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Chander S, Kumari R, Luhana S, Shiwlani S, Parkash O, Sorath F, Wang HY, Tan S, Rahaman Z, Mohammed YN, Lohana AC, Sakshi F, Vaish E, Sadarat F. Antiarrhythmic drug therapy and catheter ablation in patients with paroxysmal or persistent atrial fibrillation: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:321. [PMID: 38918704 PMCID: PMC11197351 DOI: 10.1186/s12872-024-03983-z] [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] [Received: 12/20/2023] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Catheter ablation and antiarrhythmic drug therapy are utilized for rhythm control in atrial fibrillation (AF), but their comparative effectiveness, especially with contemporary treatment modalities, remains undefined. We conducted a systematic review and meta-analysis contrasting current ablation techniques against antiarrhythmic medications for AF. METHODS We searched PubMed, SCOPUS, Cochrane CENTRAL, and Web of Science until November 2023 for randomized trials comparing AF catheter ablation with antiarrhythmics, against antiarrhythmic drug therapy alone, reporting outcomes for > 6 months. Four investigators extracted data and appraised risk of bias (ROB) with ROB 2 tool. Meta-analyses estimated pooled efficacy and safety outcomes using R software. RESULTS Twelve trials (n = 3977) met the inclusion criteria. Catheter ablation was associated with lower AF recurrence (relative risk (RR) = 0.44, 95%CI (0.33, 0.59), P ˂ 0.0001) and hospitalizations (RR = 0.44, 95%CI (0.23, 0.82), P = 0.009) than antiarrhythmic medications. Catheter ablation also improved the physical quality of life component score (assessed by a 36-item Short Form survey) by 7.61 points (95%CI -0.70-15.92, P = 0.07); but, due to high heterogeneity, it was not statistically significant. Ablation was significantly associated with higher procedural-related complications [RR = 15.70, 95%CI (4.53, 54.38), P < 0.0001] and cardiac tamponade [RR = 9.22, 95%CI (2.16, 39.40), P = 0.0027]. All-cause mortality was similar between the two groups. CONCLUSIONS For symptomatic AF, upfront catheter ablation reduces arrhythmia and hospitalizations better than continued medical therapy alone, albeit with moderately more adverse events. Careful patient selection and risk-benefit assessment are warranted regarding the timing of ablation.
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Affiliation(s)
- Subhash Chander
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA.
| | - Roopa Kumari
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA
| | - Sindhu Luhana
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA
| | - Sheena Shiwlani
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA
| | - Om Parkash
- Department of Medicine, Montefiore Medical Centre, Wakefield, NY, USA
| | - Fnu Sorath
- Department of Anesthesiology, Dow University Health Sciences, Karachi, Pakistan
| | - Hong Yu Wang
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA
| | - Sam Tan
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA
| | - Zubair Rahaman
- Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Abhi Chand Lohana
- Department of Medicine, WVU, Camden Clark Medical Centre, Parkersburg, WV, USA
| | - Fnu Sakshi
- Department of Medicine, Piedmont Augusta Hospital, Augusta, GA, USA
| | - Esha Vaish
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York City, NY, USA
| | - Fnu Sadarat
- Department of Medicine, University at Buffalo, Buffalo, NY, USA
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Shoureshi P, Tan AY, Koneru J, Ellenbogen KA, Kaszala K, Huizar JF. Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:2214-2232. [PMID: 38811098 DOI: 10.1016/j.jacc.2024.03.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/31/2024]
Abstract
Arrhythmias frequently accompany heart failure and left ventricular dysfunction. Tachycardias, atrial fibrillation, and premature ventricular contractions can induce a reversible form of dilated cardiomyopathy (CM) known as arrhythmia-induced CM (AiCM). The intriguing question is why certain individuals are more susceptible to AiCM, despite similar arrhythmia burdens. The primary challenge is determining the extent of arrhythmias' contribution to left ventricular systolic dysfunction. AiCM should be considered in patients with a mean heart rate of >100 beats/min, atrial fibrillation, or a PVC burden of >10%. Confirmation of AiCM occurs when CM reverses upon eliminating the responsible arrhythmia. Therapy choice depends on the specific arrhythmia, patient comorbidities, and preferences. After left ventricular function is restored, ongoing follow-up is essential if an abnormal myocardial substrate persists. Accurate diagnosis and treatment of AiCM have the potential to enhance patients' quality of life, improve clinical outcomes, and reduce hospital admissions and overall health care costs.
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Affiliation(s)
- Pouria Shoureshi
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Alex Y Tan
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Jayanthi Koneru
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | | | - Karoly Kaszala
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Jose F Huizar
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA.
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Attachaipanich T, Thiravetyan B, Tribuddharat N, Jaroonpipatkul S, Navaravong L. Premature Ventricular Contraction-Induced Cardiomyopathy: Contemporary Evidence from Risk Stratification, Pathophysiology, and Management. J Clin Med 2024; 13:2635. [PMID: 38731164 PMCID: PMC11084868 DOI: 10.3390/jcm13092635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Premature ventricular complexes (PVCs) are commonly encountered problems in clinical settings. The range of symptoms can be from asymptomatic to palpitations, fatigue, or heart failure symptoms. A higher burden of PVCs is a risk factor for development of PVC-induced cardiomyopathy (PIC). Rhythm evaluation by 12-lead ECG and an ambulatory monitoring device are essential. Currently, several imaging modalities, such as echocardiography and cardiac magnetic resonance imaging, are utilized to evaluate the underlying structure that may be related to PIC. Beta blockers and antiarrhythmic drugs are typically part of the initial management strategy. If these fail, catheter ablation of PVCs is typically the next step. The purpose of this article is to summarize the current evidence/knowledge about PIC.
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Affiliation(s)
- Tanawat Attachaipanich
- Cardiac Electrophysiology Research and Training Center, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Ben Thiravetyan
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | | | - Surachat Jaroonpipatkul
- Division of Cardiology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand;
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Zakharov IP, Chomakhidze PS, Kopylov FY, Sultygova EA, Mesitskaya DF, Lyubimova EA, Andreev DA. Determining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fraction. KARDIOLOGIIA 2024; 64:25-33. [PMID: 38597759 DOI: 10.18087/cardio.2024.3.n2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/23/2023] [Indexed: 04/11/2024]
Abstract
AIM To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain. MATERIAL AND METHODS Data of 168 patients with stage I-III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode. RESULTS During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7-1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample. CONCLUSION Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.
