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Li X, Jin Y. Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report. BMC Cardiovasc Disord 2024; 24:339. [PMID: 38965461 PMCID: PMC11225507 DOI: 10.1186/s12872-024-04016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 06/26/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Zolpidem is a non-benzodiazepine hypnotic widely used to manage insomnia. Zolpidem-triggered atrial fibrillation (AF) in patients with cardiomyopathy has never been reported before. CASE PRESENTATION A 40-year-old man with Duchenne muscular dystrophy-related cardiomyopathy attempted suicide and developed new-onset AF after zolpidem overdose. One year before admission, the patient visited our clinic due to chest discomfort and fatigue after daily walks for 1 month; both electrocardiography (ECG) and 24-hour Holter ECG results did not detect AF. After administration of cardiac medication (digoxin 0.125 mg/day, spironolactone 40 mg/day, furosemide 20 mg/day, bisoprolol 5 mg/day, sacubitril/valsartan 12/13 mg/day), he felt better. AF had never been observed before this admission via continuous monitoring during follow-up. Sixteen days before admission, the patient saw a sleep specialist and started zolpidem tartrate tablets (10 mg/day) due to insomnia for 6 months; ECG results revealed no significant change. The night before admission, the patient attempted suicide by overdosing on 40 mg of zolpidem after an argument, which resulted in severe lethargy. Upon admission, his ECG revealed new-onset AF, necessitating immediate cessation of zolpidem. Nine hours into admission, AF spontaneously terminated into normal sinus rhythm. Results from the ECG on the following days and the 24-hour Holter ECG at 1-month follow-up showed that AF was not detected. CONCLUSIONS This study provides valuable clinical evidence indicating that zolpidem overdose may induce AF in patients with cardiomyopathy. It serves as a critical warning for clinicians when prescribing zolpidem, particularly for patients with existing heart conditions. Further large-scale studies are needed to validate this finding and to explore the mechanisms between zolpidem and AF.
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Affiliation(s)
- Xiaolin Li
- Department of Nutrition, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China
| | - Yunpeng Jin
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine , International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China.
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2
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Zhang S, Zhang N, Liu L, Zheng W, Ma ZL, Qiao SY, Zhao YL, Wei YH, Wu G, Yu QT, Deng B, Shen L. Global epidemiology of mental disorder in atrial fibrillation between 1998-2021: A systematic review and meta-analysis. World J Psychiatry 2024; 14:179-193. [PMID: 38327890 PMCID: PMC10845231 DOI: 10.5498/wjp.v14.i1.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND As the burden of mental disorders among patients with atrial fibrillation (AF) increases, researchers are beginning to pay close attention to the risk and prevalence of these comorbidities. Although studies have independently analyzed the risk of comorbidity with depression and anxiety in patients with AF, no study has systematically focused on the global epidemiology of these two mental disorders. AIM To explore the prevalence of depression and anxiety in patients with AF. METHODS Five databases were searched from their date of establishment until January 2023. Observational studies reporting the comorbidity of AF with depression and anxiety, were included in this study. Basic information, such as the first author/ publication year, study year, study type, and prevalence of depression and anxiety, were extracted. STATA SE 15.1 was used to analyze the data. Subgroup, meta-regression, and sensitivity analyses were performed to estimate study heterogeneity. RESULTS After a thorough search, 26 studies were identified and included in this meta-analysis. The prevalence rates of depression and anxiety in adults with AF were 24.3% and 14.5%, respectively. Among adult males with AF, the prevalence was 11.7% and 8.7%, respectively, whereas in females it was 19.8% and 10.1%, respectively. In older adults with AF, the prevalence rates of depression and anxiety were 40.3% and 33.6%, respectively. The highest regional prevalence of depression and anxiety was observed in European (30.2%) and North American (19.8%) patients with AF. CONCLUSION In this study, we found that the prevalence of depression and anxiety among patients with AF varies with sex, region, and evaluation scales, suggesting the need for psychological interventions for patients with AF in clinical practice.
