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Müller M, Hanssen TA, Johansen D, Jakobsen Ø, Pedersen JE, Aamot Aksetøy IL, Rasmussen TB, Hartvigsen G, Skogen V, Thrane G. Validity of a smartwatch for detecting atrial fibrillation in patients after heart valve surgery: a prospective observational study. SCAND CARDIOVASC J 2024; 58:2353069. [PMID: 38794854 DOI: 10.1080/14017431.2024.2353069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/05/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVES Atrial fibrillation (AF) is a common early arrhythmia after heart valve surgery that limits physical activity. We aimed to evaluate the criterion validity of the Apple Watch Series 5 single-lead electrocardiogram (ECG) for detecting AF in patients after heart valve surgery. DESIGN We enrolled 105 patients from the University Hospital of North Norway, of whom 93 completed the study. All patients underwent single-lead ECG using the smartwatch three times or more daily on the second to third or third to fourth postoperative day. These results were compared with continuous 2-4 days ECG telemetry monitoring and a 12-lead ECG on the third postoperative day. RESULTS On comparing the Apple Watch ECGs with the ECG monitoring, the sensitivity and specificity to detect AF were 91% (75, 100) and 96% (91, 99), respectively. The accuracy was 95% (91, 99). On comparing Apple Watch ECG with a 12-lead ECG, the sensitivity was 71% (62, 100) and the specificity was 92% (92, 100). CONCLUSION The Apple smartwatch single-lead ECG has high sensitivity and specificity, and might be a useful tool for detecting AF in patients after heart valve surgery.
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Affiliation(s)
- Margrethe Müller
- Department of Physiotherapy, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tove Aminda Hanssen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - David Johansen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Øyvind Jakobsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - John Erling Pedersen
- Department of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Inger Lise Aamot Aksetøy
- Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St Olavs Hospital, Trondheim University Hospital, Norway
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Gunnar Hartvigsen
- Department of Computer Science, Faculty of Science and Technology, UiT The Artic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Gyrd Thrane
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Bikbov MM, Kazakbaeva GM, Rakhimova EM, Panda-Jonas S, Fakhretdinova AA, Tuliakova AM, Rusakova IA, Jonas JB. Atrial fibrillation and flutter and ocular diseases. The Ural eye and medical study and the Ural very old study. Acta Ophthalmol 2024; 102:e1057-e1065. [PMID: 38822684 DOI: 10.1111/aos.16726] [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: 03/05/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE To assess associations between atrial fibrillation/atrial flutter (AF) and ocular parameters and diseases. METHODS The population-based Ural Eye and Medical Study (UEMS) and the Ural Very Old Study (UVOS) included 4894 individuals (age: 40+ years) and 835 individuals (age: 85+ years), respectively. RESULTS In the UEMS, AF prevalence (80/4894; 1.6%; 95% CI: 1.3, 2.0) increased from 1/1029 (0.1%) in the age group of 40 to <50 years to 29/619 (4.7%) and 12/159 (7.5%) in the age groups of 70 to <80 years and 80+ years, respectively. Higher AF prevalence correlated with older age (OR: 1.08; 95% CI: 1.04, 1.12; p < 0.001), urban region of habitation (OR: 1.08; 95% CI: 1.04, 1.12; p < 0.001), higher prevalence of cardiovascular disease/stroke (OR: 2.50; 95% CI: 1.32, 4.72; p < 0.001) and lower prevalence of neck pain (OR: 0.35; 95% CI: 0.14, 0.85; p = 0.02), higher serum concentration of bilirubin (OR: 1.03; 95% CI: 1.02, 1.05; p < 0.001) and lower prothrombin index (OR: 0.96; 95% CI: 0.93, 0.99; p = 0.003), higher stage of arterial hypertension (OR: 1.52; 95% CI: 1.01, 2.28; p = 0.04) and higher ankle-brachial index (OR: 22.1; 95% CI: 4.45, 1.10; p < 0.001). In that model, AF prevalence was not associated with ocular parameters such as intraocular pressure (p = 0.52), retinal nerve fibre layer thickness (p = 0.70), refractive error (p = 0.13), axial length (p = 0.14), nuclear cataract degree (p = 0.50) and prevalence (p = 0.40), cortical cataract degree (p = 0.43) and presence (p = 0.17), lens pseudoexfoliation (p = 0.58), status after cataract surgery (p = 0.38), age-related macular degeneration prevalence (p = 0.63), open-angle glaucoma presence (p = 0.90) and stage (p = 0.55), angle-closure glaucoma prevalence (p = 0.99) and stage (p = 0.99), diabetic retinopathy prevalence presence (p = 0.37) and stage (p = 0.32), and myopic macular degeneration (p = 0.98). In the UVOS, similar results were obtained. CONCLUSIONS In these multi-ethnic populations from Russia, AF prevalence was not associated with any major ocular disease and may not play a major role in the pathogenesis of these disorders.
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Affiliation(s)
| | | | | | - Songhomitra Panda-Jonas
- Privatpraxis Prof Jonas Und Dr Panda-Jonas, Heidelberg, Germany
- Department of Ophthalmology, Heidelberg University, Heidelberg, Germany
| | | | | | | | - Jost B Jonas
- Institut Français de Myopie, Hôpital Fondation Rothschild, Paris, France
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore City, Singapore
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ball J, Mahony E, Nehme E, Voskoboinik A, Hogarty J, Dawson LP, Horrigan M, Kaye DM, Stub D, Nehme Z. The burden of atrial fibrillation on emergency medical services: A population-based cohort study. Int J Cardiol 2024; 414:132397. [PMID: 39084296 DOI: 10.1016/j.ijcard.2024.132397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a growing burden on healthcare resources, despite improvements in prevention and management. AF is a common cause of hospitalisation, and Emergency Medical Services (EMS) use. However, there is a paucity of data describing the burden of AF on EMS. We aimed to determine the prevalence, characteristics, and outcomes of patients presenting with AF to EMS using a large population-based sample. METHODS Consecutive attendances for AF in Victoria, Australia (January 2015-June 2019) were included if patients had a diagnosis of "AF" or "arrhythmia" with AF on electrocardiogram. Data were individually linked to emergency, hospital, and mortality records. RESULTS Of 2,613,056 EMS attendances, 16,525 were a first attendance for AF and linked to hospital records. Median (IQR) age was 76 (67,84) years (43% female). Seventy-eight percent had high thromboembolic risk (CHA2DS2-VASc score ≥ 2), and 72% had a heart rate ≥ 100 bpm. Forty-two percent of patients received no treatment by paramedics and 99.4% were transported to hospital. Fifty-three percent were discharged from ED. Median length of hospital stay was 2 days. Of 2542 cases reattended for AF, 19% occurred within 30 days, with increased odds for females and those of low socioeconomic status. Overall, 24% died during the study period, 12% within 30 days. Increasing age, heart failure, stroke, COPD, and low socioeconomic status increased the odds of 30-day mortality. CONCLUSIONS EMS utilisation for AF is common and associated with frequent reattendance. Further studies are required to investigate novel pathways of care to reduce AF burden on healthcare systems.
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Affiliation(s)
- Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; Monash Alfred Baker Centre for Cardiovascular Research, 55 Commercial Rd, Melbourne, Victoria 3000, Australia.
| | - Emily Mahony
- Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia
| | - Emily Nehme
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia
| | - Aleksandr Voskoboinik
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Joseph Hogarty
- Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Luke P Dawson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; Monash Alfred Baker Centre for Cardiovascular Research, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; School of Translational Medicine, Monash University, 99 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; Monash Alfred Baker Centre for Cardiovascular Research, 55 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia; Department of Paramedicine, Monash University, 47-49 Moorooduc Hwy, Frankston, Victoria 3199, Australia
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Liu J, Zhou T, Bao Y, Lin C, Chen Q, Dai Y, Zhang N, Pan W, Jin Q, Lu L, Zhao Q, Ling T, Wu L. Identification of senescence-related genes for potential therapeutic biomarkers of atrial fibrillation by bioinformatics, human histological validation, and molecular docking. Heliyon 2024; 10:e37366. [PMID: 39381104 PMCID: PMC11456832 DOI: 10.1016/j.heliyon.2024.e37366] [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: 04/20/2024] [Revised: 08/25/2024] [Accepted: 09/02/2024] [Indexed: 10/10/2024] Open
Abstract
Background Cellular senescence is pivotal in the occurrence and progression of atrial fibrillation (AF). This study aimed to identify senescence-related genes that could be potential therapeutic biomarkers for AF. Methods AF-related differentially expressed genes (DEGs) were identified using the Gene Expression Omnibus dataset. Weighted gene co-expression network analysis (WGCNA) was used to analyze important modules and potential hub genes. Integrating senescence-related genes, potential biomarkers were identified. Their differential expression levels were then validated in human atrial tissue, HL-1 cells, and Angiotensin II-infused mice. Finally, molecular docking analysis was conducted to predict potential interactions between potential biomarkers and the senolytic drug Navitoclax. Results We identified seven genes common to AF-related DEGs and senescence-related genes. Three significant modules were selected from WGCNA analysis. Taken together, three senescence-related genes (ETS1, SP1, and WT1) were found to be significantly associated with AF. Protein-protein interaction network analysis revealed biological connections among the predicted target genes of ETS1, SP1, and WT1. Notably, ETS1, SP1, and WT1 exhibited significant differential expression in clinical samples as well as in vitro and in vivo models. Molecular docking revealed favorable binding affinity between senolytic Navitoclax and these potential biomarkers. Conclusions This study highlights ETS1, SP1, and WT1 as crucial senescence-related genes associated with AF, offering potential therapeutic targets, with supportive evidence of binding affinity with senolytic Navitoclax. These findings provide novel insights into AF pathogenesis from a senescence perspective.
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Affiliation(s)
- Jingmeng Liu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Taojie Zhou
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yangyang Bao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Changjian Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qiujing Chen
- Institute of Cardiovascular Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yang Dai
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Cardiovascular Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wenqi Pan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qi Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lin Lu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Cardiovascular Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tianyou Ling
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Li G, Ma Z, Lu Y, Jiang Y, Zhao H, Sun M, Wang Y, He Q, Feng Z, Li T, Li J, Shi Y, Lou Z, Sun Z, Han Q, Sun N, Zhou Y, Shen Y. Associations of socioeconomic status and chronic stress with incident atrial fibrillation among older adults: A prospective cohort study from the UK biobank. Int J Cardiol 2024:132633. [PMID: 39395721 DOI: 10.1016/j.ijcard.2024.132633] [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: 07/08/2024] [Revised: 10/01/2024] [Accepted: 10/09/2024] [Indexed: 10/14/2024]
Abstract
BACKGROUND This study aimed to assess the relationship between socioeconomic status (SES) and chronic stress on the incidence of atrial fibrillation (AF) in older adults, and the potential role of chronic stress in the association. METHODS This study included 122,494 UK Biobank participants aged ≥60 years without AF at baseline. Latent class analysis was used to define the SES of participants. Chronic stress was measured using allostatic load (AL), and participants were categorized into low, medium and high AL groups. The Cox proportional hazards model, mediation, and interaction analyses were conducted to investigate the associations between SES, AL, and AF risk. RESULTS Low SES (hazard ratio [HR]: 1.10; 95 % confidence interval [CI]: 1.04-1.15) and high AL (HR: 1.37; 95 % CI: 1.30-1.45) were associated with an increased risk of AF, respectively. Individuals in the low SES and high AL groups exhibited the highest risk of AF compared to those in the high SES and low AL groups (HR: 1.46; 95 % CI: 1.32-1.61). We identified additive and multiplicative interactions in the low SES and high AL groups (relative risk due to interaction: 0.12 (95 % CI: 0.02-0.22); P for interaction = 0.0385). AL also exerted a partial mediating effect on the association between SES and the incidence of AF (mediation proportion: 17.3 %; 95 % CI: 5.9-28.7 %). CONCLUSIONS Our study revealed significant associations between SES, chronic stress, and the incidence of AF in older adults. Chronic stress was also shown to partially mediate the association.
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Affiliation(s)
- Guoxian Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Ze Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yujie Lu
- The Fourth Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China
| | - Yufeng Jiang
- The Fourth Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China
| | - Hanqing Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Mengtong Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Qida He
- Department of Infectious Diseases and Public Health, City University of Hong Kong, 999077, Hong Kong, China
| | - Zhaolong Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Tongxing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Jianing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yujie Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Zexin Lou
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Ziqing Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Qiang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Na Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yafeng Zhou
- The Fourth Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China.
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China; The Fourth Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China.
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Fernandes JM, Pinheiro RPS, Serpa F, de Andrade NM, Pereira V, Sbardelotto ÂEE, Gomes WF. Left Atrial Appendage Occlusion Devices vs Direct Oral Anticoagulants for Atrial Fibrillation: an Updated Systematic Review and Meta-Analysis. Curr Probl Cardiol 2024:102880. [PMID: 39395644 DOI: 10.1016/j.cpcardiol.2024.102880] [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: 10/07/2024] [Accepted: 10/08/2024] [Indexed: 10/14/2024]
Abstract
BACKGROUND Direct Oral Anticoagulants (DOACs) are the first line anticoagulation for patients with non-valvular atrial fibrillation (NVAF). Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a new therapy and its safety and effectiveness compared with DOACs are still controversial. METHODS A systematic review of randomized controlled trials and observational studies was conducted, focusing on patients with NVAF. Outcomes analyzed included: (1) all-cause mortality; (2) cardiovascular (CV) mortality; (3) thromboembolic events; (4) stroke or transient ischemic attack (TIA); (5) bleeding events; and a (6) composite of death, hemorrhagic, and thromboembolic events. We performed a subgroup analysis of major bleeding according to different definitions, according to (1) Bleeding Academic Research Consortium (BARC); (2) International Society on Thrombosis and Haemostasis (ISTH); and (3) other definitions. RESULTS Ten studies involving 18,507 patients were included, with 42.35% undergoing LAAO. In pooled analysis, LAAO was associated with lower rates of all-cause mortality (HR 0.63; 95% CI 0.50-0.80), cardiovascular mortality (HR 0.56; 95% CI 0.45-0.70), and of the composite outcome (HR 0.73; 95% CI 0.58-0.92). A trend towards lower stroke/TIA events was observed but not statistically significant. Overall bleeding events did not significantly differ between groups, using the ISTH definition, LAAO showed significantly lower incidence of bleeding events (HR 0.63; 95% CI 0.43-0.91). No significant difference was found in thromboembolic events. CONCLUSION LAAO was associated with a significantly lower all-cause mortality and cardiovascular mortality, as well as the composite of death, hemorrhagic or thromboembolic events, as compared with DOACs.
