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Apple SJ, Parker M, Flomenbaum D, Rosenbaum SM, Borck J, Choppa A, Borkowski P, Satish V, Al Deen Alhuarrat M, Fisher JD, Di Biase L, Krumerman A, Ferrick KJ. Predictors of paroxysmal atrial fibrillation in patients with a cryptogenic stroke: Selecting patients for long-term rhythm monitoring. Heart Rhythm 2024:S1547-5271(24)02875-3. [PMID: 38969049 DOI: 10.1016/j.hrthm.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND After a cryptogenic stroke, patients often will require prolonged cardiac monitoring; however, the subset of patients who would benefit from long-term rhythm monitoring is not clearly defined. OBJECTIVE The purpose of this study was to create a risk score by identifying significant predictors of atrial fibrillation (AF) using age, sex, comorbidities, baseline 12-lead electrocardiogram, short-term rhythm monitoring, and echocardiographic data and to compare it to previously published risk scores. METHODS Patients admitted to Montefiore Medical Center between May 2017 and June 2022 with a primary diagnosis of cryptogenic stroke or transient ischemic attack who underwent long-term rhythm monitoring with an implantable cardiac monitor were retrospectively analyzed. RESULTS Variables positively associated with a diagnosis of clinically significant AF include age (P <.001), race (P = .022), diabetes status (P = .026), chronic obstructive pulmonary disease status (P = .012), presence of atrial runs (P = .003), number of atrial runs per 24 hours (P <.001), total number of atrial run beats per 24 hours (P <.001), number of beats in the longest atrial run (P <.001), left atrial enlargement (P = .007), and at least mild mitral regurgitation (P = .009). We created a risk stratification score for our population, termed the ACL score. The ACL score demonstrated superiority to the CHA2DS2-VASc score and comparability to the C2HEST score for predicting device-detected AF. CONCLUSION The ACL score enables clinicians to better predict which patients are more likely to be diagnosed with device-detected AF after a cryptogenic stroke.
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Affiliation(s)
- Samuel J Apple
- New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Matthew Parker
- New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Shalom M Rosenbaum
- New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Pawel Borkowski
- New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Vikyath Satish
- New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Majd Al Deen Alhuarrat
- New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Andrew Krumerman
- Northwell Health, Northern Westchester Hospital, Mount Kisco, New York
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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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Leeper BB. Are Premature Atrial Contractions Benign? AACN Adv Crit Care 2023; 34:263-265. [PMID: 37644628 DOI: 10.4037/aacnacc2023145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Barbara Bobbi Leeper
- Barbara "Bobbi" Leeper is Consultant, Cardiovascular and Critical Care Nursing, 6059 Breakpoint Trail, Dallas, Texas 75252
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Gogos C, Zarvalis E, Pantelidis P, Davora F, Karakanas A, Pitetzis D, Stamatiadis N, Moschovidis V, Konstantinidou M, Oikonomou E, Deretzi G, Rudolf J, Styliadis I. Excessive supraventricular ectopic activity and future onset of atrial fibrillation in patients with cryptogenic stroke. J Stroke Cerebrovasc Dis 2022; 31:106820. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
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Guichard JB, Guasch E, Roche F, Da Costa A, Mont L. Premature atrial contractions: A predictor of atrial fibrillation and a relevant marker of atrial cardiomyopathy. Front Physiol 2022; 13:971691. [PMID: 36353376 PMCID: PMC9638131 DOI: 10.3389/fphys.2022.971691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/14/2022] [Indexed: 09/08/2023] Open
Abstract
An increased burden of premature atrial contractions (PACs) has long been considered a benign phenomenon. However, strong evidence of their involvement in the occurrence of atrial fibrillation (AF), ischemic stroke, and excess mortality suggests the need for management. The central question to be resolved is whether increased ectopic atrial rhythm is only a predictor of AF or whether it is a marker of atrial cardiomyopathy and therefore of ischemic stroke. After reviewing the pathophysiology of PACs and its impact on patient prognosis, this mini-review proposes to 1) detail the physiological and clinical elements linking PACs and AF, 2) present the evidence in favor of supraventricular ectopic activity as a marker of cardiomyopathy, and 3) outline the current limitations of this concept and the potential future clinical implications.