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Affiliation(s)
- Shuai Zhang
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Na Zhang
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Wang Zheng
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Zi-Lin Ma
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Si-Yu Qiao
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Ying-Li Zhao
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yi-Hong Wei
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Gang Wu
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Qiu-Ting Yu
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Bing Deng
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Lin Shen
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Depression and atrial fibrillation in a reciprocal liaison: a neuro-cardiac link. Int J Psychiatry Clin Pract 2023; 27:397-415. [PMID: 37615537 DOI: 10.1080/13651501.2023.2248214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To explore the reciprocal relationship of depression and atrial fibrillation (AF). METHODS A literature search was conducted in Pub Med, Scopus, and Google Scholar using relevant terms for depression and AF and respective therapies. RESULTS There is evidence that depression is involved in the aetiology and prognosis of AF. AF, independently of its type, incurs a risk of depression in 20-40% of patients. Also, depression significantly increases cumulative incidence of AF (from 1.92% to 4.44% at 10 years); 25% increased risk of new-onset AF is reported in patients with depression, reaching 32% in recurrent depression. Hence, emphasis is put on the importance of assessing depression in the evaluation of AF and vice versa. Persistent vs paroxysmal AF patients may suffer from more severe depression. Furthermore, depression can impact the effectiveness of AF treatments, including pharmacotherapy, anticoagulation, cardioversion and catheter ablation. CONCLUSIONS A reciprocal association of depression and AF, a neurocardiac link, has been suggested. Thus, strategies which can reduce depression may improve AF patients' course and treatment outcomes. Also, AF has a significant impact on risk of depression and quality of life. Hence, effective antiarrhythmic therapies may alleviate patients' depressive symptoms. KEY POINTSAF, independently of its type of paroxysmal, permanent or chronic, appears to have mental besides physical consequences, including depression and anxietyA reciprocal influence or bidirectional association of depression and AF, a neurocardiac link, has been suggestedAF has considerable impact on the risk of depression occurrence with 20-40% of patients with AF found to have high levels of depressionAlso, depression significantly increases 10-year cumulative incidence and risk of AF from 1.92% to 4.44% in people without depression, and the risk of new-onset AF by 25-32%Emphasis should be placed on the importance of assessing depression in the evaluation of AF and vice versaPersistent/chronic AF patients may suffer from more severe depressed mood than paroxysmal AF patients with similar symptom burdenDepression and anxiety can impact the effectiveness of certain AF treatments, including pharmacotherapy, anticoagulation treatment, cardioversion and catheter ablationThus, strategies which can reduce anxiety and depression may improve AF patients' course and treatment outcomesAlso, effective antiarrhythmic therapies to control AF may alleviate patients' depressive mood.
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4
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Li H, Gao M, Song H, Wu X, Li G, Cui Y, Li Y, Xie Z, Ren Q, Zhang H. Predicting ischemic stroke risk from atrial fibrillation based on multi-spectral fundus images using deep learning. Front Cardiovasc Med 2023; 10:1185890. [PMID: 37600060 PMCID: PMC10434281 DOI: 10.3389/fcvm.2023.1185890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/05/2023] [Indexed: 08/22/2023] Open
Abstract
Background Ischemic stroke (IS) is one of the most common serious secondary diseases of atrial fibrillation (AF) within 1 year after its occurrence, both of which have manifestations of ischemia and hypoxia of the small vessels in the early phase of the condition. The fundus is a collection of capillaries, while the retina responds differently to light of different wavelengths. Predicting the risk of IS occurring secondary to AF, based on subtle differences in fundus images of different wavelengths, is yet to be explored. This study was conducted to predict the risk of IS occurring secondary to AF based on multi-spectrum fundus images using deep learning. Methods A total of 150 AF participants without suffering from IS within 1 year after discharge and 100 IS participants with persistent arrhythmia symptoms or a history of AF diagnosis in the last year (defined as patients who would develop IS within 1 year after AF, based on fundus pathological manifestations generally prior to symptoms of the brain) were recruited. Fundus images at 548, 605, and 810 nm wavelengths were collected. Three classical deep neural network (DNN) models (Inception V3, ResNet50, SE50) were trained. Sociodemographic and selected routine clinical data were obtained. Results The accuracy of all DNNs with the single-spectral or multi-spectral combination images at the three wavelengths as input reached above 78%. The IS detection performance of DNNs with 605 nm spectral images as input was relatively more stable than with the other wavelengths. The multi-spectral combination models acquired a higher area under the curve (AUC) scores than the single-spectral models. Conclusions The probability of IS secondary to AF could be predicted based on multi-spectrum fundus images using deep learning, and combinations of multi-spectrum images improved the performance of DNNs. Acquiring different spectral fundus images is advantageous for the early prevention of cardiovascular and cerebrovascular diseases. The method in this study is a beneficial preliminary and initiative exploration for diseases that are difficult to predict the onset time such as IS.
