1
|
Boriani G, Gerra L, Mei DA, Bonini N, Vitolo M, Proietti M, Imberti JF. Detection of subclinical atrial fibrillation with cardiac implanted electronic devices: What decision making on anticoagulation after the NOAH and ARTESiA trials? Eur J Intern Med 2024; 123:37-41. [PMID: 38281819 DOI: 10.1016/j.ejim.2024.01.002] [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: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
Atrial fibrillation (AF) may be asymptomatic and the extensive monitoring capabilities of cardiac implantable electronic devices (CIEDs) revealed asymptomatic atrial tachi-arrhythmias of short duration (minutes-hours) occurring in patients with no prior history of AF and without AF detection at a conventional surface ECG. Both the terms "AHRE" (Atrial High-Rate Episodes) and subclinical AF were used in a series of prior studies, that evidenced the association with an increased risk of stroke. Two randomized controlled studies were planned in order to assess the risk-benefit profile of anticoagulation in patients with AHRE/subclinical AF: the NOAH and ARTESiA trials. The results of these two trials (6548 patients enrolled, overall) show that the risk of stroke/systemic embolism associated with AHRE/subclinical AF is in the range of 1-1.2 % per patient-year, but with an important proportion of severe/fatal strokes occurring in non-anticoagulated patients. The apparent discordance between ARTESiA and NOAH results may be approached by considering the related study-level meta-analysis, which highlights a consistent reduction of ischemic stroke with oral anticoagulants vs. aspirin/placebo (relative risk [RR] 0.68, 95 % CI 0.50-0.92). Oral anticoagulation was found to increase major bleeding (RR 1.62, 95 % CI 1.05-2.5), but no difference was found in fatal bleeding (RR 0.79, 95 % CI 0.37-1.69). Additionally, no difference was found in cardiovascular death or all-cause mortality. Taking into account these results, clinical decision-making for patients with AHRE/subclinical AF at risk of stroke, according to CHA2DS2-VASc, can now be evidence-based, considering the benefits and related risks of oral anticoagulants, to be shared with appropriately informed patients.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
| | - Luigi Gerra
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Davide A Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolo' Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Division of Subacute Care IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
2
|
AlTurki A, Essebag V. Atrial Fibrillation Burden: Impact on Stroke Risk and Beyond. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:536. [PMID: 38674182 PMCID: PMC11051719 DOI: 10.3390/medicina60040536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024]
Abstract
Atrial fibrillation (AF) is an important independent risk factor for stroke. Current guidelines handle AF as a binary entity with risk driven by the presence of clinical risk factors, which guides the decision to treat with an oral anticoagulant. Recent studies in the literature suggest a dose-response relationship between AF burden and stroke risk, in both clinical AF and subclinical atrial fibrillation (SCAF), which differs from current guidance to disregard burden and utilize clinical risk scores alone. Within clinical classification and at the same risk levels in various scores, the risk of stroke increases with AF burden. This opens the possibility of incorporating burden into risk profiles, which has already shown promise. Long-term rhythm monitoring is needed to elucidate SCAF in patients with stroke. Recent data from randomized trials are controversial regarding whether there is an independent risk from AF episodes with a duration of less than 24 h, including the duration of SCAF greater than six minutes but less than 24 h.
Collapse
Affiliation(s)
- Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, Montreal, QC H3G1A4, Canada
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya 13110, Kuwait
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, QC H3G1A4, Canada
- Division of Cardiology, Hopital Sacre-Coeur de Montreal, Montreal, QC H4J 1C5, Canada
| |
Collapse
|
3
|
Biffi M, Celentano E, Giammaria M, Curnis A, Rovaris G, Ziacchi M, Miracapillo G, Saporito D, Baroni M, Quartieri F, Marini M, Pepi P, Senatore G, Caravati F, Calvi V, Tomasi L, Nigro G, Bontempi L, Notarangelo F, Santobuono VE, Boggian G, Arena G, Solimene F, Giaccardi M, Maglia G, Perini AP, Volpicelli M, Giacopelli D, Gargaro A, Iacopino S. Device-detected atrial sensing amplitudes as a marker of increased risk for new onset and progression of atrial high-rate episodes. Heart Rhythm 2024:S1547-5271(24)00280-7. [PMID: 38493989 DOI: 10.1016/j.hrthm.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Atrial high-rate episodes (AHREs) are frequent in patients with cardiac implantable electronic devices. A decrease in device-detected P-wave amplitude may be an indicator of periods of increased risk of AHRE. OBJECTIVE The objective of this study was to assess the association between P-wave amplitude and AHRE incidence. METHODS Remote monitoring data from 2579 patients with no history of atrial fibrillation (23% pacemakers and 77% implantable cardioverter-defibrillators, of which 40% provided cardiac resynchronization therapy) were used to calculate the mean P-wave amplitude during 1 month after implantation. The association with AHRE incidence according to 4 strata of daily burden duration (≥15 minutes, ≥6 hours, ≥24 hours, ≥7 days) was investigated by adjusting the hazard ratio with the CHA2DS2-VASc score. RESULTS The adjusted hazard ratio for 1-mV lower mean P-wave amplitude during the first month increased from 1.10 (95% confidence interval [CI], 1.05-1.15; P < .001) to 1.18 (CI, 1.09-1.28; P < .001) with AHRE duration strata from ≥15 minutes to ≥7 days independent of the CHA2DS2-VASc score. Of 871 patients with AHREs, those with 1-month P-wave amplitude <2.45 mV had an adjusted hazard ratio of 1.51 (CI, 1.19-1.91; P = .001) for progression of AHREs from ≥15 minutes to ≥7 days compared with those with 1-month P-wave amplitude ≥2.45 mV. Device-detected P-wave amplitudes decreased linearly during the 1 year before the first AHRE by 7.3% (CI, 5.1%-9.5%; P < .001 vs patients without AHRE). CONCLUSION Device-detected P-wave amplitudes <2.45 mV were associated with an increased risk of AHRE onset and progression to persistent forms of AHRE independent of the patient's risk profile.
Collapse
Affiliation(s)
- Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
| | | | | | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | | | | | - Valeria Calvi
- Azienda O.U. Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Luca Tomasi
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | | | | | - Vincenzo Ezio Santobuono
- Dipartimento Interdisciplinare di Medicina (DIM)-Università degli Studi di Bari "Aldo Moro," Bari, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Svennberg E, Diederichsen SZ. Anticoagulation in device-detected atrial fibrillation: a long journey to find the sweet spot. Eur Heart J 2024; 45:850-852. [PMID: 38379436 DOI: 10.1093/eurheartj/ehae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Emma Svennberg
- Karolinska Institutet Department of Medicine Huddinge: Karolinska University Hospital, Stockholm 182 88, Sweden
| | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, 2100 Copenhagen, Denmark
| |
Collapse
|
5
|
Spartalis M, Kontogiannis C, Spartalis E, Iliopoulos DC, Siasos G. Anticoagulation in Patients with Atrial High-rate Episodes Detected by Cardiac Implantable Electronic Devices. Curr Pharm Des 2024; 30:485-488. [PMID: 38343055 DOI: 10.2174/0113816128291822240131063712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/22/2024] [Indexed: 05/18/2024]
Abstract
Atrial high-rate episodes (AHRE) are atrial tachyarrhythmias that are identified by the use of continuous rhythm monitoring devices such as pacemakers, defibrillators, or implantable cardiac monitors. Nevertheless, the therapeutic implications of these rhythm disturbances remain uncertain. The presence of AHRE is associated with an increased risk of stroke as compared to patients who do not exhibit AHRE. The utilisation of oral anticoagulation has the ability to mitigate the likelihood of stroke occurrence in patients with AHRE. However, it is important to note that this treatment approach is also linked to a severe bleeding rate of approximately 2% per year. The stroke rate among individuals diagnosed with AHRE appears to be comparatively lower when compared to patients diagnosed with atrial fibrillation. The efficacy and safety of anticoagulation in patients with AHRE have yet to be definitively established. Further research is required to provide a comprehensive understanding of the effectiveness and safety of oral anticoagulation in individuals with AHRE.
Collapse
Affiliation(s)
- Michael Spartalis
- 3rd Department of Cardiology, Sotiria Thoracic Diseases General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Kontogiannis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research 'N.S. Christeas', Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios C Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research 'N.S. Christeas', Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- 3 rd Department of Cardiology, Sotiria Thoracic Diseases General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
6
|
Okada JI, Washio T, Sugiura S, Hisada T. Transition mechanisms from atrial flutter to atrial fibrillation during anti-tachycardia pacing therapy. Pacing Clin Electrophysiol 2023; 46:1509-1518. [PMID: 37922381 DOI: 10.1111/pace.14863] [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: 07/31/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND Atrial anti-tachycardia pacing (aATP) has been shown to be effective for the termination of atrial tachyarrhythmias, but its success rate is still not high enough. OBJECTIVE The main objective of this study was to investigate the mechanisms of atrial flutter (AFL) termination by aATP and the transition from AFL to atrial fibrillation (AF) during aATP. METHODS We developed a multi-scale model of the human atrium based on magnetic resonance images and examined the atrial electrophysiology of AFL during aATP with a ramp protocol. RESULTS In successful cases of aATP, paced excitation entered the excitable gap and collided with the leading edge of the reentrant wave front. Furthermore, the excitation propagating in the opposite direction collided with the trailing edge of the reentrant wave to terminate AFL. The second collision was made possible by the distribution of the wave propagation velocity in the atria. The detailed analysis revealed that the slowing of propagation velocity occurred at the exit of the sub-Eustachian isthmus, probably due to source-sink mismatch. During the transition from AFL to AF, the excitation collided with the refractory zone of the preceding wave and broke into multiple wave fronts to induce AF. A similar observation was made for the transition from AF to sinus rhythm. In both cases, the complex anatomy of the atria played an essential role. CONCLUSION The complex anatomy of atria plays an essential role in the maintenance of stable AFL and its termination by aATP, which were revealed by the realistic three-dimensional simulation model.
Collapse
Affiliation(s)
- Jun-Ichi Okada
- UT-Heart Inc., Setagaya-ku, Tokyo, Japan
- Graduate School of Frontier Sciences, University of Tokyo, Kashiwa, Chiba, Japan
| | - Takumi Washio
- UT-Heart Inc., Setagaya-ku, Tokyo, Japan
- Graduate School of Frontier Sciences, University of Tokyo, Kashiwa, Chiba, Japan
| | | | | |
Collapse
|
7
|
Saglietto A, Ballatore A, Griffith Brookles C, Xhakupi H, De Ferrari GM, Anselmino M. Role of atrial high-rate episodes in stratifying thromboembolic risk: a multiple cut-off diagnostic meta-analysis. Front Cardiovasc Med 2023; 10:1289372. [PMID: 38028457 PMCID: PMC10662047 DOI: 10.3389/fcvm.2023.1289372] [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: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Aims Despite the high prevalence rate of atrial high-rate episodes (AHREs) detected using cardiac implantable electronic devices (CIEDs), clinical guidelines and consensus documents have disagreed on a universal AHRE definition and a temporal cut-off related to subsequent thromboembolic events. This diagnostic test accuracy meta-analysis aims to derive the optimal temporal threshold of clinically significant AHREs from the available literature. Methods The PubMed/MEDLINE and EMBASE databases were screened for studies on CIED patients reporting the incidence of thromboembolic events related to at least one AHRE temporal cut-off. A total of 23 studies were included: 19 considering the longest single AHRE and four the AHRE burden, respectively. A random-effect diagnostic test accuracy meta-analysis with multiple cut-offs was performed. Two analyses were performed according to the AHRE temporal cut-off subtype (longest episode vs. cumulative burden). Results The analysis on the longest single AHRE indicated 0.07 min as the optimal duration to differentiate AHRE associated or not with thromboembolic events [sensitivity 65.4% (95% CI 48.8%-79.0%), specificity 52.7% (95% CI 46.0%-59.4%), and area under the summary receiver operating characteristic curve (AUC-SROC): 0.62]. The analysis on AHRE burden indicated 1.4 min as the optimal cut-off [sensitivity 58.2% (95% CI 25.6%-85.0%), specificity 57.5% (95% CI 42.0%-71.7%), and AUC-SROC 0.60]. A sensitivity analysis excluding patients with a history of atrial fibrillation and including high-quality studies only yielded similar results. Conclusion The presence of AHRE, rather than a specific duration, relates to an increased, albeit low, thromboembolic risk in CIED patients. Any AHRE should constitute an additional element in patient-specific thromboembolic risk assessment.
