1
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Segan L, Canovas R, Nanayakkara S, Chieng D, Prabhu S, Ling LH, Voskoboinik A, Sugumar H, Lee G, Morton J, Kalman J, Kistler P. Development and validation of the HARMS2-AF lifestyle risk score to predict incident AF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lifestyle risk factors (RFs) are a modifiable target in atrial fibrillation (AF) management. However, the relative contribution of individual lifestyle RFs to AF incidence has not been described.
Purpose
Development and validation of a novel AF-lifestyle risk score to determine AF risk in the general population.
Methods
The UK Biobank (UKB) is a large prospective cohort with outcomes measured >10 years. In the UKB, we performed regression analysis of AF lifestyle RFs which were then evaluated in a multivariable model and a weighted score was developed. Next, the risk score was externally validated in the Framingham Heart Study (FHS) population. Kaplan-Meier estimates ascertained the 10-year risk of AF development.
Results
In the UKB, AF incidence was 5.3% among 302,926 participants, with a median time to AF 7.3 years (IQR 4.3–9.8). Hypertension, sleep apnoea, male sex, age, obesity (BMI>30 kg/m2), alcohol and smoking were predictive variables (all p<0.001); physical inactivity (OR 1.02,95% CI 0.97–1.10, p=0.3), diabetes (OR 0.98,95% CI 0.91–1.06, p=0.2) and BMI 27–30 kg/m2 (OR 1.02, 95% CI 0.97–1.07, p=0.424) were not significant. The HARMS2-AF score (Figure 1) had similar predictive performance (AUC=0.782, LogLoss 0.178, Brier Score 0.046) to the unweighted regression model (AUC 0.808) in the UKB. Validation in the FHS (AF incidence 6.7% of 7206 participants) maintained excellent predictive performance with an AUC of 0.747 (95% CI 0.724–0.769, Figure 2). A higher HARMS2-AF score (>5 points) was associated with a heightened 10-year AF risk (score 5–9: OR 9.35, score 10–14: OR 33.34).
Conclusions
The HARMS2-AF score is a novel lifestyle risk score which may help identify individuals at risk of AF and assists in general population screening.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Segan
- The Alfred Hospital , Melbourne , Australia
| | - R Canovas
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | | | - D Chieng
- The Alfred Hospital , Melbourne , Australia
| | - S Prabhu
- The Alfred Hospital , Melbourne , Australia
| | - L H Ling
- The Alfred Hospital , Melbourne , Australia
| | | | - H Sugumar
- The Alfred Hospital , Melbourne , Australia
| | - G Lee
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - J Morton
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - J Kalman
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - P Kistler
- The Alfred Hospital , Melbourne , Australia
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2
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Segan L, Nanayakkara S, Spear E, Shirwaiker A, Chieng D, Sugumar H, Ling LH, Prabhu S, Lee G, Morton J, Kalman J, Voskoboinik A, Kistler P. Clinical risk prediction for left atrial appendage thrombus among patients with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Exclusion of left atrial appendage thrombus (LAAT) by transoesophageal echocardiography (TOE) is recommended in patients with inadequate anticoagulation prior to direct cardioversion (DCR) or catheter ablation for atrial fibrillation/flutter (AF/AFL). LAAT risk factors in this population remain poorly defined.
Purpose
Determine LAAT predictors in AF/AFL patients undergoing pre-procedural TOE.
Methods
We evaluated available clinical and transthoracic echocardiographic (TTE) parameters in AF/AFL patients undergoing TOE between 1999–2022 in our institution in Melbourne, Australia. Regression analysis identified predictors of LAAT, which were applied to a weighted score developed in the derivation cohort (70%) and validated in the remaining 30%.
Results
Of 627 patients (age 62±12 years, 27% female, AF 84%,AFL 16%, left ventricular ejection fraction (LVEF) 44±20%), 24% had LAAT and 13.8% dense spontaneous echo contrast precluding DCR. Anticoagulation was NOAC 56.5%, warfarin 32.1% and none in 11.4%. In the LAAT cohort, thrombus resolution occurred in 39% on serial transoesophageal imaging with a median time to resolution of 131 days (IQR 54–398).
Diabetes (p=0.004), prior stroke (p=0.009), coronary disease (p=0.015), renal impairment (p<0.001) and CHADS2VASc >2 (73% vs. 55%, p<0.001) were higher in the LAAT cohort. Age (p=0.093), gender (p=0.689), BMI (p=0.828), anticoagulant type (p=0.316) and diabetes (p=0.107) were not univariate predictors, whereas anticoagulation duration (<30 days), creatinine and TTE markers of remodeling (LVEF, LAVI, RVSP and TAPSE) were independent predictors on univariate and multivariate regression; CHADS2VASc was not significant after adjustment (p=0.090). The weighted risk model included continuous (age, creatinine, LVEF, LAVI, TAPSE and RVSP) and categorical (anticoagulation duration) variables with excellent predictive performance: AUC 0.872 (95% CI 0.798–0.946), PPV 91%, NPV 70% and accuracy 80%.