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Affiliation(s)
- Hui Li
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Biomedical Engineering, Shenzhen, China
- National Biomedical Imaging Center, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Mengdi Gao
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Biomedical Engineering, Shenzhen, China
- National Biomedical Imaging Center, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiao Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Li
- Department of Cardiology, Beijing Yanhua Hospital, Beijing, China
| | - Yiwei Cui
- Department of Cardiology, Beijing Yanhua Hospital, Beijing, China
| | - Yang Li
- Department of Cardiology, Beijing Yanhua Hospital, Beijing, China
| | - Zhaoheng Xie
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Biomedical Engineering, Shenzhen, China
- National Biomedical Imaging Center, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Qiushi Ren
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Shenzhen Bay Laboratory, Institute of Biomedical Engineering, Shenzhen, China
- National Biomedical Imaging Center, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Haitao Zhang
- Cardio-Metabolic Medicine Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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5
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Samaritaki E, Tsiligianni I, Basta M, Alegkakis A, Vlassiadis K, Lazopoulos G. Demographic and clinical predictors of post-operative atrial fibrillation in cardio-surgical patients. Eur J Cardiovasc Nurs 2023; 22:98-106. [PMID: 35672278 DOI: 10.1093/eurjcn/zvac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 01/14/2023]
Abstract
AIMS Post-operative atrial fibrillation is defined as an episode of atrial fibrillation that occurs 1-5 days after a surgical procedure in patients without a previous history of atrial fibrillation. Multiple factors such as demographics, cardiac surgical, endogenous, or mental health may relate to post-operative atrial fibrillation.The aim of this study was to identify multivariable high-risk factors for post-operative atrial fibrillation and to propose a risk-assessment tool. METHODS AND RESULTS A cross-sectional observational study was conducted in a University Hospital of Greece. Predictor variables examined demographic and clinical variables, anxiety, depression, health-related quality of life, frailty, perioperative mortality (European System for Cardiac Operative Risk Evaluation II), and 10-year survival/mortality risk (Charlson Comorbidity Index score). The outcome variable was post-operative atrial fibrillation. Multivariable analysis was assessed to identify predictors of post-operative atrial fibrillation.Ninety-one patients were included in our sample. Post-operative atrial fibrillation was diagnosed in 44 (48.4%). Factors associated with post-operative atrial fibrillation are the following: age group of 66-75 years [OR 5.78, 95% confidence interval (CI) 1.37-24.34], Charlson Comorbidity Index score (OR 1.42, 95% CI 1.07-1.89), and hours of mechanical ventilation (OR 1.03, 95% CI 1.00-1.06). The Charlson Comorbidity Index score was identified as an independent predictor of post-operative atrial fibrillation (exp: 1.412, 95% CI: 1.017-1.961). CONCLUSION Patients with post-operative atrial fibrillation had a higher Charlson Comorbidity Index score. The Charlson Comorbidity Index was identified as an independent clinical predictor of post-operative atrial fibrillation. The risk-assessment tool proposed includes age, Charlson Comorbidity Index score, and hours of mechanical ventilation. Future studies are needed to establish such an assessment.
