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Mostafa MA, Soliman MZ, Li Y, Singleton MJ, Ahmad MI, Soliman EZ. Association between blood pressure levels and premature atrial contractions in patients with hypertension. Am J Med Sci 2024:S0002-9629(24)01269-2. [PMID: 38825075 DOI: 10.1016/j.amjms.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/13/2024] [Accepted: 05/28/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND High blood pressure (BP) induces left atrial structural and functional remodeling that increases susceptibility to atrial arrhythmia. We hypothesized that lower systolic BP (SBP) levels are associated with a lower prevalence of premature atrial contractions (PACs) in patients with hypertension. METHODS This analysis included 4,697 participants (mean age 62±13.1 years, 50% women, 25.6% blacks) with hypertension from the Third National Health and Nutrition Examination Survey who did not have a prior history of cardiovascular disease (CVD). Multivariable logistic regression was used to examine the cross-sectional association between SBP and prevalence of PACs ascertained from 12-lead resting electrocardiograms. Multivariable Cox proportional hazard analysis was used to examine the association between baseline PACs and CVD mortality. RESULTS Approximately 1.6% (n=74) of participants had baseline PACs. Patients with SBP ≤140 mmHg had a lower prevalence of PACs than those with SBP ≥140 mmHg (1.1% vs. 1.9%, p-value=0.01). In a multivariable logistic regression model, each 10 mmHg decrease in SBP was associated with a 12% lower odds of PACs (OR (95%CI): 0.88 (0.77-0.99)). During 14 years of follow-up, 645 CVD deaths occurred. In a multivariable-adjusted Cox model, presence of PACs was associated with a 78% increased risk of CVD mortality (HR (95%CI): 1.78 (1.23-2.60)). CONCLUSIONS In patients with hypertension, lower SBP levels are associated with a lower prevalence of PACs, and presence of PACs is associated with a higher risk of CVD mortality risk. These findings highlight the potential role of BP lowering in the management of cardiac arrhythmias.
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Affiliation(s)
- Mohamed A Mostafa
- Epidemiological Cardiology Research Center (EPICARE), Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | - Mai Z Soliman
- Wake Forest University, Winston-Salem, North Carolina, USA
| | - Yabing Li
- Epidemiological Cardiology Research Center (EPICARE), Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Matthew J Singleton
- Department of Cardiovascular Medicine, Wellspan York Hospital, York, Pennsylvania, USA
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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2
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Cheng X, Wang X. Electrocardiogram prediction of atrial fibrillation risk after stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37582. [PMID: 38608063 PMCID: PMC11018186 DOI: 10.1097/md.0000000000037582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/21/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most common clinical arrhythmias. This study aims to predict the risk of post-stroke AF through electrocardiographic changes in sinus rhythm. METHODS We searched the MEDLINE (PubMed) and EMBASE databases to identify relevant research articles published until August 2023. Prioritized items from systematic reviews and meta-analyses were screened, and data related to AF detection rate were extracted. A meta-analysis using a random-effects model was conducted for data synthesis and analysis. RESULTS A total of 32 studies involving electrocardiograms (ECG) were included, with a total analysis population of 330,284 individuals. Among them, 16,662 individuals (ECG abnormal group) developed AF, while 313,622 individuals (ECG normal group) did not. ECG patterns included terminal P-wave terminal force V1, interatrial block (IAB), advanced interatrial block, abnormal P-wave axis, pulse rate prolongation, and atrial premature complexes. Overall, 15,762 patients experienced AF during the study period (4.77%). In the ECG abnormal group, the proportion was 14.21% (2367/16,662), while in the control group (ECG normal group), the proportion was 4.27% (13,395/313,622). The pooled risk ratio for developing AF was 2.45 (95% confidence interval [CI]: 2.02-2.98, P < .001), with heterogeneity (I2) of 95%. The risk ratio values of alAB, P-wave terminal force V1, interatrial block, abnormal P-wave axis, pulse rate prolongation and atrial premature complexes were 4.12 (95% CI, 2.99-5.66), 1.47 (95% CI, 1.19-1.82), 2.54 (95% CI, 1.83-3.52), 1.70 (95% CI, 0.98-2.97), 2.65 (95% CI, 1.88-3.72), 3.79 (95% CI, 2.12-6.76), respectively. CONCLUSION There is a significant correlation between ECG patterns and the occurrence of AF. The alAB exhibited the highest level of predictability for the occurrence of AF. These indicators support their use as screening tools to identify high-risk individuals who may benefit from further examinations or empirical anticoagulation therapy following stroke.