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Affiliation(s)
- Jean-Baptiste Guichard
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Eduard Guasch
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Frederic Roche
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Antoine Da Costa
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Lluís Mont
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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6
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Gwak DS, Choi W, Kim YW, Kim YS, Hwang YH. Impact of Left Atrial Appendage Morphology on Recurrence in Embolic Stroke of Undetermined Source and Atrial Cardiopathy. Front Neurol 2021; 12:679320. [PMID: 34239496 PMCID: PMC8258144 DOI: 10.3389/fneur.2021.679320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The left atrial appendage (LAA) is a major source of thrombus and non-chicken wing (CW). LAA morphology is a risk factor for embolic events in atrial fibrillation. However, the association of non-CW morphology with embolic stroke recurrence is unknown in patients with embolic stroke of undetermined source (ESUS) and atrial cardiopathy. Methods: We conducted retrospective analyses using a prospective institutional stroke registry (2013–2017). Patients with ESUS and atrial cardiopathy were enrolled. Atrial cardiopathy was diagnosed if an increased left atrial diameter (>40 mm, men; >38 mm, women), supraventricular tachycardia, or LAA filling defect on computed tomography (CT) were present. Patients admitted >24 h after onset were excluded. LAA morphology was evaluated using CT and categorized into CW vs. non-CW types. The primary outcome was embolic stroke recurrence. Multivariable Cox proportional hazards models were used to examine the independent association between LAA morphology and outcome. Results: Of 157 patients, 81 (51.6%) had CW LAA morphology. The median follow-up was 41.5 (interquartile range 12.3–58.5) months corresponding to 509.8 patient years. In total, 18 participants experienced embolic stroke recurrences (3.80 per 100 patient-years). Non-CW morphology was more associated with embolic stroke recurrence than CW morphology (hazard ratio (HR), 3.17; 95% confidence interval (CI), 1.13–8.91; p = 0.029). After adjusting for CHA2DS2-VASc score and number of potential embolic sources, non-CW morphology showed an independent association with outcome (adjusted HR, 2.90; 95% CI, 1.02–8.23; p = 0.045). Conclusions: The LAA morphology types may help identify high risk of embolic stroke recurrence in ESUS with atrial cardiopathy. LAA morphology in atrial cardiopathy may provide clues for developing therapies tailored to specific mechanisms.
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Affiliation(s)
- Dong-Seok Gwak
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - WooChan Choi
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Yong-Won Kim
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea.,Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong-Sun Kim
- Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea.,Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea.,Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
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7
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Kamel H, Alwell K, Kissela BM, Sucharew HJ, Woo D, Flaherty M, Ferioli S, Demel SL, Moomaw CJ, Walsh K, Mackey J, De Los Rios La Rosa F, Jasne A, Slavin S, Martini S, Adeoye O, Baig T, Chen ML, Levitan EB, Soliman EZ, Kleindorfer DO. Racial Differences in Atrial Cardiopathy Phenotypes in Patients With Ischemic Stroke. Neurology 2021; 96:e1137-e1144. [PMID: 33239363 PMCID: PMC8055350 DOI: 10.1212/wnl.0000000000011197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/23/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To test the hypothesis that thrombogenic atrial cardiopathy may be relevant to stroke-related racial disparities, we compared atrial cardiopathy phenotypes between Black vs White patients with ischemic stroke. METHODS We assessed markers of atrial cardiopathy in the Greater Cincinnati/Northern Kentucky Stroke Study, a study of stroke incidence in a population of 1.3 million. We obtained ECGs and reports of echocardiograms performed during evaluation of stroke during the 2010/2015 study periods. Patients with atrial fibrillation (AF) or flutter (AFL) were excluded. Investigators blinded to patients' characteristics measured P-wave terminal force in ECG lead V1 (PTFV1), a marker of left atrial fibrosis and impaired interatrial conduction, and abstracted left atrial diameter from echocardiogram reports. Linear regression was used to examine the association between race and atrial cardiopathy markers after adjustment for demographics, body mass index, and vascular comorbidities. RESULTS Among 3,426 ischemic stroke cases in Black or White patients without AF/AFL, 2,391 had a left atrial diameter measurement (mean, 3.65 ± 0.70 cm). Black race was associated with smaller left atrial diameter in unadjusted (β coefficient, -0.11; 95% confidence interval [CI], -0.17 to -0.05) and adjusted (β, -0.15; 95% CI, -0.21 to -0.09) models. PTFV1 measurements were available in 3,209 patients (mean, 3,434 ± 2,525 μV*ms). Black race was associated with greater PTFV1 in unadjusted (β, 1.59; 95% CI, 1.21-1.97) and adjusted (β, 1.45; 95% CI, 1.00-1.80) models. CONCLUSIONS We found systematic Black-White racial differences in left atrial structure and pathophysiology in a population-based sample of patients with ischemic stroke. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that atrial cardiopathy phenotypes differ in Black people with acute stroke compared to White people.