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Affiliation(s)
- Evangelia Samaritaki
- School of Medicine, Department of Surgery, University of Crete, Crete, Greece.,Cardiac Surgery Department, University Hospital of Heraklion, Crete, Greece
| | - Ioanna Tsiligianni
- School of Medicine, Department of Social Medicine, University of Crete, Crete, Greece
| | - Maria Basta
- School of Medicine, Department of Psychiatry, University of Crete, Crete, Greece.,Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Athanasios Alegkakis
- School of Medicine, Department of Toxicology, University of Crete, Crete, Greece
| | - Konstantinos Vlassiadis
- School of Medicine, Laboratory of Health Planning, University of Crete, Crete, Greece.,Dental Clinic, University Hospital of Heraklion, Crete, Greece
| | - Georgios Lazopoulos
- School of Medicine, Department of Surgery, University of Crete, Crete, Greece.,Cardiac Surgery Department, University Hospital of Heraklion, Crete, Greece
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Bizhanov KA, Аbzaliyev KB, Baimbetov AK, Sarsenbayeva AB, Lyan E. Atrial fibrillation: Epidemiology, pathophysiology, and clinical complications (literature review). J Cardiovasc Electrophysiol 2023; 34:153-165. [PMID: 36434795 DOI: 10.1111/jce.15759] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/25/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
The last three decades have been characterized by an exponential increase in knowledge and advances in the clinical management of atrial fibrillation. The purpose of the study is to provide an overview of the pathogenesis of nonvalvular atrial fibrillation and a comprehensive investigation of the epidemiological data associated with various risk factors for atrial fibrillation. The leading research methods are analysis and synthesis, comparison, observation, induction and deduction, and grouping method. Research has shown that old age, male gender, and European descent are important risk factors for developing atrial fibrillation. Other modifiable risk factors include a sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and high blood pressure predisposing to atrial fibrillation, and each has been shown to induce structural and electrical atrial remodeling. Both heart failure and myocardial infarction increase the risk of developing atrial fibrillation and vice versa creating feedback that increases mortality. The review is a comprehensive study of the epidemiological data linking nonmodifiable and modifiable risk factors for atrial fibrillation, and the pathophysiological data supporting the relationship between each risk factor and the occurrence of atrial fibrillation. This may be necessary for the practice of the treatment of the cardiac system.
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Affiliation(s)
- Kenzhebek A Bizhanov
- Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan.,Department of Interventional Cardiology and Arrhythmology, National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Republic of Kazakhstan
| | - Kuat B Аbzaliyev
- Сonsultative and Diagnostic Center, Research Institute of Cardiology and Internal Diseases, Almaty, Republic of Kazakhstan
| | - Adil K Baimbetov
- Department of Interventional Cardiology and Arrhythmology, National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Republic of Kazakhstan
| | - Akmoldir B Sarsenbayeva
- Department of Interventional Cardiology and Arrhythmology, National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Republic of Kazakhstan
| | - Evgeny Lyan
- Cardiovascular Center, University Clinic Schleswig-Holstein, Kiel, Germany
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7
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Vest BM, Quigley BM, Lillvis DF, Horrigan-Maurer C, Firth RS, Curtis AB, Lackner JM. Comparing Patient and Provider Experiences with Atrial Fibrillation to Highlight Gaps and Opportunities for Improving Care. J Gen Intern Med 2022; 37:3105-3113. [PMID: 34993876 PMCID: PMC9485399 DOI: 10.1007/s11606-021-07303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF), the most common abnormal heart rhythm, places a considerable burden on patients, providers, and the US healthcare system. OBJECTIVE The purpose of this qualitative study was to compare patients' and providers' interpretations and responses to AF symptoms and to identify where treatment can be improved to better address patient needs and well-being. DESIGN Qualitative design using focus groups with patients (3 groups) and providers (3 groups). PARTICIPANTS Patients with physician-confirmed AF (n=29) and cardiologists, primary care physicians, and cardiac nurses (n=24). APPROACH Focus groups elicited patient and provider perspectives regarding the symptom experience of AF, treatment goals, and gaps in care. Patient and provider transcripts were analyzed separately, using a thematic content analysis approach, and then compared. KEY RESULTS While patients and providers described similar AF symptoms, patients' illness experiences included a wider range of symptoms that elicited anxiety and impacted quality of life (QOL) across many biopsychosocial domains. Patients and providers prioritized different treatment goals. Providers tended to focus on controlling symptoms congruent with objective findings, minimizing stroke risk, and restoring sinus rhythm. Patients focused on improving QOL by reducing medication use or procedures. Both patients and providers struggled with patients' cardiac-related anxiety. Patients expressed an unmet need for education and support. CONCLUSION Patients with AF experience a range of symptoms and QOL issues. While guidelines recommend shared-decision making, discordance between patient and provider perspectives on the importance, priority, and impact of patients' perceived AF symptoms and consequent cardiac anxiety may result in differing treatment priorities. Starting from a perspective that contextualizes AF in the broader context of patients' lives, prioritizes QOL, and addresses symptom-specific anxiety as a prime concern may better address patients' unmet needs.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Brian M Quigley
