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Almahmeed WA, Hersi A, Khalife N, Gamaleldin MFS, Kherraf SA, Sobhy MA, Lopes RD, Khoury M. The Atrial FibriLlatiOn (FLOW-AF) Registry in the Middle East and North Africa: Patient Characteristics, Treatment Patterns and Outcomes. Adv Ther 2024; 41:2868-2889. [PMID: 38802637 DOI: 10.1007/s12325-024-02895-w] [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: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Limited data on atrial fibrillation (AF) are available from the Middle East and North Africa region (MENA). The aim of the FLOW-AF registry was to evaluate the characteristics, treatment patterns, and clinical and economic outcomes of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) in MENA. METHODS This multi-center, prospective, observational study (the FLOW-AF registry) enrolled patients newly diagnosed with NVAF across Egypt, Lebanon, Kingdom of Saudi Arabia, and United Arab Emirates. The data collection occurred at enrollment (baseline) and after 6- and 12-months (follow-up). Baseline data included demographics, AF characteristics, medical history, and anti-thrombotic treatment patterns. Clinical events, healthcare resource utilization, and direct costs were collected at follow-up. RESULTS The study enrolled a total of 1418 patients (52.7% males and 47.3% females). The mean age of the patients was 64.5 years and 90.6% were white. The mean (standard deviation) CHA2DS2-VASc and HAS-BLED risk scores were 2.7 (1.6) and 1.6 (1.2), respectively. Non-vitamin K antagonist oral anticoagulants, antiplatelet therapy, and vitamin K antagonists were prescribed to 65.8%, 16.4%, and 12.9% patients, respectively. During follow-up, the following rates of clinical outcomes were observed: bleeding events (1.7%), transient ischemic attack (1.7%), all-cause mortality (1.7%), stroke (0.6%), myocardial infarction (0.2%), and systemic embolism (0.08%). CONCLUSIONS This MENA patient population was younger and had lower mean baseline CHA2DS2-VASc and HAS-BLED scores. The rates of clinical outcomes over 1-year in this study were low. Longer follow-up is required to comprehensively assess clinical outcomes in this patient population.
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Affiliation(s)
| | - Ahmad Hersi
- Faculty of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | - Mohamed A Sobhy
- Alexandria University, Alexandria, Egypt
- International Cardiac Center (ICC) Hospital, Alexandria, Egypt
- Cardiovascular Research, Education & Prevention Foundation (CVREP) Foundation, Alexandria, Egypt
| | - Renato D Lopes
- Duke University School of Medicine, The Duke Clinical Research Institute, Durham, NC, USA
| | - Maurice Khoury
- Cardiology Department, American University of Beirut, Beirut, Lebanon
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Choi JH, Kwon CH. Real-World Outcomes of a Rhythm Control Strategy for Atrial Fibrillation Patients with Reduced Left Ventricular Ejection Fraction (<50%). J Clin Med 2024; 13:3285. [PMID: 38892996 PMCID: PMC11172414 DOI: 10.3390/jcm13113285] [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: 05/09/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: The effectiveness of a rhythm control strategy in patients with atrial fibrillation (AF) and reduced left ventricular ejection fraction (LVEF < 50%) in real-world practice remains uncertain. Our objective was to evaluate the real-world outcomes of a rhythm control strategy in patients with AF and reduced LVEF, focusing on changes in LV systolic function and brain natriuretic peptide (BNP) levels. Methods: The study retrospectively reviewed the medical records of 80 patients with concurrent AF and reduced LVEF who underwent rhythm control therapy between March 2015 and December 2021. Results: The patients had an average age of 63.6 years and an initial LVEF of 34.3%. Sinus rhythm was restored using anti-arrhythmic drugs (38, 47.5%) or electrical cardioversion (42, 52.5%). Over a follow-up period of 53.0 months, AF recurred in 65% of patients, with 57.7% undergoing catheter ablation. Significant improvements were noted in LVEF (from 34.3% to 55.1%, p < 0.001) and BNP levels (from 752 pg/mL to 72 pg/mL, p < 0.001) at the last follow-up. Nearly all patients (97.5%) continued with the rhythm control strategy during the follow-up period. Conclusions: In real-world settings, a rhythm control strategy proves to be feasible and effective for improving LVEF and reducing BNP levels in AF patients with reduced LVEF.
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Affiliation(s)
| | - Chang Hee Kwon
- Department of Internal Medicine, Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
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Tan MC, Yeo YH, Ang QX, Tan BEX, Tan JL, Rattanawong P, Correia J, Tolat A. Association of Paroxysmal Versus Persistent Atrial Fibrillation with In-hospital Outcomes and 30-day Readmission After Inpatient Atrial Fibrillation Ablation. J Innov Card Rhythm Manag 2024; 15:5894-5901. [PMID: 38948660 PMCID: PMC11210677 DOI: 10.19102/icrm.2024.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/27/2024] [Indexed: 07/02/2024] Open
Abstract
Knowledge of the impact of paroxysmal and persistent atrial fibrillation (AF) after catheter ablation on in-hospital outcomes and 30-day readmission remains limited. This study aimed to evaluate the procedural outcomes and 30-day readmission rates among patients with paroxysmal or persistent AF who were hospitalized for AF ablation. Using the Nationwide Readmissions Database, our study included patients aged ≥18 years with AF who were hospitalized and underwent catheter ablation during 2017-2020. Then, we compared the in-hospital procedural outcomes and 30-day readmission rates between patients with paroxysmal and persistent AF, respectively. Our study included 7310 index admissions for paroxysmal AF ablation and 9179 index admissions for persistent AF ablation. According to our analysis, there was no significant difference in procedural complications-namely, cerebrovascular accident, vascular complications, major bleeding requiring blood transfusion, phrenic nerve palsy, pericardial complications, and systemic embolization-between the persistent and paroxysmal AF groups. There was also no significant difference in early mortality between these groups (0.5% vs. 0.7%; P = .22). Persistent AF patients had significantly higher rates of prolonged index hospitalization (9.9% vs. 7.2%; P < .01) and non-home discharge (4.8% vs. 3.1%; P < .01). The 30-day readmission rates were comparable in both groups (10.0% vs. 9.5%; P = .34), with recurrent AF and heart failure being two of the most common causes of cardiac-related readmissions. Catheter ablation among hospitalized patients with paroxysmal or persistent AF resulted in no significant difference in procedural complications, early mortality, or 30-day readmission. This suggests that catheter ablation of AF can be performed with a relatively similar safety profile for both paroxysmal and persistent AF.
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Affiliation(s)
- Min Choon Tan
- Department of Internal Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, NJ, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics, Beaumont Health, Royal Oak, MI, USA
| | - Qi Xuan Ang
- Department of Internal Medicine, Sparrow Health System and Michigan State University, East Lansing, MI, USA
| | - Bryan E-Xin Tan
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jian Liang Tan
- Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Pattara Rattanawong
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joaquim Correia
- Department of Cardiovascular Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, NJ, USA
| | - Aneesh Tolat
- Department of Cardiovascular Medicine, Hartford Healthcare/University of Connecticut, Hartford, CT, USA
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Agarwal S, Farhat K, Khan MS, DeSimone CV, Deshmukh A, Munir MB, Asad ZUA, Stavrakis S. Sex differences in atrial fibrillation ablation outcomes in patients with heart failure. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01833-8. [PMID: 38811501 DOI: 10.1007/s10840-024-01833-8] [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: 03/25/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND There is a lack of data on the impact of sex on the outcomes of patients with heart failure (HF) undergoing atrial fibrillation (AF) ablation. We aimed to analyze the association of sex with outcomes of atrial fibrillation ablation in patients with heart failure. METHODS The National Readmissions Database (NRD) was analyzed from 2016 to 2019 to identify patients ≥ 18 years old with heart failure (HF) undergoing AF ablation. The outcomes of interest included peri-procedural complications, in-hospital mortality, resource utilization, and unplanned 1-year readmissions. The final cohort was divided into patients with HFrEF and HFpEF and outcomes were compared between males and females in both cohorts. RESULTS A total of 23,277 patients with HF underwent AF ablation between 2016 and 2019, of which 14,480 had HFrEF and 8,797 had HFpEF. Among patients with HFrEF, 61.6% were males and 38.4% were females whereas, among patients with HFpEF, 35.4% were males and 64.6% were females. On a multivariable-adjusted analysis, in patients with HFrEF, there was no difference in the odds of in-hospital mortality, peri-procedural complications, or 1-year HF-related/AF-related/all-cause readmissions between males and females. In patients with HFpEF, females had a higher risk 1-year HF-related readmissions (adjusted hazards ratio: 1.46; 95% CI: 1.13-1.87; p = 0.01), without any difference in the 1-year AF-related/all-cause readmissions, in-hospital mortality, or peri-procedural complications. CONCLUSION Our results show that females with HFrEF undergoing AF ablation have similar outcomes whereas females with HFpEF have higher 1-year HF readmissions with no difference in the other outcomes, compared to males.
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Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kassem Farhat
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | - Muhammad Salman Khan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Zain Ul Abideen Asad
- Department of Cardiology, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 5400, Oklahoma City, OK, 73104, USA
| | - Stavros Stavrakis
- Department of Cardiology, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 5400, Oklahoma City, OK, 73104, USA.
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Ray WA, Chung CP, Stein CM, Smalley W, Zimmerman E, Dupont WD, Hung AM, Daugherty JR, Dickson A, Murray KT. Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban. JAMA 2024; 331:1565-1575. [PMID: 38619832 PMCID: PMC11019444 DOI: 10.1001/jama.2024.3867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/29/2024] [Indexed: 04/16/2024]
Abstract
Importance Diltiazem, a commonly prescribed ventricular rate-control medication for patients with atrial fibrillation, inhibits apixaban and rivaroxaban elimination, possibly causing overanticoagulation. Objective To compare serious bleeding risk for new users of apixaban or rivaroxaban with atrial fibrillation treated with diltiazem or metoprolol. Design, Setting, and Participants This retrospective cohort study included Medicare beneficiaries aged 65 years or older with atrial fibrillation who initiated apixaban or rivaroxaban use and also began treatment with diltiazem or metoprolol between January 1, 2012, and November 29, 2020. Patients were followed up to 365 days through November 30, 2020. Data were analyzed from August 2023 to February 2024. Exposures Diltiazem and metoprolol. Main Outcomes and Measures The primary outcome was a composite of bleeding-related hospitalization and death with recent evidence of bleeding. Secondary outcomes were ischemic stroke or systemic embolism, major ischemic or hemorrhagic events (ischemic stroke, systemic embolism, intracranial or fatal extracranial bleeding, or death with recent evidence of bleeding), and death without recent evidence of bleeding. Hazard ratios (HRs) and rate differences (RDs) were adjusted for covariate differences with overlap weighting. Results The study included 204 155 US Medicare beneficiaries, of whom 53 275 received diltiazem and 150 880 received metoprolol. Study patients (mean [SD] age, 76.9 [7.0] years; 52.7% female) had 90 927 person-years (PY) of follow-up (median, 120 [IQR, 59-281] days). Patients receiving diltiazem treatment had increased risk for the primary outcome (RD, 10.6 [95% CI, 7.0-14.2] per 1000 PY; HR, 1.21 [95% CI, 1.13-1.29]) and its components of bleeding-related hospitalization (RD, 8.2 [95% CI, 5.1-11.4] per 1000 PY; HR, 1.22 [95% CI, 1.13-1.31]) and death with recent evidence of bleeding (RD, 2.4 [95% CI, 0.6-4.2] per 1000 PY; HR, 1.19 [95% CI, 1.05-1.34]) compared with patients receiving metoprolol. Risk for the primary outcome with initial diltiazem doses exceeding 120 mg/d (RD, 15.1 [95% CI, 10.2-20.1] per 1000 PY; HR, 1.29 [95% CI, 1.19-1.39]) was greater than that for lower doses (RD, 6.7 [95% CI, 2.0-11.4] per 1000 PY; HR, 1.13 [95% CI, 1.04-1.24]). For doses exceeding 120 mg/d, the risk of major ischemic or hemorrhagic events was increased (HR, 1.14 [95% CI, 1.02-1.27]). Neither dose group had significant changes in the risk for ischemic stroke or systemic embolism or death without recent evidence of bleeding. When patients receiving high- and low-dose diltiazem treatment were directly compared, the HR for the primary outcome was 1.14 (95% CI, 1.02-1.26). Conclusions and Relevance In Medicare patients with atrial fibrillation receiving apixaban or rivaroxaban, diltiazem was associated with greater risk of serious bleeding than metoprolol, particularly for diltiazem doses exceeding 120 mg/d.
