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Shah H, Hanna KS, Kaur H, Alazzeh MS, Thandavaram A, Channar A, Purohit A, Shrestha B, Patel D, Mohammed L. The Outcome of Electrical Cardioversion in Hyperthyroid Induced Atrial Fibrillation. Cureus 2023; 15:e37928. [PMID: 37220445 PMCID: PMC10200072 DOI: 10.7759/cureus.37928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Hyperthyroidism is a prevalent cause of atrial fibrillation (AF). High cardiac output with low systemic vascular resistance, driven by hyperthyroidism, is associated with a rapid heartbeat, enhanced left ventricular systolic and diastolic function, and a higher incidence of supraventricular tachyarrhythmias. After returning to euthyroid status, hyperthyroidism-induced AF generally spontaneously reverts to sinus rhythm (SR), and a significant number of patients remain in chronic AF and require electrical cardioversion (ECV). After effective cardioversion, the long-term outcome of hyperthyroidism-induced persistent AF is unknown. Early ECV before the antithyroid medication should be explored for hyperthyroidism-induced AF to reduce the risk of thromboembolic consequences. The recurrence rate of AF between Hyperthyroid and Euthyroid Patients after ECV did not significantly differ. This review article compares the recurrence rate of AF as an outcome of ECV in Hyperthyroid induced atrial fibrillation.
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Affiliation(s)
- Hriday Shah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kerollos S Hanna
- General Physician, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Harkirat Kaur
- General Physician, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohammad S Alazzeh
- Orthopaedic Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abhay Thandavaram
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aneeta Channar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ansh Purohit
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bijay Shrestha
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Deepkumar Patel
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Akboga MK, Inanc IH, Keskin M, Sabanoglu C, Gorenek B. Current Evidence on Prevention of Atrial Fibrillation: Modifiable Risk Factors and the Effects of Risk Factor Intervention. Cardiol Rev 2023; 31:70-79. [PMID: 36735576 DOI: 10.1097/crd.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atrial fibrillation (AF) is one of the most encountered arrhythmias in clinical practice. It is also estimated that the absolute AF burden may increase by greater than 60% by 2050. It is inevitable that AF will become one of the largest epidemics in the world and may pose a major health problem for countries. Although AF rarely causes mortality in the acute period, it causes a significant increase in mortality and morbidity, including a fivefold increase in the risk of stroke, a twofold increase in dementia, and a twofold increase in myocardial infarction in the chronic period. Despite all the advances in the treatment of AF, it is better understood day by day that preventing AF may play a key role in reducing AF and its related complications. Modification of the main modifiable factors such as quitting smoking, abstaining from alcohol, changing eating habits, and exercise seems to be the first step in preventing AF. The strict adherence to the treatment process of secondary causes predisposing to AF such as DM, hypertension, obesity, and sleep apnea is another step in the prevention of AF. Both an individual approach and global public health campaigns can be highly beneficial to reduce the risk of AF. In this review, we aimed to summarize the current evidence on the relationship between modifiable risk factors and AF, and the impact of possible interventions on these factors in preventing or reducing the AF burden in the light of recently published guidelines and studies.
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Affiliation(s)
- Mehmet Kadri Akboga
- From the Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Halil Inanc
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey
| | - Cengiz Sabanoglu
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Bulent Gorenek
- Department of Cardiology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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3
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Cardiovascular changes in horses with atrial fibrillation and high thyroid hormone concentration: a case-control study. J Vet Cardiol 2022; 43:93-100. [DOI: 10.1016/j.jvc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
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4
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Bekiaridou A, Kartas A, Moysidis DV, Papazoglou AS, Baroutidou A, Papanastasiou A, Giannakoulas G. The bidirectional relationship of thyroid disease and atrial fibrillation: Established knowledge and future considerations. Rev Endocr Metab Disord 2022; 23:621-630. [PMID: 35112273 DOI: 10.1007/s11154-022-09713-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/24/2022]
Abstract
Atrial fibrillation (AF) tends to occur frequently in patients with thyroid disease, primarily hyperthyroidism. In hyperthyroidism, increased levels of thyroid hormones, via intra- and extranuclear mechanisms, have profound effects on cardiac electrophysiology. Hypothyroidism carries a lower risk for AF and is mainly associated with the overtreatment of hypothyroid patients. New-onset AF is frequently the only manifestation of thyroid disease, which renders screening for thyroid dysfunction in that scenario clinically useful. Managing thyroid disease and comorbid AF is essential. This includes thyroid hormones control along with conventional AF therapy. However, there are several open issues with this comorbid duo. The optimal management of thyroid disease and its impact on AF burden remains obscure. There is scanty information on clear-cut benefits for therapy of subclinical thyroid disease and screening of asymptomatic patients. Furthermore, the immunogenetic overlap between the autoantibodies in Graves' disease and AF genesis may lead to novel therapeutic implications. The objective of this review is to summarize the up-to-date epidemiology, pathogenesis, pathophysiology and management of interacting thyroid disease and AF.