- Division of Behavioral Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Denise F Lillvis
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Caroline Horrigan-Maurer
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rebecca S Firth
- Division of Behavioral Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Anne B Curtis
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jeffrey M Lackner
- Division of Behavioral Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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8
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Titova OE, Baron JA, Michaëlsson K, Larsson SC. Anger frequency and risk of cardiovascular morbidity and mortality. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac050. [PMID: 36117950 PMCID: PMC9472789 DOI: 10.1093/ehjopen/oeac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 11/14/2022]
Abstract
Aims Anger may increase the risk of cardiovascular diseases (CVDs) but previous findings are inconclusive and large prospective studies are needed. We investigated whether frequency of strong anger is associated with the incidence of specific CVDs and CVD mortality, and if sex, age, and cardiometabolic risk factors modify these associations. Methods and results We used data from a population-based cohort of 47 077 Swedish adults (56–94 years of age) who completed questionnaires regarding their experience of anger, lifestyle habits, and health characteristics. Participants were followed for incident cardiovascular outcomes and death up to 9 years through linkage to the Swedish National Patient and Death Registers. Hazard ratios and confidence intervals adjusted for potential confounders were assessed. In multivariable analyses, frequent episodes of strong anger were associated with an increased risk of heart failure, atrial fibrillation, and CVD mortality [hazard ratios (95% confidence intervals) = 1.19 (1.04–1.37), 1.16 (1.06–1.28), and 1.23 (1.09–1.40), respectively]. The link between anger frequency and heart failure was more pronounced in men and participants with a history of diabetes. No evidence of an independent association of anger frequency with risk of myocardial infarction, aortic valve stenosis, and abdominal aortic aneurysm was found. Conclusion Our findings indicate that anger may contribute to the development of specific CVDs and CVD mortality, especially heart failure in men and in those with diabetes.
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Affiliation(s)
- Olga E Titova
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden
| | - John A Baron
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden
- Department of Medicine, University of North Carolina School of Medicine , Chapel Hill, NC , USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, NC , USA
| | - Karl Michaëlsson
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden
| | - Susanna C Larsson
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
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9
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Fu Y, Feng S, Xu Y, Yang Y, Chen H, He W, Zhu W, Yin K, Xue Z, Wei B. Association of Depression, Antidepressants With Atrial Fibrillation Risk: A Systemic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:897622. [PMID: 35647056 PMCID: PMC9130653 DOI: 10.3389/fcvm.2022.897622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Depression is a possible influence factor for the increased risk of incident atrial fibrillation (AF). Although several investigations have assessed their association, the results are still controversial. Therefore, we conducted a meta-analysis to evaluate the association between depression or using antidepressants and AF. Methods We systemically performed the literature retrieval from two electronic databases PubMed and EMBASE until March 2022 to extract relevant data. The hazard ratios (HRs) and odds ratios (OR) from included studies with 95% confidence intervals (CIs) were adjusted into the risk ratio (RR) and pooled by using the random-effects model. Results Totally 9 studies about the associations between depression or antidepressants and incident AF risk were included in this meta-analysis. Among them, 5 studies specifically analyzed the impact of antidepressants on the risk of AF. The outcomes of our analysis indicated that depression or depressive symptoms could increase AF risk (RR = 1.15, 95% CI, 1.03–1.27, P < 0.01). In addition, the use of antidepressants can also increase AF risk (RR = 1.16, 95% CI, 1.07–1.25, P < 0.001). These results remained unchanged when we remove the source of heterogeneity or adjust the analysis model into the fixed-effects model. Conclusions Based on existing investigations, both depression and the use of antidepressants are closely related to the increase of incident AF risk.