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Affiliation(s)
- Hooman Kamel
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC.
| | - Kathleen Alwell
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Brett M Kissela
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Heidi J Sucharew
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Daniel Woo
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Matthew Flaherty
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Simona Ferioli
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Stacie L Demel
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Charles J Moomaw
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Kyle Walsh
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Jason Mackey
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Felipe De Los Rios La Rosa
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Adam Jasne
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sabreena Slavin
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sharyl Martini
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Opeolu Adeoye
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Tehniyat Baig
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Monica L Chen
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Emily B Levitan
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Elsayed Z Soliman
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Dawn O Kleindorfer
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
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8
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Meesmann M. [Premature complexes, anxiety and quality of life]. Herzschrittmacherther Elektrophysiol 2021; 32:3-8. [PMID: 33599852 DOI: 10.1007/s00399-021-00748-5] [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: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
Premature complexes can be indicative of an increased cardiac risk or can contribute to the initiation or deterioration of heart failure in particular in the presence of organic heart disease. Most premature complexes are benign. The postextrasystolic pause or the augmented postextrasystolic premature beat may cause the following symptoms: feeling of a skipped beat or the sensation of a pounding heart beat causing the feeling "that something is seriously wrong". It is mentioned that premature beats cause an unconscious reaction of the autonomic nervous system. Symptoms related to premature complexes may cause uneasiness or franc anxiety which may itself intensify the symptoms. This may cause a panic reaction which may be associated with shortness of breath or angina of the chest mimicking dyspnea of heart failure of an acute coronary syndrome. Along the "vicious cycle of anxiety" it is demonstrated how patients may be comforted. In addition, the panic disorder itself should be treated by cognitive behavioral or psychodynamic therapy.
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Affiliation(s)
- Malte Meesmann
- Medizinische Klinik - Schwerpunkt Kardiologie und Internistische Intensivmedizin, KWM - Standort Juliusspital, Salvatorstr. 7, 97074, Würzburg, Deutschland.
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9
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Vlachou M, Kamperidis V, Vlachaki E, Tziatzios G, Pantelidou D, Boutou A, Apostolou C, Papadopoulou D, Giannakoulas G, Karvounis H. Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major. Diagnostics (Basel) 2020; 11:diagnostics11010001. [PMID: 33375056 PMCID: PMC7822012 DOI: 10.3390/diagnostics11010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ patients. Demographic, laboratory, echocardiographic, cardiac magnetic resonance (CMR) T2* and 24-hour tape recording data were prospectively collected. The patients were classified according to the median value of premature atrial contractions (PACs) on 24-hour tape. In total, 50 β-TM patients (37.6 ± 9.1 years old, 50% male) were divided in 2 groups; PACs ≤ 24/day and > 24/day. Patients with PACs > 24/day were treated with blood transfusion for a longer period of time (39.0 ± 8.6 vs. 32.0 ± 8.9 years, p < 0.007), compared to their counterparts. Older age (OR: 1.121, 95% CI: 1.032–1.217, p = 0.007), longer duration of blood transfusion (OR:1.101, 95% CI:1.019–1.188, p = 0.014), larger LV end-diastolic diameter (OR: 4.522, 95% CI:1.009–20.280, p = 0.049), higher values of LA peak systolic strain (OR: 0.869, 95% CI: 0.783–0.964, p = 0.008), higher MV E/E′ average (OR: 1.407, 95% CI: 1.028–1.926, p = 0.033) and higher right ventricular systolic pressure (OR: 1.147, 95% CI: 1.039–1.266, p = 0.006) were univariably associated with PACs > 24/day. LA peak systolic strain remained significantly associated with PACs > 24/day after adjusting for the duration of blood transfusions or for CMR T2*. The multivariable model including blood transfusion duration and LA peak systolic strain was the most closely associated with PACs > 24/day. Receiver operating characteristic curve analysis identified a left atrial peak systolic strain of 31.5%, as the best cut-off value (83% sensitivity, 68% specificity) for prediction of PACs > 24/day. In β-TM patients, LA peak systolic strain was associated with the atrial arrhythmia burden independently to the duration of blood transfusions and CMR T2*.