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Affiliation(s)
- Wayne A. Ray
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Cecilia P. Chung
- Department of Medicine, University of Miami, Miami, Florida
- Miami VA Healthcare System, Miami, Florida
| | - C. Michael Stein
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Walter Smalley
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Eli Zimmerman
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William D. Dupont
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Adriana M. Hung
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - James R. Daugherty
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Alyson Dickson
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Katherine T. Murray
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Bulhões E, Antunes VLJ, Mazetto R, Defante MLR, Garcia AC, Guida C. Catheter ablation versus medical therapy for atrial fibrillation in patients with heart failure with preserved ejection fraction: A systematic review and meta-analysis. Heart Rhythm 2024:S1547-5271(24)02385-3. [PMID: 38621498 DOI: 10.1016/j.hrthm.2024.04.058] [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: 03/04/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The benefit of catheter ablation in patients with atrial fibrillation (AF) for patients with heart failure with preserved ejection fraction (HFpEF) remains uncertain. OBJECTIVE We performed a systematic review and meta-analysis to compare catheter ablation and medical therapy (antiarrhythmics for rhythm or rate control) in patients with AF and HFpEF. METHODS We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials. Outcomes were the composite end points of death or heart failure (HF) hospitalization, all-cause death, cardiovascular death, all-cause rehospitalization, and HF hospitalization. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics. RESULTS We included 20,257 patients from 8 studies. Of those, 3 were derived from RCTs, either through post hoc analysis or subgroup analysis, and 5 were observational studies. The median follow-up ranged from 24.6 to 61.2 months. Compared with medical therapy, catheter ablation was associated with a statistically significant lower risk of death or HF hospitalization (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.47-0.83; P = .001; I2 = 66%), all-cause death (HR 0.68; 95% CI 0.46-0.99; P = .047; I2 = 61%), cardiovascular death (HR 0.42; 95% CI 0.21-0.84; P = .014; I2 = 22%), and HF hospitalization (HR 0.43; 95% CI 0.23-0.82; P = .011; I2 = 87%). CONCLUSION In this meta-analysis, catheter ablation was associated with a lower risk of all-cause mortality, cardiovascular death, HF hospitalization, and all-cause rehospitalization in comparison to medical therapy in patients with AF and HFpEF.
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Affiliation(s)
- Elísio Bulhões
- Faculty of Higher Superior of the Amazon Reunida, Medicine Department, Redenção, Pará, Brazil.
| | - Vanio L J Antunes
- Federal University of Health Sciences of Porto Alegre, Medicine Department, Porto Alegre, Brazil
| | - Roberto Mazetto
- Amazonas State University, Medicine Department, Manaus, Brazil
| | | | - Anselmo C Garcia
- Goiás Military Police Hospital, Division of Cardiology, Goiás, Brazil
| | - Camila Guida
- Dante Pazzanese Institute of Cardiology, Division of Cardiology, São Paulo, Brazil
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Hailati J, Liu ZQ, Zhang YF, Zhang L, Midilibieke H, Ma XL, Wulasihan M. Increased Cyclic Guanosine Monophosphate and Interleukin-1Beta Is Activated by Mitochondrial Dysfunction and Associated With Heart Failure in Atrial Fibrillation Patients. Cardiol Res 2024; 15:108-116. [PMID: 38645829 PMCID: PMC11027785 DOI: 10.14740/cr1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/23/2024] Open
Abstract
Background This study aimed to identify the association of cyclic guanosine monophosphate (GMP)-adenosine monophosphate (AMP) synthase-stimulator interferon genes (cGAS-STING) pathway with heart failure (HF) in atrial fibrillation (AF) patients. Methods We prospectively enrolled 106 AF patients without evidence of HF. The serum levels of 2'3'-cyclic GMP-AMP (2'3'-cGAMP) and interleukin (IL)-1β were measured by enzyme-linked immunoassay (ELISA). To determine the underlying mechanism, we supplemented the complex I inhibitor rotenone and the specific cGAS inhibitor RU.521 in neonatal rat ventricular cardiomyocytes. Results During 18-month follow-up, serum concentrations of 2'3'-cGAMP (baseline 51.82 ± 11.34 pg/mL vs. follow-up 124.50 ± 75.83 pg/mL, Ppaired t < 0.01) and IL-1β (baseline 436.07 ± 165.82 vs. follow-up 632.48 ± 119.25 ng/mL, Ppaired t < 0.01) were substantially upregulated in AF patients with HF as compared with those without HF. Furthermore, serum 2'3'-cGAMP and IL-1β levels at 18-month follow-up were independently associated with the occurrence of HF in AF patients. Inhibition of cGAS by RU.521 effectively reversed the upregulation of 2'3'-cGAMP and STING phosphorylation induced by mitochondrial dysfunction, accompanied with inhibition of nod-like receptor protein 3 (NLRP3) inflammasome, IL-1β and IL-18 secretion. Conclusions Induction of mitochondrial dysfunction causes an upregulation of 2'3'-cGAMP and activation of NLRP3 inflammasome through cGAS-STING pathway in cardiomyocytes.
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Affiliation(s)
- Juledezi Hailati
- Cardiovascular Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang, China
| | - Zhi Qiang Liu
- Cardiovascular Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang, China
| | - Yun Fei Zhang
- Cardiovascular Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang, China
| | - Lei Zhang
- Cardiovascular Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang, China
| | - Hasidaer Midilibieke
- Cardiovascular Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang, China
| | - Xiang Li Ma
- Cardiovascular Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang, China
| | - Muhuyati Wulasihan
- Cardiovascular Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang, China
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Mehani SHM, Helmy ZM, Abdelhalim WA, Mohamed MI. Revealing the role of high-intensity interval training combined with inspiratory muscle training on atrial fibrillation associated with chronic heart failure: is there a shift toward anti-remodelling adaptation? Eur J Prev Cardiol 2024:zwae125. [PMID: 38551090 DOI: 10.1093/eurjpc/zwae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Sherin H M Mehani
- Physical Therapy Department for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Beni-Suef University, Beni-surf, Egypt
| | - Zeinab M Helmy
- Physical Therapy Department for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walaa A Abdelhalim
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud I Mohamed
- Physical Therapy Department for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Beni-Suef University, Beni-surf, Egypt
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Könemann H, Güler-Eren S, Ellermann C, Frommeyer G, Eckardt L. Antiarrhythmic Treatment in Heart Failure. Curr Heart Fail Rep 2024; 21:22-32. [PMID: 38224446 PMCID: PMC10828006 DOI: 10.1007/s11897-023-00642-w] [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] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW Arrhythmias are common in patients with heart failure (HF) and are associated with a significant risk of mortality and morbidity. Optimal antiarrhythmic treatment is therefore essential. Here, we review current approaches to antiarrhythmic treatment in patients with HF. RECENT FINDINGS In atrial fibrillation, rhythm control and ventricular rate control are accepted therapeutic strategies. In recent years, clinical trials have demonstrated a prognostic benefit of early rhythm control strategies and AF catheter ablation, especially in patients with HF with reduced ejection fraction. Prevention of sudden cardiac death with ICD therapy is essential, but optimal risk stratification is challenging. For ventricular tachycardias, recent data support early consideration of catheter ablation. Antiarrhythmic drug therapy is an adjunctive therapy in symptomatic patients but has no prognostic benefit and well-recognized (proarrhythmic) adverse effects. Antiarrhythmic therapy in HF requires a systematic, multimodal approach, starting with guideline-directed medical therapy for HF and integrating pharmacological, device, and interventional therapy.
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Affiliation(s)
- Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Sati Güler-Eren
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
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10
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Yang E, Rashid H. Heart failure with preserved ejection fraction and atrial fibrillation: clinical management in the context of recent therapeutic advances in heart failure and electrophysiology. Front Cardiovasc Med 2024; 11:1349584. [PMID: 38347950 PMCID: PMC10859455 DOI: 10.3389/fcvm.2024.1349584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have emerged as major age-related epidemics within cardiology. Both conditions carry overlapping symptomatology, and delineating between AF and HFpEF from a diagnostic standpoint is challenging as echocardiographic and biomarker assessments used to diagnose HFpEF may be impacted by AF. Indeed, these two conditions are commonly found in the same individual, so much so that AF has been used in proposed diagnostic criteria for HFpEF. The frequent concomitant presence of these two conditions is associated with poorer quality of life, exertional capacity, as well as increased risk for decompensated heart failure and all-cause mortality. Though these deleterious effects of AF in HFpEF patients are well described, we currently have only a superficial understanding of the complex interplay between these two conditions. Preliminary studies on intervening in AF in HFpEF are very small, with mixed data on whether modifying the natural history of AF can lead to improvement in heart failure (HF) outcomes in HFpEF. In this review, we will describe the clinical implications of carrying both cardiovascular conditions, address recent advances in HFpEF and AF, and highlight preliminary studies targeted at reduction of effects associated with AF burden in HFpEF.
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Affiliation(s)
- Eunice Yang
- Inova Schar Heart and Vascular, Arrhythmia Division, Fairfax, VA, United States
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Haroon Rashid
- Inova Schar Heart and Vascular, Arrhythmia Division, Fairfax, VA, United States
- Virginia Heart, Cardiac Electrophysiology, Falls Church, VA, United States
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11
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Wong CX, Buch EF, Beygui R, Lee RJ. Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation. J Clin Med 2024; 13:679. [PMID: 38337373 PMCID: PMC10856493 DOI: 10.3390/jcm13030679] [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: 11/28/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Atrial fibrillation (AF) is a growing health problem that increases morbidity and mortality, and in most patients progresses to more advanced diseases over time. Recent research has examined the underlying mechanisms, risk factors, and progression of AF, leading to updated AF disease classification schemes. Although endocardial catheter ablation is effective for early-stage paroxysmal AF, it consistently achieves suboptimal outcomes in patients with advanced AF. Identification of the factors that lead to the increased risk of treatment failure in advanced AF has spurred the development and adoption of hybrid ablation therapies and collaborative heart care teams that result in higher long-term arrhythmia-free survival. Patients with non-paroxysmal AF, atrial remodeling, comorbidities, or AF otherwise deemed difficult to treat may find hybrid treatment to be the most effective option. Future research of hybrid therapies in advanced AF patient populations, including those with dual diagnoses, may provide further evidence establishing the safety and efficacy of hybrid endo-epicardial ablation as a first line treatment.
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Affiliation(s)
- Christopher X. Wong
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide 5001, Australia
- Cardiac Electrophysiology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Eric F. Buch
- Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ramin Beygui
- Cardiothoracic Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Randall J. Lee
- Cardiac Electrophysiology, University of California San Francisco, San Francisco, CA 94143, USA
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12
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Wang H, Huang J, Gu W, Hao X, Li G, Yuan Y, Lu Y. Relationship between Brain Natriuretic Peptide and Thromboembolic Events in Elderly Patients with Nonvalvular Atrial Fibrillation. Cardiol Res Pract 2024; 2024:5594637. [PMID: 38268856 PMCID: PMC10807934 DOI: 10.1155/2024/5594637] [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: 04/27/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
Objective To investigate the relationship between brain natriuretic peptide (BNP) and thromboembolic events in elderly patients with nonvalvular atrial fibrillation (NVAF). Methods This is a prospective cohort study, and based on the inclusion and exclusion criteria, 180 elderly patients with NVAF were included. The patients received follow-up appointments in the clinic or by telephone every 6 months after the beginning of the study. The primary follow-up endpoints were thromboembolic and atherosclerotic events, including ischaemic stroke, myocardial infarction, and systemic embolism. The secondary endpoints were adverse events, including cardiovascular death, all-cause death, and hospitalisation for heart failure. Patients were divided into three groups according to their BNP level at admission: group A (BNP ≤334.5 pg/mL), group B (BNP = 334.5-1,288 pg/mL), and group C (BNP ≥1,288 pg/mL). Results A total of 180 patients were enrolled in this study, with 50 patients in group A, 68 in group B, and 62 in group C. Compared with groups A and B, group C had a higher CHA2DS2-VASc score (Z = 15.142; P=0.001) and a lower ejection fraction (EF) value (Z = 119.893; P=0.001). The left atrium (LA) and left ventricular end-diastolic diameter (LVEDD) were larger (Z = 105.031; P=0.001 and Z = 74.430; P=0.001), respectively, suggesting that patients with significantly increased BNP had a higher risk of thromboembolism and atherosclerosis, lower EF, larger LA and LVEDD, and worse cardiac function. After 1 year of follow-up, the incidence of primary endpoint events (χ2 = 9.556; P=0.008) and secondary endpoint events (χ2 = 59.485; P=0.001) in group C were higher than those in groups A and B. Conclusion Higher BNP levels may be an independent risk factor for thromboembolic and atherosclerotic events in elderly patients with NVAF. The higher the BNP level, the greater the risk of thromboembolic and atherosclerotic events.