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Affiliation(s)
- Yonghui Fu
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
| | - Shenghui Feng
- Department of Medical, Queen Mary School, Nanchang University, Nanchang, China
| | - Yingxiang Xu
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
| | - Yuanjian Yang
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
| | - Haibo Chen
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
| | - Wenfeng He
- Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kang Yin
- Department of Critial Care Medicine, The First Affiliated Hosptial of Gannan Medical University, Ganzhou, China
| | - Zhengbiao Xue
- Department of Critial Care Medicine, The First Affiliated Hosptial of Gannan Medical University, Ganzhou, China
- *Correspondence: Zhengbiao Xue
| | - Bo Wei
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
- Bo Wei
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10
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Cao Y, Zhou M, Guo H, Zhu W. Associations of Antidepressants With Atrial Fibrillation and Ventricular Arrhythmias: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:840452. [PMID: 35402536 PMCID: PMC8990315 DOI: 10.3389/fcvm.2022.840452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Several published studies have disagreements on whether the use of antidepressants is associated with increased risk of arrhythmias. In this study, we performed this meta-analysis to assess the association of antidepressants with cardiac arrhythmias in patients who require antidepressants. Methods The PubMed and Embase databases were systematically searched until December 2021 to find studies that investigated the association between antidepressant use and cardiac arrhythmias. Studies that assessed the effects of any antidepressant on arrhythmias in patients who require antidepressants compared with those who require no antidepressants were included. We used a random-effects model to pool the adjusted risk ratios (RRs) and 95% confidence intervals (CIs). The stability of the results was examined by omitting an individual study at a time. Results A total of 3,396 studies were screened and 6 studies with 2,626,746 participants were finally included in this meta-analysis. When compared with no antidepressants, the use of antidepressants was significantly associated with an increased risk of atrial fibrillation (RR = 1.37, 95% CI: 1.16–1.61). However, there was no difference in the risk of ventricular arrhythmias or sudden cardiac death (RR = 1.33, 95% CI: 0.88–2.01) between the two studied groups. In the subgroup analysis, tricyclic antidepressants (RR = 1.12, 95% CI: 0.89–1.41), selective serotonin reuptake inhibitors (RR = 1.46, 95% CI: 0.63–3.38), and selective serotonin reuptake inhibitors (RR = 0.99, 95% CI: 0.97–1.01) did not increase the risk of ventricular arrhythmias and/or sudden cardiac death. Conclusion Recently published data suggested that the use of antidepressants did not increase the risk of ventricular arrhythmias or sudden cardiac death. Antidepressants were associated with an increased risk of atrial fibrillation but that still needs further confirmation.