Conclusion
A novel LAAT risk model comprising clinical and echocardiographic parameters enhances risk prediction over CHADS2VASc in AF/AFL and may guide the need for pre-procedural TOE imaging.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Segan
- The Alfred Hospital , Melbourne , Australia
| | | | - E Spear
- Monash Health, General Medicine , Melbourne , Australia
| | | | - D Chieng
- The Alfred Hospital , Melbourne , Australia
| | - H Sugumar
- The Alfred Hospital , Melbourne , Australia
| | - L H Ling
- The Alfred Hospital , Melbourne , Australia
| | - S Prabhu
- The Alfred Hospital , Melbourne , Australia
| | - G Lee
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - J Morton
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - J Kalman
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | | | - P Kistler
- The Alfred Hospital , Melbourne , Australia
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3
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De Bosscher R, Janssens K, Dausin C, Goetschalckx K, Bogaert J, Ghekiere O, Van De Heyning C, Elliott A, Sanders P, Kalman J, Herbots L, Willems R, Heidbuchel H, La Gerche A, Claessen G. The prevalence and clinical significance of a reduced ventricular ejection fraction in asymptomatic young elite endurance athletes. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council of Australia
Background
Ventricular ejection fraction (EF) is the most widely used parameter to evaluate ventricular systolic function. Endurance athletes presenting with a reduced ventricular EF often raise the question of an underlying dilated or arrhythmogenic cardiomyopathy. The clinical significance of a reduced EF in athletes remains to be elucidated.
Purpose
To investigate the prevalence and clinical significance of a reduced EF in asymptomatic endurance athletes.
Methods
Two hundred eighteen asymptomatic young elite endurance athletes were evaluated at baseline. Cardiac magnetic resonance imaging (CMR) was performed to assess cardiac volumes, left ventricular and right ventricular EF (LVEF and RVEF), mass and fibrosis. Athletes with reduced EF (ATrEF) were defined as those having LVEF<50% and/or RVEF<45%. Ventricular systolic and diastolic function were assessed by trans-thoracic echocardiography. A 12-lead ECG and 24-hour holtermonitoring assessed electrical alterations and arrhythmias. In 145 athletes, LV and RV contractile reserve was evaluated by exercise CMR. Cardiopulmonary testing was performed in all athletes to measure maximal oxygen uptake (VO2max).
Results
Thirty-one ATrEF (14.2%) were compared to 187 athletes with a preserved EF (ATpEF). ATrEF were more frequently males (93 vs 77% male, p=0.033) but did not differ from ATpEF with regard to age (18.8±2.1 vs 18.3±2.1 years, p=0.25). Ten athletes had an isolated reduced LVEF, 10 had an isolated reduced RVEF and 11 had both a reduced LVEF and RVEF. ATrEF had similar end-diastolic volumes and cardiac mass but differed by higher end-systolic volumes.
Peak exercise LVEF and RVEF determined by exercise CMR remained lower in ATrEF (68±3 vs 73±4% and 62±6 vs 69±5%, p<0.001) but contractile reserve was greater (ΔLVEF 18±5 vs 14±4% and ΔRVEF 19±5 vs 15±5%, p<0.01).
A reduced EF was not associated with lower exercise capacity, in fact VO2max was higher in ATrEF than in ATpEF (65±6 vs 62±9mL/kg/min, p=0.020) and the percentage of predicted VO2max by the Wasserman equation were similar (151±14 vs 149±21%, p=0.533).
Fibrosis was present in 3 ATrEF and 18 ATpEF (9.7 vs 9.6%, p=0.993) and was isolated to the RV hinge-points in all but 3 ATpEF who had midmyocardial LV lateral wall fibrosis. LV systolic strain (-17.5±2.0 vs -19±2.1%, p<0.001) was lower in ATrEF whereas RV free wall systolic strain (-24.9±3.7 vs -25.1±3.5%, p=0.776) was similar. Diastolic function was normal in all ATrEF and ATpEF. Pathologic T-wave inversions were present in 2 ATrEF and 13 ATpEF (6.5 vs 7%, p=0.999). Ventricular premature beats (VPB) were infrequent but more prevalent in ATrEF than in ATpEF (2[0-18] vs 1[0-2]/24h, p=0.025; 16.1 vs 2.7% >100/24h, p=0.006).
Conclusion
A reduced ventricular EF is common in asymptomatic young elite endurance athletes, is more frequent in males but is not associated with structural, functional or electrical abnormalities apart from a minor excess in VPB.