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Affiliation(s)
- Alexandra Bekiaridou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Andreas S Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Anastasios Papanastasiou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1064] [Impact Index Per Article: 354.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Risk of Thromboembolism in Non-Valvular Atrial Fibrillation With or Without Clinical Hyperthyroidism. Glob Heart 2021; 16:45. [PMID: 34211831 PMCID: PMC8212838 DOI: 10.5334/gh.871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patients with hyperthyroidism have higher risk of atrial fibrillation (AF). However, the risk of thromboembolic event in patients with hyperthyroidism-related AF is controversial. Objectives: The aim of the study was to examine the risk of thromboembolic events in AF patients with/without hyperthyroidism. Methods: The national retrospective cohort study enrolled AF population was derived from the Taiwan National Health Insurance Research Database. The comparison between the AF patients with clinical hyperthyroidism (HT-AF group) and AF patients without hyperthyroidism (non-thyroid AF group) was made in a propensity score matched cohort and in a real-world setting, of which, the CHA2DS2-VASc level was treated as a stratum variable. The outcomes were ischemic stroke and systemic thromboembolism. Results: There were 3,880 patients in HT AF group and 178,711 in non-thyroid AF group. After propensity score analysis, the incidence of thromboembolism event and ischemic stroke were lower in HT AF patients than non-thyroid AF patients (1.6 versus 2.2 events per 100 person-years; HR, 0.73; 95% CI, 0.64–0.82 and 1.4 versus 1.8 events per 100 person-years; HR, 0.74; 95% CI, 0.64–0.84, respectively) in the 4.3 ± 3.2 year follow up period. The differences persistently existed in those receiving anticoagulants or not. In AF patients without anticoagulants, the incidence densities of ischemic stroke/systemic thromboembolism were significantly lower in HT AF group than those in non-thyroid AF group at CHA2DS2-VASc scores ≤ 4 (HR, 0.41; 95% CI, 0.35–0.48, p < 0.001), while the differences disappeared in case of score ≥ 5 (HR, 0.80; 95% CI, 0.63–1.02, p = 0.071). Conclusion: Patients with HT AF had lower incidence of thromboembolic events as compared to non-thyroid AF patients. The threshold of CHA2DS2-VASc score for anticoagulation in AF patients with clinical hyperthyroidism should be further evaluated. Highlights
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Wong CK, Huang D, Zhou M, Hai J, Yue WS, Li WH, Yin LX, Zuo ML, Feng YQ, Tan N, Chen JY, Kwan J, Siu CW. Antithrombotic therapy and the risk of new-onset dementia in elderly patients with atrial fibrillation. Postgrad Med J 2020; 98:98-103. [PMID: 33184131 DOI: 10.1136/postgradmedj-2020-137916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/27/2020] [Accepted: 10/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with an increased risk of dementia. Little is known about the relationship of antithrombotic therapy and the risk of dementia in patients with AF without clinical stroke. METHOD This was an observational study based on a hospital AF registry. Patients aged 65-85 years at the time of AF diagnosis were identified via the computerised database of the clinical management system. Patients with prior stroke or known cognitive dysfunction were excluded. The primary outcome was newly diagnosed dementia during the follow-up period. RESULTS 3284 patients (mean age 76.4±5.3 years, 51.6% male) were included for analysis. The mean CHA2DS2-VASc score was 3.94±1.44. 18.5% patients were prescribed warfarin, 39.8% were prescribed aspirin and 41.7% were prescribed no antithrombotic therapy. After a mean follow-up of 3.6 years, 71 patients (2.2%) developed dementia, giving rise to an incidence of 0.61%/year. The incidence of dementia were 1.04%/year, 0.69%/year and 0.14%/year for patients on no therapy, aspirin and warfarin, respectively. Both univariate and multivariate analyses showed that age ≥75 years, female gender and high CHA2DS2-VASc score were associated with significantly higher risk of dementia; warfarin use was associated with significantly lower risk of dementia (HR: 0.14%, 95% CI 0.05 to 0.36, p<0.001). Patients on warfarin with time in therapeutic range (TTR) ≥65% had a non-significant trend towards a lower risk of dementia compared with those with TTR <65%. CONCLUSION In elderly AF patients, warfarin therapy was associated with a significantly lower risk of new-onset dementia compared those with no therapy or aspirin.
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Affiliation(s)
- Chun Ka Wong
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Duo Huang
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China.,Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Mi Zhou
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - JoJo Hai
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wen Sheng Yue
- Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wen-Hua Li
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Li-Xue Yin
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Ming-Liang Zuo
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Ying Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ji Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Joseph Kwan
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chung Wah Siu
- Division of Geriatrics, Department of Medicine, The University of Hong Kong, Hong Kong, China
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8
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Jobst S, Leppla L, Köberich S. A self-management support intervention for patients with atrial fibrillation: a randomized controlled pilot trial. Pilot Feasibility Stud 2020; 6:87. [PMID: 32566244 PMCID: PMC7301515 DOI: 10.1186/s40814-020-00624-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia worldwide. Despite effective treatment, it is characterized by frequent recurrences. Optimal therapeutic management of AF requires active participation and self-management from patients. Two major components of self-management are self-monitoring and sign-and-symptom management. Pulse self-palpation (PSP) is a method of self-monitoring; however, not all AF patients are capable of successfully performing PSP. Due to a lack of interventions on this topic, a nurse-led intervention for patients with AF (PSPAF intervention) was developed to foster self-monitoring and to enhance self-management through PSP. The purpose of this pilot study was to test the acceptability, feasibility, and potential effects of this intervention on the capability of patients' PSP and sign-and-symptom management. Moreover, we aimed at gathering data on the feasibility of applied research methods to aid in the design of future studies. METHODS The pilot trial involved 20 adult patients with AF, randomized to an intervention or usual care group. At baseline and during a home visit 3-5 weeks later, we collected data using questionnaires, checklists, field notes, a mobile ECG device, and a diary. Acceptability and feasibility measures were validated through predefined cut-off points. Effect size estimates were expressed as relative risks (RR) and the number needed to treat (NNT). RESULTS The PSPAF intervention seemed feasible, but only partly acceptable. There were limitations in terms of potential effectiveness, suitability, addressing participants' willingness to implement its content in daily life, and adherence. Estimations of effect sizes suggest a large effect of the intervention on patients' PSP capability (RR = 6.0; 95% CI = [0.83, 43.3]; NNT = 2.4), but almost no effect on sign-and-symptom management (RR = 1.5; 95% CI = [0.7, 3.1]; NNT = 4.0). The feasibility of applied research methods showed minor limitations on recruitment and participant burden. CONCLUSIONS Despite some limitations, the intervention seemed to be applicable and promising. Taking into account the suggestions and amendments we have made, we recommend conducting a full-scale trial to examine the efficacy of the PSPAF intervention. TRIAL REGISTRATION This pilot study was registered in the German Clinical Trials Register at September 4, 2017 (Main ID: DRKS00012808).
