[The etiology and associated risk factors in a sample of 300 patients with atrial fibrillation]

Inflammatory myofibroblastic tumor of the heart in an older woman with paroxysmal atrial fibrillation: a case report and review of the literature

Inflammatory myofibroblastic tumors (IMTs) of the heart are rarely observed in the eldly. We report a case involving an elderly woman with an IMT situated on the right atrial wall. The tumor was fully excised. The patient had a smooth recovery post-surgery and remained free of recurrence for three years.

Association between serum albumin levels and paroxysmal atrial fibrillation by gender in a Chinese population: a case–control study

Background

Hypoalbuminemia is linked to the emergence of cardiovascular events. However, there is an unclear association between serum albumin (ALB) and gender in paroxysmal AF patients. This retrospective study aimed to explore the association between ALB levels and paroxysmal AF by gender in a Chinese population.

Methods

This study included patients with paroxysmal AF who were hospitalized consecutively in China from January 2019 to September 2021. Controls with sinus rhythm and without paroxysmal AF were matched (2:1) to cases by gender and age. Pearson correlation analysis was used to study the correlation between ALB and blood lipid profiles, multivariate regression models were performed to investigate the association between ALB and paroxysmal AF.

Results

There were 305 patients with paroxysmal AF and 610 patients with controls included in this study. Low ALB in male with AF patients were significantly associated with paroxysmal AF (OR = 0.889, 95% CI 0.832–0.950). ALB was positively correlated with triglyceride (TG) (r = 0.212, p < 0.001), total cholesterol (TC) (r = 0.381, p = 0.002), low-density lipoprotein cholesterol (LDL-C) (r = 0.263, p < 0.001), and high-density lipoprotein cholesterol (HDL-C) (r = 0.329, p < 0.001).

Conclusion

Low ALB in male patients is significantly associated with paroxysmal AF in a Chinese population. Monitoring for hypoalbuminemia in men might help reduce the incidence of paroxysmal AF.

Clinical Overview of Obesity and Diabetes Mellitus as Risk Factors for Atrial Fibrillation and Sudden Cardiac Death

The epidemics of obesity and diabetes mellitus are associated with an increased incidence of both atrial fibrillation (AF), the most common sustained arrhythmia in adults, and sudden cardiac death (SCD). Obesity and DM are known to have adverse effects on cardiac structure and function. The pathologic mechanisms are thought to involve cardiac tissue remodeling, metabolic dysregulation, inflammation, and oxidative stress. Clinical data suggest that left atrial size, epicardial fat pad thickness, and other modifiable risk factors such as hypertension, glycemic control, and obstructive sleep apnea may mediate the association with AF. Data from human atrial tissue biopsies demonstrate alterations in atrial lipid content and evidence of mitochondrial dysfunction. With respect to ventricular arrhythmias, abnormalities such as long QT syndrome, frequent premature ventricular contractions, and left ventricular hypertrophy with diastolic dysfunction are commonly observed in obese and diabetic humans. The increased risk of SCD in this population may also be related to excessive cardiac lipid deposition and insulin resistance. While nutritional interventions have had limited success, perhaps due to poor long-term compliance, weight loss and improved cardiorespiratory fitness may reduce the frequency and severity of AF.

Predictors of incident atrial fibrillation and influence of medications: a retrospective case-control study

BACKGROUND

Atrial fibrillation (AF) is a common condition, associated with raised mortality and risk of major morbidity, and is predicted to increase due to an aging population.

AIM

To update earlier research of AF predictors using UK data.

DESIGN AND SETTING

Case-control analysis of adults aged 18 years and older with a diagnosis of AF in practices registered with the General Practice Research Database (GPRD) in the UK.

METHOD

Using the GPRD, a case.control analysis was performed using logistic regression to compare 55,412 incident AF cases to 216,400 controls, for medical history and prior use of drugs. The association between time since start of diagnosis or drug use and AF risk was summarised using Spline regression.