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Affiliation(s)
- R De Bosscher
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - K Janssens
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - C Dausin
- University of Leuven, Movement Sciences, Leuven, Belgium
| | - K Goetschalckx
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - J Bogaert
- University Hospitals (UZ) Leuven, Radiology, Leuven, Belgium
| | - O Ghekiere
- Virga Jesse Hospital, Radiology, Hasselt, Belgium
| | | | - A Elliott
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - P Sanders
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - J Kalman
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - L Herbots
- Virga Jesse Hospital, Cardiology, Hasselt, Belgium
| | - R Willems
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - H Heidbuchel
- University Hospital Antwerp, Cardiology, Antwerp, Belgium
| | - A La Gerche
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - G Claessen
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
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4
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Al-Kaisey A, Parameswaran R, Anderson R, Chieng D, Hawson J, Voskoboinik A, Sugumar H, Wong G, West D, Azzopardi S, Joseph S, McLellan A, Ling L, Bryant C, Finch S, Sanders P, Lee G, Kistler P, Kalman J. Randomised Evaluation of the Impact of Catheter Ablation on Cognitive Function in Atrial Fibrillation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Segan L, Chieng D, Lee G, Sugumar H, Voskoboinik A, Ling L, Morton J, Kalman J, Kistler P, Prabhu S. The Impact of Atrial Scarring on AF Recurrence and LV Recovery in AF-Mediated Cardiomyopathy. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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6
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Al-Kaisey A, Wong G, Young P, Hawson J, Chieng D, Bakshi A, Lacaze P, Giannoulatou E, Kistler P, Fatkin D, Kalman J. Polygenic Risk Scores Identify Atrial Electrophysiological Substrate Abnormalities and Predict Atrial Fibrillation Recurrence Following Catheter Ablation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Chieng D, Segan L, Sugumar H, Al-Kaisey A, Hawson J, Moore B, Nam M, Voskoboinik A, Prabhu S, Ling L, Ng J, Brown G, Lee G, Morton J, Debinski H, Kalman J, Kistler P. High Power Short Duration (HPSD) is Safe and Improves Outcomes for Atrial Fibrillation Ablation vs Lower Power Longer Duration (LPLD): A Prospective Multi-Centre Randomised Controlled Study (Hi-Lo HEAT trial). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Chieng D, Canovas R, Segan L, Sugumar H, Voskoboinik A, Prabhu S, Ling L, Lee G, Morton J, Kaye D, Kalman J, Kistler P. Effects of Habitual Coffee Consumption on Incident Cardiovascular Disease, Arrhythmia, and Mortality: Long Term Outcomes From the UK Biobank. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Chieng D, Kistler P, Canovas R, Kaye D, Morton J, Lee G, Ling L, Prabhu S, Voskoboinik A, Sugumar H, Segan L, Kalman J. Regular Coffee Intake Is Safe and Associated With Improved Mortality in Prevalent Cardiovascular Disease and /or Arrhythmia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Segan L, Canovas R, Nanayakkara S, Chieng D, Prabhu S, Sugumar H, Voskoboinik A, Ling L, Morton J, Lee G, Kalman J, Kistler P. Development and Validation of the HARMS2-AF Lifestyle Risk Score to Predict Incident AF. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Chieng D, Sugumar H, Segan L, Tan C, Vizi D, Al-Kaisey A, Hawson J, Prabhu S, Voskoboinik A, Morton J, Lee G, Mariani J, Le Gerche A, Kistler P, Kalman J, Kaye D, Ling L. Catheter Ablation in Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction Improves Peak Pulmonary Capillary Wedge Pressure, Exercise Capacity and Quality of Life. A Prospective Randomised Controlled Trial (RCT-STALL HFpEF). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Segan L, Canovas R, Nanayakkara S, Chieng D, Prabhu S, Ling L, Voskoboinik A, Sugumar H, Lee G, Morton J, Kalman J, Kistler P. Development of an AF Lifestyle Score for Risk Prediction in Incident AF. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Yao J, Ward-Ambler E, Wong J, Kalman J. Polymorphic Ventricular Tachycardia Following Valsalva Manoeuvre Used to Terminate Supraventricular Tachycardia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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14
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Block T, Paratz E, La Gerche A, Stub D, Strathmore N, Mond H, Kistler P, Kalman J, Burke M, Voskoboinik A. Unearthing the evidence: post-mortem interrogation of cardiac implantable electronic devices. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The diagnostic yield of post-mortem interrogation of cardiac implantable electronic devices (CIEDs) including pacemakers, defibrillators and implantable loop recorders has not been well described.
Methods
We reviewed all post-mortem CIED interrogations performed by our statewide Institute of Forensic Medicine between 2005–2020 for investigation of sudden or unexplained death.
Results
260 patients (68.8% male, median age 72.8 years [IQR 62.7–82.2]) underwent post-mortem CIED interrogation (202 pacemakers, 56 defibrillators and 2 loop recorders). CIEDs were implanted for a median of 2.0 [IQR 0.75–5] years, with 19 devices requiring replacement (and 5 end of life). Post-mortem interrogation was successful in 256 (98.5%) cases. Potential CIED malfunction was identified in 21 (8.1%) cases: untreated ventricular arrhythmias (n=13), lead failures (n=3) and battery depletion (n=5). CIED interrogation directly informed cause of death in 130 (50.0%) cases, with fatal ventricular arrhythmias identified in 121 patients (46.5%). In retrospect, 72 (27.7%) patients had abnormalities recorded by their device in the 30 days preceding death: non-sustained ventricular tachycardia (n=26), rapid atrial fibrillation (n=17), longevity concerns (n=22), intrathoracic impedance alarms (n=3), lead issues (n=3) or therapy delivered (n=1). In 6 cases where the patient was found deceased after a prolonged time, CIED interrogation accurately determined time of death. In one case, CIED interrogation was the primary method of patient identification.