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Affiliation(s)
- Julia M Fernandes
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Rua Comendador Elias Jafet, 755- São Paulo, São Paulo, Brazil, 05653-000.
| | - Rafael P S Pinheiro
- Universidade Federal do Rio de Janeiro, Praia de Botafogo, 132- Rio de Janeiro, Rio de Janeiro, Brazil, 22250-145.
| | - Frans Serpa
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas, USA, 75390.
| | - Naieli M de Andrade
- Escola Bahiana de Medicina e Saúde Pública- Bahia, Av. Dom João VI, 275, Salvador, Bahia, Brazil, 40290-000.
| | - Vinicius Pereira
- Facultad Ciencias Biomédicas, Universidad Austral, Mariano Acosta, 2050- Pilar, Buenos Aires, Argentina, 1669.
| | - Ângelo E E Sbardelotto
- Universidade Federal do Rio de Janeiro, Praia de Botafogo, 132- Rio de Janeiro, Rio de Janeiro, Brazil, 22250-145.
| | - Wilton F Gomes
- INC Hospital, Department of Interventional Cardiology; Universidade Federal do Paraná; Faculdades Pequeno Príncipe, Rua Jeremias Maciel Perretto, 300, Curitiba, Paraná, Brazil, 81210-310.
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Jin S, Chen H, Fang X, Liao H, Zhan X, Fu L, Jiang J, Ye X, Liu H, Chen Y, Pu S, Wu S, Deng H, Lin W, Xue Y. Effectiveness of a Triple Antiarrhythmic Drug Strategy for Arrhythmia Recurrence after Persistent Atrial Fibrillation Ablation. Pacing Clin Electrophysiol 2024. [PMID: 39382044 DOI: 10.1111/pace.15083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 09/02/2024] [Accepted: 09/17/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND AND OBJECTIVE Treating recurrent atrial arrhythmias after persistent atrial fibrillation (PeAF) ablation is often challenging. This single-center, prospective study aimed to observe the effectiveness of different combinations of oral antiarrhythmic drugs (AADs) in reverting to sinus rhythm (SR) in patients with recurrent atrial arrhythmias after PeAF ablation. METHODS Forty-five patients who experienced recurrent atrial arrhythmias after PeAF ablation were included. Based on their medication regimens, patients were divided into two groups, with the study group being a triple-drug group (digoxin combined with amiodarone/ propafenone and β-blocker), and the control group being a non-triple-drug group. RESULTS The rate of reversion to SR was significantly higher in the study group (n = 29) than in the control group (n = 16) at 3 weeks (34.48% vs. 0%, p < 0.01) and 1 month (44.84% vs. 6.25%, p = 0.02) after initiating AADs. No patients with asymptomatic bradycardia were observed in either group. CONCLUSIONS For patients with recurrent atrial arrhythmias after PeAF ablation, a regimen of low-dose digoxin combined with amiodarone/propafenone and β-blocker may effectively improve short-term reversion rates.
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Affiliation(s)
- Shuyu Jin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haowei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xianhong Fang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Hongtao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xianzhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Lu Fu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Junrong Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xingdong Ye
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Huiyi Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yanlin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Sijia Pu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Weidong Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Ndakotsu A, Dwumah-Agyen M, Patel M. The bidirectional relationship between obstructive sleep apnea and atrial fibrillation: Pathophysiology, diagnostic challenges, and strategies - A narrative review. Curr Probl Cardiol 2024; 49:102873. [PMID: 39369771 DOI: 10.1016/j.cpcardiol.2024.102873] [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: 09/30/2024] [Accepted: 10/03/2024] [Indexed: 10/08/2024]
Abstract
Atrial fibrillation (AF), is an irregular heart rhythm disorder that increases the risk of stroke, heart failure, and death. Obstructive sleep apnea is typified by intermittent airway blockages which results in low oxygen levels and disrupted sleep. These two conditions often coexist, with each worsening the other. Understanding this connection is critical to improve diagnosis and treatment. The relationship between atrial fibrillation and obstructive sleep apnea appears bidirectional. Obstructive sleep apnea increases the risk of atrial fibrillation through various mechanisms which are arrhythmogenic. Conversely, patients with atrial fibrillation are more likely to have undiagnosed obstructive sleep apnea, complicating their treatment. Screening modalities for obstructive sleep apnea are often inadequate. Polysomnography remains the most reliable tool but is costly and not practical for routine screening of all patients which limits early diagnosis and management. Continuous positive airway pressure (CPAP) therapy is the primary treatment for obstructive sleep apnea and can reduce atrial fibrillation recurrence by decreasing oxygen deprivation and sympathetic activity. However, adherence to continuous positive airway pressure is often low due to patient discomfort. Alternative therapies, such as mandibular advancement devices and hypoglossal nerve stimulation, offer promising options for patients who cannot tolerate continuous positive airway pressure. The interplay between atrial fibrillation and obstructive sleep apnea requires an integrated approach to diagnosis and treatment. Improving screening tools, enhancing treatment adherence, and evaluating alternative therapies are critical steps to reducing the impact of these conditions and improving patient outcomes.
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Affiliation(s)
- Andrew Ndakotsu
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, United States.
| | - Matthew Dwumah-Agyen
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, United States.
| | - Meet Patel
- Department of Cardiology, SUNY Upstate Medical University, Syracuse, United States.
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9
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Suresh Kumar S, Connolly P, Maier A. Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review. J Med Internet Res 2024; 26:e54405. [PMID: 39365991 DOI: 10.2196/54405] [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: 11/13/2023] [Revised: 06/03/2024] [Accepted: 07/24/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users. OBJECTIVE This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation. METHODS Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used. RESULTS A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions. CONCLUSIONS In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research.
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Affiliation(s)
- Sagar Suresh Kumar
- Department of Design, Manufacturing and Engineering Management (DMEM), University of Strathclyde, Glasgow, United Kingdom
| | - Patricia Connolly
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Anja Maier
- Department of Design, Manufacturing and Engineering Management (DMEM), University of Strathclyde, Glasgow, United Kingdom
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Kirk F, Yong MS, Tran L, Newcomb A, He C, Stroebel A. Atrial Fibrillation Surgery in Australia: Are We Doing Enough? Heart Lung Circ 2024:S1443-9506(24)01735-9. [PMID: 39366900 DOI: 10.1016/j.hlc.2024.07.007] [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: 09/28/2023] [Revised: 05/23/2024] [Accepted: 07/05/2024] [Indexed: 10/06/2024]
Abstract
AIM This study aimed to examine contemporary burden and treatment trends of atrial fibrillation (AF) in patients undergoing cardiac surgery in Australia and New Zealand. This allows comparison of contemporary practice with the Society of Thoracic Surgeons guideline recommendations for the surgical treatment of AF in patients undergoing cardiac surgery. METHOD A 10-year retrospective review of the Australian & New Zealand Society of Cardiac & Thoracic Surgeons National Cardiac Surgery Database was performed, examining all adult cardiac surgery patients from 2011 to 2021. Patients were grouped by the presence or absence of AF, and simple descriptive statistical analysis was performed to assess baseline demographics and premorbid condition of the patients. The incidence of AF was analysed by type of surgery. Trends for surgical treatment of AF were then analysed using simple descriptive statistics, examining isolated left atrial appendage ligation, isolated surgical ablation, and combined ligation and ablation. RESULTS In the last 10 years, the Australian & New Zealand Society of Cardiac & Thoracic Surgeons database has recorded 140,680 patients who underwent cardiac surgery. Atrial fibrillation (AF) was present in 21,077 patients (14%). Patients with AF were generally older (72.25 vs 66.65 years; p<0.001). Among patients undergoing cardiac surgery, AF was more common in female than in male patients (18% vs 13%, respectively). Patients with AF more often had a higher classification of dyspnoea according to the New York Heart Association and lower ejection fractions compared with their AF-free counterparts. The incidence of AF as a comorbid condition was more frequent in patients undergoing mitral valve surgery or combined coronary artery bypass grafting and valve surgery (aortic, mitral, or both) compared with those undergoing isolated coronary or aortic surgery. Only 11.90% (n=2,509) of patients with AF received a combined ablation and left atrial appendage ligation, and 19.54% (n=693) of those received a Cox-Maze IV ablation. CONCLUSIONS The burden of concomitant AF in patients undergoing cardiac surgery in Australia is higher than previously reported (14% vs 5%-11%). Despite strong recommendation for the surgical management of AF in patients undergoing cardiac surgery and clear evidence of its benefit, both left atrial appendage ligation and surgical ablation independently or concomitantly remain heavily underutilised in this cohort.
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Affiliation(s)
- Frazer Kirk
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia.
| | - Matthew S Yong
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia
| | - Lavinia Tran
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Vic, Australia
| | - Andrew Newcomb
- Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
| | - Cheng He
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia
| | - Andrie Stroebel
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Qld, Australia
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11
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Tersalvi G, Bossard M, Aeschbacher S, Wiencierz A, Beer JH, Rodondi N, Gencer BF, Reichlin T, Auricchio A, Ammann P, Moschovitis G, Bonati L, Osswald S, Kühne M, Conen D, Kobza R. Prevalence and outcomes of heart failure phenotypes in patients with atrial fibrillation. Int J Cardiol 2024; 412:132320. [PMID: 38964549 DOI: 10.1016/j.ijcard.2024.132320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/06/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in patients with heart failure (HF). Real-world data about long-term outcomes and rhythm control interventions use in AF patients with and without HF remain scarce. METHODS AF patients from two prospective, multicentre studies were classified based on the HF status at baseline into: HF with preserved ejection fraction (HFpEF), HF with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF), and no HF. The prespecified primary outcome was risk of HF hospitalisation. Other outcomes of interest included mortality, cardiovascular events, AF progression, and quality of life. RESULTS A total of 1265 patients with AF were analysed (mean age 69.6 years, women 27.4%) with a median follow-up of 5.98 years. Patients with HFpEF (n = 126) had a 2.69-fold and patients with HFrEF/HFmrEF (n = 308) had a 2.12-fold increased risk of HF hospitalisation compared to patients without HF (n = 831, p < 0.001). Similar results applied for all-cause and cardiovascular mortality. The risk for AF progression was higher for patients with HFpEF and HFrEF/HFmrEF (6.30 and 6.79 per 100 patient-years, respectively) compared to patients without HF (4.20). The use of rhythm control strategies during follow-up was least in the HFpEF population (4.56 per 100 patient-years) compared to 7.74 in HFrEF/HFmrEF and 8.03 in patients with no HF. With regards to quality of life over time, this was worst among HFpEF patients. CONCLUSIONS The presence of HFpEF among patients with AF carried a high risk of HF hospitalisations and AF progression, and worse quality of life. Rhythm control interventions were rarely offered to HFpEF patients. These results uncover an unmet need for enhanced therapeutic interventions in patients with AF and HFpEF.
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Affiliation(s)
- Gregorio Tersalvi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Internal Medicine, Ente Ospedaliero Cantonale (EOC), Mendrisio, Switzerland.
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stefanie Aeschbacher
- Department of Cardiology, University of Basel Hospital, Basel, Switzerland.; Cardiovascular Research Institute, University of Basel Hospital, Basel, Switzerland
| | - Andrea Wiencierz
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jürg H Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland; Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Baris F Gencer
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of Cardiology, University Hospital of Geneva, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Angelo Auricchio
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Peter Ammann
- Department of Cardiology, Kantonsspital St Gallen, St. Gallen, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Cardiocentro Ticino Institute, Regional Hospital of Lugano, Lugano, Switzerland
| | - Leo Bonati
- Department of Neurology, University of Basel Hospital, Basel, Switzerland; Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University of Basel Hospital, Basel, Switzerland.; Cardiovascular Research Institute, University of Basel Hospital, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University of Basel Hospital, Basel, Switzerland.; Cardiovascular Research Institute, University of Basel Hospital, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
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12
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Ferguson C, Allida S, William S, Downie A, Wilson T, John R, McDonagh J, Lababedi J, Bajorek B, Hickman L, Wynne R. INFORM-AF II-Phase 1 pilot randomised controlled trial evaluating the effect of an atrial fibrillation digital education programme: study protocol. J Clin Nurs 2024; 33:4138-4147. [PMID: 38923162 DOI: 10.1111/jocn.17343] [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: 05/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
AIM To evaluate the effect of a novel, co-designed, digital AF educational program, 'INFORM-AF', to reduce re-hospitalisation of people with AF. The secondary aims are to examine the effect of the intervention on: (a) reducing cardiovascular-related hospitalisation, (b) increasing medication adherence, AF-related knowledge, and Atrial fibrillation (AF)-related quality of life and (c) determining the cost-effectiveness of the intervention. BACKGROUND AF is an increasingly prevalent cardiac arrythmia that involves complex clinical management. Comprehensive education is essential for successful self-management of AF and is associated with positive health-related outcomes. There has been an increase in technology-based education for AF. However, its effects on hospitalisation, medication adherence and patient-reported outcomes are unclear. DESIGN A prospective, randomised (1:1), open-label, blinded-endpoint, multicentre clinical trial. METHODS Eligible participants are aged 18 years or above, diagnosed with AF, and own a smartphone. The study will be conducted at two metropolitan hospitals. In the intervention group, participants will receive the AF educational program delivered via Qstream®. In the control group, participants will receive the Stroke Foundation 'Living with AF' booklet. The primary outcome is re-hospitalisation within 12 months from an indexed presentation or hospital admission. CONCLUSION This clinical trial is part of a developing program of work that will examine mHealth educational-behavioural interventions on cardiovascular outcomes. Findings from this pilot study will inform the development of a digital educational framework for patients living with AF. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE There remain many gaps in providing high-quality patient education for patients with AF. This trial will test a new theory-driven, smartphone-based education program on important clinical outcomes, including rehospitalisation. IMPACT This study evaluates a novel, co-designed, digital AF educational program, 'INFORM-AF', to reduce the re-hospitalisation of people with AF. Study results are expected to be reported in 2025. Findings are expected to inform practice recommendations for AF patient education that may be included in future clinical practice guideline recommendations. REPORTING METHOD SPIRIT Checklist. PATIENT OR PUBLICATION CONTRIBUTION JL is a consumer co-researcher on the project and provided critical input into intervention design, and feedback and input across the study duration.
