risk of atrial fibrillation (AF) despite having more AF risk factors, but the mechanism remains unknown. Premature atrial contraction (PAC) burden is a recently identified risk factor for AF. OBJECTIVE The purpose of this study was to determine whether the burden of PACs explains racial differences in AF risk. METHODS PAC burden (number per hour) was assessed by 24-hour ambulatory electrocardiographic (ECG) monitoring in a randomly selected subset of patients in the Cardiovascular Health Study. Participants were followed prospectively for the development of AF, diagnosed by study ECG and hospital admission records. RESULTS Among 938 participants (median age 73 years; 34% black; 58% female), 206 (22%) developed AF over a median follow-up of 11.0 years (interquartile range 6.1-13.4). After adjusting for age, sex, body mass index, coronary disease, congestive heart failure, diabetes, hypertension, alcohol consumption, smoking status, and study site, black race was associated with a 42% lower risk of AF (hazard ratio 0.58, 95% confidence interval [CI] 0.40-0.85; P = .005). The baseline PAC burden was 2.10 times (95% CI 1.57-2.83; P <.001) higher in whites than blacks. There was no detectable difference in premature ventricular contraction (PVC) burden by race. PAC burden mediated 19.5% (95% CI 6.3-52.5) of the adjusted association between race and AF. CONCLUSION On average, whites exhibited more PACs than blacks, and this difference statistically explains a modest proportion of the differential risk of AF by race. The differential PAC burden, without differences in PVCs, by race suggests that identifiable common exposures or genetic influences might be important to atrial pathophysiology.
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Affiliation(s)
- Matthew A Christensen
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California; University of Michigan Medical School, Ann Arbor, Michigan
| | - Kaylin T Nguyen
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Phyllis K Stein
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri
| | | | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Wake Forest University, Winston Salem, North Carolina
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Sciences, University of Washington, Seattle, Washington
| | - Susan R Heckbert
- Group Health Research Institute, Group Health Cooperation, Seattle, Washington
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
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118
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Yamada S, Lin CY, Chang SL, Chao TF, Lin YJ, Lo LW, Chung FP, Hu YF, Tuan TC, Liao JN, Te ALD, Chang YT, Chang TY, Wu CI, Higa S, Chen SA. Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia. Stroke 2017; 48:3232-3238. [PMID: 29146875 DOI: 10.1161/strokeaha.117.018475] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE The risk of stroke in patients with short-run atrial tachyarrhythmia (AT) remains unclear. This study aimed to investigate the relationship between short-run AT and the stroke and the use of the CHA2DS2-VASc score for the risk stratification. METHODS From the registry of 24-hour Holter monitoring, 5342 subjects without known atrial fibrillation or stroke were enrolled. Short-run AT was defined as episodes of supraventricular ectopic beats <5 seconds. RESULTS There were 1595 subjects (29.8%) with short-run AT. During the median follow-up period of 9.0 years, 494 subjects developed new-onset stroke. Patients with short-run AT had significantly higher stroke rates compared with patients without short-run AT (11.4% versus 8.3%; P<0.001). In patients with short-run AT, the number of strokes per 100 person-years for patients with CHA2DS2-VASc score of 0 and 1 were 0.23 and 0.67, respectively. However, the number of them for patients with CHA2DS2-VASc score of 2, 3, 4, and ≥5 were 1.62, 1.89, 1.30, and 2.91, respectively. In patients with CHA2DS2-VASc score of 0 or 1, age (>61 years old) and burden of premature atrial contractions (>25 beats/d) independently predicted the risk of stroke. In subgroup analyses, short-run AT patients were divided into 3 groups based on their CHA2DS2-VASc scores: low score (score of 0 [men] or 1 [women]; n=324), intermediate score (score of 1 [men] or 2 [women]; n=275), and high score (score of ≥2 [men] or ≥3 [women]; n=996). When compared with low score, intermediate and high scores were independent predictors for stroke (hazard ratio, 6.165; P<0.001 and hazard ratio, 8.577; P<0.001, respectively). CONCLUSIONS Short-run AT increases the risk of stroke. Therefore, the CHA2DS2-VASc score could be used for the risk stratification. Age and burden of premature atrial contractions were independent predictors for stroke in patients with CHA2DS2-VASc score of 0 or 1.
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Affiliation(s)
- Shinya Yamada
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Chin-Yu Lin
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Shih-Lin Chang
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.).