Conclusion
Post-mortem CIED interrogation frequently contributes important information regarding critical device malfunction, pre-mortem abnormalities, cause and time of death or patient identity. Device interrogation should be considered for select patients with CIEDs undergoing autopsy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Block
- Austin Hospital, Melbourne, Australia
| | - E Paratz
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Melbourne, Australia
| | | | - H Mond
- Royal Melbourne Hospital, Melbourne, Australia
| | - P Kistler
- The Alfred Hospital, Melbourne, Australia
| | - J Kalman
- Royal Melbourne Hospital, Melbourne, Australia
| | - M Burke
- Victorian Institute of Forensic Medicine, Melbourne, Australia
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15
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Rybińska-Fryca A, Gromelski M, Vijver M, Peijnenburg W, Châtel A, Barrick A, Manier N, Kalman J, Navas J, Jagiełło K, Puzyn T. How do the existing read-across frameworks work for nanomaterials? Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Moran T, Lammoza N, Ratnakanthan P, Fogarty S, Langenberg F, Mose S, Upton A, Kalman J, Joshi S. Coronary Ct Angiography Pre Pulmonary Vein Isolation - Incidental Coronary Disease. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Yao J, Soon H, Wong J, Fogarty S, Aggarwal A, Lee G, Kalman J, McLellan A. An Atypical Presentation of Takotsubo Cardiomyopathy Causing Torsades de Pointes. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Xiao X, Joseph S, Mariani J, Kalman J, Kistler P, Voskoboinik A. Predictors of Subsequent Pacemaker Requirement in Patients with Loop Recorders Inserted for Syncope. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Block T, Paratz E, La Gerche A, Stub D, Strathmore N, Mond H, Kistler P, Kalman J, Burke M, Voskoboinik A. Unearthing the Evidence: Post-Mortem Interrogation of Cardiac Implantable Electronic Devices. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Al-kaisey A, Parameswaran R, Anderson R, Hawson J, Chieng D, Sugumar H, Nam M, Tonchev I, Watts T, McLellan A, Kistler P, Lee G, Kalman J. Left and Right Atrial Septal Phase Mapping of Persistent Atrial Fibrillation: Marked Electrical Dissociation and Heterogeneous Activation Patterns. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Kistler P, Chieng D, Tonchev I, Sugumar H, McLellan A, Prabhu S, Voskoboinik A, Schwartz L, Parameswaran R, Anderson R, Al-Kaisey A, Ling L, Lee G, Kalman J. P-wave Morphology in Focal Atrial Tachycardia: An Updated 2021 Algorithm to Predict Site of Origin. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Flannery D, Sully F, Janssens K, Kalman J, La Gerche A. Mechanisms of Bradycardia in Athletes: A Case–Control, Blinded, Randomised, Crossover Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Chieng D, Sugumar H, Kaye D, Azzopardi S, Vizi D, Rossi E, Voskoboinik A, Prabhu S, Ling L, Lee G, Kalman J, Kistler P. Prone and Supine 12 Lead Electrocardiography Comparisons: Utility of the Prone ECG for the Detection of Cardiac Conditions in Patients Requiring Prone Ventilation with COVID-19. Heart Lung Circ 2021. [PMCID: PMC8324102 DOI: 10.1016/j.hlc.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Peters S, Thompson B, Perrin M, James P, Zentner D, Kalman J, Fatkin D. Arrhythmias are a Requisite Feature of SCN5A Mediated Dilated Cardiomyopathy: A Systematic Review of Variants. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Sugumar H, Nanayakkara S, Vizi D, Chieng D, Leet A, Mariani J, Taylor A, Kalman J, Kistler P, Ling L. Impact of catheter ablation on HFpEF in people with comorbid atrial fibrillation and HFpEF using invasive haemodynamic testing. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The impact of catheter ablation (CA) for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) is unknown.
Objectives
To determine whether CA for AF reverses adverse haemodynamic changes associated with HFpEF.
Methods
Consecutive consenting patients with EF ≥50% scheduled for index CA underwent baseline exercise right heart catheterisation (exRHC), cardiac output (CO) measurement, cardiac MRI, echocardiogram, QOL questionnaires and BNP testing. HFpEF was defined by resting pulmonary capillary wedge pressure (PCWP) ≥15mmHg or peak exercise PCWP ≥25 mmHg during exRHC. Patients with HFpEF were offered follow-up exRHC ≥6 months post-CA.
