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Soliman EZ, Chen LY. To Screen or Not to Screen for Atrial Fibrillation in Patients With Hypertension, That Is Not the Question. Hypertension 2024; 81:1489-1490. [PMID: 38865474 DOI: 10.1161/hypertensionaha.124.23078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Affiliation(s)
- Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC. Lillehei Heart Institute and Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Lin Yee Chen
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC. Lillehei Heart Institute and Department of Medicine, University of Minnesota Medical School, Minneapolis
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Chaudhary R, Nourelahi M, Thoma FW, Gellad WF, Lo-Ciganic WH, Bliden KP, Gurbel PA, Neal MD, Jain SK, Bhonsale A, Mulukutla SR, Wang Y, Harinstein ME, Saba S, Visweswaran S. Machine Learning - Based Bleeding Risk Predictions in Atrial Fibrillation Patients on Direct Oral Anticoagulants. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.27.24307985. [PMID: 38854094 PMCID: PMC11160827 DOI: 10.1101/2024.05.27.24307985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Importance Accurately predicting major bleeding events in non-valvular atrial fibrillation (AF) patients on direct oral anticoagulants (DOACs) is crucial for personalized treatment and improving patient outcomes, especially with emerging alternatives like left atrial appendage closure devices. The left atrial appendage closure devices reduce stroke risk comparably but with significantly fewer non-procedural bleeding events. Objective To evaluate the performance of machine learning (ML) risk models in predicting clinically significant bleeding events requiring hospitalization and hemorrhagic stroke in non-valvular AF patients on DOACs compared to conventional bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) at the index visit to a cardiologist for AF management. Design Prognostic modeling with retrospective cohort study design using electronic health record (EHR) data, with clinical follow-up at one-, two-, and five-years. Setting University of Pittsburgh Medical Center (UPMC) system. Participants 24,468 non-valvular AF patients aged ≥18 years treated with DOACs, excluding those with prior history of significant bleeding, other indications for DOACs, on warfarin or contraindicated to DOACs. Exposures DOAC therapy for non-valvular AF. Main Outcomes and Measures The primary endpoint was clinically significant bleeding requiring hospitalization within one year of index visit. The models incorporated demographic, clinical, and laboratory variables available in the EHR at the index visit. Results Among 24,468 patients, 553 (2.3%) had bleeding events within one year, 829 (3.5%) within two years, and 1,292 (5.8%) within five years of index visit. We evaluated multivariate logistic regression and ML models including random forest, classification trees, k-nearest neighbor, naive Bayes, and extreme gradient boosting (XGBoost) which modestly outperformed HAS-BLED, ATRIA, and ORBIT scores in predicting clinically significant bleeding at 1-year follow-up. The best performing model (random forest) showed area under the curve (AUC-ROC) 0.76 (0.70-0.81), G-Mean score of 0.67, net reclassification index 0.14 compared to 0.57 (0.50-0.63), G-Mean score of 0.57 for HASBLED score, p-value for difference <0.001. The ML models had improved performance compared to conventional risk across time-points of 2-year and 5-years and within the subgroup of hemorrhagic stroke. SHAP analysis identified novel risk factors including measures from body mass index, cholesterol profile, and insurance type beyond those used in conventional risk scores. Conclusions and Relevance Our findings demonstrate the superior performance of ML models compared to conventional bleeding risk scores and identify novel risk factors highlighting the potential for personalized bleeding risk assessment in AF patients on DOACs.
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Shao JM, Shen B, Zhou ZX, D’Angelo L, James SM, Lin JF, Zheng C. Bilirubin Elevation During Hospitalization Post Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation: Variation Trend, Related Factors, and Relevance to 1-Year Recurrence. Clin Interv Aging 2024; 19:817-825. [PMID: 38765794 PMCID: PMC11102068 DOI: 10.2147/cia.s461832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
Background The role of total bilirubin (TBIL) in cardiovascular disease has been increasingly recognized in recent decades. Studies have shown a correlation between total bilirubin levels and the prognosis of patients after heart surgery. This study aimed to investigate the clinical significance of bilirubin elevation in persistent atrial fibrillation (PAF) patients who received radiofrequency catheter ablation (RFCA). Methods and Results A total of 184 patients with PAF who received RFCA were retrospectively studied. Laboratory examinations and demographic data were analyzed to identify independent predictors of TBIL elevation. The relationship between TBIL and prognosis was further investigated. Our results indicated that TBIL increased significantly after RFCA. Multiple linear regression analysis showed that TBIL elevation owned a negative correlation with the percentile of low voltage areas (LVAs) in left atria (β=-0.490, P<0.001). In contrast, a positive correlation was observed with the white blood cell (WBC) ratio (β=0.153, P=0.042) and left atrial diameter (LAD) (β=0.232, P=0.025). It was found that postoperative TBIL levels increased and then gradually decreased to baseline within 5 days without intervention. The bilirubin ratio <1.211 indicated the possibility of 1-year AF recurrence after ablation with a predictive value of 0.743 (specificity = 75.00%, sensitivity = 66.67%). Conclusion Bilirubin elevation post PAF RFCA was a common phenomenon and was associated with 1-year recurrence of AF in PAF patients after RFCA.
