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Mohamed MS, Hashem A, Khalouf A, Osama M, Pendela VS, Rai D, Aronow WS, Balmer-Swain M. Delayed vs early cardioversion in patients with paroxysmal atrial fibrillation: a population-based study (2015-2020). Future Cardiol 2023; 19:441-452. [PMID: 37650496 DOI: 10.2217/fca-2023-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Aim: There is limited data on clinical outcomes of delayed cardioversion (DCV) compared with early cardioversion (ECV) in paroxysmal atrial fibrillation (AF) patients. Methods: We utilized data from National Inpatient Sample (2015-2020) and propensity-score matched analysis to determine adjusted odds ratio (aOR) of major clinical outcomes, including 17,879 AF cases: 9725 and 8154 underwent ECV and DCV, respectively. Results: Compared with ECV, DCV was associated with higher odds of acute heart failure (AHF; aOR 1.79 [1.67-1.92]; p < 0.01), median length of stay (4 vs 2 days; p < 0.01) and cost of hospitalization ($33,410 vs $21,738; p < 0.01) with no significant difference in inpatient mortality and other cardiovascular and neurological outcomes. Conclusion: Compared with ECV, DCV was associated with more AHF and resource utilization.
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Affiliation(s)
| | - Anas Hashem
- Department of Medicine, Rochester General Hospital, Rochester, NY 14621, USA
| | - Amani Khalouf
- Department of Medicine, Rochester General Hospital, Rochester, NY 14621, USA
| | - Muhammad Osama
- Department of Medicine, Rochester General Hospital, Rochester, NY 14621, USA
| | | | - Devesh Rai
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Mallory Balmer-Swain
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
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2
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Tang EWL, Yip BHK, Yu CP, Wong SYS, Lee EKP. Sensitivity and specificity of automated blood pressure devices to detect atrial fibrillation: A systematic review and meta-analysis of diagnostic accuracy. Front Cardiovasc Med 2022; 9:956542. [PMID: 36035905 PMCID: PMC9411860 DOI: 10.3389/fcvm.2022.956542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Atrial fibrillation (AF) is a prevalent and preventable cause of stroke and mortality. Aim This systematic review and meta-analysis aimed to investigate the sensitivity and specificity of office and out-of-office automated blood pressure (BP) devices to detect AF. Methods Diagnostic studies, extracted from databases such as Ovid Medline and Embase, on AF detection by BP device(s), electrocardiography, and reported sensitivity and specificity, were included. Screening of abstracts and full texts, data extraction, and quality assessment were conducted independently by two investigators using Covidence software. The sensitivity and specificity of the BP devices were pooled using a random-effects model. Results Sixteen studies including 10,158 participants were included. Only a few studies were conducted in primary care (n = 3) or with a low risk of bias (n = 5). Office BP devices, which utilised different algorithms to detect AF, had a sensitivity and specificity of 96.2 and 94%, respectively. Specificity was reduced when only one positive result was considered among consecutive BP measurements. Only a few studies (n = 3) investigated out-of-office BP. Only one study (n = 100) suggested the use of ≥79 and ≥26% of positive readings on 24-h ambulatory BP measurements to detect AF and paroxysmal AF, respectively. Conclusions Office BP devices can be used clinically to screen for AF in high-risk populations. Clinical trials are needed to determine the effect of AF screening using office BP devices in reducing stroke risk and mortality. Further studies are also required to guide out-of-office use of BP devices for detecting paroxysmal AF or AF. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022319541, PROSPERO CRD42022319541.
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Affiliation(s)
- Edmond W. L. Tang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Benjamin H. K. Yip
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chun-Pong Yu
- Li Ping Medical Library, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Eric K. P. Lee
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Eric K. P. Lee
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Ivanov V, Smereka Y, Rasputin V, Dmytriiev K. Homocysteine and atrial fibrillation: novel evidences and insights. Monaldi Arch Chest Dis 2022; 93. [PMID: 35443572 DOI: 10.4081/monaldi.2022.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/09/2022] [Indexed: 12/27/2022] Open
Abstract
Atrial fibrillation (AF) is one of the most prevalent rhythm disorders worldwide, with around 37.574 million cases around the globe (0.51 % global population). Different studies showed a high informative value of different biomarkers, including such related to the systemic inflammation, biomechanical stress and fibrosis. In this review article we aimed to study only the relation of homocysteine to the AF development. Homocysteine is a sulfur-containing amino acid, that is produced in the process of methionine metabolism. Which is a non-canonical amino acid, that is derived from the food proteins. From the scientific point of view there is a relation between hyperhomocysteinemia and myocardial fibrosis, but these mechanisms are complicated and not sufficiently studied. Homocysteine regulates activity of the ion channels through their redox state. Elevated homocysteine level can condition electrical remodeling of the cardiomyocytes through the increase of sodium current and change in the function of rapid sodium channels, increase of inwards potassium current and decrease in amount of rapid potassium channels. High homocysteine concentration also leads to the shortening of the action potential, loss of the rate adaptation of the action potential and persistent circulation of the re-entry waves. In a series of experimental studies on mice there was an association found between the homocysteine level and activity of vascular inflammation. Elevation of homocysteine level is an independent factor of the thromboembolic events and AF relapses. Population studies showed, that homocysteine is an independent risk factor for AF. So, homocysteine is an interesting target for up-stream therapy.
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Affiliation(s)
- Valeriy Ivanov
- Vinnytsia National Pirogov Memorial Medical University, Vinnytsia.
| | - Yuliia Smereka
- Vinnytsia Regional Clinical Center of Cardiovascular Pathology, Vinnytsia.
| | - Volodymyr Rasputin
- Vinnytsia Regional Clinical Center of Cardiovascular Pathology, Vinnytsia.
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Koniari I, Papageorgiou A, Artopoulou E, Velissaris D, Mplani V, Kounis N, Hahalis G, Tsigkas G. Prevalence and Impact of Atrial Fibrillation on Prognosis in Takotsubo Cardiomyopathy Patients. Angiology 2022; 73:800-808. [PMID: 35236144 DOI: 10.1177/00033197221079331] [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] [Indexed: 11/17/2022]
Abstract
The purpose of this review is to describe the impact of atrial fibrillation (AF) on the cardiovascular outcomes and prognosis in patients with Takotsubo Cardiomyopathy (TTC). The pathophysiological basis of TTC is set on the release of catecholamines, occurring post an emotional or stressful event. The cardiovascular system of patients with TTC is affected by the high concentrations of catecholamines, creating the ideal background for the development of AF: inflammation, myocardial stress, and excessive sympathetic activity. AF is considered to be the most frequent arrhythmia in TTC patients and is associated with higher rates of cardiovascular and all-cause mortality. AF is also linked with a worse prognosis concerning the hemodynamic status, cardiac fibrosis, lethal arrhythmias, thromboembolic events, and adverse heart failure associated outcomes. The early diagnosis of AF in these patients plays significant role in the prevention of adverse events, the reversibility of left ventricular function, and the restoration of sinus rhythm.