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Affiliation(s)
- Maria Vlachou
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Vasileios Kamperidis
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
- Correspondence: ; Tel./Fax: +30-2310-994830
| | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece; (E.V.); (C.A.)
| | - Georgios Tziatzios
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Despoina Pantelidou
- Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece; (D.P.); (D.P.)
| | - Afroditi Boutou
- Pulmonary Department, Papanikolaou Hospital, 57010 Thessaloniki, Greece;
| | - Chrysa Apostolou
- Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece; (E.V.); (C.A.)
| | - Despoina Papadopoulou
- Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece; (D.P.); (D.P.)
| | - George Giannakoulas
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
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10
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Cha JJ, Lee KY, Chung H, Kim IS, Choi EY, Min PK, Yoon YW, Lee BK, Hong BK, Rim SJ, Kwon HM, Kim JY. Frequent Premature Atrial Contractions as a Poor Prognostic Factor in Cryptogenic Stroke Patients with Concomitant Non-Sustained Atrial Tachycardia. Yonsei Med J 2020; 61:965-969. [PMID: 33107240 PMCID: PMC7593104 DOI: 10.3349/ymj.2020.61.11.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/27/2022] Open
Abstract
In cryptogenic stroke patients, early detection of new-onset atrial fibrillation (AF) and recurrent stroke is required to prevent poor clinical outcomes. Therefore, we investigated the predictors of new-onset AF and recurrent stroke in cryptogenic stroke patients without previously diagnosed AF. In total, 390 patients who were diagnosed with stroke and non-sustained atrial tachycardia (NSAT) on 24-hour Holter monitoring were followed up to assess new-onset AF and recurrent stroke. The 5-year event-free survival as well as the predictors of recurrent stroke or new-onset AF were investigated. Based on receiver operating characteristic analysis, frequent premature atrial contractions (PACs) were defined as PACs >44 beats/day. The median follow-up period was 35 months. The composite event rate was 11.5%. In Kaplan-Meier analysis, the 5-year cumulative incidence of composite events was higher in cryptogenic stroke patients with frequent PACs than in those without frequent PACs. Multivariate analysis revealed that current smoking, increased left atrial volume index, and frequent PACs were poor prognostic predictors of composite event, and frequent PACs were an independent poor prognostic factor of new-onset AF in cryptogenic stroke patients. Therefore, frequent PACs might be associated with poor clinical outcomes (new-onset AF and recurrent stroke) in cryptogenic stroke patients with concomitant NSAT.
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Affiliation(s)
- Jung Joon Cha
- Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyemoon Chung
- Department of Cardiology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - In Soo Kim
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui Young Choi
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil Ki Min
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Won Yoon
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bum Kee Hong
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Joong Rim
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Moon Kwon
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Youn Kim
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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11
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Kamel H, Merkler AE, Iadecola C, Gupta A, Navi BB. Tailoring the Approach to Embolic Stroke of Undetermined Source: A Review. JAMA Neurol 2020; 76:855-861. [PMID: 30958521 DOI: 10.1001/jamaneurol.2019.0591] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance One-third of ischemic strokes have no identifiable cause after standard evaluation. In 2014, researchers termed these embolic strokes of undetermined source (ESUS) and argued that this entity would respond to anticoagulation. Two recent randomized clinical trials have not upheld this hypothesis, leading to questions about the ESUS concept. Observations This article proposes that ESUS remains a useful concept, the clinical effect of which can be enhanced by considering 2 subsets defined by their likelihood of responding to anticoagulation. Recent studies indicate that some ESUS cases result from subclinical atrial fibrillation, atrial cardiopathy, unrecognized myocardial infarction, patent foramen ovale, or cancer, while other cases result from nonstenosing large-artery atherosclerosis, aortic atherosclerosis, or nonatherosclerotic vasculopathies. Evidence suggests that anticoagulation will prove superior to antiplatelet therapy for cases in the first group of causative mechanisms but not those in the second group, suggesting the need for personalized therapy. Conclusions and Relevance Although the ESUS concept as currently constructed cannot guide treatment, efforts to better understand ESUS and develop therapies tailored to specific mechanisms are likely to help reduce the burden of stroke.