| | - Tze-Fan Chao
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Yenn-Jiang Lin
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Li-Wei Lo
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Fa-Po Chung
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Yu-Feng Hu
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Ta-Chuan Tuan
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Jo-Nan Liao
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Abigail Louise D Te
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Yao-Ting Chang
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Ting-Yung Chang
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Cheng-I Wu
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Satoshi Higa
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Shih-Ann Chen
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
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Kumarathurai P, Mouridsen MR, Mattsson N, Larsen BS, Nielsen OW, Gerds TA, Sajadieh A. Atrial ectopy and N-terminal pro-B-type natriuretic peptide as predictors of atrial fibrillation: a population-based cohort study. Europace 2017; 19:364-370. [PMID: 27194537 DOI: 10.1093/europace/euw017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/17/2016] [Indexed: 11/15/2022] Open
Abstract
Aims The risk of incident atrial fibrillation (AF) can be estimated by clinical parameters in the Framingham AF risk model. Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) and increased rate of premature atrial contractions (PACs) have been shown to be associated with AF, but the additive value of both of these biomarkers in the Framingham AF risk model has not been fully examined. Methods and results A total of 646 subjects from the Copenhagen Holter Study (mean age 64.4 ± 6.8 years, 41.6% women) with no history of prior AF, stroke or cardiovascular disease were followed for the diagnosis of incident AF or death (median follow-up time 14.4 years). Median NT-proBNP was 6.7 pmol/L (IQR: 3.6-13.5), median PAC count was 1.4 beats/h (IQR: 0.6-4.5), 71 (11.0%) subjects developed AF, and 244 (37.8%) died. Multiple Cox regression including Framingham AF risk score, log-transformed NT-proBNP, and log-transformed PAC showed a significant increase in AF hazard risk [hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.14-1.85, P = 0.002; HR 1.23, 95% CI 1.09-1.39, P = 0.001]. The addition of PAC to the Framingham AF risk model significantly improved the time-dependent area under the receiver operating characteristic curve (AUC 65.6 vs. 72.6; P = 0.008), while the addition of NT-proBNP did not. Conclusion Atrial fibrillation risk discrimination was significantly improved by the addition of PAC to the Framingham AF risk model, but not by the addition of NT-proBNP.
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Affiliation(s)
- Preman Kumarathurai
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Mette R Mouridsen
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Nick Mattsson
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Bjørn S Larsen
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Olav W Nielsen
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
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Abstract
Premature atrial and ventricular contractions, or ectopic beats, are frequently detected on routine electrocardiogram monitoring. They are often considered to be benign with no pathological significance; however, the literature suggests that higher ectopic burdens may have clinical importance. This paper reviews the current literature and provides the treating physician with an understanding of when ectopic beats should be deemed significant and when treatment may be appropriate.
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Cogswell R, Norby FL, Gottesman RF, Chen LY, Solomon S, Shah A, Alonso A. High prevalence of subclinical cerebral infarction in patients with heart failure with preserved ejection fraction. Eur J Heart Fail 2017; 19:1303-1309. [PMID: 28738140 PMCID: PMC5933437 DOI: 10.1002/ejhf.812] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
AIMS Undetected atrial fibrillation (AF) may be common in the heart failure with preserved ejection fraction (HFpEF) population, and failure to detect this may lead to the missing of opportunities to prevent associated subclinical cerebral infarctions (SCIs) and cognitive decline. METHODS AND RESULTS We studied 1527 participants in the Atherosclerosis Risk in Communities (ARIC) Study, who underwent echocardiography, brain magnetic resonance imaging (MRI) and detailed cognitive assessment during 2011-13. Prevalences of SCI as detected by brain MRI were compared among the following groups: participants with no HFpEF/no AF; those with no HFpEF/AF; those with HFpEF/no AF, and those with HFpEF/AF. Cognitive scores were also compared. Prevalences of HFpEF and AF in this sample were 13.2% and 5.7%, respectively. Participants with HFpEF but no prior diagnosis of AF had a high prevalence of SCI by brain MRI (29.3%), which was similar to those in the no HFpEF/AF (24.5%) and HFpEF/AF (23.5%) groups, but higher than that in the no HFpEF/no AF subjects (17.3%). The odds of having SCI were higher in participants with HFpEF/no AF than in the no HFpEF/no AF group even after adjustment for potential confounders (odds ratio 1.56, 95% confidence interval 1.06-2.30). Individuals with HFpEF and SCI had lower cognitive scores than the reference (no HFpEF/no SCI) and HFpEF/no SCI groups. CONCLUSIONS Subclinical cerebral infarctions were prevalent in subjects in the ARIC cohort with HFpEF and no prior AF diagnosis and are associated with measurable cognitive deficits. Although other sources of emboli may be possible, these data suggest that paroxysmal AF may be underdiagnosed in this population. There may be a role for earlier anticoagulation in patients with HFpEF.