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Affiliation(s)
- Jia-Meng Shao
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Bing Shen
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Zhi-Xiang Zhou
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Lucia D’Angelo
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Shea Michaela James
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Jia-Feng Lin
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Cheng Zheng
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
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Shouval R, Goldman A, Flynn JR, El-Moghraby A, Rehman M, Devlin SM, Corona M, Landego I, Lin RJ, Scordo M, Raj SS, Giralt SA, Palomba ML, Dahi PB, Walji M, Salles G, Nath K, Geyer MB, Park JH, Fein JA, Kosmidou I, Shah GL, Liu JE, Perales MA, Mahmood SS. Atrial arrhythmias following CAR-chimeric antigen receptor T-cell therapy: Incidence, risk factors and biomarker profile. Br J Haematol 2024. [PMID: 38735683 DOI: 10.1111/bjh.19497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
Recent reports have raised concerns about the association of chimeric antigen receptor T cell (CAR-T) with non-negligible cardiotoxicity, particularly atrial arrhythmias. First, we conducted a pharmacovigilance study to assess the reporting of atrial arrhythmias following CD19-directed CAR-T. Subsequently, to determine the incidence, risk factors and outcomes of atrial arrhythmias post-CAR-T, we compiled a retrospective single-centre cohort of non-Hodgkin lymphoma patients. Only commercial CAR-T products were considered. Atrial arrhythmias were nearly fourfold more likely to be reported after CAR-T therapy compared to all other cancer patients in the FAERS (adjusted ROR = 3.76 [95% CI 2.67-5.29]). Of the 236 patients in our institutional cohort, 23 (10%) developed atrial arrhythmias post-CAR-T, including 12 de novo arrhythmias, with most (83%) requiring medical intervention. Atrial arrhythmias frequently co-occurred with cytokine release syndrome and were associated with higher post-CAR-T infusion peak levels of IL-10, TNF-alpha and LDH, and lower trough levels of fibrinogen. In a multivariable analysis, risk factors for atrial arrhythmia were history of atrial arrhythmia (OR = 6.80 [2.39-19.6]) and using CAR-T product with a CD28-costimulatory domain (OR = 5.17 [1.72-18.6]). Atrial arrhythmias following CD19-CAR-T therapy are prevalent and associated with elevated inflammatory biomarkers, a history of atrial arrhythmia and the use of a CAR-T product with a CD28 costimulatory domain.
