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Tang RB, Lv WH, Long DY, Dong JZ, Du X, Sang CH, Yu RH, He L, Jiang CX, Wen SN, Liu N, Li SN, Wang W, Guo XY, Zhao X, Liu XY, Wu ZY, Li YK, Wang XS, Du ZH, Ma CS. Catheter ablation of atrial fibrillation in patients with left bundle branch block. Pacing Clin Electrophysiol 2024; 47:518-524. [PMID: 38407374 DOI: 10.1111/pace.14954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Left bundle branch block (LBBB) and atrial fibrillation (AF) are commonly coexisting conditions. The impact of LBBB on catheter ablation of AF has not been well determined. This study aims to explore the long-term outcomes of patients with AF and LBBB after catheter ablation. METHODS Forty-two patients with LBBB of 11,752 patients who underwent catheter ablation of AF from 2011 to 2020 were enrolled as LBBB group. After propensity score matching in a 1:4 ratio, 168 AF patients without LBBB were enrolled as non-LBBB group. Late recurrence and a composite endpoint of stroke, all-cause mortality, and cardiovascular hospitalization were compared between the two groups. RESULTS Late recurrence rate was significantly higher in the LBBB group than that in the non-LBBB group (54.8% vs. 31.5%, p = .034). Multivariate analysis showed that LBBB was an independent risk factor for late recurrence after catheter ablation of AF (hazard ratio [HR] 2.19, 95% confidence interval [CI] 1.09-4.40, p = .031). LBBB group was also associated with a significantly higher incidence of the composite endpoint (21.4% vs. 6.5%, HR 3.98, 95% CI 1.64-9.64, p = .002). CONCLUSIONS LBBB was associated with a higher risk for late recurrence and a higher incidence of composite endpoint in the patients underwent catheter ablation.
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Affiliation(s)
- Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Wen-He Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Song-Nan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xiao-Ying Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Ze-Yang Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yu-Kun Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xue-Si Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zhuo-Hang Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Fumagalli C, Zampieri M, Argirò A, Tassetti L, Rossi G, Musumeci B, Tini G, Russo D, Sclafani M, Cipriani A, Sinigiani G, Di Bella G, Licordari R, Canepa M, Vianello PF, Merlo M, Porcari A, Rossi M, Sinagra G, Rapezzi C, Di Mario C, Ungar A, Olivotto I, Perfetto F, Cappelli F. Incidence and determinants of atrial fibrillation in patients with wild-type transthyretin cardiac amyloidosis. Int J Cardiol 2023; 392:131346. [PMID: 37689398 DOI: 10.1016/j.ijcard.2023.131346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Data on the incidence and factors associated with de novo atrial fibrillation (AF) in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is limited. We described the incidence and factors associated with de novo AF in patients diagnosed with ATTRwt-CA to drive tailored arrhythmia screening. METHODS Multicenter, retrospective, observational cohort study performed in six referral centers for CA. All consecutive patients diagnosed with ATTRwt-CA between 2004 and 2020 with >6-month follow up (FU) were enrolled and divided into three groups according to presence of AF: (1)patients with 'known AF'; (2)patients in 'sinus rhythm' and (3)patients developing 'de novo AF' during FU. Incidence and factors associated with AF in patients with ATTRwt were the primary outcomes. RESULTS Overall, 266 patients were followed for a median of 19 [11-33] months: 148 (56%) with known AF, 84 (31.6%) with sinus rhythm, and 34 (12.8%) with de novo AF. At Fine-Gray competing risk analysis to account for mortality, PR (sub-distribution hazard ratio [SHR] per Δms: 1.008, 95% C.I. 1.001-1.013, p = 0.008), QRS (SHR per Δms: 1.012, 95% C.I. 1.001-1.022, p = 0.046) and left atrial diameter ≥ 50 mm (SHR: 2.815,95% C.I. 1.483-5.342, p = 0.002) were associated with de novo AF. Patients with at least two risk factors (PR ≥ 200 ms, QRS ≥ 120 ms or LAD≥50 mm) had a higher risk of developing de novo AF compared to patients with no risk factors (HR 14.918 95% C.I. 3.242-31.646, p = 0.008). CONCLUSIONS At the end of the study almost 70% patients had AF. Longer PR and QRS duration and left atrial dilation are associated with arrhythmia onset.
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Affiliation(s)
- Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Alessia Argirò
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
| | - Luigi Tassetti
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Gabriele Rossi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Giacomo Tini
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Domitilla Russo
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Matteo Sclafani
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulio Sinigiani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | | | - Marco Canepa
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine, University of Genoa, Italy
| | | | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Maddalena Rossi
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Claudio Rapezzi
- Cardiothoracic Department, University of Ferrara, Ferrara, Italy
| | - Carlo Di Mario
- Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Andrea Ungar
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
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Kim Y, Joo G, Jeon BK, Kim DH, Shin TY, Im H, Park J. Clinical applicability of an artificial intelligence prediction algorithm for early prediction of non-persistent atrial fibrillation. Front Cardiovasc Med 2023; 10:1168054. [PMID: 37781313 PMCID: PMC10534067 DOI: 10.3389/fcvm.2023.1168054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023] Open
Abstract
Background and aims It is difficult to document atrial fibrillation (AF) on ECG in patients with non-persistent atrial fibrillation (non-PeAF). There is limited understanding of whether an AI prediction algorithm could predict the occurrence of non-PeAF from the information of normal sinus rhythm (SR) of a 12-lead ECG. This study aimed to derive a precise predictive AI model for screening non-PeAF using SR ECG within 4 weeks. Methods This retrospective cohort study included patients aged 18 to 99 with SR ECG on 12-lead standard ECG (10 seconds) in Ewha Womans University Medical Center for 3 years. Data were preprocessed into three window periods (which are defined with the duration from SR to non-PeAF detection) - 1 week, 2 weeks, and 4 weeks from the AF detection prospectively. For experiments, we adopted a Residual Neural Network model based on 1D-CNN proposed in a previous study. We used 7,595 SR ECGs (extracted from 215,875 ECGs) with window periods of 1 week, 2 weeks, and 4 weeks for analysis. Results The prediction algorithm showed an AUC of 0.862 and an F1-score of 0.84 in the 1:4 matched group of a 1-week window period. For the 1:4 matched group of a 2-week window period, it showed an AUC of 0.864 and an F1-score of 0.85. Finally, for the 1:4 matched group of a 4-week window period, it showed an AUC of 0.842 and an F1-score of 0.83. Conclusion The AI prediction algorithm showed the possibility of risk stratification for early detection of non-PeAF. Moreover, this study showed that a short window period is also sufficient to detect non-PeAF.