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Affiliation(s)
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | | | - Lin Y. Chen
- Division of Cardiology, University of Minnesota
| | - Scott Solomon
- Cardiovascular Division, Brigham and Women’s Hospital
| | - Amil Shah
- Cardiovascular Division, Brigham and Women’s Hospital
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
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Weber-Krüger M, Lutz C, Zapf A, Stahrenberg R, Seegers J, Witzenhausen J, Wasser K, Hasenfuß G, Gröschel K, Wachter R. Relevance of supraventricular runs detected after cerebral ischemia. Neurology 2017; 89:1545-1552. [PMID: 28904084 DOI: 10.1212/wnl.0000000000004487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 07/03/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Prolonged ECG monitoring after stroke frequently reveals short paroxysmal atrial fibrillation (pAF) and supraventricular (SV) runs. The minimal duration of atrial fibrillation (AF) required to induce cardioembolism, the relevance of SV runs, and whether short pAF results from cerebral damage itself are currently being debated. We aimed to study the relevance of SV runs and short pAF detected by prolonged Holter ECG after cerebral ischemia during long-term follow-up. METHODS Analysis is from the prospective Find-AF trial (ISRCTN46104198). We included patients with acute cerebral ischemia. Those without AF on admission received 7-day Holter ECG monitoring. We differentiated patients with AF on admission (AF-adm), with pAF (>30 seconds), with SV runs (>5 beats but <30 seconds in a 24-hour ECG interval), and without SV runs (controls). During follow-up, those with baseline pAF received another 7-day Holter ECG to examine AF persistence. RESULTS A total of 254 of 281 initially included patients were analyzed (mean age 70.0 years, 45.3% female). Forty-three (16.9%) had AF-adm. A total of 211 received 7-day Holter ECG monitoring: 27 (12.8%) had pAF, 67 (31.8%) had SV runs, and 117 (55.5%) were controls. During a mean 3.7 years of follow-up, the SV runs group had more recurrent strokes (p = 0.04) and showed numerically more novel AF (12% vs 5%, p = 0.09) than the controls. Seventy-five percent of the patients with manifest pAF detected after cerebral ischemia still had AF during follow-up (50% paroxysmal, 50% persisting/permanent). CONCLUSIONS Patients with cerebral ischemia and SV runs had more recurrent strokes and numerically more novel AF during follow-up and could benefit from further prolonged ECG monitoring. pAF detected after stroke is not a temporal phenomenon.
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Affiliation(s)
- Mark Weber-Krüger
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany.
| | - Constanze Lutz
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
| | - Antonia Zapf
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
| | - Raoul Stahrenberg
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
| | - Joachim Seegers
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
| | - Janin Witzenhausen
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
| | - Katrin Wasser
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
| | - Gerd Hasenfuß
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
| | - Klaus Gröschel
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
| | - Rolf Wachter
- From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany
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Huang BT, Huang FY, Peng Y, Liao YB, Chen F, Xia TL, Pu XB, Chen M. Relation of premature atrial complexes with stroke and death: Systematic review and meta-analysis. Clin Cardiol 2017; 40:962-969. [PMID: 28846809 DOI: 10.1002/clc.22780] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 02/05/2023] Open
Abstract
Frequent premature atrial complexes (PACs) are universal in the general population; however, their clinical significance is unclear. We hypothesize that frequent PACs are associated with increased risk of stroke and death. The PubMed (from 1966 to April 2017) and Embase (from 1974 to April 2017) databases were searched for longitudinal studies that reported the relation of PACs with incidence of stroke and death with various etiologies. Study quality was evaluated, and the relative risks (RR) of unfavorable outcomes in subjects with frequent PACs vs those without were calculated. Eleven studies with overall high quality were eligible according to inclusion criteria. The meta-analysis demonstrated that frequent PACs were associated with an increased risk of stroke (unadjusted RR: 2.20, 95% confidence interval [CI]: 1.79-2.70; adjusted RR: 1.41, 95% CI: 1.25-1.60) and death from all causes (unadjusted RR: 2.17, 95% CI: 1.80-2.63; adjusted RR: 1.26, 95% CI: 1.13-1.41), cardiovascular diseases (unadjusted RR: 2.89, 95% CI: 2.20-3.79; adjusted RR: 1.38, 95% CI: 1.24-1.54), and coronary artery disease (unadjusted RR: 2.74, 95% CI: 1.64-4.58; adjusted RR: 1.74, 95% CI: 1.27-2.37). No significant publication bias was detected. The association was robust in sensitivity analysis, subgroup analysis, and pooled analysis of estimates adjusting for confounding factors. Frequent PACs are not benign phenomena; they are associated with higher risk of unfavorable outcomes. Further research on the optimal management of subjects with frequent PACs is urgently required.
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Affiliation(s)
- Bao-Tao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Li Xia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Bo Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Gorenek B, Bax J, Boriani G, Chen SA, Dagres N, Glotzer TV, Healey JS, Israel CW, Kudaiberdieva G, Levin LÅ, Lip GYH, Martin D, Okumura K, Svendsen JH, Tse HF, Botto GL, Sticherling C, Linde C, Kutyifa V, Bernat R, Scherr D, Lau CP, Iturralde P, Morin DP, Savelieva I, Lip G, Gorenek B, Sticherling C, Fauchier L, Goette A, Jung W, Vos MA, Brignole M, Elsner C, Dan GA, Marin F, Boriani G, Lane D, Lundqvist CB, Savelieva I. Device-detected subclinical atrial tachyarrhythmias: definition, implications and management—an European Heart Rhythm Association (EHRA) consensus document, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2017; 19:1556-1578. [DOI: 10.1093/europace/eux163] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/04/2017] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Jeroen Bax
- Leiden University Medical Center (Lumc), Leiden, the Netherlands
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
| | - Shih-Ann Chen
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig – Heart Center, Leipzig, Germany
| | - Taya V Glotzer
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - David Martin
- Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | | | - Hung-Fat Tse
- Cardiology Division, Department of Medicine; The University of Hong Kong, Hong Kong
| | | | | | | | | | | | | | | | | | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, USA
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125
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Sejr MH, Riahi S, Larsen TB, Nielsen JC, Nielsen PB. Premature atrial complexes in an ischemic stroke population and risk of recurrent stroke: a systematic review. Expert Rev Cardiovasc Ther 2017; 15:447-455. [PMID: 28532180 DOI: 10.1080/14779072.2017.1332992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Premature atrial complexes (PACs) have been proposed as a possible mediator between normal sinus rhythm and atrial fibrillation (AF). The aim of this study was to summarize the available knowledge of association between PACs and recurrent stroke or transient ischemic attack (TIA) in ischemic stroke patients. Areas covered: In this systematic review, we investigated the risk of recurrent events in patients who experienced ischemic stroke or TIA. Occurrence of PACs in electrocardiographic monitoring after index stroke/TIA was required. We identified and included three observational cohort studies, investigating in total 1005 patients. The studies reported that a significant burden of PACs occurred in a high proportion of stroke and TIA patients. More PACs were independently associated with an increased risk of recurrent stroke or TIA or the composite of recurrent stroke/TIA or death. Definition of PACs cut-off as well as patient characteristics differed between groups. Expert Commentary: This review supports an association between higher burden of PACs and recurrent stroke, and stresses the need for studies on PACs in stroke patients. A special awareness of stroke patients with a high PACs load is recommendable particularly for assessing the intensity and duration toward AF progression, and possible future treatment recommendations.