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Affiliation(s)
- Xiaoli Cheng
- Medical Imaging Department II, Shaanxi Kangfu Hospital, Xi’an, Shaanxi Province, China
| | - Xiaoli Wang
- Medical Imaging Department II, Shaanxi Kangfu Hospital, Xi’an, Shaanxi Province, China
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3
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Berry-Noronha A, Bonavia L, Song E, Grose D, Johnson D, Maylin E, Oqueli E, Sahathevan R. ECG predictors of AF: A systematic review (predicting AF in ischaemic stroke-PrAFIS). Clin Neurol Neurosurg 2024; 237:108164. [PMID: 38377651 DOI: 10.1016/j.clineuro.2024.108164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/13/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
In 25% of patients presenting with embolic stroke, a cause is not determined. Atrial fibrillation (AF) is a commonly identified mechanism of stroke in this population, particularly in older patients. Conventional investigations are used to detect AF, but can we predict AF in this population and generally? We performed a systematic review to identify potential predictors of AF on 12-lead electrocardiogram (ECG). METHOD We conducted a search of EMBASE and Medline databases for prospective and retrospective cohorts, meta-analyses or case-control studies of ECG abnormalities in sinus rhythm predicting subsequent atrial fibrillation. We assessed quality of studies based on the Newcastle-Ottawa scale and data were extracted according to PRISMA guidelines. RESULTS We identified 44 studies based on our criteria. ECG patterns that predicted the risk of developing AF included interatrial block, P-wave terminal force lead V1, P-wave dispersion, abnormal P-wave-axis, abnormal P-wave amplitude, prolonged PR interval, left ventricular hypertrophy, QT prolongation, ST-T segment abnormalities and atrial premature beats. Furthermore, we identified that factors such as increased age, high CHADS-VASC, chronic renal disease further increase the positive-predictive value of some of these parameters. Several of these have been successfully incorporated into clinical scoring systems to predict AF. CONCLUSION There are several ECG abnormalities that can predict AF both independently, and with improved predictive value when combined with clinical risk factors, and if incorporated into clinical risk scores. Improved and validated predictive models could streamline selection of patients for cardiac monitoring and initiation of oral anticoagulants.
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Affiliation(s)
| | - Luke Bonavia
- Department of Neurology, Royal Hobart Hospital, Australia
| | - Edmund Song
- Department of Medicine, Grampians Health Ballarat, Australia
| | - Daniel Grose
- Department of Medicine, Grampians Health Ballarat, Australia
| | - Damian Johnson
- Department of Medicine, Werribee Mercy Hospital, Australia
| | - Erin Maylin
- Department of Medicine, Monash Health (Clayton), Australia
| | - Ernesto Oqueli
- Department of Medicine, Grampians Health Ballarat, Australia; School of Medicine, Deakin University, Australia
| | - Ramesh Sahathevan
- Department of Medicine, Grampians Health Ballarat, Australia; School of Medicine, Deakin University, Australia
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4
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Harms PP, Himmelreich JC, Blom MT, Beulens JW, Nijpels G, Elders P, Lucassen WA. Longitudinal association of premature atrial contractions with atrial fibrillation and brain ischemia in people with type 2 diabetes: The Hoorn Diabetes Care System cohort. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 34:100321. [PMID: 38510951 PMCID: PMC10945950 DOI: 10.1016/j.ahjo.2023.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 03/22/2024]
Abstract
Background Premature atrial contractions (PACs) are potential markers for imminent onset of both atrial fibrillation (AF) and brain ischemia (BI; transient ischemic attack [TIA] or ischemic stroke). We investigated the association of PACs with incident AF and BI events separately, and of incident AF with BI events in people with type 2 diabetes (T2D) without pre-existing AF or cerebrovascular disease. Methods A prospective longitudinal study of 12,242 people with T2D without known AF or cerebrovascular disease from the Hoorn Diabetes Care System cohort. Annual measurements (1998-2018) included cardiovascular risk factors, over 85,000 ECGs, and self-reported cardiovascular events. We assessed the association of PACs with incident AF and BI events and of incident AF with BI events using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors and medication use (Hazard Ratios with 95%CIs). Results The baseline mean age was 62.2 ± 11.9 years. During a median follow-up of 7.0 (IQR 3.4-11.0) years, 1031 (8.4 %) participants had PACs, and 566 (4.6 %) had incident AF at any of the median 6 (IQR 3-10) annual ECG recordings. BI events occurred in 517 (4.2 %) people (304 TIAs, 213 ischemic strokes). After adjustment, PACs were associated with incident AF (Hazard Ratio, 1.96 (95%CI, 1.53-2.50)), but not with overall BI events (1.09 (0.76-1.56)), or with TIA (0.91 (0.57-1.46)) or ischemic stroke (1.50 (0.88-2.54)) separately. AF was not associated with BI events (0.95 (0.55-1.63)). Conclusions In people with T2D without a history of AF or BI events, PACs are associated with a two-fold increased risk of incident AF.