Results
Of 252 patients scheduled for CA between April 2017 and Sept 2019, 131 (51.9%) qualified for inclusion, 65 (49.6%) consented to exRHC and 11 (16.9%) were excluded due to a subsequent decrease in EF (10) and uncontrolled hypertension (1). Fifty-four underwent exRHC, with 35 (65%) meeting criteria for HFpEF. Of them 26 (74.3%) who underwent CA, 20 (77%) had a follow up exRHC at 12±6 months follow-up, showing an overall decrease in peak exercise PCWP from 30.3±4.2 to 26.8±4.7 mmHg (p<0.05). Patients without arrhythmia recurrence showed significant improvements in peak exercise PCWP (29.2±3.7 to 22.9±2.0 mmHg (p<0.01). Their cardiac output increased from 10.3±3.0 to 12.1±4.0 mmHg p=0.1), and BNP decreased from (94.6±101.6 to 38.0±34.0 mmHg (p=0.06),whereas those with arrhythmia recurrence did not. Overall, 9 patients (45.0%) no longer met criteria for HFpEF.
Conclusion
There is a high prevalence of HFpEF in people referred for AF ablation. Successful CA for AF reverses the adverse haemodynamic changes associated with HFpEF
Changes in PCWP following AF ablation
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NHMRC, NHF, RACP
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Affiliation(s)
- H Sugumar
- The Alfred Hospital, Melbourne, Australia
| | | | - D Vizi
- The Alfred Hospital, Melbourne, Australia
| | - D Chieng
- The Alfred Hospital, Melbourne, Australia
| | - A Leet
- The Alfred Hospital, Melbourne, Australia
| | - J Mariani
- The Alfred Hospital, Melbourne, Australia
| | - A Taylor
- The Alfred Hospital, Melbourne, Australia
| | - J Kalman
- The Alfred Hospital, Melbourne, Australia
| | - P Kistler
- The Alfred Hospital, Melbourne, Australia
| | - L Ling
- The Alfred Hospital, Melbourne, Australia
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De Bosscher R, Claeys M, Dausin C, Goetschalckx K, Bogaert J, Van De Heyning C, Ghekiere O, Herbots L, Claus P, Kalman J, Sanders P, Elliott A, Heidbuchel H, La Gerche A, Claessen G. Hinge point fibrosis in athletes is not associated with structural, functional or electrical consequences: a comparison between young and middle-aged elite endurance athletes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The health benefits of extensive endurance training have been debated due to the report of myocardial fibrosis (MF), arrhythmias and temporary post-race cardiac impairment in middle-aged and veteran athletes. The extent of these changes is unknown in elite young athletes.
Purpose
To assess the prevalence of MF and its structural, functional and electrical impact in highly trained young endurance athletes (YA, 15–23 years) as compared to middle-aged athletes (MA, 30–50 years). We hypothesised that MF would be more frequent in MA and associated with more structural, functional and electrical abnormalities.
Methods
We prospectively assessed 197 YA and 34 MA. All had ECG, maximal oxygen consumption (VO2max) testing, cardiac magnetic resonance imaging (CMR), echocardiography and 24h-holter. Indexed left ventricular and right ventricular end diastolic volume (LVEDVi, RVEDVi), ejection fraction (LVEF, RVEF), left ventricular mass (LVMi), and MF defined as delayed gadolinium enhancement were assessed by CMR. LV and RV free wall strain (LVSL, RVfwSL) were assessed by 2D speckle tracking echocardiography. Ventricular premature beats (VPB) and non-sustained ventricular tachycardia (nsVT) were assessed by 24h-holter.
Results
YA and MA (18±2 vs 38±5 years [p<0.01]; 78% vs 80% male [p=0.99]) with an elite level of fitness (VO2max 61±8 vs 54±10 mL/min/kg [p<0.01]; % predicted VO2max 150±20 vs 158±30 [p=0.02]) had a large variance in LV and RV remodelling (Figure 1). MF was seen in 28 athletes (12.5%) and more prevalent in MA than in YA (23.5 vs 10.5%, p=0.048). MF was limited to the hinge points in all 8 MA with MF and 17 YA. 3 YA had LV lateral wall subepicardial MF. 27 of 187 (14.4%) male athletes had MF compared to 1 of 50 (2%) female athletes (p=0.01).
MF+ MA(A) and YA(B) as well as MF− MA(C) and YA(D) had similar structural remodelling (LVEDVi 110±14 vs 118±14 vs 113±19 vs 110±16 mL/m2; RVEDVi 120±14 vs 128±17 vs 117±19 vs 125±23mL/m2; LVMi 77±11 vs 83±14 vs 81±14 vs 77±15g/m2, p>0.05). LVEF, LVSL and RVSL were similar (59±3 vs 58±5 vs 61±6 vs 58±6%; −18.8±2 vs −18.8±2 vs −19.8±2 vs −19.3±2%; −26.3±2.4 vs −24.4±2.4; −26.3±3 vs −25.8±3.5% respectively, p>0.05). LVEF <50% was seen in 19 (8.2%) athletes (0 [0%] vs [5%] 1 vs 1 [3.8%] vs 17 [9.6%]; p=0.51). RVEF was higher in D compared to C without further differences between groups (54±4 vs 54±6 vs 53±6 vs 57±5, p=0.005). RVEF<45% was seen 21 (9.1%) athletes (0 [0%] vs 1 [5%] vs 0 [0%] vs 20 [11.3%]; p=0.14). Abnormal T-wave inversion was similar (12.5 vs 5 vs 7.4 vs 6.2%, p=0.93) as was the prevalence of >100VPB/24h (12.5 vs 5 vs 11.1 vs 5.1%, p=0.42). 2 athletes had nsVT, both in D. All had similar exercise capacity (% predicted VO2max 157±26 vs 152±15 vs 147±24 vs 158±32%; p=0.11).
