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Konstantinou K, Apostolos A, Tsiachris D, Dimitriadis K, Papakonstantinou PE, Pappelis K, Panoulas V, Tsioufis K. Exploring the link between blood pressure variability and atrial fibrillation: current insights and future directions. J Hum Hypertens 2024; 38:583-594. [PMID: 39026101 DOI: 10.1038/s41371-024-00936-z] [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: 01/21/2024] [Revised: 06/30/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
Atrial fibrillation (AF) is the most common heart rhythm disorder, especially in people over the age of 50, which affects more than 40 million people worldwide. Many studies have highlighted the association between hypertension with the development of AF. Blood pressure variability (BPV) is a dynamic size obtained by recording blood pressure oscillations using specific readings and at specific time intervals. A multitude of internal and external factors shape BPV while at the same time constituting a common pathogenetic pathway with the development of AF. Until recently, BPV has been applied exclusively in preclinical and clinical studies, without significant implications in clinical practice. Indeed, even from the research side, the determination of BPV is limited to patients without AF due to doubts about the accuracy of its measurement methods in patients with AF. In this review, we present the current evidence on common pathogenic pathways between BPV and AF, the reliability of quantification of BPV in patients with AF, the prognostic role of BPV in these patients, and discuss the future clinical implications of BPV in patients with AF.
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Affiliation(s)
- Konstantinos Konstantinou
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK.
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Anastasios Apostolos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panteleimon E Papakonstantinou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Pappelis
- Second Department of Ophthalmology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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2
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Meulendijks ER, Krul SPJ, Baalman SW, de Vries TAC, Wesselink R, Ernault AC, Kawasaki M, Al-Shama R, Neefs J, Limpens J, de Groot JR. Circulating adipose tissue proteins involved in atrial fibrillation: An explorative scoping review. Trends Cardiovasc Med 2024; 34:148-158. [PMID: 36538994 DOI: 10.1016/j.tcm.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Obesity increases the risk of atrial fibrillation (AF), potentially through proteins secreted by adipose tissue (AT) that affect atrial electrical and structural remodeling. We aim to give a comprehensive overview of circulating AT proteins involved in inflammation and fibrosis, that are associated with prevalent AF (paroxysmal or persistent) and the risk on developing new-onset AF. These include adipokines, defined as proteins enriched in AT as adiponectin, but also proteins less specific to AT. We systematically performed an explorative search for studies reporting associations between proteins secreted from cells residing in the AT and AF, and additionally assessed the effect of obesity on these proteins by a secondary search. The AT proteins involved in inflammation were mostly increased in patients with prevalent and new-onset AF, and with obesity, while the AT enriched adipokines were mostly not associated with AF. This review provides insight into circulating adipose tissue proteins involved in AF substrate formation.
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Affiliation(s)
- Eva R Meulendijks
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands.
| | - Sébastien P J Krul
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands
| | - Sarah W Baalman
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands
| | - Tim A C de Vries
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Robin Wesselink
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Auriane C Ernault
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Makiri Kawasaki
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands
| | - Rushd Al-Shama
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Jolien Neefs
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands
| | - Jacqueline Limpens
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands
| | - Joris R de Groot
- Amsterdam UMC, University of Amsterdam, Heart Center, department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
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3
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Ahmed B, Bunch TJ. Editorial commentary: Adiposity, altered inflammatory pathways, and atrial fibrillation: Mechanistic links or an epiphenomenon? Trends Cardiovasc Med 2024; 34:159-160. [PMID: 36669546 DOI: 10.1016/j.tcm.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Bilal Ahmed
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States.
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Esfandiari MA, Kazemzadeh K, Ansari A, Alishiri G, Afshari S, Daliri S, Saleh M, Balanian S, Tamannaeifar R, Niazi A, Vosoughian F, Abdi A, Mohebbi MB, hosseini RS, Foroughi E, Deravi N, Bafrani MA, Asadigandomani H. Associations of variability in body mass index with cardiovascular outcomes in the general population: A systematic review. JRSM Cardiovasc Dis 2024; 13:20480040241234149. [PMID: 38720874 PMCID: PMC11077937 DOI: 10.1177/20480040241234149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/17/2023] [Accepted: 02/04/2024] [Indexed: 05/12/2024] Open
Abstract
In today's world, high variability of body mass index (BMI) is known as a significant global health problem that can lead to many negative impacts on the cardiovascular system, including atrial fibrillation (AF) and coronary heart disease. The current systematic review aims to elucidate the effect of variability in BMI on the risk of cardiovascular outcomes. Four databases, including PubMed, Scopus, MEDLINE, and CENTRAL, were searched. All related articles up to 10 June 2022, were obtained. Titles, abstracts, and full texts were reviewed. After screening abstracts and full texts, four articles were included in our study. In these four cohort studies, 7,038,873 participants from the USA and South Korea were involved. These articles generally considered the BMI and outcomes including cardiovascular disease, AF, and coronary heart disease. All these articles reported an association between the variability of BMI and increased risk of cardiovascular outcomes. Due to the negative impact of the high variability of BMI on the risk of cardiovascular outcomes, health policymakers and practitioners should pay more attention to the significant role of BMI in health problems and physicians might better check the variability of BMI visits to visit.
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Affiliation(s)
- Mohammad Ali Esfandiari
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kimia Kazemzadeh
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Ansari
- Medical College, Shantou University, Shantou, Guandong, China
| | - Goharsharieh Alishiri
- Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Shaghayegh Afshari
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sepand Daliri
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Saleh
- Student Research Committee, Faculty of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Sahar Balanian
- University of Welfare Sciences and Social Health, Tehran, Iran
| | - Rozhina Tamannaeifar
- Bioprocessing and Biodetection Laboratory, Department of Food Science and Technology, University of Tehran, Tehran, Iran
| | - Alireza Niazi
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Vosoughian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Abdi
- Student Research Committee, School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | | | | | - Elaheh Foroughi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Melika Arab Bafrani
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
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5
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Upadhyay K, Frishman WH. An Exploration of the Relationship Between Atrial Fibrillation and Obesity. Cardiol Rev 2023; 31:185-192. [PMID: 36727745 DOI: 10.1097/crd.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In the past 40 years, the prevalence of atrial fibrillation and obesity have skyrocketed. It has long been established that obesity can lead to adverse cardiovascular outcomes due to its myriad of effects on cardiovascular architecture, cardiovascular hemodynamics, and electrical conduction interference. The goal of this article is to explore the pathogenesis of atrial fibrillation in obese patients and examine the role of atrial enlargement, increased adipose deposits surrounding the pericardium, interstitial fibrosis, and inflammation in the development and worsening of atrial fibrillation in obese patients.