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Affiliation(s)
- Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.,Associate Editor
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Ajay Gupta
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.,Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York
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12
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Cha JJ, Chung H, Uhm JS, Joung B, Pak HN, Lee MH, Kim JY. Multiple atrial premature contractions predict stroke recurrence in patients with cryptogenic stroke and concomitant non-sustained atrial tachycardia. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-020-00014-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and objectives
Atrial fibrillation is a known risk factor for cryptogenic stroke and therefore requires early detection and prompt management. We investigated predictors of stroke recurrence in patients with cryptogenic stroke and concomitant non-sustained atrial tachycardia but not atrial fibrillation.
Subjects and methods
We investigated 390 patients (219 men, mean age 67 ± 12 years) diagnosed with stroke and non-sustained atrial tachycardia on 24-h Holter monitoring and recorded the total number of atrial premature contractions identified by the Holter monitor. Multiple atrial premature contractions were defined as atrial premature contractions > 34 beats/day. We analyzed the rates of 5-year freedom from stroke recurrence or atrial fibrillation and investigated independent predictors of stroke recurrence and undiagnosed atrial fibrillation.
Results
The mean follow-up period was 35 ± 21 months, and the overall stroke recurrence rate was 9.0%. Kaplan–Meier survival analysis revealed that the rate of freedom from stroke recurrence was significantly lower in patients with multiple atrial premature contractions. Also, the patients with multiple atrial premature contractions had higher cumulative incidence rate of new-onset AF (p = 0.019). Multivariate analysis showed that multiple atrial premature contractions (hazard ratio 2.49, 95% confidence interval 1.05–5.88, p = 0.038), cigarette smoking status (hazard ratio 2.66, 95% confidence interval 1.15–6.17, p = 0.022), and the left atrial volume index (hazard ratio 1.05, 95% confidence interval 1.01–1.09, p = 0.020) were significantly associated with stroke recurrence in patients with cryptogenic stroke. However, these factors were not statistically significant predictors of future onset of atrial fibrillation.
Conclusions
Multiple atrial premature contractions were significantly correlated with an increased left atrial volume index, which could predict future onset of atrial fibrillation and stroke recurrence. This study showed that multiple atrial premature contractions predict stroke recurrence in patients with cryptogenic stroke without atrial fibrillation.
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13
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Pranata R. Frequent premature atrial complex: A neglected marker of adverse cardiovascular events. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2020. [DOI: 10.4103/ijca.ijca_17_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Sejr MH, May O, Damgaard D, Bruun NH, Nielsen JC. Burden of Premature Atrial Complexes and Risk of Recurrent Stroke and Death in Patients with Mild to Moderate Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 29:104490. [PMID: 31839547 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Premature atrial complexes (PACs) meet increased attention as a potential intermediary between sinus rhythm and atrial fibrillation (AF). Patients with even high numbers of PACs do not fulfill current guidelines for oral anticoagulation treatment though an associated stroke risk is suspected. OBJECTIVE We aimed to determine whether a high number of PACs or runs of AF less than 30 seconds in 2-day continuous electrocardiogram (ECG) recording was associated with risk of recurrent ischemic stroke/transient ischemic attack (TIA) or death in a large cohort of patients with acute ischemic stroke or TIA and no prior AF. METHODS We performed 48 hours continuous ECG recording within 1 week after ischemic stroke/TIA. PACs were reported as mean number of PACs per hour. Patients were followed in Danish Stroke Registry, Danish Civil Registration System, and Danish National Patient Registry. Cox Regression analysis was used to calculate hazard ratios. RESULTS We included 1507 patients with TIA (40%) or ischemic stroke (60%), of which 98.7% had mild to moderate strokes. Mean age was 72.9 (7.8) years, 43.4% were females. Follow-up was 2.3 (1.3) years. Hazard ratio for recurrent stroke/TIA or death did not differ between quartiles of PAC burden, nor did any of the 2 components of this composite endpoint. Nonsustained AF less than 30 seconds was not associated with higher risk of recurrent stroke/TIA or death. CONCLUSIONS In a large cohort of patients with recent ischemic stroke or TIA, burden of PACs or nonsustained AF less than 30 seconds were not associated to higher risk of recurrent stroke/TIA or death.