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Affiliation(s)
| | | | | | | | | | | | - D A Andreev
- Sechenov First Moscow State Medical University
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5
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Kheshti F, Abdollahifard S, Hosseinpour A, Bazrafshan M, Attar A. Ablation versus medical therapy for patients with atrial fibrillation: An updated meta-analysis. Clin Cardiol 2024; 47:e24184. [PMID: 37937825 PMCID: PMC10826237 DOI: 10.1002/clc.24184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
To investigate the effect of ablation compared to medical therapy on clinical outcomes of patients with atrial fibrillation (AF). PubMed, Scopus, Embase, and Web of Science databases were searched using ablation, medical treatment, AF, and related words. The effect of ablation and medical therapy was sought to be gathered on stroke or transitional ischemic attack, mortality, hospitalization, recurrence of AF, progression of AF, and left ventricular ejection fraction. Analyses were performed using R software. 31 studies (the results of 27 randomized controlled trials), compromising an overall 6965 patients (Ablation, n = 3643; Medical treatment, n = 3322) were reviewed in our study, revealed that catheter ablation would result in substantial benefits for patients with AF without significant difference in serious adverse events compared to medical management (Risk Ratio: 0.92, [95% Confidence Interval (CI), 0.64-1.33]). Catheter ablation in patients with AF significantly resulted in a 29% reduction in all-cause mortality (RR: 0.71, [95% CI, 0.57-0.88]), a 57% reduction in hospitalization (RR: 0.43, [95% CI, 0.27-0.67]), a 53% reduction in AF recurrence (RR: 0.47, [95% CI, 0.36-0.61]), and a dramatic reduction, 89%, in progression of paroxysmal to persistent AF (RR: 0.11, [95% CI, 0.02-0.65]); also associated with a remarkable improvement in their left ventricular ejection fraction (LVEF) (Mean Difference, MD: 6.84%, [95% CI, 3.27-10.42]) compared to medical therapy. Our study showed that ablation may be superior to medical therapy in patients with AF regarding AF recurrence, mortality, LVEF improvement, hospitalization, and AF progression outcomes.
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Affiliation(s)
- Fatemeh Kheshti
- Department of Cardiovascular Medicine, School of MedicineShiraz University of Medical SciencesShirazIran
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Saeed Abdollahifard
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
- Research Center for Neuromodulation and PainShirazIran
| | - Alireza Hosseinpour
- Department of Cardiovascular Medicine, School of MedicineShiraz University of Medical SciencesShirazIran
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Mehdi Bazrafshan
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Armin Attar
- Department of Cardiovascular Medicine, School of MedicineShiraz University of Medical SciencesShirazIran
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Braghieri L, Younis A, Tabaja C, Santangeli P, Taigen T, Saliba WI, Wazni OM, Hussein AA. Quality of Life Outcomes of Atrial Fibrillation Ablation in Heart Failure With Preserved or Mildly Reduced Left Ventricular Systolic Function. Am J Cardiol 2023; 225:22-24. [PMID: 38160919 DOI: 10.1016/j.amjcard.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Arwa Younis
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chadi Tabaja
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Pasquale Santangeli
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tyler Taigen
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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Barefield DY, Tonino P, Woulfe KC, Rahmanseresht S, O’Leary TS, Burnham HV, Wasserstrom JA, Kirk JA, Previs MJ, Granzier HL, McNally EM. Myosin-binding protein H-like regulates myosin-binding protein distribution and function in atrial cardiomyocytes. Proc Natl Acad Sci U S A 2023; 120:e2314920120. [PMID: 38091294 PMCID: PMC10741380 DOI: 10.1073/pnas.2314920120] [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: 09/01/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
Mutations in atrial-enriched genes can cause a primary atrial myopathy that can contribute to overall cardiovascular dysfunction. MYBPHL encodes myosin-binding protein H-like (MyBP-HL), an atrial sarcomere protein that shares domain homology with the carboxy-terminus of cardiac myosin-binding protein-C (cMyBP-C). The function of MyBP-HL and the relationship between MyBP-HL and cMyBP-C is unknown. To decipher the roles of MyBP-HL, we used structured illumination microscopy, immuno-electron microscopy, and mass spectrometry to establish the localization and stoichiometry of MyBP-HL. We found levels of cMyBP-C, a major regulator of myosin function, were half as abundant compared to levels in the ventricle. In genetic mouse models, loss of MyBP-HL doubled cMyBP-C abundance in the atria, and loss of cMyBP-C doubled MyBP-HL abundance in the atria. Structured illumination microscopy showed that both proteins colocalize in the C-zone of the A-band, with MyBP-HL enriched closer to the M-line. Immuno-electron microscopy of mouse atria showed MyBP-HL strongly localized 161 nm from the M-line, consistent with localization to the third 43 nm repeat of myosin heads. Both cMyBP-C and MyBP-HL had less-defined sarcomere localization in the atria compared to ventricle, yet areas with the expected 43 nm repeat distance were observed for both proteins. Isometric force measurements taken from control and Mybphl null single atrial myofibrils revealed that loss of Mybphl accelerated the linear phase of relaxation. These findings support a mechanism where MyBP-HL regulates cMyBP-C abundance to alter the kinetics of sarcomere relaxation in atrial sarcomeres.
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Affiliation(s)
- David Y. Barefield
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, IL60153
| | - Paola Tonino
- Department of Cell and Molecular Medicine, University of Arizona, Tucson, AZ85724
| | - Kathleen C. Woulfe
- Division of Cardiology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO80045
| | - Sheema Rahmanseresht
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT01655
| | - Thomas S. O’Leary
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT01655
| | - Hope V. Burnham
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, IL60153
| | - J. Andrew Wasserstrom
- Department of Medicine and The Feinberg Cardiovascular and Renal Institute, Northwestern University Feinberg School of Medicine, Chicago, IL60611
| | - Jonathan A. Kirk
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, IL60153
| | - Michael J. Previs
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT01655
| | - Henk L. Granzier
- Department of Cell and Molecular Medicine, University of Arizona, Tucson, AZ85724
| | - Elizabeth M. McNally
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
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8
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Takahashi M, Arai T, Kimura T, Hojo R, Hiraoka M, Fukamizu S. Relationship between coronary blood flow and improvement of cardiac function after catheter ablation for persistent atrial fibrillation. J Interv Card Electrophysiol 2023; 66:2063-2070. [PMID: 37043092 DOI: 10.1007/s10840-023-01542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND The relationship between coronary blood flow during atrial fibrillation (AF) and improvement of cardiac function after catheter ablation (CA) for persistent AF (PeAF) is not prominent; this study was conducted to evaluate this relationship. METHODS This was a retrospective case-control study. Eighty-five patients with PeAF (resting heart rate < 100 bpm) and heart failure with reduced ejection fraction (left ventricular ejection fraction (LVEF) < 40%) who had undergone coronary angiography within 1 week before CA were included. All patients could maintain a sinus rhythm for > 6 months after CA. The primary outcome was improvement of cardiac function with an LVEF cutoff value of > 50% during sinus rhythm 6 months after CA. RESULTS In the LVEF improvement group (N = 57), patients were younger, with a higher baseline diastolic blood pressure and lower baseline brain natriuretic peptide level than the no LVEF improvement group (N = 28). Heart rate at baseline and 6 months after CA and AF duration did not differ between the two groups. Thrombolysis in myocardial infarction frame count parameters was significantly higher in the LVEF improvement (P < 0.001) than in the no LVEF improvement group. Multivariate logistic regression analysis revealed mean thrombolysis in myocardial infarction frame count as an independent factor for LVEF improvement (odds ratio, 1.72 (95% confidence interval 1.17-2.54); P = 0.006). CONCLUSION Coronary blood flow in patients with PeAF is strongly associated with improved left ventricular systolic function after the restoration of sinus rhythm by CA for PeAF and heart failure with reduced ejection fraction.