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Affiliation(s)
- Kiran Upadhyay
- From the Department of Medicine NYU Long Island and Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
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6
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Abstract
The American Indian population is known to experience high rates of cardiovascular disease and have a heightened vulnerability to severe outcomes driven by an overall poor health status and lower access to quality health care. Our group has previously published an analysis demonstrating that American Indians have the highest risk of atrial fibrillation (AF), as well as of AF-related stroke, when compared with other races and ethnicities. Despite this, AF in this population has not been extensively studied and additional publications are scarce. Our review article provides an up-to-date summary of the relevant literature addressing the relationship between race, ethnicity, and AF by focusing on American Indians.
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Affiliation(s)
- José M. Sanchez
- Department of Cardiology and Electrophysiology, Kaiser Permanente of Colorado, Aurora, Colorado
| | - Gregory M. Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
- Address reprint requests and correspondence: Dr Gregory M. Marcus, 505 Parnassus Ave, M1180B, San Francisco, CA 94143-0124.
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Tilly MJ, Geurts S, Pezzullo AM, Bramer WM, de Groot NMS, Kavousi M, de Maat MPM. The association of coagulation and atrial fibrillation: a systematic review and meta-analysis. Europace 2022; 25:28-39. [PMID: 35942591 PMCID: PMC9907526 DOI: 10.1093/europace/euac130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS While atrial fibrillation (AF) is suggested to induce a prothrombotic state, increasing thrombotic risk, it is also hypothesized that coagulation underlies AF onset. However, conclusive evidence is lacking. With this systematic review and meta-analysis, we aimed to summarize and combine the evidence on the associations between coagulation factors with AF in both longitudinal and cross-sectional studies. METHODS AND RESULTS We systematically searched for longitudinal cohort and cross-sectional studies investigating AF and thrombosis. For longitudinal studies, pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. For cross-sectional studies, we determined pooled standardized mean differences (SMDs) and 95% CIs. A total of 17 longitudinal and 44 cross-sectional studies were included. In longitudinal studies, we found significant associations between fibrinogen (HR 1.05, 95% CI 1.00-1.10), plasminogen activator inhibitor 1 (PAI-1) (HR 1.06, 95% CI 1.00-1.12), and D-dimer (HR 1.10, 95% CI 1.02-1.19) and AF incidence. In cross-sectional studies, we found significantly increased levels of fibrinogen (SMD 0.47, 95% CI 0.20-0,74), von Willebrand factor (SMD 0.96, 95% CI 0.28-1.66), P-selectin (SMD 0.31, 95% CI 0.08-0.54), ß-thromboglobulin (SMD 0.82, 95% CI 0.61-1.04), Platelet Factor 4 (SMD 0.42, 95% CI 0.12-0.7), PAI-1 (1.73, 95% CI 0.26-3.19), and D-dimer (SMD 1.74, 95% CI 0.36-3.11) in AF patients, as opposed to controls. CONCLUSION These findings suggest that higher levels of coagulation factors are associated with prevalent and incident AF. These associations are most pronounced with prevalent AF in cross-sectional studies. Limited evidence from longitudinal studies suggests a prothrombotic state underlying AF development.
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Affiliation(s)
- Martijn J Tilly
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Angelo M Pezzullo
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands,Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Schleberger R, Metzner A, Kuck K, Andresen D, Willems S, Hoffmann E, Deneke T, Eckardt L, Brachmann J, Hochadel M, Senges J, Rillig A. Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation-Insights from the German Ablation Registry. Pharmacol Res Perspect 2021; 9:e00880. [PMID: 34664789 PMCID: PMC8525107 DOI: 10.1002/prp2.880] [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] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 12/02/2022] Open
Abstract
Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after catheter ablation for atrial fibrillation (AF) are inconsistent. The present study investigates whether postinterventional AAD leads to an improved long-term outcome. Patients from the prospective German Ablation Registry (n = 3275) discharged with or without AAD after catheter ablation for AF were compared regarding the rates of recurrences, reablations and cardiovascular events as well as patient reported outcomes during 12 months follow-up. In patients with paroxysmal AF (n = 2138) the recurrence rate did not differ when discharged with (n = 1051) or without (n = 1087) AAD (adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95-1.35]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05-1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20-2.58]). Similar rates of recurrences, reablations and treatment satisfaction were found in patients with persistent AF (n = 1137) discharged with (n = 641) or without (n = 496) AAD (recurrence: OR 1.22, 95% CI [0.95-1.56]; reablation: OR 1.21, 95% CI [0.91-1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74-2.08]). The incidence of cardiovascular events and mortality did not differ at follow-up in patients discharged with or without AAD. In conclusion, the rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction. Clinical trial registration: The trial has been registered under the number NCT01197638.