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Affiliation(s)
- Peter P. Harms
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, and Diabetes & Metabolism, Amsterdam, the Netherlands
| | - Jelle C.L. Himmelreich
- Amsterdam UMC location University of Amsterdam, General Practice Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Marieke T. Blom
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Joline W.J. Beulens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giel Nijpels
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Petra Elders
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Wim A.M. Lucassen
- Amsterdam UMC location University of Amsterdam, General Practice Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
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5
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Berry-Noronha A, Bonavia L, Wilson D, Eranti A, Rasmussen MU, Sajadieh A, Kreimer F, Gotzmann M, Sahathevan R. Predicting risk of AF in ischaemic stroke using sinus rhythm ECG abnormalities: A meta-analysis. Eur Stroke J 2023; 8:712-721. [PMID: 37641552 PMCID: PMC10472966 DOI: 10.1177/23969873231172559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/12/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To identify ECG changes in sinus rhythm that may be used to predict subsequent development of new AF. METHOD We identified prospective and retrospective cohort or case control studies evaluating ECG patterns from a 12-lead ECG in sinus rhythm taken in hospital or community predicting subsequent development of new AF. For each identified ECG predictor, we then identify absolute event rates and pooled risk ratios (RR) using an aggregate level random effects meta-analysis. RESULTS We identified 609,496 patients from 22 studies. ECG patterns included P wave terminal force V1 (PTFV1), interatrial block (IAB) and advanced interatrial block (aIAB), abnormal P wave axis (aPWA), PR prolongation and atrial premature complexes (APCs). Pooled risk ratios reached significance for each of these; PTFV1 RR 1.48 (95% CI 1.04-2.10), IAB 2.54 (95% CI 1.64-3.93), aIAB 4.05 (95% CI 2.64-6.22), aPWA 1.89 (95% CI 1.25-2.85), PR prolongation 2.22 (95% CI 1.27-3.87) and APCs 3.71 (95% CI 2.23-6.16). Diabetes reduced the predictive value of PR prolongation. CONCLUSION APC and aIAB were most predictive of AF, while IAB, PR prolongation, PTFV1 and aPWA were also significantly associated with development of AF. These support their use in a screening tool to identify at risk cohorts who may benefit from further investigation, or following stroke, with empirical anticoagulation.
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Affiliation(s)
| | | | - Duncan Wilson
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Antti Eranti
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | - Maria Uggen Rasmussen
- Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Copenhagen, Denmark
| | - Fabienne Kreimer
- Cardiology and Rhythmology, University Hospital St Josef Hospital, Ruhr University, Bochum, Germany
| | - Michael Gotzmann
- Cardiology and Rhythmology, University Hospital St Josef Hospital, Ruhr University, Bochum, Germany
| | - Ramesh Sahathevan
- Ballarat Base Hospital, Ballarat, VIC, Australia
- Department of Medicine, Deakin University, Geelong, VIC, Australia
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6
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Orini M, van Duijvenboden S, Young WJ, Ramírez J, Jones AR, Tinker A, Munroe PB, Lambiase PD. Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and prediction of cardiovascular events. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:112-118. [PMID: 36974269 PMCID: PMC10039429 DOI: 10.1093/ehjdh/ztad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Aims Wearable devices are transforming the electrocardiogram (ECG) into a ubiquitous medical test. This study assesses the association between premature ventricular and atrial contractions (PVCs and PACs) detected on wearable-format ECGs (15 s single lead) and cardiovascular outcomes in individuals without cardiovascular disease (CVD). Methods and results Premature atrial contractions and PVCs were identified in 15 s single-lead ECGs from N = 54 016 UK Biobank participants (median age, interquartile range, age 58, 50-63 years, 54% female). Cox regression models adjusted for traditional risk factors were used to determine associations with atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), stroke, life-threatening ventricular arrhythmias (LTVAs), and mortality over a period of 11.5 (11.4-11.7) years. The strongest associations were found between PVCs (prevalence 2.2%) and HF (hazard ratio, HR, 95% confidence interval = 2.09, 1.58-2.78) and between PACs (prevalence 1.9%) and AF (HR = 2.52, 2.11-3.01), with shorter prematurity further increasing risk. Premature ventricular contractions and PACs were also associated with LTVA (P < 0.05). Associations with MI, stroke, and mortality were significant only in unadjusted models. In a separate UK Biobank sub-study sample [UKB-2, N = 29,324, age 64, 58-60 years, 54% female, follow-up 3.5 (2.6-4.8) years] used for independent validation, after adjusting for risk factors, PACs were associated with AF (HR = 1.80, 1.12-2.89) and PVCs with HF (HR = 2.32, 1.28-4.22). Conclusion In middle-aged individuals without CVD, premature contractions identified in 15 s single-lead ECGs are strongly associated with an increased risk of AF and HF. These data warrant further investigation to assess the role of wearable ECGs for early cardiovascular risk stratification.