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Affiliation(s)
- Masao Takahashi
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
| | - Tomoyuki Arai
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Takashi Kimura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | | | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
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9
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Chacko P, Bhuta S, Meenakshisundaram C, Moustafa A, Davis A, Gupta R. Prevalence of Heart Failure With Preserved Ejection Fraction in Patients Undergoing Atrial Fibrillation Ablation Based on Resting and Post-Tachycardia Pacing Left Atrial Pressure. Am J Cardiol 2023; 205:445-450. [PMID: 37666016 DOI: 10.1016/j.amjcard.2023.07.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 09/06/2023]
Abstract
Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) are frequent co-morbid conditions. In patients with symptomatic AF and preserved left ventricular ejection fraction the clinical diagnosis of HFpEF may be difficult, as history, examination, and echocardiography are not sensitive or specific. This study sought to assess the prevalence of HFpEF in patients undergoing AF ablation utilizing resting and post-tachycardia pacing left atrial pressure (LAP) measurements. This retrospective cohort study consisted of consecutive patients with symptomatic AF and preserved left ventricular ejection fraction who had invasive hemodynamic assessment (IHA) of LAP under resting and post-tachycardia pacing conditions while undergoing AF ablation from 2020 to 2022 at a tertiary care academic medical center. Elevated LAP was defined as ≥15 mm Hg at rest and ≥15 mm Hg post-tachycardia pacing. Patients were stratified into 3 groups: (1) normal resting and post-tachycardia pacing LAP (control group), (2) elevated resting LAP (apparent HFpEF), (3) normal resting but elevated post-tachycardia pacing LAP (occult HFpEF). A total of 78 patients were included with age 64.6 ± 9.1 years, 28 (36%) female, body mass index 33.3 ± 6.5 kg/m2, 5 (6%) paroxysmal and 73 (94%) persistent AF, and CHA2DS2-VASc 3.0 ± 1.5. IHA categorized 31 (40%), 32 (41%), and 15 patients (19%) into groups 1, 2, and 3 respectively. Notably, while only 9 patients (12%) were diagnosed with HFpEF based on clinical evaluation, 47 patients (60%) were diagnosed by IHA. IHA in patients undergoing AF ablation suggests a high prevalence of clinically undiagnosed HFpEF through a novel methodology measuring resting and post-tachycardia pacing LAP.
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Affiliation(s)
- Paul Chacko
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio.
| | - Sapan Bhuta
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
| | | | | | - Alexander Davis
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
| | - Rajesh Gupta
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
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10
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González‐Ferrero T, Bergonti M, López‐Canoa JN, Arias FG, Eiras Penas S, Spera F, González‐Maestro A, Minguito‐Carazo C, Martínez‐Sande JL, González‐Melchor L, García‐Seara FJ, Fernández‐López JA, Álvarez‐Castro E, González‐Juanatey JR, Heidbuchel H, Sarkozy A, Rodríguez‐Mañero M. Atrial fibrillation ablation in patients with arrhythmia-induced cardiomyopathy: a prospective multicentre study. ESC Heart Fail 2023; 10:3055-3066. [PMID: 37593841 PMCID: PMC10567669 DOI: 10.1002/ehf2.14448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/27/2023] [Accepted: 06/08/2023] [Indexed: 08/19/2023] Open
Abstract
AIMS This study aims to investigate the clinical and biochemical characteristics of patients with atrial fibrillation (AF) referred for ablation who develop arrhythmia-induced cardiomyopathy (AiCM) as well as their long-term outcomes after catheter ablation (CA). METHODS AND RESULTS A prospective multicentre study was conducted on consecutive AF patients who underwent CA. AiCM was defined as the development of heart failure in the presence of AF and an improvement of left ventricular fraction by at least 10% at 6 months after ablation. A subgroup of patients underwent peripheral and left atrial blood samples [galectin-3, fatty acid-binding protein 4 (FABP4), and soluble receptor for advanced glycation end products (sRAGE)] at the time of the procedure. Of the 769 patients who underwent AF ablation, 135 (17.56%) met the criteria for AiCM. Independent predictors of AiCM included persistent AF, male gender, left atrial volume, QRS width, active smoking, and chronic kidney disease (CKD). Biomarker analysis revealed that sRAGE, FABP4, and galectin-3 levels were not predictive of AiCM development nor did they differ between groups or predict recurrence. There were no differences in AF recurrence between patients with and without AiCM (30.83% vs. 27.77%; P = 0.392) during a median follow-up of 23.83 months (inter-quartile range 9-36). CONCLUSIONS In the subset of patients referred for AF ablation, the development of AiCM was associated with persistent AF and CKD. Biomarker analysis was not different between groups nor predicted recurrence. Patients with AiCM benefited from ablation, with a significant improvement in left ventricular ejection fraction and similar AF recurrence rates to those without AiCM.