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Affiliation(s)
- Caleb Ferguson
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sabine Allida
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Scott William
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Annie Downie
- Sutherland Hospital, South East Sydney Local Health District, Caringbah, New South Wales, Australia
| | - Tonia Wilson
- Sutherland Hospital, South East Sydney Local Health District, Caringbah, New South Wales, Australia
| | - Reejamol John
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Julee McDonagh
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judith Lababedi
- Lived Experience Consumer, Sydney, New South Wales, Australia
| | - Beata Bajorek
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Louise Hickman
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rochelle Wynne
- School of Nursing & Midwifery, Centre for Quality & Patient Safety in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- Western Health Partnership, St Albans, Victoria, Australia
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13
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Flores-Umanzor E, Asghar A, Cepas-Guillén PL, Farrell A, Keshvara R, Alvarez-Rodriguez L, Osten M, Freixa X, Horlick E, Abrahamyan L. Transcatheter left atrial appendage occlusion in patients with chronic kidney disease: a systematic review and meta-analysis. Clin Res Cardiol 2024; 113:1485-1500. [PMID: 38112741 DOI: 10.1007/s00392-023-02359-1] [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: 09/14/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a risk factor for embolic stroke, and many nonvalvular atrial fibrillation (NVAF) patients have concomitant CKD. Anticoagulation therapy can be challenging in CKD due to increased bleeding risk, and left atrial appendage occlusion (LAAO) may be a promising alternative. OBJECTIVE This systematic review aimed to consolidate current evidence on the safety and effectiveness of transcatheter LAAO in patients with CKD and end-stage renal disease (ESRD). METHODS Medline, Cochrane, and Embase databases were searched from inception to September 2, 2022. We conducted a meta-analysis if an outcome was evaluated in at least two similar studies. RESULTS We included 15 studies with 77,780 total patients. Of the 15 studies, 11 had a cohort design (five prospective and six retrospective), and four were case series. Patients with CKD were older and had a higher prevalence of comorbidities than non-CKD patients. The two groups did not differ in procedural failure rate, vascular complications, or pericardial tamponade. CKD patients exhibited higher odds of in-hospital acute kidney injury (AKI) and bleeding, longer-term bleeding, and mortality than those without CKD. The risk of in-hospital and longer-term cardioembolic events was similar between CKD and non-CKD populations (odds ratio = 1.01 [95% CI 0.70-1.15] and 1.05 [95% CI 0.55-2.00], respectively). Patients with ESRD had higher odds of in-hospital mortality and cardioembolic events than non-ESRD patients, with no differences in risk of pericardial tamponade. CONCLUSIONS Based on observational studies, LAAO may be an effective option to prevent cardioembolic events in CKD. However, CKD patients may have higher odds of AKI and in-hospital and long-term bleeding and mortality. The adverse clinical outcomes observed in CKD patients may be attributed to this population's high burden of comorbidities, especially among those with ERSD, rather than the LAAO procedure itself. To ensure maximum clinical benefit, careful patient selection, management, and surveillance involving multidisciplinary teams are essential for CKD patients undergoing LAAO.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Areeba Asghar
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Pedro L Cepas-Guillén
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ashley Farrell
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Rajesh Keshvara
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Leyre Alvarez-Rodriguez
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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14
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Kwon OC, Han K, Park MC. Risk of atrial fibrillation in patients with systemic sclerosis: a nationwide population-based study. Rheumatology (Oxford) 2024; 63:2838-2845. [PMID: 38048606 DOI: 10.1093/rheumatology/kead651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/24/2023] [Accepted: 11/19/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is the most common arrhythmia in the general population, causing substantial economic burden, morbidity and mortality. The incidence rate and risk of AF in patients with SSc are unclear. We aimed to assess the incidence rate of AF in patients with SSc and the risk of incident AF in patients with SSc compared with the general population. METHODS The Korean National Health Insurance Service database was used as the data source. Patients with claims data for SSc between 2010 and 2017 were extracted from the database along with 1:5 age- and sex-matched controls. The index date was the earliest date with claims data for SSc between 2010 and 2017. The follow-up duration was from the index date to 2019. Multivariable Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% CI for AF in patients with SSc. RESULTS Overall, 2519 patients with SSc and 12 595 age- and sex-matched controls were included. Over a mean follow-up duration of 5.2 years (s.d. 2.6), the incidence rates of AF were 3.52 and 1.68 per 1000 person-years for patients with SSc and controls, respectively. Compared with controls, patients with SSc had a significantly higher risk of incident AF [adjusted HR 2.095 (95% CI 1.466, 2.994)]. CONCLUSION Patients with SSc had a 2-fold higher risk of incident AF than controls. Given the significant economic burden, morbidity and mortality that AF poses, close monitoring for incident AF in patients with SSc is warranted.
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Affiliation(s)
- Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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15
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Li A, Zhang M, Ning B. Predictive value of the left atrioventricular coupling index for recurrence after radiofrequency ablation of paroxysmal atrial fibrillation. J Cardiothorac Surg 2024; 19:552. [PMID: 39354511 PMCID: PMC11443840 DOI: 10.1186/s13019-024-03070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 09/15/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Although patients with paroxysmal atrial fibrillation (PAF) are preferred to undergo catheter ablation (CA), the high possibility of recurrence following surgery is still concerning. We aimed to evaluate the ability of the left atrioventricular coupling index (LACI), which is the ratio of the left atrium end-diastolic volume to the left ventricle end-diastolic volume, to predict PAF recurrence after CA. METHODS Patients with PAF undergoing CA for the first time between January 2018 and June 2021 were admitted and grouped by recurrence within a year. LACI was measured before CA using ultrasonography. Risk factors identified by multivariable logistic regression analysis, and the area under the receiver operating characteristic (ROC) curve was used to assess the ability of LACI to predict PAF recurrence after CAP. RESULTS Among the 204 patients treated at our hospital, 164 patients were included in the research after eliminating those who were lost to follow-up. Among them, 56 individuals had recurrence following a 90-day blanking period. Recurrence is more likely in elderly patients with high blood pressure. Patients who suffered recurrence exhibited lower left atrial ejection fraction and increased LACI, left atrial volume minimum, and left atrium volume index maximum. LACI was an independent risk factor for postoperative recurrence (OR: 1.526, 95% CI: 1.325-1.757, P < 0.001), and ROC displayed remarkable predictive value [area under the curve (AUC) = 0.868]. CONCLUSIONS High LACI is significantly associated with postoperative recurrence in PAF patients, and LACI has incremental prognostic value to predict recurrence.
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Affiliation(s)
- Aoshuang Li
- Department of Cardiology, Fuyang People's Hospital, Anhui Medical University, 236000, Fuyang, China
| | - Mingyang Zhang
- Department of Cardiology, Fuyang People's Hospital, Anhui Medical University, 236000, Fuyang, China
| | - Bin Ning
- Department of Cardiology, Fuyang People's Hospital, Anhui Medical University, 236000, Fuyang, China.
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16
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Miao Y, Xu M, Yang Z, Gong M, Yang L. The association between left atrial appendage emptying velocity and atrial fibrillation recurrence after radiofrequency catheter ablation in patients with early persistent atrial fibrillation. BMC Cardiovasc Disord 2024; 24:529. [PMID: 39354384 PMCID: PMC11443837 DOI: 10.1186/s12872-024-04215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/19/2024] [Indexed: 10/03/2024] Open
Abstract
OBJECTIVE In the present study, we aimed to explore the association between left atrial appendage emptying velocity (LAAEV) measured by transesophageal echocardiography and atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) in patients with early persistent atrial fibrillation (PeAF). METHODS We retrospectively analyzed patients with early PeAF who underwent their initial ablation procedure. The echocardiographic and clinical data of the enrolled patients were collected and recorded prior to the operation. Following adjustment for confounding factors, we investigated the relationship between the LAAEV and AF recurrence in patients with early PeAF after radiofrequency ablation. RESULTS The proportions of AF recurrence in the low, medium, and high LAAEV groups were 48.8%, 16.0%, and 13.1%, respectively. After adjusting for potential confounding factors, we observed a gradual decrease in the risk of AF recurrence with increasing LAAEV (odds ratio: 0.882, 95% confidence interval: 0.842-0.924, p<0.001). This trend was statistically significant (p<0.001), particularly when comparing the high and low LAAEV groups (odds ratio: 0.033, 95% confidence interval: 0.009-0.116, p<0.001). Curve fitting analysis demonstrated an approximate negative linear association between LAAEV and the probability of AF recurrence. CONCLUSIONS Among patients with early PeAF who successfully underwent their first RFCA, we found that the LAAEV within 24 h before the procedure was independently correlated with the risk of AF recurrence. Notably, this association was negative, indicating that higher LAAEV was associated with a lower risk of AF recurrence.
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Affiliation(s)
- Yuxia Miao
- Department of Cardiovascular Disease, Division of Echocardiography, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Chang Zhou City, Jiangsu Province, 213000, China
| | - Min Xu
- Department of Cardiovascular Disease, Division of Echocardiography, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Chang Zhou City, Jiangsu Province, 213000, China.
| | - Zhenni Yang
- Department of Cardiovascular Disease, Division of Echocardiography, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Chang Zhou City, Jiangsu Province, 213000, China
| | - Mingxia Gong
- Department of Cardiovascular Disease, Division of Echocardiography, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Chang Zhou City, Jiangsu Province, 213000, China
| | - Ling Yang
- Department of Cardiovascular Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Chang Zhou City, Jiangsu Province, 213000, China
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17
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Ghareghani A, Abbaszadeh S, Takhshid MA. The role of systemic inflammatory indices in predicting atrial fibrillation and its complications: a narrative review. Curr Med Res Opin 2024; 40:1657-1666. [PMID: 39210892 DOI: 10.1080/03007995.2024.2397074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
Atrial fibrillation (AF) is associated with increased morbidity and mortality. Inflammation and oxidative stress play critical roles in AF occurrence and its complications. Therefore, evaluating the circulating levels of inflammatory and oxidative stress biomarkers and their possible applications in AF diagnosis and management have been the focus of many efforts. The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and neutrophil-to-lymphocyte ratio (NLR) are two non-invasive, available, and established markers that serve as indicators of inflammation and oxidative stress. This review summarizes the current literature regarding alterations in the NLR, MHR, and other composite markers of systemic inflammation in AF patients. Moreover, this review discusses the clinical performance of these markers in predicting AF occurrence, recurrence, and disease outcomes. The PubMed, Scopus, and ScienceDirect online databases were searched for relevant studies using appropriate keywords, including "atrial fibrillation", "monocyte to high-density lipoprotein cholesterol ratio", and "neutrophil to lymphocyte ratio". The results of this review revealed the association of elevated levels of systemic inflammatory markers, specifically the NLR and MHR with AF and its complications. This finding indicates the potential role of subclinical inflammation in the development of AF, emphasizing its consideration in both the prevention and treatment of AF and associated complications. Despite these promising findings, the utilization of these markers in routine clinical settings faces challenges, including low specificity and sensitivity and varying cut-off values across different studies.
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Affiliation(s)
- Atefeh Ghareghani
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Shahin Abbaszadeh
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Ali Takhshid
- Division of Medical Biotechnology, Department of Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Jing M, Xi H, Li J, Liu Q, Zhu H, Sun Q, Zhang Y, Liu X, Ren W, Zhang B, Deng L, Han T, Zhou J. Left atrial appendage thrombus is associated with a higher fractal dimension in patients with atrial fibrillation. Clin Imaging 2024; 114:110247. [PMID: 39146827 DOI: 10.1016/j.clinimag.2024.110247] [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: 06/04/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE To assess the anatomical complexity of the left atrial appendage (LAA) using fractal dimension (FD) based on cardiac computed tomography angiography (CTA) and the association between LAA FD and LAA thrombosis. MATERIALS AND METHODS Patients with atrial fibrillation (AF) who underwent both cardiac CTA and transesophageal echocardiography (TEE) between December 2018 and December 2022 were retrospectively analyzed. Patients were categorized into normal (n = 925), circulatory stasis (n = 82), and thrombus groups (n = 76) based on TEE results and propensity score matching (PSM) was performed for subsequent analysis. FD was calculated to quantify the morphological heterogeneity of LAA. Independent risk factors for thrombus were screened using logistic regression. The diagnostic performance of FD and CHA2DS2-VaSc score for predicting thrombus was evaluated using the area under the receiver operating characteristics curve (AUC). RESULTS LAA FD was higher in the thrombus group (1.61 [1.49, 1.70], P < 0.001) than in the circulatory stasis (1.33 [1.18, 1.47]) and normal groups (1.30 [1.18, 1.42]) both before and after PSM. LAA FD was also an independent risk factor in the thrombus (OR [odds ratio] = 570,861.15 compared to normal, 41,122.87 compared to circulatory stasis; all P < 0.001) and circulatory stasis group (OR = 98.87, P = 0.001) after PSM. The diagnostic performance of LAA FD was significantly better than the CHA2DS2-VaSc score in identifying thrombus. CONCLUSIONS Patients with high LAA FD are more likely to develop LAA thrombus, and the use of FD provides an effective method for assessing the risk of thrombosis in AF patients, thereby guiding individualized clinical treatment.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Jianying Li
- GE Healthcare, Computed Tomography Research Center, Beijing, China
| | - Qing Liu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Hao Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Qiu Sun
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Yuting Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Xuehui Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei Ren
- GE Healthcare, Computed Tomography Research Center, Beijing, China
| | - Bin Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Liangna Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Tao Han
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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19
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Mannakkara NN, Khan I, Ghazanfar A, Wijesuriya N, Mehta VS, De Vere F, Howell S, Adhya S, Porter B, Child N, Razavi R, Rinaldi CA, Bosco P, Blauth C, Gill JS. Convergent ablation for persistent atrial fibrillation: A UK multicentre perspective. J Cardiovasc Electrophysiol 2024; 35:2039-2052. [PMID: 39136365 DOI: 10.1111/jce.16399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/23/2024] [Accepted: 07/30/2024] [Indexed: 10/11/2024]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and remains a major cause of morbidity and mortality. Unfortunately, a significant proportion of patients have persistent AF, for which conventional catheter ablation is less effective. However, convergent ablation has emerged in recent years as a hybrid treatment targeting both the epicardium and endocardium in a multidisciplinary joint cardiothoracic and electrophysiology procedure, with promising efficacy outcomes in recent studies. This treatment is increasingly being performed in the United Kingdom. This review article discusses the rationale and evidence behind convergent ablation, along with factors that need to be considered when setting up a successful ablation service.