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Affiliation(s)
- Hongxia Wang
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 200000, China
| | - Jiajun Huang
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 200000, China
| | - Wenxi Gu
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 200000, China
| | - Xiaojiao Hao
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 200000, China
| | - Guiru Li
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 200000, China
| | - Yumin Yuan
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 200000, China
| | - Yingmin Lu
- Department of Cardiology, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 200000, China
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13
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 156] [Impact Index Per Article: 156.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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14
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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15
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Alrabadi N, Al-Nusair M, El-Zubi FK, Tashtoush M, Alzoubi O, Khamis S, Masadeh MM, Alzoubi KH, Al-Hiari M, Hammoudeh A. Evaluation of Clinical, Echocardiographic, and Therapeutic Characteristics, and Prognostic Outcomes of Coexisting Heart Failure among Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study. Curr Vasc Pharmacol 2024; 22:58-66. [PMID: 38038004 DOI: 10.2174/0115701611260211231115094716] [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: 04/30/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia in clinical practice. Heart failure (HF) can occur concurrently with AF. AIM We compared different demographic, clinical, and echocardiographic characteristics between patients with AF+HF and patients with AF only. Furthermore, we explored whether concurrent HF independently predicts several outcomes (all-cause mortality, cardiovascular mortality, ischemic stroke/systemic embolism (IS/SE), major bleeding, and clinically relevant non-major bleeding (CRNMB)). MATERIALS AND METHODS Comparisons between the AF+HF and the AF-only group were carried out. Multivariable Cox proportional hazard models were constructed for each outcome to assess whether HF was predictive of any of them while controlling for possible confounding factors. RESULTS A total of 2020 patients were included in this study: 481 had AF+HF; 1539 had AF only. AF+HF patients were older, more commonly males, and had a higher prevalence of diabetes mellitus, dyslipidemia, coronary artery disease, and chronic kidney disease (p≤0.05). Furthermore, AF+HF patients more commonly had pulmonary hypertension and low ejection fraction (p≤0.001). Finally, HF was independently predictive of all-cause mortality (adjusted HR 2.17, 95% CI (1.66-2.85) and cardiovascular mortality (adjusted HR 2.37, 95% CI (1.68-3.36). CONCLUSION Coexisting AF+HF was associated with a more labile and higher-risk population among Jordanian patients. Furthermore, coexisting HF independently predicted higher all-cause mortality and cardiovascular mortality. Efforts should be made to efficiently identify such cases early and treat them aggressively.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammed Al-Nusair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Farah K El-Zubi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mais Tashtoush
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alzoubi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sa'ed Khamis
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Majd M Masadeh
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Al-Hiari
- Department of Internal Medicine, School of Medicine, Marshall University, Huntington, West Virginia, USA
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16
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Reiffel JA. Selected Advances in the Anti-arrhythmic Management of Atrial Fibrillation: 2023. J Innov Card Rhythm Manag 2024; 15:5728-5734. [PMID: 38304092 PMCID: PMC10829416 DOI: 10.19102/icrm.2024.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
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17
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Merchant FM. Atrial Fibrillation and Surgery for Mitral Regurgitation: More Work to Do? Am J Cardiol 2024; 210:302-303. [PMID: 37865145 DOI: 10.1016/j.amjcard.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Faisal M Merchant
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta,Georgia.
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18
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Del Pilar Falcón R, Centurión OA, Meza AJ, Scavenius KE, Chávez CO, Montiel CR, García LB, Cáceres C, Martínez JE, Galeano EJ. Role of the Electrocardiographic MVP Risk Score (Morphology-Voltage-P Wave Duration) in Predicting the Development of Atrial Fibrillation in Patients With Systemic Arterial Hypertension. Crit Pathw Cardiol 2023; 22:141-145. [PMID: 37535848 DOI: 10.1097/hpc.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND There is a global tendency to emphasize the prevention and early diagnosis of diseases that have a great impact on public health. Atrial fibrillation (AF) has a prevalence affecting 1.5-2% of the general population. Certain variables of the P wave allow us to identify and stratify patients at risk of developing AF. MATERIALS AND METHODS This is an observational, descriptive, and longitudinal study to determine the applicability of the electrocardiographic (ECG) morphology, voltage, and P wave duration (MVP) risk score to predict the development of AF in consecutive patients with systemic hypertension (SH) in an initial follow-up of 12 months. RESULTS Initially, 104 patients were included, of whom 12 died during follow-up and 17 did not attend subsequent checkups during the COVID-19 pandemic; therefore, they were excluded. The study patients were 75, of whom AF was detected in 25 patients (33%). The average duration of the P wave was 120 ± 26 ms, the average voltage was 0.1 ± 0.5 Mv. The high-risk MVP ECG score had an [area under the curve, 0.69; 95% confidence intervals (CI), 0.59-0.79] and demonstrated a specificity and a positive predictive value of 100%, a negative predictive value of 76%, and a sensitivity of 40% for predicting the development of AF. CONCLUSIONS The present study establishes for the first time that SH patients who possess a high-risk MVP ECG score have a significantly higher incidence of developing AF. The high-risk MVP Score has a specificity and a positive predictive value of 100% and a high negative predictive value with a moderate sensitivity for the prediction of the development of AF in SH patients.
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Affiliation(s)
- Rocío Del Pilar Falcón
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Osmar Antonio Centurión
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Alfredo J Meza
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Karina E Scavenius
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Christian O Chávez
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Carmen R Montiel
- First Department of Internal Medicine, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
| | - Laura B García
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Cristina Cáceres
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
| | - Jorge E Martínez
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
| | - Erdulfo J Galeano
- From the Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
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Sharma R, Kashyap J, Olanrewaju OA, Jabbar A, Someshwar F, Saeed H, Varrassi G, Qadeer HA, Kumar S, Cheema AY, Khatri M, Wazir M, Ullah F. Cardio-Oncology: Managing Cardiovascular Complications of Cancer Therapies. Cureus 2023; 15:e51038. [PMID: 38269231 PMCID: PMC10806352 DOI: 10.7759/cureus.51038] [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: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 01/26/2024] Open
Abstract
This narrative review explores the complex relationship between cancer medicines and cardiovascular health in the junction of oncology and cardiology, known as cardio-oncology. The study examines the historical development of cancer treatments and highlights the growing importance of cardiovascular problems in patient care. This text delves into the topic of cardiotoxicity, examining both conventional chemotherapeutic drugs like anthracyclines and more recent tyrosine kinase and immune checkpoint inhibitors. The complex molecular and cellular mechanisms that control cardiovascular problems are explained, including an understanding of how genetic predisposition influences an individual's sensitivity. The narrative expands into the crucial realm of risk stratification and evaluation, revealing advanced instruments for identifying cardiovascular risk in cancer patients. The importance of non-invasive imaging methods and biomarkers in early detection and continuous monitoring is emphasized. The prioritization of preventive tactics emphasizes the need to take proactive measures incorporating therapies to protect the heart throughout cancer treatment. It also highlights the significance of making lifestyle improvements to reduce risk factors. The narrative emphasizes the changing collaborative treatment environment, advocating for merging oncologists and cardiologists in a coordinated endeavor to maximize patient outcomes. In addition to clinical factors, the review explores the critical domain of patient education and support, acknowledging its crucial role in promoting informed decision-making and improving overall patient well-being. The latter portions of the text anticipate and consider upcoming treatments and existing research efforts that offer the potential for the future of cardio-oncology. This review seeks to provide a detailed viewpoint on the intricate connection between cancer treatments and cardiovascular well-being. Its objective is to encourage a more profound comprehension of the subject and prompt careful contemplation regarding the comprehensive care of cancer patients who confront the intricate difficulties presented by their treatment plans.
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Affiliation(s)
- Roshan Sharma
- Medicine, Sanjay Gandhi Memorial Hospital, Delhi, IND
| | - Jyoti Kashyap
- Medicine, Sri Balaji Action Medical Institute, Delhi, IND
| | - Olusegun A Olanrewaju
- Pure and Applied Biology, Ladoke Akintola University of Technology, Ogbomoso, NGA
- General Medicine, Stavropol State Medical University, Stavropol, RUS
| | - Abdul Jabbar
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Fnu Someshwar
- Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Hira Saeed
- Medicine, Federal Medical College, Islamabad, PAK
| | | | | | - Satish Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Asfand Yar Cheema
- Medicine, Services Hospital Lahore, Lahore, PAK
- Internal Medicine, Lahore Medical & Dental College, Lahore, PAK
| | - Mahima Khatri
- Internal Medicine/Cardiology, Dow University of Health Sciences, Karachi, PAK
| | - Maha Wazir
- Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Farhan Ullah
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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20
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Sun J, Zhang R, Yang M, Li W, Zhang PP, Mo BF, Wang QS, Chen M, Li YG. Combined Radiofrequency Ablation and Left Atrial Appendage Closure in Atrial Fibrillation and Systolic Heart Failure. Diagnostics (Basel) 2023; 13:3325. [PMID: 37958221 PMCID: PMC10647617 DOI: 10.3390/diagnostics13213325] [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: 09/08/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Managing patients with atrial fibrillation (AF) and comorbid heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) is of clinical importance but a great challenge. This study aimed to evaluate the clinical benefit of the combined radiofrequency catheter ablation (RFCA) and left atrial appendage closure (LAAC) procedure in AF patients complicated with systolic HF. METHODS AF patients with HFrEF or HFmrEF who underwent the combined RFCA and LAAC procedure were prospectively enrolled in the LAACablation registry. The procedural complications and long-term outcomes were evaluated. Another cohort of AF patients with systolic HF who did not undergo either RFCA or LAAC were used for prognosis comparison. RESULTS Among 802 AF patients who underwent the combined procedure, 65 patients were comorbid with systolic HF (25 with HFrEF and 40 with HFmrEF). The overall procedural complication rate was 9.2%, which was mainly attributed to acute decompensated HF (6.2%). Accompanied with markedly reduced AF burden (from median [25th, 75th percentile]: 100 [100, 100] to 0 [0, 1.2]%, p < 0.001), upward trajectories of cardiac function were observed in 51 (78.4%) patients, showing improvement in New York Heart Classification (p < 0.01), natriuretic peptide levels (from 1492 [809, 3259] to 413 [163, 880] pg/mL, p < 0.001) and left ventricular EF (from 42.6 ± 5.3 to 53.8 ± 8.2%, p < 0.001). During the 27-month follow-up period, death, thromboembolism, major bleeding, and HF rehospitalization were observed in three, one, one, and four patients, respectively. The observed event rates showed a significant reduction compared with the non-procedure AF-HF cohort (n = 138; for composite endpoint: hazard ratio: 2.509, 95% confidence interval: 1.415-4.449, p = 0.002) and with the respective rates predicted by risk scores. CONCLUSIONS Combining RFCA and LAAC achieves acceptable safety and credible long-term efficacy in AF patients with systolic HF. Further randomized studies are warranted in a larger patient cohort.
