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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:ehae176. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Rao MS, Mullasari A, Hiremath JS, Sengottuvelu G, Jaiswal A, Jhala D, Makkar JS, Kalmath BC, Benjamin B, Dharmadhikari A, Tanna M, Khan A, Jain S, Sambasivam KA, Purnanand A, Raju NSR, Sarkar G, Prajapati H, Verberk WJ. Prevalence of atrial fibrillation on a 24-hour Holter in adult Indians. Indian Heart J 2024; 76:218-220. [PMID: 38878964 PMCID: PMC11328999 DOI: 10.1016/j.ihj.2024.06.012] [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: 03/15/2024] [Revised: 05/31/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To evaluate paroxysmal atrial fibrillation (AF) prevalence in Indian adults who completed 24-Hour Holter monitoring. METHODS A total of 23,847 patients (36.9 % women) were analyzed for AF duration using a software algorithm. RESULTS AF was diagnosed in 4153 (17.4 %) patients with a median AF duration of 13 min and 55 s. CONCLUSION AF prevalence was high and largely untreated. The short duration of AF episodes indicates a low likelihood of detection during clinical visits, highlighting its potential underestimation in Indian healthcare.
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Affiliation(s)
| | | | | | | | | | | | | | - B C Kalmath
- Bombay Hospital Institute of Medical Science & Jupiter Hospital and Horizon Group of Hospital, Thane, Maharashtra, India
| | - Bino Benjamin
- Jubilee Mission Medical College & Research Centre, Thrissur, Kerala, India
| | | | | | - Aziz Khan
- Crescent Hospital & Heart Centre, Nagpur, Maharashtra, India
| | | | | | - A Purnanand
- Purna Heart Institute, Vijayawada, Andhra Pradesh, India
| | | | | | - Hiren Prajapati
- Department of Medical Affairs, Eris Lifesciences Ltd., Ahmedabad, Gujarat, India
| | - Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
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3
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Kell DB, Lip GYH, Pretorius E. Fibrinaloid Microclots and Atrial Fibrillation. Biomedicines 2024; 12:891. [PMID: 38672245 PMCID: PMC11048249 DOI: 10.3390/biomedicines12040891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is a comorbidity of a variety of other chronic, inflammatory diseases for which fibrinaloid microclots are a known accompaniment (and in some cases, a cause, with a mechanistic basis). Clots are, of course, a well-known consequence of atrial fibrillation. We here ask the question whether the fibrinaloid microclots seen in plasma or serum may in fact also be a cause of (or contributor to) the development of AF. We consider known 'risk factors' for AF, and in particular, exogenous stimuli such as infection and air pollution by particulates, both of which are known to cause AF. The external accompaniments of both bacterial (lipopolysaccharide and lipoteichoic acids) and viral (SARS-CoV-2 spike protein) infections are known to stimulate fibrinaloid microclots when added in vitro, and fibrinaloid microclots, as with other amyloid proteins, can be cytotoxic, both by inducing hypoxia/reperfusion and by other means. Strokes and thromboembolisms are also common consequences of AF. Consequently, taking a systems approach, we review the considerable evidence in detail, which leads us to suggest that it is likely that microclots may well have an aetiological role in the development of AF. This has significant mechanistic and therapeutic implications.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Søltofts Plads, Building 220, 2800 Kongens Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool L7 8TX, UK;
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Etheresia Pretorius
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
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Katsiki N, Kolovou G, Melidonis A, Banach M. The Cardiac-Kidney-Liver (CKL) syndrome: the "real entity" of type 2 diabetes mellitus. Arch Med Sci 2024; 20:207-215. [PMID: 38414467 PMCID: PMC10895975 DOI: 10.5114/aoms/183070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/29/2024] Open
Affiliation(s)
- Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Genovefa Kolovou
- Cardiometabolic Center, Lipid Clinic, LA Apheresis Unit, Metropolitan Hospital, Athens, Greece
| | | | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
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Yu D, Qu B, Osuagwu UL, Pickering K, Baker J, Cutfield R, Cai Y, Orr‐Walker BJ, Sundborn G, Zhao Z, Simmons D. Association Between Onset of Type 2 Diabetes and Risk of Atrial Fibrillation in New Zealanders With Impaired Glucose Tolerance Over 25 Years. J Am Heart Assoc 2023; 12:e030159. [PMID: 37702092 PMCID: PMC10547295 DOI: 10.1161/jaha.123.030159] [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: 06/05/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023]