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Affiliation(s)
- Ioanna Koniari
- Department of Cardiology, NHS Foundation Trust, University Hospital of South Manchester, Manchester, UK
| | | | - Eleni Artopoulou
- Department of Internal Medicine, 37795University Hospital of Patras, Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, 37795University Hospital of Patras, Patras, Greece
| | - Virginia Mplani
- Department of Cardiology, 37795University Hospital of Patras, Patras, Greece
| | - Nicholas Kounis
- Department of Cardiology, 37795University Hospital of Patras, Patras, Greece
| | - George Hahalis
- Department of Cardiology, 37795University Hospital of Patras, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, 37795University Hospital of Patras, Patras, Greece
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Benjamin MM, Moulki N, Waqar A, Ravipati H, Schoenecker N, Wilber D, Kinno M, Rabbat M, Sanagala T, Syed MA. Association of left atrial strain by cardiovascular magnetic resonance with recurrence of atrial fibrillation following catheter ablation. J Cardiovasc Magn Reson 2022; 24:3. [PMID: 34980165 PMCID: PMC8722067 DOI: 10.1186/s12968-021-00831-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a progressive condition, which is characterized by inflammation/fibrosis of left atrial (LA) wall, an increase in the LA size/volumes, and decrease in LA function. We sought to investigate the relationship of anatomical and functional parameters obtained by cardiovascular magnetic resonance (CMR), with AF recurrence in paroxysmal AF (pAF) patients after catheter ablation. METHODS We studied 80 consecutive pAF patients referred for ablation, between January 2014 and December 2019, who underwent pre- and post-ablation CMR while in sinus rhythm. LA volumes were measured using the area-length method and included maximum, minimum, and pre-atrial-contraction volumes. CMR-derived LA reservoir strain (ℇR), conduit strain (ℇCD), and contractile strain (ℇCT) were measured by computer assisted manual planimetry. We used a multivariate logistical regression to estimate the independent predictors of AF recurrence after ablation. RESULTS Mean age was 58.6 ± 9.4 years, 75% men, mean CHA2DS2-VASc score was 1.7, 36% had prior cardioversion and 51% were taking antiarrhythmic drugs. Patients were followed for a median of 4 years (Q1-Q3 = 2.5-6.2 years). Of the 80 patients, 21 (26.3%) patients had AF recurrence after ablation. There were no significant differences between AF recurrence vs. no recurrence groups in age, gender, CHA2DS2-VASc score, or baseline comorbidities. At baseline, patients with AF recurrence compared to without recurrence had lower LV end systolic volume index (32 ± 7 vs 37 ± 11 mL/m2; p = 0.045) and lower ℇCT (7.1 ± 4.6 vs 9.1 ± 3.7; p = 0.05). Post-ablation, patients with AF recurrence had higher LA minimum volume (68 ± 32 vs 55 ± 23; p = 0.05), right atrial volume index (62 ± 20 vs 52 ± 19 mL/m2; p = 0.04) and lower LA active ejection fraction (24 ± 8 vs 29 ± 11; p = 0.05), LA total ejection fraction (39 ± 14 vs 46 ± 12; p = 0.02), LA expansion index (73.6 ± 37.5 vs 94.7 ± 37.1; p = 0.03) and ℇCT (6.2 ± 2.9 vs 7.3 ± 1.7; p = 0.04). Adjusting for clinical variables in the multivariate logistic regression model, post-ablation minimum LA volume (OR 1.09; CI 1.02-1.16), LA expansion index (OR 0.98; CI 0.96-0.99), and baseline ℇR (OR 0.92; CI 0.85-0.99) were independently associated with AF recurrence. CONCLUSION Significant changes in LA volumes and strain parameters occur after AF ablation. CMR derived baseline ℇR, post-ablation minimum LAV, and expansion index are independently associated with AF recurrence.
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Affiliation(s)
- Mina M Benjamin
- Division of Cardiovascular Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Naeem Moulki
- Division of Cardiovascular Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Aneeq Waqar
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Harish Ravipati
- Department of Internal Medicine, MacNeal Hospital, Berwyn, IL, USA
| | - Nancy Schoenecker
- Division of Cardiovascular Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - David Wilber
- Division of Cardiovascular Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Menhel Kinno
- Division of Cardiovascular Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Mark Rabbat
- Division of Cardiovascular Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Thriveni Sanagala
- Division of Cardiovascular Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Mushabbar A Syed
- Division of Cardiovascular Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA.
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Bailey MJ, Soliman EZ, McClure LA, Howard G, Howard VJ, Judd SE, Unverzagt FW, Wadley V, Sachs BC, Hughes TM. Relation of Atrial Fibrillation to Cognitive Decline (from the REasons for Geographic and Racial Differences in Stroke [REGARDS] Study). Am J Cardiol 2021; 148:60-68. [PMID: 33684372 DOI: 10.1016/j.amjcard.2021.02.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 01/24/2023]
Abstract
The association of atrial fibrillation (AF) with cognitive function remains unclear, especially among racially/geographically diverse populations. This analysis included 25,980 black and white adults, aged 48+, from the national REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, free from cognitive impairment and stroke at baseline. Baseline AF was identified by self-reported medical history or electrocardiogram (ECG). Cognitive testing was conducted yearly with the Six Item Screener (SIS) to define impairment and at 2-year intervals to assess decline on: animal naming and letter fluency, Montreal Cognitive Assessment (MoCA), Word List Learning (WLL) and Delayed Recall tasks (WLD). Multivariable regression models estimated the relationships between AF and baseline impairment and time to cognitive impairment. Models were adjusted sequentially for age, sex, race, geographic region, and education, then cardiovascular risk factors and finally incident stroke. AF was present in 2,168 (8.3%) participants at baseline. AF was associated with poorer baseline performance on measures of: semantic fluency (p<0.01); global cognitive performance (MoCA, p<0.01); and WLD (p<0.01). During a mean follow-up of 8.06 years, steeper declines in list learning were observed among participants with AF (p<0.03) which remained significant after adjusting for cardiovascular risk factors (p<0.04) and incident stroke (p<0.03). Effect modification by race, sex and incident stroke on AF and cognitive decline were also detected. In conclusion, AF was associated with poorer baseline cognitive performance across multiple domains and incident cognitive impairment in this bi-racial cohort. Additional adjustment for cardiovascular risk factors attenuated these relations with the exception of learning.
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Affiliation(s)
- Margie J Bailey
- Hypertension & Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elsayed Z Soliman
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University, Winston-Salem, North Carolina
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Winston-Salem, North Carolina
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Winston-Salem, North Carolina
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Winston-Salem, North Carolina
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Winston-Salem, North Carolina
| | - Virginia Wadley
- Department of Medicine, University of Alabama at Birmingham, Winston-Salem, North Carolina
| | - Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Timothy M Hughes
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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7
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Kang Y, Choi HY, Kwon YE, Shin JH, Won EM, Yang KH, Oh HJ, Ryu DR. Clinical outcomes among hemodialysis patients with atrial fibrillation: a Korean nationwide population-based study. Kidney Res Clin Pract 2021; 40:99-108. [PMID: 33789385 PMCID: PMC8041641 DOI: 10.23876/j.krcp.20.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022] Open
Abstract
Background The number of patients requiring dialysis is increasing worldwide, and the atrial fibrillation and atrial flutter (AF) prevalence among hemodialysis (HD) patients is higher than in the general population. There have been no studies of Korean AF patients undergoing HD that investigated how AF affects outcomes, such as all-cause mortality, hospitalization, and stroke events. We conducted a large-scale retrospective cohort study with data from the National Health Insurance System to determine how AF affects these outcomes. Methods In 2013, the Health Insurance Review and Assessment service, a Korean national health insurance scheme, collected data from 21,839 HD patients to evaluate the adequacy of dialysis centers. All-cause mortality, hospitalization, and stroke events were compared between patients with and without AF. Sub-analyses compared these outcomes between AF patients receiving warfarin and those not receiving warfarin. Results Cox regression analysis found that AF was a significant risk factor for death from any cause (hazard ratio [HR], 1.356; 95% confidence interval [CI], 1.222–1.506; p < 0.001), hospitalization (HR, 1.323; 95% CI, 1.225–1.430; p < 0.001), and hemorrhagic stroke (HR, 1.500; 95% CI, 1.050–2.141; p = 0.026). AF was not significantly associated with an increased risk of ischemic stroke. The use of warfarin was significantly associated with hemorrhagic stroke incidence (HR, 1.593; 95% CI, 1.075–2.360; p = 0.020), while there was no significant correlation between warfarin treatment and all-cause mortality, hospitalization, and ischemic stroke. Conclusion This cohort study of Korean dialysis patients showed that AF was a risk factor for multiple outcomes among HD patients.