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Affiliation(s)
- Yalin Cao
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Mingyu Zhou
- Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Huaiyun Guo
- College of Pharmacy, Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wengen Zhu
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Sadlonova M, Senges J, Nagel J, Celano C, Klasen-Max C, Borggrefe M, Akin I, Thomas D, Schwarzbach CJ, Kleeman T, Schneider S, Hochadel M, Süselbeck T, Schwacke H, Alonso A, Haass M, Ladwig KH, Herrmann-Lingen C. Symptom Severity and Health-Related Quality of Life in Patients with Atrial Fibrillation: Findings from the Observational ARENA Study. J Clin Med 2022; 11:jcm11041140. [PMID: 35207412 PMCID: PMC8877113 DOI: 10.3390/jcm11041140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with impaired health-related quality of life (HRQoL), high symptom severity, and poor cardiovascular outcomes. Both clinical and psychological factors may contribute to symptom severity and HRQoL in AF. Methods: Using data from the observational Atrial Fibrillation Rhine-Neckar Region (ARENA) trial, we identified medical and psychosocial factors associated with AF-related symptom severity using European Heart Rhythm Association symptom classification and HRQoL using 5-level EuroQoL- 5D. Results: In 1218 AF patients (mean age 71.1 ± 10.5 years, 34.5% female), female sex (OR 3.7, p < 0.001), preexisting coronary artery disease (CAD) (OR 1.7, p = 0.020), a history of cardioversion (OR 1.4, p = 0.041), cardiac anxiety (OR 1.2; p < 0.001), stress from noise (OR 1.4, p = 0.005), work-related stress (OR 1.3, p = 0.026), and sleep disturbance (OR 1.2, p = 0.016) were associated with higher AF-related symptom severity. CAD (β = −0.23, p = 0.001), diabetes mellitus (β = −0.25, p < 0.001), generalized anxiety (β = −0.30, p < 0.001), cardiac anxiety (β = −0.16, p < 0.001), financial stress (β = −0.11, p < 0.001), and sleep disturbance (β = 0.11, p < 0.001) were associated with impaired HRQoL. Conclusions: Psychological characteristics, preexisting CAD, and diabetes may play an important role in the identification of individuals at highest risk for impaired HRQoL and high symptom severity in patients with AF.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany; (J.N.); (C.K.-M.); (C.H.-L.)
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, 37075 Gottingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 37075 Gottingen, Germany
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: ; Tel.: +1-(617)-643-0119
| | - Jochen Senges
- Institute of Myocardial Infarction Research, Hospital of Ludwigshafen, 67063 Ludwigshafen, Germany; (J.S.); (S.S.); (M.H.)
| | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany; (J.N.); (C.K.-M.); (C.H.-L.)
| | - Christopher Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
| | - Caroline Klasen-Max
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany; (J.N.); (C.K.-M.); (C.H.-L.)
| | - Martin Borggrefe
- Department of Cardiology, Pneumology, Angiology, and Emergency Medicine, University of Mannheim Medical Center, 68167 Mannheim, Germany; (M.B.); (I.A.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany;
| | - Ibrahim Akin
- Department of Cardiology, Pneumology, Angiology, and Emergency Medicine, University of Mannheim Medical Center, 68167 Mannheim, Germany; (M.B.); (I.A.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany;
| | - Dierk Thomas
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany;
- Department of Internal Medicine III—Cardiology, Angiology and Pneumology, Medical University, Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | | | - Steffen Schneider
- Institute of Myocardial Infarction Research, Hospital of Ludwigshafen, 67063 Ludwigshafen, Germany; (J.S.); (S.S.); (M.H.)
| | - Matthias Hochadel
- Institute of Myocardial Infarction Research, Hospital of Ludwigshafen, 67063 Ludwigshafen, Germany; (J.S.); (S.S.); (M.H.)
| | | | - Harald Schwacke
- Diakonissen-Stiftungs-Hospital Speyer, 67346 Speyer, Germany;
| | - Angelika Alonso
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Markus Haass
- Department of Cardiology, Theresien Hospital and St. Hedwig Clinic GmbH, 68165 Mannheim, Germany;
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University Munich, 81675 Munich, Germany;
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81675 Munich, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany; (J.N.); (C.K.-M.); (C.H.-L.)