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Affiliation(s)
- Stefan Jobst
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Fehrenbachallee 8, D-79106 Freiburg, Germany
| | - Lynn Leppla
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Stefan Köberich
- Pflegedirektion, Heart Center University of Freiburg, Hugstetter Straße 55, D-79106 Freiburg, Germany
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Duraes AR, Filho CRH, de Souza Lima Bitar Y, Neto MG. Heart Failure and Comorbidities—Part 1. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40138-020-00210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Wang EY, Hulme OL, Khurshid S, Weng LC, Choi SH, Walkey AJ, Ashburner JM, McManus DD, Singer DE, Atlas SJ, Benjamin EJ, Ellinor PT, Trinquart L, Lubitz SA. Initial Precipitants and Recurrence of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e007716. [PMID: 32078361 DOI: 10.1161/circep.119.007716] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) may occur after an acute precipitant and subsequently resolve. Management guidelines for AF in these settings are unclear as the risk of recurrent AF and related morbidity is poorly understood. We examined the relations between acute precipitants of AF and long-term recurrence of AF in a clinical setting. METHODS From a multi-institutional longitudinal electronic medical record database, we identified patients with newly diagnosed AF between 2000 and 2014. We developed algorithms to identify acute AF precipitants (surgery, sepsis, pneumonia, pneumothorax, respiratory failure, myocardial infarction, thyrotoxicosis, alcohol, pericarditis, pulmonary embolism, and myocarditis). We assessed risks of AF recurrence in individuals with and without a precipitant and the relations between AF recurrence and heart failure, stroke, and mortality. RESULTS Among 10 723 patients with newly diagnosed AF (67.9±9.9 years, 41% women), 19% had an acute AF precipitant, the most common of which were cardiac surgery (22%), pneumonia (20%), and noncardiothoracic surgery (15%). The cumulative incidence of AF recurrence at 5 years was 41% among individuals with a precipitant compared with 52% in those without a precipitant (adjusted hazard ratio [HR], 0.75 [95% CI, 0.69-0.81]; P<0.001). The lowest risk of recurrence among those with precipitants occurred with postoperative AF (5-year incidence 32% in cardiac surgery and 39% in noncardiothoracic surgery). Regardless of the presence of an initial precipitant, recurrent AF was associated with increased adjusted risks of heart failure (hazard ratio, 2.74 [95% CI, 2.39-3.15]; P<0.001), stroke (hazard ratio, 1.57 [95% CI, 1.30-1.90]; P<0.001), and mortality (hazard ratio, 2.96 [95% CI, 2.70-3.24]; P<0.001). CONCLUSIONS AF after an acute precipitant frequently recurs, although the risk of recurrence is lower than among individuals without an acute precipitant. Recurrence is associated with substantial long-term morbidity and mortality. Future studies should address surveillance and management after newly diagnosed AF in the setting of an acute precipitant.
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Affiliation(s)
- Elizabeth Y Wang
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine, Columbia University Medical Center, New York, NY (E.Y.W.)
| | - Olivia L Hulme
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
| | - Shaan Khurshid
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Division of Cardiology (S.K., S.A.L.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Lu-Chen Weng
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Allan J Walkey
- Boston University School of Medicine (A.J.W.), Harvard Medical School, MA
| | - Jeffrey M Ashburner
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester (D.D.M.)
| | - Daniel E Singer
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - Steven J Atlas
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - Emelia J Benjamin
- Department of Medicine, Sections of Preventive Medicine and Cardiovascular Medicine (E.J.B.), Harvard Medical School, MA.,Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study (E.J.B.), Boston University School of Public Health, MA.,Department of Epidemiology (E.J.B.), Boston University School of Public Health, MA
| | - Patrick T Ellinor
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Ludovic Trinquart
- Department of Biostatistics (L.T.), Boston University School of Public Health, MA
| | - Steven A Lubitz
- Division of Cardiology (S.K., S.A.L.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
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Tips for management of arrhythmias in endocrine disorders from an European Heart Rhythm Association position paper. Anatol J Cardiol 2019; 20:241-245. [PMID: 30297583 PMCID: PMC6249537 DOI: 10.14744/anatoljcardiol.2018.87260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In endocrine diseases, hormonal changes, electrolyte abnormalities, and the deterioration of heart structure can lead to various arrhythmias. In diabetic patients, hypoglycemia, hyperglycemia, and hypokalemia can trigger arrhythmias, and diabetic cardiomyopathy can also cause electrical and structural remodeling to form substrates for arrhythmias. The risk of atrial fibrillation (AF) increases in hyperthyroidism; however, the prevalence of ventricular arrhythmias in hypothyroidism is higher. Besides AF and ventricular tachycardias, bradycardias and atrioventricular blocks can also be seen in pheochromocytoma due to the desensitization of adrenergic cardiovascular receptors. The correction of metabolic and electrolyte disturbances in patients with adrenal cortex disease should be the main approach in the prevention and treatment of arrhythmias. Early initiation of treatment in patients with acromegaly seems to decrease the development of cardiac remodeling and ventricular arrhythmia. Early and late after depolarizations due to hypercalcemia in hyperparathyroidism can lead to life-threatening ventricular arrhythmias. This elegant position paper provides important recommendations regarding prevention and treatment of arrhythmias for specific endocrine disorders.
