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Kłosiewicz T, Cholerzyńska H, Zasada WA, Shadi A, Olszewski J, Konieczka P, Podlewski R, Puślecki M. Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications-3 Years of a Single-Center Experience. J Clin Med 2023; 13:190. [PMID: 38202197 PMCID: PMC10779744 DOI: 10.3390/jcm13010190] [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: 10/27/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia presenting in emergency departments (EDs), vastly increasing mainly due to society's lifestyles leading to numerous comorbidities. Its management depends on many factors and is still not unified. Aims: The aim of this study was to compare different AF management strategies in the ED and to evaluate their influence on the length of stay (LOS) in the ED and their safety. We analyzed medical records over 3 years of data collection, including age, primary AF diagnosis, an attempt to restore sinus rhythm, complications, and length of stay. Patients were divided into three groups according to the treatment method received: only pharmacological cardioversion (MED), only electrical cardioversion (EC), and patients who received medications followed by electrical cardioversion (COMB). We included 599 individuals in the analysis with a median age of 71. The restoration of sinus rhythm and LOS were as follows: MED: 64.95%, 173 min; COMB: 87.91%, 295 min; SH: 92.40%, 180 min. The difference between the MED and EC strategies, as well as MED and COMB, was statistically significant (p < 0.001 in both). The total number of complications was 16, with a rate of 32.67%. The majority of them followed a drug administration, and the most common complication was bradycardia. Electrical cardioversion is a safe and effective treatment strategy in stable patients with AF in the ED. It is associated with a shortened LOS. Medication administration preceded the majority of complications.
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Affiliation(s)
- Tomasz Kłosiewicz
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Hanna Cholerzyńska
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Wiktoria Antonina Zasada
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Amira Shadi
- College of Emergency Physicians in Poland, 5 Truflowa Street, 62-070 Dopiewiec, Poland; (A.S.); (J.O.)
| | - Jakub Olszewski
- College of Emergency Physicians in Poland, 5 Truflowa Street, 62-070 Dopiewiec, Poland; (A.S.); (J.O.)
| | - Patryk Konieczka
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Roland Podlewski
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Mateusz Puślecki
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
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Mariana Barros Melo da Silveira M, Victor Batista Cabral J, Tavares Xavier A, Palmeira do Ó K, Francisco de Moura Junior J, Tavares de Carvalho O, Bezerra Mendes Filho E, Furtado de Mendonça Belmont T, Maria Del Castillo J, Jesus Barreto de Melo Rêgo M, Richardson da Silva Vasconcelos L, Celestino Sobral Filho D, Cavalcanti de Oliveira D. The role of galectin-3 in patients with permanent and paroxysmal Atrial Fibrillation and echocardiographic parameters of left atrial fibrosis. Mol Biol Rep 2023; 50:9019-9027. [PMID: 37716919 DOI: 10.1007/s11033-023-08774-x] [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: 05/17/2023] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Biochemical markers and imaging tests have been used with the aim of stratifying the risk and detecting atrial fibrosis. Speckle-tracking echocardiography (STE) is used for the detection of atrial fibrosis and Gal-3 provides an important prognostic value. The objective of the study was to assess the association between atrial fibrosis markers and serum levels, genetic polymorphisms and genic expression of galectin-3. METHODS 206 patients with permanent AF and 70 patients with paroxysmal AF were included in the study. Real time PCR (TaqMan) system was used to study SNPs rs4652 and 4644 of the gene LGALS3. Serum levels of Gal-3 were determined by ELISA and STE was performed to assess fibrosis. RESULTS Mean age of individuals with permanent AF was 66.56 ± 12 years. As for the echocardiography results, those patients showed an decrease in the following parameters peak atrial longitudinal strain (PALS) (p = 0.002) when compared to the same parameters from the paroxysmal AF group of patients. There was a correlation between serum levels of Gal-3 and PALS in the group of patients with permanent AF; the lower the levels of gal-3, the lower the LA strain (r = 0.24; p = 0.01). CONCLUSIONS Echocardiographic findings showed association with the groups, and with serum levels of Gal-3 in patients with permanent AF. The distribution of allelic and genotypic frequencies, and of the haplotypes of polymorphism LGALS3 rs4652 and rs4644 did not present statistical variation, which suggests that those SNPs are not associated with the AF clinical forms (permanent and paroxysmal).
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Affiliation(s)
- Maria Mariana Barros Melo da Silveira
- Program in Therapeutic Innovation, Federal University of Pernambuco - PPGIT/UFPE, Recife, PE, Brazil.