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Affiliation(s)
- Yeji Kim
- Cardiovascular Center, Department of Internal Medicine, College of Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Gihun Joo
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Republic of Korea
| | - Bo-Kyung Jeon
- Cardiovascular Center, Department of Internal Medicine, College of Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Dong-Hyeok Kim
- Cardiovascular Center, Department of Internal Medicine, College of Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Tae Young Shin
- Department of Urology, College of Medicine, Ewha Womans University Medical Center, SYNERGY AI, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Hyeonseung Im
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Republic of Korea
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon, Republic of Korea
| | - Junbeom Park
- Cardiovascular Center, Department of Internal Medicine, College of Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
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Tikkanen JT, Soliman EZ, Pester J, Danik JS, Gomelskya N, Copeland T, Lee IM, Buring JE, Manson JE, Cook NR, Albert CM. A randomized clinical trial of omega-3 fatty acid and vitamin D supplementation on electrocardiographic risk profiles. Sci Rep 2023; 13:11454. [PMID: 37454148 PMCID: PMC10349832 DOI: 10.1038/s41598-023-38344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
Beneficial and adverse associations with arrhythmias have been reported for omega-3 fatty acids (omega-3 FA) and Vitamin D. The 12 lead electrocardiogram (ECG) contains quantitative measures reflecting diverse aspects of electrophysiology that might provide insights into mechanisms underlying these associations. In a pre-specified ancillary study of the VITaminD and omegA-3 (VITAL) trial, we examined the effect of 1 g of marine omega-3 FA per day, comprised of 460 mg eicosapentanoic acid and 380 mg of docosahexaenoic acid, and 2000 IU VitaminD3 per day on ECG characteristics associated with atrial and ventricular arrhythmias among individuals age 50 years or greater. A total of 911 study participants underwent ECGs at baseline and again at 2 years after the randomization. Individuals randomized to active omega-3 FA demonstrated significant net increase in PR-interval duration (p = 0.005) and P-wave duration (p = 0.03) as well significant net decrease in P-wave amplitude (p = 0.037) as compared to placebo. RMSSD increased to a greater extent in the omega-3 FA arm compared to placebo (p = 0.040). For Vitamin D3, the Cornell voltage increased to a lesser extent in the participants assigned to active treatment as compared to placebo (p = 0.044). There were no other significant differences in QRS, QTc, Cornell voltage or heart rate. Thus, randomized treatment with omega-3 FA supplements resulted in changes on the ECG that are potentially reflective of heightened vagal tone and/or slowing of intraatrial and AV conduction. Vitamin D3 supplementation resulted in modest reductions in progressive LV voltage suggestive of a potential antihypertrophic effect.Trial registration ClinicalTrials.gov Identifiers: NCT01169259, NCT02178410 (06/26/2010 and 06/30/2014).
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Affiliation(s)
- Jani T Tikkanen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elsayed Z Soliman
- Department of Internal Medicine, Epidemiological Cardiology Research Center, Section On Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Julie Pester
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vincente Blvd., AHSP 3100, Los Angeles, CA, 90048, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacqueline S Danik
- Division of Cardiovascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia Gomelskya
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - I-Min Lee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vincente Blvd., AHSP 3100, Los Angeles, CA, 90048, USA.
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou VS, Pugh PJ. Electrocardiographic Predictors of Atrial Fibrillation. Med Sci (Basel) 2023; 11:medsci11020030. [PMID: 37092499 PMCID: PMC10123668 DOI: 10.3390/medsci11020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common pathological arrhythmia, and its complications lead to significant morbidity and mortality. However, patients with AF can often go undetected, especially if they are asymptomatic or have a low burden of paroxysms. Identification of those at high risk of AF development may help refine screening and management strategies. METHODS PubMed and Embase databases were systematically searched for studies looking at electrocardiographic predictors of AF from inception to August 2021. RESULTS A total of 115 studies were reported which examined a combination of atrial and ventricular parameters that could be electrocardiographic predictors of AF. Atrial predictors include conduction parameters, such as the PR interval, p-wave index and dispersion, and partial interatrial or advanced interatrial block, or morphological parameters, such as p-wave axis, amplitude and terminal force. Ventricular predictors include abnormalities in QRS amplitude, morphology or duration, QT interval duration, r-wave progression and ST segment, i.e., t-wave abnormalities. CONCLUSIONS There has been significant interest in electrocardiographic prediction of AF, especially in populations at high risk of atrial AF, such as those with an embolic stroke of undetermined source. This review highlights the breadth of possible predictive parameters, and possible pathological bases for the predictive role of each parameter are proposed.
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Affiliation(s)
- Panagiota Anna Chousou
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Rahul Chattopadhyay
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Peter John Pugh
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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Scovner KM, Correa S, Claggett BL, Barrett CD, Waikar SS, Solomon SD, Mc Causland FR. Specific Electrocardiograph Intervals Predict Hospitalization with Atrial Fibrillation in Those with Chronic Kidney Disease. Am J Nephrol 2021; 52:412-419. [PMID: 33951623 DOI: 10.1159/000515670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is common in patients with chronic kidney disease (CKD) and is associated with higher rates of hospitalization compared to those without AF. Whether routine electrocardiographic parameters are predictive of future hospitalizations with AF is not clear. METHODS The present study is an analysis of a prospective cohort of 2,759 patients without baseline AF from the Chronic Renal Insufficiency Cohort, a large prospective multicenter study of patients with nondialysis-dependent CKD. Unadjusted and adjusted Cox regression models were fit to examine the association of baseline categories of QTc, QRS, and PR intervals with time to first hospitalization with AF. Restricted cubic splines were used to display nonlinear associ-ations. RESULTS The mean age of subjects at baseline was 58 ± 11 years, 55% were male, and 44% were Black. The mean follow-up was 6.6 years during which 224 participants experienced a hospitalization with AF. The association of baseline QTc interval with risk of AF hospitalization was nonlinear, such that the lowest and highest quartiles of QTc (<407 and >431 ms, respectively) had higher adjusted risk of AF hospitalization, compared with the second quartile (407-416 ms) (aHR Q1:Q2 1.58, 95% CI 1.03-2.41; p = 0.03; aHR Q4:Q2 1.84, 95% CI 1.22-2.78; p < 0.01). Longer QRS was associated with a higher risk of hospitalization with AF among the subgroup of patients with a history of heart failure (HF). PR interval was not associated with AF hospitalization. DISCUSSION/CONCLUSION The association of QTc with risk for hospitalization with AF among patients with CKD is nonlinear, while the association of longer QRS with AF hospitalization is restricted to patients with baseline HF. Electrocardiography may represent a simple and widely accessible method for risk stratification of future AF in patients with CKD.
