Comparison of Frequency of Atrial Fibrillation in Blacks Versus Whites and the Utilization of Race in a Novel Risk Score

Incidence and Clinical Management of Supraventricular Arrhythmias in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia

BACKGROUND

Smaller studies suggest supraventricular arrhythmias (SVAs) are common in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT).

OBJECTIVES

This study aimed to determine the incidence, type, and clinical management of SVAs observed within a large, single-center cohort of CPVT cases.

METHODS

The electronic medical records of 206 patients (51% female; average age at diagnosis 21 ± 17 years) diagnosed clinically with CPVT between January 2000 and September 2023 were reviewed for electrocardiographic evidence of SVAs, including atrial fibrillation (AF), atrial flutter (AFL), atrial tachycardia (AT), and supraventricular tachycardia. SVAs were considered clinically significant when sustained for >30 seconds, with or without symptoms, ultimately necessitating clinical evaluation. SVA type, symptoms, and therapeutic efficacy were assessed.

RESULTS

Overall, 17 (8.3%) of 206 patients had evidence of an SVA (AF/AFL in 8, AT in 9, and supraventricular tachycardia in 1 [1 patient experienced both AT and AF/AFL]). The median age at SVA diagnosis was 28 years (Q1-Q3: 16-34 years). A total of 11 (65%) of 17 patients were symptomatic, 3 (27%) of whom experienced inappropriate shocks. All patients were trialed on antiarrhythmics. Owing to drug failure, intolerance, or patient/provider preference; 5 (29%) of 17 patients with SVAs underwent radiofrequency ablation. Notably, over a median follow-up duration of 11 months (Q1-Q3: 5-45 months), 1 SVA recurrence was observed in a patient treated medically.

CONCLUSIONS

In comparison with prior studies, the incidence of SVAs in this large, single-center CPVT cohort was substantially lower (8.3% vs 26%-35%). Although a larger multicenter study is needed to confirm, this study suggests that radiofrequency ablation durably treats CPVT-associated SVAs.

Comparison of diagnostic accuracy of electrocardiogram-based versus photoplethysmography-based smartwatches for atrial fibrillation detection: A Systematic Review and Meta-Analysis

Background

Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, significantly affects morbidity and mortality, making early detection crucial for preventing stroke and heart failure. Recent advancements in wearable technology have introduced smartwatches as potential tools for continuous non-invasive AF detection.

Objective

This systematic review and meta-analysis aimed to evaluate and compare the diagnostic accuracy of electrocardiography (ECG)-and photoplethysmography (PPG)-based smartwatches in detecting AF.

Methodology

A comprehensive search was conducted on PubMed, Google Scholar, and other databases from 18 August to 23 September 2024, to fetch original studies that evaluated performance metrics of ECG and PPG smartwatches in AF detection. The obtained literature was screened according to preset inclusion and exclusion criteria. For included studies, the random-effects model was used to calculate their pooled sensitivity and specificity in AF detection using Jamovi 2.3.28 software. A significance threshold of P <0.05 was applied to all statistical analyses.

Results

Out of the 2564 studies screened, 25 met the inclusion criteria: 11 on PPG and 14 on ECG smartwatches. PPG smartwatches exhibited higher diagnostic performance with a pooled sensitivity of 97.4% (95% CI: 96.5-98.3) and specificity of 96.6% (95% CI: 94.9-98.3). Conversely, ECG smartwatches showed a pooled sensitivity of 83% (95% CI: 78-88) and specificity of 88.4% (95% CI: 84.5-92.2), lower than PPG smartwatches.

Conclusion

PPG-based smartwatches outperformed ECG-based devices in AF detection, offering higher sensitivity and specificity. Even though both modalities are effective in AF detection, the considerable variability in ECG smartwatch performance highlights the need for further research and standardization.