Abstract
Background The association between the onset of type 2 diabetes (T2D) and atrial fibrillation (AF) risk in individuals with impaired glucose tolerance (IGT) remains unclear. This study aimed to investigate the relationship between the incident onset of T2D and 5- and 10-year (after the landmark period) risks of AF in people with IGT identified in South and West Auckland primary care settings between 1994 and 2019. Methods and Results We compared AF risk in patients with IGT with and without newly diagnosed T2D within a 1- to 5-year exposure window. Tapered matching and landmark analysis (to address immortal bias) were used to control for confounding variables. The cohorts incorporated 785 patients who had T2D newly diagnosed within 5 years from enrollment (landmark date) and 15 079 patients without a T2D diagnosis. Patients progressing to T2D exhibited significantly higher 5-year (after the landmark period) AF risk (hazard ratio [HR], 1.34 [95% CI, 1.10-1.63]) and 10-year (after the landmark period) AF risk (HR, 1.28 [95% CI, 1.02-1.62]) compared with those without incident T2D. The association was more pronounced among men, older patients, socioeconomically deprived individuals, current smokers, those with higher metabolic measures, and lower renal function. New Zealand European ethnicity was associated with a lower 5- and 10-year risk of AF. Conclusions This study found a mediating effect of T2D on the risk of AF in a population with IGT in New Zealand. The development of risk scores and future replication studies can help identify and guide management of individuals with IGT at the highest risk of AF following incident T2D.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
- Primary Care Centre Versus Arthritis, School of MedicineKeele UniversityKeeleUnited Kingdom
| | - Bingjie Qu
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI)Western Sydney University, CampbelltownSydneyAustralia
- School of MedicineWestern Sydney University, CampbelltownSydneyAustralia
| | | | - John Baker
- Diabetes Foundation AotearoaOtaraNew Zealand
- Department of Diabetes and EndocrinologyCounties Manukau HealthAucklandNew Zealand
| | - Richard Cutfield
- Diabetes Foundation AotearoaOtaraNew Zealand
- Department of Diabetes and EndocrinologyWaitemata District Health BoardAucklandNew Zealand
| | - Yamei Cai
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
| | - Brandon J. Orr‐Walker
- Diabetes Foundation AotearoaOtaraNew Zealand
- Department of Diabetes and EndocrinologyCounties Manukau HealthAucklandNew Zealand
| | - Gerhard Sundborn
- Section of Pacific HealthThe University of AucklandAucklandNew Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
| | - David Simmons
- Department of Nephrology, The First Affiliated HospitalZhengzhou UniversityZhengzhouChina
- Translational Health Research Institute (THRI)Western Sydney University, CampbelltownSydneyAustralia
- School of MedicineWestern Sydney University, CampbelltownSydneyAustralia
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Mohsin M, Zeyad H, Khalid H, Gapizov A, Bibi R, Kamani YG, Rashid A, Shams M, Khalid F, Khan S, Waqas M, Ishfaq A, Kebede AH, Subhan M. The Synergistic Relationship Between Atrial Fibrillation and Diabetes Mellitus: Implications for Cardiovascular and Metabolic Health. Cureus 2023; 15:e45881. [PMID: 37885547 PMCID: PMC10599207 DOI: 10.7759/cureus.45881] [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] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF) are widespread chronic conditions that profoundly impact public health. While the intricate mechanisms linking these two diseases remain incompletely understood, this review sets out to comprehensively analyze the current evidence about their pathophysiology, epidemiology, diagnosis, prognosis, and treatment. We reveal that T2DM can influence the electrical and structural properties of the atria through multiple pathways, including oxidative stress, inflammation, fibrosis, connexin remodeling, glycemic variability, and autonomic dysfunction. Moreover, it significantly influences AF's clinical course, elevating the risk of heart failure, stroke, and cardiovascular mortality. Our review also explores treatment options for individuals with T2DM and AF, encompassing antidiabetic and antiarrhythmic drugs and non-pharmacological interventions, such as cardioversion catheter ablation and direct current cardioversion. This review depicts an insight into the clinical interplay between T2DM and AF. It deepens our comprehension of the fundamental mechanisms, potential therapeutic interventions, and their implications for patient care. This comprehensive resource benefits researchers seeking to deepen their knowledge in this domain. Ultimately, our findings pave the way for more effective strategies in managing AF within the context of T2DM.