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Affiliation(s)
- Michala Herskind Sejr
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| | - Ole May
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Henrik Bruun
- Department of Public Health, Biostatistical Advisory Service (BIAS), Aarhus University, Aarhus, Denmark
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Lu HT, Loo HC, Ng KS, Wong YO, Nordin R. Cardiac arrhythmia triggered by diuretic-induced hyponatremia. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2019; 14:39-43. [PMID: 31827736 PMCID: PMC6818697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diuretics have a long and distinguished history in the treatment of hypertension and heart failure. Clinical practice guidelines recommend that diuretics should be considered to be as suitable as other antihypertensive agents for the initiation and maintenance of antihypertensive treatment. However, diuretics may potentially cause electrolyte disturbances and metabolic side effects. Diuretic-induced hyponatremia is probably more prevalent than generally acknowledged. We present an unusual case of indapamide-induced hyponatremia and hypokalemia complicated by cardiac arrhythmia. The adverse drug reaction was reversible and non-life-threatening, but this case serves as a reminder that careful evaluation and constant monitoring are necessary when prescribing diuretics.
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Affiliation(s)
- H T Lu
- MD (USM), FRCP (EDINBURGH) Department of Cardiology, Sultanah Aminah Hospital, 8 Jalan Masjid Abu Bakar, 80100 Johor Bahru Johor, Malaysia.
| | - H C Loo
- MD (UKM), FRACGP (Australia] MRCP (London) Ledang Specialist Clinic, 141 Jalan Muar, 84900 Tangkak Johor, Malaysia
| | - K S Ng
- MBBS (Singapore), MASTER OF MEDICINCE IM (Singapore], FAFPM (Malaysia), Klinik Malaysia, 118, Jalan, Mersing, 86000 Kluang, Johor Malaysia
| | - Y O Wong
- MBBS (UM), AM (MAL), FRCP, (Glasgow), Klinik Pakar Perubatan Century 14A, Jalan Harimau, Century Garden 80250 Johor Bahru, Johor Malaysia
| | - R Nordin
- MD (Monash, Australia), MPH, PhD (Japan), Clinical School Johor Bahru Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 8 Jalan Masjid Abu Bakar, 80100 Johor Bahru Johor, Malaysia
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Kamel H, Okin PM, Merkler AE, Navi BB, Campion TR, Devereux RB, Díaz I, Weinsaft JW, Kim J. Relationship between left atrial volume and ischemic stroke subtype. Ann Clin Transl Neurol 2019; 6:1480-1486. [PMID: 31402612 PMCID: PMC6689681 DOI: 10.1002/acn3.50841] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Atrial cardiopathy without atrial fibrillation (AF) may be a potential cardiac source of embolic strokes of undetermined source (ESUS). Atrial volume is a feature of atrial cardiopathy, but the relationship between atrial volume and ESUS remains unclear. METHODS We compared left atrial volume among ischemic stroke subtypes in the Cornell Acute Stroke Academic Registry (CAESAR), which includes all patients with acute ischemic stroke at our hospital since 2011. Stroke subtype was determined by neurologists per the TOAST classification and consensus ESUS definition. Left atrial volume index (LAVI) was obtained directly from our echocardiography image system (Xcelera, Philips Healthcare). We used t-tests and analysis of variance for unadjusted comparisons and targeted minimum loss-based estimation for comparisons adjusted for demographics and comorbidities. RESULTS Among 2116 patients in CAESAR from 2011 to 2016, 1293 had LAVI measurements. LAVI varied across subtypes (P < 0.001) from 48.8 (±30.0) mL/m2 in cardioembolic strokes to 30.3 (±10.5) mL/m2 in small-vessel strokes. LAVI was larger in ESUS (33.3 ± 13.6 mL/m2 ) than in small- or large-vessel stroke (30.9 ± 10.7 mL/m2 ) (P = 0.01). The association between LAVI and ESUS persisted after the adjustment for demographics and comorbidities: a 10 mL/m2 increase in LAVI was associated with a 4.4% increase in ESUS probability (95% CI, 2.3%-6.4%). Results were similar after excluding patients with AF during post-discharge heart-rhythm monitoring. INTERPRETATION We found larger left atria among patients with ESUS versus non-cardioembolic stroke. There was significant overlap in left atrial size between ESUS and non-cardioembolic stroke, highlighting that many ESUS cases are not cardioembolic.
