Correlation between genetic polymorphisms in apolipoprotein E and atrial fibrillation

This work explores correlations between genetic polymorphisms in apolipoprotein E (ApoE) and atrial fibrillation (AF). We detected polymorphisms in the APOE gene in 64 patients with AF and 49 non-AF volunteers at the Department of Cardiology of Lianyungang Second People's Hospital between July 2017 and July 2019. We found significant differences in age, body mass index, left atrial diameter, and left ventricular ejection fraction between the two groups. Six APOE genotypes were observed: ɛ2/ɛ2; ɛ2/ɛ3; ɛ2/ɛ4; ɛ3/ɛ3; ɛ3/ɛ4; and ɛ4/ɛ4. The ɛ3/ɛ3 genotype was significantly less frequent in the AF group than in the control group, while the ɛ3/ɛ4 and ɛ4/ɛ4 genotypes were significantly more frequent in the AF group than in the control group (p<0.05). ApoE3 penetrance was significantly lower in the AF group than in the control group (p<0.05), while ApoE4 penetrance was significantly higher in the AF group than in the control group (p<0.05). ApoE3 penetrance was significantly lower in the AF group than in the control group (p<0.05). Binary logistic regression analysis showed that age, body mass index, left atrial diameter, left ventricular ejection fraction, and ApoE4 were risk factors for AF. Finally, we found that ApoE polymorphisms impacted the occurrence of AF and that ApoE4 is an AF-sensitive phenotype.

Effect of Non-fluoroscopic Catheter Tracking on Radiation Exposure during Pulmonary Vein Isolation: Comparison of Four ablation systems

Background

A novel non-fluoroscopic catheter tracking system (Mediguide) can be used in combination with a 3D mapping system for atrial fibrillation (AF) ablation. However, the benefit on radiation exposure of the Mediguide system compared to other ablation systems is unknown.

Methods

We retrospectively enrolled consecutive 73 patients (51 men; 59±11 years; 60 paroxysmal AF) undergoing pulmonary vein isolation by the same operator. Radiation time, radiation effective dose, procedure time, AF recurrence after ablation, and procedure-related complications were compared among 4 different ablation systems.

Results

Mediguide was used in 16 patients (group A), CARTO™ in 17 (group B), Cryoballoon in 30 (group C), and Multi-electrode Pulmonary Vein Ablation Catheter (PVAC) in 10 (group D). Although procedure time was shorter in patients with Cryoballoon (median 110 [interquartile range 99-120] min) and PVAC (123 [112-146] min) compared to those with Mediguide (181 [168-214] min) and CARTO (179 [160-195] min) (P<0.001), radiation exposure time and effective dose were decreased in patients with Mediguide compared to the other ablation systems (A: 5 [3-6] min; B: 14 [11-16] min; C: 14 [11-18] min; D: 20 [16-24] min, P<0.001 and A: 1.1 [0.8-2.0] mSv; B: 2.5 [1.3-3.8] mSv; C: 2.0 [1.4-2.5] mSv; D: 1.7 [1.4-3.6] mSv, P=0.015, respectively). AF recurrence rates and procedure-related complications were comparable among the 4 groups.

Conclusion

The Mediguide system reduces radiation exposure compared to other ablation systems without increasing AF recurrence or procedure-related complications.

Impact of Metabolic Status on the Course of Atrial Fibrillation

Background and aims: Metabolic syndrome (MS) might influence the course of atrial fibrillation (AF) similarly to diabetes (DM). Aim of this research is to evaluate the quality of life, disease burden and medication adherence of patients with different metabolic states. Material and methods: A cross-sectional study of Latvian Center of Cardiology Arrhythmology Department patients with AF, sorting patients in 3 categories according to the National Institutes for Health guidelines criteria for MS. Results: From 133 patients, 51 were in metabolically healthy (MH) group, 58 in MS group and 24 had DM. Average age was 62.59 in MH, 67.59 in MS and 66.25 in DM group. Most common form of AF was persistent - MH 49%, MS 65.5%, DM 75%. Best EHRA median value was observed in DM group (29.2% reporting mild symptoms). Majority of patients had 1-2 comorbidities in MH and MS group and 3-5 in the DM group, with almost all patients using 4-9 drugs daily. Conclusions: A similar course of AF was observed in MS and DM groups. Since the same molecular pathways are involved, MS should be viewed as a cluster of risk factors with a cumulative effect - greater than the effect of a single risk factor.

Effect of Significant Weight Change on Inappropriate Implantable Cardioverter-Defibrillator Therapy

BACKGROUND

Weight loss has been associated with adverse outcomes among heart failure (HF) patients, including those receiving cardiac resynchronization therapy with defibrillator (CRT-D). The effect of significant weight change on inappropriate implantable cardioverter-defibrillator (ICD) therapy among CRT-D patients is not well understood.

METHODS

We evaluated the impact of significant weight change at 1 year on subsequent inappropriate ICD therapy during follow-up among 993 CRT-D patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy. Patients were divided into three subgroups based on weight change at 1 year after enrollment: weight loss (weight loss ≥ 5%), weight gain (weight gain ≥ 5%), and stable weight (weight loss and weight gain < 5%). The primary end point was inappropriate ICD therapy. Secondary end point included inappropriate ICD therapy related to supraventricular arrhythmias (SVAs).

RESULTS

There were 102 (10.3%) patients who experienced weight loss, 689 (69.4%) whose weight was stable, and 202 (20.3%) who gained weight at 1 year. Patients with weight loss had increased risk of subsequent inappropriate ICD therapy relative to patients with stable weight (hazard ratio [HR] = 2.35, 95% confidence interval [CI]: 1.39-3.98, P = 0.001) or weight gain (HR = 2.27, 95% CI: 1.18-4.38, P = 0.014). Furthermore, patients losing weight were at greater risk of subsequent inappropriate ICD therapy related to SVAs when compared to patients with stable weight (HR = 2.16, 95% CI: 1.18-3.95, P = 0.013) or weight gain (HR = 2.02, 95% CI: 0.95-4.29, P = 0.068).

CONCLUSION

In mild HF patients receiving CRT-D, significant weight loss at 1 year is associated with increased risk of subsequent inappropriate ICD therapy, including risk related to SVAs.