Collapse
Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta Della Salute e Della Scienza” Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Ballatore
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta Della Salute e Della Scienza” Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Carola Griffith Brookles
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta Della Salute e Della Scienza” Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Henri Xhakupi
- Dipartimento di Medicina Interna, Università Degli Studi di Genova, Genova, Italia
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta Della Salute e Della Scienza” Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta Della Salute e Della Scienza” Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
8
|
Trohman RG. Understanding and Managing the Impact of Atrial High-Rate Episodes: Still a Work in Progress. Am J Cardiol 2023; 205:517-519. [PMID: 37612216 DOI: 10.1016/j.amjcard.2023.07.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois..
| |
Collapse
|
9
|
Jiang J, Sun X, Cheng C, Chen K, Hua W, Su Y, Xu W, Chen R, Zhang S. Progression of Device-Detected Atrial High-Rate Episodes and the Risk of All-Cause Mortality. Am J Cardiol 2023; 204:96-103. [PMID: 37541154 DOI: 10.1016/j.amjcard.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023]
Abstract
Atrial high-rate episodes (AHREs) are prevalent in approximately 1/3 of patients with cardiac implanted electronic devices and are associated with an increased risk of several adverse outcomes. This study aimed to explore the factors associated with AHRE progression and the risk of all-cause mortality. At least 1 day with AHRE burden ≥15 minutes was identified in 124 of 343 recipients (36.2%) of an implantable cardioverter defibrillator or cardiac resynchronization therapy device. We included patients whose AHRE burden at the time of first detection was ≥15 minutes but <24 hours (n = 107). Various cut-off values (15 minutes, 6 hours, and 24 hours) of daily AHRE burden were analyzed. During an average follow-up of 4.2 years, 60 patients (56.1%) experienced ≥1 progression to greater AHRE burden. Patients with hypertension or greater AHRE burden at first detection were associated with faster progression. In addition, 27 deaths (45%) occurred among 60 patients with AHRE progression, compared with 25.5% (12 of 47) for those without progression. After multivariable adjustment, AHRE progression was independently associated with all-cause mortality (hazard ratio 2.56, 95% confidence interval 1.23 to 5.35, p = 0.012). Notably, AHRE progression within 1 month after their first detection was associated with an increased risk for all-cause mortality (hazard ratio 4.01, 95% confidence interval 1.76 to 9.16, p = 0.001) compared with patients without progression. However, a similar risk was not observed among patients with AHRE progression occurring after 1 month after their first detection. In conclusion, >1/2 of the patients with AHRE progressed to a greater burden over time. Continuous monitoring of the AHRE burden may help identify patients at great risk for death.
Collapse
Affiliation(s)
- Jiang Jiang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuerong Sun
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chendi Cheng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangang Su
- Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
10
|
Lip GYH, Proietti M, Potpara T, Mansour M, Savelieva I, Tse HF, Goette A, Camm AJ, Blomstrom-Lundqvist C, Gupta D, Boriani G. Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal. Europace 2023; 25:euad226. [PMID: 37622590 PMCID: PMC10451006 DOI: 10.1093/europace/euad226] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Stroke prevention in patients with atrial fibrillation (AF) is one pillar of the management of this common arrhythmia. Substantial advances in the epidemiology and associated pathophysiology underlying AF-related stroke and thrombo-embolism are evident. Furthermore, the introduction of the non-vitamin K antagonist oral anticoagulants (also called direct oral anticoagulants) has clearly changed our approach to stroke prevention in AF, such that the default should be to offer oral anticoagulation for stroke prevention, unless the patient is at low risk. A strategy of early rhythm control is also beneficial in reducing strokes in selected patients with recent onset AF, when compared to rate control. Cardiovascular risk factor management, with optimization of comorbidities and attention to lifestyle factors, and the patient's psychological morbidity are also essential. Finally, in selected patients with absolute contraindications to long-term oral anticoagulation, left atrial appendage occlusion or exclusion may be considered. The aim of this state-of-the-art review article is to provide an overview of the current status of AF-related stroke and prevention strategies. A holistic or integrated care approach to AF management is recommended to minimize the risk of stroke in patients with AF, based on the evidence-based Atrial fibrillation Better Care (ABC) pathway, as follows: A: Avoid stroke with Anticoagulation; B: Better patient-centred, symptom-directed decisions on rate or rhythm control; C: Cardiovascular risk factor and comorbidity optimization, including lifestyle changes.
Collapse
Affiliation(s)
- Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Irina Savelieva
- Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George’s University of London, Cranmer Terrace London SW17 0RE, UK
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Andreas Goette
- Medizinische Klinik II: Kardiologie und Intensivmedizin, St. Vincenz-Krankenhaus Paderborn, Am Busdorf 2, 33098 Paderborn, Germany
| | - A John Camm
- Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George’s University of London, Cranmer Terrace London SW17 0RE, UK
| | - Carina Blomstrom-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo 71, 41125 Modena, Italy
| |
Collapse
|
11
|
Boriani G, Bertini M, Manzo M, Calò L, Santini L, Savarese G, Dello Russo A, Santobuono VE, Lavalle C, Viscusi M, Amellone C, Calvanese R, Santoro A, Rapacciuolo A, Ziacchi M, Arena G, Imberti JF, Campari M, Valsecchi S, D’Onofrio A. Performance of a multi-sensor implantable defibrillator algorithm for heart failure monitoring in the presence of atrial fibrillation. Europace 2023; 25:euad261. [PMID: 37656991 PMCID: PMC10498140 DOI: 10.1093/europace/euad261] [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: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
AIMS The HeartLogic Index combines data from multiple implantable cardioverter defibrillators (ICDs) sensors and has been shown to accurately stratify patients at risk of heart failure (HF) events. We evaluated and compared the performance of this algorithm during sinus rhythm and during long-lasting atrial fibrillation (AF). METHODS AND RESULTS HeartLogic was activated in 568 ICD patients from 26 centres. We found periods of ≥30 consecutive days with an atrial high-rate episode (AHRE) burden <1 h/day and periods with an AHRE burden ≥20 h/day. We then identified patients who met both criteria during the follow-up (AHRE group, n = 53), to allow pairwise comparison of periods. For control purposes, we identified patients with an AHRE burden <1 h throughout their follow-up and implemented 2:1 propensity score matching vs. the AHRE group (matched non-AHRE group, n = 106). In the AHRE group, the rate of alerts was 1.2 [95% confidence interval (CI): 1.0-1.5]/patient-year during periods with an AHRE burden <1 h/day and 2.0 (95% CI: 1.5-2.6)/patient-year during periods with an AHRE-burden ≥20 h/day (P = 0.004). The rate of HF hospitalizations was 0.34 (95% CI: 0.15-0.69)/patient-year during IN-alert periods and 0.06 (95% CI: 0.02-0.14)/patient-year during OUT-of-alert periods (P < 0.001). The IN/OUT-of-alert state incidence rate ratio of HF hospitalizations was 8.59 (95% CI: 1.67-55.31) during periods with an AHRE burden <1 h/day and 2.70 (95% CI: 1.01-28.33) during periods with an AHRE burden ≥20 h/day. In the matched non-AHRE group, the rate of HF hospitalizations was 0.29 (95% CI: 0.12-0.60)/patient-year during IN-alert periods and 0.04 (95% CI: 0.02-0.08)/patient-year during OUT-of-alert periods (P < 0.001). The incidence rate ratio was 7.11 (95% CI: 2.19-22.44). CONCLUSION Patients received more alerts during periods of AF. The ability of the algorithm to identify increased risk of HF events was confirmed during AF, despite a lower IN/OUT-of-alert incidence rate ratio in comparison with non-AF periods and non-AF patients. CLINICAL TRIAL REGISTRATION http://clinicaltrials.gov/Identifier: NCT02275637.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Matteo Bertini
- Cardiology Department, University of Ferrara, S. Anna University Hospital, Ferrara, Italy
| | - Michele Manzo
- Cardiology Department, OO.RR. San Giovanni di Dio Ruggi d'Aragona, Salerno, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Luca Santini
- Division of Cardiology, Giovan Battista Grassi’ Hospital, Rome, Italy
| | - Gianluca Savarese
- Division of Cardiology, ‘S. Giovanni Battista’ Hospital, Foligno, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy
| | - Vincenzo Ezio Santobuono
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Miguel Viscusi
- Cardiology Department, S. Anna e S. Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Matteo Ziacchi
- Cardiology Unit, Cardio-Thoracic and Vascular Department, S.Orsola University Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Arena
- Cardiology Department, Ospedale Civile Apuane, Massa (MS), Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Campari
- Rhythm Management Division, Boston Scientific, Milan, Italy
| | | | - Antonio D’Onofrio
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, Naples, Italy
| |
Collapse
|
12
|
Sumiyoshi H, Tasaka H, Yoshida K, Yoshino M, Kadota K. Combined effects of high atrial septal pacing and reactive atrial antitachycardia pacing for reducing atrial fibrillation in sick sinus syndrome. J Arrhythm 2023; 39:566-573. [PMID: 37560282 PMCID: PMC10407182 DOI: 10.1002/joa3.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/03/2023] [Accepted: 06/15/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND It is unknown whether atrial fibrillation (AF) burden varies by pacing site in patients with reactive atrial antitachycardia pacing (rATP). We aimed to compare AF burden in patients with high atrial septal pacing (HASp) via delivery catheter and right atrial appendage pacing (RAAp) in patients with sick sinus syndrome (SSS). METHODS We retrospectively identified 109 patients with a history of paroxysmal AF and SSS who had received dual-chamber pacemaker implantation between January 2017 and December 2019, of whom 39 and 70 patients had HASp and RAAp, respectively. rATP was initiated after a 1-month post-implantation run-in period. RESULTS Patients with HASp had a significantly shorter P-wave duration during atrial pacing than those with RAAp (99.3 ± 10.4 vs. 116.0 ± 14.3 ms, p < .001). During the 3-year follow-up period, the incidence of an AF lasting longer than 1 or 7 days was significantly lower (hazard ratio [HR], 0.45; p = .016; HR, 0.24; p = .004) than in those with RAAp. The median time of AF/AT per day in the follow-up periods was significantly shorter in the HASp group than in the RAAp group (10 vs. 18 min/day, p = .018). Atrial lead division did not occur in the HASp group during the follow-up period. CONCLUSIONS HASp via delivery catheter is as safe as RAAp, and HASp combined with rATP is effective for reducing AF burden in patients with SSS and paroxysmal AF.
Collapse
Affiliation(s)
- Hironobu Sumiyoshi
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Hiroshi Tasaka
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Kenta Yoshida
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Mitsuru Yoshino
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Kazushige Kadota
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| |
Collapse
|
13
|
Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1. Front Cardiovasc Med 2023; 10:1060030. [PMID: 37396596 PMCID: PMC10311453 DOI: 10.3389/fcvm.2023.1060030] [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: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia. It was once thought to be benign as long as the ventricular rate was controlled, however, AF is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a MEDLINE search to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched via the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare noninvasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
Collapse
|
14
|
Razina TV, Serova MV, Andreev DA, Sazonova YS, Komarova AG. [Tactics of anticoagulant therapy in patients with cardiac implantable electronic devices and subclinical atrial fibrillation: A review]. TERAPEVT ARKH 2023; 95:472054. [PMID: 38158984 DOI: 10.26442/00403660.2023.04.202189] [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: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 01/03/2024]
Abstract
Screening for atrial fibrillation (AF) has attracted considerable attention recently. Of special interest are patients with cardiac implantable electronic devices (CIEDs) that allow for recording episodes of atrial arrhythmias of various durations, including asymptomatic ones, in which case they are referred to as subclinical atrial fibrillation (SCAF). The available data suggest that the risk of thromboembolic events varies between patients with SCAF and clinically overt AF. As of today, the question regarding anticoagulant therapy in patients with SCAF remains unresolved. The article presents an overview of previous and ongoing studies on this issue, as well as current guidelines on anticoagulant use in patients with SCAF and CIEDs.