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Affiliation(s)
- Roni Shouval
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Adam Goldman
- Department of Internal Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Jessica R Flynn
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ahmed El-Moghraby
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mahin Rehman
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sean M Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Magdalena Corona
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ivan Landego
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, Section of Medical Oncology and Hematology, University of Manitoba, Manitoba, Canada
| | - Richard J Lin
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sandeep S Raj
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sergio A Giralt
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M Lia Palomba
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Parastoo B Dahi
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moneeza Walji
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Gilles Salles
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Karthik Nath
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark B Geyer
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jae H Park
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joshua A Fein
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ioanna Kosmidou
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gunjan L Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer E Liu
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Syed S Mahmood
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Cardio-Oncology Service, St. Francis Hospital & Heart Center, Catholic Health Services in Long Island, Roslyn, New York, USA
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Radauskaite G, Rackauskas G, Danilenko S, Janusauskas V, Aidietis A. Long-Term Results of the Mini Maze Standalone Bi-Atrial Surgical Ablation: A 10-Year Follow-Up. J Clin Med 2024; 13:2195. [PMID: 38673468 PMCID: PMC11050341 DOI: 10.3390/jcm13082195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: One way to treat atrial fibrillation is through surgical ablation. However, the literature only provides information on patient follow-up results for up to 5 years. Methods: In order to assess long-term monitoring data over ten years, this retrospective study included 58 patients with paroxysmal or persistent atrial fibrillation who underwent Mini Maze surgical ablation at Santaros Clinics between 1 February 2009 and 1 June 2014. The follow-up time after surgery was 144 ± 48 months. We evaluated the absence of atrial fibrillation, echocardiographic and clinical parameters, and EHRA score. Results: Sinus rhythm remained in 69.4%, 75.5%, 55.6%, and 44.1% of patients with paroxysmal AF, and 68,2%, 59.1%, 50%, and 41.9% of patients with persistent AF (p = 0.681). In the post-operative period, one patient (1.7%) had a transient ischemic attack, and another patient (1.7%) had a thoracotomy for post-operative bleeding. A total of 20% of patients were diagnosed with a post-operative respiratory tract infection. EHRA scores showed that patients' quality of life improved after they underwent Mini Maze surgical ablation. Conclusions: Despite AF recurrences after surgery, quality of life remains better than before surgery, showing that Mini Maze surgery is an effective and safe second-line treatment method for atrial fibrillation.
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Affiliation(s)
- Greta Radauskaite
- Department of Cardiovascular Medicine, Faculty of Medicine, Vilnius University, 01513 Vilniaus, Lithuania; (G.R.); (V.J.); (A.A.)
- Vilnius University Hospital Santaros Klinikos, 08661 Vilniaus, Lithuania
| | - Gediminas Rackauskas
- Department of Cardiovascular Medicine, Faculty of Medicine, Vilnius University, 01513 Vilniaus, Lithuania; (G.R.); (V.J.); (A.A.)
- Vilnius University Hospital Santaros Klinikos, 08661 Vilniaus, Lithuania
| | - Svetlana Danilenko
- Department of Mathematical Statistics, Vilnius Gediminas Technical University, 10223 Vilniaus, Lithuania;
| | - Vilius Janusauskas
- Department of Cardiovascular Medicine, Faculty of Medicine, Vilnius University, 01513 Vilniaus, Lithuania; (G.R.); (V.J.); (A.A.)
- Vilnius University Hospital Santaros Klinikos, 08661 Vilniaus, Lithuania
| | - Audrius Aidietis
- Department of Cardiovascular Medicine, Faculty of Medicine, Vilnius University, 01513 Vilniaus, Lithuania; (G.R.); (V.J.); (A.A.)
- Vilnius University Hospital Santaros Klinikos, 08661 Vilniaus, Lithuania
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Aldaas OM, Malladi C, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK, Hsu JC. Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy. J Interv Card Electrophysiol 2024; 67:639-648. [PMID: 37855992 PMCID: PMC11016003 DOI: 10.1007/s10840-023-01660-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) induces cell death through electroporation using ultrarapid electrical pulses. We sought to compare the procedural efficiency characteristics, safety, and efficacy of ablation of atrial fibrillation (AF) using PFA compared with thermal energy ablation. METHODS We performed an extensive literature search and systematic review of studies that compared ablation of AF with PFA versus thermal energy sources. Risk ratio (RR) 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where RR < 1 and MD < 0 favor the PFA group. RESULTS We included 6 comparative studies for a total of 1012 patients who underwent ablation of AF: 43.6% with PFA (n = 441) and 56.4% (n = 571) with thermal energy sources. There were significantly shorter procedures times with PFA despite a protocolized 20-min dwell time (MD - 21.95, 95% CI - 33.77, - 10.14, p = 0.0003), but with significantly longer fluroscopy time (MD 5.71, 95% CI 1.13, 10.30, p = 0.01). There were no statistically significant differences in periprocedural complications (RR 1.20, 95% CI 0.59-2.44) or recurrence of atrial tachyarrhythmias (RR 0.64, 95% CI 0.31, 1.34) between the PFA and thermal ablation cohorts. CONCLUSIONS Based on the results of this meta-analysis, PFA was associated with shorter procedural times and longer fluoroscopy times, but no difference in periprocedural complications or rates of recurrent AF when compared to ablation with thermal energy sources. However, larger randomized control trials are needed.
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Affiliation(s)
- Omar Mahmoud Aldaas
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Chaitanya Malladi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - David Krummen
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Ulrika Birgersdotter-Green
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA.
