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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, Olsen A, Dahm CC, Jensen HK. Five-year changes in weight and risk of atrial fibrillation in the Danish Diet, Cancer, and Health Cohort. Eur J Prev Cardiol 2024; 31:244-249. [PMID: 37708406 PMCID: PMC10809168 DOI: 10.1093/eurjpc/zwad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
AIMS Obesity is a major risk factor for atrial fibrillation (AF). Compared with stable weight, gaining weight was associated with a higher risk of incident AF in observational studies. The results, however, are conflicting regarding weight loss and risk of AF. This study aimed to assess the association between 5-year weight changes and risk of incident AF. METHODS AND RESULTS The study was based on participants from the Danish Diet, Cancer, and Health Cohort. Body mass index (BMI) was assessed at a baseline examination and at a second examination 5 years later. Diagnoses of AF and co-morbidities were retrieved from the Danish National Patient Registry. In total, 43 758 participants without prior AF were included. The median age was 61 years and 54% were female. During a median follow-up of 15.7 years, 5312 individuals had incident AF (incidence rate 8.6/1000 person-years). Compared with stable weight, weight gain between 2.5 and 5 BMI units (kg/m2) was associated with a higher risk of AF [hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.09-1.41]. Weight gain of 5 or more BMI units (kg/m2) was associated with a HR of 1.95 (95% CI 1.48-2.56) of incident AF. However, there was no statistically significant association between weight loss and risk of AF. CONCLUSION Five-year weight gain was associated with greater risk of AF compared with stable weight in the Danish Diet, Cancer, and Health Cohort. There was no statistically significant association between weight loss and risk of AF.
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Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kim Overvad
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anja Olsen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Cancer Society Research Center, København Ø, Denmark
| | | | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Antia A, Evbayeka E, Okorare O, Ubokudom D, Gbegbaje O, Daniel E. Impact of Bariatric Surgery on the Prevalence and Outcomes of Atrial Fibrillation in Obese Patients. Curr Probl Cardiol 2024; 49:102083. [PMID: 37717860 DOI: 10.1016/j.cpcardiol.2023.102083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
Obesity has been identified as a significant factor contributing to the development of numerous cardiovascular conditions and as a result, the cardiovascular community has prioritized efforts to address obesity and reduce its associated risks. However, despite these efforts, the prevalence of obesity continues to rise steadily, and is projected to double in the upcoming years. Atrial fibrillation is among the most prevalent and extensively researched cardiovascular comorbidities associated with obesity. Several mechanisms have been postulated, including scar tissue formation and fat deposition, which ultimately leads to atrial remodeling and subsequent arrhythmogenesis. Numerous strategies have been implemented to prevent and manage obesity, encompassing lifestyle adjustments, dietary modifications, pharmacological treatments, and surgical interventions. Bariatric surgery has garnered significant recognition over the years due to its promising outcomes, including a decrease in the overall prevalence of atrial fibrillation and other cardiovascular comorbidities in general in obese patients. This study focuses on the current trends regarding the impact of bariatric surgery on obese patients with atrial fibrillation.
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Affiliation(s)
- Akanimo Antia
- Department of Medicine, Lincoln Medical Center, Bronx, New York, United States of America.
| | - Endurance Evbayeka
- Department of Medicine, St. Luke's Hospital, St. Louis, Missouri, United States of America
| | - Ovie Okorare
- Department of Medicine, Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York, United States of America
| | - Daniel Ubokudom
- Department of Medicine, Thomas Hospital, Fairhope, Alabama, United States of America
| | - Oghenetejiri Gbegbaje
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, United States of America
| | - Emmanuel Daniel
- Department of Medicine, Trinity Health Ann Arbor, Ypsilanti, Michigan, United States of America
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Gawałko M, Saljic A, Li N, Abu-Taha I, Jespersen T, Linz D, Nattel S, Heijman J, Fender A, Dobrev D. Adiposity-associated atrial fibrillation: molecular determinants, mechanisms, and clinical significance. Cardiovasc Res 2023; 119:614-630. [PMID: 35689487 PMCID: PMC10409902 DOI: 10.1093/cvr/cvac093] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity is an important contributing factor to the pathophysiology of atrial fibrillation (AF) and its complications by causing systemic changes, such as altered haemodynamic, increased sympathetic tone, and low-grade chronic inflammatory state. In addition, adipose tissue is a metabolically active organ that comprises various types of fat deposits with discrete composition and localization that show distinct functions. Fatty tissue differentially affects the evolution of AF, with highly secretory active visceral fat surrounding the heart generally having a more potent influence than the rather inert subcutaneous fat. A variety of proinflammatory, profibrotic, and vasoconstrictive mediators are secreted by adipose tissue, particularly originating from cardiac fat, that promote atrial remodelling and increase the susceptibility to AF. In this review, we address the role of obesity-related factors and in particular specific adipose tissue depots in driving AF risk. We discuss the distinct effects of key secreted adipokines from different adipose tissue depots and their participation in cardiac remodelling. The possible mechanistic basis and molecular determinants of adiposity-related AF are discussed, and finally, we highlight important gaps in current knowledge, areas requiring future investigation, and implications for clinical management.