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Larsen TB, Lip GYH, Løchen ML, Marín F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Marques-Vidal PM, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace 2018; 19:190-225. [PMID: 28175283 DOI: 10.1093/europace/euw242] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- University of Birmingham, Birmingham, UK.,Aalborg University Hospital, Aalborg, Denmark
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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Ecker V, Knoery C, Rushworth G, Rudd I, Ortner A, Begley D, Leslie SJ. A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation. Clin Cardiol 2018; 41:862-870. [PMID: 29878481 DOI: 10.1002/clc.22931] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation is the most common heart-rhythm disorder, affecting about 1.5% to 2% of the population with an increased risk of mortality and morbidity due to stroke, thromboembolism, and heart failure. If the conversion back to sinus rhythm does not happen spontaneously, pharmacological or electrical cardioversion (ECV) is the next available treatment options for some patients. However, the long-term success following ECV is variable. This review describes the factors that are associated with maintenance of sinus rhythm following ECV and proposes a clinical strategy based on the available evidence.
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Affiliation(s)
- Veronika Ecker
- Institute for Pharmaceutical Sciences, Karl-Franzens-Universität, Graz, Austria
| | - Charles Knoery
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK
| | - Gordon Rushworth
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK.,Highland Pharmacy Education & Research Centre, Centre for Health Science, Inverness, UK
| | - Ian Rudd
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK
| | - Astrid Ortner
- Institute for Pharmaceutical Sciences, Karl-Franzens-Universität, Graz, Austria
| | - David Begley
- Cardiac Department, Royal Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Stephen J Leslie
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK.,Department of Diabetes & Cardiovascular Science, University of the Highlands and Islands, Centre for Health Science, Inverness, UK
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14
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Gorenek B, Boriani G, Dan GA, Fauchier L, Fenelon G, Huang H, Kudaiberdieva G, Lip GYH, Mahajan R, Potpara T, Ramirez JD, Vos MA, Marin F, Blomstrom-Lundqvist C, Rinaldi A, Bongiorni MG, Sciaraffia E, Nielsen JC, Lewalter T, Zhang S, Gutiérrez O, Fuenmayor A. European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS). Europace 2018; 20:895-896. [DOI: 10.1093/europace/euy051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/25/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gheorge-Andrei Dan
- University of Medicine and Pharmacy “Carol Davila”, Colentina University Hospital, Bucharest, Romania
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - He Huang
- Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rajiv Mahajan
- The University of Adelaide, Lyell McEwin Hospital, Royal Adelaide Hospital and SAHMRI, Adelaide, Australia
| | - Tatjana Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | | | | | | | | | | | | | | | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, China
| | | | - Abdel Fuenmayor
- Electrophysiology and Arrhythmia Section, Cardiovascular Research Institute, University Hospital of The Andes, Avenida 16 de Septiembre, Mérida 5101, Venezuela
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15
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Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke. J Thyroid Res 2017; 2017:4259183. [PMID: 29379659 PMCID: PMC5742874 DOI: 10.1155/2017/4259183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke. Methods We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke. Results Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, p = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, p = 0.023) and had a trend towards higher CHA2DS2-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, p = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], p = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], p = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], p = 0.008) were associated with persistence of AF on multivariate analysis. Conclusion Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.
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16
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Lam CC, Tse HF, Siu CW. Transient atrial fibrillation complicating acute myocardial infarction: A nuisance or a nemesis? Thromb Haemost 2017; 107:6-7. [DOI: 10.1160/th11-11-0807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 11/22/2011] [Indexed: 11/05/2022]
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17
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Bjerregaard Larsen T, Lip GYH, Løchen ML, Marin F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Manuel Marques-Vidal P, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Eur J Prev Cardiol 2017; 24:4-40. [PMID: 27815538 PMCID: PMC5427484 DOI: 10.1177/2047487316676037] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- UiT The Arctic University of Norway, Tromso, Norway
- Mary MacKillop Institute for Health Research, Centre for Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Melbourne, Australia
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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18
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Chan PH, Lau CP, Tse HF, Chiang CE, Siu CW. CHA 2DS 2-VASc Recalibration With an Additional Age Category (50-64 Years) Enhances Stroke Risk Stratification in Chinese Patients With Atrial Fibrillation. Can J Cardiol 2016; 32:1381-1387. [PMID: 27523274 DOI: 10.1016/j.cjca.2016.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Chinese patients with atrial fibrillation (AF) and a low CHA2DS2-VASc have a disproportionately high ischemic stroke risk; nonetheless, little is known about the impact of age on ischemic stroke risk in this population. In this study, we aimed to examine the age-related ischemic stroke risk in Chinese patients with nonvalvular AF without other risk factors for stroke. METHODS This was a hospital-based observational registry. RESULTS A total of 1198 Chinese patients with AF (mean age, 73.6 ± 16.5 years; male sex, 53.3%) were included in this analysis. The mean CHA2DS2-VASc and HAS-BLED score were 1.81 ± 1.00 and 1.32 ± 0.77, respectively, and none of the patients was prescribed antiplatelet or anticoagulation therapy. After a mean follow-up of 2.95 years, there were 234 ischemic strokes (19.5%), with an annual ischemic stroke incidence of 6.62%/y. The overall annual ischemic stroke risk was 0.43%/y, 5.87%/y, 7.49%/y, and 8.04%/y for age groups < 50 years, 50-64 years, 65-74 years, and ≥ 75 years, respectively. There was a 10- to 20-fold gradient in ischemic stroke risk that increased sharply after the age of 50 years. The hazard ratios were 1.0, 13.0, 19.3, and 21.6 for age groups < 50 years, 50-64 years, 65-74 years and ≥ 75 years, respectively (P for trend < 0.0001). Similar trends were also observed in both male and female patients with AF. CONCLUSIONS Chinese patients with AF and a low CHA2DS2-VASc were at a disproportionally high risk of ischemic stroke. Chinese patients between 50 and 64 years have a high risk for stroke despite a low CHA2DS2-VASc and a low bleeding risk. Only patients aged < 50 years have a truly low risk.