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Affiliation(s)
| | | | | | | | | | | | | | - Mu Chen
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yi-Gang Li
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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21
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Simionescu K, Łoboda D, Adamek M, Wilczek J, Gibiński M, Gardas R, Biernat J, Gołba KS. Relationships between Heart Chamber Morphology or Function and Respiratory Parameters in Patients with HFrEF and Various Types of Sleep-Disordered Breathing. Diagnostics (Basel) 2023; 13:3309. [PMID: 37958204 PMCID: PMC10648695 DOI: 10.3390/diagnostics13213309] [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: 08/29/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Sleep-disordered breathing (SDB), i.e., central sleep apnea (CSA) and obstructive sleep apnea (OSA), affects the prognosis of patients with heart failure with reduced ejection fraction (HFrEF). The study assessed the relationships between heart chamber size or function and respiratory parameters in patients with HFrEF and various types of SDB. The 84 participants were patients aged 68.3 ± 8.4 years (80% men) with an average left ventricular ejection fraction (LVEF) of 25.5 ± 6.85% who qualified for cardioverter-defibrillator implantation with or without cardiac resynchronization therapy. SDB, defined by an apnea-hypopnea index (AHI) ≥ five events/hour, was diagnosed in 76 patients (90.5%); SDB was severe in 31 (36.9%), moderate in 26 (31.0%), and mild in 19 (22.6%). CSA was the most common type of SDB (64 patients, 76.2%). A direct proportional relationship existed only in the CSA group between LVEF or stroke volume (SV) and AHI (p = 0.02 and p = 0.07), and between LVEF or SV and the percentage of total sleep time spent with hemoglobin oxygen saturation < 90% (p = 0.06 and p = 0.07). In contrast, the OSA group was the only group in which right ventricle size showed a positive relationship with AHI (for basal linear dimension [RVD1] p = 0.06), mean duration of the respiratory event (for RVD1 p = 0.03, for proximal outflow diameter [RVOT proximal] p = 0.009), and maximum duration of respiratory event (for RVD1 p = 0.049, for RVOT proximal p = 0.006). We concluded that in HFrEF patients, SDB severity is related to LV systolic function and SV only in CSA, whereas RV size correlates primarily with apnea/hypopnea episode duration in OSA.
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Affiliation(s)
- Karolina Simionescu
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Danuta Łoboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Mariusz Adamek
- Department of Thoracic Surgery, Medical University of Silesia, 40-055 Katowice, Poland;
- 2nd Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Michał Gibiński
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Rafał Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Krzysztof S. Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
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22
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Sapna F, Raveena F, Chandio M, Bai K, Sayyar M, Varrassi G, Khatri M, Kumar S, Mohamad T. Advancements in Heart Failure Management: A Comprehensive Narrative Review of Emerging Therapies. Cureus 2023; 15:e46486. [PMID: 37927716 PMCID: PMC10623504 DOI: 10.7759/cureus.46486] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Heart failure is a substantial and escalating global health challenge, affecting millions worldwide. This complex syndrome arises from diverse etiologies, encompassing ischemic heart disease, hypertension, valvular abnormalities, and cardiomyopathies. Heart failure is characterized by the heart's inability to pump blood efficiently to meet the body's metabolic demands, leading to debilitating symptoms, frequent hospitalizations, and high mortality rates. Traditionally, the management of Heart failure has focused on alleviating symptoms, reducing fluid retention, and enhancing cardiac contractility. These goals have been achieved through a combination of pharmacological therapies such as angiotensin-converting enzyme inhibitors, beta-blockers, and diuretics, often complemented by device-based interventions like implantable cardioverter-defibrillators and cardiac resynchronization therapy. However, despite these advances, the relentless progression of heart failure remains a significant clinical challenge. Neurohormonal activation, cardiac fibrosis, and cellular remodeling are just a few of the intricate processes contributing to the disease's progression. In recent years, researchers and clinicians have embarked on a quest to identify novel therapeutic approaches that address these underlying mechanisms. One such avenue of exploration involves the revolutionary field of gene therapy, with promising gene-editing techniques, such as CRISPR-Cas9, offering potential routes for correcting genetic mutations that contribute to heart failure. Additionally, regenerative medicine approaches, including stem cell therapy and tissue engineering, hold significant promise for repairing damaged cardiac tissue and restoring function. Furthermore, precision medicine initiatives have gained traction, aiming to tailor heart failure therapies to individual patient profiles, taking into account genetics, biomarkers, and comorbidities. Integrating artificial intelligence and machine learning in heart failure management has also enabled the development of predictive models for early intervention, risk stratification, and personalized treatment recommendations. This narrative review navigates the intricate landscape of emerging therapies for heart failure, emphasizing their potential to revolutionize the field by targeting the disease's fundamental mechanisms. By exploring these innovative approaches, we aspire to provide a comprehensive perspective on the evolving paradigm of heart failure management, fostering a hopeful outlook for patients and clinicians alike.
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Affiliation(s)
- Fnu Sapna
- Pathology, Albert Einstein College of Medicine, New York, USA
| | - Fnu Raveena
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Maria Chandio
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Karoona Bai
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
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23
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Bergonti M, Ascione C, Marcon L, Pambrun T, Della Rocca DG, Ferrero TG, Pannone L, Kühne M, Compagnucci P, Bonomi A, Gevaert AB, Anselmino M, Casella M, Krisai P, Tondo C, Rodríguez-Mañero M, Derval N, Chierchia GB, de Asmundis C, Heidbuchel H, Jaïs P, Sarkozy A. Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure: a prediction model. Eur Heart J 2023; 44:3327-3335. [PMID: 37387689 DOI: 10.1093/eurheartj/ehad428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/27/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
AIMS Management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains complex. The Antwerp score, based on four parameters [QRS >120 ms (2 points), known aetiology (2 points), paroxysmal AF (1 point), severe atrial dilation (1 point)] adequately estimated the probability of left ventricular ejection fraction (LVEF) recovery after AF ablation in a single-centre cohort. The present study aims to externally validate this prediction model in a large European multi-centre cohort. METHODS AND RESULTS A total of 605 patients (61.1 ± 9.4 years, 23.8% females, 79.8% with persistent AF) with HF and impaired LVEF (<50%) undergoing AF ablation in 8 European centres were retrospectively identified. According to the LVEF changes at 12-month echocardiography, 427 (70%) patients fulfilled the '2021 Universal Definition of HF' criteria for LVEF recovery and were defined as 'responders'. External validation of the score yielded good discrimination and calibration {area under the curve 0.86 [95% confidence interval (CI) 0.82-0.89], P < .001; Hosmer-Lemeshow P = .29}. Patients with a score < 2 had a 93% probability of LVEF recovery as opposed to only 24% in patients with a score > 3. Responders experienced more often positive ventricular remodelling [odds ratio (OR) 8.91, 95% CI 4.45-17.84, P < .001], fewer HF hospitalizations (OR 0.09, 95% CI 0.05-0.18, P < .001) and lower mortality (OR 0.11, 95% CI 0.04-0.31, P < .001). CONCLUSION In this multi-centre study, a simple four-parameter score predicted LVEF recovery after AF ablation in patients with HF and discriminated clinical outcomes. These findings support the use of the Antwerp score to standardize shared decision-making regarding AF ablation referral in future clinical studies.
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Affiliation(s)
- Marco Bergonti
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Ciro Ascione
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Lorenzo Marcon
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France
| | - Domenico G Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Teba Gonzalez Ferrero
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Michael Kühne
- Cardiology Division, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti Umberto I-Lancisi-Salesi', Ancona, Italy
| | - Alice Bonomi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Andreas B Gevaert
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Matteo Anselmino
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti Umberto I-Lancisi-Salesi', Ancona, Italy
| | - Philipp Krisai
- Cardiology Division, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Claudio Tondo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Moises Rodríguez-Mañero
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
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Nagarakanti R, Gopinathannair R. Atrial fibrillation ablation in heart failure with mid-range ejection fraction: Is it time to open the champagne? Indian Pacing Electrophysiol J 2023; 23:142-143. [PMID: 37652619 PMCID: PMC10491964 DOI: 10.1016/j.ipej.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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25
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Sakamoto K, Tohyama T, Ide T, Mukai Y, Enzan N, Nagata T, Ikeda M, Takase S, Nagayama T, Fujino T, Matsushima S, Tsutsui H. Efficacy of Early Catheter Ablation for Atrial Fibrillation After Admission for Heart Failure. JACC Clin Electrophysiol 2023; 9:1948-1959. [PMID: 37480855 DOI: 10.1016/j.jacep.2023.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Advances in catheter ablation (CA) for atrial fibrillation (AF) have improved the prognosis of patients with heart failure (HF) and AF. However, its optimal timing remains to be fully elucidated. OBJECTIVES The aim of this study was to investigate the prognostic impact of early CA in patients with HF and AF hospitalized for worsening HF. METHODS From JROADHF (Japanese Registry of Acute Decompensated Heart Failure) (n = 13,238), patients with HF and AF who underwent CA within 90 days after admission for HF (early CA; n = 103) and those who did not (control; n = 2,683) were identified. Mortality was compared between these groups in the crude cohort, as well as in the propensity-matched cohort (n = 83 in each group). RESULTS In the crude cohort, all-cause mortality was significantly lower in the early CA group than in the control group (log-rank P < 0.001; HR: 0.38; 95% CI: 0.24-0.60). In the matched cohort, all-cause mortality was likewise significantly lower in the early CA group (log-rank P = 0.014; HR: 0.47; 95% CI: 0.25-0.88). Cardiovascular death and HF mortality were significantly lower in both cohorts (crude: Gray' test: P < 0.001 and P = 0.005; subdistribution HR: 0.28 [95% CI: 0.13-0.63] and HR: 0.31 [95% CI: 0.13-0.75]; matched: Gray's test: P = 0.006 and P = 0.017; subdistribution HR: 0.24 [95% CI: 0.08-0.70] and HR: 0.28 [95% CI: 0.09-0.84], respectively). CONCLUSIONS In a nationwide representative real-world cohort, CA for AF within 90 days after admission for HF was associated with improved long-term outcomes, including cardiovascular and HF death in patients with HF and AF.
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Affiliation(s)
- Kazuo Sakamoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Clinical and Translational Research of Kyushu University Hospital, Fukuoka, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yasushi Mukai
- Division of Cardiology, Japanese Red-Cross Fukuoka Hospital, Fukuoka, Japan
| | - Nobuyuki Enzan
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Nagata
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Susumu Takase
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomomi Nagayama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Advanced Cardiopulmonary Failure, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; School of Medicine and Graduate School, International University of Health and Welfare, Otawara, Japan
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26
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Chua SK, Huang PS, Chen JJ, Chiu FC, Hwang JJ, Tsai CT. Use of the CHA 2DS 2-VASc score to predict subsequent myocardial infarction in atrial fibrillation. Hellenic J Cardiol 2023:S1109-9666(23)00147-1. [PMID: 37633490 DOI: 10.1016/j.hjc.2023.08.010] [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: 06/01/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The risk of subsequent myocardial infarction (MI) varies widely in patients with atrial fibrillation (AF). No convenient scoring system currently exists to identify MI in AF. While each element of the CHA2DS2-VASc (congestive heart failure; hypertension; age ≥75 years [doubled]; type 2 diabetes; previous stroke or thromboembolism [doubled]; vascular disease; age 65-75 years; and sex category) score can increase the likelihood of MI, this retrospective longitudinal study aimed to determine the accuracy of the CHA2DS2-VASc score in predicting subsequent MI risk in AF. METHODS A total of 29,341 patients with AF were enrolled and followed up from January 2010 until the first occurrence of MI or until December 2020. The primary endpoint was the occurrence of subsequent MI. RESULTS The average age of the study population was 71 years, and 43.2% were male. The mean CHA2DS2-VASc score was found to be higher in patients with AF who had experienced an MI than in those who had not (3.56 ± 1.92 vs. 3.32 ± 1.81, p < 0.001). During the long-term follow-up, the risk of subsequent MI increased by 22% with every one-point increase in the CHA2DS2-VASc score (hazard ratio 1.22, 95% confidence interval 1.19-1.25; p < 0.001). Kaplan-Meier analysis revealed that high CHA2DS2-VASc scores were more likely to experience an MI than those with low CHA2DS2-VASc scores (log-rank p < 0.001). Furthermore, the CHA2DS2-VASc score was a significant predictor of MI in multivariate regression analysis. CONCLUSION The CHA2DS2-VASc score is a valuable predictor of subsequent MI risk in patients with AF.