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Affiliation(s)
- Maryam Mohsin
- Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - Hafiz Zeyad
- Medicine and Surgery, Services Institute of Medical Science (SIMS), Lahore, PAK
- Medicine and Surgery, Services Hospital Lahore, Lahore, PAK
- Cardiac Surgery, Punjab Institute of Cardiology (PIC), Lahore, PAK
| | - Hareem Khalid
- Medical School, Lahore Medical and Dental College, Lahore, PAK
| | - Abubakar Gapizov
- General Surgery, American University of Antigua, St. John's, ATG
| | - Ruqiya Bibi
- Medicine and Surgery, Jinnah Hospital, Lahore, PAK
- Medical College, Allama Iqbal Medical College, Lahore, PAK
| | | | - Ahmed Rashid
- General Practice, Yangtze University, Jingzhou, CHN
| | | | - Faizan Khalid
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Syeda Khan
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
- Internal Medicine, Iqra Medical Center and Maternity Home, Karachi, PAK
| | - Muhammad Waqas
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | | | - Muhammad Subhan
- Internal Medicine, Allama Iqbal Medical College, Jinnah Hospital, Lahore, PAK
- Medicine and Surgery, Al Barkat Health Care and Collection Centre, Lahore, PAK
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7
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Li W, Wang Y, Zhong G. Glycemic variability and the risk of atrial fibrillation: a meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1126581. [PMID: 37274320 PMCID: PMC10232736 DOI: 10.3389/fendo.2023.1126581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/22/2023] [Indexed: 06/06/2023] Open
Abstract
Background Glycemic variability (GV) has been associated with vascular complications in patients with diabetes. However, the relationship between GV and risk of atrial fibrillation (AF) remains not fully determined. We therefore conducted a systematic review and meta-analysis to evaluate the above association. Methods Medline, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure were searched for longitudinal follow-up studies comparing the incidence of AF between patients with higher versus lower GV. A random-effects model incorporating the potential heterogeneity was used to pool the results. Results Nine cohort studies with 6,877,661 participants were included, and 36,784 (0.53%) participants developed AF during follow-up. Pooled results showed that a high GV was associated with an increased risk of AF (risk ratio [RR]: 1.20, 95% confidence interval [CI]: 1.11 to 1.30, p < 0.001, I2 = 20%). Subgroup analyses suggested consistent association between GV and AF in prospective (RR: 1.29, 95% CI: 1.05 to 1.59, p = 0.01) and retrospective studies (RR: 1.18, 95% CI: 1.08 to 1.29, p = 0.002), in diabetic (RR: 1.24, 95% CI: 1.03 to 1.50, p = 0.03) and non-diabetic subjects (RR: 1.13, 95% CI: 1.00 to 1.28, p = 0.05), in studies with short-term (RR: 1.25, 95% CI: 1.11 to 1.40, p < 0.001) and long-term GV (RR: 1.18, 95% CI: 1.05 to 1.34, p = 0.006), and in studies with different quality scores (p for subgroup difference all > 0.05). Conclusion A high GV may predict an increased risk of AF in adult population.