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Affiliation(s)
- Yeunmi Kang
- Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Hyung Yun Choi
- The Korean Society of Nephrology, Seoul, Republic of Korea
| | - Young Eun Kwon
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Ji Hyeon Shin
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Eun Mi Won
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Ki Hwa Yang
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Hyung Jung Oh
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.,Research Institute for Human Health Information, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Dong-Ryeol Ryu
- Research Institute for Human Health Information, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
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Age threshold for anticoagulation in patients with atrial fibrillation: A Swedish nationwide observational study. Int J Cardiol 2020; 326:92-97. [PMID: 33152417 DOI: 10.1016/j.ijcard.2020.10.075] [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: 05/12/2020] [Revised: 10/12/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is controversy as to whether patients with atrial fibrillation (AF) and perceived low risk of cerebral infarction should be treated with anticoagulants, especially at what age a cut-off treatment might be indicated. METHOD We performed a retrospective, nationwide cohort study based on the Swedish National Patient Register and the Prescribed Drugs Register. Patients with a diagnosis of AF between July 1, 2005, and December 31, 2014, were included and divided into age categories (<55, 55-59, 60-64 and 65-74 years) and CHA2DS2-VA score of 0 and 1. Incidence rates (IR) of cerebral infarction and cerebral bleeding were calculated. Associations between outcomes from anticoagulant therapy and no therapy were calculated with Cox regression and given as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS The analyzed cohort consisted of 294,470 patients. All age categories older than 55 years on anticoagulants had lower IR and HR for cerebral infarction compared to patients off anticoagulants, from HR 0.72, 95% CI (0.54-0.96) for patients 55-59 years with 0 points according to the CHA2DS2-VA score, to HR 0.37, 95% CI (0.33-0.42) for patients 65-74 years with 1 point. Anticoagulant therapy was associated to an increased risk of cerebral bleeding in three of seven categories, <55 years with 0 point, 55-59 years with 1 point, and 65-74 years with 1 point. CONCLUSION Anticoagulant therapy in patients with AF and age 55 years and older may be considered even if the patient has no other known risk factors for cerebral infarction.
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Lernfelt G, Mandalenakis Z, Hornestam B, Lernfelt B, Rosengren A, Sundh V, Hansson PO. Atrial fibrillation in the elderly general population: a 30-year follow-up from 70 to 100 years of age. SCAND CARDIOVASC J 2020; 54:232-238. [PMID: 32079431 DOI: 10.1080/14017431.2020.1729399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives. There is limited knowledge of atrial fibrillation (AF) incidence among the very old. Data from longitudinal cohort studies may give us a better insight. The aim of the study was to investigate the incidence rate and prevalence of AF, as well as the impact of AF on mortality, in the general population, from 70 to 100 years of age. Design. This was a population-based prospective cohort study where three representative samples of 70-year-old men and women (n = 2,629) from the Gerontological and Geriatric Populations Studies in Gothenburg (H-70) were included between 1971 and 1982. The participants were examined at age 70 years and were re-examined repeatedly until 100 years of age. AF was diagnosed according to a 12-lead electrocardiogram (ECG) recording at baseline and follow-up examinations, from the Swedish National Patient Register (NPR), or from the Cause of Death Register. Results. The cumulative incidence of AF from 70 to 100 years of age was 65.6% for men and 52.8% for women. Mortality was significantly higher in participants with AF compared with those without, rate ratio (RR) 1.92 (95% CI 1.73-2.14). In a subgroup analysis comprising only participants with AF diagnosed by ECG at screening, the RR for death was 1.29 (95% C.I: 1.03-1.63). Conclusions. Among persons surviving to age 70, the cumulative incidence of AF was over 50% during follow-up. Mortality rate was twice as high in participants with AF compared to participants without AF. Among participants with AF first recorded at a screening examination, the increased risk was only 29%.
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Affiliation(s)
- Gustaf Lernfelt
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Hornestam
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bodil Lernfelt
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Valter Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Per-Olof Hansson
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Johnkoski J, Miles B, Sudbury A, Osman M, Munir MB, Balla S, Benjamin MM. Safety and long-term efficacy of thoracoscopic Epicardial ablation in patients with paroxysmal atrial fibrillation: a retrospective study. J Cardiothorac Surg 2019; 14:188. [PMID: 31694695 PMCID: PMC6836534 DOI: 10.1186/s13019-019-1018-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF). Methods This was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia. Results Fifty-five patients (78% males, mean age = 61.6 years) qualified for the study. The average duration in AF was 3.64 +/− 3.4 years, mean CHA2DS2-VASc Score was 2.0 +/− 1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% (n = 49/55), 85.5% (n = 47/55) and 76.9% (n = 40/52) at 6, 12 and 24 months, respectively. In the multivariate cox-proportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24 months, respectively. Conclusion In this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.
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Affiliation(s)
- John Johnkoski
- Department of Cardiothoracic Surgery, Aspirus Wausau Hospital, 2400 Pine Ridge Blvd, Wausau, WI, 54401, USA
| | - Bryan Miles
- School of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA
| | - Anna Sudbury
- School of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA
| | - Mohammed Osman
- Department of Internal Medicine (Division of Cardiovascular Medicine), West Virginia University Hospitals, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Muhammad Bilal Munir
- Department of Internal Medicine (Division of Cardiovascular Medicine), West Virginia University Hospitals, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Sudarshan Balla
- Department of Internal Medicine (Division of Cardiovascular Medicine), West Virginia University Hospitals, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Mina M Benjamin
- Department of Internal Medicine (Division of Cardiovascular Medicine), West Virginia University Hospitals, 1 Medical Center Dr, Morgantown, WV, 26506, USA.
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Medeiros de Vasconcelos JT. Reflections on CABANA Trial (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial). JOURNAL OF CARDIAC ARRHYTHMIAS 2019. [DOI: 10.24207/jca.v32i2.989_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Atrial fibrillation has been consolidated in recent decades as a serious public health problem, considering its notorious increase in prevalence with aging combined with increased population survival. Data from the Framingham Heart Study indicate that, even in an optimal scenario of absence of classic risk factors for its occurrences, such as smoking, alcohol abuse, obesity, hypertension, diabetes, and heart disease, about 10% of individuals aged 80 or over and about 25% of those aged 90 or over will have atrial fibrillation. These rates substantially increase when added to single or combined risk factors. Despite its already well-known association with the occurrence of thromboembolic stroke, the presence of atrial fibrillation has been identified as an independent mortality risk factor in large population studies.