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Affiliation(s)
- Nilanka N Mannakkara
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ibrar Khan
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
| | - Auns Ghazanfar
- Department of Cardiology, St. Richard's Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Nadeev Wijesuriya
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Vishal S Mehta
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Felicity De Vere
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sandra Howell
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Shaumik Adhya
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- Department of Cardiology, Medway Maritime Hospital, Gillingham, UK
| | - Bradley Porter
- South West Cardiothoracic Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Nicholas Child
- Department of Cardiology, St. Richard's Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Christopher A Rinaldi
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Paolo Bosco
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
| | - Christopher Blauth
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
| | - Jaswinder S Gill
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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20
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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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21
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Zhang S, Hu L, Tang H, Liao L, Li X. Stereotactic arrhythmia radioablation (STAR) opens a new era in the treatment of arrhythmias? Front Cardiovasc Med 2024; 11:1449028. [PMID: 39399514 PMCID: PMC11469775 DOI: 10.3389/fcvm.2024.1449028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/10/2024] [Indexed: 10/15/2024] Open
Abstract
Tachyarrhythmias are common cardiovascular emergencies encountered in clinical practice. Among these, atrial fibrillation (AF) and ventricular tachycardia (VT) pose significant hazards due to their prevalence and severity. Initially, non-invasive pharmacological antiarrhythmic interventions were the primary treatment modality; however, due to their limited control rates and side effects, invasive therapies have been introduced in recent years. These include catheter ablation, alcohol ablation, cardiac implantable electronic devices, and heart transplantation. Nonetheless, for some patients, invasive treatments do not offer a definitive cure for arrhythmias and carry the risk of recurrence, especially with AF and VT, where the relapse rates are high and the treatment for VT is correlated with the type of tachycardia present. Currently, novel non-invasive treatment methods are emerging, with stereotactic radioablation therapy becoming an effective alternative for the management of refractory tachyarrhythmias. This review provides an overview of the application background of Stereotactic Arrhythmia Radioablation (STAR) therapy and promising results from its use in animal models and clinical applications.
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Affiliation(s)
| | | | | | | | - Xuping Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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22
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Peng L, Liu L, Chai M, Cai Z, Wang D. Predictive value of neutrophil to lymphocyte ratio for clinical outcome in patients with atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1461923. [PMID: 39390991 PMCID: PMC11464451 DOI: 10.3389/fcvm.2024.1461923] [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: 07/09/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024] Open
Abstract
Background The association between the Neutrophil-to-Lymphocyte Ratio (NLR) and the prognosis of Atrial Fibrillation (AF) has been extensively studied, yet clinical outcomes have varied. Consequently, this analysis was undertaken to explore the link between NLR and the prognostic markers of AF. Methods We conducted an exhaustive search across electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, to investigate the correlation between the NLR and indicators of adverse clinical outcomes associated with AF from the database establishment date through March 31, 2024. In this study, the recurrence rate of AF was the primary outcome measure, while the secondary outcome measures were mortality, stroke, and left atrial thrombus. Odds ratio (OR), relative risk (RR), hazard ratio (HR) and standard mean difference (SMD) with a 95% confidence interval (CI) were integrated for assessment, and the stability of prognostic outcomes and publication bias were verified by sensitivity analysis and Egger's test, respectively. Subgroup analyses were performed to pinpoint the sources of heterogeneity. Results This analysis included 20 studies, encompassing a total of 59,256 patients. Our statistical analysis of both categorical and continuous variables revealed that an elevated NLR was significantly associated with increased risks in AF patients for recurrence (categorical variable: OR = 1.39, 95% CI = 1.21-1.60; continuous variable: SMD = 0.49, 95% CI = 0.24-0.74), mortality (categorical variable: OR = 1.87, 95% CI = 1.59-2.20), stroke (categorical variable: OR = 1.56, 95% CI = 1.13-2.17; continuous variable: SMD = 0.77, 95% CI = 0.63-0.91), and left atrial thrombus (categorical variable: OR = 1.87, 95% CI = 1.27-2.75; continuous variable: SMD = 0.59, 95% CI = 0.30-0.89). Subgroup analyses found that high NLR was significantly linked to AF recurrence when the NLR was >3. High NLR was significantly linked to the risk of stroke in AF when the NLR was ≤3. Conclusions This study suggested that a high NLR is significantly linked to prognostic risk markers of AF, and NLR may be an effective biomarker for the prognosis of AF in clinical practice. Systematic Review Registration PROSPERO (CRD42024530970).
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Affiliation(s)
- Lei Peng
- Department of Cardiology, Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Li Liu
- Department of Cardiology, Jinan Integrated Traditional Chinese and Western Medicine Hospital, Jinan, China
| | - Miaomiao Chai
- Department of Cardiology, Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Zhonggui Cai
- Department of Interventional Cardiology, Shandong Healthcare Group Zaozhuang Hospital, Zaozhuang, China
| | - Deqi Wang
- Department of Interventional Cardiology, Zaozhuang Municipal Hospital, Zaozhuang, China
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23
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Patel B, Khadke S, Mahajan K, Dhingra A, Trivedi R, Brar SS, Dixit S, Periwal V, Chauhan S, Desai R. Association of cannabis use disorder with atrial fibrillation in young men without concomitant tobacco use: Insights from nationwide propensity matched analysis. World J Exp Med 2024; 14:93742. [PMID: 39312691 PMCID: PMC11372734 DOI: 10.5493/wjem.v14.i3.93742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/23/2024] [Accepted: 07/04/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Recent data are inconclusive regarding the risk of arrhythmias among young cannabis users. Furthermore, many young adults use both cannabis and tobacco, which could add a residual confounding effect on outcomes. So, we studied young men who have cannabis use disorder (CUD) excluding tobacco use disorder (TUD) to understand their independent association with atrial fibrillation (AF) and related outcomes. AIM To study the association of CUD with AF and related outcomes. METHODS We used weighted discharge records from National Inpatient Sample (2019) to assess the baseline characteristics and mortality rates for AF-related hospitalizations in young (18-44 years) men in 1:1 propensity-matched CUD + vs CUD- cohorts without TUD. RESULTS Propensity matched CUD + and CUD- cohorts consisted of 108495 young men in each arm. Our analysis showed an increased incidence of AF in black population with CUD. In addition, the CUD + cohort had lower rates of hyperlipidemia (6.4% vs 6.9%), hypertension (5.3% vs 6.3%), obesity (9.1% vs 10.9%), alcohol abuse (15.5% vs 16.9%), but had higher rates of anxiety (24.3% vs 18.4%) and chronic obstructive pulmonary disease (COPD) (9.8% vs 9.4%) compared to CUD-cohort. After adjustment with covariates including other substance abuse, a non-significant association was found between CUD + cohort and AF related hospitalizations (odd ratio: 1.27, 95% confidence interval: 0.91-1.78, P = 0.15). CONCLUSION Among hospitalized young men, the CUD + cohort had a higher prevalence of anxiety and COPD, and slightly higher proportion of black patients. Although there were higher odds of AF hospitalizations in CUD + cohort without TUD, the association was statistically non-significant. The subgroup analysis showed higher rates of AF in black patients. Large-scale prospective studies are required to evaluate long-term effects of CUD on AF risk and prognosis without TUD and concomitant substance abuse.
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Affiliation(s)
- Bhavin Patel
- Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, United States
| | - Sumanth Khadke
- Lahey Hospital and Medical Center, Division of Cardiovascular Medicine, Department of Medicine, Burlington, MA 01805, United States
| | - Kshitij Mahajan
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
| | - Avleen Dhingra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Rishika Trivedi
- Department of Internal Medicine, DHR Health, Edinburg, TX 78539, United States
| | - Samrath Singh Brar
- Department of Medicine, Government Medical College, Patiala 147001, Punjab, India
| | - Sakshi Dixit
- Department of Medicine, Government Medical College, Patiala 147001, Punjab, India
| | - Vaibhav Periwal
- Department of Medicine, Government Medical College, Patiala 147001, Punjab, India
| | - Shaylika Chauhan
- Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States
| | - Rupak Desai
- Independent Researcher, Outcomes Research, Atlanta, GA 30079, United States
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24
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Zhao S, Wehrens XHT. Pathways to precision medicine: deciphering the secrets of physiological and pathological atrial enlargement. Clin Sci (Lond) 2024; 138:1173-1177. [PMID: 39289952 DOI: 10.1042/cs20241421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/19/2024]
Abstract
Cardiac functional, morphological, and histological analysis, coupled with liquid chromatography and mass spectrometry, of two transgenic mouse models with cardiomyocyte-specific overexpression of insulin-like growth factor 1 receptor (IGF1R) or a dominant-negative PI3K mutant (DCM-dnPI3K) revealed distinctive functional and molecular profiles during physiological (driven by IGF1R overexpression) and pathological (driven by dn-PI3K overexpression) atrial remodeling. The current study confirmed previously reported findings, including ventricular dilatation and enhanced systolic function with no evidence of arrhythmia in IGF1R model, as well as ventricular hypertrophy and decreased systolic function with intermittent atrial fibrillation in DCM-dnPI3K model. Novel findings obtained from the left atrial (LA) characterization of female mice revealed that physiological atrial enlargement resulted from increased atrial myocyte size and was associated with preserved atrial function, as determined by maintained LA ejection fraction (EF). The proteomic profile of IGF1R transgenic (Tg) mice was enriched for metabolic remodeling and showed a protein expression pattern similar to that of healthy human atria; on the other hand, pathological atrial enlargement resulted from increased atrial fibrosis with normal myocyte size and was associated with impaired atrial function due to a reduced LA EF. The proteomic profile of DCM-dnPI3K mice was enriched to both metabolic and structural remodeling and showed a protein expression pattern similar to that of human AF atria.
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Affiliation(s)
- Shuai Zhao
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX 77030, U.S.A
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX 77030, U.S.A
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX 77030, U.S.A
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX 77030, U.S.A
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, U.S.A
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, U.S.A
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, U.S.A
- Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, U.S.A
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25
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Buckley BJR, Long L, Risom SS, Lane DA, Berg SK, Gluud C, Palm P, Sibilitz KL, Svendsen JH, Zwisler AD, Lip GYH, Neubeck L, Taylor RS. Exercise-based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database Syst Rev 2024; 9:CD011197. [PMID: 39287086 PMCID: PMC11406592 DOI: 10.1002/14651858.cd011197.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, disrupts the heart's rhythm through numerous small re-entry circuits in the atrial tissue, leading to irregular atrial contractions. The condition poses significant health risks, including increased stroke risk, heart failure, and reduced quality of life. Given the complexity of AF and its growing incidence globally, exercise-based cardiac rehabilitation (ExCR) may provide additional benefits for people with AF or those undergoing routine treatment for the condition. OBJECTIVES To assess the benefits and harms of ExCR compared with non-exercise controls for people who currently have AF or who have been treated for AF. SEARCH METHODS We searched the following electronic databases: CENTRAL in the Cochrane Library, MEDLINE Ovid, Embase Ovid, PsycINFO Ovid, Web of Science Core Collection Thomson Reuters, CINAHL EBSCO, LILACS BIREME, and two clinical trial registers on 24 March 2024. We imposed no language restrictions. SELECTION CRITERIA We included randomised clinical trials (RCTs) that investigated ExCR interventions compared with any type of non-exercise control. We included adults 18 years of age or older with any subtype of AF or those who had received treatment for AF. DATA COLLECTION AND ANALYSIS Five review authors independently screened and extracted data in duplicate. We assessed risk of bias using Cochrane's RoB 1 tool as outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We assessed clinical and statistical heterogeneity by visual inspection of the forest plots and by using standard Chi² and I² statistics. We performed meta-analyses using random-effects models for continuous and dichotomised outcomes. We calculated standardised mean differences where different scales were used for the same outcome. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 20 RCTs involving a total of 2039 participants with AF. All trials were conducted between 2006 and 2024, with a follow-up period ranging from eight weeks to five years. We assessed the certainty of evidence as moderate to very low. Five trials assessed comprehensive ExCR programmes, which included educational or psychological interventions, or both; the remaining 15 trials compared exercise-only cardiac rehabilitation with controls. The overall risk of bias in the included studies was mixed. Details on random sequence generation, allocation concealment, and use of intention-to-treat analysis were typically poorly reported. Evidence from nine trials (n = 1173) suggested little to no difference in mortality between ExCR and non-exercise controls (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.76 to 1.49; I² = 0%; 101 deaths; low-certainty evidence). Based on evidence from 10 trials (n = 825), ExCR may have little to no effect on SAEs (RR 1.30, 95% CI 0.63 to 2.67; I² = 0%; 28 events; low-certainty evidence). Evidence from four trials (n = 378) showed that ExCR likely reduced AF recurrence (measured via Holter monitoring) compared to controls (RR 0.70, 95% CI 0.56 to 0.88; I² = 2%; moderate-certainty evidence). ExCR may reduce AF symptom severity (mean difference (MD) -1.59, 95% CI -2.98 to -0.20; I² = 61%; n = 600; low-certainty evidence); likely reduces AF symptom burden (MD -1.61, 95% CI -2.76 to -0.45; I² = 0%; n = 317; moderate-certainty evidence); may reduce AF episode frequency (MD -1.29, 95% CI -2.50 to -0.07; I² = 75%; n = 368; low-certainty evidence); and likely reduces AF episode duration (MD -0.58, 95% CI -1.14 to -0.03; I² = 0%; n = 317; moderate-certainty evidence), measured via the AF Severity Scale (AFSS) questionnaire. Moderate-certainty evidence from six trials (n = 504) showed that ExCR likely improved the mental component summary measure in health-related quality of life (HRQoL) of the 36-item Short Form Health Survey (SF-36) (MD 2.66, 95% CI 1.22 to 4.11; I² = 2%), but the effect of ExCR on the physical component summary measure was very uncertain (MD 1.75, 95% CI -0.31 to 3.81; I² = 52%; very low-certainty evidence). ExCR also may improve individual components of HRQoL (general health, vitality, emotional role functioning, and mental health) and exercise capacity (peak oxygen uptake (VO2peak) and 6-minute walk test) following ExCR. The effects of ExCR on serious adverse events and exercise capacity were consistent across different models of ExCR delivery: centre compared to home-based, exercise dose, exercise only compared to comprehensive programmes, and aerobic training alone compared to aerobic plus resistance programmes. Using univariate meta-regression, there was evidence of significant association between location of trial and length of longest follow-up on exercise capacity. AUTHORS' CONCLUSIONS Due to few randomised participants and typically short-term follow-up, the impact of ExCR on all-cause mortality or serious adverse events for people with AF is uncertain. ExCR likely improves AF-specific measures including reduced AF recurrence, symptom burden, and episode duration, as well as the mental components of HRQoL. ExCR may improve AF symptom severity, episode frequency, and VO2peak. Future high-quality RCTs are needed to assess the benefits of ExCR for people with AF on patient-relevant outcomes including AF symptom severity and burden, AF recurrence, AF-specific quality of life, and clinical events such as mortality, readmissions, and serious adverse events. High-quality trials are needed to investigate how AF subtype and clinical setting (i.e. primary and secondary care) may influence ExCR effectiveness.