Collapse
Affiliation(s)
- T V Razina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M V Serova
- Sechenov First Moscow State Medical University (Sechenov University)
- Pirogov City Clinical Hospital №1 Moscow
| | - D A Andreev
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | |
Collapse
|
15
|
Pastore G, Bertini M, Bonanno C, Coluccia G, Dell'Era G, De Mattia L, Grieco D, Katsouras G, Maines M, Marcantoni L, Marinaccio L, Paglino G, Palmisano P, Ziacchi M, Zoppo F, Noventa F. The PhysioVP-AF study, a randomized controlled trial to assess the clinical benefit of physiological ventricular pacing vs. managed ventricular pacing for persistent atrial fibrillation prevention in patients with prolonged atrioventricular conduction: design and rationale. Europace 2023; 25:euad082. [PMID: 36974970 PMCID: PMC10228539 DOI: 10.1093/europace/euad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/23/2023] [Indexed: 03/29/2023] Open
Abstract
AIMS In patients with prolonged atrioventricular (AV) conduction and pacemaker (PM) indication due to sinus node disease (SND) or intermittent AV-block who do not need continuous ventricular pacing (VP), it may be difficult to determine which strategy to adopt. Currently, the standard of care is to minimize unnecessary VP by specific VP avoidance (VPA) algorithms. The superiority of this strategy over standard DDD or DDD rate-responsive (DDD/DDDR) in improving clinical outcomes is controversial, probably owing to the prolongation of the atrialventricular conduction (PR interval) caused by the algorithms. Conduction system pacing (CSP) may offer the most physiological-VP approach, providing appropriate AV conduction and preventing pacing-induced dyssynchrony. METHODS AND RESULTS PhysioVP-AF is a prospective, controlled, randomized, single-blind trial designed to determine whether atrial-synchronized conduction system pacing (DDD-CSP) is superior to standard DDD-VPA pacing in terms of 3-year reduction of persistent-AF occurrence. Cardiovascular hospitalization, quality-of-life, and safety will be evaluated. Patients with indication for permanent DDD pacing for SND or intermittent AV-block and prolonged AV conduction (PR interval > 180 ms) will be randomized (1:1 ratio) to DDD-VPA (VPA-algorithms ON, septal/apex position) or to DDD-CSP (His bundle or left bundle branch area pacing, AV-delay setting to control PR interval, VPA-algorithms OFF). Approximately 400 patients will be randomized in 24 months in 13 Italian centres. CONCLUSION The PhysioVP-AF study will provide an essential contribution to patient management with prolonged AV conduction and PM indication for sinus nodal disease or paroxysmal 2nd-degree AV-block by determining whether CSP combined with a controlled PR interval is superior to standard management that minimizes unnecessary VP in terms of reducing clinical outcomes.
Collapse
Affiliation(s)
- Gianni Pastore
- Department of Cardiology, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy
| | - Matteo Bertini
- Department of Cardiology, University Hospital, via Aldo Moro, n 8, 44124 Ferrara, Italy
| | - Carlo Bonanno
- Department of Cardiology, San Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy
| | - Giovanni Coluccia
- Department of Cardiology, C. G. Panico Hospital, via San Pio X 4, 73039 LecceItaly
| | - Gabriele Dell'Era
- Department of Cardiology, Maggiore della Carità Hospital, corso Mazzini 18, 28100 Novara, Italy
| | - Luca De Mattia
- Department of Cardiology, Ca’ Foncello Hospital, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Domenico Grieco
- Department of Cardiology, Policlinico Casilino, via Casilina n.1049, 00169 Roma, Italy
| | - Grigorius Katsouras
- Department of Cardiology, F. Miulli Hospital, Strada Provinciale 127, 70021 Acquaviva delle Fonti, BA, Italy
| | - Massimiliano Maines
- Department of Cardiology, Santa Maria del Carmine Hospital, corso Verona 4, 38068 Rovereto, TN, Italy
| | - Lina Marcantoni
- Department of Cardiology, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy
| | - Leonardo Marinaccio
- Department of Cardiology, Immacolata Concezione Hospital, via San Rocco 8, 35028 Piove di Sacco, PD, Italy
| | - Gabriele Paglino
- Department of Cardiology, IRCCS San Raffaele Hospital, via Olgettina 60, 20132 Milano, Italy
| | - Pietro Palmisano
- Department of Cardiology, C. G. Panico Hospital, via San Pio X 4, 73039 LecceItaly
| | - Matteo Ziacchi
- Department of Cardiology, IRCCS Az. Osp. Università Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Franco Zoppo
- Department of Cardiology, Osp. Civile Portogruaro, via Piemonte 1, 30026 Portogruaro VE, Italy
| | - Franco Noventa
- QUOVADIS no-profit Association, Gall. Ezzelino 5, 35139 Padova, Italy
| |
Collapse
|
16
|
Xing LY, Diederichsen SZ, Højberg S, Krieger DW, Graff C, Olesen MS, Nielsen JB, Brandes A, Køber L, Haugan KJ, Svendsen JH. Electrocardiographic markers of subclinical atrial fibrillation detected by implantable loop recorder: insights from the LOOP Study. Europace 2023; 25:euad014. [PMID: 37068888 PMCID: PMC10227658 DOI: 10.1093/europace/euad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/10/2023] [Indexed: 04/19/2023] Open
Abstract
AIMS Insights into subclinical atrial fibrillation (AF) development are warranted to inform the strategies of screening and subsequent clinical management upon AF detection. Hence, this study sought to characterize the onset and progression of subclinical AF with respect to 12-lead electrocardiogram (ECG) parameters. METHODS AND RESULTS We included AF-naïve individuals aged 70-90 years with additional stroke risk factors who underwent implantable loop recorder (ILR) monitoring in the LOOP Study. Using data from daily ILR recordings and the computerized analysis of baseline ECG, we studied empirically selected ECG parameters for AF detection (≥6 min), cumulative AF burden, long-lasting AF (≥24 h), and AF progression. Of 1370 individuals included, 419 (30.6%) developed AF during follow-up, with a mean cumulative AF burden of 1.5% [95% CI: 1.2-1.8]. Several P-wave-related and ventricular ECG parameters were associated with new-onset AF and with cumulative AF burden in AF patients. P-wave duration (PWD), P-wave terminal force in Lead V1, and interatrial block (IAB) further demonstrated significant associations with long-lasting AF. Among AF patients, we observed an overall reduction in cumulative AF burden over time (IRR 0.70 [95% CI: 0.51-0.96]), whereas IAB was related to an increased risk of progression to AF ≥24 h (HR 1.86 [95% CI: 1.02-3.39]). Further spline analysis also revealed longer PWD to be associated with this progression in AF duration. CONCLUSION We identified several ECG parameters associated with new-onset subclinical AF detected by ILR. Especially PWD and IAB were robustly related to the onset and the burden of AF as well as progression over time.
Collapse
Affiliation(s)
- Lucas Yixi Xing
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
- Department of Cardiology, Zealand University Hospital Roskilde, 4000 Roskilde, Denmark
| | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, 2400 Copenhagen, Denmark
| | - Søren Højberg
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, 2400 Copenhagen, Denmark
| | - Derk W Krieger
- Department of Neurology, Mediclinic City Hospital, Dubai, United Arabic Emirates
- Department of Neuroscience, Mohammed Bin Rashid University of Medicine and Health Science, Dubai, United Arabic Emirates
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Morten S Olesen
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jonas Bille Nielsen
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Axel Brandes
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense C, Denmark
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark
- Department of Cardiology, University Hospital of Southern Denmark Esbjerg, 6700 Esbjerg, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ketil Jørgen Haugan
- Department of Cardiology, Zealand University Hospital Roskilde, 4000 Roskilde, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| |
Collapse
|
17
|
Hindricks G, Theuns DA, Bar-Lev D, Anguera I, Ayala Paredes FA, Arnold M, Geller JC, Merkely B, Dyrda KM, Perings C, Maglia G, Ploux S, Meyhöfer J, Blomström-Lundqvist C, Karjalainen P, Liang Y, Diemberger I, Wranicz JK, Barr C, Quartieri F, Timmel T, Bollmann A. Ability to remotely monitor atrial high-rate episodes using a single-chamber implantable cardioverter-defibrillator with a floating atrial sensing dipole. Europace 2023; 25:euad061. [PMID: 37038759 PMCID: PMC10227664 DOI: 10.1093/europace/euad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/06/2022] [Indexed: 04/12/2023] Open
Abstract
AIMS To allow timely initiation of anticoagulation therapy for the prevention of stroke, the European guidelines on atrial fibrillation (AF) recommend remote monitoring (RM) of device-detected atrial high-rate episodes (AHREs) and progression of arrhythmia duration along pre-specified strata (6 min…<1 h, 1 h…<24 h, ≥ 24 h). We used the MATRIX registry data to assess the capability of a single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (DX ICD system) to follow this recommendation in patients with standard indication for single-chamber ICD. METHODS AND RESULTS In 1841 DX ICD patients with daily automatic RM transmissions, electrograms of first device-detected AHREs per patient in each duration stratum were adjudicated, and the corresponding positive predictive values (PPVs) for the detections to be true atrial arrhythmia were calculated. Moreover, the incidence and progression of new-onset AF was assessed in 1451 patients with no AF history. A total of 610 AHREs ≥6 min were adjudicated. The PPV was 95.1% (271 of 285) for episodes 6min…<1 h, 99.6% (253/254) for episodes 1 h…<24 h, 100% (71/71) for episodes ≥24 h, or 97.5% for all episodes (595/610). The incidence of new-onset AF was 8.2% (119/1451), and in 31.1% of them (37/119), new-onset AF progressed to a higher duration stratum. Nearly 80% of new-onset AF patients had high CHA2DS2-VASc stroke risk, and 70% were not on anticoagulation therapy. Age was the only significant predictor of new-onset AF. CONCLUSION A 99.7% detection accuracy for AHRE ≥1 h in patients with DX ICD systems in combination with daily RM allows a reliable guideline-recommended screening for subclinical AF and monitoring of AF-duration progression.