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Affiliation(s)
- Ruben Schleberger
- Department of CardiologyUniversity Heart and Vascular CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Andreas Metzner
- Department of CardiologyUniversity Heart and Vascular CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | | | | | - Stephan Willems
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Ellen Hoffmann
- Department of Cardiology and Internal Intensive Care MedicineHeart Center Munich‐BogenhausenBogenhausen HospitalMunichGermany
| | - Thomas Deneke
- Department of CardiologyRhön Clinic Campus Bad NeustadtBad Neustadt a. d. SaaleGermany
| | - Lars Eckardt
- Department of Cardiology (Electrophysiology)University Hospital MünsterMünsterGermany
| | - Johannes Brachmann
- Department of Cardiology, Angiology and PneumologyCoburg HospitalCoburgGermany
| | | | - Jochen Senges
- Stiftung für Herzinfarktforschung (IHF)LudwigshafenGermany
| | - Andreas Rillig
- Department of CardiologyUniversity Heart and Vascular CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Wang W, Norby FL, Zhang MJ, Reyes JL, Shah AM, Soliman EZ, Lutsey PL, Alonso A, Solomon SD, Inciardi RM, Chen LY. Differences in Left Atrial Size and Function and Supraventricular Ectopy Between Black and White Participants in the ARIC Study. J Am Heart Assoc 2021; 10:e021723. [PMID: 34713724 PMCID: PMC8751819 DOI: 10.1161/jaha.121.021723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022]
Abstract
Background Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. Methods and Results We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2-week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%-47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. Conclusions Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial arrhythmias in Black individuals.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Faye L. Norby
- Center for Cardiac Arrest PreventionDepartment of CardiologyCedars‐Sinai Smidt Heart InstituteLos AngelesCA
| | - Michael J. Zhang
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Jorge L. Reyes
- Department of MedicineHennepin County Medical CenterMinneapolisMN
| | - Amil M. Shah
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMA
| | - Elsayed Z. Soliman
- Department of EpidemiologyDivision of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNC
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | | | - Riccardo M. Inciardi
- Institute of CardiologyDepartment of Medical and Surgical SpecialtiesRadiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Lin Y. Chen
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
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10
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Healey JS, Roberts JD, Field TS. Who is at risk of atrial fibrillation? Heart Rhythm 2021; 18:853-854. [PMID: 33639297 DOI: 10.1016/j.hrthm.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jeff S Healey
- Population Health Research Institute, Hamilton, Ontario, Canada.
| | - Jason D Roberts
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Thalia S Field
- Vancouver Stroke Program, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Bräuner EV, Jørgensen JT, Duun-Henriksen AK, Backalarz C, Laursen JE, Pedersen TH, Simonsen MK, Andersen ZJ. Long-term wind turbine noise exposure and the risk of incident atrial fibrillation in the Danish Nurse cohort. ENVIRONMENT INTERNATIONAL 2019; 130:104915. [PMID: 31344645 DOI: 10.1016/j.envint.2019.104915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/19/2019] [Accepted: 06/09/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND The potential health effects related to wind turbine noise (WTN) have received increased focus during the past decades, but evidence is sparse. We examined the association between long-term exposure to wind turbine noise and incidence of atrial fibrillation (AF). METHODS First ever hospital admission of AF amongst 28,731 female nurses in the Danish Nurse Cohort were identified in the Danish National Patient register until ultimo 2013. WTN levels at residential addresses between 1982 and 2013 were estimated using the Nord2000 noise propagation model, as the annual means of Lden, Lday, Levening and Lnight at the most exposed façade. Time-varying Cox proportional hazard regression models were used to examine the association between the 11-, 5- and 1-year rolling means of WTN levels and AF incidence. RESULTS 1430 nurses developed AF by end of follow-up in 2013. Mean (standard deviation) baseline residential noise levels amongst exposed nurses were 26.3 (6.7) dB and slightly higher in those who developed AF (27.3 (7.31) dB), than those who didn't (26.2 (6.6)). We observed a 30% statistically significant increased risk (95% CI: 1.05-1.61) of AF amongst nurses exposed to long-term (11-year running mean) WTN levels ≥20 dB(A) at night compared to nurses exposed to levels <20 dB(A). Similar effects were observed with day (HR 1.25; 95% CI: 1.01-1.54), and evening (HR 1.25; 95% CI: 1.01-1.54) noise levels. CONCLUSIONS We found suggestive evidence of an association between long-term exposure to WTN and AF amongst female nurses. However, interpretation should be cautious as exposure levels were low.
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Affiliation(s)
- Elvira V Bräuner
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Mette K Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark; The Parker Institute, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark.
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12
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Bräuner EV, Jørgensen JT, Duun‐Henriksen AK, Backalarz C, Laursen JE, Pedersen TH, Simonsen MK, Andersen ZJ. Association Between Long-Term Exposure to Wind Turbine Noise and the Risk of Stroke: Data From the Danish Nurse Cohort. J Am Heart Assoc 2019; 8:e013157. [PMID: 31310571 PMCID: PMC6662131 DOI: 10.1161/jaha.119.013157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Epidemiological studies suggest that road traffic noise increases the risk of stroke. Similar effects may be expected from wind turbine noise (WTN) exposure, but epidemiological evidence is lacking. The present study investigated the association between long‐term exposure to WTN and the risk for stroke. Methods and Results First‐ever stroke in 28 731 female nurses in the Danish Nurse Cohort was identified in the Danish National Patient register until the end of 2013. WTN, traffic noise, and air pollution exposures were estimated for all historic and present residential addresses between 1982 and 2013. Time‐varying Cox proportional hazard regression was used to examine the associations between the 11‐, 5‐, and 1‐year rolling means of WTN levels and stroke incidence. Of 23 912 nurses free of stroke at the cohort baseline, 1097 nurses developed stroke by the end of follow‐up. At the cohort baseline, 10.3% of nurses were exposed to WTN (≥1 turbine within a 6000‐meter radius of the residence) and 13.3% in 2013. Mean baseline residential noise levels among exposed nurses were 26.3 dB(A). No association between long‐term WTN exposure and stroke incidence was found. The adjusted hazard ratios and 95% CIs for the 11‐, 5‐, and 1‐year running mean residential WTN exposures preceding stroke diagnosis, comparing nurses with residential WTN levels above and below 20 dB(A) were 1.09 (0.90–1.31), 1.08 (0.89–1.31) and 1.08 (0.89–1.32), respectively. Conclusions This comprehensive cohort study lends no support to an association between long‐term WTN exposure and stroke risk.