Atrial fibrillation: pathophysiology, genetic and epigenetic mechanisms

Atrial fibrillation (AF) is the most common supraventricular arrhythmia affecting up to 1% of the general population. Its prevalence dramatically increases with age and could reach up to ∼10% in the elderly. The management of AF is a complex issue that is object of extensive ongoing basic and clinical research, it depends on its genetic and epigenetic causes, and it varies considerably geographically and also according to the ethnicity. Mechanistically, over the last decade, Genome Wide Association Studies have uncovered over 100 genetic loci associated with AF, and have shown that European ancestry is associated with elevated risk of AF. These AF-associated loci revolve around different types of disturbances, including inflammation, electrical abnormalities, and structural remodeling. Moreover, the discovery of epigenetic regulatory mechanisms, involving non-coding RNAs, DNA methylation and histone modification, has allowed unravelling what modifications reshape the processes leading to arrhythmias. Our review provides a current state of the field regarding the identification and functional characterization of AF-related genetic and epigenetic regulatory networks, including ethnic differences. We discuss clear and emerging connections between genetic regulation and pathophysiological mechanisms of AF.

Antiarrhythmic drugs for atrial fibrillation in the outpatient setting

With burgeoning evidence for early rhythm control in patients with atrial fibrillation (AF), the management of AF in the outpatient setting has become more challenging. The primary care clinician often serves as the frontline in the pharmacologic management of AF. Because of drug interactions and the risk of proarrhythmia, many clinicians remain hesitant about the initiation and chronic management of antiarrhythmic drug prescriptions. However, with the likely increased use of antiarrhythmics for early rhythm control, understanding and familiarity with these medications have likewise become more important, especially since patients with AF probably have other non-cardiac medical conditions that can impact their antiarrhythmic therapy. In this comprehensive review, we provide informative, high-yield cases and edifying references that will help primary care providers become comfortable handling various clinical scenarios.

Changes in Controllable Coronary Artery Bypass Grafting Practice for White and Black Americans

BACKGROUND

Racial disparities in outcomes after cardiac surgery are well reported. We sought to determine whether variation by race exists in controllable practices during coronary artery bypass graft surgery (CABG). We hypothesized that racial disparities exist in CABG quality metrics, but have improved over time.

METHODS

All patients undergoing isolated CABG (2000 to 2019) in a multiple state database were stratified into three eras by race. Analysis included propensity matched White Americans and Black Americans. Primary outcomes included left internal mammary artery use, multiple arterial grafting, revascularization completeness, and guideline-directed medication prescription.

RESULTS

Of 72 248 patients undergoing CABG, Black American patients (n = 10 270, 15%) had higher rates of diabetes mellitus, hypertension, prior stroke, and myocardial infarction. After matching, 19 806 patients (n = 9903 per group) were well balanced. Left internal mammary artery use was significantly different early (era 1, Black Americans 84.7% vs White Americans 86.6%; P = .03), but equalized over time. Importantly, multiarterial grafting differed between Black Americans and White Americans over the entire study (9.1% vs 11.5%, P < .001) and within each era. Black Americans had more incomplete revascularization during the study period (14% vs 12.8%, P = .02) driven by a large disparity in era 1 (9.5% vs 7.2%, P < .001). Despite similar rates of preoperative use, Black Americans were more often discharged on a regimen of β-blockers (91.8% vs 89.6%, P < .001).

CONCLUSIONS

Coronary artery bypass graft surgery metrics of left internal mammary artery use and optimal medical therapy have improved over time and are similar despite patient race. Black Americans undergo less frequent multiarterial grafting and greater discharge β-blocker prescription. Identifying changes in controllable CABG quality practices across races supports a continued focus on standardizing such efforts.

Ethnic and Racial Disparities in Resource Utilization and In-hospital Outcomes Among Those Admitted for Atrial Fibrillation: A National Analysis

INTRODUCTION

Disparities in overall outcomes for atrial fibrillation (AF) across racial and ethnic groups have been demonstrated in prior studies. We aim to evaluate in-hospital outcomes and resource utilization across three racial/ethnic groups with AF using contemporary data.

METHODS

We identified patients admitted with AF in the National Inpatient Sample registry from 2015 to 2018. ICD-10-CM codes were used to identify variables of interest. The primary outcomes were in-hospital complications and resource utilization.