Conclusion
Hinge-point fibrosis was more prevalent in MA, possibly due to repeated hemodynamic stress during exercise, but is not associated with structural, functional or electrical consequences.
Figure 1. Cardiac remodelling in elite athletes
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fonds voor Wetenschappelijk Onderzoek (FWO)
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Affiliation(s)
- R De Bosscher
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - M Claeys
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | | | - K Goetschalckx
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - J Bogaert
- University Hospitals (UZ) Leuven, Radiology, Leuven, Belgium
| | | | - O Ghekiere
- Virga Jesse Hospital, Radiology, Hasselt, Belgium
| | - L Herbots
- Virga Jesse Hospital, Cardiology, Hasselt, Belgium
| | | | - J Kalman
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - P Sanders
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - A Elliott
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - H Heidbuchel
- University Hospital Antwerp, Cardiology, Antwerp, Belgium
| | - A La Gerche
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - G Claessen
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
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Nalliah C, Wong G, Lee G, Voskoboinik A, Kee K, Goldin J, Watts T, Linz D, Parameswaren R, Sugumar H, Prabhu S, McLellan A, Ling H, Joseph S, Morton J, Kistler P, Sanders P, Kalman J. 005 Impact of Continuous Positive Airway Pressure on the Atrial Substrate in Patients With Obstructive Sleep Apnoea and Atrial Fibrillation: The SLEEP-AF Substrate Sub-Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Kistler P, Chieng D, Sugumar H, Prabhu S, Voskoboinik A, McLellan A, Ling H, Lee G, Kalman J. 241 P Wave Morphology in Focal Atrial Tachycardia: An Updated 2020 Algorithm to Predict site of Origin. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Anderson R, Kumar S, Binny S, Joshi S, Prabhu M, Sparks P, Joseph S, Morton J, McLellan A, Kistler P, Kalman J, Lee G. 236 Modified High Precordial Lead R-Wave Deflection Interval Accurately Predicts Left and Right-Sided Idiopathic Outflow Tract Ventricular Arrhythmias. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Wong G, Nalliah C, Lee G, Voskoboinik A, Prabhu S, Parameswaran R, Sugumar H, Anderson R, Al-Kaisey A, McLellan A, Ling L, Sanders P, Kistler P, Kalman J. 029 Gender Differences in Atrial Remodelling in Atrial Fibrillation: Relationship to Ablation Outcomes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Wong G, Nalliah C, Lee G, Voskoboinik A, Prabhu S, Parameswaran R, Sugumar H, Al-Kaisey A, Anderson R, McLellan A, Ling L, Morris G, Sanders P, Kistler P, Kalman J. 255 Sinus Node Remodelling in Atrial Fibrillation: Insights from High Density Mapping. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Abstract
Abstract
Background
It is well known that athletes and in particular endurance athletes have lower resting heart rates than non-athletes. This has generally been considered a healthy adaptation. Traditionally this was thought be due to increased vagal tone. Several studies have shown that endurance athletes continue to have lower heart rates in the absence of autonomic influence suggesting bradycardia is due to intrinsic changes within the heart. A subset of endurance athletes have very low heart rates with Tour de France cyclists having described heart rates in the 30s. It is unclear whether in these elite athletes with very low heart rates the profound bradycardia is due to autonomic influence or intrinsic changes within the heart.
Aim
The aim of this study was to determine if extreme bradycardia in athletes is due to excess vagal tone or more profound intrinsic changes within the heart.
Methods
We recruited three cohorts for this study: non-athlete controls (NA), endurance athletes with a documented resting heart rate >40 (EA) and endurance athletes with a resting heart rate <40 (BA). All participants underwent baseline testing including ECG, echocardiography and VO2 max testing. All participants came back on a second occasion for treatment with dual autonomic blockade (DAB) to determine intrinsic heart rate in the following manner. After resting supine for five minutes resting heart rate was measured. Participants were then administered 0.04mg/kg of intravenous atropine. After five minutes participants were then administered 0.05mg/kg of intravenous metoprolol. This was repeated every five minutes until there was no further drop in heart rate or 0.2mg/kg had been administered. The resting heart rate at this stage was recorded as the intrinsic heart rate. Parasympathetic blockade was confirmed by lack of response to Valsalva manoeuvre and sympathetic blockade was confirmed by lack of response to metoprolol. VO2 max testing was then performed to determine maximum heart rate.