- Pernambuco Cardiovascular Emergency Room Teacher Luiz Tavares - PROCAPE/UPE, Recife, PE, Brazil.
| | | | | | | | | | - Osmário Tavares de Carvalho
- Faculty of Medical Sciences, University of Pernambuco - FCM/UPE, Recife, PE, Brazil
- Pernambuco Cardiovascular Emergency Room Teacher Luiz Tavares - PROCAPE/UPE, Recife, PE, Brazil
| | | | | | | | | | | | - Dário Celestino Sobral Filho
- Faculty of Medical Sciences, University of Pernambuco - FCM/UPE, Recife, PE, Brazil
- Pernambuco Cardiovascular Emergency Room Teacher Luiz Tavares - PROCAPE/UPE, Recife, PE, Brazil
| | - Dinaldo Cavalcanti de Oliveira
- Program in Therapeutic Innovation, Federal University of Pernambuco - PPGIT/UFPE, Recife, PE, Brazil
- Pernambuco Cardiovascular Emergency Room Teacher Luiz Tavares - PROCAPE/UPE, Recife, PE, Brazil
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Lobo HM, Naves ÍG, Marçal SB, Canzi CC, Rodrigues ABS, Menezes Jr AS. Atrial Fibrillation in Endurance Training Athletes: Scoping Review. Rev Cardiovasc Med 2023; 24:155. [PMID: 39077536 PMCID: PMC11264108 DOI: 10.31083/j.rcm2406155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 07/31/2024] Open
Abstract
Background Moderate regular physical activity is indicated to avoid atrial fibrillation (AF), whereas athletes should be counseled that long-lasting vigorous sports engagement may cause AF, according to the 2016 European Society of Cardiology (ESC) recommendations for AF treatment. Exercise and AF are complex. Objectives To evaluate the relationship between Endurance training and AF, in addition to the starting point/trigger by which Endurance Training causes impairment of cardiac function and AF, considering the time and intensity of Endurance training. Materials and Methods We synthesized evidence from articles published in the PubMed, EMBASE, and SciELO databases using their respective Boolean operators. A total of 112 original articles related to AF and endurance athletes published up to the year 2023 were reviewed. Results Our study verified multiples aspects of the genesis of AF in athletes, such as cardiac adaptations to exercise, disturbances in cardiac injury biomarkers, sex differences in cardiac adaptations and their role in AF risk, and the relationship between body composition (height, weight, and physical fitness) and AF pathogenesis. Conclusions Variations in cardiac structure (increased atrial thickness and size in addition to myocardial fibrosis) and significant increases in vagal tone (sinus bradycardia and imbalances in sympathetic and parasympathetic activation) shorten the refractory period shortening in athletes, induce the onset of re-entrance mechanisms, and serve as ectopic triggers that can lead to AF.
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Affiliation(s)
- Henrique M. Lobo
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | - Ícaro G. Naves
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | - Silvia Botelho Marçal
- Internal Medicine Department, Medicine Faculty, Federal University of Goiás, 74690-900 Goiânia, Goiás, Brazil
| | - Camila Cassia Canzi
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | | | - Antonio S. Menezes Jr
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
- Internal Medicine Department, Medicine Faculty, Federal University of Goiás, 74690-900 Goiânia, Goiás, Brazil
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Circulating MicroRNAs as Specific Biomarkers in Atrial Fibrillation: A Meta-Analysis. Noncoding RNA 2023; 9:ncrna9010013. [PMID: 36827546 PMCID: PMC9967089 DOI: 10.3390/ncrna9010013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Atrial fibrillation (AF) is the most frequently occurring supraventricular arrhythmia. Although microRNAs (miRNAs) have been associated with AF pathogenesis, standard protocols for quantifying and selecting specific miRNAs for clinical use as biomarkers should be optimized. In this study, we evaluated the clinical application of miRNAs as biomarkers for the prognosis and diagnosis of AF. Literature searches were conducted on PubMed, Cochrane Library, and EMBASE. We included prospective or retrospective observational studies that had been published as of 14 February 2022; our main objective was to analyze the relationship between circulating miRNAs and AF. The data were extracted using the descriptors "Atrial fibrillation AND miRNA", "Atrial fibrillation AND diagnostic AND miRNA", and "Atrial fibrillation AND prognosis AND miRNA". No filters were applied for period delimitation, type of publication, or language. Studies using samples isolated from blood plasma and TaqMan and RT-qPCR for detecting and quantifying miRNAs were selected, and those that used atrial tissue samples were excluded. We identified 272 articles and excluded 102 duplicated articles. Two authors independently read the titles and abstracts of 170 out of 272 articles and selected 56 potential articles, 6 of which were selected for final review. Our analysis revealed a significant association between AF and miR-4798 [OR = 1.90 (95% CI 1.45-2.47)], AF and miRNA-133a [2.77 (2.73-2.82)], AF and miRNA-150 [3.77 (1.50-9.46); I2 = 70%], AF and miRNA-21 [2.23 (1.20-4.17); I2 = 99%], AF and hsa-miRNA4443 [2.32 (2.20-2.44)], and AF and miR-20a-5p [3.67 (1.42-9.49)]. The association between miRNAs and AF showed an OR of 2.51 [95% CI 1.99-3.16; I2 = 99%]. Our meta-analysis demonstrated that circulating miRNAs are potential biomarkers of AF, as they exhibit stable expression post-sample collection. In addition to regulating cellular processes, such as proliferation, differentiation, development, and cell death, miRNAs were found to be linked to arrhythmia development.