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Affiliation(s)
- Pak-Hei Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chu-Pak Lau
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chern-En Chiang
- Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China.
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19
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Gürdoğan M, Ari H, Tenekecioğlu E, Ari S, Bozat T, Koca V, Melek M. Predictors of Atrial Fibrillation Recurrence in Hyperthyroid and Euthyroid Patients. Arq Bras Cardiol 2016; 106:84-91. [PMID: 26815460 PMCID: PMC4765005 DOI: 10.5935/abc.20160013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/06/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia in adults, and is encountered in 10-15% of the patients with hyperthyroidism. Unless euthyroidism is restored, pharmacological or electrical cardioversion is controversial in patients with AF who remain hyperthyroid. OBJECTIVE The aim of this study was to assess the efficacy of electrical cardioversion and predictors of AF recurrence in hyperthyroid and euthyroid patients. METHODS The study included 33 hyperthyroid (21 males) and 48 euthyroid (17 males) patients with persistent AF. The patients were sedated with intravenous midazolam before undergoing electrical cardioversion delivered by synchronized biphasic shocks. Rates of AF recurrence were recorded. RESULTS Mean follow-up was 23.63 ± 3.74 months in the hyperthyroid group and 22.78 ± 3.15 months in the euthyroid group (p = 0.51). AF recurred in 14 (43.8%) and 21 (44.7%) patients in each group, respectively (p = 0.93). Multivariate regression analysis in each group showed that AF duration was the only predictor of AF recurrence, with odds ratios of 1.38 (95% confidence interval [CI] = 1.05 - 1.82, p = 0.02) in the hyperthyroid group and 1.42 (95% CI = 1.05 - 1.91, p= 0.02) in the euthyroid group. CONCLUSION Rates of long-term AF recurrence were similar in successfully cardioverted hyperthyroid and euthyroid patients. The only predictor of AF recurrence in both groups was AF duration.
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Affiliation(s)
| | - Hasan Ari
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | | | - Selma Ari
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Tahsin Bozat
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Vedat Koca
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Mehmet Melek
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
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20
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Abstract
BACKGROUND Little is known about the clinical benefit of a non-vitamin K antagonist oral anticoagulant compared with warfarin in elderly Chinese patients with atrial fibrillation (AF). OBJECTIVE The purpose of this study was to evaluate the clinical benefit of dabigatran in elderly (age ≥80 years) Chinese patients with nonvalvular AF with regard to the risk of ischemic stroke and intracranial hemorrhage (ICH). METHODS This was an observational study. RESULTS We studied 571 Chinese patients (mean age 84.8 ± 4.0 years; 58.1% women) with nonvalvular AF. The primary outcome was hospital admission for ischemic stroke, and the secondary outcome was admission for ICH. The mean CHA2DS2-VASc (congestive heart failure [1 point], hypertension [1 point], age 65-74 years [1 point] and age ≥75 years [2 points], diabetes mellitus [1 point], prior stroke or transient ischemic attack [2 points], vascular disease [1 point], sex category [female] [1 point]) and HAS-BLED (hypertension [1 point], abnormal renal/liver function [1 point], stroke [1 point], bleeding history [1 point] or predisposition [1 point], labile international normalized ratio [1 point], elderly [age >65 years] [1 point], drugs/alcohol concomitantly [1 point]) scores were 4.8 ± 1.6 and 2.4 ± 0.8, respectively. Of 571 patients, 129 (22.6%) were taking dabigatran 110 mg twice daily and the remaining were on warfarin. After a mean follow-up of 2.6 years (a total of 1471 patient-years), ischemic stroke occurred in 83 patients on warfarin (6.9% per year) compared with 4 patients on dabigatran (1.4% per year) (hazard ratio 0.22; 95% confidence interval 0.23-0.67). There were 8 incidences of ICH: 7 in patients on warfarin (0.59% per year) and 1 patient on dabigatran (0.35% per year). Dabigatran was associated with a substantially lower ischemic stroke risk (1.4% per year vs 5.4% per year) and similar ICH risk (0.35% per year vs 0.36% per year) as compared with warfarin with time in therapeutic range (TTR) ≥55%. CONCLUSION In elderly Chinese patients with AF, this study suggested that dabigatran achieved superior stroke risk reduction and similar risk of ICH compared with warfarin with TTR ≥55%. Dabigatran may be preferable to warfarin in elderly patients with AF for stroke prevention, particularly in those with poor TTR.