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Affiliation(s)
| | - Sam Riahi
- b Department of Clinical Medicine and AF-study group , Aalborg University , Aalborg , Denmark
| | | | | | - Peter Brønnum Nielsen
- b Department of Clinical Medicine and AF-study group , Aalborg University , Aalborg , Denmark.,d Department of Health Science and Technology , Aalborg University , Aalborg , Denmark
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Abstract
Cardiac embolism accounts for an increasing proportion of ischemic strokes and might multiply several-fold during the next decades. However, research points to several potential strategies to stem this expected rise in cardioembolic stroke. First, although one-third of strokes are of unclear cause, it is increasingly accepted that many of these cryptogenic strokes arise from a distant embolism rather than in situ cerebrovascular disease, leading to the recent formulation of embolic stroke of undetermined source as a distinct target for investigation. Second, recent clinical trials have indicated that embolic stroke of undetermined source may often stem from subclinical atrial fibrillation, which can be diagnosed with prolonged heart rhythm monitoring. Third, emerging evidence indicates that a thrombogenic atrial substrate can lead to atrial thromboembolism even in the absence of atrial fibrillation. Such an atrial cardiomyopathy may explain many cases of embolic stroke of undetermined source, and oral anticoagulant drugs may prove to reduce stroke risk from atrial cardiomyopathy given its parallels to atrial fibrillation. Non-vitamin K antagonist oral anticoagulant drugs have recently expanded therapeutic options for preventing cardioembolic stroke and are currently being tested for stroke prevention in patients with embolic stroke of undetermined source, including specifically those with atrial cardiomyopathy. Fourth, increasing appreciation of thrombogenic atrial substrate and the common coexistence of cardiac and extracardiac stroke risk factors suggest benefits from global vascular risk factor management in addition to anticoagulation. Finally, improved imaging of ventricular thrombus plus the availability of non-vitamin K antagonist oral anticoagulant drugs may lead to better prevention of stroke from acute myocardial infarction and heart failure.
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Affiliation(s)
- Hooman Kamel
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (H.K.) and Department of Neurology, Weill Cornell Medicine, New York, NY (H.K.); and Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.).
| | - Jeff S Healey
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (H.K.) and Department of Neurology, Weill Cornell Medicine, New York, NY (H.K.); and Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
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127
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Mattsson N, Kumarathurai P, Larsen BS, Nielsen OW, Sajadieh A. Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects. Stroke 2017; 48:537-543. [PMID: 28174323 DOI: 10.1161/strokeaha.116.015439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/05/2016] [Accepted: 12/13/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is independently associated with the common conditions of hypokalemia and supraventricular ectopy, and we hypothesize that the combination of excessive supraventricular ectopic activity and hypokalemia has a synergistic impact on the prognosis in terms of stroke in the general population. METHODS Subjects (55-75 years old) from the Copenhagen Holter Study cohort (N=671) with no history of atrial fibrillation or stroke were studied-including baseline values of potassium and ambulatory 48-hour Holter monitoring. Excessive supraventricular ectopic activity is defined as ≥30 premature atrial complexes per hour or any episodes of runs of ≥20. Hypokalemia was defined as plasma-potassium ≤3.6 mmol/L. The primary end point was ischemic stroke. Cox models were used. RESULTS Hypokalemia was mild (mean, 3.4 mmol/L; range, 2.7-3.6). Hypokalemic subjects were older (67.0±6.94 versus 64.0±6.66 years; P<0.0001) and more hypertensive (165.1±26.1 versus 154.6±23.5 mm Hg; P<0.0001). Median follow-up time was 14.4 years (Q1-Q3, 9.4-14.7 years). The incidence of stroke was significantly higher in the hypokalemic group (hazard ratio, 1.84; 95% confidence interval, 1.04-3.28) after covariate adjustments, as well as in a competing risk analysis with death (hazard ratio, 1.51; 95% confidence interval, 1.12-2.04). Excessive supraventricular ectopic activity was also associated with stroke (hazard ratio, 2.23; 95% confidence interval, 1.33-3.76). The combination of hypokalemia and excessive supraventricular ectopic activity increased the risk of events synergistically. Stroke rate was 93 per 1000 patient-year (P<0.0001) in this group (n=17) compared with 6.9 (n=480); 11 (n=81), and 13 (n=93) per 1000 patient-year in the groups without the combination. CONCLUSIONS The combination of hypokalemia and excessive supraventricular ectopy carries a poor prognosis in terms of stroke.