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Affiliation(s)
- Michele Orini
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
| | - Stefan van Duijvenboden
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - William J Young
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Julia Ramírez
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Aragon Institute of Engineering Research, University of Zaragoza and Centro de Investigación Biomédica en Red, Bioingeniería, Biomateriales y Nanotecnología Zaragoza, C/ de Mariano Esquillor Gómez, Zaragoza 50018, Spain
| | - Aled R Jones
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Andrew Tinker
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Patricia B Munroe
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
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Excessive Supraventricular Ectopic Activity and the Risk of Atrial Fibrillation and Stroke: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2022; 9:jcdd9120461. [PMID: 36547459 PMCID: PMC9784080 DOI: 10.3390/jcdd9120461] [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: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Excessive supraventricular ectopic activity (ESVEA) is correlated with the development of atrial fibrillation (AF) and is frequently observed in ischemic stroke patients. This meta-analysis aims to summarize the evidence on the association between ESVEA and the risk of AF and stroke. METHODS PubMed and Embase databases were systematically searched to identify all publications providing relevant data from inception to 23 August 2022. Hazard ratio (HR) and 95% confidence interval (CI) were pooled using fixed-effect or random-effect models. RESULTS We included 23,272 participants from 20 studies. Pooled results showed that ESVEA was associated with an increased risk of AF in the general population (HR: 2.57; 95% CI 2.16-3.05), increased risk of AF in ischemic stroke patients (HR: 2.91; 95% CI 1.80-4.69), new-onset ischemic stroke (HR: 1.91; 95% CI 1.30-2.79), and all-cause mortality (HR: 1.41; 95% CI 1.24-1.59). Pooled analysis indicated that ESVEA was not associated with recurrent ischemic stroke/transient ischemic attack (TIA) (HR: 1.24; 95% CI 0.91-1.67). CONCLUSIONS ESVEA is associated with AF, new-onset ischemic stroke, and all-cause mortality.
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8
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Scridon A. Autonomic imbalance and atrial ectopic activity-a pathophysiological and clinical view. Front Physiol 2022; 13:1058427. [PMID: 36531175 PMCID: PMC9755506 DOI: 10.3389/fphys.2022.1058427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/22/2022] [Indexed: 09/29/2023] Open
Abstract
The heart is one of the most richly innervated organs and the impact of the complex cardiac autonomic network on atrial electrophysiology and arrhythmogenesis, including on atrial ectopy, is widely recognized. The aim of this review is to discuss the main mechanisms involved in atrial ectopic activity. An overview of the anatomic and physiological aspects of the cardiac autonomic nervous system is provided as well as a discussion of the main pathophysiological pathways linking autonomic imbalance and atrial ectopic activity. The most relevant data on cardiac neuromodulation strategies are emphasized. Unanswered questions and hotspots for future research are also identified.