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Affiliation(s)
- Su-Kiat Chua
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Pang-Shuo Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, ROC
| | - Jien-Jiun Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, ROC
| | - Fu-Chun Chiu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, ROC
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, 100, Taiwan, ROC; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, 100, Taiwan, ROC; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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27
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Hashem AM, Al Ali O, Khalouf A, Shehadah A, Mohammed M, Mahmoud A, Laguio-Vila M, Rao M. Shocked to death: a case report of cardiogenic shock and death following electrocardioversion for atrial fibrillation. BMC Cardiovasc Disord 2023; 23:350. [PMID: 37452312 PMCID: PMC10349499 DOI: 10.1186/s12872-023-03376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is prevalent, especially in patients with heart failure. Their prevalence increases with age and both conditions are interrelated. Electrocardioversion (ECV) is considered a safe and effective procedure and is among one of the recommended therapies to terminate AF back to normal sinus rhythm. Our study highlights one of the rare complications following ECV. A 71-year-old female with a history of atrial fibrillation underwent electrocardioversion and developed sudden onset of ventricular stunning resulting in refractory cardiogenic shock. She was treated with mechanical cardiac support including IABP and Impella. Both provided minimal support then rapid clinical deterioration happened leading to imminent death. CONCLUSION Patients with atrial fibrillation and heart failure treated with electrocardioversion might develop refractory cardiogenic shock and death as a complication of this procedure.
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Affiliation(s)
- Anas Mohamad Hashem
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA.
| | - Omar Al Ali
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Amani Khalouf
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Ahmed Shehadah
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Moghniuddin Mohammed
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Amir Mahmoud
- Internal medicine resident, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Maryrose Laguio-Vila
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Mohan Rao
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, 14621, USA
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28
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Hulsmans M, Schloss MJ, Lee IH, Bapat A, Iwamoto Y, Vinegoni C, Paccalet A, Yamazoe M, Grune J, Pabel S, Momin N, Seung H, Kumowski N, Pulous FE, Keller D, Bening C, Green U, Lennerz JK, Mitchell RN, Lewis A, Casadei B, Iborra-Egea O, Bayes-Genis A, Sossalla S, Ong CS, Pierson RN, Aster JC, Rohde D, Wojtkiewicz GR, Weissleder R, Swirski FK, Tellides G, Tolis G, Melnitchouk S, Milan DJ, Ellinor PT, Naxerova K, Nahrendorf M. Recruited macrophages elicit atrial fibrillation. Science 2023; 381:231-239. [PMID: 37440641 PMCID: PMC10448807 DOI: 10.1126/science.abq3061] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/02/2023] [Indexed: 07/15/2023]
Abstract
Atrial fibrillation disrupts contraction of the atria, leading to stroke and heart failure. We deciphered how immune and stromal cells contribute to atrial fibrillation. Single-cell transcriptomes from human atria documented inflammatory monocyte and SPP1+ macrophage expansion in atrial fibrillation. Combining hypertension, obesity, and mitral valve regurgitation (HOMER) in mice elicited enlarged, fibrosed, and fibrillation-prone atria. Single-cell transcriptomes from HOMER mouse atria recapitulated cell composition and transcriptome changes observed in patients. Inhibiting monocyte migration reduced arrhythmia in Ccr2-∕- HOMER mice. Cell-cell interaction analysis identified SPP1 as a pleiotropic signal that promotes atrial fibrillation through cross-talk with local immune and stromal cells. Deleting Spp1 reduced atrial fibrillation in HOMER mice. These results identify SPP1+ macrophages as targets for immunotherapy in atrial fibrillation.
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Affiliation(s)
- Maarten Hulsmans
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Maximilian J. Schloss
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - I-Hsiu Lee
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aneesh Bapat
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yoshiko Iwamoto
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Claudio Vinegoni
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandre Paccalet
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Masahiro Yamazoe
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jana Grune
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steffen Pabel
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Noor Momin
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hana Seung
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nina Kumowski
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Fadi E. Pulous
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Keller
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Constanze Bening
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ursula Green
- Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jochen K. Lennerz
- Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard N. Mitchell
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew Lewis
- Radcliffe Department of Medicine, NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Barbara Casadei
- Radcliffe Department of Medicine, NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Oriol Iborra-Egea
- Institut del Cor Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Institut del Cor Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
- Department of Cardiology and Angiology, University of Giessen/DZHK, Partner Site Rhein-Main, Germany
| | - Chin Siang Ong
- Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Richard N. Pierson
- Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jon C. Aster
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Rohde
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory R. Wojtkiewicz
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Filip K. Swirski
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Tellides
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - George Tolis
- Department of Cardiac Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Patrick T. Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Kamila Naxerova
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
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Moltó-Balado P, Reverté-Villarroya S, Monclús-Arasa C, Balado-Albiol MT, Baset-Martínez S, Carot-Domenech J, Clua-Espuny JL. Heart Failure and Major Adverse Cardiovascular Events in Atrial Fibrillation Patients: A Retrospective Primary Care Cohort Study. Biomedicines 2023; 11:1825. [PMID: 37509465 PMCID: PMC10376826 DOI: 10.3390/biomedicines11071825] [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: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with an increased risk of major adverse cardiovascular events (MACE). The main goal was to analyze the links and associations between AF and MACE. METHODS A multicenter, observational, retrospective, community-based study of a cohort (n = 40,297) of the general population aged 65-95 years between 1 January 2015 and 31 December 2021 without a previous diagnosis of AF or MACE in the Primary Care setting. RESULTS 2574 people (6.39%) developed a first AF event, resulting in an overall incidence of 8.9/1000 people-years [CI95% 8.6-9.2]. The incidence of MACE among those with AF was 75.1/1000 people-years [CI95% 70.8-79.5], whereas among those without AF, it was 20.6/1000 people-years [CI 95% 20.2-21.1], resulting in a rate ratio of 3.65 [CI 95% 3.43-3.88, p < 0.001]. Besides, the incidence of HF with AF was 40.1 people-years [CI 95% 37.1-43.2], while in the group without AF, it was 8.3 people-years [CI 95% 7.9-8.6, p < 0.001], with a rate ratio of 4.85 [CI 95% 4.45-55.3, p < 0.001]. Before an AF diagnosis, there is already a higher risk of chronic kidney disease, ischemic cardiopathy, and peripheral artery disease. A higher risk of poor nutritional status was detected among those with MACE (49.7% vs. 26.6%, p < 0.001). CONCLUSIONS AF diagnosis increases the incidence of heart failure fourfold. Additional information is required to establish the connection between AF, major adverse cardiovascular events, and nutritional status.
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Affiliation(s)
- P Moltó-Balado
- Primary Health-Care Centre Tortosa Oest, Institute Català de la Salut, Primary Care Service (SAP) Terres de l'Ebre, 43500 Tortosa, Spain
- Biomedicine Doctoral Programme, Universitat Rovira I Virgili, 43500 Tortosa, Spain
| | - S Reverté-Villarroya
- Biomedicine Doctoral Programme, Advanced Nursing Research Group, Nursing Department, Campus Terres de l'Ebre, Universitat Rovira I Virgili, 43500 Tortosa, Spain
| | - C Monclús-Arasa
- Primary Health-Care Centre Tortosa Oest, Institute Català de la Salut, Primary Care Service (SAP) Terres de l'Ebre, 43500 Tortosa, Spain
| | - M T Balado-Albiol
- Conselleria de Sanitat, Departament de Salut de La Plana, Primary Health-Care Centre CS Burriana I, 12540 Burriana, Spain
| | - S Baset-Martínez
- Nusing Management Primary Health-Care Center Tortosa Est, Institut Català de la Salut, Primary Care Service (SAP) Terres de l'Ebre, 43500 Tortosa, Spain
| | - J Carot-Domenech
- Direction of Information and Communication Systems, Territorial Management of Terres de l'Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
| | - J L Clua-Espuny
- Ebrictus Research Group, Research Support Unit Terres de l'Ebre, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 43500 Tortosa, Spain
- Primary Health-Care Center Tortosa Est, Institut Català de la Salut, Primary Care Service (SAP) Terres de l'Ebre, 43500 Toosa, Spain
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Ray WA, Chung CP, Stein CM, Smalley W, Zimmerman E, Dupont WD, Hung AM, Daugherty JR, Dickson AL, Murray KT. Risk for Bleeding-Related Hospitalizations During Use of Amiodarone With Apixaban or Rivaroxaban in Patients With Atrial Fibrillation : A Retrospective Cohort Study. Ann Intern Med 2023; 176:769-778. [PMID: 37216662 DOI: 10.7326/m22-3238] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Amiodarone, the most effective antiarrhythmic drug in atrial fibrillation, inhibits apixaban and rivaroxaban elimination, thus possibly increasing anticoagulant-related risk for bleeding. OBJECTIVE For patients receiving apixaban or rivaroxaban, to compare risk for bleeding-related hospitalizations during treatment with amiodarone versus flecainide or sotalol, antiarrhythmic drugs that do not inhibit these anticoagulants' elimination. DESIGN Retrospective cohort study. SETTING U.S. Medicare beneficiaries aged 65 years or older. PATIENTS Patients with atrial fibrillation began anticoagulant use between 1 January 2012 and 30 November 2018 and subsequently initiated treatment with study antiarrhythmic drugs. MEASUREMENTS Time to event for bleeding-related hospitalizations (primary outcome) and ischemic stroke, systemic embolism, and death with or without recent (past 30 days) evidence of bleeding (secondary outcomes), adjusted with propensity score overlap weighting. RESULTS There were 91 590 patients (mean age, 76.3 years; 52.5% female) initiating use of study anticoagulants and antiarrhythmic drugs, 54 977 with amiodarone and 36 613 with flecainide or sotalol. Risk for bleeding-related hospitalizations increased with amiodarone use (rate difference [RD], 17.5 events [95% CI, 12.0 to 23.0 events] per 1000 person-years; hazard ratio [HR], 1.44 [CI, 1.27 to 1.63]). Incidence of ischemic stroke or systemic embolism did not increase (RD, -2.1 events [CI, -4.7 to 0.4 events] per 1000 person-years; HR, 0.80 [CI, 0.62 to 1.03]). The risk for death with recent evidence of bleeding (RD, 9.1 events [CI, 5.8 to 12.3 events] per 1000 person-years; HR, 1.66 [CI, 1.35 to 2.03]) was greater than that for other deaths (RD, 5.6 events [CI, 0.5 to 10.6 events] per 1000 person-years; HR, 1.15 [CI, 1.00 to 1.31]) (HR comparison: P = 0.003). The increased incidence of bleeding-related hospitalizations for rivaroxaban (RD, 28.0 events [CI, 18.4 to 37.6 events] per 1000 person-years) was greater than that for apixaban (RD, 9.1 events [CI, 2.8 to 15.3 events] per 1000 person-years) (P = 0.001). LIMITATION Possible residual confounding. CONCLUSION In this retrospective cohort study, patients aged 65 years or older with atrial fibrillation treated with amiodarone during apixaban or rivaroxaban use had greater risk for bleeding-related hospitalizations than those treated with flecainide or sotalol. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Wayne A Ray
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee (W.A.R., J.R.D.)
| | - Cecilia P Chung
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee (C.P.C., A.M.H., A.L.D.)
| | - C Michael Stein
- Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee (C.M.S., K.T.M.)
| | - Walter Smalley
- Departments of Health Policy and Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee (W.S.)
| | - Eli Zimmerman
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.Z.)
| | - William D Dupont
- Departments of Health Policy and Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee (W.D.D.)
| | - Adriana M Hung
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee (C.P.C., A.M.H., A.L.D.)
| | - James R Daugherty
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee (W.A.R., J.R.D.)
| | - Alyson L Dickson
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee (C.P.C., A.M.H., A.L.D.)
| | - Katherine T Murray
- Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee (C.M.S., K.T.M.)