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Affiliation(s)
- Teba González‐Ferrero
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - Marco Bergonti
- Department of CardiologyAntwerp University HospitalAntwerpBelgium
- Cardiovascular Research, GENCORUniversity of AntwerpAntwerpBelgium
- Division of Cardiology, Cardiocentro Ticino InstituteEnte Ospedaliero CantonaleLuganoSwitzerland
| | - José Nicolás López‐Canoa
- CIBERCVCarlos III Health InstituteMadridSpain
- Department of CardiologyUniversity Hospital Complex of PontevedraPontevedraSpain
| | - Federico García‐Rodeja Arias
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - Sonia Eiras Penas
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - Francesco Spera
- Department of CardiologyAntwerp University HospitalAntwerpBelgium
- Cardiovascular Research, GENCORUniversity of AntwerpAntwerpBelgium
| | - Adrián González‐Maestro
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
| | - Carlos Minguito‐Carazo
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - José Luis Martínez‐Sande
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - Laila González‐Melchor
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - Francisco Javier García‐Seara
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - Jesús Alberto Fernández‐López
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - Ezequiel Álvarez‐Castro
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - José Ramón González‐Juanatey
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
| | - Hein Heidbuchel
- Department of CardiologyAntwerp University HospitalAntwerpBelgium
- Cardiovascular Research, GENCORUniversity of AntwerpAntwerpBelgium
| | - Andrea Sarkozy
- Department of CardiologyAntwerp University HospitalAntwerpBelgium
- Cardiovascular Research, GENCORUniversity of AntwerpAntwerpBelgium
| | - Moisés Rodríguez‐Mañero
- Cardiovascular Area and Coronary UnitUniversity Clinical Hospital of Santiago de CompostelaSantiago de CompostelaSpain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS)University Clinical Hospital of Santiago de CompostelaTravesía da Choupana s/nSantiago de Compostela15706A CoruñaSpain
- CIBERCVCarlos III Health InstituteMadridSpain
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11
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Segan L, Chieng D, Sugumar H, Voskoboinik A, Ling LH, Costello B, Azzopardi S, Nderitu Z, Parameswaran R, Amerena J, McLellan AJ, Lee G, Morton J, Joseph S, Wong M, Taylor A, Kalman JM, Kistler PM, Prabhu S. The impact of age on ablation outcomes in AF-mediated cardiomyopathy. J Cardiovasc Electrophysiol 2023; 34:2065-2075. [PMID: 37694615 DOI: 10.1111/jce.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION The absence of ventricular scar in patients with atrial fibrillation (AF) and systolic heart failure (HF) predicts left ventricular (LV) recovery following AF ablation. It is unknown whether age impacts the degree of LV recovery, reverse remodeling, or AF recurrence following catheter ablation (CA) among this population. OBJECTIVES To evaluate the impact of age on LV recovery and AF recurrence in a population with AF and systolic HF without fibrosis (termed AF-mediated cardiomyopathy) following CA. METHODS Consecutive patients undergoing CA between 2013 and 2021 with LV ejection fraction (LVEF) < 45% and absence of cardiac magnetic resonance imaging (CMR) detected LV myocardial fibrosis were stratified by age (<65 vs. ≥65 years). Following CA, participants underwent remote rhythm monitoring for 12 months with repeat CMR for HF surveillance. RESULTS The study population consisted of 70 patients (10% female, mean LVEF 33 ± 9%), stratified into younger (age < 65 years, 63%) and older (age ≥ 65 years, 37%) cohorts. Baseline comorbidities, LVEF (34 ± 9 vs. 33 ± 8 ≥65 years, p = .686), atrial and ventricular dimensions (left atrial volume index: 55 ± 21 vs. 56 ± 14 mL/m2 age ≥ 65, p = .834; indexed left ventricular end-diastolic volume: 108 ± 40 vs. 104 ± 28 mL/m2 age ≥ 65, p = .681), pharmacotherapy and ablation strategy (pulmonary vein isolation in all; posterior wall isolation in 27% vs. 19% age ≥ 65, p = .448; cavotricuspid isthmus in 9% vs. 11.5% age ≥ 65) were comparable (all p > .05) albeit a higher CHADS2 VASc score in the older cohort (2.7 ± 0.9 vs. 1.6 ± 0.6 age < 65, p < .001). Freedom from AF was comparable (hazard ratio: 0.65, 95% confidence interval: 0.38-1.48, LogRank p = .283) as was AF burden [0% (interquartile range, IQR: 0.0-2.1) vs. age ≥ 65: [0% (IQR 0.0-1.7), p = .516], irrespective of age. There was a significant improvement in LV systolic function in both groups (ΔLVEF + 21 ± 14% vs. +21 ± 12% age ≥ 65, p = .913), with LV recovery in the vast majority (73% vs. 69%, respectively, p = .759) at 13 (IQR: 12-16) months. This was accompanied by comparable improvements in functional status (New York Heart Association class p = .851; 6-min walk distance 50 ± 61 vs. 93 ± 134 m in age ≥ 65, p = .066), biomarkers (ΔN-terminal-pro brain natriuretic peptide -139 ± 246 vs. -168 ± 181 age ≥ 65,p = .629) and HF symptoms (Short Form-36 survey Δphysical component summary p = .483/Δmental component summary, p = .841). CONCLUSION In patients undergoing CA for AF with systolic HF in the absence of ventricular scar, comparable improvements in ventricular function, symptoms, and freedom from AF are achieved irrespective of age.
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Affiliation(s)
- Louise Segan
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - David Chieng
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - Hariharan Sugumar
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - Aleksandr Voskoboinik
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
- Western Health, Melbourne, Australia
| | - Liang-Han Ling
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - Ben Costello
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- Western Health, Melbourne, Australia
| | - Sonia Azzopardi
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
| | - Ziporah Nderitu
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
| | - Ramanathan Parameswaran
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
- Barwon Health, Geelong, Australia
| | | | - Alex J McLellan
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | - Geoffrey Lee
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | - Joseph Morton
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | | | - Michael Wong
- University of Melbourne, Melbourne, Australia
- Western Health, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | | | - Jonathan M Kalman
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | - Peter M Kistler
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Cabrini Hospital, Melbourne, Australia
| | - Sandeep Prabhu
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
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12
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Chi R, Shan X, Guan C, Yang H, Wang X, Li B, Zhang Q. Association between systemic inflammatory response index and left ventricular remodeling and systolic dysfunction in atrial fibrillation patients. BMC Cardiovasc Disord 2023; 23:377. [PMID: 37507722 PMCID: PMC10386546 DOI: 10.1186/s12872-023-03403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Cardiac remodeling and dysfunction can be caused by atrial fibrillation (AF). The aim of this research is to investigate the relationship between the systemic inflammatory response index (SIRI) and left ventricular (LV) remodeling and systolic function in individuals with AF. METHODS 416 patients with AF who were admitted to the Second Department of Cardiology in the East Ward of the Qingdao Municipal Hospital between January 2020 and May 2022 were included in the present retrospective research. The relationship between SIRI and various cardiac parameters was analyzed. The patients' left atrial (LA) enlargement and left ventricular (LV) hypertrophy and systolic dysfunction were evaluated. SIRI was calculated by the formula: neutrophil × monocyte/lymphocyte. RESULTS SIRI significantly correlated with LV end-diastolic diameter (LVDd), LV posterior wall thickness at end-diastole (LVPWTd), interventricular septal thickness at end-diastole (IVSTd), LV mass index (LVMI), LV ejection fraction (LVEF), LA diameter (LAD), C-reactive protein (CRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with AF. In multivariate linear regression analyses, SIRI was discovered to be significantly related to LVMI (ln-transformed) (p = 0.025), LVEF (ln-transformed) (p = 0.005), and LAD (ln-transformed) (p = 0.007). In multivariate logistic regression, the highest quartile of SIRI (SIRI > 1.62) was significantly associated with LV hypertrophy (p = 0.026), impaired LV systolic function (p = 0.002), and LA enlargement (p = 0.025). CONCLUSIONS SIRI was significantly associated with LV remodeling and systolic function impairment in patients with AF. SIRI may serve as a reliable and convenient inflammatory biomarker for detecting impaired cardiac structure and systolic function in patients with AF.