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21
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Wongcharoen W, Lin YJ, Chang SL, Lo LW, Hu YF, Chung FP, Chong E, Chao TF, Tuan TC, Chang YT, Lin CY, Liao JN, Lin YC, Chen YY, Chen SA. History of hyperthyroidism and long-term outcome of catheter ablation of drug-refractory atrial fibrillation. Heart Rhythm 2015; 12:1956-62. [DOI: 10.1016/j.hrthm.2015.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Indexed: 11/28/2022]
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22
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Chan PH, Hai J, Yeung CY, Lip GYH, Lam KSL, Tse HF, Siu CW. Benefit of Anticoagulation Therapy in Hyperthyroidism-Related Atrial Fibrillation. Clin Cardiol 2015; 38:476-82. [PMID: 26248681 DOI: 10.1002/clc.22427] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/01/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Existing data on the risk of ischemic stroke in hyperthyroidism-related atrial fibrillation (AF) and the impact of long-term anticoagulation in these patients, particularly those with self-limiting AF, remain inconclusive. HYPOTHESIS Risk of stroke in hyperthyroidism-related AF is the same as nonhyperthyroid counterparts. METHODS This was a single-center observational study of 9727 Chinese patients with nonvalvular AF from July 1997 to December 2011. Patients with AF diagnosed concomitantly with hyperthyroidism were identified. Primary and secondary endpoints were defined as hospitalization with ischemic stroke and intracranial hemorrhage in the first 2 years. Patient characteristics, duration of AF, and choice of antithrombotic therapy were recorded. Self-limiting AF was defined as <7 days' duration. RESULTS Out of 9727 patients, 642 (6.6%) had concomitant hyperthyroidism and AF at diagnosis. For stroke prevention, 136 and 243 patients (21.1% and 37.9%) were prescribed warfarin and aspirin, respectively, whereas the remaining patients (41.0%) received no therapy. Ischemic stroke occurred in 50 patients (7.8%), and no patient developed hemorrhagic stroke. Patients with CHA2 DS2 -VASc of 0 did not develop stroke. Warfarin effectively reduced the incidence of stroke compared with aspirin or no therapy in patients with CHA2 DS2 -VASc ≥1 and non-self-limiting AF, but not in those with self-limiting AF or CHA2 DS2 -VASc of 0. Presence of hyperthyroidism did not confer additional risk of ischemic stroke compared with nonhyperthyroid AF. CONCLUSIONS Patients with hyperthyroidism-related AF are at high risk of stroke (3.9% per year). Warfarin confers stroke prevention in patients with CHA2 DS2 -VASc ≥1 and non-self-limiting AF. Overall stroke risk was lower in hyperthyroid non-self-limiting AF patients compared with nonhyperthyroid counterparts.
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Affiliation(s)
- Pak-Hei Chan
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Jojo Hai
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Chun-Yip Yeung
- Research Center of Heart, Brain, Hormone and Healthy Aging, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Gregory Y H Lip
- University of Birmingham, Centre for Cardiovascular Sciences (Lip), City Hospital, Birmingham, United Kingdom
| | - Karen Siu-Ling Lam
- Research Center of Heart, Brain, Hormone and Healthy Aging, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.,Division of Endocrinology and Metabolism, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,Research Center of Heart, Brain, Hormone and Healthy Aging, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,Research Center of Heart, Brain, Hormone and Healthy Aging, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
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23
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Slow Heart Rate Predicts New Occurrence of Atrial Fibrillation. Heart Lung Circ 2015; 24:1087-93. [PMID: 26105987 DOI: 10.1016/j.hlc.2015.04.185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 04/25/2015] [Accepted: 04/29/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study aims to investigate the relation between baseline heart rate and new occurrence of AF in patients with mild symptoms. METHODS Patients without pre-existing AF or structural heart disease who underwent 24-hour electrocardiogram (ECG) monitoring for palpitations, dizziness or syncope were followed up for new-onset AF. RESULTS 428 patients (mean age 66.6±10.2 years, 43.7% male) were classified according to the average heart rate into four quartiles (1(st) quartile: <63 beat per minute (bpm); 2(nd) quartile: 63-70 bpm; 3(rd) quartile 70-77 bpm; and 4(th) quartile: >77 bpm). There were no significant differences in gender, prevalence of diabetes, hypertension, left ventricular ejection fraction, or medications but a higher prevalence of coronary artery disease was noted among patients in the lower quartiles of average heart rate. After a mean follow-up of 5.8±1.8 years, 60 patients (14.0%) developed new-onset AF. The annual incidence of new-onset AF was highest amongst those at the lowest quartile of average heart rate (9.39%/year) as compared to those amongst other quartiles. Cox regression analysis revealed that increasing age, decreasing quartile of average heart rate, and the use of calcium channel blocker were associated with increased risk of new-onset AF. CONCLUSIONS Average heart rate predicts new AF.
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24
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Chan PH, Li WH, Hai JJ, Tse HF, Siu CW. Impact of Antithrombotic Therapy in Atrial Fibrillation on the Presentation of Coronary Artery Disease. PLoS One 2015; 10:e0131479. [PMID: 26098876 PMCID: PMC4476741 DOI: 10.1371/journal.pone.0131479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/01/2015] [Indexed: 01/20/2023] Open
Abstract
Background Little is known about whether atrial fibrillation is a presentation of coronary disease. There is a paucity of knowledge about their causal relationship and also the impact of different antithrombotic strategies on the subsequent presentation of symptomatic coronary disease. Methods and Results We studied 7,526 Chinese patients diagnosed with non-valvular atrial fibrillation and no documented history of coronary artery disease. The primary endpoint was the new occurrence of coronary artery disease—either stable coronary artery disease or acute coronary syndrome. After a mean follow-up of 3.2±3.5 years (24,071 patient-years), a primary endpoint occurred in 987 patients (13.1%). The overall annual incidence of coronary artery disease was 4.10%/year. No significant differences in age, sex, and mean CHA2DS2-VASc score were observed between patients with and without the primary endpoint. When stratified according to the antithrombotic strategies applied for stroke prevention, the annual incidence of coronary artery disease was 5.49%/year, 4.45%/year and 2.16%/year respectively in those prescribed no antithrombotic therapy, aspirin, and warfarin. Similar trends were observed in patients with acute coronary syndromes. Diabetes mellitus, smoking history and renal failure requiring dialysis were predictors for primary endpoint in all antithrombotic therapies. Conclusion In patients with non-valvular atrial fibrillation, there is a modest association with coronary artery disease. Patients prescribed warfarin had the lowest risk of new onset coronary artery disease.