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Affiliation(s)
- Nick Mattsson
- From the Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark.
| | - Preman Kumarathurai
- From the Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark
| | - Bjørn Strøier Larsen
- From the Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark
| | - Olav Wendelboe Nielsen
- From the Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark
| | - Ahmad Sajadieh
- From the Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark
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128
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Long-Term Antiarrhythmic Effects of Thrombolytic Therapy in Pulmonary Embolism. Heart Lung Circ 2017; 26:1094-1100. [PMID: 28169085 DOI: 10.1016/j.hlc.2016.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The role of thrombolytic therapy in acute pulmonary embolism patients is still controversial considering the occurrence of arrhythmias. Short-term effects of thrombolytics are well-known whereas long-term effects on cardiac electrophysiology have not been reported before. The objective of our study was to assess the arrhythmic differences in pulmonary embolism patients who received thrombolytics followed by anticoagulation or anticoagulation alone. METHODS Sixty patients who received thrombolytic therapy followed by anticoagulation (group 1) and 60 patients who received anticoagulation alone (group 2) were included in this retrospective, single-centre observational study. Twenty-four-hour ambulatory electrocardiography was performed 31 ± 9 months after pulmonary embolism hospitalisation in order to compare arrhythmias originating from both ventricles and atria. RESULTS The age and gender distribution of the patients were statistically similar. Ventricular arrhythmias were found to be the same between t-PA and non t-PA groups. All types of atrial arrhythmias were found to be increased in non t-PA group even though left and right atrial volume indexes were statistically identical between the two groups. CONCLUSION In long-term pulmonary embolism, follow-up thrombolytic therapy was demonstrated to have atrial antiarrhythmic effects.
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129
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Meyer ML, Soliman EZ, Wruck LM, Mosley TH, Wagenknecht LE, Poon AK, Whitsel EA, Alonso A, Heiss G, Loehr LR. Repeatability of ectopic beats from 48-hr ambulatory electrocardiography: The Atherosclerosis Risk in Communities (ARIC) Study. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28058808 DOI: 10.1111/anec.12426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize the repeatability of ectopic beats, defined by premature atrial contractions (PACs) and premature ventricular contractions (PVCs), on ambulatory electrocardiogram (aECG) monitoring and evaluate the effect of length of aECG monitoring on the repeatability estimates. METHODS This analysis includes 95 randomly selected participants from the Atherosclerosis Risk in Communities Study (ARIC; 2011-2013). The participants wore a Holter monitor for two, 48-hr periods separated by a mean of 38 days following an identical, standardized protocol. We divided each 48-hr recording into 3-, 6-, 12-, and 24-hr recording periods and calculated intraclass correlation coefficients (ICCs) for PACs and PVCs and also as a percentage of the corresponding total of recorded beats per hour among these periods. RESULTS All participants had ≥1 PAC during the 48-hr recordings, and only two participants had no PVCs. ICCs were >0.83 for all indices and recording lengths ≥12 hrs. ICCs were intermediate for 6-hr recordings (range 0.80-0.83) and lower for 3-hr recordings (range 0.74-0.80). The ratio of the between- to within-participant variation increased with recording length. CONCLUSION Repeatability of PACs and PVCs was excellent for recording lengths of 6-24 hr and fair for 3 hr. Repeatability varies over shorter duration recordings within the 48-hr recording period, and thus the present results have implications for detection algorithms for ectopic beats and can facilitate epidemiologic and clinical applications in which knowledge of measurement variability and misclassification are needed.