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Affiliation(s)
- Alina Scridon
- Physiology Department, Center for Advanced Medical and Pharmaceutical Research, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
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9
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Sadeh B, Merdler I, Sadon S, Lupu L, Borohovitz A, Ghantous E, Taieb P, Granot Y, Goldstein O, Soriano JC, Rubio-Oliver R, Ruiz-Rivas J, Zalevsky Z, Garcia-Monreal J, Shatsky M, Polani S, Arbel Y. A novel contact-free atrial fibrillation monitor: a pilot study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 3:105-113. [PMID: 36713997 PMCID: PMC9707913 DOI: 10.1093/ehjdh/ztab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/21/2021] [Accepted: 12/14/2021] [Indexed: 02/01/2023]
Abstract
Aims Atrial fibrillation (AF) is a major cause of morbidity and mortality. Current guidelines support performing electrocardiogram (ECG) screenings to spot AF in high-risk patients. The purpose of this study was to validate a new algorithm aimed to identify AF in patients measured with a recent FDA-cleared contact-free optical device. Methods and results Study participants were measured simultaneously using two devices: a contact-free optical system that measures chest motion vibrations (investigational device, 'Gili') and a standard reference bed-side ECG monitor (Mindray®). Each reference ECG was evaluated by two board certified cardiologists that defined each trace as: regular rhythm, AF, other irregular rhythm or indecipherable/missing. A total of 3582, 30-s intervals, pertaining to 444 patients (41.9% with a history of AF) were made available for analysis. Distribution of patients with active AF, other irregular rhythm, and regular rhythm was 16.9%, 29.5%, and 53.6% respectively. Following application of cross-validated machine learning approach, the observed sensitivity and specificity were 0.92 [95% confidence interval (CI): 0.91-0.93] and 0.96 (95% CI: 0.95-0.96), respectively. Conclusion This study demonstrates for the first time the efficacy of a contact-free optical device for detecting AF.
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Affiliation(s)
- Ben Sadeh
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel
| | - Ilan Merdler
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel
| | - Sapir Sadon
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel
| | - Lior Lupu
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel
| | - Ariel Borohovitz
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel
| | - Eihab Ghantous
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel
| | - Philippe Taieb
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel
| | - Yoav Granot
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel
| | - Orit Goldstein
- Donisi Health (formerly ContinUse Biometrics Ltd.), HaNechoshet 6, Tel Aviv, 6971070, Israel
| | | | - Ricardo Rubio-Oliver
- Donisi Health (formerly ContinUse Biometrics Ltd.), HaNechoshet 6, Tel Aviv, 6971070, Israel
| | - Joaquin Ruiz-Rivas
- Donisi Health (formerly ContinUse Biometrics Ltd.), HaNechoshet 6, Tel Aviv, 6971070, Israel
| | - Zeev Zalevsky
- Donisi Health (formerly ContinUse Biometrics Ltd.), HaNechoshet 6, Tel Aviv, 6971070, Israel,Faculty of Engineering, Bar-Ilan University, Ramat Gan, 5290002, Israel
| | - Javier Garcia-Monreal
- Donisi Health (formerly ContinUse Biometrics Ltd.), HaNechoshet 6, Tel Aviv, 6971070, Israel,Department of Optics, University of Valencia, Spain
| | - Maxim Shatsky
- Donisi Health (formerly ContinUse Biometrics Ltd.), HaNechoshet 6, Tel Aviv, 6971070, Israel
| | - Sagi Polani
- Donisi Health (formerly ContinUse Biometrics Ltd.), HaNechoshet 6, Tel Aviv, 6971070, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, affiliated Tel Aviv University, Tel Aviv, Israel,Donisi Health (formerly ContinUse Biometrics Ltd.), HaNechoshet 6, Tel Aviv, 6971070, Israel,Corresponding author. Tel: +972 3 6973395, Fax: +972 3 6962334, The last two authors contributed equally to the study
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10
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Wang W, Norby FL, Zhang MJ, Reyes JL, Shah AM, Soliman EZ, Lutsey PL, Alonso A, Solomon SD, Inciardi RM, Chen LY. Differences in Left Atrial Size and Function and Supraventricular Ectopy Between Black and White Participants in the ARIC Study. J Am Heart Assoc 2021; 10:e021723. [PMID: 34713724 PMCID: PMC8751819 DOI: 10.1161/jaha.121.021723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022]
Abstract
Background Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. Methods and Results We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2-week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%-47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. Conclusions Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial arrhythmias in Black individuals.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Faye L. Norby
- Center for Cardiac Arrest PreventionDepartment of CardiologyCedars‐Sinai Smidt Heart InstituteLos AngelesCA
| | - Michael J. Zhang
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Jorge L. Reyes
- Department of MedicineHennepin County Medical CenterMinneapolisMN
| | - Amil M. Shah
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMA
| | - Elsayed Z. Soliman
- Department of EpidemiologyDivision of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNC
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | | | - Riccardo M. Inciardi
- Institute of CardiologyDepartment of Medical and Surgical SpecialtiesRadiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Lin Y. Chen
