The relationship between erectile dysfunction and paroxysmal lone atrial fibrillation

Relationship between serum uric acid levels and different types of atrial fibrillation: An updated meta-analysis

AIM

Increasing evidence supports the hypothesis that high serum uric acid (SUA) levels are related to atrial fibrillation (AF). However, the incidence of AF in patients with hyperuricemia and SUA levels in different types of AF is not entirely clear. This meta-analysis was designed to evaluate the relationship between SUA and incidence of AF, and the variation in SUA levels in different types of AF.

DATA SYNTHESIS

Relevant reports were searched for in Embase, PubMed and the Cochrane Library. A fixed-effects model combining relative risk (RR) and the corresponding 95% confidence interval (95% CI) was used to evaluate the correlation between SUA and AF. The standardized mean differences (SMDs) of SUA values were calculated using a random-effects model to evaluate the differences in SUA levels among different types of AF. A total of 31 studies with 504,958 participants were included in this research. The results from 8 cohort studies showed that high SUA levels significantly increased the incidence of AF [RR (95% CI): 1.92 (1.68-2.20); P < 0.01]. The results from 29 studies revealed that SUA levels elevated in patients with AF [SMD (95% CI): 0.55 (0.43-0.66); P < 0.001]. Meanwhile, SUA levels in new-onset AF [SMD (95%CI): 0.24 (0.10-0.38); P = 0.001], paroxysmal AF [SMD (95%CI): 0.52 (0.33-0.72); P < 0.001] and persistent AF [SMD (95%CI): 1.23 (0.98-1.48); P < 0.001] were significantly higher than that in patients without AF.

CONCLUSIONS

High SUA levels had an obvious correlation with the occurrence rate of AF. In addition, SUA levels were significantly different among patients with new-onset, paroxysmal and persistent AF.

Atrial electromechanical duration prolongs in patients with erectile dysfunction

Background: It is well known that erectile dysfunction (ED) is associated with increased risk of atrial fibrillation (AF) development. On the other hand, prolongation of the duration of atrial electromechanical delay (AEMD) is known to be a precursor for AF development. We aimed to evaluate AEMD in patients with ED patients without documented AF.Methods: Total of 68 outpatients with previously documented vascular ED and 44 participants without ED were enrolled to the current study. Sixty-eight patients with ED called as ED group and 44 participants without ED served as control group. We performed International Index of Erectile Function (IIEF-5) questionnaire for all participants to determine the disease severity of ED groups and to diagnose ED in control groups. Patients with a IIEF-5 score ≥22 were defined as having normal erectile functions. Both intra- and inter-AEMD were measured with tissue Doppler imaging. P-wave dispersion (PWD) was measured on a 12-lead electrocardiogram.Results: Basal characteristics were similar between the two groups. PWD, inter- and right intra-AEMD were significantly prolonged in patients with ED, compared to the control group (p = .02, p < .001 and p < .001, respectively). In the correlation analysis, IIEF-5 score was significantly negative correlated with systolic blood pressure, right intra- and inter-AEMD (r = -0.37, p = .02; r= -0.27, p = .02; r = -0.39, p = .001, respectively).Conclusions: According to current study results, AEMD is significantly correlated with ED severity and may be useful to stratify ED patients to the high-risk group for future development of AF as a cheap and easy method.

Association of Erectile Dysfunction with Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA)

PURPOSE

Erectile dysfunction has been associated with atrial fibrillation in cross-sectional studies, but the association of erectile dysfunction with incident atrial fibrillation is less well established. This study aimed to determine whether erectile dysfunction is independently associated with incident atrial fibrillation after adjusting for conventional risk factors.

METHODS

We studied 1760 male participants (mean age 68 ± 9 years) from the Multi-Ethnic Study of Atherosclerosis (MESA), who completed self-reported erectile dysfunction assessment at MESA exam 5 (2010-2012). Cumulative incidence of atrial fibrillation was estimated by Kaplan-Meier analysis. Cox proportional hazards regression was used to calculate the unadjusted and adjusted hazard ratios (HR) using 3 models in which variables were added in a stepwise manner. In model 3, HR was adjusted for age, race and ethnicity, education, smoking status, alcohol use, systolic blood pressure, body mass index, diabetes, anti-hypertensive medication use, lipid-lowering medication use, total cholesterol, and estimated glomerular filtration rate.