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Affiliation(s)
- Michelle L Meyer
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Lisa M Wruck
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Anna K Poon
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric A Whitsel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alvaro Alonso
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura R Loehr
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Gaita F, Castagno D. Do supraventricular premature beats identify patients at high risk for atrial fibrillation? J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1:e117-e120. [DOI: 10.2459/jcm.0000000000000473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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131
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Excessive Premature Atrial Complexes and the Risk of Recurrent Stroke or Death in an Ischemic Stroke Population. J Stroke Cerebrovasc Dis 2016; 26:1163-1170. [PMID: 27894888 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 10/28/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Our aim was to investigate the association of premature atrial complexes and the risk of recurrent stroke or death in patients with ischemic stroke in sinus rhythm. METHODS In a prospective cohort study, we used 24-hour Holter recordings to evaluate premature atrial complexes in patients consecutively admitted with ischemic strokes. Excessive premature atrial complexes were defined as >14 premature atrial complexes per hour and 3 or more runs of premature atrial complexes per 24 hours. During follow-up, 48-hour Holter recordings were performed after 6 and 12 months. Among patients in sinus rhythm, the association of excessive premature atrial complexes and the primary end point of recurrent stroke or death were estimated in both crude and adjusted Cox proportional hazards models. We further evaluated excessive premature atrial complexes contra atrial fibrillation in relation to the primary end point. RESULTS Of the 256 patients included, 89 had atrial fibrillation. Of the patients in sinus rhythm (n = 167), 31 had excessive premature atrial complexes. During a median follow-up of 32 months, 50 patients (30% of patients in sinus rhythm) had recurrent strokes (n = 20) or died (n = 30). In both crude and adjusted models, excessive premature atrial complexes were associated with the primary end point, but not with newly diagnosed atrial fibrillation. Compared with patients in atrial fibrillation, those with excessive premature atrial complexes had similarly high risks of the primary end point. CONCLUSIONS In patients with ischemic stroke and sinus rhythm, excessive premature atrial complexes were associated with a higher risk of recurrent stroke or death.
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Clinical Implications of Brief Device-Detected Atrial Tachyarrhythmias in a Cardiac Rhythm Management Device Population. Circulation 2016; 134:1130-1140. [DOI: 10.1161/circulationaha.115.020252] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 09/02/2016] [Indexed: 12/12/2022]
Abstract
Background:
The RATE Registry (Registry of Atrial Tachycardia and Atrial Fibrillation Episodes) is a prospective, outcomes-oriented registry designed to document the prevalence of atrial tachycardia and/or fibrillation (AT/AF) of any duration in patients with pacemakers and implantable cardioverter defibrillators (ICDs) and evaluate associations between rigorously adjudicated AT/AF and predefined clinical events, including stroke. The appropriate clinical response to brief episodes of AT/AF remains unclear.
Methods:
Rigorously adjudicated electrogram (EGM) data were correlated with adjudicated clinical events with logistic regression and Cox models.
Long episodes of AT/AF
were defined as episodes in which the onset and/or offset of AT/AF was not present within a single EGM recording.
Short episodes of AT/AF
were defined as episodes in which both the onset and offset of AT/AF were present within a single EGM recording.
Results:
We enrolled 5379 patients with pacemakers (N=3141) or ICDs (N=2238) at 225 US sites (median follow-up 22.9 months). There were 359 deaths. There were 478 hospitalizations among 342 patients for clinical events. We adjudicated 37 531 EGMs; 50% of patients had at least one episode of AT/AF. Patients with clinical events were more likely than those without to have long AT/AF (31.9% vs. 22.1% for pacemaker patients and 28.7% vs. 20.2% for ICD patients;
P
<0.05 for both groups). Only short episodes of AT/AF were documented in 9% of pacemaker patients and 16% of ICD patients. Patients with clinical events were no more likely than those without to have short AT/AF (5.1% vs. 7.9% for pacemaker patients and 11.5% vs. 10.4% for ICD patients;
P
=0.21 and 0.66, respectively).
Conclusions:
In the RATE Registry, rigorously adjudicated short episodes of AT/AF, as defined, were not associated with increased risk of clinical events compared with patients without documented AT/AF.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00837798.
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133
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Yetim E, Topcuoglu MA, Canpolat U, Gocmen R, Oguz KK, Ozer N, Aytemir K, Arsava EM. Nonsustained Atrial Fibrillation in Ischemic Stroke Patients and Stroke-Free Controls From the Perspective of Stroke Pathophysiology. J Am Heart Assoc 2016; 5:e004021. [PMID: 27694327 PMCID: PMC5121503 DOI: 10.1161/jaha.116.004021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/08/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Short-lasting (<30 s), nonsustained episodes of atrial fibrillation (NS-AF) are considered a risk factor for future development of paroxysmal or persistent AF. Nonetheless, their causal role in stroke pathogenesis is currently unknown. In this study we determined the frequency of NS-AF, together with the associated clinical and imaging features, in stroke-free controls and ischemic stroke patients. METHODS AND RESULTS A total of 332 controls, ≥50 years of age and no prior history of stroke or AF, were evaluated with 24-hour Holter monitoring for the presence of <30-s-long AF episodes. The demographic and cardiovascular features of this cohort, together with imaging finding on magnetic resonance imaging, were compared to a consecutive series of ≥50-year-old ischemic stroke patients without AF (n=498). The prevalence of NS-AF was significantly higher among ischemic stroke patients in comparison to controls (37% versus 27%; P=0.002). In multivariable analyses, after adjustment for demographic and cardiovascular risk factors, patients with ischemic stroke were more likely to harbor NS-AF episodes (odds ratio 1.43; 95% CI 1.01-2.02; P=0.041). The association between ischemic stroke and NS-AF weakened when the analyses were restricted to cryptogenic stroke patients (odds ratio 1.31; 95% CI 0.82-2.08). No significant association was observed between the presence of chronic cortical infarcts and NS-AF. CONCLUSIONS Our study shows a higher prevalence of NS-AF episodes in ischemic stroke patients in comparison to controls. Nonetheless, the lack of a stronger association with cryptogenic strokes and absence of a relationship with chronic cortical infarcts brings into question the causal influence of NS-AF in the ischemic stroke setting.