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
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11
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Alsagaff MY, Oktaviono YH, Dharmadjati BB, Lefi A, Al‐Farabi MJ, Gandi P, Marsudi BA, Azmi Y. Electrocardiography on admission is associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients: A systematic review and meta-analysis. J Arrhythm 2021; 37:877-885. [PMID: 34386111 PMCID: PMC8339106 DOI: 10.1002/joa3.12573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Electrocardiogram (ECG) is a widely accessible diagnostic tool that can easily be obtained on admission and can reduce excessive contact with coronavirus disease 2019 (COVID-19) patients. A systematic review and meta-analysis were performed to evaluate the latest evidence on the association of ECG on admission and the poor outcomes in COVID-19. METHODS A literature search was conducted on online databases for observational studies evaluating ECG parameters and composite poor outcomes comprising ICU admission, severe illness, and mortality in COVID-19 patients. RESULTS A total of 2,539 patients from seven studies were included in this analysis. Pooled analysis showed that a longer corrected QT (QTc) interval and more frequent prolonged QTc interval were associated with composite poor outcome ([WMD 6.04 [2.62-9.45], P = .001; I 2:0%] and [RR 1.89 [1.52-2.36], P < .001; I 2:17%], respectively). Patients with poor outcome had a longer QRS duration and a faster heart rate compared with patients with good outcome ([WMD 2.03 [0.20-3.87], P = .030; I 2:46.1%] and [WMD 5.96 [0.96-10.95], P = .019; I 2:55.9%], respectively). The incidence of left bundle branch block (LBBB), premature atrial contraction (PAC), and premature ventricular contraction (PVC) were higher in patients with poor outcome ([RR 2.55 [1.19-5.47], P = .016; I 2:65.9%]; [RR 1.94 [1.32-2.86], P = .001; I 2:62.8%]; and [RR 1.84 [1.075-3.17], P = .026; I 2:70.6%], respectively). T-wave inversion and ST-depression were more frequent in patients with poor outcome ([RR 1.68 [1.31-2.15], P < .001; I 2:14.3%] and [RR 1.61 [1.31-2.00], P < .001; I 2:49.5%], respectively). CONCLUSION Most ECG abnormalities on admission are significantly associated with an increased composite poor outcome in patients with COVID-19.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular MedicineFaculty of MedicineSoetomo General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular MedicineFaculty of MedicineSoetomo General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Budi Baktijasa Dharmadjati
- Department of Cardiology and Vascular MedicineFaculty of MedicineSoetomo General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Achmad Lefi
- Department of Cardiology and Vascular MedicineFaculty of MedicineSoetomo General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Makhyan Jibril Al‐Farabi
- Department of Cardiology and Vascular MedicineFaculty of MedicineSoetomo General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Parama Gandi
- Department of Cardiology and Vascular MedicineFaculty of MedicineSoetomo General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Bagas Adhimurda Marsudi
- Department of Cardiology and Vascular MedicineFaculty of MedicineHarapan Kita National Heart CenterUniversitas IndonesiaJakartaIndonesia
| | - Yusuf Azmi
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
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12
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Szili-Torok T, Kis Z, Bhagwandien R, Wijchers S, Yap SC, Hoogendijk M, Dumas N, Haeusser P, Geczy T, Kong MH, Ruppersberg P. Functional electrographic flow patterns in patients with persistent atrial fibrillation predict outcome of catheter ablation. J Cardiovasc Electrophysiol 2021; 32:2148-2158. [PMID: 34041824 PMCID: PMC8453922 DOI: 10.1111/jce.15115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
Aims Electrographic flow (EGF) mapping is a method to detect action potential sources within the atria. In a double‐blinded retrospective study we evaluated whether sources detected by EGF are related to procedural outcome. Methods EGF maps were retrospectively generated using the Ablamap® software from unipolar data recorded with a 64‐pole basket catheter from patients who previously underwent focal impulse and rotor modulation‐guided ablation. We analyzed patient outcomes based on source activity (SAC) and variability. Freedom from atrial fibrillation (AF) was defined as no recurrence of AF, atypical flutter or atrial tachycardia at the follow‐up visits. Results EGF maps were from 123 atria in 64 patients with persistent or long‐standing persistent AF. Procedural outcome correlation with SAC peaked at >26%. S‐type EGF signature (source‐dependent AF) is characterized by stable sources with SAC > 26% and C‐type (source‐independent AF) is characterized by sources with SAC ≤ 26%. Cases with AF recurrence at 3‐, 6‐, or 12‐month follow‐up showed a median final SAC 34%; while AF‐free patients had sources with significantly lower median final SAC 21% (p = .0006). Patients with final SAC and Variability above both thresholds had 94% recurrence, while recurrence was only 36% for patients with leading source SAC and variability below threshold (p = .0001). S‐type EGF signature post‐ablation was associated with an AF recurrence rate 88.5% versus 38.1% with C‐type EGF signature. Conclusions EGF mapping enables the visualization of active AF sources. Sources with SAC > 26% appear relevant and their presence post‐ablation correlates with high rates of AF recurrence.