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Affiliation(s)
- Katherine Mikovna Scovner
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Simon Correa
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Conor D Barrett
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Scott D Solomon
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Finnian R Mc Causland
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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7
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Rowan CJ, Eskander MA, Seabright E, Rodriguez DE, Linares EC, Gutierrez RQ, Adrian JC, Cummings D, Beheim B, Tolstrup K, Achrekar A, Kraft T, Michalik DE, Miyamoto MI, Allam AH, Wann LS, Narula J, Trumble BC, Stieglitz J, Thompson RC, Thomas GS, Kaplan HS, Gurven MD. Very Low Prevalence and Incidence of Atrial Fibrillation among Bolivian Forager-Farmers. Ann Glob Health 2021; 87:18. [PMID: 33633929 PMCID: PMC7894370 DOI: 10.5334/aogh.3252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Atrial fibrillation is the most common arrhythmia in post-industrialized populations. Older age, hypertension, obesity, chronic inflammation, and diabetes are significant atrial fibrillation risk factors, suggesting that modern urban environments may promote atrial fibrillation. Objective Here we assess atrial fibrillation prevalence and incidence among tropical horticulturalists of the Bolivian Amazon with high levels of physical activity, a lean diet, and minimal coronary atherosclerosis, but also high infectious disease burden and associated inflammation. Methods Between 2005-2019, 1314 Tsimane aged 40-94 years (52% female) and 534 Moseten Amerindians aged 40-89 years (50% female) underwent resting 12-lead electrocardiograms to assess atrial fibrillation prevalence. For atrial fibrillation incidence assessment, 1059 (81% of original sample) Tsimane and 310 Moseten (58%) underwent additional ECGs (mean time to follow up 7.0, 1.8 years, respectively). Findings Only one (male) of 1314 Tsimane (0.076%) and one (male) of 534 Moseten (0.187%) demonstrated atrial fibrillation at baseline. There was one new (female) Tsimane case in 7395 risk years for the 1059 participants with >1 ECG (incidence rate = 0.14 per 1,000 risk years). No new cases were detected among Moseten, based on 542 risk years. Conclusion Tsimane and Moseten show the lowest levels of atrial fibrillation ever reported, 1/20 to ~1/6 of rates in high-income countries. These findings provide additional evidence that a subsistence lifestyle with high levels of physical activity, and a diet low in processed carbohydrates and fat is cardioprotective, despite frequent infection-induced inflammation. Findings suggest that atrial fibrillation is a modifiable lifestyle disease rather than an inevitable feature of cardiovascular aging.
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Affiliation(s)
| | | | - Edmond Seabright
- University of New Mexico, Department of Anthropology, New Mexico, USA
| | - Daniel Eid Rodriguez
- Universidad de San Simon, Bolivia
- Tsimane Health and Life History Project, San Borja, Beni, Bolivia
| | | | | | | | - Daniel Cummings
- University of New Mexico, Department of Anthropology, New Mexico, USA
| | - Bret Beheim
- Max Plank Institute of Evolutionary Anthropology, Department of Human Behavior, Culture and Ecology, Leipzig, Germany
| | - Kirsten Tolstrup
- Cardiology, Dept. of Medicine, University of California, San Francisco, CA, USA
| | - Abinash Achrekar
- University of New Mexico, Division of Cardiology, Albuquerque, New Mexico, USA
| | - Thomas Kraft
- University of California, Santa Barbara, Department of Anthropology, USA
| | - David E. Michalik
- Miller Children’s and Women’s Hospital Long Beach, CA, USA
- Division of Pediatric Infectious Diseases, University of California, Irvine, CA, USA
| | | | | | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Department of Cardiology, NY, USA
| | - Benjamin C. Trumble
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Arizona State University, Tempe, AZ, USA
| | | | - Randall C. Thompson
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, USA
| | - Gregory S. Thomas
- MemorialCare, Southern California, USA
- Division of Cardiology, University of California, Irvine, Orange, California, USA
| | - Hillard S. Kaplan
- Chapman University, Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Orange, California, USA
| | - Michael D. Gurven
- University of California, Santa Barbara, Department of Anthropology, USA
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8
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Yamaguchi S, Hamano T, Oka T, Doi Y, Kajimoto S, Yasuda S, Shimada K, Matsumoto A, Sakaguchi Y, Inoue K, Matsui I, Suzuki A, Isaka Y. Electrocardiogram findings at the initiation of hemodialysis and types of subsequent cardiovascular events. Hypertens Res 2021; 44:571-580. [PMID: 33398130 DOI: 10.1038/s41440-020-00592-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/09/2022]
Abstract
The prognostic value of electrocardiograms (ECGs) has been reported in predialysis patients but not in incident hemodialysis patients with overhydration and electrolyte disturbances, both of which potentially affect ECG results. We performed a retrospective multicenter cohort study involving incident hemodialysis patients and examined whether ECG parameters immediately before hemodialysis initiation can predict subsequent cardiovascular disease (CVD) using Cox proportional hazards models. We explored potential effect modifications by several electrolytes on the predictive power of ECG abnormalities. Among the 618 enrolled patients, 16%, 10%, 46%, and 22% showed a PR interval ≥ 200 ms, QRS interval ≥120 ms, QTc interval ≥ 450/460 ms (male/female), and left ventricular hypertrophy (LVH) by voltage criteria, respectively. Over a median 3-year follow-up, 19% and 16% of the patients developed atherosclerotic and nonatherosclerotic CVD, respectively. The Cox regression model results revealed that the sum of the number of abnormalities in PR, QRS, and QT intervals was a significant risk factor for nonatherosclerotic CVD (hazard ratios (HRs) [95% confidence interval (CI)]: 1.58 [1.24-2.01] per number of abnormalities). The predictive value of LVH for atherosclerotic CVD was attenuated over time. At up to 36 months, although the proportional hazards assumption was met, LVH was significantly associated with atherosclerotic CVD (HR [95% CI]: 1.89 [1.15-3.11]). The adjusted HR was particularly high (HR [95% CI]: 4.02 [1.68-9.60]) among patients who were in the lowest tertile of serum magnesium levels (P for interaction = 0.04). PR, QRS, and QT prolongation additively predicted nonatherosclerotic CVD, while LVH predicted atherosclerotic CVD in the short term.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Internal Medicine, Japan Community Health care Organization Osaka Hospital, Osaka, Japan