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Affiliation(s)
- Monika Gawałko
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-197 Warsaw, Poland
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Arnela Saljic
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Na Li
- Department of Medicine (Section of Cardiovascular Research), Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
- Cardiovascular Research Institute, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Issam Abu-Taha
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Port Road, SA 5000 Adelaide, Australia
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Stanley Nattel
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Medicine and Research Center, Montréal Heart Institute and University de Montréal, 3655 Promenade Sir William Osler, Montreal, QC H3G 1Y6, Canada
- IHU LIRYC Institute, Avenue du Haut Lévêque, 33600 Pessac, Bordeaux, France
| | - Jordi Heijman
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Anke Fender
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
- Medicine and Research Center, Montréal Heart Institute and University de Montréal, 3655 Promenade Sir William Osler, Montreal, QC H3G 1Y6, Canada
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Pontiroli AE, Centofanti L, Le Roux CW, Magnani S, Tagliabue E, Folli F. Effect of Prolonged and Substantial Weight Loss on Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15040940. [PMID: 36839298 PMCID: PMC9964297 DOI: 10.3390/nu15040940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Background. Overweight and obesity are associated with atrial fibrillation (AF), and bariatric surgery (BS), able to induce sustained and prolonged weight loss, might represent the ideal treatment in the prevention of AF. Previous studies could not definitely establish a role for weight loss and BS in preventing incident AF so far. During the last few years, several studies on the effect of bariatric surgery on cardiovascular diseases have been published, and we performed a systematic review and meta-analysis to evaluate the role of weight loss through BS in the prevention of incident AF in obesity. Methods. This meta-analysis followed the PRISMA guideline. Eligible studies were controlled trials evaluating the appearance of atrial fibrillation in patients undergoing weight loss through BS as compared with patients receiving medical treatment. Quality of studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale, and risk-of-bias was evaluated employing the Egger's test. All analyses were run by a random-effects model according to Hartung and Knapp and sensitivity analyses were performed. Heterogeneity was assessed through Q and I2 statistics for each comparison, and potential publication bias was formally investigated. Results. Ten studies were included in the meta-analysis, and the overall result was statistically significant [OR = 0.665 (0.475-0.929), p = 0.017], with significant heterogeneity (Q = 48.98, p < 0.001; I2 = 81.6%), but with no publication bias. In sensitivity analyses, the amount of weight loss, percentage of patients with diabetes and value of the Newcastle-Ottawa Quality Assessment Scale, were all associated with significance of effect. Since age was different in one study, a sensitivity analysis was performed by excluding this study; OR was similar [OR = 0.608 (0.454-0.814), p < 0.001]; heterogeneity was reduced but still significant (Q = 35.74, p < 0.001, I2 = 77.6%) and again no publication bias was detected. Conclusions. Bariatric surgery as compared to medical treatment is associated with reduced appearance of incident AF.