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Affiliation(s)
- Ezgi Yetim
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Ugur Canpolat
- Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Rahsan Gocmen
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kader K Oguz
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Necla Ozer
- Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Freedman B, Potpara TS, Lip GYH. Stroke prevention in atrial fibrillation. Lancet 2016; 388:806-17. [PMID: 27560276 DOI: 10.1016/s0140-6736(16)31257-0] [Citation(s) in RCA: 275] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/06/2016] [Accepted: 07/12/2016] [Indexed: 02/08/2023]
Abstract
Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K antagonist anticoagulants. The default strategy should be to offer anticoagulant thromboprophylaxis to all patients with atrial fibrillation unless defined as truly low risk by simple validated risk scores, such as CHA2DS2-VASc. Assessment of bleeding risk using the HAS-BLED score should focus attention on reversible bleeding risk factors. Finally, patients need support from physicians and various other sources to start anticoagulant treatment and to ensure adherence to and persistence with treatment in the long term.
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Affiliation(s)
- Ben Freedman
- Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology and Anzac Research Institute, Concord Hospital, Concord, NSW, Australia.
| | - Tatjana S Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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O'Neal WT, Kamel H, Kleindorfer D, Judd SE, Howard G, Howard VJ, Soliman EZ. Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study. Neuroepidemiology 2016; 47:53-8. [PMID: 27529786 DOI: 10.1159/000448619] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is currently unknown if premature atrial contractions (PACs) detected on the routine screening electrocardiogram are associated with an increased risk of ischemic stroke. METHODS We examined the association between PACs and ischemic stroke in 22,975 (mean age 64 ± 9.2; 56% women; 40% black) participants from the Reasons for Geographic and Racial Differences in Stroke study. Participants who were free of stroke at baseline were included. PACs were detected from centrally read electrocardiograms at baseline. Cox regression was used to examine the association between PACs and ischemic stroke events through March 31, 2014. RESULTS PACs were present in 1,687 (7.3%) participants at baseline. In a Cox regression model adjusted for stroke risk factors and potential confounders, PACs were associated with an increased risk of ischemic stroke (hazards ratio (HR) 1.34, 95% CI 1.04-1.74). The relationship was limited to non-lacunar infarcts (HR 1.42, 95% CI 1.08-1.87), and not lacunar strokes (HR 1.01, 95% CI 0.51-2.03). An interaction by sex was detected, with the association between PACs and ischemic stroke being stronger among women (HR 1.82, 95% CI 1.29-2.56) than men (HR 1.03, 95% CI 0.69-1.52; p-interaction = 0.0095). CONCLUSION PACs detected on the routine electrocardiogram are associated with an increased risk for non-lacunar ischemic strokes, especially in women.
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Affiliation(s)
- Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga., USA
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Calenda BW, Fuster V, Halperin JL, Granger CB. Stroke risk assessment in atrial fibrillation: risk factors and markers of atrial myopathy. Nat Rev Cardiol 2016; 13:549-59. [PMID: 27383079 DOI: 10.1038/nrcardio.2016.106] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Atrial fibrillation (AF) is a complex phenomenon associated with electrical, mechanical, and structural abnormalities of the atria. Ischaemic stroke in AF is only partially understood, but the mechanisms are known to be related to the atrial substrate as well as the atrial rhythm. The temporal dissociation between timing of AF and occurrence of stroke has led to the hypothesis that fibrotic, prothrombotic atrial tissue is an important cause of thrombus formation in patients with AF, independent of the atrial rhythm. Current stroke risk scores are practical, but limited in their capacity to predict stroke risk accurately in individual patients. Stroke prediction might be improved by the addition of emerging risk factors, many of which are expressions of atrial fibrosis. The use of novel parameters, including clinical criteria, biomarkers, and imaging data, might improve stroke risk prediction and inform on optimal treatment for patients with AF and perhaps individuals only at risk of AF.
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Affiliation(s)
- Brandon W Calenda
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, BOX 1030, New York, New York 10029, USA
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, BOX 1030, New York, New York 10029, USA
| | - Jonathan L Halperin
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, BOX 1030, New York, New York 10029, USA
| | - Christopher B Granger
- Duke University Medical Center, 2400 Pratt Street, Durham, North Carolina 27705, USA
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137
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O'Neal WT, Kamel H, Zhang ZM, Chen LY, Alonso A, Soliman EZ. Advanced interatrial block and ischemic stroke: The Atherosclerosis Risk in Communities Study. Neurology 2016; 87:352-6. [PMID: 27343071 DOI: 10.1212/wnl.0000000000002888] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/02/2016] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Given that recent reports have suggested left atrial disease to be an independent risk factor for ischemic stroke, we sought to examine if advanced interatrial block (aIAB) is an independent stroke risk factor. METHODS We examined the association between aIAB and incident ischemic stroke in 14,716 participants (mean age 54 ± 5.8 years; 55% female; 26% black) from the Atherosclerosis Risk in Communities Study (ARIC). Cases of aIAB were identified from digital ECGs recorded during the baseline ARIC visit (1987-1989) and the first 3 follow-up study visits (1990-1992, 1993-1995, and 1996-1998). Adjudicated ischemic stroke events were ascertained through December 31, 2010. RESULTS There were 266 (1.8%) participants who had evidence of aIAB. Over a median follow-up of 22 years, 916 (6.2%) ischemic stroke events were detected. The incidence rate (per 1,000 person-years) of ischemic stroke among those with aIAB (incidence rate 8.05, 95% confidence interval [CI] 5.7, 11.4) was more than twice the rate in those without aIAB (incidence rate 3.14, 95% CI 2.94, 3.35). In a multivariable Cox regression analysis adjusted for stroke risk factors and potential confounders, aIAB was associated with an increased risk of ischemic stroke (hazard ratio 1.63, 95% CI 1.13, 2.34). The results were consistent across subgroups of participants stratified by age, sex, and race. CONCLUSIONS In the ARIC, aIAB was associated with incident ischemic stroke, which strengthens the hypothesis that left atrial disease should be considered an independent stroke risk factor.