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Ayub MT, Rangavajla G, Thoma F, Mulukutla S, Aronis K, Bhonsale A, Kancharla K, Voigt A, Shalaby A, Estes NAM, Jain S, Saba S. Relative Contribution of Atrial Fibrillation to Outcomes of Patients With Cardiomyopathy Based on Severity of Left Ventricular Dysfunction. Am J Cardiol 2023; 198:9-13. [PMID: 37182255 DOI: 10.1016/j.amjcard.2023.04.033] [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: 02/14/2023] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023]
Abstract
In patients with left ventricular (LV) dysfunction, the risk of death or heart failure hospitalizations (HFHs) increases with worsening ejection fraction (EF). Whether the relative contribution of atrial fibrillation (AF) to outcomes is more pronounced in patients with worse EF is not confirmed. The present study aimed to investigate the relative influence of AF on the outcome of cardiomyopathy patients by severity of LV dysfunction. In this observational study, data from 18,003 patients with EF ≤50% seen at a large academic institution between 2011 and 2017 were analyzed. Patients were stratified by EF quartiles (EF<25%, 25%≤EF<35%, 35%≤EF<40%, and EF≥40%, for quartiles 1, 2, 3, and 4, respectively). and followed to the end point of death or HFH. Outcomes of AF versus non-AF patients were compared within each EF quartile. During a median follow-up of 3.35 years, 8,037 patients (45%) died and 7,271 (40%) had at least 1 HFH. Rates of HFH and all-cause mortality increased as EF decreased. The hazard ratios (HRs) of death or HFH for AF versus non-AF patients increased steadily with increasing EF (HR of 1.22, 1.27, 1.45, 1.50 for quartiles 1, 2, 3, and 4, respectively, p = 0.045) driven primarily by the risk of HFH (HR of 1.26, 1.45, 1.59, 1.69 for quartiles 1, 2, 3, and 4, respectively, p = 0.045). In conclusion, in patients with LV dysfunction, the detrimental influence of AF on the risk of HFH is more pronounced in those with more preserved EF. Mitigation strategies for AF with the goal of decreasing HFH may be more impactful in patients with more preserved LV function.
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Affiliation(s)
- Mumammad Talha Ayub
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gautam Rangavajla
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Suresh Mulukutla
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Konstantinos Aronis
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrew Voigt
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alaa Shalaby
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nathan Anthony Mark Estes
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sandeep Jain
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Samir Saba
- The Heart and Vascular Institute at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Lee WC, Fang HY, Wu PJ, Chen HC, Fang YN, Chen MC. Outcomes of catheter ablation vs. medical treatment for atrial fibrillation and heart failure: a meta-analysis. Front Cardiovasc Med 2023; 10:1165011. [PMID: 37234370 PMCID: PMC10206232 DOI: 10.3389/fcvm.2023.1165011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
Background The benefit of catheter ablation vs. medical treatment has been reported to be inconsistent in randomized controlled trials (RCTs) for patients with atrial fibrillation (AF) and heart failure (HF) due to different enrollment criteria. This meta-analysis aimed to decipher the differential outcomes stratified by different left ventricular ejection fractions (LVEFs) and AF types. Methods We searched PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov databases for RCTs comparing medical treatment and catheter ablation in patients with AF and HF published before March 31, 2023. Nine studies were included. Results When patients were stratified by LVEF, improved LVEF and 6-min walk distance, less AF recurrence, and lower all-cause mortality in favor of catheter ablation were observed in patients with LVEF ≤50% but not in patients with LVEF ≤35%, and short HF hospitalization was observed in patients with LVEF ≤50% and LVEF ≤35%. When patients were stratified by AF types, improved LVEF and 6-min walk distance, better HF questionnaire score, and short HF hospitalization in favor of catheter ablation were observed both in patients with nonparoxysmal AF and mixed AF (paroxysmal and persistent) and less AF recurrence and lower all-cause mortality in favor of catheter ablation were observed in only patients with mixed AF. Conclusions This meta-analysis showed improved LVEF and 6-min walk distance, less AF recurrence, and lower all-cause mortality in favor of catheter ablation vs. medical treatment in AF patients with HF and LVEF of 36%-50%. Compared with medical treatment, catheter ablation improved LVEF and had better HF status in patients with nonparoxysmal AF and mixed AF; however, AF recurrence and all-cause mortality in favor of catheter ablation were observed in only HF patients with mixed AF.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Nan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Joglar JA. Atrial Fibrillation and Heart Failure: Is It the Chicken or the Egg? Am J Cardiol 2023; 197:75-76. [PMID: 37150721 DOI: 10.1016/j.amjcard.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Jose A Joglar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Health, Dallas, Texas.
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Hsu JC, Yang YY, Chuang SL, Lin LY, Chen THH. Prediabetes as a risk factor for new-onset atrial fibrillation: the propensity-score matching cohort analyzed using the Cox regression model coupled with the random survival forest. Cardiovasc Diabetol 2023; 22:35. [PMID: 36804876 PMCID: PMC9940357 DOI: 10.1186/s12933-023-01767-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The glycemic continuum often indicates a gradual decline in insulin sensitivity leading to an increase in glucose levels. Although prediabetes is an established risk factor for both macrovascular and microvascular diseases, whether prediabetes is independently associated with the risk of developing atrial fibrillation (AF), particularly the occurrence time, has not been well studied using a high-quality research design in combination with statistical machine-learning algorithms. METHODS Using data available from electronic medical records collected from the National Taiwan University Hospital, a tertiary medical center in Taiwan, we conducted a retrospective cohort study consisting 174,835 adult patients between 2014 and 2019 to investigate the relationship between prediabetes and AF. To render patients with prediabetes as comparable to those with normal glucose test, a propensity-score matching design was used to select the matched pairs of two groups with a 1:1 ratio. The Kaplan-Meier method was used to compare the cumulative risk of AF between prediabetes and normal glucose test using log-rank test. The multivariable Cox regression model was employed to estimate adjusted hazard ratio (HR) for prediabetes versus normal glucose test by stratifying three levels of glycosylated hemoglobin (HbA1c). The machine-learning algorithm using the random survival forest (RSF) method was further used to identify the importance of clinical factors associated with AF in patients with prediabetes. RESULTS A sample of 14,309 pairs of patients with prediabetes and normal glucose test result were selected. The incidence of AF was 11.6 cases per 1000 person-years during a median follow-up period of 47.1 months. The Kaplan-Meier analysis revealed that the risk of AF was significantly higher in patients with prediabetes (log-rank p < 0.001). The multivariable Cox regression model indicated that prediabetes was independently associated with a significant increased risk of AF (HR 1.24, 95% confidence interval 1.11-1.39, p < 0.001), particularly for patients with HbA1c above 5.5%. The RSF method identified elevated N-terminal natriuretic peptide and altered left heart structure as the two most important risk factors for AF among patients with prediabetes. CONCLUSIONS Our study found that prediabetes is independently associated with a higher risk of AF. Furthermore, alterations in left heart structure make a significant contribution to this elevated risk, and these structural changes may begin during the prediabetes stage.
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Affiliation(s)
- Jung-Chi Hsu
- Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No.7, Chung-Chan South Road, Taipei, 100, Taiwan
| | - Yen-Yun Yang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lin Chuang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No.7, Chung-Chan South Road, Taipei, 100, Taiwan. .,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Zhang E, Liang S, Sun T, Xu J, Lu F, Wu D, Zhang J, He L, Zhang F, Fan S, Ma W. Prognostic value of heart rate variability in atrial fibrillation recurrence following catheter ablation: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1048398. [PMID: 36818913 PMCID: PMC9932203 DOI: 10.3389/fcvm.2022.1048398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Background Atrial fibrillation (AF) has been a worldwide health issue with increasing prevalence and mortality. Recently, increasing attention has been gained to the relationship between heart rate variability (HRV) and the clinical prognosis of AF catheter ablation. We aimed to evaluate the prognostic value of HRV in AF recurrence. Methods We systematically searched Web of Science, PubMed, and Embase from inception until 17 August 2022 to conduct the systematic review and meta-analysis. We included the studies reporting the predictive value of HRV parameters for AF recurrence or in which HRV parameters in AF recurrence and non-recurrence groups were individually reported. Results Finally, we enrolled 16 studies, including 2,352 patients. Higher rMSSD could independently predict AF recurrence following catheter ablation (OR: 1.02, 95% CI: 1.00-1.04; p = 0.03). Higher HF (OR: 1.55, 95% CI: 1.05-2.28; p = 0.03) and lower LF/HF (OR: 1.12, 95% CI: 1.03-1.20; p = 0.004) could independently predict AF recurrence within 1 year. Higher SDNN (OR: 1.02, 95% CI: 101-1.02; p = 0.0006) could independently predict AF recurrence among patients with paroxysmal AF. Almost all HRV parameters within 3 days after catheter ablation and lnHF, lnLF, and rMSSD at 3 months after catheter ablation performed significant differences in AF recurrence and non-recurrence groups. Conclusion Heart rate variability, especially higher rMSSD (within short-term and long-term periods), was closely related to recurrent AF following catheter ablation, highlighting the clinical importance of HRV in the prognosis of AF following catheter ablation.
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Affiliation(s)
- Enyuan Zhang
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Shuo Liang
- Department of Radiology, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Tianhong Sun
- Cardiac Function Department, Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Jing Xu
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China,Jing Xu ✉
| | - Fengmin Lu
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Dongyan Wu
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Jingkun Zhang
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, United States
| | - Le He
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Fan Zhang
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Shaobo Fan
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Wei Ma
- Heart Rhythm Center, Department of Cardiology, Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin, China,*Correspondence: Wei Ma ✉
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Chang TY, Chao TF, Lin CY, Lin YJ, Chang SL, Lo LW, Hu YF, Chung FP, Chen SA. Catheter ablation of atrial fibrillation in heart failure with impaired systolic function: An updated meta-analysis of randomized controlled trials. J Chin Med Assoc 2023; 86:11-18. [PMID: 36227015 DOI: 10.1097/jcma.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The recent Atrial Fibrillation Management in Congestive Heart Failure With Ablation trial did not reveal any benefit of catheter ablation in patients with atrial fibrillation (AF), advanced heart failure (HF), and severely reduced left ventricular ejection fraction (LVEF). We hypothesized that radiofrequency catheter ablation (RFCA) could improve outcomes in HF patients with AF and impaired left ventricular systolic function (LVEF <50%) as compared with only medical therapy. METHODS We searched the literature for randomized clinical trials (RCTs) that compared RFCA to medical therapy in this population. RESULTS Compared with the medical therapy group, the RFCA group had significantly less all-cause mortality, HF hospitalization, and AF recurrence rates. The RFCA group had significantly higher peak oxygen consumption (VO 2max ), a better quality of life (Minnesota Living with Heart Failure Questionnaire score), and improved LVEF. However, RFCA for AF failed to reduce all-cause mortality in a specific meta-analysis of four RCTs that enrolled patients with LVEF ≤35%. CONCLUSION Compared with medical therapy, RFCA for AF in the setting of HF with impaired systolic function is associated with better clinical (HF hospitalization and all-cause mortality), structural (LVEF improvement), functional (VO 2max ), and quality of life outcomes. However, RFCA for AF failed to reduce all-cause mortality in RCTs that enrolled patients with LVEF ≤35% and thereby indicated the necessary stratification to identify patients who may benefit more from RFCA.
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Affiliation(s)
- Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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Liebe V, Kruska M, Dürschmied D, Akin I. [What is confirmed in the treatment of atrial fibrillation?]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2022; 63:1244-1249. [PMID: 36355078 DOI: 10.1007/s00108-022-01418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Atrial fibrillation is the most common clinically relevant cardiac arrhythmia. Important goals in the treatment of atrial fibrillation are improvement of the quality of life, relief of symptoms and the prevention of stroke. New in the current European guidelines on atrial fibrillation from 2020 is a structured approach with the introduction of the 4S-AF scheme (4S estimation of the risk of stroke, severity of symptoms, degree of severity of atrial fibrillation load and substrate, AF atrial fibrillation) for better characterization of atrial fibrillation and the ABC pathway in the treatment. The decision on the use of anticoagulation should be made after appropriate risk stratification. Depending on the characterization and symptoms of atrial fibrillation, the planning of further treatment should be made with respect to symptom control. Based on recent studies, rhythm-maintaining treatment by means of drugs or catheter ablation is gaining in importance over a strategy purely aimed at controlling the frequency. Integral components of treatment are also the identification and treatment of comorbidities and cardiovascular risk factors as well as the modification of an unhealthy lifestyle.