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Affiliation(s)
- Benjamin JR Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpoool, UK
| | - Linda Long
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, , University of Glasgow, Glasgow, UK
| | - Signe S Risom
- Department of Cardiology, Herlev and Gentofte , University Hospital, Copenhagen, Denmark
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Science, University of Liverpool, Liverpool, UK
| | - Selina K Berg
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
- University of Southern Denmark, Odense, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Gluud
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pernille Palm
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kirstine L Sibilitz
- Department of Cardiology and Internal Medicine, Amager and Hvidovre University Hospital, Copenhagen, Denmark
| | - Jesper H Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Gregory YH Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Science, University of Liverpool, Liverpool, UK
| | - Lis Neubeck
- Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Younes H, Ademi B, Tsakiris E, Feng H, Pandey AC, Mekhael M, Noujaim C, Lim C, Dagher L, Hajjar AHE, Bidaoui G, Bsoul M, Assaf A, Rao S, Mahnkopf C, Shamaileh G, Kreidieh O, Hassan A, Liu Y, Jia Y, Polo FT, Marrouche NF, Donnellan E. Direct-to-catheter ablation versus second line catheter ablation for persistent atrial fibrillation: Effect on arrhythmia recurrence, AF burden, early left atrium remodeling and quality of life. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01916-6. [PMID: 39264394 DOI: 10.1007/s10840-024-01916-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 08/28/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Catheter ablation has obtained class 1 indication in ablation of young, healthy patients with symptomatic paroxysmal atrial fibrillation (AF). Anti-arrhythmic drugs (AADs) remain first-line therapy before ablating persistent AF (PersAF). We sought to evaluate the efficacy of a direct-to-catheter ablation approach against catheter ablation post AADs in PersAF. METHODS In this DECAAF II subanalysis, patients were stratified into two subgroups: 'Direct-to-catheter' group comprising patients who had not received AADs prior to ablation, and'second-line ablation' group, comprising patients who had been on any AAD therapy at any time before ablation. Patients were followed over 18 months. The primary outcome was AF recurrence. Secondary outcomes included AF burden, quality of life (QoL) that assessed by the AFSS and SF-36 scores, and changes in the left atrial volume index (LAVI) assessed by LGE-MRI scans. RESULTS The analysis included 815 patients, with 279 classified as'direct-to-catheter' group and 536 classified as'Second-line ablation' group. The primary outcome was similar between both groups (44.8% vs 44.4%, p > 0.05), as was AF burden (20% vs 16%, p > 0.05). Early remodeling, reflected by LAVI reduction, was similar between the groups (9.1 [1.6-18.0] in the second-line ablation group and 9.5 [2.5-19.7] in the direct-to-catheter group, p > 0.05). QoL pre/post ablation was also similar (p > 0.05). On multivariate analysis, history of AAD was not predictive of AF recurrence(p > 0.05). CONCLUSION Prior AAD therapy demonstrated minimal impact on atrial remodeling and QoL improvement, in addition to limited benefit on AF recurrence and burden post-ablation in patients with PersAF. Additional studies are warranted to explore the efficacy of catheter ablation as a first-line therapy in PersAF.
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Affiliation(s)
- Hadi Younes
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Besim Ademi
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eli Tsakiris
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Han Feng
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Amitabh C Pandey
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mario Mekhael
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Charbel Noujaim
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Chanho Lim
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Lilas Dagher
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Abdel Hadi El Hajjar
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ghassan Bidaoui
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mayana Bsoul
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ala Assaf
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Swati Rao
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Christian Mahnkopf
- Department of Cardiology, Klinikum Coburg, Coburg, Germany
- Medical School, University of Split, 21000, Split, Croatia
| | - Ghaith Shamaileh
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Omar Kreidieh
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Abboud Hassan
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Yinshuo Liu
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Yishi Jia
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Francisco T Polo
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Nassir F Marrouche
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eoin Donnellan
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
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27
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Kim HM, Hwang IC, Park J, Choi HJ, Choi HM, Yoon YE, Cho GY. Impact of changes in left heart geometry on predicting new-onset atrial fibrillation in patients with hypertension. J Hypertens 2024:00004872-990000000-00545. [PMID: 39288249 DOI: 10.1097/hjh.0000000000003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND Hypertension-induced left ventricular hypertrophy (LVH) increases end-diastolic LV pressure and contributes to left atrial enlargement (LAE), which are associated with development of atrial fibrillation. However, the impact of LVH and LAE and their regression following antihypertensive therapy on atrial fibrillation incidence remains unclear. METHODS This retrospective analysis included consecutive patients with sinus rhythm who underwent echocardiography at hypertension diagnosis and after 6-18 months between 2006 and 2021 at tertiary care centres in Korea. LVH was defined as LV mass index greater than 115 g/m2 (men) and greater than 95 g/m2 (women), and LAE was defined as LA volume index greater than 42 ml/m2. The occurrence of new-onset atrial fibrillation (NOAF) was assessed in relation to changes in LVH and LAE status. RESULTS Among the 1464 patients included, 163 (11.1%) developed NOAF during a median 63.8 [interquartile range (IQR) 35.9-128.5] months of surveillance period. New-onset LVH [adjusted hazard ratio (aHR) 1.88, 95% confidence interval (CI) 1.20-2.94, P = 0.006] and LAE (aHR 1.89, 95% CI 1.05-3.40, P = 0.034) were significant predictors of NOAF. Conversely, regression of LVH (aHR 0.51, 95% CI 0.28-0.91, P = 0.022) or LAE (aHR 0.30, 95% CI 0.15-0.63, P = 0.001) was associated with a reduced risk for developing NOAF. Patients with both LVH and LAE at follow-up echocardiography had a higher risk for NOAF (aHR 4.30, 95% CI 2.81-6.56, P < 0.001) than those with either LVH or LAE or those with neither. CONCLUSION The changes in left heart geometry can serve as a predictive marker for NOAF in patients with hypertension.
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Affiliation(s)
- Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jiesuck Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi
| | - Hye Jung Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi
| | - Hong-Mi Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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28
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Amrouch C, Vetrano DL, Damiano C, Dai L, Calderón-Larrañaga A, Grymonprez M, Proietti M, Lip GYH, Johnsen SP, Wastesson JW, Johnell K, De Smedt D, Petrovic M. Potentially inappropriate prescribing in polymedicated older adults with atrial fibrillation and multimorbidity: a Swedish national register-based cohort study. Front Pharmacol 2024; 15:1476464. [PMID: 39318774 PMCID: PMC11420530 DOI: 10.3389/fphar.2024.1476464] [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: 08/05/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction Current research on potentially inappropriate prescribing (PIP) in polymedicated older adults with atrial fibrillation (AF) and multimorbidity is predominantly focused on PIP of oral anticoagulants (OAC). Our study aimed to assess (i) the overall prevalence of PIP in older multimorbid adults with AF, (ii) potential associated factors of PIP, and (iii) the association of PIP with adverse health outcomes in a nationwide sample of Swedish older adults. Methods Swedish national registries were linked to establish a cohort with a 2-year follow-up of older adults (≥65y) who, on 1 January 2017, had a diagnosis of AF and had at least one comorbidity (n = 203,042). PIP was assessed using the reduced STOPP/START version 2 screening tool. The STOPP criteria identify potentially inappropriate prescribed medications (PIM), while the START criteria identify potential prescribing omissions (PPO). PIP is identified as having at least one PIM and/or PPO. Cox regression analyses were conducted to examine the association between PIP and adverse health outcomes: mortality, hospitalisation, stroke, bleeding, and falls. Results PIP was highly prevalent in older adults with AF, with both polypharmacy (69.6%) and excessive polypharmacy (85.9%). In the study population, benzodiazepines (22.9%), hypnotic Z-medications (17.8%) and analgesics (8.7%) were the most frequent PIM. Anticoagulants (34.3%), statins (11.1%), vitamin D and calcium (13.4%) were the most frequent PPO. Demographic factors and polypharmacy were associated with different PIM and PPO categories, with the nature of these associations differing based on the specific type of PIM and PPO. The co-occurrence of PIM and PPO, compared to appropriate prescribing, was associated with an increased risk of adverse health outcomes compared to all appropriately prescribed medications: cardiovascular (CV) (Hazard ratio (HR) [95% confidence interval] = 1.97 [1.88-2.07]) and overall mortality (HR = 2.09 [2.03-2.16]), CV (HR = 1.34 [1.30-1.37]) and overall hospitalisation (HR = 1.48 [1.46-1.51]), stroke (HR = 1.93 [1.78-2.10]), bleeding (HR = 1.10 [1.01-1.21]), and falls (HR = 1.63 [1.56-1.71]). Conclusion The present study reports a high prevalence of PIP in multimorbid polymedicated older adults with AF. Additionally, a nuanced relationship between prescribing patterns, patient characteristics, and adverse health outcomes was observed. These findings emphasise the importance of implementing tailored interventions to optimise medication management in this patient population.
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Affiliation(s)
- Cheima Amrouch
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Davide Liborio Vetrano
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Cecilia Damiano
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Lu Dai
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Maxim Grymonprez
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren P Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jonas W Wastesson
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
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29
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Alreshidi FS, Alsaffar M, Chengoden R, Alshammari NK. Fed-CL- an atrial fibrillation prediction system using ECG signals employing federated learning mechanism. Sci Rep 2024; 14:21038. [PMID: 39251753 PMCID: PMC11383942 DOI: 10.1038/s41598-024-71366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/26/2024] [Indexed: 09/11/2024] Open
Abstract
Deep learning has shown great promise in predicting Atrial Fibrillation using ECG signals and other vital signs. However, a major hurdle lies in the privacy concerns surrounding these datasets, which often contain sensitive patient information. Balancing accurate AFib prediction with robust user privacy remains a critical challenge to address. We suggest Federated Learning , a privacy-preserving machine learning technique, to address this privacy barrier. Our approach makes use of FL by presenting Fed-CL, a advanced method that combines Long Short-Term Memory networks and Convolutional Neural Networks to accurately predict AFib. In addition, the article explores the importance of analysing mean heart rate variability to differentiate between healthy and abnormal heart rhythms. This combined approach within the proposed system aims to equip healthcare professionals with timely alerts and valuable insights. Ultimately, the goal is to facilitate early detection of AFib risk and enable preventive care for susceptible individuals.
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Affiliation(s)
- Fayez Saud Alreshidi
- Department of Family and Community Medicine, College of Medicine, University of Ha'il, Ha'il, Saudi Arabia
| | - Mohammad Alsaffar
- Department of Computer Science and Software Engineering, College of Computer Science and Engineering, University of Ha'il, 81481, Ha'il, Saudi Arabia
| | - Rajeswari Chengoden
- School of Computer Science Engineering and Information Systems, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India.
| | - Naif Khalaf Alshammari
- Mechanical Engineering Department, Engineering College, University of Ha'il, 8148, Ha'il, Saudi Arabia
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30
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Antoun I, Li X, Kotb AI, Vali Z, Abdelrazik A, Koya A, Mavilakandy A, Koev I, Nizam A, Eldeeb H, Somani R, Ng A. The Role of P Wave Parameters in Predicting Pulmonary Vein Isolation Outcomes for Paroxysmal Atrial Fibrillation: An Observational Cohort Study. J Cardiovasc Dev Dis 2024; 11:277. [PMID: 39330335 PMCID: PMC11431974 DOI: 10.3390/jcdd11090277] [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: 07/21/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is an effective management method for paroxysmal atrial fibrillation (PAF). The P wave in the 12-lead electrocardiogram (ECG) represents atrial depolarisation. This study aims to utilise the P wave to predict PVI outcomes for PAF. METHODS This single-centre retrospective study aimed to predict PVI outcomes using P wave parameters. It included 211 consecutive patients with first PVI for PAF between 2018 and 2019 and targeted the pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12-lead ECGs with 1-50 hertz bandpass filters were monitored before the procedure. Corrected P wave duration (PWDc), P wave amplitude (PWV), P wave dispersion (PWDisp), intra-atrial block (IAB), P wave area (PWA), and P wave terminal force in V1 (PTFV1) were measured before ablation and correlated with the outcomes. RESULTS Successful PVI occurred in 154 patients (73%). Demographics were similar between both arms. P wave parameters correlated with PVI failure included increased PWDc in all leads except for lead III, aVR, and V3, decreased PWV in lead I (hazard ratio [HR]: 0.7, 95% confidence interval [CI]: 0.53-0.95), lead II (HR: 0.45, 95% CI: 0.22-0.65), aVL (HR: 0.58, 95% CI: 0.22-0.98), and aVF (HR: 0.67, 95% CI: 0.58-0.87), decreased PWA in lead I (HR: 0.55, 95% CI: 0.21-0.76), lead II (HR: 0.48, 95% CI: 0.34-0.87), aVL (HR: 0.65, 95% CI: 0.45-0.96), and aVF (HR: 0.61, 95% CI: 0.32-0.89), and the presence of IAB (HR: 2, 95% CI: 1.4-4.2, p = 0.02). PWDisp and PTFV1 were not correlated with PVI outcome. CONCLUSIONS PWDc, PWA, PWV, and IAB are valuable predictors for PVI outcome for PAF at 12 months.
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Affiliation(s)
- Ibrahim Antoun
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Xin Li
- Department of Engineering, University of Leicester, Leicester LE1 7RH, UK
| | - Ahmed I Kotb
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Zakkariya Vali
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Ahmed Abdelrazik
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Abdulmalik Koya
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Akash Mavilakandy
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Ivelin Koev
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Ali Nizam
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Hany Eldeeb
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Riyaz Somani
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - André Ng
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
- National Institute for Health Biomedical Centre, Leicester LE3 9QP, UK
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31
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Karakasis P, Patoulias D, Popovic DS, Pamporis K, Theofilis P, Nasoufidou A, Stachteas P, Samaras A, Tzikas A, Giannakoulas G, Stavropoulos G, Kassimis G, Karamitsos T, Fragakis N. Effects of mineralocorticoid receptor antagonists on new-onset or recurrent atrial fibrillation: a Bayesian and frequentist network meta-analysis of randomized trials. Curr Probl Cardiol 2024; 49:102742. [PMID: 39002620 DOI: 10.1016/j.cpcardiol.2024.102742] [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: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
Background Clinical and translational research suggests that mineralocorticoid receptor antagonists (MRAs) may prevent atrial fibrosis and electrical remodeling associated with atrial fibrillation (AF). This study aimed to consolidate existing evidence from randomized controlled trials (RCTs) evaluating the effect of MRAs on incident or recurrent AF. Methods Medline, Cochrane Library and Scopus were searched until February 12, 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using both pairwise and Bayesian and frequentist network meta-analyses. Results Twenty-three RCTs (13,358 participants) were identified. Based on the pairwise random effects meta-analysis, MRAs were associated with a significant reduction in AF events compared to placebo or usual care (risk ratio {RR}= 0.75; 95% confidence interval {CI}= [0.66, 0.87]; P< 0.001; I2= 3%). This protective effect was robust both for new-onset and recurrent AF episodes (subgroup p-value= 0.69), while the baseline HF status was not a significant effect modifier (subgroup p-value= 0.58). MRAs demonstrated a significantly higher reduction in AF events for patients with chronic renal disease compared to placebo (RR= 0.78; 95% CI= [0.62, 0.98]; P= 0.03; I2= 0%). The network meta-analyses revealed that only spironolactone was associated with a significant reduction in AF events (Bayesian RR= 0.76; 95% CI= [0.65, 0.89]; P< 0.001; level of evidence moderate; SUCRA 0.731), while eplerenone and finerenone showed a neutral effect. Conclusion MRAs confer a significant benefit in terms of reducing incident or recurrent AF episodes, irrespective of HF status. In this context, spironolactone may be preferable compared to eplerenone or finerenone.