| | - Takayuki Hamano
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan. .,Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Tatsufumi Oka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yohei Doi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Sachio Kajimoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiichi Yasuda
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Karin Shimada
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayumi Matsumoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Sakaguchi
- Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazunori Inoue
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Isao Matsui
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Suzuki
- Department of Internal Medicine, Japan Community Health care Organization Osaka Hospital, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
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9
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Ríos-Muñoz GR, Artés-Rodríguez A, Fernández-Avilés F, Arenal Á. Real-Time Ventricular Cancellation in Unipolar Atrial Fibrillation Electrograms. Front Bioeng Biotechnol 2020; 8:789. [PMID: 32850699 PMCID: PMC7406791 DOI: 10.3389/fbioe.2020.00789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Unipolar atrial fibrillation (AF) electrograms (EGMs) require far-field ventricle cancellation to recover hidden atrial activations. Current methods cannot achieve real-time cancellation because of the temporal delay they introduce. We propose a new real-time ventricular cancellation (RVC) method based on causal implementation optimized for real-time functioning. The method is similar to the classical average beat subtraction (ABS) method but it computes the ventricular contribution before the ventricular activation finishes. We compare the proposed method to the ABS on synthetic and real EGM databases for the time and frequency domains. All parameters and their optimal values are analyzed and validated. The RVC method provides a good reconstruction of the unipolar EGMs and a better local activation time detection than the classical approach with average F1scores 0.7307 and 0.7125, respectively. The spectral analysis shows that the average power after ventricular cancellation is reduced for frequency bands between 3 and 5.5 Hz, demonstrating that the proposed method removes the ventricular component present in the unipolar EGM signals compared to the ABS method. The phase mapping analysis on the RVC method presented lower error when comparing the annotated EGM cycles with the phase inversion intervals. In terms of performance ABS and RVC behave similarly, but the real-time capability of the latter justifies its preference over the offline implementations. In the clinical environment other online investigations, e.g., rotational activity assessment, dominant frequency or local activation time mapping, might benefit from the real-time potential of the proposed cancellation method.
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Affiliation(s)
- Gonzalo R Ríos-Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Antonio Artés-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Departamento de Teoría de la Señal y Comunicaciones, Universidad Carlos III de Madrid, Madrid, Spain
| | - Francisco Fernández-Avilés
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángel Arenal
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
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10
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Sex-related electrocardiographic differences in patients with different types of atrial fibrillation: Results from the SWISS-AF study. Int J Cardiol 2020; 307:63-70. [DOI: 10.1016/j.ijcard.2019.12.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022]
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11
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Cheng C, Liu H, Tan C, Tong D, Zhao Y, Liu X, Si W, Wang L, Liang L, Li J, Wang C, Chen Q, Du Y, Wang QK, Ren X. Mutation in NPPA causes atrial fibrillation by activating inflammation and cardiac fibrosis in a knock-in rat model. FASEB J 2019; 33:8878-8891. [PMID: 31034774 DOI: 10.1096/fj.201802455rrr] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Atrial fibrillation (AF) affects >30 million individuals worldwide. However, no genetic mutation from human patients with AF has been linked to inflammation. Here, we show that AF-associated human variant p.Ile138Thr in natriuretic peptide A (NPPA) encoding the atrial natriuretic peptide (ANP) causes inflammation, fibroblast activation, atrial fibrosis, and AF in knock-in (KI) rats. Variant p.Ile138Thr inhibits the interaction between ANP and its receptor natriuretic peptide receptor A and reduces intracellular cGMP levels. RNA sequencing and follow-up analyses showed that mutant ANP (mANP) activates multiple innate immunity pathways, including TNF-α, NF-κB, and IL-1β signaling. mANP induces differentiation of cardiac fibroblasts (CFs) to myofibroblasts and promotes CF proliferation and fibrosis. These results suggest that NPPA variant p.Ile138Thr causes AF by activating TNF-α, NF-κB, and IL-1β signaling, inflammation, and fibrosis. Multiple computational programs suggest that p.Ile138Thr is damaging or deleterious. Based on the 2015 American College of Medical Genetics and Genomics Standards and Guidelines, p.Ile138Thr can be classified as a likely pathogenic variant. Variant p.Ile138Thr was found only in Asian people in the Genome Aggregation Database and Exome Aggregation Consortium database at an averaged frequency of 0.026%. An estimated 1.15 million Asian people carry the variant and might be at risk of AF. The KI rats may provide an inflammation-based, genetic animal model for AF valuable for testing anti-inflammation or other therapies for AF.-Cheng, C., Liu, H., Tan, C., Tong, D., Zhao, Y., Liu, X., Si, W., Wang, L., Liang, L., Li, J., Wang, C., Chen, Q., Du, Y., Wang, Q. K., Ren, X. Mutation in NPPA causes atrial fibrillation by activating inflammation and cardiac fibrosis in a knock-in rat model.