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Mateo EIP. Role of the Autonomic Nervous System in Atrial Fibrillation. Arq Bras Cardiol 2021; 117:1008-1009. [PMID: 34817010 PMCID: PMC8682107 DOI: 10.36660/abc.20210771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fernandes VM, Rocha GRDA, Milet TC, Barreto DM, Santos JFDEM, Oliveira MM. Polysonographic changes in obese patients with indication of bariatric surgery. Rev Col Bras Cir 2021; 48:e20213030. [PMID: 34816882 PMCID: PMC10683421 DOI: 10.1590/0100-6991e-20213030] [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: 04/08/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION obstructive Sleep Apnea Syndrome (OSAS) is a serious confition that compromises the quality of life and survival of patients. Its main risk fator in adults is obesity and the gold standard test for diagnosis is polysomnography (PSG), mainly through the apneia-hypopnea index (AHI). Objective: to analyze the sleep pattern of obese patients with indication for bariatric surgery, determining the main polisomnographic parameters compromised by obesity. METHODS This work is a cross-sectional study with analysis of polysomnography perfomed in patients with obesity in the peroperative period of bariatric surgery at a clinic in Vitória da Conquista/BA during 2017. The Epi Info 7 platform was used for analysis of the data. RESULTS 58 polysomnographic reports were analyzed, with 56,9% morbdly obese and 43,1% non-morbid. The prevalence of OSAS was 70,68% and de AHI ranged from zero to 84,6 with a mean of 19,47±22,89 e/h. morbidly obese, compared to "non-morbid", had a longer saturation time below 80% and 90% (0,4±0,93 vs. 0,12±0,45 e 4,87±7,38 vs. 1,36±2,87 respectively; p-value=0,02 in both), worse index respiratory disorders ((29,24±25,36 vs. 16,88±16,21; p-value=0,02), higher AHI (24,71±25,68 vs. 12,56±16,67; p-value=0,02), higher hypopnea index values (16,41±17,10 vs. 6,99±8,52; p-value=0,006) and lower minimum saturation (78,24±9,80 vs. 85,24±6,33; p-value=0,004). CONCLUSIONS the high prevalence of OSAS found confirms its indication in the preoperative period of bariatric surgery. The main respiratory event involved in most individuals with OSAS was the hypopnea index.
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Affiliation(s)
- Victor Martins Fernandes
- - Universidade Estadual do Sudoeste da Bahia, Departamento de Ciências Naturais, Faculdade de Medicina - Vitória da Conquista - BA - Brasil
| | - Gibran Ribeiro DA Rocha
- - Universidade Estadual do Sudoeste da Bahia, Departamento de Ciências Naturais, Faculdade de Medicina - Vitória da Conquista - BA - Brasil
- - Hospital Geral de Vitória da Conquista, Cirurgia Geral - Vitória da Conquista - BA - Brasil
| | - Thiago Carvalho Milet
- - Hospital Geral de Vitória da Conquista, Cirurgia Geral - Vitória da Conquista - BA - Brasil
| | - Daniel Matos Barreto
- - Universidade Estadual do Sudoeste da Bahia, Departamento de Ciências Naturais, Faculdade de Medicina - Vitória da Conquista - BA - Brasil
| | | | - Monica Medrado Oliveira
- - Centro Especializado em Pneumologia e Distúrbios do Sono, Salvador - BA - Brasil
- - Núcleo de Tratamento e Cirurgia da Obesidade, Salvador - BA - Brasil
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