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Affiliation(s)
- Wesley T O'Neal
- From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Hooman Kamel
- From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zhu-Ming Zhang
- From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lin Y Chen
- From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Alvaro Alonso
- From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Elsayed Z Soliman
- From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Prevalence and Prognostic Significance of Runs of Premature Atrial Complexes in Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2016; 25:2338-43. [PMID: 27282304 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/10/2016] [Accepted: 05/21/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Runs of premature atrial complexes (PACs) are common in stroke patients and perceived to be clinically insignificant, but their prognostic significance is unclear. This study investigated the association between runs of PACs in ischemic stroke patients and the risk of recurrent ischemic strokes/transient ischemic attacks (TIAs) or death. METHODS The study included consecutive patients admitted with an ischemic stroke from August 2008 to April 2011. Patients with known and newly detected atrial fibrillation were excluded. Runs of PACs were defined as 3 or more PACs lasting less than 30 seconds during 48 hours of continuous inpatient cardiac telemetry. The patients were followed for 4 years or until death, whichever came first. They were stratified according to stroke severity. The combined primary endpoint was a recurrent ischemic stroke/TIA or death. RESULTS Of the 565 patients included in the study, 28% had runs of PACs. Patients with runs of PACs were likely to be older, female, and to have experienced more severe strokes. During the follow-up, 210 (37%) patients had a recurrent ischemic stroke/TIA (n = 73) or died (n = 137) respectively. Among the 489 patients who had mild-to-moderate strokes, runs of PACs were associated with recurrent ischemic strokes/TIAs or death (hazard ratio = 1.47; 95% CI 1.06-2.04; P = .023). CONCLUSION Runs of PACs were frequent in patients with acute ischemic strokes and sinus rhythm, and they were independently associated with an increased risk of recurrent ischemic strokes/TIAs or death in patients with mild-to-moderate strokes.
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139
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Martínez-Sellés M, Fernández Lozano I, Baranchuk A, Bayes-Genis A, Bayés de Luna A. ¿Debemos anticoagular a pacientes en alto riesgo de sufrir fibrilación auricular? Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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140
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Martínez-Sellés M, Fernández Lozano I, Baranchuk A, Bayes-Genis A, Bayés de Luna A. Should We Anticoagulate Patients at High Risk of Atrial Fibrillation? ACTA ACUST UNITED AC 2016; 69:374-6. [PMID: 26944349 DOI: 10.1016/j.rec.2016.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/11/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea y Universidad Complutense, Madrid, Spain.
| | | | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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141
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Kamel H, Okin PM, Elkind MSV, Iadecola C. Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model. Stroke 2016; 47:895-900. [PMID: 26786114 DOI: 10.1161/strokeaha.115.012004] [Citation(s) in RCA: 415] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Hooman Kamel
- From the Feil Family Brain and Mind Research Institute (H.K., C.I.) and Division of Cardiology (P.M.O.), Weill Cornell Medicine, New York, NY; and Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
| | - Peter M Okin
- From the Feil Family Brain and Mind Research Institute (H.K., C.I.) and Division of Cardiology (P.M.O.), Weill Cornell Medicine, New York, NY; and Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Mitchell S V Elkind
- From the Feil Family Brain and Mind Research Institute (H.K., C.I.) and Division of Cardiology (P.M.O.), Weill Cornell Medicine, New York, NY; and Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Costantino Iadecola
- From the Feil Family Brain and Mind Research Institute (H.K., C.I.) and Division of Cardiology (P.M.O.), Weill Cornell Medicine, New York, NY; and Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
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142
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Larsen BS, Kumarathurai P, Nielsen OW, Sajadieh A. The circadian variation of premature atrial contractions. Europace 2015; 18:1573-1580. [DOI: 10.1093/europace/euv389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/27/2015] [Indexed: 11/12/2022] Open
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143
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Premature Atrial Contractions: A Wolf in Sheep's Clothing? J Am Coll Cardiol 2015; 66:242-244. [PMID: 26184617 DOI: 10.1016/j.jacc.2015.04.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 04/15/2015] [Accepted: 04/20/2015] [Indexed: 11/20/2022]
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