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Affiliation(s)
- Elvira V. Bräuner
- Section of Environmental HealthDepartment of Public HealthUniversity of CopenhagenDenmark
- Department of Growth and Reproduction, RigshospitaletUniversity of CopenhagenDenmark
| | - Jeanette T. Jørgensen
- Section of Environmental HealthDepartment of Public HealthUniversity of CopenhagenDenmark
| | | | | | | | | | - Mette K. Simonsen
- DiakonissestiftelsenFrederiksbergDenmark
- The Parker InstituteCopenhagen University HospitalBispebjerg and FrederiksbergDenmark
| | - Zorana J. Andersen
- Section of Environmental HealthDepartment of Public HealthUniversity of CopenhagenDenmark
- Centre for Epidemiological ResearchNykøbing F HospitalNykøbing FDenmark
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13
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Adiponectin and the risk of new-onset atrial fibrillation: a meta-analysis of prospective cohort studies. Biosci Rep 2019; 39:BSR20182284. [PMID: 31088901 PMCID: PMC6558722 DOI: 10.1042/bsr20182284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 01/14/2023] Open
Abstract
Background: Adiponectin has been suggested as a marker of many cardiovascular diseases. However, the association between serum adiponectin and incidence of atrial fibrillation (AF) in general population remains unclear. A meta-analysis was performed to systematically evaluate the potential influence of serum adiponectin at baseline on the incidence of AF during follow-up in general population. Methods: Prospective cohort studies were identified via electronic search of PubMed and Embase databases. A randomized effect model was applied to combine the results. Predefined subgroup analyses were performed to evaluate the influence of study characteristics on the association between baseline adiponectin and risk of new-onset AF. Results: Six cohort studies with 18558 community-derived participants were included, and 3165 AF cases were developed with a mean follow-up duration of up to 22 years. Meta-analysis showed that higher baseline circulating adiponectin was significantly associated with higher risk of new-onset AF during follow-up (hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 1.08–1.27, P<0.001, I2 = 52%). Subgroup analyses showed that the association between adiponectin and new-onset AF was significant in studies with mean follow-up duration over 10 years (five cohorts, HR = 1.22, P<0.001), but not in that with a follow-up duration < 10 years (one cohort, HR = 0.95, P=0.51; P for subgroup difference = 0.002). Conclusions: Higher circulating adiponectin at baseline may be an independent risk factor for the development of new-onset AF during follow-up, particularly in cohort studies with longer follow-up durations.
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14
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Triggers for Atrial Fibrillation: The Role of Anxiety. Cardiol Res Pract 2019; 2019:1208505. [PMID: 30906592 PMCID: PMC6398072 DOI: 10.1155/2019/1208505] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/15/2019] [Indexed: 12/26/2022] Open
Abstract
Atrial fibrillation (AF) is the most widely recognized arrhythmia. Systemic arterial hypertension, diabetes, obesity, heart failure, and valvular heart diseases are major risk factors for the onset and progression of AF. Various studies have emphasized the augmented anxiety rate among AF patients due to the poor quality of life; however, little information is known about the possibility of triggering atrial fibrillation by anxiety. The present review sought to underline the possible pathophysiological association between AF and anxiety disorders and suggests that anxiety can be an independent risk factor for AF, acting as a trigger, creating an arrhythmogenic substrate, and modulating the autonomic nervous system. The awareness of the role of anxiety disorders as a risk factor for AF may lead to the development of new clinical strategies for the management of AF.
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15
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Maruyama T, Fukata M, Akashi K. Association of atrial fibrillation and gastroesophageal reflux disease: Natural and therapeutic linkage of the two common diseases. J Arrhythm 2019; 35:43-51. [PMID: 30805043 PMCID: PMC6373829 DOI: 10.1002/joa3.12125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/01/2018] [Accepted: 09/13/2018] [Indexed: 12/24/2022] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia and gastroesophageal reflux disease (GERD) is popular in Japan. The two common diseases share several predisposing factors such as lifestyle and senescence, and inflammation and oxidative stress play an important role in their development and progression. Incidental cases of AF treated successfully by proton pump inhibitor (PPI) applied for coexisting GERD have been sporadically reported. An increasing evidence indicates that GERD induces the initiation and the perpetuation of AF. This is caused by the autonomic nerve influence, mechanical compression, and propagation of local inflammation due to proximity of left atrium (LA) and lower esophagus. Meanwhile, AF also develops GERD by mechanical and inflammatory actions of LA characterized by remodeling and inflammation. The robust association of AF with GERD is not limited to their natural interaction, i.e., pharmacological or nonpharmacological treatment of AF is reported to aggravate GERD. Many cardiac drugs (anticoagulants, calcium antagonists, and nitrates) induce esophageal mucosal damage and lower esophageal sphincter relaxation promoting acid reflux. These drugs are frequently prescribed in patients with AF for stroke prevention, rate control, and for coexisting coronary heart disease. Catheter ablation also yields both GERD and esophageal thermal injury, which is a precursor lesion of atrioesophageal fistula. The notion that AF and GERD are mutually interdependent is widely and empirically recognized. However, mechanistic link of the two common diseases and objective evaluation of PPI as an adjunctive AF treatment warrant future large-scale prospective trials.
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Affiliation(s)
- Toru Maruyama
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical SciencesFukuokaJapan
| | - Mitsuhiro Fukata
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical SciencesFukuokaJapan
| | - Koichi Akashi
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical SciencesFukuokaJapan
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16
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Race and atrial fibrillation: A riddle, wrapped in a mystery, inside an enigma. Heart Rhythm 2018; 15:1346-1347. [DOI: 10.1016/j.hrthm.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 11/18/2022]
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17
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Duan XL, Li L, Li YN. Association of serum nesfatin-1 concentrations with atrial fibrillation. Kaohsiung J Med Sci 2018; 34:348-351. [DOI: 10.1016/j.kjms.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022] Open
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18
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Yamaguchi N, Okumura Y, Watanabe I, Nagashima K, Takahashi K, Iso K, Watanabe R, Arai M, Kurokawa S, Ohkubo K, Nakai T, Hirayama A. Clinical implications of serum adiponectin on progression of atrial fibrillation. J Arrhythm 2017; 33:608-612. [PMID: 29255509 PMCID: PMC5728982 DOI: 10.1016/j.joa.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/08/2017] [Accepted: 07/13/2017] [Indexed: 11/16/2022] Open
Abstract
Background The association between circulating adiponectin levels and atrial fibrillation (AF) is uncertain. We, therefore, investigated whether an increased serum adiponectin level is implicated in the long-term recurrence of AF after ablation therapy. Methods Our study included 100 consecutive patients (88 men; median age, 57.9±10.9 years) who underwent catheter ablation for AF at our hospital between 2011 and 2013. The adiponectin and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured before ablation and compared between those in whom AF recurred and those in whom AF did not recur. Results Elevation in adiponectin levels was significantly associated with female sex, non-paroxysmal AF, heart failure, higher NT-proBNP and matrix metallo-proteinase-2 levels, and lower body mass index. After a stepwise adjustment for any potential confounding variables, the adiponectin levels remained significantly associated with female sex (beta=0.2601, P=0.0041), non-paroxysmal AF (beta=0.2708, P=0.0080), and higher NT-proBNP levels (beta=0.2536, P= 0.0138). During the median follow-up period of 26.2 months, AF recurred in 48 of the 100 patients. Stepwise multivariate adjustment showed that an increased log-transformed NT-proBNP (Hazard ratio [HR], 2.18; 95% confidence interval [CI] 1.25-4.00; P=0.0055), longer duration of AF (HR, 1.87; 95%CI 1.01-3.76; P=0.0465), and decreased left ventricular ejection fraction (HR, 0.96; 95%CI 0.93-0.99; P=0.0391) were independent predictors of recurrent AF after catheter ablation, but adiponectin was not. Conclusions Our data indicated that adiponectin was partially responsible for progression of AF, but the correlation between adiponectin levels and AF recurrence was not significant.