Collapse
Affiliation(s)
- Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig and Leipzig Heart Institute, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Dominic A Theuns
- Erasmus University Medical Center,‘s-Gravendijkwal 230, 3015 GD Rotterdam, TheNetherlands
| | - David Bar-Lev
- Chaim Sheba Medical Center,52621 Tel Hashomer, Israel
| | - Ignasi Anguera
- Arrhythmia Unit, Heart Diseases Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Feixa Llarga, 08907 L'Hospitalet, Barcelona, Spain
| | | | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - J Christoph Geller
- Zentralklinik Bad Berka GmbH,Robert-Koch-Allee 9, 99437 Bad Berka, Germany
| | - Béla Merkely
- Semmelweis Medical University, Városmajorutca 68, 1122 Budapest, Hungary
| | - Katia Marjolaine Dyrda
- Montreal Heart Institute affiliated with Université de Montréal, 5000, rue Belanger, H1T 1C8 Montréal, Québec, Canada
| | | | - Giampiero Maglia
- Azienda Ospedaliera Pugliese Ciaccio, Via Vinicio Cortese 25, 88100 Catanzaro, Italia
| | - Sylvain Ploux
- Hôpital Haut Lévêque (CHU), 1 avenue de Magellan, 33600 Pessac Cedex, France
| | - Jürgen Meyhöfer
- Maria Heimsuchung—Caritas-Klinik Pankow,Breite Str. 46/47, 13187 Berlin, Germany
| | - Carina Blomström-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Department of Medical Science and Cardiology, Uppsala University, S-751 85 Uppsala, Sweden
| | - Pasi Karjalainen
- Satakunta Central Hospital, Sydänyksikkö, Sairaalantie 3, 28500 Pori, Finland
| | - Yanchun Liang
- General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, 110016 Shenyang, China
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italia
| | - Jerzy Krzysztof Wranicz
- Department of Electrocardiology, Medical University of Lodz, Ul. Pomorska 251, 92-213 Łódź, Poland
| | - Craig Barr
- Russells Hall Hospital, Pensett Road, DY1 2HQ Dudley, UK
| | - Fabio Quartieri
- Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italia
| | - Tobias Timmel
- Biotronik SE & Co. KG,Woermannkehre 1, 12359 Berlin, Germany
| | | |
Collapse
|
18
|
Yang Y, Lu J, Xiong C, Shen Z, Shen C, Tong J, Jiang J, Fu G, Xu F. Establishment and Verification of a Nomogram for Predicting the Probability of New-Onset Atrial Fibrillation After Dual-Chamber Pacemaker Implantation. Tex Heart Inst J 2023; 50:492746. [PMID: 37130328 DOI: 10.14503/thij-21-7796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study aims to establish and validate a nomogram as a predictive model in patients with new-onset atrial fibrillation (AF) after dual-chamber cardiac implantable electronic device (pacemaker) implantation. METHODS A total of 1120 Chinese patients with new-onset AF after pacemaker implantation were included in this retrospective study. Patients had AF of at least 180/minute lasting 5 minutes or longer, detected by atrial lead and recorded at least 3 months after implantation. Patients with previous atrial tachyarrhythmias before device implantation were excluded. A total of 276 patients were ultimately enrolled, with 51 patients in the AF group and 225 patients in the non-AF group. Least absolute shrinkage and selection operator (LASSO) method was used to determine the best predictors. Through multivariate logistic regression analysis, a nomogram was drawn as a predictive model. Concordance index, calibration plot, and decision curve analyses were applied to evaluate model discrimination, calibration, and clinical applicability. Internal verification was performed using a bootstrap method. RESULTS The LASSO method regression analysis found that variables including peripheral arterial disease, atrial pacing-ventricular pacing of at least 50%, atrial sense-ventricular sense of at least 50%, increased left atrium diameter, and age were important predictors of developing AF. In multivariate logistic regression, peripheral arterial disease, atrial pacing-ventricular pacing of at least 50%, and age were found to be independent predictors of new-onset AF. CONCLUSION This nomogram may help physicians identify patients at high risk of new-onset AF after pacemaker implantation at an early stage in a Chinese population.
Collapse
Affiliation(s)
- Ying Yang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jiangting Lu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Cui Xiong
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Zhida Shen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Chao Shen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jinshan Tong
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jiangfen Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Fen Xu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| |
Collapse
|
19
|
Kalarus Z, Mairesse GH, Sokal A, Boriani G, Średniawa B, Casado-Arroyo R, Wachter R, Frommeyer G, Traykov V, Dagres N, Lip GYH. Searching for atrial fibrillation: looking harder, looking longer, and in increasingly sophisticated ways. An EHRA position paper. Europace 2023; 25:185-198. [PMID: 36256580 PMCID: PMC10112840 DOI: 10.1093/europace/euac144] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zbigniew Kalarus
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Georges H Mairesse
- Department of Cardiology and Electrophysiology, Cliniques du Sud Luxembourg—Vivalia, Arlon, Belgium
| | - Adam Sokal
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Beata Średniawa
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
20
|
Carrington M, Providência R, Chahal CAA, Ricci F, Epstein AE, Gallina S, Fedorowski A, Sutton R, Khanji MY. Clinical applications of heart rhythm monitoring tools in symptomatic patients and for screening in high-risk groups. Europace 2022; 24:1721-1729. [PMID: 35983729 DOI: 10.1093/europace/euac088] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/12/2022] [Indexed: 12/15/2022] Open
Abstract
Recent technological advances have facilitated and diversified the options available for the diagnosis of cardiac arrhythmias. Ranging from simple resting or exercise electrocardiograms to more sophisticated and expensive smartphones and implantable cardiac monitors. These tests and devices may be used for varying periods of time depending on symptom frequency. The choice of the most appropriate heart rhythm test should be guided by clinical evaluation and optimized following accurate characterization of underlying symptoms, 'red flags', risk factors, and consideration of cost-effectiveness of the different tests. This review provides evidence-based guidance for assessing suspected arrhythmia in patients who present with symptoms or in the context of screening, such as atrial fibrillation or advanced conduction disturbances following transcatheter aortic valve implantation in high-risk groups. This is intended to help clinicians choose the most appropriate diagnostic tool to facilitate the management of patients with suspected arrhythmias.
Collapse
Affiliation(s)
- Mafalda Carrington
- Department of Cardiology, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Rui Providência
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Newham University Hospital, BartsHealth NHS Trust, London, UK.,Institute of Health Informatics Research, University College London, London, UK
| | - C Anwar A Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.,Department of Cardiology, Casa di Cura Villa Serena, Città Sant'Angelo, Italy.,Department of Clinical Sciences, Lund University, 205 02 Malmö, Sweden
| | - Andrew E Epstein
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Artur Fedorowski
- Department of Cardiology, Casa di Cura Villa Serena, Città Sant'Angelo, Italy.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Richard Sutton
- Department of Clinical Sciences, Lund University, 205 02 Malmö, Sweden.,Department of Cardiology, Hammersmith Hospital Campus, Imperial College, London, UK
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Newham University Hospital, BartsHealth NHS Trust, London, UK.,NIHR Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
| |
Collapse
|
21
|
Heradien M, Mahfoud F, Greyling C, Lauder L, van der Bijl P, Hettrick DA, Stilwaney W, Sibeko S, Jansen van Rensburg R, Peterson D, Khwinani B, Goosen A, Saaiman JA, Ukena C, Böhm M, Brink PA. Renal denervation prevents subclinical atrial fibrillation in patients with hypertensive heart disease: Randomized, sham-controlled trial. Heart Rhythm 2022; 19:1765-1773. [PMID: 35781044 DOI: 10.1016/j.hrthm.2022.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Catheter-based renal denervation (RD), in addition to pulmonary vein isolation (PVI), reduces atrial fibrillation (AF) recurrence in hypertensive patients. Whether RD, without additional PVI, can prevent subclinical atrial fibrillation (SAF) in patients with hypertensive heart disease (HHD) is unknown. OBJECTIVE The purpose of this study was to assess the efficacy of RD in preventing SAF in patients with HHD. METHODS A single-center, randomized, sham-controlled pilot trial, including patients >55 years in sinus rhythm, but with a high risk of developing SAF was conducted. Patients had uncontrolled hypertension despite taking 3 antihypertensive drugs, including a diuretic. The primary endpoint was the first SAF episode lasting ≥6 minutes recorded via an implantable cardiac monitor scanned every 6 months for 24 months. A blinded independent monitoring committee assessed electrocardiographic rhythm recordings. Change in SAF burden (SAFB), and office and 24-hour ambulatory blood pressure (BP) at 6-month follow-up were secondary endpoints. RESULTS Eighty patients were randomly assigned to RD (n = 42) or sham groups (n = 38). After 24 months of follow-up, SAF occurred in 8 RD patients (19%) and 15 sham patients (39.5%) (hazard ratio 0.40; 95% confidence interval 0.17-0.96; P = .031). Median [interquartile range] SAFB was low in both groups but was significantly lower in the RD vs sham group (0% [0-0] vs 0% [0-0.3]; P = .043). Fast AF (>100 bpm) occurred less frequently in the RD than sham group (2% vs 26%; P = .002). After adjusting for baseline values, there were no significant differences in office or 24-hour BP changes between treatment groups. CONCLUSION RD reduced incident SAF events, SAFB, and fast AF in patients with HHD. The observed effects may occur independent of BP lowering.
Collapse
Affiliation(s)
- Marshall Heradien
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa; SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa.
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | | | - Lucas Lauder
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | | | | | - Warren Stilwaney
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa
| | - Siyolise Sibeko
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa
| | | | - Dale Peterson
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa
| | - Bonke Khwinani
- SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa
| | - Althea Goosen
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa; SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa
| | - Jan A Saaiman
- SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa
| | - Christian Ukena
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Paul A Brink
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa; SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa
| |
Collapse
|
22
|
Nakagomi T, Inden Y, Yanagisawa S, Suzuki N, Tsurumi N, Watanabe R, Shimojo M, Okajima T, Suga K, Shibata R, Murohara T. Characteristics of Successful Reactive Atrial‐based Antitachycardia Pacing in Patients with Cardiac Implantable Electronic Devices: History of Catheter Ablation of Atrial Fibrillation as a Predictor of High Treatment Efficacy. J Cardiovasc Electrophysiol 2022; 33:1515-1528. [DOI: 10.1111/jce.15551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/29/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Toshifumi Nakagomi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Noriyuki Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Naoki Tsurumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Ryo Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Masafumi Shimojo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Takashi Okajima
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Kazumasa Suga
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Rei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa‐kuNagoyaAichi466‐8550Japan
| |
Collapse
|
23
|
Boriani G, Diemberger I, Pisanò EC, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias MA, Checchinato C, La Rovere MT, Sinagra G, Emdin M, Ricci RP, D'Onofrio A. Association between implantable defibrillator-detected sleep apnea and atrial fibrillation: the DASAP-HF study. J Cardiovasc Electrophysiol 2022; 33:1472-1479. [PMID: 35499267 DOI: 10.1111/jce.15506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
AIM The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe sleep apnea (SA). In the present analysis we tested the hypothesis that RDI could also predict AF burden. METHODS Patients with ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly mean RDI value was considered, as calculated during the entire follow-up period and over a 1-week period preceding the sleep study. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours, ≥23 hours. RESULTS 164 patients had usable RDI values during the entire follow-up period. Severe SA (RDI≥30 episodes/h) was diagnosed in 92 (56%) patients at the time of the sleep study. During follow-up, AF burden ≥5 minutes/day was documented in 70 (43%), ≥6 hours/day in 48 (29%), and ≥23 hours/day in 33 (20%) patients. Device-detected RDI≥30 episodes/h at the time of the polygraphy, as well as the polygraphy-measured apnea hypopnea index ≥30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using a time-dependent model, continuously measured weekly mean RDI≥30episodes/h was independently associated with AF burden ≥5 minutes/day (HR:2.13, 95%CI:1.24-3.65, p=0.006), ≥6 hours/day (HR:2.75, 95%CI:1.37-5.49, p=0.004), and ≥23 hours/day (HR:2.26, 95%CI:1.05-4.86, p=0.037). CONCLUSIONS In heart failure patients, ICD-diagnosed severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Igor Diemberger
- University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | | | | | - Marcello Piacenti
- Institute of Life Science, Scuola Superiore Sant'Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ciro Indolfi
- Division of Cardiology, "Magna Graecia" University, Catanzaro, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | | | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia
| | | | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | |
Collapse
|
24
|
Huang SH, Liao CF, Chen ZY, Chao TF, Chen SA, Tsao HM. Distinct atrial remodeling in patients with subclinical atrial fibrillation: Lessons from computed tomographic images. Pharmacol Res Perspect 2022; 10:e00927. [PMID: 35194973 PMCID: PMC8863578 DOI: 10.1002/prp2.927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Cardiac implanted electronic devices (CIEDs) can detect atrial high-rate episodes (AHREs) and challenge current management of subclinical atrial fibrillation (AF). METHODS To characterize the anatomic and functional remodeling of cardiac structures between patients with subclinical AF (SCAF) and clinical AF. The predictors for AHREs ≥6 min were also investigated. RESULTS We compared the atrial volume, dynamic function, and peri-atrial fat between 104 CIEDs (AHREs = 0, n = 12; SCAF, n = 66; CIEDs with AF, n = 26) and 40 paroxysmal AF patients who were planning for catheter ablation (AF for ablation) using 256-slice multidetector computed tomography for the duration of the AHREs. The maximal volume of the left atrium (LA) and LA appendage (LAA) were significantly smaller; the total emptying fraction (EF) and active EF of the LA and LAA were significantly better in the patients with SCAF than in those with clinical AF. Less peri-atrial fat (p < 0.001) and a greater LAA/ascending aorta (AA) Hounsfield unit (HU) ratio (p < 0.05) were noted in the patients with SCAF. Significantly increased volume reduced the total EF of LA and LAA and a reduced LAA/AA HU ratio (0.91 ± 0.18 vs 0.98 ± 0.03 vs 0.97 ± 0.05, p < 0.05) were demonstrated in patients with AHREs ≥6 min compared to those with AHREs <6 min and without AHRE. Multivariate analysis showed the reduced LAA/AA HU ratio is an independent predictor for the development of AHREs ≥6 min. CONCLUSION As compared to clinical AF, patients with SCAF show a more favorable LA remodeling process. Among the patients with device-detected AHREs, worse LA remodeling and a reduced LAA/AA HU ratio were associated with the occurrence of AHREs ≥6 min. These findings may provide an incremental value for understanding SCAF.