RESULTS

There were 1,250,075 AF admissions. Our sample was made up of 85.49% White, 8.12% Black, and 6.38% Hispanic patients. Black patients were younger but had a higher burden of cardiovascular comorbidities including obesity, hypertension, and chronic kidney disease. Social determinants were also less favorable in Black patients, with a higher percentage of Medicaid insurance and a high proportion of patients being in the lowest percentile for household income. Total hospital charge was highest in Hispanic patients. Despite higher rates of gastrointestinal bleed, Black patients were least likely to undergo left atrial appendage occlusion device implantation. Black and Hispanic patients were less like to undergo catheter ablation therapy. Black race was an independent predictor of mortality, stroke, mechanical ventilation, acute kidney injury, hemodynamic shock, need for vasopressor, upper GI bleed, need for blood transfusion, total hospital charges, and length of stay when compared to other groups.

CONCLUSION

Disparities exist in the risk of AF, and its management among racial and ethnic groups. Health care costs and inpatient outcomes disproportionately impact minorities in the United States.

Incidence and risk factors of atrial fibrillation and atrial arrhythmias in people living with HIV: a systematic review and meta-analysis

BACKGROUND

Cardiovascular diseases in people living with HIV (PLWH) are becoming increasingly relevant as HIV/AIDS has become more treatable with the advent of highly efficacious antiretroviral therapy. Previous studies suggested that HIV infection is an independent risk factor for atrial arrhythmia. This study aims to collectively analyze these studies to elucidate the incidence and risk factors of atrial arrhythmia in PLWH.

METHODS

Full-text assessments and data extraction were performed from available literature. Atrial arrhythmia was defined as atrial fibrillation or atrial flutter. Incidence rate, risk, and potential risk factors of atrial arrhythmia in PLWH were catalogued, after which random-effects models were used to estimate pooled summary statistics. PRISMA standardized meta-analysis guidelines were followed.

RESULTS

Analysis of 94,928 PLWH had an averaged incidence rate of 6.4 cases of atrial arrhythmia per 1000 person-years. Risk of atrial arrhythmia was significantly higher in PLWH than in the general population (RR 1.35; 95% CI 1.19-1.53). Sex had no association with the risk of incidental atrial arrhythmia in PLWH (RR 1.47; 95% CI 0.95-2.28). Black race (RR 0.68; 95% CI 0.47-0.97) was associated with decreased risk, whereas lower CD4 counts (RR 1.80; 95% CI 1.18-2.77) and increased viral load (RR 1.57; 95% CI 1.19-2.09) suggested increased risk of atrial arrhythmia in PLWH.

CONCLUSIONS

HIV infection is a risk factor of atrial arrhythmia. Providers should be aware of the increased burden of atrial arrhythmia in PLWH and continue to encourage treatment of HIV infection while managing cardiovascular risk factors and screening for arrhythmias in symptomatic patients.

Catheter ablation versus medical therapy for atrial fibrillation: Penny-wise Pound-foolish

Catheter ablation for atrial fibrillation has emerged as a mainstay for the management of atrial fibrillation. It has been shown to be clinically effective and cost-effective in multiple trials.

Racial and Ethnic Differences in the Management of Atrial Fibrillation

Atrial fibrillation (AF) is the most common clinical arrhythmia, and it results in adverse outcomes and increased healthcare costs. Racial and ethnic differences in AF management, although recognized, are poorly understood. This review summarizes racial differences in AF epidemiology, genetics, clinical presentation, and management. In addition, it highlights the underrepresentation of racial and ethnic populations in AF clinical trials, especially trials focused on stroke prevention. Specific strategies are proposed for future research and initiatives that have potential to eliminate racial and ethnic differences in the care of patients with AF. Addressing racial and ethnic disparities in healthcare access, enrollment in clinical trials, resource allocation, prevention, and management will likely narrow the gaps in the care and outcomes of racial and ethnic minorities suffering from AF.