Results
9 NA (7 male), 10 EA (8 male) and 5 BA (4 male) participated in this study. The average age was similar in all groups (NA 32.9y, EA 32.4y, BA 31.4y). The average resting heart rate was 71.7 in the NA group, 48.3 in the EA group and 41.6 in the BA group (p<0.05 for comparisons between all three groups). Following dual autonomic blockade resting heart rate was 86.0 in the NA group, 76.9 in the EA group and 64.4 in the BA group (p<0.05 for comparisons between all three groups). Maximum heart rate under DAB was 140.1 in the NA group, 138.0 in the EA group and 140.4 in the BA group. These differences were not significant.
Conclusion
In athletes with very low heart rates, bradycardia is due to more profound intrinsic changes within the heart.
Acknowledgement/Funding
NHMRC Project Grant
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Affiliation(s)
- M D Flannery
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - F Sully
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - K Janssens
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - G Morris
- University of Manchester, Manchester, United Kingdom
| | - J Kalman
- Royal Melbourne Hospital, Melbourne, Australia
| | - A La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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33
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Linz D, Nalliah C, Baumert M, Kadhim K, Middeldorp M, Elliott A, Lau D, McEvoy D, Kalman J, Sanders P. P661Nocturnal hypoxemic burden in ambulatory patients with atrial fibrillation: a disease-orientated assessment of sleep-disordered breathing severity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Studies investigating the relationship between sleep-disordered breathing (SDB) and atrial fibrillation (AF) have largely assessed SDB-severity by the apnea–hypopnea index (AHI). However, the AHI does not incorporate nocturnal hypoxemic burden, which may increase the risk of non-paroxysmal AF (nPAF) as the clinical manifestation of more progressed AF substrates. This investigation sought to systematically characterize and compare the composition of AHI and hypoxemic burden with the aim to defining a disease-orientated metric for SDB-severity best associated with prevalent nPAF.
Methods
Polysomnography including overnight oximetry data were obtained in 435 consecutive ambulatory AF patients to determine the composition of AHI (apneas vs. hypopneas), the number of acute episodic desaturations per hour (oxygen desaturation index, ODI) and the composition of total time spent below 90% oxygen saturation (T90Total) attributed to acute desaturations (T90Desaturation). Logistic regression analysis was used to characterize the association with prevalent nPAF.
Results
One hundred sixty-nine AF patients (38%) had nPAF and one third (n=149, 34%) had moderate-to-severe SDB (AHI>15). 82% of the median total AHI (9.4 [3.6–20.1]) could be attributed to hypopneas. Only 29% of events were associated with episodic desaturations, which contributed to 96% (T90Desaturation) of the variation in T90Total. The high variability in durations and nadirs of distinct desaturation events can expose patients to long T90Total, even if the AHI is low. Not AHI, but T90Total and ODI were associated with nPAF independent of gender and age. However, diabetes, hypertension and body mass index contributed more significantly to the overall risk of nPAF.
Conclusions
In AF patients, hypopneas constitute a majority of respiratory events during sleep. Patients with low AHI can still be exposed to high nocturnal hypoxemic burden, which is mainly a cumulative consequence of episodic desaturations. T90Total and ODI, but not AHI, were associated with nPAF independent of gender and age, but concomitant modifiable risk factors made a more significant contribution to the overall risk of nPAF versus PAF.