Collapse
Affiliation(s)
- Sung-Hao Huang
- Division of Cardiology, Department of Medicine, National Yang-Ming Chiao-Tung University Hospital, Yilan, Taiwan
| | - Chao-Feng Liao
- Division of Cardiology, Department of Medicine, National Yang-Ming Chiao-Tung University Hospital, Yilan, Taiwan
| | - Zu-Yin Chen
- Division of Cardiology, Department of Medicine, National Yang-Ming Chiao-Tung University Hospital, Yilan, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsuan-Ming Tsao
- Division of Cardiology, Department of Medicine, National Yang-Ming Chiao-Tung University Hospital, Yilan, Taiwan.,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| |
Collapse
|
25
|
Kreimer F, Mügge A, Gotzmann M. How should I treat patients with subclinical atrial fibrillation and atrial high-rate episodes? Current evidence and clinical importance. Clin Res Cardiol 2022; 111:994-1009. [PMID: 35292844 PMCID: PMC9424173 DOI: 10.1007/s00392-022-02000-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
Long-term and continuous ECG monitoring using cardiac implantable electronic devices and insertable cardiac monitors has improved the capability of detecting subclinical atrial fibrillation (AF) and atrial high-rate episodes. Previous studies demonstrated a high prevalence (more than 20%) in patients with cardiac implantable electronic devices or insertable cardiac monitors. Subclinical AF and atrial high-rate episodes are often suspected as the cause of prior or potential future ischemic stroke. However, the clinical significance is still uncertain, and the evidence is limited. This review aims to present and discuss the current evidence on the clinical impact of subclinical AF and atrial high-rate episodes. It focuses particularly on the association between the duration of the episodes and major clinical outcomes like thromboembolic events. As subclinical AF and atrial high-rate episodes are presumed to be associated with ischemic strokes, detection will be particularly important in patients with cryptogenic stroke and in high-risk patients for thromboembolism. In this context, it is also interesting whether there is a temporal relationship between the detection of subclinical AF and atrial high-rate episodes and the occurrence of thromboembolic events. In addition, the review will examine the question whether there is a need for a therapy with oral anticoagulation.
Collapse
Affiliation(s)
- Fabienne Kreimer
- University Hospital St Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Andreas Mügge
- University Hospital St Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Michael Gotzmann
- University Hospital St Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
| |
Collapse
|
26
|
Atrial High-Rate Episodes Detected by Cardiac Implantable Electronic Devices: Dynamic Changes in Episodes and Predictors of Incident Atrial Fibrillation. BIOLOGY 2022; 11:biology11030443. [PMID: 35336817 PMCID: PMC8945035 DOI: 10.3390/biology11030443] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 12/03/2022]
Abstract
Simple Summary Atrial high rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) may be associated with a risk of progression towards long-lasting episodes (≥24 h) and clinical atrial fibrillation (AF). Identification of this subset of patients is key to promptly starting oral anticoagulant therapy and possibly avoiding stroke and systemic thromboembolism. In the present study, we describe the clinical characteristics of 104 retrospectively enrolled patients with AHRE episodes lasting 5 min–23 h 59 min, no AF at 12-lead ECG, and no history of prior clinical AF. Moreover, we define predictors of the composite outcome of clinical AF and/or AHRE episodes lasting ≥24 h. Over a median follow-up of 24.3 (10.6–40.3) months, 31/104 (29.8%) patients experienced the composite outcome. Baseline CHA2DS2-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were independently associated with the composite outcome and with incident clinical AF as well. To conclude, in patients with AHRE, the incidence of clinical AF or AHRE episodes lasting ≥24 h is high. Baseline patients’ characteristics (CHA2DS2-VASc score) and AHRE duration may help to intensify monitoring and decision-making, being independently associated with clinical AF in a two-year follow-up. Abstract Background. Atrial high rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) may be associated with a risk of progression towards long-lasting episodes (≥24 h) and clinical atrial fibrillation (AF). Methods. Consecutive CIED patients presenting AHRE (with confirmation of an arrhythmia lasting 5 min–23 h 59 min, atrial rate ≥175/min, with no AF at 12-lead ECG and no prior clinical AF) were retrospectively enrolled. The aims of this study were to describe patients’ characteristics and the incidence of adverse events, and second, to identify potential predictors of the composite outcome of clinical AF and/or AHRE episodes lasting ≥24 h. Results. 104/107 (97.2%) patients (median age 79.7 (74.0–84.2), 33.7% female) had available follow-up data. Over a median follow-up of 24.3 (10.6–40.3) months, 31/104 (29.8%) patients experienced the composite outcome of clinical AF or AHRE episodes lasting ≥24 h. Baseline CHA2DS2-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were independently associated with the composite outcome (Hazard ratio (HR); 95% CI: 1.40; 1.07–1.83 and HR: 8.15; 95% CI 2.32–28.65, respectively). Baseline CHA2DS2-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were the only independent predictors of incident clinical AF (HR: 1.45; 95% CI 1.06–2.00 and HR: 4.25; 95% CI 1.05–17.20, respectively). Conclusions. In patients with AHRE, the incidence of clinical AF or AHRE episodes lasting ≥24 h is high in a two-year follow-up. Baseline patients’ characteristics (CHA2DS2-VASc score) and AHRE duration may help to intensify monitoring and decision-making, being independently associated with clinical AF at follow-up.
Collapse
|
27
|
Papaccioli G, Bassi G, Lugi C, Parente E, D'Andrea A, Proietti R, Imbalzano E, Alturki A, Russo V. Smartphone and new tools for Atrial Fibrillation diagnosis: evidence for clinical applicability. Minerva Cardiol Angiol 2022; 70:616-627. [PMID: 35212504 DOI: 10.23736/s2724-5683.22.05841-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia in adults. AF increases the risk of heart failure, cardiac ischemic disease, dementia and Alzheimer's disease. Either clinical and subclinical AF increase the risk of stroke and worsen the patients' clinical outcome. The early diagnosis of AF episodes, even if asymptomatic or clinically silent, is of pivotal importance to ensure prompt and adequate thromboembolic risk prevention therapies. The development of technology is allowing new systematic mass screening possibilities, especially in patients with higher stroke risk. The mobile health devices available for AF detection are: smartphones, wristworn, earlobe sensors and handheld ECG. These devices showed a high accuracy in AF detection especially when a combined approach with single-Lead ECG and photoplethysmography algorithms is used. The use of wearable devices for AF screening is a feasible method but more head-to-head comparisons between mHealth and medical devices are needed to establish their comparative effectiveness across different study populations.
Collapse
Affiliation(s)
- Giovanni Papaccioli
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Bassi
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Cecilia Lugi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Erika Parente
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Riccardo Proietti
- Liverpool center for cardiovascular science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University Hospital of Messina G. Martino, University of Messina, Messina, Italy
| | - Ahmed Alturki
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy -
| |
Collapse
|
28
|
Russo V, Rapacciuolo A, Rago A, Tavoletta V, De Vivo S, Ammirati G, Pergola V, Ciriello GD, Napoli P, Nigro G, D'Onofrio A. Early evaluation of atrial high rate episodes using remote monitoring in pacemaker patients: Results from the RAPID study. J Arrhythm 2022; 38:213-220. [PMID: 35387134 PMCID: PMC8977570 DOI: 10.1002/joa3.12685] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/11/2022] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Remote monitoring (RM) of implantable cardiac devices has enabled continuous surveillance of atrial high rate episodes (AHREs) with well‐recognized clinical benefits. We aimed to add evidence on the role of the RM as compared to conventional follow‐up by investigating the interval from AHRE onset to physician’s evaluation and reaction time in actionable episodes. Methods and Results A total of 97 dual‐chamber pacemaker recipients were followed with RM (RM‐ON group; N = 64) or conventional in‐office visits (RM‐OFF group; N = 33) for 18 months. In‐office visits were scheduled at 1, 6, 12, and 18 months in the RM‐OFF group and at 1 and 18 months in the RM‐ON group. The overall AHRE rate was 1.98 per patient‐year (95% confidence interval [CI], 1.76–2.20) with no difference between the two groups (RM‐ON vs. RM‐OFF weighted‐HR, 0.88; CI, 0.36–2.13; p = .78). In the RM‐ON group, 100% AHREs evaluated within 11 days from onset, and within 202 days in the RM‐OFF group, with a median evaluation delay 79 days shorter in the RM‐ON group versus the RM‐OFF group (p < .0001). Therapy adjustment in actionable AHREs occurred 77 days earlier in the RM‐ON group versus the control group (p < .001). In the RM‐ON group, there were 50% less in‐office visits as compared to the RM‐OFF group (p < .001). Conclusions In our pacemaker population with no history of atrial fibrillation, RM allowed significant reduction of AHRE evaluation delay and prompted treatment of actionable episodes as compared to biannual in‐office visit schedule.
Collapse
Affiliation(s)
- Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences University of Campania “Luigi Vanvitelli”, Monaldi Hospital Naples Italy
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Anna Rago
- Cardiology Unit, Department of Medical Translational Sciences University of Campania “Luigi Vanvitelli”, Monaldi Hospital Naples Italy
| | - Vincenzo Tavoletta
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias Monaldi Hospital Naples Italy
| | - Stefano De Vivo
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias Monaldi Hospital Naples Italy
| | - Giuseppe Ammirati
- Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Valerio Pergola
- Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Giovanni Domenico Ciriello
- Cardiology Unit, Department of Medical Translational Sciences University of Campania “Luigi Vanvitelli”, Monaldi Hospital Naples Italy
| | - Paola Napoli
- Clinical Research Unit Biotronik Italia Milan Italy
| | - Gerardo Nigro
- Cardiology Unit, Department of Medical Translational Sciences University of Campania “Luigi Vanvitelli”, Monaldi Hospital Naples Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias Monaldi Hospital Naples Italy
| |
Collapse
|
29
|
Rivard L, Friberg L, Conen D, Healey JS, Berge T, Boriani G, Brandes A, Calkins H, Camm AJ, Yee Chen L, Lluis Clua Espuny J, Collins R, Connolly S, Dagres N, Elkind MSV, Engdahl J, Field TS, Gersh BJ, Glotzer TV, Hankey GJ, Harbison JA, Haeusler KG, Hills MT, Johnson LSB, Joung B, Khairy P, Kirchhof P, Krieger D, Lip GYH, Løchen ML, Madhavan M, Mairesse GH, Montaner J, Ntaios G, Quinn TJ, Rienstra M, Rosenqvist M, Sandhu RK, Smyth B, Schnabel RB, Stavrakis S, Themistoclakis S, Van Gelder IC, Wang JG, Freedman B. Atrial Fibrillation and Dementia: A Report From the AF-SCREEN International Collaboration. Circulation 2022; 145:392-409. [PMID: 35100023 DOI: 10.1161/circulationaha.121.055018] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Growing evidence suggests a consistent association between atrial fibrillation (AF) and cognitive impairment and dementia that is independent of clinical stroke. This report from the AF-SCREEN International Collaboration summarizes the evidence linking AF to cognitive impairment and dementia. It provides guidance on the investigation and management of dementia in patients with AF on the basis of best available evidence. The document also addresses suspected pathophysiologic mechanisms and identifies knowledge gaps for future research. Whereas AF and dementia share numerous risk factors, the association appears to be independent of these variables. Nevertheless, the evidence remains inconclusive regarding a direct causal effect. Several pathophysiologic mechanisms have been proposed, some of which are potentially amenable to early intervention, including cerebral microinfarction, AF-related cerebral hypoperfusion, inflammation, microhemorrhage, brain atrophy, and systemic atherosclerotic vascular disease. The mitigating role of oral anticoagulation in specific subgroups (eg, low stroke risk, short duration or silent AF, after successful AF ablation, or atrial cardiopathy) and the effect of rhythm versus rate control strategies remain unknown. Likewise, screening for AF (in cognitively normal or cognitively impaired patients) and screening for cognitive impairment in patients with AF are debated. The pathophysiology of dementia and therapeutic strategies to reduce cognitive impairment warrant further investigation in individuals with AF. Cognition should be evaluated in future AF studies and integrated with patient-specific outcome priorities and patient preferences. Further large-scale prospective studies and randomized trials are needed to establish whether AF is a risk factor for cognitive impairment, to investigate strategies to prevent dementia, and to determine whether screening for unknown AF followed by targeted therapy might prevent or reduce cognitive impairment and dementia.