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Affiliation(s)
- Antonio E. Pontiroli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence:
| | - Lucia Centofanti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20133 Milan, Italy
| | - Carel W. Le Roux
- Diabetes Complications Research Centre, University College Dublin, D04 V1W8 Dublin, Ireland
| | | | - Elena Tagliabue
- IRCCS MultiMedica, Value-Based Healthcare Unit, 20099 Milan, Italy
| | - Franco Folli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20133 Milan, Italy
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Wang M, Yu G, Wang X, Xu B. Evaluation of changes in atrial fibrillation predictors(P wave parameters and left atrial diameter) in morbidly obese patients undergoing bariatric surgery. J Electrocardiol 2023; 78:12-16. [PMID: 36696818 DOI: 10.1016/j.jelectrocard.2023.01.001] [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: 10/10/2022] [Revised: 12/20/2022] [Accepted: 01/01/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bariatric surgery has been associated with reduced cardiovascular event in obese patients.In this study, we aimed to investigate the changes between pre-operation and post-operation atrial fibrillation predictors(p-wave parameters and left atrial diameter)in morbidly obese patients who underwent bariatric surgery. METHODS 176 obese patients undergoing bariatric surgery were enrolled. Heart rate, PR, P-wave max, P-wave min,P-wave dispersion (PWdis), average P-axis, P-wave peak time (PWPT) of lead II and lead V1, terminal force of lead V1 (PWTF V1), partial interatrial block (p-IAB), advanced interatrial block(a-IAB), and left atrial diamete were measured both before operation and 8 months post-operation. RESULTS Heart rate, PR, PW max, PW min, PWdis, mean P-axis, PWPT II, PWPT V1, and PWTF V1 were near their upper limits before operation. Left atrial diameter was larger than the upper limit before operation. All parameters showed statistically significant decrease at 8 months post-operation. The most significant changes were observed in PWPT II (55.69 ± 6.87 ms vs 50.43 ± 7.48 ms, p < 0.001), PWPT V1(54.21 ± 7.01 ms vs 48.02 ± 7.13 ms, p < 0.001), PWTF V1(74 [42.0%] vs 41 [23.3%], p < 0.001),p-IAB(41[23.2%]vs11[6.2%],p < 0.001),a-IAB(6[3.4%]vs2[1.1%], p < 0.001), and left atrial diameter(43.25 ± 9.23 mm vs 34.27 ± 6.21 mm,p < 0.001). CONCLUSIONS The results of our study showed that bariatric surgery had a positive effect on the regression of P wave parameters and left atrial diameter which are predictors of atrial fibrillation.
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Affiliation(s)
- Meng Wang
- Department of Cardiology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Gang Yu
- Department of Gastroenterology, the Second Affiliated Hospital of Anhui Medical University, China
| | - Xiaochen Wang
- Department of Cardiology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Banglong Xu
- Department of Cardiology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Oesterle A, Giancaterino S, Van Noord MG, Pellegrini CN, Fan D, Srivatsa UN, Amsterdam EA. Effects of Supervised Exercise Training on Atrial Fibrillation: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Cardiopulm Rehabil Prev 2022; 42:258-265. [PMID: 35235540 DOI: 10.1097/hcr.0000000000000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Atrial fibrillation (AF) is associated with the comorbidities of a sedentary lifestyle. Endurance athletes also show an increased incidence of AF. The role of exercise in the treatment of AF is unknown so this study aimed to examine the effects of supervised exercise on AF. METHODS A meta-analysis of randomized controlled trials (RCTs) examining supervised exercise training in participants with AF was performed. The primary outcome was AF recurrence and burden. Secondary outcomes included AF symptoms, quality of life, and cardiorespiratory fitness (CRF). RESULTS Thirteen RCTs, involving 1155 participants, were included. Paroxysmal AF was present in 34% and persistent AF in 64%. The types of exercise were diverse and included cardiac rehabilitation (64%), aerobic training (7%), Qi Gong (4%), interval training (11%), and yoga (15%). Exercise training reduced AF recurrence (relative risk = 0.77: 95% CI, 0.60-0.99), improved quality of life in 5 of the 10 components of the Short Form 36 survey, and improved CRF (standardized mean difference [SMD] = 0.56: 95% CI, 0.27-0.85). The AF burden was reduced only in studies that included continuous ambulatory monitoring (SMD =-0.49: 95% CI, -0.96 to -0.01) but not when all studies were included (SMD =-0.12: 95% CI, -0.61 to 0.38). There was no difference in adverse events between exercise and control. CONCLUSIONS Supervised exercise training is safe, reduces AF recurrence, and improves quality of life and CRF in participants with AF. Further large RCTs with ambulatory monitoring and robust exercise regimens are needed to assess the effects of exercise training on AF burden and AF symptoms.
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Affiliation(s)
- Adam Oesterle
- Department of Cardiology, University of California, San Francisco-Veterans Affairs Medical Center, San Francisco (Drs Oesterle and Pellegrini); Department of Cardiology, University of California, Davis (Drs Giancaterino, Fan, Srivatsa and Amsterdam); and University of California, Davis (Ms Van Noord)
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