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Medeiros de Vasconcelos JT. Reflexões sobre o estudo CABANA (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial). JOURNAL OF CARDIAC ARRHYTHMIAS 2019. [DOI: 10.24207/jca.v32i2.989_pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A fibrilação atrial se consolidou nas últimas décadas como um grave problema de saúde pública, considerando o seu notório aumento de prevalência com o envelhecimento aliado ao aumento da sobrevida da população. Dados do Framingham Heart Study indicam que, mesmo em um cenário ótimo de ausência dos clássicos fatores de risco para sua ocorrência, como tabagismo, consumo abusivo de álcool, obesidade, hipertensão, diabetes e cardiopatia, cerca de 10% dos indivíduos com idade igual ou superior a 80 anos e algo em torno de 25% daqueles com idade igual ou superior a 90 anos terão fibrilação atrial1. Essas taxas aumentam substancialmente quando se agregam a fatores de risco isolados ou combinados. A despeito da sua já bem conhecida relação com a ocorrência do acidente vascular encefálico trombo-embólico2, a presença de fibrilação atrial tem sido identificada como um fator de risco de mortalidade independente em grandes estudos populacionais3.
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13
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Persistent atrial fibrillation: A systematic review and meta-analysis of invasive strategies. Int J Cardiol 2019; 278:137-143. [DOI: 10.1016/j.ijcard.2018.11.127] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/30/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
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14
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Higuchi S, Kabeya Y, Matsushita K, Tachibana K, Kawachi R, Takei H, Suzuki Y, Abe N, Imanishi Y, Moriyama K, Yorozu T, Saito K, Sugiyama M, Kondo H, Yoshino H. The study protocol for PREDICT AF RECURRENCE: a PRospEctive cohort stuDy of surveIllanCe for perioperaTive Atrial Fibrillation RECURRENCE in major non-cardiac surgery for malignancy. BMC Cardiovasc Disord 2018; 18:127. [PMID: 29940875 PMCID: PMC6019832 DOI: 10.1186/s12872-018-0862-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/11/2018] [Indexed: 12/24/2022] Open
Abstract
Background A previous retrospective cohort study established the relationship between perioperative atrial fibrillation (POAF) and subsequent mortality and stroke. However, the details regarding the cause of death and etiology of stroke remain unclear. Methods The prospective cohort study of surveillance for perioperative atrial fibrillation recurrence in major non-cardiac surgery for malignancy (PREDICT AF RECURRENCE) registry is an ongoing prospective cohort study to elucidate the long-term recurrence rate and the clinical impact of new-onset POAF in the setting of head and neck, non-cardiac thoracic, and abdominal surgery for malignancy. In this study, cardiologists collaborate with a surgical team during the perioperative period, carefully observe the electrocardiogram (ECG) monitor, and treat arrhythmia as required. Furthermore, patients who develop new-onset POAF are followed up using a long-term Holter ECG monitor, SPIDER FLASH-t AFib®, to assess POAF recurrence. Discussion Even if patients with malignancy survive by overcoming the disease, they may die from any preventable cardiovascular diseases. In particular, those with POAF may develop cardiogenic stroke in the future. Because details of the natural history of patients with POAF remain unclear, investigating the need to continue anticoagulation therapy for such patients is necessary. This study will provide essential information on the recurrence rate of POAF and new insights into the prediction and treatment of POAF. Trial registration University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR): UMIN000016146; Data of Registration: January 7, 2015. Electronic supplementary material The online version of this article (10.1186/s12872-018-0862-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Satoshi Higuchi
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan. .,Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
| | - Yusuke Kabeya
- Division of General Internal Medicine, Department of Internal Medicine, Tokai University, Isehara, Kanagawa, Japan.,Department of Home Care Medicine, Saiyu Clinic, Saitama, Japan
| | - Kenichi Matsushita
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
| | - Keisei Tachibana
- Department of General Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Riken Kawachi
- Department of General Thoracic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hidefumi Takei
- Department of General Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology, Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Kiyoshi Moriyama
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Koichiro Saito
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Masanori Sugiyama
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Haruhiko Kondo
- Department of General Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Yoshino
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
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15
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Williams BA, Honushefsky AM, Berger PB. Temporal Trends in the Incidence, Prevalence, and Survival of Patients With Atrial Fibrillation From 2004 to 2016. Am J Cardiol 2017; 120:1961-1965. [PMID: 29033050 DOI: 10.1016/j.amjcard.2017.08.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/28/2022]
Abstract
A growing epidemic of atrial fibrillation (AF) has been predicted, although no data on the AF burden has been reported for the United States since 2010. The objectives of this study were to (1) describe trends in AF incidence, prevalence, and postdiagnosis survival from 2004 to 2016 within a large health-care system and (2) extrapolate observed prevalence rates to the entire US population to estimate the national AF burden. This retrospective cohort study incorporates the patients and electronic medical record of the Geisinger Health System, an integrated health-care delivery system serving central and northeast Pennsylvania. Standardized incidence rates were calculated per 1,000 person-years by calendar year, and point prevalence rates estimated on July 1st of the respective years from 2004 to 2016. Rate ratios were estimated from Poisson regression as the annual relative change over time. A total of 464,363 patients met study inclusion criteria. Age- and sex-adjusted AF incidence rates increased over the study period: 4.7, 5.0, 5.8, and 6.2 in 2004, 2008, 2012, and 2016, respectively (rate ratio 1.03 per year, 95% confidence interval 1.02, 1.03). Age- and sex-adjusted prevalence rates increased consistently over time from 2.7%, 3.0%, 3.4%, to 4.1% in 2004, 2008, 2012, and 2016, respectively. In 2004, an estimated 6.1 million Americans had diagnosed AF, increasing to 6.7, 7.8, and 9.3 million in 2008, 2012, and 2016, respectively. Postdiagnosis survival has not improved in recent years. In conclusion, AF incidence and prevalence have increased steadily since 2004, whereas postdiagnosis survival has not improved.
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16
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Jiang YY, Hou HT, Yang Q, Liu XC, He GW. Chloride Channels are Involved in the Development of Atrial Fibrillation - A Transcriptomic and proteomic Study. Sci Rep 2017; 7:10215. [PMID: 28860555 PMCID: PMC5579191 DOI: 10.1038/s41598-017-10590-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/11/2017] [Indexed: 11/23/2022] Open
Abstract
Electrical and structural remodeling processes are contributors to the self-perpetuating nature of atrial fibrillation (AF). However, their correlation has not been clarified. In this study, human atrial tissues from the patients with rheumatic mitral valve disease in either sinus rhythm or persistent AF were analyzed using a combined transcriptomic and proteomic approach. An up-regulation in chloride intracellular channel (CLIC) 1, 4, 5 and a rise in type IV collagen were revealed. Combined with the results from immunohistochemistry and electron microscope analysis, the distribution of type IV collagen and effects of fibrosis on myocyte membrane indicated the possible interaction between CLIC and type IV collagen, confirmed by protein structure prediction and co-immunoprecipitation. These results indicate that CLICs play an important role in the development of atrial fibrillation and that CLICs and structural type IV collagen may interact on each other to promote the development of AF in rheumatic mitral valve disease.