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Affiliation(s)
- Volker Liebe
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland.
| | - Mathieu Kruska
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland
| | - Daniel Dürschmied
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland
| | - Ibrahim Akin
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland
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Karnik AA, Saczynski JS, Chung JJ, Gurwitz JH, Bamgbade BA, Paul TJ, Lessard DM, McManus DD, Helm RH. Cognitive impairment, age, quality of life, and treatment strategy for atrial fibrillation in older adults: The SAGE-AF study. J Am Geriatr Soc 2022; 70:2818-2826. [PMID: 35735210 PMCID: PMC10719956 DOI: 10.1111/jgs.17886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) treatment includes anticoagulation for high stroke risk individuals and either rate or rhythm control strategies. We aimed to investigate the impact of age, geriatric factors, and medical comorbidities on choice of rhythm versus rate control strategy in older adults. METHODS Patients with AF aged ≥65 years with CHA2 DS2 VASc score ≥2 and eligible for anticoagulation were recruited for the Systematic Assessment of Geriatric Elements-AF (SAGE-AF) prospective cohort study. An interview that included measures of HRQoL, cognitive function, vision, hearing, and frailty was performed. The association between these elements and AF treatment strategy was examined by multivariable logistic regression models. RESULTS One thousand two hundred forty-four participants (mean age 76 years; 49% female; 85% non-Hispanic white) were enrolled. Rate and rhythm control were used in 534 and 710 participants, respectively. Compared to participants <75 years, those ≥75 were more likely to be treated with a rate control strategy (age 75-84 adjusted odds ratio [aOR] 1.37 [95% CI 0.99, 1.88]; age 85+ aOR = 2.05, 95% CI 1.30, 3.21). Those treated with a rate control strategy were more likely to have cognitive impairment (aOR = 1.50, 95% CI 1.13, 1.99), and peripheral vascular disease (PVD) (aOR = 1.82, 95% CI 1.22, 2.72) but less likely to have visual impairment (aOR 0.73 [0.55, 0.98]), congestive heart failure (CHF; aOR 0.68 [0.49, 0.94]) or receive anticoagulation (aOR 0.53, 95% CI 0.36, 0.78). CONCLUSION Older age, cognitive impairment, and PVD were associated with use of rate control strategy. Visual impairment, CHF, and anticoagulation use were associated with a rhythm control strategy. There was no difference in HRQoL between the rate and rhythm control groups. This study suggests that certain geriatric elements may be associated with AF treatment strategies. Further study is needed to evaluate how these decisions affect outcomes.
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Affiliation(s)
- Ankur A. Karnik
- Evans Department of Medicine, Cardiovascular Medicine Section, Arrhythmia Service, Boston University School of Medicine, Boston, MA
| | - Jane S. Saczynski
- Bouvé College of Health Sciences, Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - Joseph J. Chung
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Jerry H. Gurwitz
- Meyers Primary Care Institute and Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Benita A. Bamgbade
- Bouvé College of Health Sciences, Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - Tenes J. Paul
- Meyers Primary Care Institute and Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Darleen M. Lessard
- Division of Epidemiology of Chronic Diseases, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - David D. McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Robert H. Helm
- Evans Department of Medicine, Cardiovascular Medicine Section, Arrhythmia Service, Boston University School of Medicine, Boston, MA
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The Role of Hypomagnesemia in Cardiac Arrhythmias: A Clinical Perspective. Biomedicines 2022; 10:biomedicines10102356. [PMID: 36289616 PMCID: PMC9598104 DOI: 10.3390/biomedicines10102356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
The importance of magnesium (Mg2+), a micronutrient implicated in maintaining and establishing a normal heart rhythm, is still controversial. It is known that magnesium is the cofactor of 600 and the activator of another 200 enzymatic reactions in the human organism. Hypomagnesemia can be linked to many factors, causing disturbances in energy metabolism, ion channel exchanges, action potential alteration and myocardial cell instability, all mostly leading to ventricular arrhythmia. This review article focuses on identifying evidence-based implications of Mg2+ in cardiac arrhythmias. The main identified benefits of magnesemia correction are linked to controlling ventricular response in atrial fibrillation, decreasing the recurrence of ventricular ectopies and stopping episodes of the particular form of ventricular arrhythmia called torsade de pointes. Magnesium has also been described to have beneficial effects on the incidence of polymorphic ventricular tachycardia and supraventricular tachycardia. The implication of hypomagnesemia in the genesis of atrial fibrillation is well established; however, even if magnesium supplementation for rhythm control, cardioversion facility or cardioversion success/recurrence of AF after cardiac surgery and rate control during AF showed some benefit, it remains controversial. Although small randomised clinical trials showed a reduction in mortality when magnesium was administered to patients with acute myocardial infarction, the large randomised clinical trials failed to show any benefit of the administration of intravenous magnesium over placebo.
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Yang E, Calkins H. Who Benefits Most From Early Rhythm Control in Newly Diagnosed Atrial Fibrillation? Circulation 2022; 146:848-850. [PMID: 36095065 DOI: 10.1161/circulationaha.122.060945] [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] [Indexed: 01/24/2023]
Affiliation(s)
- Eunice Yang
- Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, VA (E.Y.)
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.Y., H.C.)
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Palau P, Domínguez E, Seller J, Sastre C, Sanchis J, López L, Bodí V, Llàcer P, Miñana G, Espriella RDELA, Bayés-Genís A, Núñez J. Chronotropic index and long-term outcomes in heart failure with preserved ejection fraction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022:S1885-5857(22)00211-0. [PMID: 36038124 DOI: 10.1016/j.rec.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Little is known about the usefulness of heart rate (HR) response to exercise for risk stratification in heart failure with preserved ejection fraction (HFpEF). Therefore, this study aimed to assess the association between HR response to exercise and the risk of total episodes of worsening heart failure (WHF) in symptomatic stable patients with HFpEF. METHODS This single-center study included 133 patients with HFpEF (NYHA II-III) who performed maximal cardiopulmonary exercise testing. HR response to exercise was evaluated using the chronotropic index (CIx) formula. A negative binomial regression method was used. RESULTS The mean age of the sample was 73.2± 10.5 years; 56.4% were female, and 51.1% were in atrial fibrillation. The median for CIx was 0.4 [0.3-0.55]. At a median follow-up of 2.4 [1.6-5.3] years, a total of 146 WHF events in 58 patients and 41 (30.8%) deaths were registered. In the whole sample, CIx was not associated with adverse outcomes (death, P=.319, and WHF events, P=.573). However, we found a differential effect across electrocardiographic rhythms for WHF events (P for interaction=.002). CIx was inversely and linearly associated with the risk of WHF events in patients with sinus rhythm and was positively and linearly associated with those with atrial fibrillation. CONCLUSIONS In patients with HFpEF, CIx was differentially associated with the risk of total WHF events across rhythm status. Lower CIx emerged as a risk factor for predicting higher risk in patients with sinus rhythm. In contrast, higher CIx identified a higher risk in those with atrial fibrillation.
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Affiliation(s)
- Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.
| | - Eloy Domínguez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Universitat Jaume I, Castellón, Spain.
| | - Julia Seller
- Servicio de Cardiología, Hospital de Denia, Denia, Alicante, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Laura López
- Facultad de Fisioterapia. Universitat de València, Valencia, Spain
| | - Vicent Bodí
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pau Llàcer
- Servicio de Medicina Interna, Hospital Ramón y Cajal, Madrid, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rafael dE lA Espriella
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Li Z, Pang M, Li Y, Yu Y, Peng T, Hu Z, Niu R, Li J, Wang X. Development and validation of a predictive model for new-onset atrial fibrillation in sepsis based on clinical risk factors. Front Cardiovasc Med 2022; 9:968615. [PMID: 36082114 PMCID: PMC9447992 DOI: 10.3389/fcvm.2022.968615] [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: 06/14/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveNew-onset atrial fibrillation (NOAF) is a common complication and one of the primary causes of increased mortality in critically ill adults. Since early assessment of the risk of developing NOAF is difficult, it is critical to establish predictive tools to identify the risk of NOAF.MethodsWe retrospectively enrolled 1,568 septic patients treated at Wuhan Union Hospital (Wuhan, China) as a training cohort. For external validation of the model, 924 patients with sepsis were recruited as a validation cohort at the First Affiliated Hospital of Xinjiang Medical University (Urumqi, China). Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were used to screen predictors. The area under the ROC curve (AUC), calibration curve, and decision curve were used to assess the value of the predictive model in NOAF.ResultsA total of 2,492 patients with sepsis (1,592 (63.88%) male; mean [SD] age, 59.47 [16.42] years) were enrolled in this study. Age (OR: 1.022, 1.009–1.035), international normalized ratio (OR: 1.837, 1.270–2.656), fibrinogen (OR: 1.535, 1.232–1.914), C-reaction protein (OR: 1.011, 1.008–1.014), sequential organ failure assessment score (OR: 1.306, 1.247–1.368), congestive heart failure (OR: 1.714, 1.126–2.608), and dopamine use (OR: 1.876, 1.227–2.874) were used as risk variables to develop the nomogram model. The AUCs of the nomogram model were 0.861 (95% CI, 0.830–0.892) and 0.845 (95% CI, 0.804–0.886) in the internal and external validation, respectively. The clinical prediction model showed excellent calibration and higher net clinical benefit. Moreover, the predictive performance of the model correlated with the severity of sepsis, with higher predictive performance for patients in septic shock than for other patients.ConclusionThe nomogram model can be used as a reliable and simple predictive tool for the early identification of NOAF in patients with sepsis, which will provide practical information for individualized treatment decisions.
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Affiliation(s)
- Zhuanyun Li
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Pang
- Department of Neurophysiology, Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Cangzhou, China
| | - Yongkai Li
- Department of Emergency Medicine, The First Affiliated Hospital, Xinjiang Medical University, Ürümqi, China
| | - Yaling Yu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianfeng Peng
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenghao Hu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruijie Niu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiming Li
- Department of Emergency Medicine, The First Affiliated Hospital, Xinjiang Medical University, Ürümqi, China
- Jiming Li,
| | - Xiaorong Wang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiaorong Wang,
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Deneke T, Berkovitz A, Ene E, Müller J, Sonne K, Kerber S, Zhuravlev V, Nentwich K. Herzinsuffizienz und Vorhofflimmern – eine
Zwillingsepidemie. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1820-8099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungVorhofflimmern (VHF) und eine Herzinsuffizienz begünstigen sich gegenseitig und
treten häufig in Kombination auf. Eine effektive Therapie des VHF inklusive der
möglicherweise notwendigen Antikoagulation sollte zentraler Baustein bei
Patienten mit eingeschränkter systolischer Funktion und VHF sein. Medikamentöse
Therapieoptionen sind in der Regel wenig effektiv, sodass zunehmend
Katheterablationsverfahren zur Behandlung dieser Patienten in den Vordergrund
gestellt werden. Randomisierte Studien bei selektierten Patienten zeigen nicht
nur einen symptomatischen Effekt auf die Herzinsuffizienz, sondern neben
Verbesserung der LV-Funktion auch einen Letalitätsbenefit der effektiven
Ablation von VHF. In der Zukunft gilt es, Patienten sinnvoll für die
Katheterablation zu identifizieren. Ob das reine Vorhandensein von VHF oder eher
die VHF-Last bei Patienten mit Herzinsuffizienz entscheidend für die Prognose
ist, wird aktuell in weiteren Studien untersucht.