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Affiliation(s)
- Naoko Yamaguchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Keiko Takahashi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuki Iso
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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19
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Christensen MA, Nguyen KT, Stein PK, Fohtung RB, Soliman EZ, Dewland TA, Vittinghoff E, Psaty BM, Heckbert SR, Marcus GM. Atrial ectopy as a mediator of the association between race and atrial fibrillation. Heart Rhythm 2017; 14:1856-1861. [PMID: 29110996 PMCID: PMC5712237 DOI: 10.1016/j.hrthm.2017.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Blacks have a lower risk of atrial fibrillation (AF) despite having more AF risk factors, but the mechanism remains unknown. Premature atrial contraction (PAC) burden is a recently identified risk factor for AF. OBJECTIVE The purpose of this study was to determine whether the burden of PACs explains racial differences in AF risk. METHODS PAC burden (number per hour) was assessed by 24-hour ambulatory electrocardiographic (ECG) monitoring in a randomly selected subset of patients in the Cardiovascular Health Study. Participants were followed prospectively for the development of AF, diagnosed by study ECG and hospital admission records. RESULTS Among 938 participants (median age 73 years; 34% black; 58% female), 206 (22%) developed AF over a median follow-up of 11.0 years (interquartile range 6.1-13.4). After adjusting for age, sex, body mass index, coronary disease, congestive heart failure, diabetes, hypertension, alcohol consumption, smoking status, and study site, black race was associated with a 42% lower risk of AF (hazard ratio 0.58, 95% confidence interval [CI] 0.40-0.85; P = .005). The baseline PAC burden was 2.10 times (95% CI 1.57-2.83; P <.001) higher in whites than blacks. There was no detectable difference in premature ventricular contraction (PVC) burden by race. PAC burden mediated 19.5% (95% CI 6.3-52.5) of the adjusted association between race and AF. CONCLUSION On average, whites exhibited more PACs than blacks, and this difference statistically explains a modest proportion of the differential risk of AF by race. The differential PAC burden, without differences in PVCs, by race suggests that identifiable common exposures or genetic influences might be important to atrial pathophysiology.
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Affiliation(s)
- Matthew A Christensen
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California; University of Michigan Medical School, Ann Arbor, Michigan
| | - Kaylin T Nguyen
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Phyllis K Stein
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri
| | | | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Wake Forest University, Winston Salem, North Carolina
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Sciences, University of Washington, Seattle, Washington
| | - Susan R Heckbert
- Group Health Research Institute, Group Health Cooperation, Seattle, Washington
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
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20
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Lin YK, Chen YA, Lee TI, Chen YC, Chen SA, Chen YJ. Aging Modulates the Substrate and Triggers Remodeling in Atrial Fibrillation. Circ J 2017; 82:1237-1244. [PMID: 28904308 DOI: 10.1253/circj.cj-17-0242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aging plays a critical role in the genesis of atrial fibrillation (AF) and also increases the risks of cardiac dysfunction and stroke in AF patients. AF is caused by increased AF triggering from abnormalities of the thoracic vein and/or modulated substrate (atrial) with enhancement of AF maintenance. Clinical and laboratory evidence indicates that aging is significant in the creation of atrial electrical and structural remodeling that leads to increased susceptibility to AF occurrence. Aging is commonly associated with cardiovascular comorbidities, oxidative stress, calcium dysregulation, atrial myopathy with apoptosis, and fibrosis, which all contribute to the genesis of AF. This review updates the current understanding of the effects of aging on the pathophysiology of AF.