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Affiliation(s)
- Runze Chi
- Qingdao Municipal Hospital, Qingdao University Affiliated Qingdao Municipal Hospital, 266011, Qingdao, Shandong, China
| | - Xiaoli Shan
- Qingdao Municipal Hospital, Qingdao University Affiliated Qingdao Municipal Hospital, 266011, Qingdao, Shandong, China
| | - ChunPing Guan
- Qingdao Municipal Hospital, Qingdao University Affiliated Qingdao Municipal Hospital, 266011, Qingdao, Shandong, China
| | - Hao Yang
- Weifang Medical University, 261000, Weifang, Shandong, China
| | - Xiangkun Wang
- Qingdao Municipal Hospital, Qingdao University Affiliated Qingdao Municipal Hospital, 266011, Qingdao, Shandong, China
| | - Bingong Li
- Department of Cardiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 266011, Qingdao, Shandong, China.
| | - Qing Zhang
- Department of Cardiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 266011, Qingdao, Shandong, China.
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13
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Caldarola P, De Iaco F, Pugliese FR, De Luca L, Fabbri A, Riccio C, Scicchitano P, Vanni S, Di Pasquale G, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. ANMCO-SIMEU consensus document: appropriate management of atrial fibrillation in the emergency department. Eur Heart J Suppl 2023; 25:D255-D277. [PMID: 37213798 PMCID: PMC10194824 DOI: 10.1093/eurheartjsupp/suad110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Atrial fibrillation (AF) accounts for 2% of the total presentations to the emergency department (ED) and represents the most frequent arrhythmic cause for hospitalization. It steadily increases the risk of thromboembolic events and is often associated with several comorbidities that negatively affect patient's quality of life and prognosis. AF has a considerable impact on healthcare resources, making the promotion of an adequate and coordinated management of this arrhythmia necessary in order to avoid clinical complications and to implement the adoption of appropriate technological and pharmacological treatment options. AF management varies across regions and hospitals and there is also heterogeneity in the use of anticoagulation and electric cardioversion, with limited use of direct oral anticoagulants. The ED represents the first access point for early management of patients with AF. The appropriate management of this arrhythmia in the acute setting has a great impact on improving patient's quality of life and outcomes as well as on rationalization of the financial resources related to the clinical course of AF. Therefore, physicians should provide a well-structured clinical and diagnostic pathway for patients with AF who are admitted to the ED. This should be based on a tight and propositional collaboration among several specialists, i.e. the ED physician, cardiologist, internal medicine physician, anesthesiologist. The aim of this ANMCO-SIMEU consensus document is to provide shared recommendations for promoting an integrated, accurate, and up-to-date management of patients with AF admitted to the ED or Cardiology Department, in order to make it homogeneous across the national territory.
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Affiliation(s)
| | - Fabio De Iaco
- Pronto Soccorso e Medicina d'Urgenza, A.O. Martini, Via Luigi Ferdinando Marsigli, 84 - 10141 Torino (TO), Italy
| | - Francesco Rocco Pugliese
- U.O.C. Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale Sandro Pertini, Via dei Monti Tiburtini, 385 - 00157 Roma, Italy
| | - Leonardo De Luca
- U.O.C. di Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Cir.ne Gianicolense, 87 - 00152 Rome, Italy
| | - Andrea Fabbri
- Pronto Soccorso e Medicina d'Urgenza-118, Azienda USL della Romagna, Via Carlo Forlanini, 34 - 47121 Forlì, Italy
| | - Carmine Riccio
- U.O.S.D. Follow up del Paziente Post-Acuto, Dipartimento Cardiovascolare, A.O.R.N. Sant'Anna e San Sebastiano, Via Ferdinando Palasciano, 81100 Caserta, Italy
| | - Pietro Scicchitano
- U.O. Cardiologia-UTIC, Ospedale "F. Perinei", SS96 - 70022 Altamura (BA), Italy
| | - Simone Vanni
- S.O.C. Medicina d'Urgenza, Ospedale San Giuseppe, Empoli (FI) e Direttore Area Formazione, Dipartimento di Emergenza e Area Critica, Azienda USL Toscana Centro, Viale Giovanni Boccaccio, 16/20, 50053 Empoli FI, Italy
| | - Giuseppe Di Pasquale
- Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-Romagna, Viale Aldo Moro, 21 - 40127 Bologna, Italy
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Piazza Santa Maria di Gesù, 5 - 95124 Catania, Italy
| | - Domenico Gabrielli
- U.O.C. di Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Cir.ne Gianicolense, 87 - 00152 Rome, Italy
- Fondazione per il Tuo cuore - Heart Care Foundation, Via Alfonso la Marmora, 36- 50121 Firenze, Italy
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3 - 20162 Milano, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Via Giovanni Martinotti, 20 - 00135 Roma, Italy
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14
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Chango Azanza DX, Tenorio C, Picón X, Coello J, Robles J, Pinos J. [Left atrium remodeling after catheter ablation of atrial fibrillation]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:62-67. [PMID: 37780948 PMCID: PMC10538919 DOI: 10.47487/apcyccv.v4i2.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/18/2023] [Indexed: 10/03/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. It has a high association with cardiovascular embolic events and heart failure. Structural and functional changes are a fundamental part of the pathophysiological process, leading to left atrial myopathy and progressive left ventricular dysfunction that modifies the prognosis of patients. We present the case of a 75-year-old patient with symptomatic paroxysmal AF with good functional class who was referred for pulmonary vein ablation after antiarrhythmic therapy failure. The initial echocardiogram showed preserved biventricular systolic function, mild diastolic dysfunction, and normal left atrium (LA) volumes. However, functional LA impairment was observed with decreased reservoir phase strain. Pulmonary vein isolation was successfully performed without evidence of new arrhythmic events, in addition to improvement in LA reservoir strain, left ventricular (LV) global longitudinal strain, and myocardial work index at three months follow-up. The patient has remained asymptomatic and is under clinical follow-up. LA and LV strain as new advanced echocardiography techniques is useful in the assessment of reverse remodeling of atrial myopathy and LV structural assessment.