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Affiliation(s)
- Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Peter M Okin
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Thomas R Campion
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Iván Díaz
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | | | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medical College, New York, New York
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Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, Deharo JC, Svendsen JH, Heidbüchel H, Isa R, Kalman JM, Lane DA, Louw R, Lip GYH, Maury P, Potpara T, Sacher F, Sanders P, Varma N, Fauchier L, Haugaa K, Schwartz P, Sarkozy A, Sharma S, Kongsgård E, Svensson A, Lenarczyk R, Volterrani M, Turakhia M, Obel IWP, Abello M, Swampillai J, Kalarus Z, Kudaiberdieva G, Traykov VB, Dagres N, Boveda S, Vernooy K, Kalarus Z, Kudaiberdieva G, Mairesse GH, Kutyifa V, Deneke T, Hastrup Svendsen J, Traykov VB, Wilde A, Heinzel FR. Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). Europace 2019; 21:844–845. [DOI: 10.1093/europace/euz046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractAsymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.
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Affiliation(s)
- David O Arnar
- Department of Medicine, Landspitali - The National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hugh Calkins
- Department of Arrhythmia Services, Johns Hopkins Medical Institutions Baltimore, MD, USA
| | - Ashley Chin
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andrew Coats
- Department of Cardiology, University of Warwick, Warwickshire, UK
| | - Jean-Claude Deharo
- Department of Rhythmology, Hôpital Universitaire La Timone, Marseille, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Heidbüchel
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Ruan Louw
- Department Cardiology (Electrophysiology), Mediclinic Midstream Hospital, Centurion, South Africa
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Tatjana Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Frederic Sacher
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Laurent Fauchier
- Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Kristina Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | - Erik Kongsgård
- Department of Cardiology, OUS-Rikshospitalet, Oslo, Norway
| | - Anneli Svensson
- Department of Cardiology, University Hospital of Linkoping, Sweden
| | | | | | - Mintu Turakhia
- Stanford University, Cardiac Arrhythmia & Electrophysiology Service, Stanford, USA
| | | | | | - Janice Swampillai
- Electrophysiologist & Cardiologist, Waikato Hospital, University of Auckland, New Zealand
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze
| | | | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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18
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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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Younis A, Nof E, Israel A, Goldenberg I, Sabbag A, Glikson M, Peled Y, Klempfner R, Beinart R. Relation of Atrial Premature Complexes During Exercise Stress Testing to the Risk for the Development of Atrial Fibrillation in Patients Undergoing Cardiac Rehabilitation. Am J Cardiol 2018; 122:395-399. [PMID: 30049459 DOI: 10.1016/j.amjcard.2018.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is associated with increased morbidity and mortality. We sought to determine whether atrial premature complexes (APCs) detected during a standard exercise stress test (EST) in patients undergoing cardiac rehabilitation (CR) are associated with an increased risk of AF. The present study population comprised 6,523 consecutive patients without prior AF who participated in a CR program in a tertiary medical center in years 2009 to 2016. Multivariate analysis was used to identify the association between APCs during the baseline EST at CR and the risk for the development of AF over a mean follow-up period of 2.5 years. A total of 213 (3.7%) patients had APCs during their EST. Despite being older (mean age 63 ± 13 years old vs 58 ± 13; p <0.001, respectively), no other statistically significant differences were documented. Kaplan-Meier survival analysis showed that the rate of AF development during follow-up was significantly higher in patients with APCs at baseline EST (11%) as compared with those without APCs (5%; log-rank p <0.001 for the overall difference during follow-up). Consistently, multivariate analysis showed that patients with APCs showed >twofold increase risk for AF compared with those without APCs (hazard ratio 2.1; 95% confidence interval 1.36 to 3.25; p <0.001). In conclusion, our findings suggest that APCs detected during EST in patients participating in the CR program independently predict AF and can be used to improve risk stratification in this population.