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Affiliation(s)
- Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Yi-Ann Chen
- Division of Nephrology, Sijhih Cathay General Hospital
| | - Ting-I Lee
- Division of Endocrinology and Metabolism, Wan Fang Hospital, Taipei Medical University
| | - Yao-Chang Chen
- Department of Biomedical Engineering, National Defense Medical Center
| | - Shih-Ann Chen
- Division of Cardiology and Cardiovascular Research Center, Veterans General Hospital-Taipei
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University
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21
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Monrad M, Sajadieh A, Christensen JS, Ketzel M, Raaschou-Nielsen O, Tjønneland A, Overvad K, Loft S, Sørensen M. Long-Term Exposure to Traffic-Related Air Pollution and Risk of Incident Atrial Fibrillation: A Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:422-427. [PMID: 27472911 PMCID: PMC5332191 DOI: 10.1289/ehp392] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Atrial fibrillation is the most common sustained arrhythmia and is associated with cardiovascular morbidity and mortality. The few studies conducted on short-term effects of air pollution on episodes of atrial fibrillation indicate a positive association, though not consistently. OBJECTIVES The aim of this study was to evaluate the long-term impact of traffic-related air pollution on incidence of atrial fibrillation in the general population. METHODS In the Danish Diet, Cancer, and Health cohort of 57,053 people 50-64 years old at enrollment in 1993-1997, we identified 2,700 cases of first-ever hospital admission for atrial fibrillation from enrollment to end of follow-up in 2011. For all cohort members, exposure to traffic-related air pollution assessed as nitrogen dioxide (NO2) and nitrogen oxides (NOx) was estimated at all present and past residential addresses from 1984 to 2011 using a validated dispersion model. We used Cox proportional hazard model to estimate associations between long-term residential exposure to NO2 and NOx and risk of atrial fibrillation, after adjusting for lifestyle and socioeconomic position. RESULTS A 10 μg/m3 higher 10-year time-weighted mean exposure to NO2 preceding diagnosis was associated with an 8% higher risk of atrial fibrillation [incidence rate ratio: 1.08; 95% confidence interval (CI): 1.01, 1.14] in adjusted analysis. Though weaker, similar results were obtained for long-term residential exposure to NOx. We found no clear tendencies regarding effect modification of the association between NO2 and atrial fibrillation by sex, smoking, hypertension or myocardial infarction. CONCLUSION We found long-term residential traffic-related air pollution to be associated with higher risk of atrial fibrillation. Accordingly, the present findings lend further support to the demand for abatement of air pollution. Citation: Monrad M, Sajadieh A, Christensen JS, Ketzel M, Raaschou-Nielsen O, Tjønneland A, Overvad K, Loft S, Sørensen M. 2017. Long-term exposure to traffic-related air pollution and risk of incident atrial fibrillation: a cohort study. Environ Health Perspect 125:422-427; http://dx.doi.org/10.1289/EHP392.
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Affiliation(s)
- Maria Monrad
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg, Denmark
| | | | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
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22
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Chatterjee NA, Giulianini F, Geelhoed B, Lunetta KL, Misialek JR, Niemeijer MN, Rienstra M, Rose LM, Smith AV, Arking DE, Ellinor PT, Heeringa J, Lin H, Lubitz SA, Soliman EZ, Verweij N, Alonso A, Benjamin EJ, Gudnason V, Stricker BHC, Van Der Harst P, Chasman DI, Albert CM. Genetic Obesity and the Risk of Atrial Fibrillation: Causal Estimates from Mendelian Randomization. Circulation 2017; 135:741-754. [PMID: 27974350 PMCID: PMC5322057 DOI: 10.1161/circulationaha.116.024921] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Observational studies have identified an association between body mass index (BMI) and incident atrial fibrillation (AF). Inferring causality from observational studies, however, is subject to residual confounding, reverse causation, and bias. The primary objective of this study was to evaluate the causal association between BMI and AF by using genetic predictors of BMI. METHODS We identified 51 646 individuals of European ancestry without AF at baseline from 7 prospective population-based cohorts initiated between 1987 and 2002 in the United States, Iceland, and the Netherlands with incident AF ascertained between 1987 and 2012. Cohort-specific mean follow-up ranged from 7.4 to 19.2 years, over which period there was a total of 4178 cases of incident AF. We performed a Mendelian randomization with instrumental variable analysis to estimate a cohort-specific causal hazard ratio for the association between BMI and AF. Two genetic instruments for BMI were used: FTO genotype (rs1558902) and a BMI gene score comprising 39 single-nucleotide polymorphisms identified by genome-wide association studies to be associated with BMI. Cohort-specific estimates were combined by random-effects, inverse variance-weighted meta-analysis. RESULTS In age- and sex-adjusted meta-analysis, both genetic instruments were significantly associated with BMI (FTO: 0.43 [95% confidence interval, 0.32-0.54] kg/m2 per A-allele, P<0.001; BMI gene score: 1.05 [95% confidence interval, 0.90-1.20] kg/m2 per 1-U increase, P<0.001) and incident AF (FTO, hazard ratio, 1.07 [1.02-1.11] per A-allele, P=0.004; BMI gene score, hazard ratio, 1.11 [1.05-1.18] per 1-U increase, P<0.001). Age- and sex-adjusted instrumental variable estimates for the causal association between BMI and incident AF were hazard ratio, 1.15 (1.04-1.26) per kg/m2, P=0.005 (FTO) and 1.11 (1.05-1.17) per kg/m2, P<0.001 (BMI gene score). Both of these estimates were consistent with the meta-analyzed estimate between observed BMI and AF (age- and sex-adjusted hazard ratio 1.05 [1.04-1.06] per kg/m2, P<0.001). Multivariable adjustment did not significantly change findings. CONCLUSIONS Our data are consistent with a causal relationship between BMI and incident AF. These data support the possibility that public health initiatives targeting primordial prevention of obesity may reduce the incidence of AF.