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Affiliation(s)
- Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece.
| | - Dimitrios Patoulias
- Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
| | - Djordje S Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Konstantinos Pamporis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, General Hospital of Athens "Hippocratio", University of Athens Medical School, Athens, Greece
| | - Athina Nasoufidou
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
| | - Panagiotis Stachteas
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
| | - Athanasios Samaras
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
| | - Apostolos Tzikas
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece; European Interbalkan Medical Center, Department of Cardiology, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, Aristotle University Medical School, Thessaloniki, AHEPA University General Hospital, Greece
| | - George Stavropoulos
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
| | - George Kassimis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
| | - Theodoros Karamitsos
- First Department of Cardiology, Aristotle University Medical School, Thessaloniki, AHEPA University General Hospital, Greece
| | - Nikolaos Fragakis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
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Al-Obaidi S, Hijazeen R, Arabyat RM, Alabbadi I. Adherence to oral anticoagulants in patients with non-valvular atrial fibrillation: the role of patients' characteristics and out-of-pocket payments. Expert Rev Pharmacoecon Outcomes Res 2024; 24:845-852. [PMID: 38967473 DOI: 10.1080/14737167.2024.2377663] [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: 02/21/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Recent practice guidelines favor direct oral anticoagulants (DOACs) over warfarin for primary stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, challenges persist in Iraq's private pharmaceutical sector. DOACs have been sold at high and inconsistent retail prices and lack insurance coverage, leading to significant out-of-pocket (OOP) costs. The objective of this study is to investigate the impact of OOP costs on oral anticoagulants (OAC) adherence among NVAF patients. RESEARCH DESIGN AND METHODS This multicenter cross-sectional study interviewed 359 eligible patients attending three private cardiology clinics within Iraq's southern region from December 2022 to February 2023. The 8-item Morisky Adherence Scale evaluated patient adherence. Statistical analyses, including descriptive analysis, ANOVA, and chi-square. p < 0.05 was considered statistically significant. RESULTS The most frequently prescribed OAC were DOACs (62.8%). Patient adherence level to OAC was chiefly medium (54.6%) with no significant difference in adherence based on OAC type. Patient adherence was significantly associated with monthly income (p = 0.001), number of daily pills (p = 0.006), and OACs' average monthly cost (p = 0.011). CONCLUSION Addressing the issue of cost-related non-adherence to OACs requires multiple actions. These include ensuring comprehensive health insurance coverage for OACs, increasing the use of affordable generic alternatives, and establishing effective cost-related discussions between healthcare providers and patients.
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Affiliation(s)
- Siraj Al-Obaidi
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rima Hijazeen
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rasha M Arabyat
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Ibrahim Alabbadi
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
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Dias KJ, Pignataro RM, Heick JD. Risk Factor Management for Patients with Atrial Fibrillation in Home Healthcare. Home Healthc Now 2024; 42:301-307. [PMID: 39250261 DOI: 10.1097/nhh.0000000000001274] [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: 09/11/2024]
Abstract
Atrial fibrillation (AF) is a common and persistent cardiac arrhythmia that impacts morbidity, mortality, disability, quality of life, and healthcare costs. Typically, AF is managed using a three-pillar approach of rate control, rhythm control, and anticoagulation. However, these interventions fail to address the underlying pathophysiological factors that contribute to AF. A compelling body of research expands traditional management by focusing on lifestyle modification to lower the risk of AF incidence, prevalence, progression, and severity. Home healthcare clinicians possess the knowledge and skills to examine and treat a wide range of risk factors that lead to AF, and therefore can substantially reduce incident and persistent AF and facilitate optimal outcomes. This perspective paper presents a clinical paradigm shift by proposing a five-factor Partner, Quantify, Recommend, Support, and Teach (PQRST) framework to support AF risk factor modification in home healthcare. The PQRST framework incorporates a greater focus on patient self-management through education and exercise to reduce incidence, prevalence, progression, and severity of AF.
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Shu L, Jack N, de Havenon A, Goldstein ED, Khan F, Nguyen TN, Henninger N, Siegler JE, Stretz C, Perelstein E, Kala N, Rana M, Furie KL, Douketis JD, Yaghi S. Risk factors for MACE and bleeding in atrial fibrillation patients undergoing surgery: Insights from the bridge trial. J Stroke Cerebrovasc Dis 2024; 33:107839. [PMID: 38944363 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107839] [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: 01/16/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION Patients with atrial fibrillation (AF) undergoing elective procedures are at risk for Major Adverse Cardiovascular Events (MACE) and symptomatic bleeding. We aimed to identify risk factors to guide perioperative risk stratification. METHODS We conducted a post-hoc analysis of the "Bridging Anticoagulation in Patients who Require Temporary Interruption of Warfarin Therapy for an Elective Invasive Procedure or Surgery" randomized trial. The primary outcomes were MACE and symptomatic bleeding. Our statistical approach encompassed standard univariate analysis, logistic stepwise regression, and Cox regression models. Additional interaction analyses evaluated the interplay between low-molecular-weight heparin bridge therapy and other identified risk factors. RESULTS Among a total of 1,813 participants (mean age 71.6 ± 8.8, 73.3 % male), MACE occurred in 25 (1.4 %) individuals, with pre-procedure clopidogrel use (adjusted hazard ratio [aHR] 7.73, 95 % CI 2.63-22.72, p < 0.001) and CHA2DS2-VASc score ≥ 5 (aHR 2.89, 95 % CI 1.26-6.63, p = 0.012) identified as risk factors. Symptomatic bleeding occurred in 57 (3.1 %) individuals, with bridge therapy (aHR 1.84, 95 % CI 1.07-3.19, p = 0.029), renal disease (aHR 2.50, 95 % CI 1.34-4.67, p = 0.004), post-procedure aspirin use (aHR 2.86, 95 % CI 1.66-4.91, p < 0.001), post-procedure nonsteroidal anti-inflammatory drug use excluding aspirin (aHR 3.40, 95 % CI 1.22-9.43, p = 0.019), and major surgery (aHR 3.94, 95 % CI 2.26-6.85, p < 0.001) identified as risk factors. The interactions between risk factors and bridging therapy on MACE and symptomatic bleeding outcomes were not significant (p > 0.05). CONCLUSION We identified predictors for MACE and symptomatic bleeding in AF patients undergoing elective procedures. These insights may help guide perioperative decisions to reduce the risk of adverse outcomes.
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Affiliation(s)
- Liqi Shu
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI; Department of Neurology, The Miriam Hospital, Providence, RI, USA.
| | - Naomi Jack
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Adam de Havenon
- Department of Neurology, Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT.
| | - Eric D Goldstein
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Farhan Khan
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Thanh N Nguyen
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | | | - Christoph Stretz
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Elizabeth Perelstein
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Narendra Kala
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Maheen Rana
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Karen L Furie
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - James D Douketis
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI
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Eromosele OB, Shapira-Daniels A, Yuan A, Lukan A, Akinrimisi O, Chukwurah M, Nayor M, Benjamin EJ, Lin H. The association of exhaled carbon monoxide with atrial fibrillation and left atrial size in the Framingham Heart Study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 45:100439. [PMID: 39234302 PMCID: PMC11372625 DOI: 10.1016/j.ahjo.2024.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/06/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024]
Abstract
Background Exhaled carbon monoxide (eCO) is associated with subclinical and overt cardiovascular disease and stroke. The association between eCO with left atrial size, prevalent, or incident atrial fibrillation (AF) are uncertain. Methods eCO was measured using an Ecolyzer instrument among Framingham Heart Study Offspring and Omni participants who attended an examination from 1994 to 1998. We analyzed multivariable-adjusted (current smoking, and other covariates including age, race, sex, height, weight, systolic blood pressure, diastolic blood pressure, diabetes, hypertension treatment, prevalent myocardial infarction [MI], and prevalent heart failure [HF]). Cox and logistic regression models assessed the relations between eCO and incident AF (primary model), and prevalent AF and left atrial (LA) size (pre-specified secondary analyses). We also conducted secondary analyses adjusting for biomarkers, and interim MI and interim HF. Results Our study sample included 3814 participants (mean age 58 ± 10 years; 54.4 % women, 88.4 % White). During an average of 18.8 ± 6.5 years follow-up, 683 participants were diagnosed with AF. eCO was associated with incident AF after adjusting for established AF risk factors (HR, 1.31 [95 % CI, 1.09-1.58]). In secondary analyses the association remained significant after additionally adjusting for C-reactive protein and B-type natriuretic peptide, and interim MI and CHF, and in analyses excluding individuals who currently smoked. eCO was not significantly associated with LA size and prevalent AF. Conclusion In our community-based sample of individuals without AF, higher mean eCO concentrations were associated with incident AF. Further investigation is needed to explore the biological mechanisms linking eCO with AF.
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Affiliation(s)
- Oseiwe B Eromosele
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| | - Ayelet Shapira-Daniels
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| | - Amy Yuan
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| | - Abdulkareem Lukan
- Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Olumuyiwa Akinrimisi
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Marius Chukwurah
- Department of Medicine, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Nayor
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Honghuang Lin
- Boston University and NHLBI's Framingham Heart Study, USA
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Fiorina L, Chemaly P, Cellier J, Said MA, Coquard C, Younsi S, Salerno F, Horvilleur J, Lacotte J, Manenti V, Plesse A, Henry C, Lefebvre B. Artificial intelligence-based electrocardiogram analysis improves atrial arrhythmia detection from a smartwatch electrocardiogram. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:535-541. [PMID: 39318690 PMCID: PMC11417483 DOI: 10.1093/ehjdh/ztae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/29/2024] [Accepted: 05/29/2024] [Indexed: 09/26/2024]
Abstract
Aims Smartwatch electrocardiograms (SW ECGs) have been identified as a non-invasive solution to assess abnormal heart rhythm, especially atrial arrhythmias (AAs) that are related to stroke risk. However, the performance of these tools is limited and could be improved with the use of deep neural network (DNN) algorithms, particularly for specific populations encountered in clinical cardiology practice. Methods and results A total of 400 patients from the electrophysiology department of one tertiary care hospital were included in two similar clinical trials (respectively, 200 patients per study). Simultaneous ECGs were recorded with the watch and a 12-lead recording system during consultation or before and after an electrophysiology procedure if any. The SW ECGs were processed by using the DNN and with the Apple watch ECG software (Apple app). Corresponding 12-lead ECGs (12L ECGs) were adjudicated by an expert electrophysiologist. The performance of the DNN was assessed vs. the expert interpretation of the 12L ECG, and inconclusive rates were reported. Overall, the DNN and the Apple app presented, respectively, a sensitivity of 91% [95% confidence interval (CI) 85-95%] and 61% (95% CI 44-75%) with a specificity of 95% (95% CI 91-97%) and 97% (95% CI 93-99%) when compared with the physician 12L ECG interpretation. The DNN was able to provide a diagnosis on 99% of ECGs, while the Apple app was able to classify only 78% of strips (22% of inconclusive diagnosis). Conclusion In this study, by including patients from a cardiology department, a DNN-based algorithm applied to an SW ECG provided an accurate diagnosis for AA detection on virtually all tracings, outperforming the SW algorithm.
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Affiliation(s)
- Laurent Fiorina
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Pascale Chemaly
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Joffrey Cellier
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Mina Ait Said
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Charlène Coquard
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Salem Younsi
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Fiorella Salerno
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Jérôme Horvilleur
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Jérôme Lacotte
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
| | - Vladimir Manenti
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, 6 avenue du Noyer Lambert, 91 300 Massy, France
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Wang W, Liu L, Jin L, Hu B. A Predictive Nomogram of In-Hospital Mortality After 48 h for Atrial Fibrillation Patients in the Coronary Care Unit. Clin Cardiol 2024; 47:e70017. [PMID: 39289906 PMCID: PMC11408711 DOI: 10.1002/clc.70017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) suffer a higher risk of death, and it is necessary to develop prediction tools for mortality risk in critically ill patients with AF. This study aimed to develop a novel predictive nomogram of in-hospital mortality after 48 h in the coronary care unit (CCU) for patients with AF. METHODS We collected information on CCU patients with AF from the "Medical Information Mart for Intensive Care-III" database and developed a nomogram model for predicting the all-cause mortality risk after 48 h in the hospital. Key variables were selected by univariate logistic and least absolute shrinkage and selection operator regression. The independent predictors with p < 0.05 were screened out by multivariate logistic regression. A predictive nomogram was constructed using these independent predictors, and the model calibration and discrimination were evaluated. RESULTS This study finally enrolled 1248 CCU patients with AF, and the in-hospital mortality was 17% (209/1248). The predictive nomogram was constructed by 13 selected independent predictors, including age, smoking status, acute kidney injury, chronic obstructive pulmonary disease, ventricular arrhythmia, shock, urea, red cell distribution width, leucocytosis, continuous renal replacement therapy, continuous positive airway pressure, anticoagulation, and heart rate. The area under the curve of the nomogram was 0.803 (95% confidence interval 0.771-0.835). The nomogram was verified to have good accuracy and calibration. CONCLUSIONS This study developed a novel nomogram containing age, acute kidney injury, and heart rate that can be a good predictor of potential in-hospital mortality after 48 h in CCU patients with AF.