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Affiliation(s)
- Arwa Younis
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Nof
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Israel
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Research Program, University of Rochester, Rochester, New York
| | - Avi Sabbag
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Nguyen KT, Vittinghoff E, Dewland TA, Dukes JW, Soliman EZ, Stein PK, Gottdiener JS, Alonso A, Chen LY, Psaty BM, Heckbert SR, Marcus GM. Ectopy on a Single 12-Lead ECG, Incident Cardiac Myopathy, and Death in the Community. J Am Heart Assoc 2017; 6:JAHA.117.006028. [PMID: 28775064 PMCID: PMC5586444 DOI: 10.1161/jaha.117.006028] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation and heart failure are 2 of the most common diseases, yet ready means to identify individuals at risk are lacking. The 12-lead ECG is one of the most accessible tests in medicine. Our objective was to determine whether a premature atrial contraction observed on a standard 12-lead ECG would predict atrial fibrillation and mortality and whether a premature ventricular contraction would predict heart failure and mortality. METHODS AND RESULTS We utilized the CHS (Cardiovascular Health) Study, which followed 5577 participants for a median of 12 years, as the primary cohort. The ARIC (Atherosclerosis Risk in Communities Study), the replication cohort, captured data from 15 792 participants over a median of 22 years. In the CHS, multivariable analyses revealed that a baseline 12-lead ECG premature atrial contraction predicted a 60% increased risk of atrial fibrillation (hazard ratio, 1.6; 95% CI, 1.3-2.0; P<0.001) and a premature ventricular contraction predicted a 30% increased risk of heart failure (hazard ratio, 1.3; 95% CI, 1.0-1.6; P=0.021). In the negative control analyses, neither predicted incident myocardial infarction. A premature atrial contraction was associated with a 30% increased risk of death (hazard ratio, 1.3; 95% CI, 1.1-1.5; P=0.008) and a premature ventricular contraction was associated with a 20% increased risk of death (hazard ratio, 1.2; 95% CI, 1.0-1.3; P=0.044). Similarly statistically significant results for each analysis were also observed in ARIC. CONCLUSIONS Based on a single standard ECG, a premature atrial contraction predicted incident atrial fibrillation and death and a premature ventricular contraction predicted incident heart failure and death, suggesting that this commonly used test may predict future disease.
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Affiliation(s)
- Kaylin T Nguyen
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Jonathan W Dukes
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Elsayed Z Soliman
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Phyllis K Stein
- Division of Cardiology, Washington University School of Medicine, St Louis, MO
| | - John S Gottdiener
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA.,Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Susan R Heckbert
- Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle, WA.,Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
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Sejr MH, Riahi S, Larsen TB, Nielsen JC, Nielsen PB. Premature atrial complexes in an ischemic stroke population and risk of recurrent stroke: a systematic review. Expert Rev Cardiovasc Ther 2017; 15:447-455. [PMID: 28532180 DOI: 10.1080/14779072.2017.1332992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Premature atrial complexes (PACs) have been proposed as a possible mediator between normal sinus rhythm and atrial fibrillation (AF). The aim of this study was to summarize the available knowledge of association between PACs and recurrent stroke or transient ischemic attack (TIA) in ischemic stroke patients. Areas covered: In this systematic review, we investigated the risk of recurrent events in patients who experienced ischemic stroke or TIA. Occurrence of PACs in electrocardiographic monitoring after index stroke/TIA was required. We identified and included three observational cohort studies, investigating in total 1005 patients. The studies reported that a significant burden of PACs occurred in a high proportion of stroke and TIA patients. More PACs were independently associated with an increased risk of recurrent stroke or TIA or the composite of recurrent stroke/TIA or death. Definition of PACs cut-off as well as patient characteristics differed between groups. Expert Commentary: This review supports an association between higher burden of PACs and recurrent stroke, and stresses the need for studies on PACs in stroke patients. A special awareness of stroke patients with a high PACs load is recommendable particularly for assessing the intensity and duration toward AF progression, and possible future treatment recommendations.
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Affiliation(s)
| | - Sam Riahi
- b Department of Clinical Medicine and AF-study group , Aalborg University , Aalborg , Denmark
| | | | | | - Peter Brønnum Nielsen
- b Department of Clinical Medicine and AF-study group , Aalborg University , Aalborg , Denmark.,d Department of Health Science and Technology , Aalborg University , Aalborg , Denmark
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