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Affiliation(s)
- Neal A. Chatterjee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Franco Giulianini
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Bastiaan Geelhoed
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kathryn L. Lunetta
- The Framingham Heart Study, Framingham, MA, USA; Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey R. Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maartje N. Niemeijer
- Department of Epidemiology, Erasmus Medical Center-University Medical Center, Rotterdam, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lynda M. Rose
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Albert V. Smith
- Icelandic Heart Association, Research Institute, Kpoavogur, Iceland and University of Iceland, Reykjavik, Iceland
| | - Dan E. Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patrick T. Ellinor
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA and Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Jan Heeringa
- Department of Epidemiology, Erasmus Medical Center-University Medical Center, Rotterdam, The Netherlands
| | - Honghuang Lin
- The Framingham Heart Study, Framingham, MA, USA; Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
- Computational Biomedicine Section, Boston University School of Medicine, Boston, MA, USA
| | - Steven A. Lubitz
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA and Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Niek Verweij
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Emelia J. Benjamin
- The Framingham Heart Study, Framingham, MA, USA; Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Research Institute, Kpoavogur, Iceland and University of Iceland, Reykjavik, Iceland
| | - Bruno H. C. Stricker
- Department of Epidemiology, Erasmus Medical Center-University Medical Center, Rotterdam, The Netherlands
| | - Pim Van Der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daniel I. Chasman
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine M. Albert
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol 2017; 32:181-192. [PMID: 28194602 PMCID: PMC5380695 DOI: 10.1007/s10654-017-0232-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/01/2017] [Indexed: 12/18/2022]
Abstract
Different adiposity measures have been associated with increased risk of atrial fibrillation, however, results have previously only been summarized for BMI. We therefore conducted a systematic review and meta-analysis of prospective studies to clarify the association between different adiposity measures and risk of atrial fibrillation. PubMed and Embase databases were searched up to October 24th 2016. Summary relative risks (RRs) were calculated using random effects models. Twenty-nine unique prospective studies (32 publications) were included. Twenty-five studies (83,006 cases, 2,405,381 participants) were included in the analysis of BMI and atrial fibrillation. The summary RR was 1.28 (95% confidence interval: 1.20-1.38, I2 = 97%) per 5 unit increment in BMI, 1.18 (95% CI: 1.12-1.25, I2 = 73%, n = 5) and 1.32 (95% CI: 1.16-1.51, I2 = 91%, n = 3) per 10 cm increase in waist and hip circumference, respectively, 1.09 (95% CI: 1.02-1.16, I2 = 44%, n = 4) per 0.1 unit increase in waist-to-hip ratio, 1.09 (95% CI: 1.02-1.16, I2 = 94%, n = 4) per 5 kg increase in fat mass, 1.10 (95% CI: 0.92-1.33, I2 = 90%, n = 3) per 10% increase in fat percentage, 1.10 (95% CI: 1.08-1.13, I2 = 74%, n = 10) per 5 kg increase in weight, and 1.08 (95% CI: 0.97-1.19, I2 = 86%, n = 2) per 5% increase in weight gain. The association between BMI and atrial fibrillation was nonlinear, p nonlinearity < 0.0001, with a stronger association at higher BMI levels, however, increased risk was observed even at a BMI of 22-24 compared to 20. In conclusion, general and abdominal adiposity and higher body fat mass increase the risk of atrial fibrillation.
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Tan Q, Zhang S, Qi X, Zou X, Sun Q. Permanent atrial fibrillation impairs the function of circulating endothelial progenitor cells. Postgrad Med 2017; 129:198-204. [PMID: 28128678 DOI: 10.1080/00325481.2017.1288063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE to determine whether functions of endothelial progenitor cells (EPCs) were impaired in patients with permanent atrial fibrillation (AF). METHODS 35 patients with permanent AF (AF group) and 35 age and sex matched controls (control group) were collected. The numbers of circulating CD34+/KDR+ cells were determined with flow cytometry in the two groups. Cell proliferation, tube formation, nitric oxygen (NO) and vascular endothelial growth factor (VEGF) were assayed. RESULTS the numbers of CD34+/KDR+ cells were lower in the AF group than the control group (20.01 ± 12.66 /105 vs 77.93 ± 58.93 /105,p = 0.022). Colony formation unit (CFU) of EPCs were decreased in AF group compared to the control group(1.76 ± 0.59 CFU vs 3.45 ± 0.82 CFU, p = 0.0000). The AF group had lower cell proliferation ability than control group(0.401 ± 0.113 A vs 0.558 ± 0.130 A, p = 0.004). Tube formation ability was decreased in AF patients compared to controls(434.30 ± 96.22μm/mm2 vs 568.09 ± 196.17μm/mm2,p = 0.041). AF patients had lower VEGF secretion than controls (27.35 ± 9.93 ng/L vs 41.86 ± 7.31 ng/L,p = 0.001),they also had lower NO secretion than controls(16.55 ± 6.92μmol/l vs 23.65 ± 5.48,p = 0.012). CONCLUSIONS proliferation, tube formation and paracrine of EPCs were reduced in patients with permanent AF.
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Affiliation(s)
- Qiang Tan
- a Department of Cardiology , Qinhuangdao First Hospital, Hebei Medical University , Qinhuangdao , Hebei Province , China
| | - Shuangyue Zhang
- a Department of Cardiology , Qinhuangdao First Hospital, Hebei Medical University , Qinhuangdao , Hebei Province , China
| | - Ximing Qi
- a Department of Cardiology , Qinhuangdao First Hospital, Hebei Medical University , Qinhuangdao , Hebei Province , China
| | - Xiaoyi Zou
- a Department of Cardiology , Qinhuangdao First Hospital, Hebei Medical University , Qinhuangdao , Hebei Province , China
| | - Qiang Sun
- a Department of Cardiology , Qinhuangdao First Hospital, Hebei Medical University , Qinhuangdao , Hebei Province , China
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Chen Y, Zeng J, Zhang R, Zeng L, Li Y, Wei H, Yang Q. Effect of Interleukin-27 Genetic Variants on Atrial Fibrillation Susceptibility. Genet Test Mol Biomarkers 2017; 21:97-101. [PMID: 28055231 DOI: 10.1089/gtmb.2016.0219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM Atrial fibrillation (AF) is the most common cardiac arrhythmia. No data are available on the association between the polymorphisms of interleukin-27 (IL-27) and AF in the Chinese Han population. This study was performed to determine if polymorphisms within the IL-27 gene are involved in the AF susceptibility. METHODS Two hundred seventy AF patients and 303 healthy individuals were examined for two IL-27 gene polymorphisms (rs153109 and rs17855750) by polymerase chain reaction-restriction fragment length polymorphism methodology. RESULTS An association between the IL-27 single nucleotide polymorphism (SNP) rs153109 and AF was found in Chinese Han population. The G allele and GG genotype of rs153109 were associated with increased AF risk (odds ratio [OR]: 1.35, 95% confidence intervals [CI] = 1.06-1.71, p = 0.02 and OR: 1.66, 95% CI = 1.03-2.65, p = 0.03 in the recessive genetic model, respectively). The significance of the association between the GG genotype and AF risk did not survive a Bonferroni's correction. Similarly, no significant differences in the allele and genotype frequencies of the rs17855750 SNP was observed between the AF patients and controls. CONCLUSIONS Our findings indicated that the IL-27 genetic polymorphisms may be associated with susceptibility of AF in Chinese Han population.