Collapse
Affiliation(s)
- Léna Rivard
- Montreal Heart Institute, Université de Montréal, Canada (L.R., P. Khairy)
| | - Leif Friberg
- Karolinska Institute, Stockholm, Sweden (L.F., M.R.)
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy (G.B.)
| | | | | | - A John Camm
- Cardiovascular Clinical Academic Group, St Georges Hospital, London, UK (A.J.C.)
| | | | | | | | - Stuart Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Germany (N.D.)
| | | | - Johan Engdahl
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital, Stockholm, Sweden (J.E.)
| | - Thalia S Field
- University of British Columbia, Vancouver Stroke Program, Canada (T.S.F.)
| | | | | | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia (G.J.H.)
| | | | - Karl G Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Germany (K.G.H.)
| | | | | | - Boyoung Joung
- Yonsei University College of Medicine, Seoul, South Korea (B.J.)
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Canada (L.R., P. Khairy)
| | - Paulus Kirchhof
- University Heart and Vascular Center UKE Hamburg, Germany (P. Kirchhof)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (P. Kirchhof)
- Institute of Cardiovascular Sciences, University of Birmingham, UK, and AFNET, Münster, Germany (P. Kirchhof)
| | - Derk Krieger
- University Hospital of Zurich, Switzerland (D.K.)
| | | | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø (M.L.L.)
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M.)
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain (J.M.)
- Stroke Research Program, Institute of Biomedicine of Seville, Spain (J.M.)
- IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Spain (J.M.)
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain (J.M.)
| | | | | | - Michiel Rienstra
- Karolinska Institute, Stockholm, Sweden (L.F., M.R.)
- University of Groningen, University Medical Center Groningen, the Netherlands (M.R., I.C.V.G.)
| | | | | | - Breda Smyth
- Department of Public Health, Health Service Executive West, Galway, Ireland (B.S.)
| | | | | | | | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, the Netherlands (M.R., I.C.V.G.)
| | - Ji-Guang Wang
- Jiaotong University School of Medicine, China (J.G.W.)
| | - Ben Freedman
- Charles Perkins Centre and Concord Hospital Cardiology, University of Sydney, Australia (B.F.)
| |
Collapse
|
30
|
Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias. J Arrhythm 2022; 38:1-30. [PMID: 35222748 PMCID: PMC8851582 DOI: 10.1002/joa3.12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
31
|
Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:337-363. [PMID: 34987141 DOI: 10.1253/circj.cj-21-0162] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | | | | |
Collapse
|
32
|
Bertini M, Vitali F, Santini L, Tavoletta V, Giano A, Savarese G, Dello Russo A, Santobuono VE, Mattera A, Lavalle C, Amellone C, Pecora D, Calvanese R, Rapacciuolo A, Campari M, Valsecchi S, Calò L. Implantable defibrillator-detected heart failure status predicts atrial fibrillation occurrence. Heart Rhythm 2022; 19:790-797. [DOI: 10.1016/j.hrthm.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/04/2022]
|
33
|
Szummer K, Pundi K, Perino AC, Fan J, Kothari M, Turakhia MP. Association of kidney function and atrial fibrillation progression to clinical outcomes in patients with cardiac implantable electronic devices. Am Heart J 2021; 241:6-13. [PMID: 34118202 DOI: 10.1016/j.ahj.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Kidney function may promote progression of AF. OBJECTIVE We evaluated the association of kidney function to AF progression and resultant clinical outcomes in patients with cardiac implantable electronic devices (CIED). METHODS We performed a retrospective cohort study using national clinical data from the Veterans Health Administration linked to CIED data from the Carelink® remote monitoring data warehouse (Medtronic Inc, Mounds View, MN). All devices had atrial leads and at least 75% of remote monitoring transmission coverage. Patients were included at the date of the first AF episode lasting ≥6 minutes, and followed until the occurrence of persistent AF in the first year, defined as ≥7 consecutive days with continuous AF. We used Cox regression analyses with persistent AF as a time-varying covariate to examine the association to stroke, myocardial infarction, heart failure and death. RESULTS Of, 10,323 eligible patients, 1,771 had a first CIED-detected AF (mean age 69 ± 10 years, 1.2% female). In the first year 355 (20%) developed persistent AF. Kidney function was not associated with persistent AF after multivariable adjustment including CHA2DS2-VASc variables and prior medications. Only higher age increased the risk (HR: 1.37 per 10 years; 95% CI:1.22-1.54). Persistent AF was associated to higher risk of heart failure (HR: 2.27; 95% CI: 1.88-2.74) and death (HR: 1.60; 95% CI: 1.30-1.96), but not stroke (HR: 1.28; 95% CI: 0.62-2.62) or myocardial infarction (HR: 1.43; 95% CI: 0.91-2.25). CONCLUSION Kidney function was not associated to AF progression, whereas higher age was. Preventing AF progression could reduce the risk of heart failure and death.
Collapse
|
34
|
Vitolo M, Imberti JF, Maisano A, Albini A, Bonini N, Valenti AC, Malavasi VL, Proietti M, Healey JS, Lip GY, Boriani G. Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis. Eur J Intern Med 2021; 92:100-106. [PMID: 34154879 DOI: 10.1016/j.ejim.2021.05.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Atrial High Rate Episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device. The risks of stroke/Thromboembolic (TE) events and incident clinical Atrial Fibrillation (AF) associated with AHRE varies markedly. OBJECTIVES To assess the relationship between AHRE and TE events, and between AHRE and incident clinical AF. METHODS This systematic review and meta-analysis was conducted following the PRISMA recommendations. PubMed, Scopus, and Google Scholar were searched from inception to 18/02/2021 for studies reporting TE events and incident clinical AF in patients with AHRE, as compared with patients without. RESULTS Ten out of 8081 records fulfilled the inclusion criteria, for a total of 37 266 patients. Seven out of ten studies excluded patients with prior history of clinical AF (4961 patients), embracing the most recent definition of AHRE. The risk ratio (RR) for TE events in AHRE patients was 2.13 (95% CI: 1.53-2.95, I2: 0%). The incidence of clinical AF was reported in four studies excluding patients with a history of clinical AF (3574 patients). The RR for incident clinical AF was 3.34 (95%CI: 1.89-5.90, I2: 73%). CONCLUSIONS AHRE are significantly associated with systemic thromboembolism and incident clinical AF. Further studies are needed to improve patients' risk stratification and management.
Collapse
Affiliation(s)
- Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Anna Maisano
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Alessandro Albini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vincenzo L Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy..
| |
Collapse
|
35
|
Arbelo E, Aktaa S, Bollmann A, D'Avila A, Drossart I, Dwight J, Hills MT, Hindricks G, Kusumoto FM, Lane DA, Lau DH, Lettino M, Lip GYH, Lobban T, Pak HN, Potpara T, Saenz LC, Van Gelder IC, Varosy P, Gale CP, Dagres N, Boveda S, Deneke T, Defaye P, Conte G, Lenarczyk R, Providencia R, Guerra JM, Takahashi Y, Pisani C, Nava S, Sarkozy A, Glotzer TV, Martins Oliveira M. Quality indicators for the care and outcomes of adults with atrial fibrillation. Europace 2021; 23:494-495. [PMID: 32860039 DOI: 10.1093/europace/euaa253] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS To develop quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). METHODS AND RESULTS We followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of AF care for the diagnosis and management of AF (by a group of experts including members of the ESC Clinical Practice Guidelines Task Force for AF); (ii) the construction of candidate QIs (including a systematic review of the literature); and (iii) the selection of the final set of QIs (using a modified Delphi method). Six domains of care for the diagnosis and management of AF were identified: (i) Patient assessment (baseline and follow-up), (ii) Anticoagulation therapy, (iii) Rate control strategy, (iv) Rhythm control strategy, (v) Risk factor management, and (vi) Outcomes measures, including patient-reported outcome measures (PROMs). In total, 17 main and 17 secondary QIs, which covered all six domains of care for the diagnosis and management of AF, were selected. The outcome domain included measures on the consequences and treatment of AF, as well as PROMs. CONCLUSION This document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes), and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.
Collapse
Affiliation(s)
| | | | - Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | - André D'Avila
- Cardiac Arrhythmia Service, Hospital SOS Cardio, Florianopolis, SC, Brazil; Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Inga Drossart
- European Society of Cardiology, Sophia Antipolis, France; ESC Patient Forum, Sophia Antipolis, France
| | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | - Fred M Kusumoto
- Cardiology Department, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maddalena Lettino
- Cardiovascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Trudie Lobban
- Arrhythmia Alliance/AF Association/STARS, Chipping Norton, UK
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Luis C Saenz
- Fundación Cardio Infantil-Instituto de Cardiología, Bogotá, Colombia
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Paul Varosy
- Rocky Mountain Regional Veterans Affairs Medical Center and the University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, 31076 Toulouse, France
| | | | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Centre RHÖN-KLINIKUM Campus Bad Neustadt, Germany
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Radoslaw Lenarczyk
- First Department of Cardiology and Angiology, Silesian Centre for Heart Disease, Curie-Sklodowskiej Str 9, 41-800 Zabrze, Poland
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK and Institute of Health Informatics, University College of London, London, UK
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Yoshihide Takahashi
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Santiago Nava
- Head of Electrocardiology Department, Instituto Nacional de Cardiologia 'Ignacio Chavez', Mexico
| | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - Taya V Glotzer
- Hackensack Meridian-Seton Hall School of Medicine, Rutgers New Jersey Medical School; Director of Cardiac Research, Hackensack University Medical Center, Hackensack, USA
| | - Mario Martins Oliveira
- Hospital Santa Marta, Department of Cardiology, Rua Santa Marta, 1167-024 Lisbon, Portugal
| |
Collapse
|
36
|
Chu SY, Jiang J, Wang YL, Sheng QH, Zhou J, Ding YS. Atrial Fibrillation Burden Detected by Dual-Chamber Pacemakers as a Predictor for Cardiac Outcomes: A Retrospective Single-Center Cohort Study. Front Cardiovasc Med 2021; 8:654532. [PMID: 34250036 PMCID: PMC8267005 DOI: 10.3389/fcvm.2021.654532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Atrial fibrillation (AF) might lead to adverse cardiac consequences. The association between AF burden and cardiac prognosis is unknown. Methods and Results: This retrospective cohort study enrolled 204 patients (117 males; age 74.5 ± 11.5 years) who underwent dual-chamber pacemaker implantation in our center from October 2003 to May 2017. During a median follow-up of 66.5 months, AF could be detected in 153 (75%) of the 204 pacemaker patients. Primary endpoint events (composite cardiac readmission, stroke or systemic embolism, and all-cause death) occurred in 83 cases (40.7%). In logistic regression analysis, AF detection was associated with increased risks of composite endpoints [odds ratio (OR) = 2.9, 95% confidence interval (CI): 1.3-6.2, p = 0.007], and the hazard was mainly driven by increased cardiac readmission (OR = 2.2, 95% CI: 1.1-4.7, p = 0.034). No significantly elevated risk for new-onset stroke, systemic embolism, or deaths were found in patients with AF detected than those without AF recorded. AF duration grade of more than 6 min suggested progressively increased composite endpoints (OR = 1.8, 95% CI: 1.2-2.7, p for trend = 0.005), cardiac readmission (OR = 1.8, 95% CI: 1.2-2.7, p for trend = 0.005), especially heart failure or acute coronary syndrome-associated readmission (OR = 1.8, 95% CI: 1.2-2.9, p for trend = 0.010), than those with shorter (<6 min) or no AF episodes. Kaplan-Meier analyses and Cox regression also suggested that episodes of AF more than 6 min predicted future cardiac events. Conclusions: AF detected by pacemakers were common. Higher AF burden predicted more adverse cardiac outcomes and might suggest the intervention of rhythm control in these population.