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Affiliation(s)
- Wenhui Wang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Linlin Liu
- Department of Cardiology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lu Jin
- Department of Cardiology, Anda Hospital, Shanghai, China
| | - Bo Hu
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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Grubb A, Aleong R, Rosenberg MA, Chang S, Padalia K, Ashur C, Adewumi J, Saqi B, Varela D, Sandhu A, Cerbin L, Barrett C, Tumolo AZ, Varosy P, Zipse MM, Tzou WS, Garg L, Sabzwari SRA. Development and validation of the Atri-Risk Conduction Index risk score to predict risk of atrial fibrillation after typical atrial flutter ablation. Heart Rhythm 2024; 21:1621-1629. [PMID: 38762137 DOI: 10.1016/j.hrthm.2024.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Identification of patients at risk for atrial fibrillation (AF) after typical atrial flutter (tAFL) ablation is important to guide monitoring and treatment. OBJECTIVE The purpose of this study was to create and validate a risk score to predict AF after tAFL ablation METHODS: We identified patients who underwent tAFL ablation with no AF history between 2017 and 2022 and randomly allocated to derivation and validation cohorts. We collected clinical variables and measured conduction parameters in sinus rhythm on an electrophysiology recording system (CardioLab, GE Healthcare). Univariate and multivariate logistic regressions (LogR) were used to evaluate association with AF development. RESULTS A total of 242 consecutive patients (81% male; mean age 66 ± 11 years) were divided into derivation (n =142) and validation (n = 100) cohorts. Forty-two percent developed AF over median follow-up of 330 days. In multivariate LogR (derivation cohort), proximal to distal coronary sinus time (pCS-dCS) ≥70 ms (odds ratio [OR] 16.7; 95% confidence interval [CI] 5.6-49), pCS time ≥36 ms (OR 4.5; 95% CI 1.5-13), and CHADS2-VASc score ≥3 (OR 4.3; 95% CI 1.6-11.8) were independently associated with new AF during follow-up. The Atri-Risk Conduction Index (ARCI) score was created with 0 as minimal and 4 as high-risk using pCS-dCS ≥70 ms = 2 points; pCS ≥36 ms = 1 point; and CHADS2-VASc score ≥3 = 1 point. In the validation cohort, 0% of patients with ARCI score = 0 developed AF, whereas 89% of patients with ARCI score = 4 developed AF. CONCLUSION We developed and validated a risk score using atrial conduction parameters and clinical risk factors to predict AF after tAFL ablation. It stratifies low-, moderate-, and high-risk patients and may be helpful in individualizing approaches to AF monitoring and anticoagulation.
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Affiliation(s)
- Alex Grubb
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ryan Aleong
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael A Rosenberg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Shu Chang
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kishan Padalia
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Carmel Ashur
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Joseph Adewumi
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Bilal Saqi
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel Varela
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amneet Sandhu
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Rocky Mountain VA Medical Center, Aurora, Colorado
| | - Lukasz Cerbin
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Christopher Barrett
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Denver Health Medical Center, Denver, Colorado
| | - Alexis Z Tumolo
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Paul Varosy
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Rocky Mountain VA Medical Center, Aurora, Colorado
| | - Matthew M Zipse
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wendy S Tzou
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lohit Garg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Syed Rafay A Sabzwari
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Heinzinger CM, Lapin B, Thompson NR, Li Y, Milinovich A, May AM, Pena Orbea C, Faulx M, Van Wagoner DR, Chung MK, Foldvary-Schaefer N, Mehra R. Novel Sleep Phenotypic Profiles Associated With Incident Atrial Fibrillation in a Large Clinical Cohort. JACC Clin Electrophysiol 2024; 10:2074-2084. [PMID: 39023484 DOI: 10.1016/j.jacep.2024.05.027] [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: 04/10/2024] [Accepted: 05/02/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND While sleep disorders are implicated in atrial fibrillation (AF), the interplay of physiologic alterations and symptoms remains unclear. Sleep-based phenotypes can account for this complexity and translate to actionable approaches to identify at-risk patients and therapeutic interventions. OBJECTIVES This study hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF. METHODS Data from the STARLIT (sleep Signals, Testing, And Reports LInked to patient Traits) registry on Cleveland Clinic patients (≥18 years of age) who underwent PSG from November 27, 2004, to December 30,2015, were retrospectively examined. Phenotypes were identified using latent class analysis of symptoms and PSG-based measures of sleep-disordered breathing and sleep architecture. Phenotypes were included as the primary predictor in a multivariable-adjusted Cox proportional hazard models for incident AF. RESULTS In our cohort (N = 43,433, age 51.8 ± 14.5 years, 51.9% male, 74.9% White), 7.3% (n = 3,166) had baseline AF. Over a 7.6- ± 3.4-year follow-up period, 8.9% (n = 3,595) developed incident AF. Five phenotypes were identified. The hypoxia subtype (n = 3,245) had 48% increased incident AF (HR: 1.48; 95% CI: 1.34-1.64), the apneas + arousals subtype (n = 4,592) had 22% increased incident AF (HR: 1.22; 95% CI: 1.10-1.35), and the short sleep + nonrapid eye movement subtype (n = 6,126) had 11% increased incident AF (HR: 1.11; 95% CI: 1.01-1.22) compared with long sleep + rapid eye movement (n = 26,809), the reference group. The hypopneas subtype (n = 2,661) did not differ from reference (HR: 0.89; 95% CI: 0.77-1.03). CONCLUSIONS Consistent with prior evidence supporting hypoxia as an AF driver and cardiac risk of the sleepy phenotype, this constellation of symptoms and physiologic alterations illustrates vulnerability for AF development, providing potential value in enhancing our understanding of integrated sleep-specific symptoms and physiologic risk of atrial arrhythmogenesis.
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Affiliation(s)
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA; Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA; Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yadi Li
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA; Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna M May
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Cinthya Pena Orbea
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Faulx
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Mina K Chung
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Reena Mehra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA.
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Krittayaphong R, Permsuwan U. Employing Real-World Evidence for the Economic Evaluation of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation in Thailand. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:725-734. [PMID: 38858344 DOI: 10.1007/s40258-024-00891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND This study aimed to assess the cost-effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) in comparison with warfarin using data from real practice based on the perspective of the health care system in Thailand. METHODS A four-state Markov model encompassing well-controlled atrial fibrillation (AF), stroke and systemic embolism, major bleeding and death was utilised to forecast clinical and economic outcomes. Transitional probabilities, direct medical costs and utilities were derived from the real-world data of the 'COOL-AF Thailand' registry, Thailand's largest nationwide registry spanning 27 hospitals. The cohort comprised AF patients. The primary outcomes assessed were total costs, life years, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio. All costs and outcomes were subject to an annual discount rate of 3.0%. A spectrum of sensitivity analyses was conducted. RESULTS The mean age of the cohort was 68.8 ± 10.7 years. The NOACs group incurred a marginally lower total lifetime cost than the warfarin group (247,857 Thai baht [THB] vs 253,654 THB or 7137 USD vs 7304 USD) and experienced gains of 0.045 life years and 0.043 QALYs over the warfarin group. Given the lower cost and higher benefits associated with NOACs, this implies that NOAC treatment is a dominant strategy compared to warfarin for AF patients. At a ceiling ratio of 160,000 THB (4607 USD) per QALY, NOACs presented a 61.2% probability of being cost effective. CONCLUSIONS Non-vitamin K antagonist oral anticoagulants represent a cost-saving alternative to warfarin in the real clinical practice. However, with a probability of being cost effective below 65%, it suggests some parameter uncertainty regarding their overall cost effectiveness compared to warfarin.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Unchalee Permsuwan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Lawin D, Lawrenz T, Chun KRJ, Lim HE, Obidigbo V, Selma JM, Peytchev P, Nguyen DQ, Földesi C, Stellbrink C. Cryoballoon ablation of atrial fibrillation in octogenarians: one year outcomes from the cryo global registry. J Interv Card Electrophysiol 2024; 67:1341-1351. [PMID: 38082096 PMCID: PMC11379788 DOI: 10.1007/s10840-023-01680-z] [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: 08/29/2023] [Accepted: 10/23/2023] [Indexed: 09/07/2024]
Abstract
BACKGROUND Limited information is available on the safety and efficacy of cryoballoon ablation (CBA) in elderly patients with atrial fibrillation (AF). Moreover, global utilization of CBA in this population (≥ 80 years old) has not been reported. This study's objectives were to determine the use, efficacy, and safety of CBA to treat octogenarians suffering from AF. METHODS In this sub-analysis of the Cryo Global Registry, 12-month outcomes of treating AF via CBA in octogenarians were compared to patients < 80 years old. Efficacy was evaluated as time to a ≥ 30 s atrial arrhythmia (AA) recurrence. Healthcare utilization was determined via repeat ablations and hospitalizations. Improvement upon disease burden was evaluated through patient reporting of symptoms and the EQ-5D-3L quality of life (QoL) survey. RESULTS The octogenarian cohort (n = 101) had a higher prevalence of females (51.5% vs 35.7%) and CHA2DS2-VASc scores (4.2 ± 1.3 vs 2.0 ± 1.5) compared to the control cohort (n = 1573, both p < 0.01). Even when adjusting for baseline characteristics and antiarrhythmic drug usage, freedom from AA recurrence at 12 months (80.6% vs 78.9%, HRadj:0.97 [95% CI:0.59-1.58], p = 0.90) was comparable between octogenarians and control, respectively. Similar serious adverse event rates were observed between octogenarians (5.0%) and control (3.2%, p = 0.38). The groups did not differ in healthcare utilization nor reduction of AF-related symptoms from baseline to follow-up, but both experienced an improvement in QoL at 12 months. CONCLUSIONS Despite more age-related comorbidities, CBA is a safe and effective treatment for AF in octogenarians, with efficacy and adverse events rates akin to ablations performed in younger patients. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02752737.
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Affiliation(s)
- Dennis Lawin
- Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, 50 Teutoburger Street Bielefeld, 33604, Bielefeld, Germany
| | - Thorsten Lawrenz
- Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, 50 Teutoburger Street Bielefeld, 33604, Bielefeld, Germany
| | | | - Hong-Euy Lim
- Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | | | | | | | | | - Csaba Földesi
- Gottsegen György Országos Kardiovaszkuláris Intézet, Budapest, Hungary
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, 50 Teutoburger Street Bielefeld, 33604, Bielefeld, Germany.
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Soleimani H, Tavakoli K, Nasrollahizadeh A, Azadnajafabad S, Mashayekhi M, Ebrahimi P, Masoudkabir F, Vasheghani-Farahani A, Hosseini K. Estimating the burden of atrial fibrillation and atrial flutter with projection to 2050 in Iran. Sci Rep 2024; 14:20264. [PMID: 39217230 PMCID: PMC11365946 DOI: 10.1038/s41598-024-71296-4] [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] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
Atrial fibrillation (AF)/atrial flutter (AFL) is the most common cardiac tachyarrhythmia, with an increasing trend in its burden in recent years. However, the burden of AF/AFL in Iran remains unclear. This study aimed to estimate the burden of AF/AFL and its attributable risk factors from 1990 to 2019 at national and subnational levels. Using the comparative risk assessment method of the Global Burden of Disease (GBD) Study 2019, we extracted data on AF/AFL incidence, prevalence, deaths, disability-adjusted life years (DALYs), and their age-standardized rates from 1990 to 2019 and analyzed them based on by age, sex, and socio-demographic index (SDI). The percentage contribution of AF/AFL major risk factors was calculated. Moreover, the AF/AFL burden in 2050 was projected using the United Nations world population prospect data. In 2019, there were 339.1 (259.4-433.7) thousand AF/AFL patients in Iran, with 30.2 (23.2-38.5) thousand new cases, 1.7 (1.5-2) thousand deaths and 48 (37.7-60.5) thousand DALYs. Females and 50-69-year-old patients recorded a higher burden for AF/AFL; however, the increasing trend was more pronounced in males and more than 85-year-old patients. High systolic blood pressure and elevated body mass index (BMI) were the predominant attributable risk factors for AF/AFL-related deaths and DALYs. It is estimated that in 2050, the number of AF/AFL patients will increase to 1.1 million people, the incidence of AF/AFL will increase to 91 thousand patients, and the number of AF/AFL-related deaths and DALYs will surge to 7.2 and 170.8 thousand, respectively. Despite advancements in prevention and treatment, AF/AFL remains a major public health problem in Iran. Given its largely preventable and treatable nature, more cost-effective strategies are required to target modifiable risk factors, especially within susceptible age and sex groups.
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Affiliation(s)
- Hamidreza Soleimani
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, North Kargar-Ave, Tehran, Iran
| | - Kiarash Tavakoli
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, North Kargar-Ave, Tehran, Iran.
- Cardiac Primary Prevention Research Center, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amir Nasrollahizadeh
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, North Kargar-Ave, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Mashayekhi
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, North Kargar-Ave, Tehran, Iran
| | - Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, North Kargar-Ave, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, North Kargar-Ave, Tehran, Iran
| | - Ali Vasheghani-Farahani
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, North Kargar-Ave, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, North Kargar-Ave, Tehran, Iran
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Krittayaphong R, Treewaree S, Lip GYH. Components of the Atrial fibrillation Better Care pathway for holistic care of patients with atrial fibrillation: a win ratio analysis from the COOL-AF registry. Europace 2024; 26:euae237. [PMID: 39283957 PMCID: PMC11424996 DOI: 10.1093/europace/euae237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 09/09/2024] [Indexed: 09/27/2024] Open
Abstract
AIMS Compliance with integrated care based on the Atrial fibrillation Better Care (ABC) pathway has been associated with improved clinical outcomes. The primary objective of this study was to compare clinical outcomes of AF patients according to the compliant status of each component of the ABC pathway in a hierarchical win ratio approach. METHODS AND RESULTS We studied AF patients in the COOL-AF registry. Each patient was followed every 6 months until 3 years. A win ratio analysis was performed, as not all clinical outcomes are equivalent. The hierarchical outcomes were (1) all-cause death, (2) intracranial haemorrhage (ICH), (3) ischaemic stroke/systemic embolism, (4) non-ICH major bleedings, and (5) acute myocardial infarction or heart failure. We also assessed win ratio and win proportion variance over the follow-up time, and the variations over time. A total of 3405 patients (mean age 67.8 ± 11.3; 41.8% female) were studied. Win ratio of ABC-compliant (all three components) vs. ABC-not-compliant was 1.57 (1.35-1.83), P < 0.001. When adding time in therapeutic range (TTR) data for compliant criteria for those who were on warfarin, the win ratio increased to 2.28 (1.89-2.75), P < 0.001. The A-compliant group (plus TTR data), B-compliant, and C-compliant had the win ratio of 1.81 (1.51-2.12), 1.82 (1.53-2.16), and 1.39 (1.18-1.62), all P < 0.001, compared to not compliant group. CONCLUSION Management of AF patients according to each component of the ABC pathway is associated with better clinical outcomes compared to those non-compliant to ABC pathway. This finding underscores the importance of a holistic management approach strategy for AF patients.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Rd, Bangkok 10700, Thailand
| | - Sukrit Treewaree
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Rd, Bangkok 10700, Thailand
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Richard Espiga F, Almendro Delia M, Caballero Martínez F, Monge Martín D, Neira Serrano F, Quirós López R. Delayed diagnosis and missed opportunities in the early detection of atrial fibrillation: a cross-sectional study. Rev Clin Esp 2024:S2254-8874(24)00111-5. [PMID: 39214340 DOI: 10.1016/j.rceng.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
INTRODUCTION We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients. METHODS This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain. RESULTS A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1 and 6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis. CONCLUSIONS In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.