RESULTS

The following were confirmed as risk factors for AF: heart failure (risk ratio [RR] 2.91 [95% CI = 2.59 to 3.27]); ischaemic heart disease (IHD) (RR 2.00 [95% CI = 1.78 to 2.24]); hypertension (RR 2.60 [95% CI = 2.32 to 2.92]); hyperthyroidism (RR 1.56 [95% CI = 1.39 to 1.75]); being a heavy drinker (RR 1.43 [95% CI = 1.27 to 1.60]); cerebrovascular accident (RR 1.48 [95% CI = 1.32 to 1.66]); and obesity (body mass index ≥30 kg/m(2) RR 1.29 [95% CI = 1.15 to 1.45]). Current use of oral glucocorticoids (RR 1.62 [95% CI = 1.44 to 1.82]) and of beta-2 agonists (RR 1.30 [95% CI = 1.16 to 1.46]) were identified as significant risk factors, and statins (RR 0.82 [95% CI = 0.73 to 0.92]) as a significant protective factor. No effect was found for current use of bisphosphonates (RR 0.95 [95% CI = 0.85 to 1.07]), renin.angiotensin.aldosterone system (RAAS) agents (RR 1.04 [95% CI = 0.93 to 1.17]), or xanthine derivatives (RR 1.09 [95% CI = 0.97 to 1.22]). Spline regression analysis found the effect of heart failure, IHD, use of oral glucocorticoids, and use of statins on the likelihood of developing AF was sustained over a number of years.

CONCLUSION

These findings update the risk factors that are associated with AF, and confirm the protective properties of statins and the risks of beta-2 agonists in developing AF, but not the supposed protective qualities of glucocorticoids and RAAS agents.

[Incidence and characteristics of clinical and sub-clinic hyperthyroidism]

OBJECTIVES

Estimate the incidence of hyperthyroidism in the region of Lleida and compare patients with clinic and subclinic hyperthyroidism.

DESIGN

Descriptive retrospective.

LOCALIZATION

City of Lleida and the towns of the provinces of Lleida and Huesca.

PATIENTS

190 people diagnosed of hyperthyroidism detected from a sample of 1885 patients with different pathologies, belonging to first visits to de Service of Endocrinology of the Hospital Arnau de Vilanova, during the period from 1999 to 2000.

MAIN MEASUREMENTS

The following clinic and demographical variables related to the thyroid pathology were recorded: TSH, T(4), T(3), anti-Tg antibodies, anti-TPO antibodies, age, gender, consumption of salt with iodine and the incidence tax of hyperthyroidism.

RESULTS

The incidence tax of hyperthyroidism in the province of Lleida was 46.2 ×10(5) people/year (95% CI, 33.5-61.0). For the 190 patients, the 85% (95% CI, 79.4-90) of them were women; the 38% (95% CI, 31%-45.2%) and the 62% (95% CI, 54.8-69) were diagnosed of clinic and subclinic hyperthyroidism respectively. The subclinic profile was characteristically for had a superior mean of age (P<.003), double of TSH level (P<.03) and half of T(4) level of (P<.001).

CONCLUSION

Our study shows a high incidence of hyperthyroidism, and a difference of the two hyperthyroidisms. The detection of this pathology by professionals of primary care can help to improve their therapeutic control.

[Pitfalls in left atrial reduction. Superior neo-cava with pericardium]

Left atrial reduction is a surgical technique that has been proposed for eliminating chronic atrial fibrillation associated with mitral valve disease. A potential complication of the technique is the unnoticed rotation of the heart while the left atrium is anastomosed. Such an event makes it impossible to reconstruct the superior vena cava, leading to superior vena cava syndrome due to the rotation of that vessel. We report our experience with a case of left atrial reduction and rotation of the superior vena cava while it was being anastomosed. The complication was successfully resolved by placing an autologous pericardial tube between the two ends of the superior vena cava.

[Clinical profile of idiopathic paroxsysmal atrial fibrillation. (FAP registry)]

OBJECTIVE

To assess the relative frequency and clinical profile of paroxysmal lone atrial fibrillation in comparison with that of secondary atrial fibrillation.

PATIENTS AND METHOD

A prospective multicenter study (FAP Register) was designed to include 300 patients with symptomatic paroxysmal atrial fibrillation admitted to the emergency ward of 11 secondary hospitals of Catalonia.

RESULTS

Lone atrial fibrillation was found in 67 patients (22.3%) while systemic hypertension was present in 33.7% of the cases; mitral or aortic valvular disease in 12% and coronary heart disease in 9.7%. As compared with patients with evidence of cardiac or systemic etiology, patients with isolated paroxysmal atrial fibrillation were younger (mean age of 55 vs 65 years of age; p = 0.0001), dyspnea was less frequent (p = 0.007); had a tendency to appear at night; left atrial size was smaller (p < 0.001) and response to treatment of sinusal rhythm was not different.

CONCLUSIONS

Relative frequency of paroxysmal lone atrial fibrillation was only second to hypertension, which appears to be the most important pathogenic factor in our population. The clinical profile shows similarities in secondary fibrillation