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Affiliation(s)
- Pak Hei Chan
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Wen Hua Li
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Jo Jo Hai
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Chung Wah Siu
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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25
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Lubitz SA, Yin X, Rienstra M, Schnabel RB, Walkey AJ, Magnani JW, Rahman F, McManus DD, Tadros TM, Levy D, Vasan RS, Larson MG, Ellinor PT, Benjamin EJ. Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study. Circulation 2015; 131:1648-55. [PMID: 25769640 DOI: 10.1161/circulationaha.114.014058] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines have proposed that atrial fibrillation (AF) can occur as an isolated event, particularly when precipitated by a secondary, or reversible, condition. However, knowledge of long-term AF outcomes after diagnosis during a secondary precipitant is limited. METHODS AND RESULTS In 1409 Framingham Heart Study participants with new-onset AF, we examined associations between first-detected AF episodes occurring with and without a secondary precipitant and both long-term AF recurrence and morbidity. We selected secondary precipitants based on guidelines (surgery, infection, acute myocardial infarction, thyrotoxicosis, acute alcohol consumption, acute pericardial disease, pulmonary embolism, or other acute pulmonary disease). Among 439 patients (31%) with AF diagnosed during a secondary precipitant, cardiothoracic surgery (n=131 [30%]), infection (n=102 [23%]), noncardiothoracic surgery (n=87 [20%]), and acute myocardial infarction (n=78 [18%]) were most common. AF recurred in 544 of 846 eligible individuals without permanent AF (5-, 10-, and 15-year recurrences of 42%, 56%, and 62% with versus 59%, 69%, and 71% without secondary precipitants; multivariable-adjusted hazard ratio, 0.65 [95% confidence interval, 0.54-0.78]). Stroke risk (n=209/1262 at risk; hazard ratio, 1.13 [95% confidence interval, 0.82-1.57]) and mortality (n=1098/1409 at risk; hazard ratio, 1.00 [95% confidence interval, 0.87-1.15]) were similar between those with and without secondary precipitants, although heart failure risk was reduced (n=294/1107 at risk; hazard ratio, 0.74 [95% confidence interval, 0.56-0.97]). CONCLUSIONS AF recurs in most individuals, including those diagnosed with secondary precipitants. Long-term AF-related stroke and mortality risks were similar between individuals with and without secondary AF precipitants. Future studies may determine whether increased arrhythmia surveillance or adherence to general AF management principles in patients with reversible AF precipitants will reduce morbidity.
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Affiliation(s)
- Steven A Lubitz
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA.
| | - Xiaoyan Yin
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Michiel Rienstra
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Renate B Schnabel
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Allan J Walkey
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Jared W Magnani
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Faisal Rahman
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - David D McManus
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Thomas M Tadros
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Daniel Levy
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Ramachandran S Vasan
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Martin G Larson
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Patrick T Ellinor
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Emelia J Benjamin
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
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Protective role of folic acid in thyroxine-induced cardiac hypertrophy in hyperthyroid rat. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.biomag.2013.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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New-onset atrial fibrillation is a predictor of subsequent hyperthyroidism: a nationwide cohort study. PLoS One 2013; 8:e57893. [PMID: 23469097 PMCID: PMC3585274 DOI: 10.1371/journal.pone.0057893] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/28/2013] [Indexed: 11/19/2022] Open
Abstract
AIMS To examine the long-term risk of hyperthyroidism in patients admitted to hospital with new-onset AF. Hyperthyroidism is a well-known risk factor for atrial fibrillation (AF), but it is unknown whether new-onset AF predicts later-occurring hyperthyroidism. METHODS AND RESULTS All patients admitted with new-onset AF in Denmark from 1997-2009, and their present and subsequent use of anti-thyroid medication was identified by individual-level linkage of nationwide registries. Patients with previous thyroid diagnosis or thyroid medication use were excluded. Development of hyperthyroidism was assessed as initiation of methimazole or propylthiouracil up to a 13-year period. Risk of hyperthyroidism was analysed by Poisson regression models adjusted for important confounders such as amiodarone treatment. Non-AF individuals from the general population served as reference. A total of 145,623 patients with new-onset AF were included (mean age 66.4 years [SD ±13.2] and 55.3% males) of whom 3% (4,620 events; 62.2% women) developed hyperthyroidism in the post-hospitalization period compared to 1% (48,609 events; 82% women) in the general population (n = 3,866,889). In both women and men we found a significantly increased risk of hyperthyroidism associated with new-onset AF compared to individuals in the general population. The highest risk was found in middle-aged men and was consistently increased throughout the 13-year period of observation. The results were confirmed in a substudy analysis of 527,352 patients who had thyroid screening done. CONCLUSION New-onset AF seems to be a predictor of hyperthyroidism. Increased focus on subsequent risk of hyperthyroidism in patients with new-onset AF is warranted.