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Affiliation(s)
| | - Zsuzsanna Kis
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Sip Wijchers
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Mark Hoogendijk
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Nadege Dumas
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Philip Haeusser
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Tamas Geczy
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
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13
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Soliman EZ, Howard G, Judd S, Bhave PD, Howard VJ, Herrington DM. Factors Modifying the Risk of Atrial Fibrillation Associated With Atrial Premature Complexes in Patients With Hypertension. Am J Cardiol 2020; 125:1324-1331. [PMID: 32139160 DOI: 10.1016/j.amjcard.2020.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
Patients with hypertension who develop atrial premature complexes (APCs) are at a particularly high risk for atrial fibrillation (AF). We sought to identify medications and modifiable risk factors that could reduce the risk of AF imposed by presence of APCs in such a high risk group. This analysis included 4,331 participants with treated hypertension from the Reasons for Geographic and Racial Differences in Stroke study who were free of AF and cardiovascular disease at the time of enrollment (2003-2007). APCs were detected in 8.2% (n = 356) of the participants at baseline. During a median follow-up of 9.4 years, 9.9% (n = 429) of the participants developed AF. Participants with APCs, compared with those without, were more than twice as likely to develop AF (Odds ratio [95% confidence interval]: 2.36[1.75, 3.19]). This association was significantly weaker in statin users than nonusers (Odds ratio [95% confidence interval]:1.42[0.81,2.48] vs 3.01[2.11,4.32], respectively; interaction p-value = 0.02), and in angiotensin-II receptor blocker users than nonusers (Odds ratio [95% confidence interval]:1.31[0.66,2.61] vs 2.78[1.99,3.89], respectively; interaction p-value = 0.05). Borderline weaker associations between APCs and AF were also observed in alpha-blocker users than nonusers, nondiabetics than diabetics, and in those with systolic blood pressure level 130 to 139 mm Hg compared with those with other systolic blood pressure levels. No significant effect modifications were observed by use of other medications or by presence of other cardiovascular risk factors. In conclusion, the significant AF risk associated with APCs in patients with hypertension could potentially be reduced by treatment with angiotensin-II receptor blockers and statins along with lowering blood pressure and management of diabetes.
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14
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Hasegawa T, Nakanishi K, Yoshida Y, Uetsuhara T, Kosaka M, Shirai N, Yamashita H. Atrial ectopy after pulmonary vein isolation and left heart reverse remodeling in patients with atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1125-1132. [PMID: 31216052 DOI: 10.1111/pace.13747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Maintenance of sinus rhythm after pulmonary vein isolation (PVI) for atrial fibrillation (AF) is associated with left atrial (LA) and ventricular (LV) reverse remodeling, although the degree varies among individuals. We hypothesized that frequent premature atrial complex (PAC) after PVI may attenuate the left heart reverse remodeling benefited from maintenance of sinus rhythm. METHODS We included 82 AF patients who underwent first-time PVI and 24-h Holter recordings at 6 months after PVI. All patients had no AF recurrence before this time. The number of PAC was categorized into tertiles: <90, 90-488 and >488 PACs/day. All patients underwent two-dimensional echocardiography and serum plasma B-type natriuretic peptide (BNP) measurement before and 6 months after PVI. LA reverse remodeling was defined as ≥15% decrease in LA volume index. RESULTS There was no significant difference in the baseline characteristics among the PAC tertiles except for sex. Six months after PVI, LA volume index, LV mass index, and serum BNP levels were significantly decreased in lower and middle PAC tertiles (all P < .05), whereas no significant changes were observed in upper PAC tertile. Frequency of LA reverse remodeling was significantly lower in upper tertile of PAC compared with middle and lower tertiles (22.2%, 57.1%, and 59.3%, P < .001). Baseline LA volume index, changes in LV mass index, and the frequency of PAC were independently associated with LA reverse remodeling (all P < .05). CONCLUSIONS Frequent PAC after PVI was associated with less left heart reverse remodeling in AF patients even without AF recurrence.