Collapse
Affiliation(s)
- Song-Yun Chu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yu-Ling Wang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Qin-Hui Sheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jing Zhou
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan-Sheng Ding
- Department of Cardiology, Peking University First Hospital, Beijing, China
| |
Collapse
|
37
|
Elkind MSV, Wachter R, Verma A, Kowey PR, Halperin JL, Gersh BJ, Ziegler PD, Pouliot E, Franco N, Reiffel JA. Use of the HAVOC Score to Identify Patients at Highest Risk of Developing Atrial Fibrillation. Cardiology 2021; 146:633-640. [PMID: 34157712 DOI: 10.1159/000517827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/13/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, New York, USA
| | - Rolf Wachter
- University Hospital Leipzig, Leipzig, Germany
- University Medicine Göttingen and German Cardiovascular Research Center, Göttingen, Germany
| | - Atul Verma
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | - Peter R Kowey
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
38
|
O'Shea CJ, Middeldorp ME, Thomas G, Harper C, Elliott AD, Ray N, Campbell K, Lau DH, Sanders P. Atrial fibrillation burden during the coronavirus disease 2019 pandemic. Europace 2021; 23:1493-1501. [PMID: 34077513 PMCID: PMC8195127 DOI: 10.1093/europace/euab099] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/30/2021] [Indexed: 01/14/2023] Open
Abstract
Aims The aim of this study is to determine the association between the coronavirus disease 2019 (COVID-19) pandemic and atrial fibrillation (AF) occurrence in individuals with cardiac implantable electronic devices (CIEDs). Method and results Multi-centre, observational, cohort study over a 100-day period during the COVID-19 pandemic (COVID-19) in the USA. Remote monitoring was used to assess AF episodes in patients with a CIED (pacemaker or defibrillator; 20 centres, 13 states). For comparison, the identical 100-day period in 2019 was used (Control). The primary outcomes were the AF burden during the COVID-19 pandemic, and the association of the pandemic with AF occurrence, as compared with 1 year prior. The secondary outcome was the association of AF occurrence with per-state COVID-19 prevalence. During COVID-19, 10 346 CIEDs with an atrial lead were monitored. There were 16 570 AF episodes of ≥6 min transmitted (16 events per 1000 patient days) with a significant increase in proportion of patients with AF episodes in high COVID-19 prevalence states compared with low prevalence states [odds ratio 1.34, 95% confidence interval (CI) 1.21–1.48, P < 0.001]. There were significantly more AF episodes during COVID-19 compared with Control [incident rate ratio (IRR) 1.33, 95% CI 1.25–1.40, P < 0.001]. This relationship persisted for AF episodes ≥1 h (IRR 1.65, 95% CI 1.53–1.79, P < 0.001) and ≥6 h (IRR 1.54, 95% CI 1.38–1.73, P < 0.001). Conclusion During the first 100 days of COVID-19, a 33% increase in AF episodes occurred with a 34% increase in the proportion of patients with AF episodes observed in states with higher COVID-19 prevalence. These findings suggest a possible association between pandemic-associated social disruptions and AF in patients with CIEDs. Clinical TRIAL registration Australian New Zealand Clinical Trial Registry: ACTRN12620000692932.
Collapse
Affiliation(s)
- Catherine J O'Shea
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Department of Cardiology, Port Road, Adelaide, South Australia, 5000, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Department of Cardiology, Port Road, Adelaide, South Australia, 5000, Australia
| | - Gijo Thomas
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia
| | | | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia
| | | | - Kevin Campbell
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Pacemate, Bradenton, FL, USA
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Department of Cardiology, Port Road, Adelaide, South Australia, 5000, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Department of Cardiology, Port Road, Adelaide, South Australia, 5000, Australia
| |
Collapse
|
39
|
Eckardt L, Wolfes J, Ellermann C. ESC-Leitlinie 2020 zum Vorhofflimmern: Was ist neu, was ist wichtig, was ist zu tun? AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1464-0646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDie aktuelle, 2020 erschienene Leitlinie der Europäischen Gesellschaft für Kardiologie zum
Management von Vorhofflimmern gibt eine sehr gute Übersicht und aktuelle Empfehlungen zur
Diagnostik und Therapie von Vorhofflimmern. Als Neuerung wurde das 4S-AF-Schema zur
Charakterisierung von Vorhofflimmern eingeführt. Es berücksichtigt das Schlaganfallrisiko, den
Schweregrad der Symptome, das Ausmaß der Vorhofflimmerlast und das elektrophysiologische
Substrat. Außerdem wurde mit dem ABC-Modell ein einprägsamer Therapieleitfaden eingeführt. Er
soll die strukturierte Behandlung von Patienten mit Vorhofflimmern erleichtern und umfasst die
Themen Antikoagulation/Schlaganfallprävention, bessere Symptomkontrolle und das Management
kardiovaskulärer Risikofaktoren sowie vorhandener Begleiterkrankungen. Die Empfehlungen zur
Antikoagulation und medikamentösen antiarrhythmischen Therapie haben sich in den aktuellen
Leitlinien nicht wesentlich geändert, wohingegen die Indikation zur Katheterablation
heraufgestuft wurde.
Collapse
Affiliation(s)
- Lars Eckardt
- Klinik für Kardiologie II – Rhythmologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Julian Wolfes
- Klinik für Kardiologie II – Rhythmologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Christian Ellermann
- Klinik für Kardiologie II – Rhythmologie, Universitätsklinikum Münster, Münster, Deutschland
| |
Collapse
|
40
|
Garweg C, Khelae SK, Chan JYS, Chinitz L, Ritter P, Johansen JB, Sagi V, Epstein LM, Piccini JP, Pascual M, Mont L, Willems R, Splett V, Stromberg K, Sheldon T, Kristiansen N, Steinwender C. Behavior of AV synchrony pacing mode in a leadless pacemaker during variable AV conduction and arrhythmias. J Cardiovasc Electrophysiol 2021; 32:1947-1957. [PMID: 33928713 PMCID: PMC8360010 DOI: 10.1111/jce.15061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Introduction MARVEL 2 assessed the efficacy of mechanical atrial sensing by a ventricular leadless pacemaker, enabling a VDD pacing mode. The behavior of the enhanced MARVEL 2 algorithm during variable atrio‐ventricular conduction (AVC) and/or arrhythmias has not been characterized and is the focus of this study. Methods Of the 75 patients enrolled in the MARVEL 2 study, 73 had a rhythm assessment and were included in the analysis. The enhanced MARVEL 2 algorithm included a mode‐switching algorithm that automatically switches between VDD and ventricular only antibradycardia pacing (VVI)‐40 depending upon AVC status. Results Forty‐two patients (58%) had persistent third degree AV block (AVB), 18 (25%) had 1:1 AVC, 5 (7%) had variable AVC status, and 8 (11%) had atrial arrhythmias. Among the 42 patients with persistent third degree AVB, the median ventricular pacing (VP) percentage was 99.9% compared to 0.2% among those with 1:1 AVC. As AVC status changed, the algorithm switched to VDD when the ventricular rate dropped less than 40 bpm. During atrial fibrillation (AF) with ventricular response greater than 40 bpm, VVI‐40 mode was maintained. No pauses longer than 1500 ms were observed. Frequent ventricular premature beats reduced the percentage of AV synchrony. During AF, the atrial signal was of low amplitude and there was infrequent sensing. Conclusion The mode switching algorithm reduced VP in patients with 1:1 AVC and appropriately switched to VDD during AV block. No pacing safety issues were observed during arrhythmias.
Collapse
Affiliation(s)
- Christophe Garweg
- Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Surinder Kaur Khelae
- Department of Electrophysiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Joseph Yat Sun Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Philippe Ritter
- Department of Electrophysiology and Cardiac Stimulation, Hôpital Haut- Lévêque-CHU de Bordeaux, Pessac, France
| | | | - Venkata Sagi
- Baptist Heart Specialists, Baptist Medical Center, Jacksonville, Florida, USA
| | - Laurence M Epstein
- Department of Electrophysiology, North Shore University Hospital, Manhasset, New York, USA
| | - Jonathan P Piccini
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Mario Pascual
- Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, Florida, USA
| | - Lluis Mont
- Institut Clinic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Rik Willems
- Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | | | | | | | | | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria.,Department of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| |
Collapse
|
41
|
Sandgren E, Wickbom A, Kalm T, Ahlsson A, Edvardsson N, Engdahl J. The contribution of intermittent handheld electrocardiogram and continuous electrocardiogram monitoring with an implantable loop recorder to detect incident and recurrent atrial fibrillation during 1 year after coronary artery bypass graft surgery: A prospective cohort study. Heart Rhythm O2 2021; 2:247-254. [PMID: 34337575 PMCID: PMC8322816 DOI: 10.1016/j.hroo.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Atrial fibrillation (AF) is common after coronary artery bypass graft (CABG) surgery. Objective To evaluate the incidence and recurrence rate of AF during 1 year after CABG surgery. We also aimed at calculating the AF burden and compare long-term intermittent vs continuous electrocardiogram (ECG) monitoring. Methods Forty patients scheduled for CABG surgery were equipped with an implantable loop recorder (ILR). After discharge, they carried out handheld ECG 3 times daily during the first 30 postoperative days and during 2 weeks at 3 and 12 months. During hospital stay they were monitored with telemetry. Results Altogether 27 of 40 (68%) patients were diagnosed with AF, 24 during the first month (21 in-hospital and 3 after discharge) and 3 during months 2–12. Three patients progressed into persistent AF. In addition, 17 patients had AF recurrence, 9 of them after the first 30 days. In patients with paroxysmal AF, the AF burden was low, 0.1% (interquartile range [IQR] 0.02%–0.3%). Patients with AF had higher CHA2DS2-VASc scores than non-AF patients: median 4 (IQR 3–4) and 3 (IQR 2–3.5), respectively, P = .006. The handheld ECG identified 45% (9/20) of the patients with AF episodes identified with continuous ECG monitoring with the ILR after discharge from hospital, P = .001. Conclusions Patients with AF during the postoperative hospitalization showed a high likelihood of recurrent AF, usually within 30 days. Continuous ECG monitoring with an ILR was superior to the handheld ECG for detecting patients with AF. The AF burden was low.