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Affiliation(s)
- Yu Chen
- 1 Department of Cardiology, Hospital of The University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital , Chengdu, China
| | - Jianhui Zeng
- 2 Department of Cardiology, The Affiliated Hospital of North Sichuan Medical College , Nanchong, China
| | - Rui Zhang
- 3 Department of Cardiovascular Surgery, The Seventh People's Hospital of Chengdu , Chengdu, China .,4 Department of Cardiovascular Surgery, West China Hospital of Sichuan University , Chengdu, China
| | - Linjun Zeng
- 5 Department of Cardiology, West China Hospital of Sichuan University , Chengdu, China
| | - Yajiao Li
- 5 Department of Cardiology, West China Hospital of Sichuan University , Chengdu, China
| | - Hong Wei
- 6 Department of Ophthalmology, West China Hospital of Sichuan University , Chengdu, China
| | - Qing Yang
- 5 Department of Cardiology, West China Hospital of Sichuan University , Chengdu, China
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Significance and clinical characteristics of atrial fibrillation post epicardial access. J Interv Card Electrophysiol 2016; 48:141-146. [DOI: 10.1007/s10840-016-0215-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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The Predictive Role of Inflammatory Biomarkers in Atrial Fibrillation as Seen through Neutrophil-Lymphocyte Ratio Mirror. J Biomark 2016; 2016:8160393. [PMID: 27446629 PMCID: PMC4947500 DOI: 10.1155/2016/8160393] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 12/25/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and is responsible for significant disease burden worldwide. Current evidence has suggested that systemic inflammatory response plays a crucial role in the initiation, maintenance, and progression of AF. So, recent efforts have been directed in search of measurable inflammatory biomarkers as additional tools in severity and prognosis assessment of AF. A simple, and easily obtainable, inflammatory marker is the neutrophil-lymphocyte ratio (NLR), which has shown good performance in preliminary studies as a potential prognostic biomarker in patients with AF. In this work, we performed a thorough review of clinical studies that evaluated the role of C-reactive protein (CRP), interleukin-6 (IL-6), and NLR as predictors of outcomes in AF. We gave a particular emphasis on the NLR because it is a simpler, widely available, and inexpensive biomarker.
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Monrad M, Sajadieh A, Christensen JS, Ketzel M, Raaschou-Nielsen O, Tjønneland A, Overvad K, Loft S, Sørensen M. Residential exposure to traffic noise and risk of incident atrial fibrillation: A cohort study. ENVIRONMENT INTERNATIONAL 2016; 92-93:457-63. [PMID: 27164554 DOI: 10.1016/j.envint.2016.04.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/06/2016] [Accepted: 04/24/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Studies have found long-term exposure to traffic noise to be associated with higher risk for hypertension, ischemic heart disease and stroke. We aimed to investigate the novel hypothesis that traffic noise increases the risk of atrial fibrillation (A-fib). METHODS In a population-based cohort of 57,053 people aged 50-64years at enrolment in 1993-1997, we identified 2692 cases of first-ever hospital admission of A-fib from enrolment to end of follow-up in 2011 using a nationwide registry. The mean follow-up time was 14.7years. Present and historical residential addresses were identified for all cohort members from 1987 to 2011. For all addresses, exposure to road traffic and railway noise was estimated using the Nordic prediction method and exposure to air pollution was estimated using a validated dispersion model. We used Cox proportional hazard model for the analyses with adjustment for lifestyle, socioeconomic position and air pollution. RESULTS A 10dB higher 5-year time-weighted mean exposure to road traffic noise was associated with a 6% higher risk of A-fib (incidence rate ratio (IRR): 1.06; 95% confidence interval (95% CI): 1.00-1.12) in models adjusted for factors related to lifestyle and socioeconomic position. The association followed a monotonic exposure-response relationship. In analyses with adjustment for air pollution, NOx or NO2, there were no statistically significant associations between exposure to road traffic noise and risk of A-fib; IRR: 1.04; (95% CI: 0.96-1.11) and IRR: 1.01; (95% CI: 0.94-1.09), respectively. Exposure to railway noise was not associated with A-fib. CONCLUSION Exposure to residential road traffic noise may be associated with higher risk of A-fib, though associations were difficult to separate from exposure to air pollution.
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Affiliation(s)
- Maria Monrad
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg, Denmark
| | | | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
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Xu B, Peng F, Tang W, Du Y, Guo H. Short-term Antiarrhythmic Drugs After Catheter Ablation for Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials. Ann Pharmacother 2016; 50:697-705. [PMID: 27317015 DOI: 10.1177/1060028016653140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The incidence of recurrent arrhythmia after catheter ablation (CA) for atrial fibrillation (AF) is unacceptable. Short-term antiarrhythmic drug (AAD) treatment following CA was presumed to be effective in reducing recurrent arrhythmia. OBJECTIVE To fully evaluate the efficacy of short-term use of AADs following CA for AF in preventing recurrence of atrial tachyarrhythmias. METHODS PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched up until May 1, 2016. We enrolled randomized controlled trials (RCTs) that evaluated the efficacy of short-term use of AADs following CA for AF in preventing early and/or late recurrence of atrial tachyarrhythmias. The statistical analyses were performed using Review Manager Version 5.3. RESULTS Six RCTs were included in this analysis, involving a total of 2764 patients. The frequency of early recurrence of atrial tachyarrhythmias was 39.5% in the AAD group (556 of 1407) and 47.2% (640 of 1357) in the control group. The pooled risk ratio of the AAD group to the control group was 0.78 (95% CI = 0.62-0.98). Regarding late recurrence of AF (LRAF), the incidence in the AAD group and the control group was 32.5% (420 of 1293) and 34.6% (450 of 1300), respectively. No significant difference was identified between the 2 groups (relative risk = 0.94, 95% CI = 0.85-1.05). CONCLUSIONS Short-term use of AADs following CA for AF reduced the incidence of early recurrent atrial tachyarrhythmias but did not prevent LRAF.
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Affiliation(s)
- Buyun Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Fang Peng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Weiliang Tang
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Ye Du
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hangyuan Guo
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
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Scott LR. Antiarrhythmic drugs after ablation for atrial fibrillation: the hope, the hype, and the reality. Eur Heart J 2016; 37:619-20. [PMID: 26450010 DOI: 10.1093/eurheartj/ehv536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luis R Scott
- Mayo Clinic College of Medicine, Phoenix, AZ, USA
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