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Affiliation(s)
- Diego Xavier Chango Azanza
- Servicio de Cardiología, Hospital del Rio, Cuenca, Ecuador. Servicio de Cardiología Hospital del Rio Cuenca Ecuador
- Servicio de Cardiología, Cardiológico del Austro, Cuenca, Ecuador. Servicio de Cardiología Cardiológico del Austro Cuenca Ecuador
| | - Cristina Tenorio
- Servicio de Clínica Médica, Clínica Santa Ana, Cuenca, Ecuador Servicio de Clínica Médica Clínica Santa Ana Cuenca Ecuador
| | - Xavier Picón
- Servicio de Clínica Médica, Clínica Santa Ana, Cuenca, Ecuador Servicio de Clínica Médica Clínica Santa Ana Cuenca Ecuador
| | - Jorge Coello
- Servicio de Clínica Médica, Clínica Santa Ana, Cuenca, Ecuador Servicio de Clínica Médica Clínica Santa Ana Cuenca Ecuador
| | - Jessica Robles
- Servicio de Cardiología, Hospital del Rio, Cuenca, Ecuador. Servicio de Cardiología Hospital del Rio Cuenca Ecuador
| | - Javier Pinos
- Servicio de Cardiología, Hospital del Rio, Cuenca, Ecuador. Servicio de Cardiología Hospital del Rio Cuenca Ecuador
- Servicio de Cardiología, Cardiológico del Austro, Cuenca, Ecuador. Servicio de Cardiología Cardiológico del Austro Cuenca Ecuador
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15
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Shono A, Matsumoto K, Ishii N, Kusunose K, Suzuki M, Shibata N, Suto M, Dokuni K, Takami M, Kiuchi K, Fukuzawa K, Tanaka H, Hirata KI. Ability of Left Atrial Distensibility After Radiofrequency Catheter Ablation to Predict Recurrence of Atrial Fibrillation. Am J Cardiol 2022; 181:59-65. [PMID: 35973835 DOI: 10.1016/j.amjcard.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022]
Abstract
This study sought to assess the left atrial (LA) functional recovery after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) and to evaluate the determining factor of procedural success of RFCA, using a novel preload stress echocardiography. A total of 111 patients with AF were prospectively recruited. The echocardiographic parameters were obtained during the leg-positive pressure (LPP) maneuver, both at baseline and midterm after RFCA. As an index of LA distensibility, the LA expansion index was calculated as (LAVmax - LAVmin) × 100 / LAVmin. During a median follow-up period of 14.2 months, AF recurrence was observed in 23 patients (20.7%). In LA functional parameters at baseline, only the Δ LA expansion index was significantly larger in the success group (16 ± 11% vs 4 ± 9%, p <0.05). At midterm follow-up, the Δ LA expansion index significantly increased to 32 ± 19% (p <0.05), together with structural LA reverse remodeling only in the success group. Moreover, the Δ stroke volume index during the LPP stress test significantly increased only in the success group (from 2.3 ± 1.3 ml/m2 to 3.1 ± 4.8 ml/m2, p <0.05). In a multivariate analysis, left ventricular ejection fraction (hazard ratio 0.911, p <0.05) and baseline Δ LA expansion index (hazard ratio 0.827, p <0.001) were independent predictors of AF recurrence. In conclusion, the baseline Δ LA expansion index during LPP stress is a reliable marker for predicting procedural success after RFCA. Moreover, maintenance of sinus rhythm resulted in an improvement of the preload reserve after RFCA.
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Affiliation(s)
- Ayu Shono
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Nao Ishii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Kenya Kusunose
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Makiko Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nao Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makiko Suto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kumiko Dokuni
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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16
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Chong L, Gopinathannair R, Ahmad A, Mar P, Olshansky B. Arrhythmia-Induced Cardiomyopathy: Mechanisms and Risk Assessment to Guide Management and Follow-Up. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00699-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Kawajiri K, Ihara K, Sasano T. Gene therapy to terminate tachyarrhythmias. Expert Rev Cardiovasc Ther 2022; 20:431-442. [PMID: 35655364 DOI: 10.1080/14779072.2022.2085686] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION To date, the treatment option for tachyarrhythmia is classified into drug therapy, catheter ablation, and implantable device therapy. However, the efficacy of the antiarrhythmic drugs is limited. Although the indication of catheter ablation is expanding, several fatal tachyarrhythmias are still refractory to ablation. Implantable cardioverter-defibrillator increases survival, but it is not a curable treatment. Therefore, a novel therapy for tachyarrhythmias refractory to present treatments is desired. Gene therapy is being developed as a promising candidate for this purpose, and basic research and translational research have been accumulated in recent years. AREAS COVERED This paper reviews the current state of gene therapy for arrhythmias, including susceptible arrhythmias, the route of administration to the heart, and the type of vector to use. We also discuss the latest progress in the technology of gene delivery and genome editing. EXPERT OPINION Gene therapy is one of the most promising technologies for arrhythmia treatment. However, additional technological innovation to achieve safe, localized, homogeneous, and long-lasting gene transfer is required for its clinical application.
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Affiliation(s)
- Kohei Kawajiri
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 113-8519, Japan
| | - Kensuke Ihara
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo 113-8519, Japan
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18
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Legault MA, Perreault LPL, Tardif JC, Dubé MP. ExPheWas: a platform for cis-Mendelian randomization and gene-based association scans. Nucleic Acids Res 2022; 50:W305-W311. [PMID: 35474380 PMCID: PMC9252780 DOI: 10.1093/nar/gkac289] [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: 02/22/2022] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Establishing the relationship between protein-coding genes and phenotypes has the potential to inform on the molecular etiology of diseases. Here, we describe ExPheWas (exphewas.ca), a gene-based phenome-wide association study browser and platform that enables the conduct of gene-based Mendelian randomization. The ExPheWas data repository includes sex-stratified and sex-combined gene-based association results from 26 616 genes with 1746 phenotypes measured in up to 413 133 individuals from the UK Biobank. Interactive visualizations are provided through a browser to facilitate data exploration supported by false discovery rate control, and it includes tools for enrichment analysis. The interactive Mendelian randomization module in ExPheWas allows the estimation of causal effects of a genetically predicted exposure on an outcome by using genetic variation in a single gene as the instrumental variable.