RESULTS

During the median follow-up of 3.8 (interquartile range, 3.5-4.2) years, 94 cases of incident atrial fibrillation were observed. There was a significant difference between males with and without erectile dysfunction for cumulative incident atrial fibrillation rates at 4 years (9.6 vs 2.9%, P < .01). In the fully adjusted model, erectile dysfunction remained associated with incident atrial fibrillation (model 3; HR, 1.66; 95% confidence interval 1.01-2.72, P = .044).

CONCLUSIONS

Among older male participants in this prospective study, we found that self-reported erectile dysfunction was associated with incident atrial fibrillation.

P wave dispersion in patients with erectile dysfunction

Background and aims

P wave dispersion (PWD) has been reported to be a non-invasive electrocardiographic predictor for atrial fibrillation. The aim of this study is to evaluate PWD between men with erectile dysfunction (ED) and healthy controls in order to investigate whether PWD was prolonged in patients with ED and related to severity of the disease.

Methods

This study included a total of 72 men (42 patients with ED and 30 healthy controls). Demographic data and clinical features were recorded on admission. An electrocardiographic evaluation was obtained to measure PWD values for both patients and controls.

Results

Maximum P wave duration was 108.5 ± 4.7 and 108.3 ± 4.3 in ED group and control group, respectively (p = 0.748). Minumum P wave duration was significantly higher in the control group than in the ED group. PWD was 48.1 ± 5.9 in the ED group. As a result, PWD was prolonged in patients with ED (48.1 ± 5.9 vs. 38.0 ± 3.9, p < 0.05). A significant negative correlation was observed between IIEF score and PWD values (p < 0.05, r = −0.662).

Conclusions

Patients with ED exhibited prolonged PWD values compared with normal controls. In addition, PWD was found to be associated with severity of the disease.

Baseline atrial fibrillation is a risk factor for erectile dysfunction: Systemic review and meta-analysis

Objective: To assess the association between atrial fibrillation (AF) and erectile dysfunction (ED) by a systematic review of the literature and meta-analysis, as ED is commonly found amongst male patients with concurrent cardiovascular conditions, especially atherosclerosis, coronary syndrome, and diabetes; and recent studies suggest that AF is associated with ED in the general male population.

Methods: Studies from inception to May 2018 in the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE) were searched. Prospective or retrospective cohort studies that compared new-onset ED between male patients with and without AF were included. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios (RRs) and 95% confidence intervals (CIs).

Results: Five studies from 2007 to 2016 were included in the meta-analysis involving 29829 male patients (4096 with AF and 25733 without). The presence of AF was associated with ED (pooled RR 1.61, 95% CI 1.23–2.10; P < 0.001, I² = 42%).

Conclusions: Baseline AF increased the risk of ED up to 1.6-fold amongst the general male population. This suggests that AF in male patients is significantly associated with ED.

Abbreviations: AF: atrial fibrillation; CV: cardiovascular; ED: erectile dysfunction; EMBASE: Excerpta Medica database; HR: hazard ratio; ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification; (S)IR: (standardised) incidence ratio; IIEF: International Index of Erectile Function; LVDD: left ventricular diastolic dysfunction; MEDLINE: Medical Literature Analysis and Retrieval System Online; NO: nitric oxide; OR: odds ratio; RR: relative risk

Serum Uric Acid and Atrial Fibrillation: Meta-analysis

Hyperuricemia has been recently speculated to be associated with the development of atrial fibrillation (AF). A meta-analysis of observational studies was conducted to explore the relationship between serum uric acid (SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and performed extensive bibliography search to identify studies with mean SUA level for patients with and without AF. Key search terms were "atrial fibrillation" and "uric acid." Under the random-effects model, the pooled standardized difference in means between patients with and without AF was calculated. A total of 24 studies with 30,609 patients were included for quantitative analyzation of the difference in SUA levels between the patients with and without AF. The SUA level of patients with atrial AF was found to be significantly higher compared with those without AF (standardized difference in means = 0.66; 95% confidence interval, 0.43-0.88; P < 0.0001). The mean SUA level of patients with AF significantly is higher than those without AF.