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Affiliation(s)
- Yi-Yao Jiang
- Department of Cardiovascular Surgery & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, The Chinese Academy of Medical Sciences & Peking Union Medical College, & Nankai University, Tianjin, China.,The Affiliated Hospital of Hangzhou Normal University & Zhejiang University, Hangzhou, China
| | - Hai-Tao Hou
- Department of Cardiovascular Surgery & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, The Chinese Academy of Medical Sciences & Peking Union Medical College, & Nankai University, Tianjin, China
| | - Qin Yang
- Department of Cardiovascular Surgery & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, The Chinese Academy of Medical Sciences & Peking Union Medical College, & Nankai University, Tianjin, China
| | - Xiao-Cheng Liu
- Department of Cardiovascular Surgery & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, The Chinese Academy of Medical Sciences & Peking Union Medical College, & Nankai University, Tianjin, China
| | - Guo-Wei He
- Department of Cardiovascular Surgery & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, The Chinese Academy of Medical Sciences & Peking Union Medical College, & Nankai University, Tianjin, China. .,The Affiliated Hospital of Hangzhou Normal University & Zhejiang University, Hangzhou, China. .,Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
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17
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Brown JR, Moslehi J, O'Brien S, Ghia P, Hillmen P, Cymbalista F, Shanafelt TD, Fraser G, Rule S, Kipps TJ, Coutre S, Dilhuydy MS, Cramer P, Tedeschi A, Jaeger U, Dreyling M, Byrd JC, Howes A, Todd M, Vermeulen J, James DF, Clow F, Styles L, Valentino R, Wildgust M, Mahler M, Burger JA. Characterization of atrial fibrillation adverse events reported in ibrutinib randomized controlled registration trials. Haematologica 2017; 102:1796-1805. [PMID: 28751558 PMCID: PMC5622864 DOI: 10.3324/haematol.2017.171041] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 12/22/2022] Open
Abstract
The first-in-class Bruton's tyrosine kinase inhibitor ibrutinib has proven clinical benefit in B-cell malignancies; however, atrial fibrillation (AF) has been reported in 6-16% of ibrutinib patients. We pooled data from 1505 chronic lymphocytic leukemia and mantle cell lymphoma patients enrolled in four large, randomized, controlled studies to characterize AF with ibrutinib and its management. AF incidence was 6.5% [95% Confidence Interval (CI): 4.8, 8.5] for ibrutinib at 16.6-months versus 1.6% (95%CI: 0.8, 2.8) for comparator and 10.4% (95%CI: 8.4, 12.9) at the 36-month follow up; estimated cumulative incidence: 13.8% (95%CI: 11.2, 16.8). Ibrutinib treatment, prior history of AF and age 65 years or over were independent risk factors for AF. Multiple AF events were more common with ibrutinib (44.9%; comparator, 16.7%) among patients with AF. Most (85.7%) patients with AF did not discontinue ibrutinib, and more than half received common anticoagulant/antiplatelet medications on study. Low-grade bleeds were more frequent with ibrutinib, but serious bleeds were uncommon (ibrutinib, 2.9%; comparator, 2.0%). Although the AF rate among older non-trial patients with comorbidities is likely underestimated by this dataset, these results suggest that AF among clinical trial patients is generally manageable without ibrutinib discontinuation (clinicaltrials.gov identifier: 01578707, 01722487, 01611090, 01646021).
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Affiliation(s)
| | - Javid Moslehi
- Division of Cardiovascular Medicine and Cardio-Oncology Program Vanderbilt School of Medicine, Nashville, TN, USA
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Peter Hillmen
- CA Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds, UK
| | | | | | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Simon Rule
- Department of Haematology, Plymouth University Medical School, Plymouth, UK
| | | | - Steven Coutre
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA, USA
| | | | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, University of Cologne, Germany
| | | | | | - Martin Dreyling
- Department of Medicine III, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Germany
| | - John C Byrd
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
| | - Michael Todd
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | | | | | | | | | - Mark Wildgust
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | - Jan A Burger
- Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Stiermaier T, Santoro F, Eitel C, Graf T, Möller C, Tarantino N, Guastafierro F, Di Biase M, Thiele H, Brunetti ND, Eitel I. Prevalence and prognostic relevance of atrial fibrillation in patients with Takotsubo syndrome. Int J Cardiol 2017; 245:156-161. [PMID: 28743481 DOI: 10.1016/j.ijcard.2017.07.053] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/30/2017] [Accepted: 07/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is associated with a considerable risk of complications during the acute phase and substantial long-term mortality rates. Concomitant atrial fibrillation may have an impact on outcome in these patients. Aim of this study was to assess the prevalence and prognostic relevance of atrial fibrillation in TTS. METHODS We performed an international, multicenter study including 387 TTS patients consecutively enrolled at 3 centers. Atrial fibrillation was defined as known history before admission or documented episodes during hospital stay. Long-term mortality was evaluated in median 2.9years after the acute event. RESULTS Atrial fibrillation was found in 97 TTS patients (25.1%) and was associated with older age (p<0.01), less emotional triggers (p=0.03), higher incidence of cardiogenic shock (p<0.01), lower left ventricular ejection fraction (p<0.01), and a prolonged hospital stay (p<0.01). Determinants of atrial fibrillation at admission (n=34 patients; 9.0%) in multivariate logistic regression analysis were age (p=0.001) and cardiogenic shock (p=0.013). Long-term mortality was significantly higher in TTS patients with as compared to patients without atrial fibrillation (35.2% versus 15.3%; hazard ratio 3.02, 95% confidence interval 1.90-4.78; p<0.001). In multivariate Cox regression analysis atrial fibrillation was identified as an independent determinant of outcome even after adjustment for clinical variables, left ventricular functional parameters (ballooning pattern, ejection fraction), and cardiogenic shock. CONCLUSIONS In TTS patients, atrial fibrillation is frequent and associated with increased long-term mortality rates. Furthermore, our study identifies atrial fibrillation as an independent predictor of outcome and a potential tool for risk stratification in TTS.