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Affiliation(s)
- Chen Cheng
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Huixia Liu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chengcheng Tan
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Doudou Tong
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Yongxuan Zhao
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Xia Liu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Wenxia Si
- Department of Basic Medicine, Medical College, Hubei Polytechnic University, Huangshi, China
| | - Linlin Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Lina Liang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Li
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Chenghui Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuyun Chen
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Yimei Du
- Institute of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Qing K Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China.,Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.,Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xiang Ren
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
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12
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Aeschbacher S, O'Neal WT, Krisai P, Loehr L, Chen LY, Alonso A, Soliman EZ, Conen D. Relationship between QRS duration and incident atrial fibrillation. Int J Cardiol 2018; 266:84-88. [PMID: 29887479 PMCID: PMC6027639 DOI: 10.1016/j.ijcard.2018.03.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/23/2018] [Accepted: 03/12/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND QRS duration (QRSd), a measure of ventricular conduction, has been associated with adverse cardiovascular outcomes, but its relationship with incident atrial fibrillation (AF) is poorly understood. METHODS AND RESULTS This study included 15,314 participants from the Atherosclerosis Risk in Communities (ARIC) study who were free of AF at baseline. QRSd was automatically measured from resting 12-lead electrocardiograms (ECGs) at baseline. Incident AF cases were systematically ascertained using ECGs, hospital discharge diagnoses and death certificates. Multivariable adjusted Cox regression analyses were performed to investigate the relationship between QRSd and incident AF. Mean age of our population was 54 ± 6 years (55% females). During a median follow-up of 21.2 years, 2041 confirmed incident AF cases occurred. In multivariable adjusted Cox models, a 1-SD increase in QRSd was associated with a hazard ratio (HR) (95% CI) for AF of 1.05 (1.01; 1.10), p = 0.01. This relationship was significant among women (HR per 1-SD increase in QRSd (95% CI) 1.13 (1.06; 1.20), p < 0.001), but not among men (1.00 (0.95; 1.06), p = 0.97) (p for interaction 0.005). Compared to individuals with a QRSd <100 ms, the HRs for incident AF in individuals with a QRSd of 100-119 and ≥120 ms were 1.13 (1.02; 1.26) and 1.35 (1.08; 1.68), respectively (p for trend 0.002). Again, this relationship was significant among women (p for trend <0.001) but not among men (p for trend 0.23). CONCLUSION In this large population-based study, QRSd was an independent predictor of incident AF among women, but not in men. Further studies are needed to better understand the underlying mechanisms.
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Affiliation(s)
- Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, Cardiology Division, University Hospital Basel, Basel, University of Basel, Switzerland.
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Philipp Krisai
- Cardiovascular Research Institute Basel, Cardiology Division, University Hospital Basel, Basel, University of Basel, Switzerland.
| | - Laura Loehr
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - David Conen
- Cardiovascular Research Institute Basel, Cardiology Division, University Hospital Basel, Basel, University of Basel, Switzerland; Population Health Research Institute, McMaster University, Hamilton, Canada.
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13
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Nielsen JB, Fritsche LG, Zhou W, Teslovich TM, Holmen OL, Gustafsson S, Gabrielsen ME, Schmidt EM, Beaumont R, Wolford BN, Lin M, Brummett CM, Preuss MH, Refsgaard L, Bottinger EP, Graham SE, Surakka I, Chu Y, Skogholt AH, Dalen H, Boyle AP, Oral H, Herron TJ, Kitzman J, Jalife J, Svendsen JH, Olesen MS, Njølstad I, Løchen ML, Baras A, Gottesman O, Marcketta A, O'Dushlaine C, Ritchie MD, Wilsgaard T, Loos RJF, Frayling TM, Boehnke M, Ingelsson E, Carey DJ, Dewey FE, Kang HM, Abecasis GR, Hveem K, Willer CJ. Genome-wide Study of Atrial Fibrillation Identifies Seven Risk Loci and Highlights Biological Pathways and Regulatory Elements Involved in Cardiac Development. Am J Hum Genet 2018; 102:103-115. [PMID: 29290336 DOI: 10.1016/j.ajhg.2017.12.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 12/04/2017] [Indexed: 01/03/2023] Open
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia and a major risk factor for stroke, heart failure, and premature death. The pathogenesis of AF remains poorly understood, which contributes to the current lack of highly effective treatments. To understand the genetic variation and biology underlying AF, we undertook a genome-wide association study (GWAS) of 6,337 AF individuals and 61,607 AF-free individuals from Norway, including replication in an additional 30,679 AF individuals and 278,895 AF-free individuals. Through genotyping and dense imputation mapping from whole-genome sequencing, we tested almost nine million genetic variants across the genome and identified seven risk loci, including two novel loci. One novel locus (lead single-nucleotide variant [SNV] rs12614435; p = 6.76 × 10-18) comprised intronic and several highly correlated missense variants situated in the I-, A-, and M-bands of titin, which is the largest protein in humans and responsible for the passive elasticity of heart and skeletal muscle. The other novel locus (lead SNV rs56202902; p = 1.54 × 10-11) covered a large, gene-dense chromosome 1 region that has previously been linked to cardiac conduction. Pathway and functional enrichment analyses suggested that many AF-associated genetic variants act through a mechanism of impaired muscle cell differentiation and tissue formation during fetal heart development.
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Affiliation(s)
- Jonas B Nielsen
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lars G Fritsche
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger 7600, Norway; Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Wei Zhou
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA; Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Oddgeir L Holmen
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger 7600, Norway; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway; Department of Cardiology, St. Olav's University Hospital, Trondheim 7030, Norway
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden
| | - Maiken E Gabrielsen
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger 7600, Norway; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Ellen M Schmidt
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Robin Beaumont
- Royal Devon & Exeter NHS Foundation Trust and University of Exeter Barrack Road Exeter, Exeter EX2 5WD, UK
| | - Brooke N Wolford
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Maoxuan Lin
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michael H Preuss
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lena Refsgaard
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Erwin P Bottinger
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Mindich Child Health Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sarah E Graham
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ida Surakka
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yunhan Chu
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger 7600, Norway; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Anne Heidi Skogholt
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger 7600, Norway; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Håvard Dalen
- Department of Cardiology, St. Olav's University Hospital, Trondheim 7030, Norway; Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger 7600, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Alan P Boyle
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hakan Oral
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Todd J Herron
- Department of Internal Medicine, Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jacob Kitzman
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - José Jalife
- Department of Internal Medicine, Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109, USA; Fundacion Centro Nacional de Investigaciones Cardiovasculares, Madrid 28029, Spain
| | - Jesper H Svendsen
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Morten S Olesen
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark; Department of Biomedicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9019, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9019, Norway
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, NY 10591, USA
| | | | | | | | | | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9019, Norway
| | - Ruth J F Loos
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Timothy M Frayling
- Royal Devon & Exeter NHS Foundation Trust and University of Exeter Barrack Road Exeter, Exeter EX2 5WD, UK
| | - Michael Boehnke
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala 75237, Sweden; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | | | - Hyun M Kang
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Gonçalo R Abecasis
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger 7600, Norway; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway; Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger 7600, Norway.
| | - Cristen J Willer
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA; Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Norwegian University of Science and Technology, Trondheim 7491, Norway; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA.