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Affiliation(s)
- Toshifumi Hasegawa
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan.,Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuto Uetsuhara
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Michihiko Kosaka
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Naoya Shirai
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Hajime Yamashita
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
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15
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Himmelreich JCL, Lucassen WAM, Heugen M, Bossuyt PMM, Tan HL, Harskamp RE, van Etten-Jamaludin FS, van Weert HCPM. Frequent premature atrial contractions are associated with atrial fibrillation, brain ischaemia, and mortality: a systematic review and meta-analysis. Europace 2018; 21:698-707. [DOI: 10.1093/europace/euy276] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Martijn Heugen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Amsterdam UMC, University of Amsterdam, Biostatistics and Bioinformatics, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Hanno L Tan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Faridi S van Etten-Jamaludin
- Medical Library, Amsterdam UMC, University of Amsterdam, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, Netherlands
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16
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Acampa M, Lazzerini PE, Martini G. Atrial Cardiopathy and Sympatho-Vagal Imbalance in Cryptogenic Stroke: Pathogenic Mechanisms and Effects on Electrocardiographic Markers. Front Neurol 2018; 9:469. [PMID: 29971041 PMCID: PMC6018106 DOI: 10.3389/fneur.2018.00469] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/31/2018] [Indexed: 01/18/2023] Open
Abstract
Recently, atrial cardiopathy has emerged as possible pathogenic mechanism in cryptogenic stroke and many electrocardiographic (ECG) markers have been proposed in order to detect an altered atrial substrate at an early stage. The autonomic nervous system (ANS) plays a well-known role in determining significant and heterogeneous electrophysiological changes of atrial cardiomyocytes, that promote atrial fibrillation episodes in cardioembolic stroke. Conversely, the role of ANS in atrial cardiopathy and cryptogenic stroke is less known, as well as ANS effects on ECG markers of atrial dysfunction. In this paper, we review the evidence linking ANS dysfunction and atrial cardiopathy as a possible pathogenic factor in cryptogenic stroke.
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Affiliation(s)
- Maurizio Acampa
- Stroke Unit, Department of Neurological and Neurosensorial Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Siena, Italy
| | - Pietro E Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giuseppe Martini
- Stroke Unit, Department of Neurological and Neurosensorial Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Siena, Italy
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17
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Prasitlumkum N, Rattanawong P, Limpruttidham N, Kanitsoraphan C, Sirinvaravong N, Suppakitjanusant P, Chongsathidkiet P, Chung EH. Frequent premature atrial complexes as a predictor of atrial fibrillation: Systematic review and meta-analysis. J Electrocardiol 2018; 51:760-767. [PMID: 30177309 DOI: 10.1016/j.jelectrocard.2018.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Frequent premature atrial complexes (PACs) are associated with higher morbidity and mortality. Recent studies suggest that frequent PACs are associated with new onset atrial fibrillation (AF). However, a systematic review and meta-analysis of the literature has not been done. We assessed the association between frequent PACs and new onset AF by a systematic review and a meta-analysis. METHODS We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published cohort (prospective or retrospective) that compared new onset AF among patients with and without frequent PACs documented by Holter monitoring or 12-lead electrocardiogram. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. RESULTS Twelve studies from 2009 to 2017 were included in this meta-analysis involving 109,689 subjects (9217frequent and 100,472 non-frequent PACs). Frequent PACs were associated with increased risk of new onset AF (pooled risk ratio = 2.76, 95% confidence interval: 2.05-3.73, p < 0.000, I2 = 90.6%). CONCLUSION Frequent PACs are associated with up to three-fold increased risk of new onset AF. Our study suggests that frequent PACs in general population is an independent predictor of new onset AF.
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Affiliation(s)
- Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA.
| | - Pattara Rattanawong
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nath Limpruttidham
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Natee Sirinvaravong
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Eugene H Chung
- University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
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18
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Sorajja D, Shen WK. On the road to atrial fibrillation. Heart Rhythm 2017; 14:1862-1863. [PMID: 29110995 DOI: 10.1016/j.hrthm.2017.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona
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