Collapse
Affiliation(s)
- Emma Sandgren
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.,Department of Medicine, Halland Hospital Varberg, Varberg, Sweden
| | - Anders Wickbom
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Torbjörn Kalm
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Anders Ahlsson
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Nils Edvardsson
- Sahlgrenska Academy at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Engdahl
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|
42
|
Gladstone DJ, Wachter R, Schmalstieg-Bahr K, Quinn FR, Hummers E, Ivers N, Marsden T, Thornton A, Djuric A, Suerbaum J, von Grünhagen D, McIntyre WF, Benz AP, Wong JA, Merali F, Henein S, Nichol C, Connolly SJ, Healey JS. Screening for Atrial Fibrillation in the Older Population: A Randomized Clinical Trial. JAMA Cardiol 2021; 6:558-567. [PMID: 33625468 DOI: 10.1001/jamacardio.2021.0038] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Atrial fibrillation (AF) is a major cause of preventable strokes. Screening asymptomatic individuals for AF may increase anticoagulant use for stroke prevention. Objective To evaluate 2 home-based AF screening interventions. Design, Setting, and Participants This multicenter randomized clinical trial recruited individuals from primary care practices aged 75 years or older with hypertension and without known AF. From April 5, 2015, to March 26, 2019, 856 participants were enrolled from 48 practices. Interventions The control group received standard care (routine clinical follow-up plus a pulse check and heart auscultation at baseline and 6 months). The screening group received a 2-week continuous electrocardiographic (cECG) patch monitor to wear at baseline and at 3 months, in addition to standard care. The screening group also received automated home blood pressure (BP) machines with oscillometric AF screening capability to use twice-daily during the cECG monitoring periods. Main Outcomes and Measures With intention-to-screen analysis, the primary outcome was AF detected by cECG monitoring or clinically within 6 months. Secondary outcomes included anticoagulant use, device adherence, and AF detection by BP monitors. Results Of the 856 participants, 487 were women (56.9%); mean (SD) age was 80.0 (4.0) years. Median cECG wear time was 27.4 of 28 days (interquartile range [IQR], 18.4-28.0 days). In the primary analysis, AF was detected in 23 of 434 participants (5.3%) in the screening group vs 2 of 422 (0.5%) in the control group (relative risk, 11.2; 95% CI, 2.7-47.1; P = .001; absolute difference, 4.8%; 95% CI, 2.6%-7.0%; P < .001; number needed to screen, 21). Of those with cECG-detected AF, median total time spent in AF was 6.3 hours (IQR, 4.2-14.0 hours; range 1.3 hours-28 days), and median duration of the longest AF episode was 5.7 hours (IQR, 2.9-12.9 hours). Anticoagulation was initiated in 15 of 20 patients (75.0%) with cECG-detected AF. By 6 months, anticoagulant therapy had been prescribed for 18 of 434 participants (4.1%) in the screening group vs 4 of 422 (0.9%) in the control group (relative risk, 4.4; 95% CI, 1.5-12.8; P = .007; absolute difference, 3.2%; 95% CI, 1.1%-5.3%; P = .003). Twice-daily AF screening using the home BP monitor had a sensitivity of 35.0% (95% CI, 15.4%-59.2%), specificity of 81.0% (95% CI, 76.7%-84.8%), positive predictive value of 8.9% (95% CI, 4.9%-15.5%), and negative predictive value of 95.9% (95% CI, 94.5%-97.0%). Adverse skin reactions requiring premature discontinuation of cECG monitoring occurred in 5 of 434 participants (1.2%). Conclusions and Relevance In this randomized clinical trial, among older community-dwelling individuals with hypertension, AF screening with a wearable cECG monitor was well tolerated, increased AF detection 10-fold, and prompted initiation of anticoagulant therapy in most cases. Compared with continuous ECG, intermittent oscillometric screening with a BP monitor was an inferior strategy for detecting paroxysmal AF. Large trials with hard clinical outcomes are now needed to evaluate the potential benefits and harms of AF screening. Trial Registration ClinicalTrials.gov Identifier: NCT02392754.
Collapse
Affiliation(s)
- David J Gladstone
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, and Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital, Leipzig, Germany.,Department of Cardiology, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Katharina Schmalstieg-Bahr
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.,Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - F Russell Quinn
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Eva Hummers
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Noah Ivers
- Women's College Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tamara Marsden
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Thornton
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Angie Djuric
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Johanna Suerbaum
- Department of Cardiology, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Doris von Grünhagen
- Clinic for Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
| | - William F McIntyre
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alexander P Benz
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jorge A Wong
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | - Sam Henein
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Chris Nichol
- Camrose Primary Care Network, Camrose, Alberta, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
43
|
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
44
|
Maines M, Tomasi G, Moggio P, Poian L, Peruzza F, Catanzariti D, Angheben C, Cont N, Valsecchi S, Del Greco M. Scheduled versus alert transmissions for remote follow-up of cardiac implantable electronic devices: Clinical relevance and resource consumption. Int J Cardiol 2021; 334:49-54. [PMID: 33930512 DOI: 10.1016/j.ijcard.2021.04.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The remote follow-up of pacemakers and implantable cardiac defibrillators (ICDs) usually includes scheduled checks and alert transmissions. However, this results in a high volume of remote data reviews to be managed. We measured the relative contribution of scheduled and alert transmissions to the detection of relevant conditions, and the workload generated by their management. METHODS At our center, the frequency of remote scheduled transmissions is 4/year. Moreover, all system-integrity and clinical alerts are turned on for wireless notification. We calculated the number of transmissions received from January to December 2020, and identified transmissions that necessitated in-hospital access for further assessment and transmissions that required clinical discussion with the physician. For all alert transmissions, we identified whether the alert was clinically meaningful (i.e. center was not previously aware of the condition and no action had yet been taken to treat it). RESULTS Of 8545 transmissions received from 1697 pacemakers and ICDs, 5766 (67%) were scheduled and 2779 (33%) were alert transmissions received from 764 patients (45%); 499 (9%) scheduled transmissions required clinical discussion with the physician, but only 2 of these necessitated in-hospital visits for further assessment. Of the alert transmissions, 664 (24%) required clinical discussion, and 75 (3%) necessitated in-hospital visits. The proportion of alerts judged clinically meaningful was 7%. CONCLUSION Scheduled transmissions generate 67% of remote data reviews for pacemakers and ICDs, but their ability to detect clinically relevant events is very low. A strategy that relies exclusively on alert transmissions could ensure continuity of patient monitoring while reducing the workload at the center.
Collapse
Affiliation(s)
| | | | - Paolo Moggio
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | - Luisa Poian
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | | | | | | | - Natascia Cont
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | | | | |
Collapse
|
45
|
Boriani G, Vitolo M, Diemberger I, Proietti M, Valenti AC, Malavasi VL, Lip GYH. Optimizing indices of AF susceptibility and burden to evaluate AF severity, risk and outcomes. Cardiovasc Res 2021; 117:1-21. [PMID: 33913486 PMCID: PMC8707734 DOI: 10.1093/cvr/cvab147] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/15/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) has heterogeneous patterns of presentation concerning symptoms,
duration of episodes, AF burden, and the tendency to progress towards the terminal step of
permanent AF. AF is associated with a risk of stroke/thromboembolism traditionally
considered dependent on patient-level risk factors rather than AF type, AF burden, or
other characterizations. However, the time spent in AF appears related to an incremental
risk of stroke, as suggested by the higher risk of stroke in patients with clinical AF vs.
subclinical episodes and in patients with non-paroxysmal AF vs. paroxysmal AF. In patients
with device-detected atrial tachyarrhythmias, AF burden is a dynamic process with
potential transitions from a lower to a higher maximum daily arrhythmia burden, thus
justifying monitoring its temporal evolution. In clinical terms, the appearance of the
first episode of AF, the characterization of the arrhythmia in a specific AF type, the
progression of AF, and the response to rhythm control therapies, as well as the clinical
outcomes, are all conditioned by underlying heart disease, risk factors, and
comorbidities. Improved understanding is needed on how to monitor and modulate the effect
of factors that condition AF susceptibility and modulate AF-associated outcomes. The
increasing use of wearables and apps in practice and clinical research may be useful to
predict and quantify AF burden and assess AF susceptibility at the individual patient
level. This may help us reveal why AF stops and starts again, or why AF episodes, or
burden, cluster. Additionally, whether the distribution of burden is associated with
variations in the propensity to thrombosis or other clinical adverse events. Combining the
improved methods for data analysis, clinical and translational science could be the basis
for the early identification of the subset of patients at risk of progressing to a longer
duration/higher burden of AF and the associated adverse outcomes.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinico Scientifici Maugeri, Milan, Italy
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
46
|
Engdahl J, Rosenqvist M. Large-scale screening studies for atrial fibrillation - is it worth the effort? J Intern Med 2021; 289:474-492. [PMID: 33411987 PMCID: PMC8048511 DOI: 10.1111/joim.13217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) is a common disease with increasing prevalence, approximately 3.2% in the adult population. In addition, about one third of AF cases are considered asymptomatic. Due to increased longevity, increased detection and increased prevalence of risk factors, the prevalence of AF is expected to at least double by the year 2060. Patients with AF have an increased risk for ischaemic stroke, heart failure, death and cognitive decline. Treatment with oral anticoagulation reduces the risk of ischaemic stroke and mortality, and the effect on cognitive decline is being studied. Based on the increasing prevalence of AF, its often asymptomatic and paroxysmal presentation and the efficacy of oral anticoagulation treatment, screening for AF has been proposed. AF seems to fulfil most of the Wilson-Jungner criteria for screening issued by the World Health Organization, but some knowledge gaps remain, gaps that will be addressed by several ongoing studies. The knowledge gaps in AF screening consist of the magnitude of the net benefit or net harm inflicted by AF screening because the oral anticoagulation treatment will also increase the risk of bleeding, and the psychological effects of AF screening are not very well studied. So far, the AF screening recommendations issued by the European Society of Cardiology have had limited impact on national and regional AF screening activities. Several large-scale AF screening studies will report results on hard endpoints within the next few years, and these results will hopefully manifest AF as a cardiovascular disease which we need to pay more attention to.
Collapse
Affiliation(s)
- J Engdahl
- From the, Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
| | - M Rosenqvist
- From the, Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
| |
Collapse
|
47
|
Heijman J, Luermans JGLM, Linz D, van Gelder IC, Crijns HJGM. Risk Factors for Atrial Fibrillation Progression. Card Electrophysiol Clin 2021; 13:201-209. [PMID: 33516398 DOI: 10.1016/j.ccep.2020.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atrial fibrillation is a chronic, progressive condition that presents a major health burden. This review summarizes recent studies assessing atrial fibrillation progression and its associated risk factors, describes the mechanisms underlying atrial fibrillation progression, and discusses the clinical implications of the progressive nature of atrial fibrillation. Progression of atrial fibrillation burden, and clinical progression from paroxysmal to more advanced (persistent/permanent) forms is common, but progression rates are variable. Atrial fibrillation progression parallels progressive atrial remodeling induced by atrial fibrillation risk factors and atrial fibrillation itself, and is associated with worse clinical outcomes.
Collapse
Affiliation(s)
- Jordi Heijman
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 5800, Maastricht 6202 AZ, The Netherlands. https://twitter.com/JordiHeijman
| | - Justin G L M Luermans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 5800, Maastricht 6202 AZ, The Netherlands. https://twitter.com/JLuermans
| | - Dominik Linz
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 5800, Maastricht 6202 AZ, The Netherlands. https://twitter.com/Dominik_Linz
| | - Isabelle C van Gelder
- Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
| |
Collapse
|
48
|
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 4923] [Impact Index Per Article: 1641.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
49
|
Abstract
PURPOSE OF REVIEW Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended as part of the individualized multidisciplinary follow-up of heart failure (HF) patients. Aim of this article is to critically review recent findings on RM, highlighting potential benefits and barriers to its implementation. RECENT FINDINGS Device-based RM is useful in the early detection of CIEDs technical issues and cardiac arrhythmias. Moreover, RM allows the continuous monitoring of several patients' clinical parameters associated with impending HF decompensation, but there is still uncertainty regarding its effectiveness in reducing mortality and hospitalizations. Implementation of RM strategies, together with a proactive physicians' attitude towards clinical actions in response to RM data reception, will make RM a more valuable tool, potentially leading to better outcomes.
Collapse
|
50
|
Abstract
Atrial high rate episodes (AHREs) are defined as asymptomatic atrial tachyarrhythmias detected by cardiac implantable electronic devices with atrial sensing, providing automated continuous monitoring and tracings storage, occurring in subjects with no previous clinical atrial fibrillation (AF) and with no AF detected at conventional electrocardiogram recordings. AHREs are associated with an increased thrombo-embolic risk, which is not negligible, although lower than that of clinical AF. The thrombo-embolic risk increases with increasing burden of AHREs, and moreover, AHREs burden shows a dynamic pattern, with tendency to progression along with time, with potential transition to clinical AF. The clinical management of AHREs, in particular with regard to prophylactic treatment with oral anticoagulants (OACs), remains uncertain and heterogeneous. At present, in patients with confirmed AHREs, as a result of device tracing analysis, an integrated, individual and clinically-guided assessment should be applied, taking into account the patients’ risk of stroke (to be reassessed regularly) and the AHREs burden. The use of OACs, preferentially non-vitamin K antagonists OACs, may be justified in selected patients, such as those with longer AHREs durations (in the range of several hours or ≥24 h), with no doubts on AF diagnosis after device tracing analysis and with an estimated high/very high individual risk of stroke, accounting for the anticipated net clinical benefit, and informed patient’s preferences. Two randomized clinical trials on this topic are currently ongoing and are likely to better define the role of anticoagulant therapy in patients with AHREs.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
- Corresponding author. Tel: +39 059 4225836, Fax: +39 059 4224498,
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, dr Subotica 8, 11000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Visegradska 26, 11000 Belgrade, Serbia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| |
Collapse
|