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14
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Gigliotti JN, Sidhu MS, Robert AM, Zipursky JS, Brown JR, Costa SP, Palac RT, Steckman DA, Malenka DJ, Kono AT, Greenberg ML. The association of QRS duration with atrial fibrillation in a heart failure with preserved ejection fraction population: a pilot study. Clin Cardiol 2017; 40:861-864. [PMID: 28586090 DOI: 10.1002/clc.22736] [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] [Received: 02/13/2017] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Heart failure is a significant cause of morbidity and mortality, yet patient risk stratification may be difficult. Prevention or treatment of atrial fibrillation (AF) may be an important strategy in these patients that could positively affect their outcome. It has been demonstrated that in patients with systolic dysfunction, prolonged QRS duration (QRSd), an easily measured electrocardiographic parameter, is associated with AF. HYPOTHESIS Prolonged QRSd is associated with an increase in prevalence of AF in patients with heart failure with preserved ejection fraction(HFPEF). METHODS Between February 2006 and February 2009, 718 patients were discharged with a diagnosis of HF from the Dartmouth-Hitchcock Medical Center. Of these, 206 had EF ≥50% by echocardiography performed within 72 hours of admission. After exclusions, 82 patients remained, of which 25 had AF and 57 had sinus rhythm. Characteristics of the AF and sinus-rhythm patients were compared in this pilot study. RESULTS After adjustment for age, prior diagnosis of HF, and left atrial area, there was a nonsignificant trend (odds ratio: 2.2, 95% CI of 0.3-17.2) for a QRSd >120 ms to be associated with AF. CONCLUSIONS Similar to results in patients with systolic dysfunction, patients with preserved EF may have an association between a prolonged QRSd and AF.
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Affiliation(s)
- Joseph N Gigliotti
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Mandeep S Sidhu
- Department of Medicine(Cardiology), Albany Medical Center, Albany, New York.,Department of Medicine(Cardiology), Albany Medical College, Albany, New York
| | - Alina M Robert
- Department of Medicine(Cardiology), St. Luke's Clinic, Boise, Idaho
| | | | - Jeremiah R Brown
- Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine, Hanover, New Hampshire
| | - Salvatore P Costa
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Robert T Palac
- Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.,Department of Medicine(Cardiology), White River Junction VA Medical Center, Vermont
| | - David A Steckman
- Department of Medicine(Cardiology), Albany Medical Center, Albany, New York.,Department of Medicine(Cardiology), Albany Medical College, Albany, New York
| | - David J Malenka
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Alan T Kono
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Mark L Greenberg
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
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15
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Gu J, Andreasen JJ, Melgaard J, Lundbye-Christensen S, Hansen J, Schmidt EB, Thorsteinsson K, Graff C. Preoperative Electrocardiogram Score for Predicting New-Onset Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:69-76. [DOI: 10.1053/j.jvca.2016.05.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Indexed: 11/11/2022]
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16
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Karakoyun S, Tanboğa IH, Gökdeniz T, Lazoğlu Z, Topçu S, Karal H, Aksakal E, Sevimli S. Assessment of Left Atrial Mechanics in Patients with Preexcitation Syndrome Scheduled for Catheter Ablation. Echocardiography 2015; 33:249-56. [DOI: 10.1111/echo.13040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Süleyman Karakoyun
- Department of Cardiology; Kars Kafkas University Medical School; Kars Turkey
| | | | - Tayyar Gökdeniz
- Department of Cardiology; Kars Kafkas University Medical School; Kars Turkey
| | - Zakir Lazoğlu
- Department of Cardiology; Kars State Hospital; Kars Turkey
| | - Selim Topçu
- Department of Cardiology; Ataturk University Medical School; Erzurum Turkey
| | - Hüseyin Karal
- Department of Cardiology; Gümüşhane State Hospital; Gümüşhane Turkey
| | - Enbiya Aksakal
- Department of Cardiology; Ataturk University Medical School; Erzurum Turkey
| | - Serdar Sevimli
- Department of Cardiology; Ataturk University Medical School; Erzurum Turkey
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17
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Ntusi NBA, Badri M, Gumedze F, Sliwa K, Mayosi BM. Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy. PLoS One 2015; 10:e0133466. [PMID: 26252951 PMCID: PMC4529210 DOI: 10.1371/journal.pone.0133466] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/28/2015] [Indexed: 01/26/2023] Open
Abstract
Aims There is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM), as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP) (i.e., peripartum cardiac failure associated with any form of hypertension) and PPCM have similar or different clinical features and outcome. Methods and Results We compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features) and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years) and PPCM (n = 30; age 31.5 ± 7.5 years). The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001). PPCM was more significantly associated with the following features than HHFP (p<0.05): twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05) to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05). There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005) during follow-up. Conclusion There are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM.
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Affiliation(s)
- Ntobeko B. A. Ntusi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Motasim Badri
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Freedom Gumedze
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Bongani M. Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- * E-mail:
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18
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Baturova MA, Lindgren A, Carlson J, Shubik YV, Olsson SB, Platonov PG. Predictors of new onset atrial fibrillation during 10-year follow-up after first-ever ischemic stroke. Int J Cardiol 2015. [PMID: 26209828 DOI: 10.1016/j.ijcard.2015.07.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Paroxysmal atrial fibrillation (AF) may be underdiagnosed in ischemic stroke patients but may be pivotal for initiation of oral anticoagulation therapy. We assessed clinical and ECG predictors of new-onset AF during 10-year follow-up (FU) in ischemic stroke patients. METHODS The study sample comprised of 227 first-ever ischemic stroke patients without AF (median age 73, interquartile range 25%-75% 63-80years, 92 female) and 1:1 age- and gender-matched controls without stroke and AF enrolled in the Lund Stroke Register from March 2001 to February 2002. New-onset AF during FU was assessed by screening through regional ECG database and by record linkage with Swedish National Patient Register. The standard 12-lead sinus rhythm ECGs at stroke admission were retrieved from electronic database and digitally processed. Clinical baseline characteristics were studied using medical records. RESULTS During FU, AF was found in 39 stroke patients and 30 controls, p=0.296. In stroke patients in multivariate Cox regression analysis AF was associated with hypertension (HR 3.45 CI 95% 1.40-3.49, p=0.007) and QRS duration (HR 1.02 CI 95% 1.00-1.03, p=0.049). High cardiovascular risk was predictive for AF development: for CHADS2≥4 HR 2.46 CI 95% 1.45-4.18, p=0.001 and for CHA2DS2-VASc≥5 HR 2.29 CI 95% 1.43-3.68, p=0.001. New onset AF was not associated with baseline ischemic stroke: HR 1.46 95% CI 0.90-2.35, p=0.121. CONCLUSION High CHADS2 and CHA2DS2-VASc scores, but not baseline ischemic stroke, predict new onset AF in FU. QRS duration might be considered a potential risk marker for prediction of AF after ischemic stroke.