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Scheen AJ. Antidiabetic agents and risk of atrial fibrillation/flutter: A comparative critical analysis with a focus on differences between SGLT2 inhibitors and GLP-1 receptor agonists. DIABETES & METABOLISM 2022; 48:101390. [DOI: 10.1016/j.diabet.2022.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 04/11/2023]
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Yildiz M, Lavie CJ, Morin DP, Oktay AA. The complex interplay between diabetes mellitus and atrial fibrillation. Expert Rev Cardiovasc Ther 2022; 20:707-717. [PMID: 35984314 DOI: 10.1080/14779072.2022.2115357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
INTRODUCTION : A growing body of evidence suggests that diabetes mellitus (DM) is associated with an increased risk of new-onset atrial fibrillation (AF) and contributes to suboptimal arrhythmia control and poor prognosis in patients with AF. The high prevalence of AF among patients with DM is primarily attributed to common risk factors, shared pathophysiological mechanisms, and associated atrial remodeling and autonomic dysfunction. AREAS COVERED : This comprehensive review covers the current data on the role of DM in the development and prognosis of AF. In addition, we review the impact of anti-DM medications on AF prevention and the role of anticoagulation in patients with coexisting DM and AF. EXPERT OPINION : DM is independently associated with new-onset AF, and the coexistence of these two conditions contributes to poor outcomes, from reduced quality of life to increased risks of thromboembolic events, heart failure, and mortality. Despite this strong link, the current evidence is insufficient to recommend routine screening for AF in patients with DM. Although some observations exist on preventing AF with anti-DM medications, randomized controlled trials are warranted to explore the proposed benefits of novel anti-DM medicines in reducing the risk of incident AF.
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Affiliation(s)
- Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Ahmet Afsin Oktay
- The Heart and Vascular Institute, Rush University Medical Center, Chicago, IL
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Papazoglou AS, Kartas A, Moysidis DV, Tsagkaris C, Papadakos SP, Bekiaridou A, Samaras A, Karagiannidis E, Papadakis M, Giannakoulas G. Glycemic control and atrial fibrillation: an intricate relationship, yet under investigation. Cardiovasc Diabetol 2022; 21:39. [PMID: 35287684 PMCID: PMC8922816 DOI: 10.1186/s12933-022-01473-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 12/26/2022] Open
Abstract
Atrial fibrillation (AF) and diabetes mellitus (DM) constitute two major closely inter-related chronic cardiovascular disorders whose concurrent prevalence rates are steadily increasing. Although, the pathogenic mechanisms behind the AF and DM comorbidity are still vague, it is now clear that DM precipitates AF occurrence. DM also affects the clinical course of established AF; it is associated with significant increase in the incidence of stroke, AF recurrence, and cardiovascular mortality. The impact of DM on AF management and prognosis has been adequately investigated. However, evidence on the relative impact of glycemic control using glycated hemoglobin levels is scarce. This review assesses up-to-date literature on the association between DM and AF. It also highlights the usefulness of glycated hemoglobin measurement for the prediction of AF and AF-related adverse events. Additionally, this review evaluates current anti-hyperglycemic treatment in the context of AF, and discusses AF-related decision-making in comorbid DM. Finally, it quotes significant remaining questions and sets some future strategies with the potential to effectively deal with this prevalent comorbidity.
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Affiliation(s)
- Andreas S Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.,Athens Naval Hospital, Athens, Greece
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | | | - Stavros P Papadakos
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Bekiaridou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Athanasios Samaras
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - Marios Papadakis
- University Hospital Witten-Herdecke, University of Witten-Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany.
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
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