- German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 37075 Gottingen, Germany
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12
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Du H, Yang L, Hu Z, Zhang H. Anxiety is associated with higher recurrence of atrial fibrillation after catheter ablation: A meta‐analysis. Clin Cardiol 2022; 45:243-250. [PMID: 35043425 PMCID: PMC8922539 DOI: 10.1002/clc.23753] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 12/20/2022] Open
Abstract
Previous studies that evaluated the influence of anxiety on recurrence of atrial fibrillation (AF) after catheter ablation showed inconsistent results. We performed a meta‐analysis of cohort study to systematically evaluate the association between anxiety and AF recurrence after catheter ablation. Electronic databases of PubMed, Embase, and Web of Science were searched for relevant cohort studies from inception to January 20, 2021. We applied the random‐effect model to combine the results to incorporate the potential influence of heterogeneity among studies. Five cohort studies were eligible for the meta‐analysis, which included 549 patients with AF that received catheter ablation. No significant heterogeneity was observed among the included studies (I2 = 7%, P for Cochrane's Q test = 0.37). During a mean follow‐up of 9.7 months, 216 (39.3%) cases of recurrent AF occurred. Results of the meta‐analysis showed that anxiety was independently associated with an increased risk of AF recurrence after catheter ablation (adjusted relative risk: 2.36, 95% confidence interval: 1.71–3.26; p < .001). Subgroup analyses did not show that differences in study characteristics including study design, ethnicity of the patients, sample size, AF type, anxiety evaluation method, follow‐up duration, or adjustment of LAD may significantly affect the association between anxiety and AF recurrence (p for subgroup difference all > .10). Anxiety may be an independent risk factor for AF recurrence after catheter ablation. Whether alleviating anxiety mood could reduce the risk of AF recurrence after catheter ablation should also be investigated.
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Affiliation(s)
- Hong Du
- Department of Cardiology Second Hospital of Hebei Medical University Shijiazhuang China
| | - Lei Yang
- Department of Neurosurgery Shijiazhuang People's Hospital Shijiazhuang China
| | - Zheng Hu
- Department of Cardiology Second Hospital of Hebei Medical University Shijiazhuang China
| | - Hui Zhang
- Department of Cardiology Second Hospital of Hebei Medical University Shijiazhuang China
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13
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Kranert M, Benz ABE, Shchetynska-Marinova T, Hetjens S, Liebe V, Rosenkaimer S, Doesch C, Akin I, Borggrefe M, Hohneck A. Perception of atrial fibrillation in dependence of neuroticism. J Psychosom Res 2020; 138:110225. [PMID: 32877820 DOI: 10.1016/j.jpsychores.2020.110225] [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] [Received: 04/08/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Atrial fibrillation (AF) is associated with a varying symptom burden, which ranges from completely unawareness to disabling conditions. The present cross-sectional study tried to assess if neuroticism is associated with a greater degree of perception of AF related symptoms. METHODS 162 patients who were considered for catheter ablation of AF were included. AF related symptom burden was quantified according to the European Heart Rhythm Association (EHRA) score. Personality traits were assessed using the Big Five personality traits (5BT). RESULTS Female patients reported higher symptom burden. Higher EHRA scores were furthermore associated with treatment with antiarrhythmic agents, digitalis, direct oral anticoagulants (DOAC), and antidepressant treatment, as well as suffering from heart failure or chronic kidney disease. Neuroticism showed a positive correlation to AF related symptom burden with significantly higher neuroticism scores in patients with higher EHRA scores (Rho = 0.41; 95%CI 0.26 to 0.53; p < .001), while no association was demonstrated for the other four personality traits. Multiple linear regression analysis revealed neuroticism as strongest independent predictor for symptomatic AF, followed by treatment with antiarrhythmic agents and DOAC. CONCLUSIONS Perception of AF related symptoms is a multifactorial process, which in our cohort was independently associated with neuroticism. Patients with higher symptom burden were also more likely to receive antiarrhythmic agents and DOAC, as well as antidepressants. TRIAL REGISTRATION German registry for clinical studies (DRKS), DRKS00019007.
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Affiliation(s)
- Malte Kranert
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | | | - Tetyana Shchetynska-Marinova
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Svetlana Hetjens
- Department of Biometry and Statistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Volker Liebe
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stephanie Rosenkaimer
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christina Doesch
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Anna Hohneck
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
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