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Affiliation(s)
- Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Francesco Santoro
- University of Foggia, Department of Medical and Surgical Science, Foggia, Italy
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tobias Graf
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Möller
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nicola Tarantino
- University of Foggia, Department of Medical and Surgical Science, Foggia, Italy
| | | | - Matteo Di Biase
- University of Foggia, Department of Medical and Surgical Science, Foggia, Italy
| | - Holger Thiele
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Natale D Brunetti
- University of Foggia, Department of Medical and Surgical Science, Foggia, Italy
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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19
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Andersson T, Magnuson A, Bryngelsson IL, Frøbert O, Henriksson KM, Edvardsson N, Poçi D. Patients with atrial fibrillation and outcomes of cerebral infarction in those with treatment of warfarin versus no warfarin with references to CHA2DS2-VASc score, age and sex - A Swedish nationwide observational study with 48 433 patients. PLoS One 2017; 12:e0176846. [PMID: 28472091 PMCID: PMC5417522 DOI: 10.1371/journal.pone.0176846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/18/2017] [Indexed: 12/26/2022] Open
Abstract
AIMS There is controversy in the guidelines as to whether patients with atrial fibrillation and a low risk of stroke should be treated with anticoagulation, especially those with a CHA2DS2-VASc score of 1 point. METHODS In a retrospective, nationwide cohort study, we used the Swedish National Patient Registry, the National Prescribed Drugs Registry, the Swedish Registry of Education and the Population and Housing Census Registry. 48 433 patients were identified between 1 January 2006 and 31 December 2008 with incident atrial fibrillation who were divided in age categories, sex and a CHA2DS2-VASc score of 0, 1, 2 and ≥3 and they were included in a time-varying analysis of warfarin treatment versus no treatment. The primary end-point was cerebral infarction and stroke, and patients were followed until 31 December 2009. RESULTS Patients with 1 point from the CHA2DS2-VASc score showed the following adjusted hazard ratios (HR) with a 95% confidence interval: men 65-74 years 0.46 (0.25-0.83), men <65 years 1.11 (0.56-2.23) and women <65 years 2.13 (0.94-4.82), where HR <1 indicates protection with warfarin. In patients <65 years and 2 points, HR in men was 0.35 (0.18-0.69) and in women 1.84 (0.86-3.94) while, in women with at least 3 points, HR was 0.31 (0.16-0.59). In patients 65-74 years and 2 points, HR in men was 0.37 (0.23-0.59) and in women 0.39 (0.21-0.73). Categories including age ≥65 years or ≥3 points showed a statistically significant protection from warfarin. CONCLUSIONS Our results support that treatment with anticoagulation may be considered in all patients with an incident atrial fibrillation diagnosis and an age of 65 years and older, i.e. also when the CHA2DS2-VASc score is 1.
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Affiliation(s)
- Tommy Andersson
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ing-Liss Bryngelsson
- Department of Occupational and Environmental Medicine, Örebro University, Örebro, Sweden
| | - Ole Frøbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | | | - Nils Edvardsson
- Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden
| | - Dritan Poçi
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
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20
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Moss TJ, Calland JF, Enfield KB, Gomez-Manjarres DC, Ruminski C, DiMarco JP, Lake DE, Moorman JR. New-Onset Atrial Fibrillation in the Critically Ill. Crit Care Med 2017; 45:790-797. [PMID: 28296811 PMCID: PMC5389601 DOI: 10.1097/ccm.0000000000002325] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To determine the association of new-onset atrial fibrillation with outcomes, including ICU length of stay and survival. DESIGN Retrospective cohort of ICU admissions. We found atrial fibrillation using automated detection (≥ 90 s in 30 min) and classed as new-onset if there was no prior diagnosis of atrial fibrillation. We identified determinants of new-onset atrial fibrillation and, using propensity matching, characterized its impact on outcomes. SETTING Tertiary care academic center. PATIENTS A total of 8,356 consecutive adult admissions to either the medical or surgical/trauma/burn ICU with available continuous electrocardiogram data. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS From 74 patient-years of every 15-minute observations, we detected atrial fibrillation in 1,610 admissions (19%), with median burden less than 2%. Most atrial fibrillation was paroxysmal; less than 2% of admissions were always in atrial fibrillation. New-onset atrial fibrillation was subclinical or went undocumented in 626, or 8% of all ICU admissions. Advanced age, acute respiratory failure, and sepsis were the strongest predictors of new-onset atrial fibrillation. In propensity-adjusted regression analyses, clinical new-onset atrial fibrillation was associated with increased hospital mortality (odds ratio, 1.63; 95% CI, 1.01-2.63) and longer length of stay (2.25 d; CI, 0.58-3.92). New-onset atrial fibrillation was not associated with survival after hospital discharge (hazard ratio, 0.99; 95% CI, 0.76-1.28 and hazard ratio, 1.11; 95% CI, 0.67-1.83, respectively, for subclinical and clinical new-onset atrial fibrillation). CONCLUSIONS Automated analysis of continuous electrocardiogram heart rate dynamics detects new-onset atrial fibrillation in many ICU patients. Though often transient and frequently unrecognized, new-onset atrial fibrillation is associated with poor hospital outcomes.
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Affiliation(s)
- Travis J. Moss
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | | | - Kyle B. Enfield
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Diana C. Gomez-Manjarres
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | | | - John P. DiMarco
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Douglas E. Lake
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - J. Randall Moorman
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA
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21
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Twelve-year follow-up of catheter ablation for atrial fibrillation: A prospective, multicenter, randomized study. Heart Rhythm 2017; 14:486-492. [DOI: 10.1016/j.hrthm.2016.12.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Indexed: 11/20/2022]
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22
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Fedeli U, Ferroni E, Pengo V. Mortality associated to atrial fibrillation still on the rise: United States, 1999 to 2014. Int J Cardiol 2016; 222:788-789. [PMID: 27521561 DOI: 10.1016/j.ijcard.2016.08.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Veneto Region, Italy.
| | | | - Vittorio Pengo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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23
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Formiga F, Ferrer A, Mestre D, Brasé A, Soldevila L, Corbella X. High rate of mortality in Spanish community-dwelling population aged 85 with atrial fibrillation after three years of follow-up: The Octabaix study. Australas J Ageing 2016; 35:216-9. [PMID: 26991145 DOI: 10.1111/ajag.12261] [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: 11/29/2022]
Abstract
AIM To assess the possible association between three-year global mortality and atrial fibrillation (AF) in 328 community-dwelling participants aged 85 at baseline. METHODS Sociodemographic data, comorbidity and geriatric assessment tools, thromboembolic risk, and AF therapy were assessed. We compared the patients who survived with those who died. RESULTS At baseline, 41 (12.5%) of participants had permanent AF, and 13 of them died (31.7%) after the three-year follow-up period compared with 44 (15.3%) of the rest of cohort (P = 0.01). Cox regression analysis identified two significant clinical variables as independent predictors of three-year risk of global mortality: Lawton Index (hazard ratio 0.82, 95% confidence interval 0.75-0.91) and AF (hazard ratio 1.90, 95% confidence interval 1.01-3.56). None of the other of variables evaluated showed predictive value of global mortality in the AF patients. CONCLUSION In oldest old community-dwelling participants, AF is an independent risk factor for global mortality after a three-year follow-up period.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Assumpta Ferrer