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Affiliation(s)
- Maria A Baturova
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; St. Petersburg University Clinic, St. Petersburg, Russia; Cardiology Research, Clinical and Educational Center, St. Petersburg State University, St. Petersburg, Russia.
| | - Arne Lindgren
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Neurology, Lund University, Sweden
| | - Jonas Carlson
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Yuri V Shubik
- St. Petersburg University Clinic, St. Petersburg, Russia; Cardiology Research, Clinical and Educational Center, St. Petersburg State University, St. Petersburg, Russia
| | - S Bertil Olsson
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Arrythmia Clinic, Skåne University Hospital, Lund, Sweden
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19
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Incidence and Predictors of New-Onset Atrial Fibrillation in Septic Shock Patients in a Medical ICU: Data from 7-Day Holter ECG Monitoring. PLoS One 2015; 10:e0127168. [PMID: 25965915 PMCID: PMC4428753 DOI: 10.1371/journal.pone.0127168] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 02/19/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose We investigated incidence, risk factors for new-onset atrial fibrillation (NAF), and prognostic impact during septic shock in medical Intensive Care Unit (ICU) patients. Methods Prospective, observational study in a university hospital. Consecutive patients from 03/2011 to 05/2013 with septic shock were eligible. Exclusion criteria were age <18 years, history of AF, transfer with prior septic shock. Included patients were equipped with long-duration (7 days) Holter ECG monitoring. NAF was defined as an AF episode lasting >30 seconds. Patient characteristics, infection criteria, cardiovascular parameters, severity of illness, support therapies were recorded. Results Among 66 patients, 29(44%) developed NAF; 10 (34%) would not have been diagnosed without Holter ECG monitoring. NAF patients were older, with more markers of heart failure (troponin and NT-pro-BNP), lower left ventricular ejection fraction (LVEF), longer QRS duration and more nonsustained supra ventricular arrhythmias (<30s) on day 1 than patients who maintained sinus rhythm. By multivariate analysis, age (OR: 1.06; p = 0.01) and LVEF<45% (OR: 13.01, p = 0.03) were associated with NAF. NAF did not predict 28 or 90 day mortality. Conclusions NAF is common, especially in older patients, and is associated with low ejection fraction. We did not find NAF to be independently associated with higher mortality.
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20
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Hatala R, Lunati M, Calvi V, Favale S, Goncalvesová E, Haim M, Jovanovic V, Kaczmarek K, Kautzner J, Merkely B, Pokushalov E, Revishvili A, Theodorakis G, Vatasescu R, Zalevsky V, Zupan I, Vicini I, Corbucci G. Clinical implementation of cardiac resynchronization therapy-regional disparities across selected ESC member countries. Ann Noninvasive Electrocardiol 2014; 20:43-52. [PMID: 25546696 PMCID: PMC4654273 DOI: 10.1111/anec.12243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The present analysis aimed to estimate the penetration of cardiac resynchronization therapy (CRT) on the basis of the prevalence and incidence of eligible patients in selected European countries and in Israel. Methods and Results The following countries were considered: Italy, Slovakia, Greece, Israel, Slovenia, Serbia, the Czech Republic, Poland, Romania, Hungary, Ukraine, and the Russian Federation. CRT penetration was defined as the number of patients treated with CRT (CRT patients) divided by the prevalence of patients eligible for CRT. The number of CRT patients was estimated as the sum of CRT implantations in the last 5 years, the European Heart Rhythm Association (EHRA) White Book being used as the source. The prevalence of CRT indications was derived from the literature by applying three epidemiologic models, a synthesis of which indicates that 10% of heart failure (HF) patients are candidates for CRT. HF prevalence was considered to range from 1% to 2% of the general population, resulting in an estimated range of prevalence of CRT indication between 1000 and 2000 patients per million inhabitants. Similarly, the annual incidence of CRT indication, representing the potential target population once CRT has fully penetrated, was estimated as between 100 and 200 individuals per million. The results showed the best CRT penetration in Italy (47–93%), while in some countries it was less than 5% (Romania, Russian Federation, and Ukraine). Conclusion CRT penetration differs markedly among the countries analyzed. The main barriers are the lack of reimbursement for the procedure and insufficient awareness of guidelines by the referring physicians.
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Affiliation(s)
- R Hatala
- National Cardiovascular Institute, Bratislava, Slovakia
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21
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Röger S, Michels J, Heggemann F, Stach K, Rousso B, Borggrefe M, Kuschyk J. Long term impact of cardiac contractility modulation on QRS duration. J Electrocardiol 2014; 47:936-40. [PMID: 25201417 DOI: 10.1016/j.jelectrocard.2014.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Cardiac contractility modulation (CCM) is an implantable device treatment for heart failure with reduced ejection fraction. CCM therapy improves patient functional status but its effect on intra-ventricular conduction remains unknown. METHODS 70 patients treated with CCM between 12/2002 and 5/2013 had 12-vector-ECG recordings made at baseline and final follow-up visits. QRS complex duration was measured at each time point. RESULTS Mean follow-up was 2.8 years. Mean QRS duration was unchanged from baseline (112.0 ms) to last follow up (112.9 ms, p=n.s.). These results are strikingly different from comparative published data of several studies with heart failure patients without CCM, consistently indicating an increase in QRS duration (6.0-23.4 ms) over a similar time period. CONCLUSIONS CCM prevents chronic ventricular depolarization delay that occurs in heart failure and that is associated with poorer outcomes. This supports the safety of long-term CCM therapy and suggests a possible long-term benefit in maintaining QRS duration.