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Affiliation(s)
- Marc-André Legault
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Louis-Philippe Lemieux Perreault
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
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19
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Manolis AS, Manolis TA, Manolis AA, Melita H. Atrial fibrillation-induced tachycardiomyopathy and heart failure: an underappreciated and elusive condition. Heart Fail Rev 2022; 27:2119-2135. [PMID: 35318562 DOI: 10.1007/s10741-022-10221-1] [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] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
Many patients with persistent, chronic, or frequently recurring paroxysmal atrial fibrillation (AF) may develop a tachycardiomyopathy (TCM) with left ventricular (LV) dysfunction and heart failure (HF), which is reversible upon restoration and maintenance of sinus rhythm, when feasible, or via better and tighter ventricular rate (VR) control. Mechanisms involved in producing this leading cause of TCM (AF-TCM) include loss of atrial contraction, irregular heart rate, fast VR, neurohumoral activation, and structural myocardial changes. The most important of all mechanisms relates to optimal VR control, which seems to be an elusive target. Uncontrolled AF may also worsen preexisting LV dysfunction and exacerbate HF symptoms. Data, albeit less robust, also point to deleterious effects of slow VRs on LV function. Thus, a J-shaped relationship between VR and clinical outcome has been suggested, with the optimal VR control hovering at ~ 65 bpm, ranging between 60 and 80 bpm; VRs above and below this range may confer higher morbidity and mortality rates. A convergence of recent guidelines is noted towards a stricter rather than a more lenient VR control with target heart rate < 80 bpm at rest and < 110 bpm during moderate exercise which seems to prevent TCM or improve LV function and exercise capacity and relieve TCM-related symptoms and signs. Of course, restoring and maintaining sinus rhythm is always a most desirable target, when feasible, either with drugs or more likely with ablation. All these issues are herein reviewed, current guidelines are discussed and relevant data are tabulated and pictorially illustrated.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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20
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Marwick TH, Brugger N. Effects of Atrial Fibrillation and Sinus Rhythm on Cardiac Remodeling and Valvular Regurgitation. J Am Coll Cardiol 2022; 79:962-964. [PMID: 35272800 DOI: 10.1016/j.jacc.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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21
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Zigova M, Petrejèíková E, Blašèáková M, Kmec J, Bernasovská J, Boroòová I, Kmec M. Genetic targets in the management of atrial fibrillation in patients with cardiomyopathy. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_65_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Yang Y, Bartz TM, Brown MR, Guo X, Zilhao NR, Trompet S, Weiss S, Yao J, Brody JA, Defilippi CR, Hoogeveen RC, Lin HJ, Gudnason V, Ballantyne CM, Dorr M, Jukema JW, Petersmann A, Psaty BM, Rotter JI, Boerwinkle E, Fornage M, Jun G, Yu B. Identification of Functional Genetic Determinants of Cardiac Troponin T and I in a Multiethnic Population and Causal Associations With Atrial Fibrillation. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2021; 14:e003460. [PMID: 34732054 PMCID: PMC8692416 DOI: 10.1161/circgen.121.003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated cardiac troponin levels in blood are associated with increased risk of cardiovascular diseases and mortality. Cardiac troponin levels are heritable, but their genetic architecture remains elusive. METHODS We conducted a transethnic genome-wide association analysis on high-sensitivity cTnT (cardiac troponin T; hs-cTnT) and high-sensitivity cTnI (cardiac troponin I; hs-cTnI) levels in 24 617 and 14 336 participants free of coronary heart disease and heart failure from 6 population-based cohorts, followed by a series of bioinformatic analyses to decipher the genetic architecture of hs-cTnT and hs-cTnI. RESULTS We identified 4 genome-wide significant loci for hs-cTnT including a novel locus rs3737882 in PPFIA4 and 3 previously reported loci at NCOA2, TRAM1, and BCL2. One known locus at VCL was replicated for hs-cTnI. One copy of C allele for rs3737882 was associated with a 6% increase in hs-cTnT levels (minor allele frequency, 0.18; P=2.80×10-9). We observed pleiotropic loci located at BAG3 and ANO5. The proportions of variances explained by single-nucleotide polymorphisms were 10.15% and 7.74% for hs-cTnT and hs-cTnI, respectively. Single-nucleotide polymorphisms were colocalized with BCL2 expression in heart tissues and hs-cTnT and with ANO5 expression in artery, heart tissues, and whole blood and both troponins. Mendelian randomization analyses showed that genetically increased hs-cTnT and hs-cTnI levels were associated with higher odds of atrial fibrillation (odds ratio, 1.38 [95% CI, 1.25-1.54] for hs-cTnT and 1.21 [95% CI, 1.06-1.37] for hs-cTnI). CONCLUSIONS We identified a novel genetic locus associated with hs-cTnT in a multiethnic population and found that genetically regulated troponin levels were associated with atrial fibrillation.
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Affiliation(s)
- Yunju Yang
- The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, Texas, USA
| | - Traci M. Bartz
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Michael R. Brown
- Department of Epidemiology, Human Genetics & Environmental Sciences and Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | | | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center and Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Stefan Weiss
- Interfaculty Institute for Genetics and Functional Genomics; Department of Functional Genomics; University Medicine and University of Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Jie Yao
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Ron C. Hoogeveen
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Henry J. Lin
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christie M. Ballantyne
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, TX, USA
| | - Marcus Dorr
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- Department of Internal Medicine B - Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - J. Wouter Jukema
- Department of Cardiology and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden and the Netherlands Heart Institute, Utrecht, the Netherlands
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald and Institute of Clinical Chemistry and Laboratory Medicine, Universitätsmedizin Oldenburg, Oldenburg, Germany
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, and Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Eric Boerwinkle
- The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, Texas, USA
- Department of Epidemiology, Human Genetics & Environmental Sciences and Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Myriam Fornage
- The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, Texas, USA
- Department of Epidemiology, Human Genetics & Environmental Sciences and Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Goo Jun
- Department of Epidemiology, Human Genetics & Environmental Sciences and Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Bing Yu
- Department of Epidemiology, Human Genetics & Environmental Sciences and Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
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23
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Apiyasawat S, Kornbongkotmas S, Chichareon P, Krittayaphong R. Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry. J Arrhythm 2021; 37:1434-1442. [PMID: 34887947 PMCID: PMC8637082 DOI: 10.1002/joa3.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 11/07/2022] Open
Abstract
AIMS Persistent and permanent atrial fibrillation (AF) often occurs in the presence of multiple comorbidities and is linked to adverse outcomes. It is unclear whether the sustained pattern of AF itself is prognostic or if it is confounded by underlying comorbidities. Here, we tested the association between the temporal patterns of AF and the risks of ischemic stroke and all-cause mortality. METHODS AND RESULTS In a prospective multicenter cohort, 3046 non-valvular AF patients were consecutively enrolled and followed for adverse outcomes of all-cause mortality and ischemic stroke. The risks of both outcomes were adjusted for underlying comorbidities, and compared between the patterns of AF. At baseline, the patients were classified as paroxysmal (N = 963, 31.6%), persistent (N = 604, 19.8%), and permanent AF (N = 1479, 45.6%) according to the standard definition. Anticoagulants were administered in 75% of all patients and 83% of those with CHA2DS2-VASc score ≥2 in males or ≥3 in females. During a mean follow up of 26 (SD 10.5) months, all-cause mortality occurred less in paroxysmal AF (2.5 per 100 patient-years) than in persistent AF (4.4 per 100 patient-years; adjusted hazard ratio [HR] 0.66, 95% CI, 0.46-0.96; P = .029) and permanent AF (4.1 per 100 patient-years; adjusted HR 0.71, 95% CI, 0.52-0.98; P = .036). The risk of ischemic stroke was similar across all patterns of AF. CONCLUSIONS In this multicenter cohort of AF patients, persistent and permanent AF was associated with higher all-cause mortality than paroxysmal AF, independent of baseline comorbidities. CLINICAL TRIAL REGISTRATION Thai Clinical Trial Registration; Study ID: TCTR20160113002 (http://www.thaiclinicaltrials.org/show/TCTR20160113002).