- Primary Healthcare Centre 'El Plà' CAP -I, Sant Feliu de Llobregat, Barcelona, Spain
| | - Delia Mestre
- Primary Healthcare Centre 'El Plà' CAP -I, Sant Feliu de Llobregat, Barcelona, Spain
| | - Ariadna Brasé
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Soldevila
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute. IDIBELL, L'Hospitalet de Llobregat, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Increased left atrial stiffness in patients with atrial fibrillation detected by left atrial speckle tracking echocardiography. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Katzenellenbogen JM, Woods JA, Teng THK, Thompson SC. Atrial fibrillation in the Indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review. BMC Cardiovasc Disord 2015; 15:87. [PMID: 26268309 PMCID: PMC4535416 DOI: 10.1186/s12872-015-0081-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/03/2015] [Indexed: 11/26/2022] Open
Abstract
Background The epidemiology of atrial fibrillation (AF) among Indigenous minorities in affluent countries is poorly delineated, despite the high cardiovascular disease burden in these populations. We undertook a systematic scoping review examining the epidemiology of AF in the Indigenous populations of Australia, Canada, New Zealand (NZ) and the United States (US). Methods PubMed, Scopus, EMBASE and CINAHL-Plus databases were systematically searched in May 2014. Supplementary full-text searches of Google Scholar and government website searches were also undertaken. Results Key findings from 27 publications with diverse aims and methods were included. Small studies from Canada and NZ suggest higher AF prevalence in Indigenous than other populations. However, this was not reflected in a large sample of US male military veterans. No data were identified on community-based incidence rates of AF in Indigenous populations. Australian and Canadian studies indicate higher first-ever and overall AF hospitalisation rates among Indigenous than other populations, at younger ages and with more comorbidity. Studies in stroke, heart failure and other clinical groups demonstrate AF as a common comorbidity, with AF possibly more prevalent at younger ages in Indigenous people. Indigenous patients have similar early post-hospitalisation adjusted mortality but higher 1-year risk-adjusted mortality than non-Indigenous patients. Conclusions No clear epidemiological pattern of AF frequency across the considered Indigenous populations emerges from the limited available evidence. AF should be included in key conditions reported in national surveillance reports, although Indigenous identifiers are required in administrative data from Canada and the US. Sufficiently powered, community-based studies of AF epidemiology in diverse Indigenous populations are needed. Electronic supplementary material The online version of this article (doi:10.1186/s12872-015-0081-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith M Katzenellenbogen
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,School of Population Health, The University of Western Australia (M431), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - John A Woods
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Tiew-Hwa Katherine Teng
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
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Coronary atherosclerosis and adverse outcomes in patients with recent-onset atrial fibrillation and troponin rise. Am J Emerg Med 2015; 33:1407-13. [PMID: 26272437 DOI: 10.1016/j.ajem.2015.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The relationship between troponin and atrial fibrillation (AF) without acute coronary syndrome is still unclear. We sought to investigate the presence of coronary atherosclerosis and adverse outcomes in patients with AF. METHODS Consecutive patients with recent-onset AF and without severe comorbidities were enrolled between 2004 and 2013. Patients with a troponin rise or with adverse outcomes were considered for coronary angiography and revascularization when "critical" stenosis (≥70%) was recognized. Propensity score matching was performed to adjust for baseline characteristics; after matching, no differences existed between the groups of patients with or without troponin rise. The primary end point was the composite of acute coronary syndrome, revascularization, and cardiac death at 1- and 12-month follow-ups. RESULTS Of 3627 patients enrolled, 3541 completed the study; 202 (6%) showed troponin rise; and 91 (3%), an adverse outcome. In the entire cohort, on multivariate analysis, the odds ratio for the occurrence of the primary end point of troponin rise was 14 (95% confidence interval [CI], 10-23; P<.001), and that of known coronary artery disease was 3 (CI, 2-5; P=.001). In the matching cohort, the odds ratio of troponin rise was 10 (CI, 4-22; P<.001), and that of TIMI score greater than 2 was 4 (CI, 2-9; P≤.001). In the entire cohort, patients with or without troponin rise achieved the primary end point in 38 (19%) and 43 (1%) patients, respectively (P<.001). Stroke occurred in 4 (2%) and 20 (1%), respectively (P=.018). Critical stenosis and revascularization account for 23 (12%) and 15 (1%), respectively (P<.001). In the matching cohort, results were confirmed, but incidence of stroke was comparable. CONCLUSIONS Patients with recent-onset AF and troponin rise showed higher prevalence of coronary atherosclerosis and adverse cardiac events. Stroke per se did not succeed in justifying the high morbidity. Thus, beyond stroke, coronary atherosclerosis might have a pivotal role in poor outcomes.
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Ramlawi B, Bedeir K. Surgical options in atrial fibrillation. J Thorac Dis 2015; 7:204-13. [PMID: 25713738 DOI: 10.3978/j.issn.2072-1439.2014.12.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/14/2014] [Indexed: 11/14/2022]
Abstract
Atrial fibrillation (AF) is not benign and its prevalence is increasing. The two main goals in management of atrial fibrillation are to optimize hemodynamics through rate or rhythm control and to prevent systemic thrombo-embolism. To date, these two goals are still sub-optimally achieved, raising the need for alternative methods and strategies both pharmacologically and through interventions. In this review, we discuss surgical strategies of achieving both goals with insights on the evolution and potential future of these strategies.
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Affiliation(s)
- Basel Ramlawi
- Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Kareem Bedeir
- Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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González-Pacheco H, Márquez MF, Arias-Mendoza A, Álvarez-Sangabriel A, Eid-Lidt G, González-Hermosillo A, Azar-Manzur F, Altamirano-Castillo A, Briseño-Cruz JL, García-Martínez A, Mendoza-García S, Martínez-Sánchez C. Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation. J Cardiol 2014; 66:148-54. [PMID: 25480145 DOI: 10.1016/j.jjcc.2014.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with an acute coronary syndrome (ACS), no conclusive agreement has been reached to date regarding the association between the different types of atrial fibrillation (AF) and the in-hospital mortality risk. We conducted a retrospective cohort study in patients with ACS to determine the prognostic implications of the different types of AF. METHODS We analyzed 6705 consecutive patients with ACS admitted to a coronary care unit (CCU), including 3094 with ST segment elevation myocardial infarction (STEMI) and 3611 with non-ST-elevation acute coronary syndrome (NSTE-ACS). We identified the patients with pre-existing AF, new-onset AF at admission, and new-onset AF at the CCU. RESULTS The overall incidence of AF was documented in 360 (5.4%) of the patients (STEMI, 5%; NSTE-ACS, 5.6%), 140 (2.1%) of whom had pre-existing AF, and 220 (3.2%) of whom had new-onset AF (AF at admission, 1.3%; AF at the CCU, 1.9%). The patients with AF had high-risk clinical characteristics and developed major adverse events more frequently than did the patients without AF. The unadjusted in-hospital mortality risk was significantly higher in the patients with pre-existing AF (STEMI, 3.79-fold; NSTE-ACS, 3.4-fold) and AF at the CCU (STEMI, 2.02-fold; NSTE-ACS, 8.09-fold). After adjusting for the multivariate analysis, only the AF at the CCU in the NSTE-ACS group was associated with a 4.40-fold increase in the in-hospital mortality risk (odds ratio 4.40, CI 1.82-10.60, p=0.001). In the STEMI group, the presence of any type of AF was not associated with an increased risk of mortality. CONCLUSION Among the different types of AF in patients with ACS, only the new-onset AF that developed during the CCU stay in patients with NSTE-ACS was associated with a 4.40-fold increase in the in-hospital mortality risk.