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Affiliation(s)
- Susanne Röger
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
| | - Julia Michels
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Felix Heggemann
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Ksenija Stach
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | | | - Martin Borggrefe
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Jürgen Kuschyk
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
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22
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Turak O, Özcan F, Canpolat U, Başar FN, Işleyen A, Sökmen E, Tüfekçioğlu O, Çağli K, Aydoğdu S. Relation between QRS Duration and Atrial Synchronicity in Patients with Systolic Heart Failure. Echocardiography 2014; 31:972-9. [PMID: 24447113 DOI: 10.1111/echo.12504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Osman Turak
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
| | - Fırat Özcan
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
| | - Uğur Canpolat
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
| | - Fatma Nurcan Başar
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
| | - Ahmet Işleyen
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
| | - Erdoğan Sökmen
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
| | - Omaç Tüfekçioğlu
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
| | - Kumral Çağli
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
| | - Sinan Aydoğdu
- Cardiology Clinic; Türkiye Yüksek Ihtisas Training and Research Hospital; Ankara Turkey
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23
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Whitbeck MG, Charnigo RJ, Shah J, Morales G, Leung SW, Fornwalt B, Bailey AL, Ziada K, Sorrell VL, Zegarra MM, Thompson J, Hosn NA, Campbell CL, Gurley J, Anaya P, Booth DC, Di Biase L, Natale A, Smyth S, Moliterno DJ, Elayi CS. QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: evidence from the AFFIRM study. Europace 2013; 16:803-11. [PMID: 24368753 DOI: 10.1093/europace/eut335] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF. METHODS AND RESULTS QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90-119, ≥120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS ≥ 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95% confidence interval (CI): 1.29-2.03, P < 0.001] and hospitalizations (HR 1.14, 95% CI: 1.07-1.34, P = 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90-119 ms, mortality and hospitalization were also increased (HR 1.31, P = 0.005 and 1.11, P = 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40%), mortality was increased for QRS ≥ 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P = 0.02). In the QRS 90-119 ms group, mortality was increased (HR 1.38, P = 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P = 0.14). CONCLUSION Among patients with AF, QRSd ≥ 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90-119 ms and concomitant HF.
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Affiliation(s)
- Matthew G Whitbeck
- Essentia Heart and Vascular, Department of Cardiology, Fargo, ND 58103, USA
| | - Richard J Charnigo
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Jignesh Shah
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Gustavo Morales
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Steve W Leung
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Brandon Fornwalt
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Alison L Bailey
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Khaled Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Vincent L Sorrell
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Milagros M Zegarra
- Department of Veterans Affairs, North Dakota State University, Fargo, ND 58102, USA
| | - Jenks Thompson
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Neil Aboul Hosn
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Charles L Campbell
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - John Gurley
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Paul Anaya
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - David C Booth
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, Department of Cardiology, Austin, TX 78746, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Department of Cardiology, Austin, TX 78746, USA
| | - Susan Smyth
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - David J Moliterno
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Claude S Elayi
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
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Park HS, Kim H, Park JH, Han S, Yoo BS, Shin MS, Seong IW, Ahn Y, Kang SM, Kim JJ, Jeon ES, Cho MC, Choi DJ, Chae SC, Kim YJ, Seo HS, Oh BH, Lee MM, Ryu KH. QRS prolongation in the prediction of clinical cardiac events in patients with acute heart failure: analysis of data from the Korean Acute Heart Failure Registry. Cardiology 2013; 125:96-103. [PMID: 23711763 DOI: 10.1159/000348334] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/21/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES A prolonged QRS duration has been associated with an unfavorable prognosis in chronic compensated heart failure (HF). However, its predictive value during an admission for acute HF is limited, even in HF with a preserved ejection fraction (EF). The purpose of this study was to evaluate the prognostic utility of the QRS duration in acute HF. METHODS Analyses were performed using data from 1,489 patients with a 2-year follow-up. The patients were selected from the Korean Acute Heart Failure Registry and were divided into three groups according to QRS duration (≤80, 81-119 or ≥120 ms). The all-cause mortality and readmission for HF were assessed. RESULTS During the study period, 774 primary events occurred (359 deaths and 415 HF). The event frequencies were higher in patients with a prolonged QRS duration. The increased risk associated with the QRS duration was also demonstrated after adjustment for cardiac outcome variables. The prognostic significance of the QRS duration was demonstrated in patients with reduced EF but not in those with a preserved EF. CONCLUSIONS A prolonged QRS duration could be a significant predictor of the 2-year cardiac outcome in patients with acute HF, particularly in those with a reduced EF.
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Affiliation(s)
- Hyoung-Seob Park
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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25
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Nada A, Gintant GA, Kleiman R, Gutstein DE, Gottfridsson C, Michelson EL, Strnadova C, Killeen M, Geiger MJ, Fiszman ML, Koplowitz LP, Carlson GF, Rodriguez I, Sager PT. The evaluation and management of drug effects on cardiac conduction (PR and QRS intervals) in clinical development. Am Heart J 2013; 165:489-500. [PMID: 23537964 DOI: 10.1016/j.ahj.2013.01.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 01/17/2013] [Indexed: 01/31/2023]
Abstract
Recent advances in electrocardiographic monitoring and waveform analysis have significantly improved the ability to detect drug-induced changes in cardiac repolarization manifested as changes in the QT/corrected QT interval. These advances have also improved the ability to detect drug-induced changes in cardiac conduction. This White Paper summarizes current opinion, reached by consensus among experts at the Cardiac Safety Research Consortium, on the assessment of electrocardiogram-based safety measurements of the PR and QRS intervals, representing atrioventricular and ventricular conduction, respectively, during drug development.
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Affiliation(s)
- Adel Nada
- Baxter Healthcare Corporation, Deerfield, IL 60015, USA.
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26
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El-Chami MF. Letter to the Editor. Clin Cardiol 2011; 34:E13. [DOI: 10.1002/clc.20797] [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: 04/19/2010] [Revised: 04/20/2010] [Indexed: 11/08/2022] Open
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27
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Madias JE. On a possible mechanistic association of QRS duration and atrial fibrillation. Clin Cardiol 2011; 34:E12; author reply E13. [PMID: 21280057 DOI: 10.1002/clc.20798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 04/20/2010] [Indexed: 11/12/2022] Open
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