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Affiliation(s)
- Thomas Deneke
- Klinik für interventionelle Elektrophysiologie, Herz- und Gefäß-Klinik
GmbH Bad Neustadt, Bad Neustadt a. d. Saale, Deutschland
| | - Artur Berkovitz
- Klinik für Kardiologie II, Rhythmologie und
interventionelle Elektrophysiologie, Rhön Klinikum Campus Bad Neustadt, Bad
Neustadt, Deutschland
| | - Elena Ene
- Klinik für Kardiologie II, Rhön Klinikum Campus Bad
Neustadt, Bad Neustadt, Deutschland
| | - Julian Müller
- Klinik für Kardiologie II, Rhön Klinikum Campus Bad
Neustadt, Bad Neustadt, Deutschland
| | - Kai Sonne
- Klinik für Kardiologie II, Rhön Klinikum Campus Bad
Neustadt, Bad Neustadt, Deutschland
| | - Sebastian Kerber
- Klinik für Kardiologie I, Rhön Klinikum Campus Bad
Neustadt, Bad Neustadt, Deutschland
| | - Vitali Zhuravlev
- Klinik für Kardiologie II, Rhön Klinikum Campus Bad
Neustadt, Bad Neustadt, Deutschland
| | - Karin Nentwich
- Klinik für Kardiologie II, Rhön Klinikum Campus Bad
Neustadt, Bad Neustadt, Deutschland
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Optimal Catheter Ablation Strategy for Patients with Persistent Atrial Fibrillation and Heart Failure: A Retrospective Study. Cardiol Res Pract 2022; 2022:3002391. [PMID: 35784946 PMCID: PMC9246569 DOI: 10.1155/2022/3002391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
The optimal catheter ablation (CA) strategy for patients with persistent atrial fibrillation (PeAF) and heart failure (HF) remains uncertain. Between 2016 and 2020, 118 consecutive patients with PeAF and HF who underwent the CA procedure in two centers were retrospectively evaluated and divided into the pulmonary vein isolation (PVI)-only and PVI + additional ablation groups. Transthoracic echocardiography (TTE) was performed at baseline, one month, and 12 months after the CA procedure. The HF symptoms and left ventricular ejection fraction (LVEF) improvements were analyzed. Fifty-six patients underwent PVI only, and 62 patients received PVI with additional ablation. Compared with the baseline, a significant improvement in the LVEF and left atrial diameter postablation was observed in all patients. No significant HF improvement was detected in the PVI + additional ablation group than in the PVI-only group (74.2% vs. 71.4%, P = 0.736), but the procedure and ablation time were significantly longer (137.4 ± 7.5 vs. 123.1 ± 11.5 min, P = 0.001). There was no significant difference in the change in TTE parameters and the number of rehospitalizations. For patients with PeAF and HF, CA appears to improve left ventricular function. Additional ablation does not improve outcomes and has a significantly longer procedure time. Trial registration number is as follows: ChiCTR2100053745 (Chinese Clinical Trial Registry; https://www.chictr.org.cn/index.aspx).
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Gopinathannair R, Pothineni NVK, Trivedi JR, Roukoz H, Cowger J, Ahmed MM, Bhan A, K. Ravichandran A, Bhat G, Al Ahmad A, Natale A, Di Biase L, Slaughter MS, Lakkireddy D. Amiodarone Use and All-Cause Mortality in Patients With a Continuous-Flow Left Ventricular Assist Device. J Am Heart Assoc 2022; 11:e023762. [PMID: 35656998 PMCID: PMC9238747 DOI: 10.1161/jaha.121.023762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous‐flow left ventricular assist device (CF‐LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long‐term all‐cause mortality in ptients with a CF‐LVAD. Methods and Results A retrospective multicenter study of CF‐LVAD was conducted at 5 centers including all CF‐LVAD implants from 2007 to 2015. Patients were stratified based on pre–CF‐LVAD implant amiodarone use. Additional use of amiodarone after CF‐LVAD implantation was also evaluated. Primary outcome was all‐cause mortality during long‐term follow‐up. Kaplan‐Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF‐LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF‐LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all‐cause mortality over the follow‐up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone (P=0.008). Similar results were noted in the propensity‐matched group (log‐rank, P=0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all‐cause mortality (hazard ratio, 1.68 [95% CI, 1.1–2.5]; P=0.01). Conclusions Amiodarone use was associated with significantly increased rates of all‐cause mortality in CF‐LVAD recipients. Earlier interventions for arrhythmias to avoid long‐term amiodarone exposure may improve long‐term outcomes in CF‐LVAD recipients and needs further study.
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Affiliation(s)
| | | | - Jaimin R. Trivedi
- Department of Cardiothoracic SurgeryUniversity of LouisvilleLouisvilleKY
| | - Henri Roukoz
- Division of CardiologyUniversity of MinnesotaMinneapolisMN
| | | | | | - Adarsh Bhan
- Division of CardiologyAdvocate Christ Medical CenterOak LawnIL
| | | | - Geetha Bhat
- Division of CardiologyPennsylvania State UniversityHersheyPA
| | | | | | - Luigi Di Biase
- Division of CardiologyMontefiore Medical CenterNew YorkNY
| | - Mark S. Slaughter
- Department of Cardiothoracic SurgeryUniversity of LouisvilleLouisvilleKY
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George B, Sood MR. Coronary-pulmonary artery fistula with lung hypoplasia and a bicuspid aortic valve: A case report. JRSM Cardiovasc Dis 2022; 11:20480040221082905. [PMID: 35295191 PMCID: PMC8918961 DOI: 10.1177/20480040221082905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background With an incidence of less than 1%, a Coronary Artery to Pulmonary Artery fistula (CAPF) is a rare coronary anomaly that causes heart failure. It causes a left to right cardiac shunt. While guidelines favor surgical correction in symptomatic patients, we present a challenging case with multiple cardio-thoracic pathologies. Case Presentation We present a 38-year-old obese male with persistent atrial fibrillation (AF). He presented to our hospital in decompensated heart failure and AF with rapid ventricular response. He was found to have a CAPF, a bicuspid aortic valve and left lung hypoplasia in the presence of severely reduced left ventricular systolic dysfunction. The patient subsequently underwent various cardiac testing demonstrating advanced anatomical and physiologic involvement of his CAPF, including suggested coronary steal. Despite some indications for percutaneous or surgical referral, we optimized his AF and congestive heart failure in lieu of formulating a treatment strategy for his CAPF and other abnormalities. Conclusion This report illustrates a case of a young adult who presented in decompensated heart failure with newly diagnosed left ventricular systolic function and rapid AF, who had a triad of congenital defects including a CAPF, a bicuspid aortic valve and left lung hypoplasia. To the best of our knowledge, this triad of defects is unreported. This case highlights the clinical approach in the evaluation of a cardiac shunt and it's management strategies in the presence of multiple cardio-thoracic comorbidities.
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Affiliation(s)
- Blessen George
- Department of Medicine, Mount Sinai South Nassau, One Healthy way, Oceanside, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael R Sood
- Department of Medicine, Mount Sinai South Nassau, One Healthy way, Oceanside, New York, USA
- Division of Cardiology, Mount Sinai South Nassau
- Icahn School of Medicine at Mount Sinai, New York, USA
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Reiffel JA. Selected Advancements in the Management of Atrial Fibrillation from the Year 2021. J Innov Card Rhythm Manag 2022; 13:4840-4846. [PMID: 35127237 PMCID: PMC8812470 DOI: 10.19102/icrm.2022.130107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pharmacological Management of Atrial Fibrillation: A Century of Expert Opinions in Cecil Textbook of Medicine. Am J Ther 2022; 29:e18-e25. [PMID: 34994347 DOI: 10.1097/mjt.0000000000001464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Advances in drug therapy for atrial fibrillation (AF) have had a significant impact on the quality of life of a substantial majority of affected persons, which has contributed to a remarkable decrease in the frequency and severity of thromboembolic complications, hospitalizations, and mortality. STUDY QUESTION What are the milestones of the changes in the expert approach to the pharmacological management of AF in the past century? STUDY DESIGN To determine the changes in the experts' approach to the management of AF, as presented in a widely used textbook in the United States. DATA SOURCES The chapters presenting the management of AF in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. RESULTS AF was consistently described in Cecil Textbook of Medicine as the most common sustained arrhythmia in adults. The authors emphasized its thromboembolic complications and potential for hemodynamic deterioration. Rate control with digitalis and rhythm control with quinidine were the standard in 1927. The pharmacological advances have focused on atrioventricular nodal blocking for rate control, conversion to and maintenance of sinus rhythm, and preventive anticoagulation. The first new class of drugs for rate control was beta-adrenergic receptor blockers, starting with propranolol which was introduced in 1979, followed by the calcium channel blocker verapamil in 1988. Rhythm control with amiodarone, a potassium channel blocker, has been recommended since 2004, and the sodium channel blockers propafenone and flecainide became part of standard therapy in 2008. Anticoagulation with warfarin was recommended starting in 2000, followed by the introduction of direct thrombin inhibitor in 2012 and factor Xa inhibitors in 2016. CONCLUSIONS The pharmacological management of AF was unchanged for more than 50 years (1927-1979), a period during which the devastating effects of thromboembolic complications were not addressed. The major therapeutic advance is represented by preventive anticoagulation with the newer, safer, and more user-friendly direct thrombin and factor Xa inhibitors.
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Lee JZ, Cha YM. Atrial fibrillation and heart failure: A contemporary review of current management approaches. Heart Rhythm O2 2021; 2:762-770. [PMID: 34988528 PMCID: PMC8710620 DOI: 10.1016/j.hroo.2021.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Atrial fibrillation (AF) and heart failure (HF) frequently coexist and complicate the course of treatment of each other. AF with rapid ventricular conduction can lead to tachycardia-mediated cardiomyopathy, which is a reversible cause of cardiomyopathy. However, in most cases, AF is the manifestation of various underlying cardiomyopathies. Guideline-directed pharmacological and device therapy for HF is essential. The management options for AF and HF include pharmacological rhythm control, pharmacological rate control, and interventional approaches, which include catheter ablation for AF via pulmonary vein isolation and atrioventricular node ablation. This is a contemporary review to discuss the available evidence regarding the various management approaches in this specific patient group.
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Vinter N, Cordsen P, Lip GYH, Benjamin EJ, Trinquart L, Johnsen SP, Frost L. Newly diagnosed atrial fibrillation and hospital utilization in heart failure: a nationwide cohort study. ESC Heart Fail 2021; 8:4808-4819. [PMID: 34726349 PMCID: PMC8712819 DOI: 10.1002/ehf2.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
Aims Atrial fibrillation (AF) constitutes a major burden to health services, but the importance of incident AF in patients with heart failure (HF) is unclear. We examined the associations between incident AF and hospital utilization in patients with HF. Methods and results In a nationwide matched‐cohort study of HF patients, we identified patients diagnosed with incident AF between 2008 and 2018 in the Danish Heart Failure Registry (N = 4463), and we compared them to matched referents without AF (N = 17 802). Incident AF was associated with a multivariable‐adjusted 4.8‐fold increase (95% CI 4.1–5.6) and 4.3‐fold increase (95% CI 3.9–4.8) in the cumulative incidence of inpatient and outpatient contacts within 30 days, respectively. At 1 year, the cumulative incidence ratios were 1.8 (95% CI 1.7–1.9) and 1.4 (95% CI 1.4–1.5). Incident AF was also associated with increases in the total numbers of inpatient and outpatient hospital contacts within 30 days (multivariable‐adjusted rate ratio 1.4, 95% CI 1.4–1.5, and 1.6, 95% CI 1.6–1.7, respectively). At 1 year, the ratios were 2.2 (95% CI 2.1–2.3) and 2.0 (95% CI 1.9–2.1). The multivariable‐adjusted proportion of bed‐day use among HF patients with incident AF was 10.9‐fold (95% CI 9.3–12.9) higher at 30 days and 5.3‐fold (95% CI 4.3–6.4) higher at 1 year compared with AF‐free referents. Conclusions Incident AF in HF is associated with earlier hospital contact, more hospital contacts, and more hospital bed‐days. More evidence on interventions that may prevent the risk and subsequent burden of AF in HF is urgently needed.
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Affiliation(s)
- Nicklas Vinter
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 3, Silkeborg, 8600, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Pia Cordsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Frost
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 3, Silkeborg, 8600, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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