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Affiliation(s)
| | - Manlio F Márquez
- Cardiac Electrophysiology Laboratory, National Institute of Cardiology, Mexico City, Mexico
| | | | | | - Guering Eid-Lidt
- Catheterization Laboratory, National Institute of Cardiology, Mexico City, Mexico
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Ruwald AC, Schuger C, Moss AJ, Kutyifa V, Olshansky B, Greenberg H, Cannom DS, Estes NAM, Ruwald MH, Huang DT, Klein H, McNitt S, Beck CA, Goldstein R, Brown MW, Kautzner J, Shoda M, Wilber D, Zareba W, Daubert JP. Mortality reduction in relation to implantable cardioverter defibrillator programming in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT). Circ Arrhythm Electrophysiol 2014; 7:785-92. [PMID: 25136077 DOI: 10.1161/circep.114.001623] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The benefit of novel implantable cardioverter defibrillator (ICD) programming in reducing inappropriate ICD therapy and mortality was demonstrated in Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT). However, the cause of mortality reduction remains incompletely evaluated. We aimed to identify factors associated with mortality, with focus on ICD therapy and programming in the MADIT-RIT population. METHODS AND RESULTS In MADIT-RIT, 1500 patients with a primary prophylactic indication for ICD or cardiac resynchronization therapy with defibrillator were randomized to 1 of 3 different ICD programming arms: conventional programming (ventricular tachycardia zone ≥170 beats per minute), high-rate programming (ventricular tachycardia zone ≥200 beats per minute), and delayed programming (60-second delay before therapy ≥170 beats per minute). Multivariate Cox models were used to assess the influence of time-dependent appropriate and inappropriate ICD therapy (shock and antitachycardia pacing) and randomized programming arm on all-cause mortality. During an average follow-up of 1.4±0.6 years, 71 of 1500 (5%) patients died: cardiac in 40 patients (56.3%), noncardiac in 23 patients (32.4%), and unknown in 8 patients (11.3%). Appropriate shocks (hazard ratio, 6.32; 95% confidence interval, 3.13-12.75; P<0.001) and inappropriate therapy (hazard ratio, 2.61; 95% confidence interval, 1.28-5.31; P=0.01) were significantly associated with an increased mortality risk. There was no evidence of increased mortality risk in patients who experienced appropriate antitachycardia pacing only (hazard ratio, 1.02; 95% confidence interval, 0.36-2.88; P=0.98). Randomization to conventional programming was identified as an independent predictor of death when compared with patients randomized to high-rate programming (hazard ratio, 2.0; 95% confidence interval, 1.06-3.71; P=0.03). CONCLUSIONS In MADIT-RIT, appropriate shocks, inappropriate ICD therapy, and randomization to conventional ICD programming were independently associated with an increased mortality risk. Appropriate antitachycardia pacing was not related to an adverse outcome. CLINICAL TRIAL REGISTRATION URL clinicaltrials.gov Unique identifier: NCT00947310.
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Affiliation(s)
- Anne-Christine Ruwald
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Claudio Schuger
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Arthur J Moss
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Valentina Kutyifa
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Brian Olshansky
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Henry Greenberg
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - David S Cannom
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - N A Mark Estes
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Martin H Ruwald
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - David T Huang
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Helmut Klein
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Scott McNitt
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Christopher A Beck
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Robert Goldstein
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Mary W Brown
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Josef Kautzner
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Morio Shoda
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - David Wilber
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - Wojciech Zareba
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.)
| | - James P Daubert
- From the Heart Research Follow-up Program, University of Rochester Medical Center, NY (A.-C.R., A.J.M., V.K., M.H.R., D.T.H., H.K., S.M., C.A.B., M.W.B., W.Z.); Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (A.-C.R., M.H.R.); Division of Cardiology, Henry Ford Hospital, Detroit, MI (C.S.); Department of Medicine, University of Iowa Health Care, Iowa City (B.O.); St Luke's and Roosevelt Hospitals, Departments of Medicine and Epidemiology, Columbia University, New York, NY (H.G.); Division of Cardiology, Hospital of the Good Samaritan, Los Angeles, CA (D.S.C.); Cardiology Division, Cedars-Sinai Heart Institute, Los Angeles, CA (D.S.C.); New England Cardiac Arrhythmia Center, Tufts-New England Medical Center, Boston, MA (N.A.M.E.); Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (R.G.); Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan (M.S.); Cardiovascular Institute, Loyola University Medical Center, Chicago, IL (D.W.); and Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.D.).
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Becker C. Cost-of-illness studies of atrial fibrillation: methodological considerations. Expert Rev Pharmacoecon Outcomes Res 2014; 14:661-84. [DOI: 10.1586/14737167.2014.940904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Boriani G, Tukkie R, Manolis AS, Mont L, Pürerfellner H, Santini M, Inama G, Serra P, de Sousa J, Botto GL, Mangoni L, Grammatico A, Padeletti L. Atrial antitachycardia pacing and managed ventricular pacing in bradycardia patients with paroxysmal or persistent atrial tachyarrhythmias: the MINERVA randomized multicentre international trial. Eur Heart J 2014; 35:2352-62. [PMID: 24771721 PMCID: PMC4163193 DOI: 10.1093/eurheartj/ehu165] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aims Atrial fibrillation (AF) is a common comorbidity in bradycardia patients. Advanced pacemakers feature atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), which minimizes unnecessary right ventricular pacing. We evaluated whether DDDRP and MVP might reduce mortality, morbidity, or progression to permanent AF when compared with standard dual-chamber pacing (Control DDDR). Methods and results In a randomized, parallel, single-blind, multi-centre trial we enrolled 1300 patients with bradycardia and previous atrial tachyarrhythmias, in whom a DDDRP pacemaker had recently been implanted. History of permanent AF and third-degree atrioventricular block were exclusion criteria. After a 1-month run-in period, 1166 eligible patients, aged 74 ± 9 years, 50% females, were randomized to Control DDDR, DDDRP + MVP, or MVP. Analysis was intention-to-treat. The primary outcome, i.e. the 2-year incidence of a combined endpoint composed of death, cardiovascular hospitalizations, or permanent AF, occurred in 102/385 (26.5%) Control DDDR patients, in 76/383 (19.8%) DDDRP + MVP patients [hazard ratio (HR) = 0.74, 95% confidence interval 0.55–0.99, P = 0.04 vs. Control DDDR] and in 85/398 (21.4%) MVP patients (HR = 0.89, 95% confidence interval 0.77–1.03, P = 0.125 vs. Control DDDR). When compared with Control DDDR, DDDRP + MVP reduced the risk for AF longer than 1 day (HR = 0.66, 95% CI 0.52–0.85, P < 0.001), AF longer than 7 days (HR = 0.52, 95% CI 0.36–0.73, P < 0.001), and permanent AF (HR = 0.39, 95% CI 0.21–0.75, P = 0.004). Conclusion In patients with bradycardia and atrial tachyarrhythmias, DDDRP + MVP is superior to standard dual-chamber pacing. The primary endpoint was significantly lowered through the reduction of the progression of atrial tachyarrhythmias to permanent AF. ClinicalTrials.gov Identifier NCT00262119.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | | | - Antonis S Manolis
- First Department of Cardiology, Evagelismos General Hospital, Athens, Greece
| | - Lluis Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Massimo Santini
- Cardiology Department, S. Filippo Neri Hospital, Rome, Italy
| | - Giuseppe Inama
- Institute of Cardiology, Maggiore Hospital, Crema, Italy
| | - Paolo Serra
- Cardiology Department, G. Mazzini Hospital, Teramo, Italy
| | - João de Sousa
- Institute of Cardiology, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Lorenza Mangoni
- Medtronic Clinical Research Institute, Regional Clinical Centre, Rome, Italy
| | - Andrea Grammatico
- Medtronic Clinical Research Institute, Regional Clinical Centre, Rome, Italy
| | - Luigi Padeletti
- Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy
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