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Chong BH, Pong V, Lam KF, Liu S, Zuo ML, Lau YF, Lau CP, Tse HF, Siu CW. Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events. Europace 2012; 14:942-947. [DOI: 10.1093/europace/eur389] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Wong SM, Tse HF, Siu CW. Pulmonary Hypertension and Isolated Right Heart Failure Complicating Amiodarone Induced Hyperthyroidism. Heart Lung Circ 2012; 21:163-5. [DOI: 10.1016/j.hlc.2011.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 11/13/2011] [Indexed: 10/14/2022]
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Yue WS, Chong BH, Zhang XH, Liao SY, Jim MH, Kung AWC, Tse HF, Siu CW. Hyperthyroidism-induced left ventricular diastolic dysfunction: implication in hyperthyroidism-related heart failure. Clin Endocrinol (Oxf) 2011; 74:636-43. [PMID: 21470287 DOI: 10.1111/j.1365-2265.2011.03981.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure occurs in 6% of hyperthyroid patients. Nonetheless, only half of those with hyperthyroidism-related heart failure have impaired left ventricular (LV) systolic function. Thus, diastolic dysfunction may play an important role in the pathogenesis. METHODS AND RESULTS We performed serial echocardiographic examinations in 70 consecutive patients with hyperthyroidism (39 ± 2 years, 47 women) to determine their diastolic function and repeated the examinations 6 months after achieving a euthyroid state. All patients had normal LV systolic function, but diastolic dysfunction was detected in 22 cases (mild: 3, moderate: 15 and severe: 4). The prevalence of diastolic dysfunction increased with age from 17·9 % in patients <40 years to 100% in those >60 years. Increasing age was the only independent predictor for diastolic dysfunction in hyperthyroid patients. After achievement of a euthyroid state, most patients (16/22, 72%) had completely normalized diastolic function: 100% of patients <40 years, 33·3 % of those ≥ 60 years. Further analyses revealed significant age-related differences in the cardiovascular response to hyperthyroidism. Among patients <40 years, hyperthyroidism resulted in a marked reduction in total peripheral vascular resistance, increased cardiac output and enhanced diastolic function as determined by E'. No such significant change in total peripheral vascular resistance or cardiac output was observed in hyperthyroid patients ≥ 40 years. In addition, hyperthyroidism was associated with reduced E', signifying diastolic dysfunction in older hyperthyroid patients. CONCLUSION Hyperthyroidism is associated with diastolic dysfunction, particularly in older patients. It is partly reversible following achievement of a euthyroid state.
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Affiliation(s)
- Wen-Sheng Yue
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Zhou ZH, Ma LL, Wang LX. Risk factors for persistent atrial fibrillation following successful hyperthyroidism treatment with radioiodine therapy. Intern Med 2011; 50:2947-51. [PMID: 22185984 DOI: 10.2169/internalmedicine.50.6135] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To investigate the predicting factors for persistent atrial fibrillation (AF) following radioiodine therapy for hyperthyroidism. METHODS Standard 12-lead ECG and 24-h Holter monitoring were performed in 94 patients (38 males, mean age 46.1±8.2 years) with persistent AF following radioiodine therapy for hyperthyroidism. Left ventricular (LV) function was assessed with two-dimensional echocardiography. RESULTS Euthyroidism or hypothyroidism was achieved in 81% and 19% of the patients, respectively, after radioiodine therapy. At the end of follow-up (1.6±1.3 years), LV ejection fraction in the 52 patients with LV dysfunction was increased from 39.3±3.3% to 59.0±5.5% (p<0.01). In the 38 patients with pre-treatment paroxysmal AF, no AF was documented during the follow-up. In the 45 patients with pre-treatment persistent AF, AF was found in 27 (60%) during the follow-up. Multivariate logistic regression analysis showed that more than 55 years old in age (RR 2.76, 95% CI: 1.16-8.79, p<0.01), duration of hyperthyroidism (RR 3.08, 95% CI: 1.22-11.41, p<0.01) and duration of pre-treatment atrial fibrillation (RR 2.96, 95% CI: 1.31-7.68, p<0.01) were independent predictors for persistent AF following radioiodine therapy. CONCLUSION Older age, duration of hyperthyroidism and pre-treatment duration of AF are risk factors for persistent AF following radioiodine therapy.
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Affiliation(s)
- Zhen-Hu Zhou
- Department of Nuclear Medicine, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, China
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Abstract
Hyperthyroidism is mainly caused by Graves' disease and toxic adenoma or multinodular goiter. In Europe, treatment of both disorders is usually started with antithyroidal drugs such as methimazole. Complications include agranulocytosis and the risk is dose-dependent. The starting dose of methimazole should not exceed 15-20 mg/d. Propylthiouracil can cause severe liver failure, leading to liver transplantation or death. Propylthiouracil, therefore, should not be used as first line agent and is only recommended when an antithyroid drug is to be started during the first trimester of pregnancy or in individuals who have experienced adverse responses to methimazole. Toxic adenoma is finally treated with radioioidine. To reduce the risk of treatment failure, antithyroidal drugs should be stopped at least one week prior to radioiodine. For Graves' disease, remission is unlikely if antibodies against the TSH-receptor remain above 10 mU/l after 6 months of antithyroidal treatment and radioiodine or thyroidectomy can be recommended. Thyroidectomy should be performed as (near) total thyreoidectomy.
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Affiliation(s)
- L Möller
- Klinik für Endokrinologie und Zentrallabor, Bereich Forschung und Lehre, Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Deutschland.
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