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Affiliation(s)
- D Linz
- University of Adelaide, Adelaide, Australia
| | - C Nalliah
- Royal Melbourne Hospital, Royal Melbourne Hospital, Melbourne, Australia
| | - M Baumert
- University of Adelaide, Adelaide, Australia
| | - K Kadhim
- University of Adelaide, Adelaide, Australia
| | | | - A Elliott
- University of Adelaide, Adelaide, Australia
| | - D Lau
- University of Adelaide, Adelaide, Australia
| | - D McEvoy
- University of Adelaide, Adelaide, Australia
| | - J Kalman
- Royal Melbourne Hospital, Royal Melbourne Hospital, Melbourne, Australia
| | - P Sanders
- Royal Melbourne Hospital, Royal Melbourne Hospital, Melbourne, Australia
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34
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Voskoboinik A, Kalman J, Nicholls T, Nanayakkara S, Wong G, Prabhu S, Nalliah C, Sugumar H, Stub D, Kaye D, Wong M, Kotschet E, Taylor A, Kistler P. Alcohol Abstinence in Moderate Drinkers with Atrial Fibrillation: Results from the Alcohol-AF Randomised Controlled Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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MacPherson M, Sajeev J, Wong G, Kalman J, Dewey H, Koshy A, Roberts L, Cooke J, Teh A. An Elevated P Wave Terminal Force V1 is not Associated with Worsening Atrial Electroanatomic Substrate. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Binny S, Nalliah C, Joshi S, Lui E, Bui J, Kistler P, Kalman J. Regional Epicardial Adipose Tissue (EAT) Analysis as a Better Predictor of Localised Cardiac Pathology than Total Epicardial Adipose Tissue Volume. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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37
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Nalliah C, James B, Sanders P, Binny S, Watts T, Lui E, Joshi S, Larobina M, O’Keefe M, Goldblatt J, Royse A, Kistler P, Delbridge L, Kalman J. Epicardial Adipose Tissue and the Substrate for Atrial Fibrillation: Radiological, Electrophysiological, Histological and Molecular Characterisation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Wong G, Nalliah C, Voskoboinik A, Lee G, Prabhu S, Sugumar H, Parameswaran R, Anderson R, McLellan A, Ling L, Morton J, Johnson R, Kistler P, Fatkin D, Kalman J. Genetic Susceptibility to Atrial Fibrillation at the chr 4q25 Locus is Associated with Left Atrial Electrical Remodelling. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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39
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Sajeev J, Burrell L, Dewey H, Kalman J, Chou B, Frost T, Patel S, Roberts L, Cooke J, Koshy A, Gould M, Ngoh J, Denver R, Teh A. Elevated Plasma Angiotensin Converting Enzyme 2 (ACE2) Activity is Associated with Embolic Stroke of Undetermined Source. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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40
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Nalliah C, Baumert M, Kadhim K, Middeldorp M, Elliott A, Lau D, Mahajan R, Wong C, McEvoy D, Kalman J, Sanders P, Linz D. Nocturnal Hypoxemic Burden in Ambulatory Patients with Atrial Fibrillation: a Disease-Orientated Assessment of Sleep-Disordered Breathing Severity. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Anderson R, Kumar S, Parameswaran R, Wong G, Voskoboinik A, Sugumar H, Watts T, Sparks P, Morton J, McLellan A, Kistler P, Kalman J, Lee G. Differentiating Right- and Left-Sided Outflow Tract Ventricular Arrhythmias – A Review of “Classical” ECG Signatures and Prediction Algorithms. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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42
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Anderson R, Lee G, Watts T, Trivic I, Kalman J, Kumar S. Clinical Significance of Focal Ventricular Tachycardias (VT) Remote or Adjacent to Scar in Patients with Structural Heart Disease: Procedural Characteristics and Clinical outcomes. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Binny S, Joshi S, Lui E, Nalliah C, Bui J, Kalman J. Surrogate Measurements to Simplify Regional Epicardial Adipose Tissue (EAT) Analysis. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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44
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Wong G, Nalliah C, Voskoboinik A, Parameswaran R, Prabhu S, Pathik B, Sugumar H, Anderson R, Ling L, Lee G, Morton J, Kistler P, Kalman J. Gender-Based Differences in High-Density Electroanatomic Mapping: More Advanced Atrial Remodelling in Females with Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Wong G, Nalliah C, Voskoboinik A, Parameswaran R, Prabhu S, Pathik B, Sugumar H, Anderson R, Ling L, Lee G, Morton J, Kistler P, Sanders P, Kalman J. Greater Regional Left Atrial Complex Fractionated Potentials in Obese Patients with Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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46
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Wong G, Nalliah C, Voskoboinik A, Parameswaran R, Prabhu S, Pathik B, Sugumar H, Ling L, Anderson R, Lee G, Morton J, Kistler P, Kalman J. Incremental Pacing Identifies Target Atrial Substrate in Paroxysmal and Persistent Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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47
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Voskoboinik A, Costello B, Kalman E, Prabhu S, Sugumar H, Ling L, Wong G, Nalliah C, Mclellan A, Laerche A G, Taylor A, Kalman J, Kistler P. Regular Alcohol Consumption is Associated with Impaired Atrial Mechanical Function in the Atrial Fibrillation Population: A Prospective Magnetic Resonance Imaging-Based Study. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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Nalliah C, Wong G, Parameswaran R, Voskoboinik A, Wirth D, Pathik B, Prabhu S, Morton J, Goldin J, Lee G, Kee K, Ling H, McLellan A, Joseph S, Kistler P, Sanders P, Kalman J. High-Density Mapping of the Substrate for Atrial Fibrillation in Obstructive Sleep Apnoea: Implications for the Crista Terminalis and Posterior Right Atrium. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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49
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Nalliah C, Wong G, Parameswaran R, Voskoboinik A, Pathik B, Prabhu S, Morton J, Lee G, Joseph S, Ling H, McLellan A, Kistler P, Sanders P, Kalman J. The Crista Terminalis: A Site of Localised Re-Entry in Persistent Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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Emami M, Kadhim K, Linz D, Mishima R, Thiyagarajah A, Munawar D, Khokhar K, Kutieleh R, Lee G, Kalman J, Mahajan R, Lau D, Sanders P. Posterior Left Atrium and Pulmonary Veins Demonstrate the Characteristics of the Substrate in Longstanding Persistent Atrial Fibrillation: Insights from High-Density Mapping. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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