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Affiliation(s)
- Sirin Apiyasawat
- Faculty of Medicine, Ramathibodi HospitalMahidol UniversityBangkokThailand
| | | | - Ply Chichareon
- Faculty of MedicinePrince of Songkla UniversitySongklaThailand
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24
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Zhang Y, Xie Y, Lv W, Hu C, Xu T, Liu X, Zhang R, Xu G, Xia Y, Zhao X. A high throughput lipidomics method and its application in atrial fibrillation based on 96-well plate pretreatment and liquid chromatography-mass spectrometry. J Chromatogr A 2021; 1651:462271. [PMID: 34102397 DOI: 10.1016/j.chroma.2021.462271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022]
Abstract
Successful applications of lipidomics in clinic need study large-scale samples, and the bottlenecks are in throughput and robustness of the lipid analytical method. Here, we report an untargeted lipidomics method by combining high throughput pretreatment in the 96-well plate with ultra-high performance liquid chromatography coupled to quadrupole time-of-flight tandem mass spectrometry. The developed method was validated to have satisfactory analytical characteristics in terms of linearity, repeatability and extraction recovery. It can be used to handle 96 samples simultaneously in 25 min and detect 441 lipids in plasma sample. Storage stability investigation on lipid extracts provided an operable procedure for large-scale sample analysis and demonstrated most lipids were stable in autosampler at 10 °C within 36 h and at -80 °C within 72 h after the pretreatment. To prove the usefulness, the method was employed to investigate abnormal plasma lipidome related to atrial fibrillation. A biomarker panel with the area under the curve (AUC) values of 0.831 and 0.745 was achieved in the discovery and external validation sets, respectively. These results showed that the developed method is applicable for large-scale biological sample handling and lipid analysis of plasma.
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Affiliation(s)
- Yuqing Zhang
- Zhang Dayu School of Chemistry, Dalian University of Technology, Dalian 116024, P. R. China; CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, P. R. China
| | - Yunpeng Xie
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wangjie Lv
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, P. R. China
| | - Chunxiu Hu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, P. R. China
| | - Tianrun Xu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, P. R. China
| | - Xinyu Liu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, P. R. China
| | - Rongfeng Zhang
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guowang Xu
- Zhang Dayu School of Chemistry, Dalian University of Technology, Dalian 116024, P. R. China; CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, P. R. China
| | - Yunlong Xia
- The First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Xinjie Zhao
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, P. R. China.
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25
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Takahashi K, Yamashita M, Sakaue T, Enomoto D, Uemura S, Okura T, Ikeda S, Takemoto M, Utsunomiya Y, Hyodo T. Suppression of amiodarone-induced torsade de pointes by landiolol in a patient with atrial fibrillation-mediated cardiomyopathy. Ann Noninvasive Electrocardiol 2021; 26:e12842. [PMID: 33755267 PMCID: PMC8588365 DOI: 10.1111/anec.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/28/2022] Open
Abstract
An elderly Japanese woman developed acute decompensated heart failure caused by persistent atrial fibrillation (AF) and left ventricular systolic dysfunction. Approximately 6 days after starting intravenous administration of amiodarone (600 mg/day) for maintaining sinus rhythm after cardioversion of AF, electrocardiograms revealed a prolonged QT interval associated with torsade de pointes (TdP). The amiodarone-induced TdP disappeared after intravenous administration of landiolol plus magnesium and potassium, without discontinuation of amiodarone or overdrive cardiac pacing, although the prolonged QT interval persisted. To the best of our knowledge, this is the first report that landiolol could be effective for amiodarone-induced TdP.
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Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Mina Yamashita
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Daijiro Enomoto
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Masafumi Takemoto
- Department of Medical Engineering, Yawatahama City General Hospital, Ehime, Japan
| | - Yutaka Utsunomiya
- Department of Medical Engineering, Yawatahama City General Hospital, Ehime, Japan
| | - Takashi Hyodo
- Department of Medical Engineering, Yawatahama City General Hospital, Ehime, Japan
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26
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Taniguchi N, Miyasaka Y, Suwa Y, Harada S, Nakai E, Shiojima I. Heart Failure in Atrial Fibrillation - An Update on Clinical and Echocardiographic Implications. Circ J 2020; 84:1212-1217. [PMID: 32641592 DOI: 10.1253/circj.cj-20-0258] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and has unfavorable consequences such as stroke, heart failure (HF), and death. HF is the most common adverse event following AF and the leading cause of death. Therefore, identifying the association between AF and HF is important to establish risk stratification for HF in AF. Recent studies suggested that left atrial and ventricular fibrosis is an important link between AF and HF, and the prognostic impact may differ with respect to HF subtype, stratified with left ventricular ejection fraction (EF). Mortality risk in patients with concurrent AF and HF with reduced EF (HFrEF) appears slightly higher compared with those with concurrent AF and HF with preserved EF (HFpEF). On the other hand, the prognostic impact of HF in AF is similar between HFrEF and HFpEF. Further, left atrial size, as well as left atrial and left ventricular functional assessment, are reported to be useful for the prediction of HF in AF, incremental to the conventional risk factors. In this review, we focus on the epidemiological, pathophysiological, and prognostic associations between AF and HF, and review the clinical and echocardiographic predictors for HF in AF.
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Affiliation(s)
- Naoki Taniguchi
- Division of Cardiology, Department of Medicine II, Kansai Medical University
| | - Yoko Miyasaka
- Division of Cardiology, Department of Medicine II, Kansai Medical University
| | - Yoshinobu Suwa
- Division of Cardiology, Department of Medicine II, Kansai Medical University
| | - Shoko Harada
- Division of Cardiology, Department of Medicine II, Kansai Medical University
| | - Eri Nakai
- Division of Cardiology, Department of Medicine II, Kansai Medical University
| | - Ichiro Shiojima
- Division of Cardiology, Department of Medicine II, Kansai Medical University
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27
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Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res 2020; 127:4-20. [PMID: 32716709 DOI: 10.1161/circresaha.120.316340] [Citation(s) in RCA: 581] [Impact Index Per Article: 145.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.
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Affiliation(s)
- Jelena Kornej
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
| | - Christin S Börschel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
| | - Emelia J Benjamin
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
- Department of Epidemiology (E.J.B.), Boston University School of Medicine, MA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
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28
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Qin D, Heist EK. Atrial fibrillation ablation in congestive heart failure with preserved ejection fraction: Tackling the vicious twins. J Cardiovasc Electrophysiol 2020; 31:689-691. [PMID: 32022340 DOI: 10.1111/jce.14370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Dingxin Qin
- Division of Cardiology, Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - E Kevin Heist
- Division of Cardiology, Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
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