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Affiliation(s)
- F Richard Espiga
- Servicio de Urgencias Hospital Universitario de Burgos, Burgos, Spain.
| | - M Almendro Delia
- Unidad de Investigación Cardiovascular y Ensayos Clínicos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - D Monge Martín
- Vicedecana de Investigación, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | - F Neira Serrano
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | - R Quirós López
- Servicio de Medicina Interna, Hospital Costa del Sol de Marbella, Málaga, Spain
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Tang J, Zhang Q, Peng S, Li H, Hu W, Hao M, Liu Y, Sun M, Cao W, Yin N, Liu X, Xu T. Differences in global, regional, and national time trends in disability-adjusted life years for atrial fibrillation and flutter, 1990-2019: an age-period-cohort analysis from the 2019 global burden of disease study. Front Cardiovasc Med 2024; 11:1401722. [PMID: 39267808 PMCID: PMC11390633 DOI: 10.3389/fcvm.2024.1401722] [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: 03/15/2024] [Accepted: 08/14/2024] [Indexed: 09/15/2024] Open
Abstract
Background Atrial fibrillation and flutter, collectively referred to as AF/AFL, pose substantial public health challenges across nations of different economic statuses. Abjective This research is intended to assess the discrepancies in global, regional, and national trends in DALYs for atrial fibrillation and flutter throughout 1990 and 2019. Methods The GBD 2019 report included statistics on AF/AFL. An age-period-cohort (APC) model was used to calculate the changes in DALYs from ages 30 to 34 years up to 95 + years. The model calculated both net drifts and local drifts in DALYs. In addition, we analysed the relative risks for certain time periods and birth cohorts from 1990 to 2019 in order to assess their impact. In order to measure the changes over time in the age-standardized rate (ASR) of DALYs caused by AF/AFL, we calculated the average annual percentage changes (AAPCs) based on age, gender, socio-demographic index (SDI), and location. This approach enables us to analyse the impact of age, period, and cohort on trends in DALYs, which may uncover disparities in the management of AF/AFL. Results The global number of DALYs cases was 8,393,635 [95% uncertainty interval (UI): 6,693,987 to 10,541,461], indicating a 121.6% rise (95% UI: 111.5 to 132.0) compared to 1990. From 1990 to 2019, the worldwide ASR of DALYs decreased by 2.61% (95% UI -6.9 to 1.3). However, the other SDI quintiles, except for high SDI and high-middle SDI, had an increase. During the last three decades, high-income nations in the Asia Pacific region had the most significant reduction in ASR of DALYs, whereas Central Asia experienced the highest rise (with a net drift of -0.9% [95% Confidence Interval (CI): -1.0 to -0.9] and 0.6% [95% CI: 0.5 to 0.7], respectively). Approximately 50% of the burden of AF/AFL has been transferred from areas with high and high-middle SDI to those with lower SDI. There was an inverse relationship between the AAPC and the SDI. In addition, men and older individuals were shown to have a greater burden of AF/AFL DALYs. Conclusion The findings of this research demonstrate that the worldwide impact of AF/AFL remains significant and increasing, with the burden differing depending on SDI. The exhaustive and comparable estimates provided by these results may contribute to international efforts to attain equitable AF/AFL control.
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Affiliation(s)
- Juan Tang
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Shengxian Peng
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Huan Li
- Chongqing College of Electronic Engineering, Chongqing, China
| | - Weike Hu
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Min Hao
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Yue Liu
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Mengyan Sun
- Department of Continuing Education, Oxford University, Oxford, United Kingdom
| | - Wenzhai Cao
- Department of Cardiology, Zigong First People's Hospital, Zigong, China
| | - Niying Yin
- Department of Blood Transfusion, Suqian First Hospital, Suqian, China
| | - Xiaozhu Liu
- Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Te Xu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Fan K, Xiao Y, Xue A, Zhou J. Clinical outcomes, management, healthcare resource utilization, and cost according to the CHA 2DS 2-VASc scores in Asian patients with nonvalvular atrial fibrillation. Int J Cardiol 2024; 417:132496. [PMID: 39214472 DOI: 10.1016/j.ijcard.2024.132496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/12/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The prognosis among non-valvular atrial fibrillation (NVAF) patients with different CHA2DS2-VASc scores in the contemporary Asian population remains unclear. Additionally, there is a lack of research examining the disparities in management patterns, healthcare resource utilization (HCRU), and cost among these patients. METHODS AND RESULTS This retrospective cohort study assessed patients diagnosed with NVAF between January 2018 and July 2022. Patients were stratified into 3 cohorts by CHA2DS2-VASc scores: low-risk, intermediate-risk, and high-risk. One-year incidence rates and cumulative incidence of clinical outcomes (including ischemic stroke [IS], transient ischemic attack [TIA], arterial embolism [AE], and major bleeding [MB]) were calculated. Management patterns, HCRU, and cost were analyzed descriptively. Among 419,490 NVAF patients (mean age: 75.2 years, 45.1 % female), 16,541 (3.9 %) were classified as low-risk, 38,494 (9.2 %) as intermediate-risk, and 364,455 (86.9 %) as high-risk. The one-year incidence rates for IS, TIA, AE, and MB were 12.4 (95 % CI, 12.3-12.5), 1.1 (95 % CI, 1.0-1.1), 0.5 (95 % CI, 0.5-0.5), and 3.1 per 100 person-years (95 % CI, 3.1-3.2), with an increasing trend from the low-risk to the high-risk group, respectively. During follow-up, 16.4 % and 11.1 % of patients in the low-risk and high-risk cohorts received oral anticoagulants (OACs), respectively. In addition, significant differences in HCRU and cost were observed in these three cohorts. CONCLUSION This study demonstrates that contemporary Asian NVAF patients with higher CHA2DS2-VASc scores experience higher incidence of adverse outcomes and increased hospital resource consumption. Additionally, suboptimal management was present across all CHA2DS2-VASc score groups.
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Affiliation(s)
- Keye Fan
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China
| | - Yue Xiao
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China
| | - Aoming Xue
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China.
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Chinitz JS, Epstein LM. COVID-19 vaccination and atrial fibrillation: When pandemics collide. J Cardiovasc Electrophysiol 2024. [PMID: 39171651 DOI: 10.1111/jce.16404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/03/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Jason S Chinitz
- Department of Cardiology, Northwell, New Hyde Park, New York, USA
- Department of Cardiology, Northwell Cardiovascular Institute, Manhasset, New York, USA
- Department of Cardiology, South Shore University Hospital, Bay Shore, New York, USA
| | - Laurence M Epstein
- Department of Cardiology, Northwell, New Hyde Park, New York, USA
- Department of Cardiology, Northwell Cardiovascular Institute, Manhasset, New York, USA
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
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Daoudi S, John K, Chalhoub F, Chee J, Infeld M, Elbaz-Greener G, Homoud M, Ruskin JN, Heist EK, Madias C, Udelson J, Rozen G. Nationwide Trends in Hospitalizations for Atrial Fibrillation and Flutter in the United States before and during the Outbreak of the COVID-19 Pandemic. J Clin Med 2024; 13:4883. [PMID: 39201025 PMCID: PMC11355455 DOI: 10.3390/jcm13164883] [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: 05/31/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Atrial fibrillation (AF) and flutter (AFL) are the most common cardiac arrhythmias worldwide. Cardiovascular complications are a common manifestation of acute and post-acute COVID-19 infection. We aimed to analyze the nationwide trends in clinical characteristics and outcomes of patients hospitalized for AF/AFL before and during the COVID-19 outbreak in the U.S. Methods: This study is a retrospective analysis of patients, aged 18 and older, hospitalized for AF/AFL in the U.S. between 2016 and 2020. We drew data from the National Inpatient Sample (NIS) database. Baseline sociodemographic and clinical data, as well as outcomes including stroke, acute coronary syndrome (ACS), and mortality, were analyzed. Multivariable analysis was performed to identify independent associations between the different clinical and demographic characteristics and the composite endpoint of Mortality/ACS/Stroke. Results: An estimated total of 2,163,699 hospitalizations for AF/AFL were identified. The hospitalization volume between 2016 and 2019 was stable, averaging 465,176 a year, followed by a significant drop to 302,995 in 2020. Patients' median age was 72 years (IQR 62-80), 50.9% were male, and 81.5% were white. The composite endpoint steadily increased from 6.5% in 2016 to 11.8% in 2020 (Ptrend < 0.001). In a multivariable regression analysis, age > 75 (OR: 1.35; 95% CI 1.304-1.399, p < 0.001), ischemic heart disease (OR: 1.466; 95% CI: 1.451-1.481; p < 0.001), and chronic kidney disease (OR: 1.635; 95% CI: 1.616-1.653; p < 0.001) were associated with the composite endpoint. COVID-19 was associated with the composite endpoint outcome in the year 2020 (OR: 1.147; 95% CI: 1.037-1.265; p = 0.007). Conclusions: Hospitalization for AF/AFL dropped significantly during the first year of the COVID-19 pandemic outbreak, possibly due to patients' avoidance of hospital visits. The composite endpoint of Mortality/ACS/Stroke uptrended significantly during the study period. COVID-19 was shown to be independently associated with the adverse composite outcome Mortality/ACS/Stroke.
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Affiliation(s)
- Sarah Daoudi
- Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Kevin John
- Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
| | | | - Jennifer Chee
- Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Margaret Infeld
- Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190400, Israel
| | - Munther Homoud
- Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Jeremy N. Ruskin
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - E. Kevin Heist
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Christopher Madias
- Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
| | - James Udelson
- Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Guy Rozen
- Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Rafaqat S, Sharif S, Naz S, Patoulias D, Klisic A. Contributing role of metabolic genes APOE, FTO, and LPL in the development of atrial fibrillation: insights from a case-control study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240263. [PMID: 39166676 PMCID: PMC11329263 DOI: 10.1590/1806-9282.20240263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/05/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE The aim of the study was to examine the expression profile of genes (APOE, FTO, and LPL) associated with metabolic syndrome (MetS) in subjects with concomitant atrial fibrillation (AF). METHODS A total of 690 subjects were categorized into control, AF without MetS, and AF with MetS. RESULTS The expression profiles of the APOE, FTO, and LPL genes were decreased in AF subjects and AF subjects with MetS as compared to the controls. In AF without the MetS group, an inverse relationship was found between the expression of the LPL gene with body mass index (BMI) and a positive relationship with creatine kinase-MB, whereas expression of the FTO gene was inversely associated with fasting blood glucose and positively with cardiac troponin I in AF suffering from MetS. Expression of the LPL gene was directly linked with systolic blood pressure (SBP) and high-density lipoprotein-cholesterol (HDL-C), whereas an inverse correlation with heart rate and expression of the FTO gene in AF with MetS were shown. The expression of the LPL gene was inversely related to BMI in subjects with AF. The expression of the LPL gene was positively correlated with SBP and HDL-C and negatively correlated with heart rate, while the expression of the FTO gene was an important predictor of AF with MetS. CONCLUSION The decreased expression of APOE, FTO, and LPL genes in AF with and without MetS indicates their potential contributing role in the pathogenesis of AF.
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Affiliation(s)
- Saira Rafaqat
- Lahore College for Women University, Department of Zoology - Lahore, Pakistan
| | - Saima Sharif
- Lahore College for Women University, Department of Zoology - Lahore, Pakistan
| | - Shagufta Naz
- Lahore College for Women University, Department of Zoology - Lahore, Pakistan
| | - Dimitrios Patoulias
- Aristotle University of Thessaloniki, General Hospital "Hippokration", Second Department of Cardiology, Outpatient Department of Cardiometabolic Medicine - Thessaloniki, Greece
| | - Aleksandra Klisic
- University of Montenegro, Faculty of Medicine - Podgorica, Montenegro
- Primary Health Care Center, Center for Laboratory Diagnostics - Podgorica, Montenegro
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Adji AS, de Liyis BG. Comparison between non-vitamin K oral antagonist versus warfarin in atrial fibrillation with and without valvular heart disease: a systematic review and meta-analysis. Egypt Heart J 2024; 76:102. [PMID: 39120758 PMCID: PMC11315858 DOI: 10.1186/s43044-024-00535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/04/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) poses a significant stroke risk in heart disease patients. This systematic review aims to evaluate the efficacy and safety of non-vitamin K oral antagonists (NOACs) versus vitamin K antagonists (VKAs) in AF patients with and without any valvular heart disease (VHD/N-VHD). METHODS A systematic search was conducted on PubMed, Scopus, and Google Scholar up to March 3, 2022. Efficacy and safety parameters were analyzed. RESULTS A total of 85,423 subjects from 10 studies were included in this meta-analysis. NOACs and VKAs showed similar effects on ischemic stroke in AF patients with VHD/N-VHD (RR 0.97; 95% CI 0.72-1.30; p = 0.83) and also on systemic embolic events (RR 1.02; 95% CI 0.83-1.25; p = 0.86). Similar effects were seen in VHD and N-VHD subgroups. Both treatments had similar effects on myocardial infarction in AF patients with VHD/N-VHD (RR 0.79; 95% CI 0.49-1.26; p = 0.32), VHD (RR 0.78; 95% CI 0.59-1.02; p = 0.07), and N-VHD subgroups (RR 0.82; 95% CI 0.30-2.21; p = 0.69). NOACs reduced the risk of intracranial bleeding in AF VHD/N-VHD (RR 0.64; 95% CI 0.54-0.77; p < 0.0001), VHD (RR 0.59; 95% CI 0.42-0.82; p = 0.002), and N-VHD subgroups (RR 0.70; 95% CI 0.57-0.85; p = 0.0003). Additionally, NOACs reduced the risk of gastrointestinal bleeding in AF VHD/N-VHD (RR 0.80; 95% CI 0.66-0.96; p = 0.02), specifically in the VHD subgroup (RR 0.69; 95% CI 0.54-0.89; p = 0.004). Moreover, NOACs were associated with a decreased risk for minor and non-fatal bleeding in AF patients with VHD/N-VHD (RR 0.86; 95% CI 0.75-0.99; p = 0.04). CONCLUSION NOACs are effective and safe for ischemic stroke, systemic embolic events, myocardial infarction, intracranial bleeding, and gastrointestinal bleeding in AF patients with VHD/N-VHD.
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Affiliation(s)
- Arga Setyo Adji
- Faculty of Medicine, Hang Tuah University, Surabaya, East Java, Indonesia.
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