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of CA - San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
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Ahmed B, Bunch TJ. Editorial commentary: Adiposity, altered inflammatory pathways, and atrial fibrillation: Mechanistic links or an epiphenomenon? Trends Cardiovasc Med 2024; 34:159-160. [PMID: 36669546 DOI: 10.1016/j.tcm.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Bilal Ahmed
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States.
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Tsiachris D, Argyriou N, Tsioufis P, Antoniou CK, Laina A, Oikonomou G, Doundoulakis I, Kordalis A, Dimitriadis K, Gatzoulis K, Tsioufis K. Aggressive Rhythm Control Strategy in Atrial Fibrillation Patients Presenting at the Emergency Department: The HEROMEDICUS Study Design and Initial Results. J Cardiovasc Dev Dis 2024; 11:109. [PMID: 38667727 PMCID: PMC11049958 DOI: 10.3390/jcdd11040109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation has progressively become a more common reason for emergency department visits, representing 0.5% of presenting reasons. Registry data have indicated that about 60% of atrial fibrillation patients who present to the emergency department are admitted, emphasizing the need for more efficient management of atrial fibrillation in the acute phase. Management of atrial fibrillation in the setting of the emergency department varies between countries and healthcare systems. The most plausible reason to justify a conservative rather than an aggressive strategy in the management of atrial fibrillation is the absence of specific guidelines from diverse societies. Several trials of atrial fibrillation treatment strategies, including cardioversion, have demonstrated that atrial fibrillation in the emergency department can be treated safely and effectively, avoiding admission. In the present study, we present the epidemiology and characteristics of atrial fibrillation patients presenting to the emergency department, as well as the impact of diverse management strategies on atrial-fibrillation-related hospital admissions. Lastly, the design and initial data of the HEROMEDICUS protocol will be presented, which constitutes an electrophysiology-based aggressive rhythm control strategy in patients with atrial fibrillation in the emergency department setting.
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Affiliation(s)
- Dimitrios Tsiachris
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.A.); (P.T.); (C.K.A.); (A.L.); (G.O.); (A.K.); (K.D.); (K.G.); (K.T.)
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Almassi GH, Quin JA, Stock EM, DeMatt EJ, Biswas K, Hattler B, Tseng E, Zenati MA. Impact of Oral Anticoagulation on Clinical Outcomes in Postoperative Atrial Fibrillation. J Surg Res 2024; 295:122-130. [PMID: 38007859 DOI: 10.1016/j.jss.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/14/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION The impact of postoperative oral anticoagulation (OAC) with warfarin on postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) was the focus of this examination of patients from the randomized endo-vein graft prospective (REGROUP) Trial. MATERIAL AND METHODS REGROUP was a prospective randomized Veterans Affairs cooperative study comparing endoscopic versus open vein harvest in elective CABG patients (March 2014-April 2017) at 16 Veterans Affairs facilities. This study compared new-onset POAF patients who were treated with warfarin versus no-warfarin. Outcomes included stroke during active follow-up and a major adverse cardiac event composite of mortality, acute myocardial infarction, and repeat revascularization during active and passive follow-up. RESULTS Of the 316/1103 (28.6%) of REGROUP patients who developed new-onset POAF, 45 patients were excluded - mainly for preoperative warfarin use. Of the remaining 269 patients, 85 received OAC with warfarin (OAC group); 184 did not (no-OAC group). Stroke rates during active follow-up (32 [IQR 24-38] mo) were 3.5% OAC group versus 5.4% no-OAC group (P = 0.76); major adverse cardiac eventrates were 20% OAC versus 11.4% no-OAC (P = 0.06). On longer follow-up of (median 4.61 [IQR 3.9-5.1] y), discharge OAC use was associated with all-cause mortality after adjusting for Society of Thoracic Surgeons mortality risk (20.0% versus 11.4% no-OAC use; HR = 2.00, 95% CI: 1.05-3.81, P = 0.035). CONCLUSIONS REGROUP patients with POAF treated with OAC had similar stroke and higher mortality rates versus no-OAC patients. Further investigation of the risk-benefit ratio of OAC in post-CABG patients and which POAF patient subgroups might derive the most benefit with anticoagulation appears warranted.
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Affiliation(s)
- G Hossein Almassi
- Division of Cardiothoracic Surgery, Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, Wisconsin; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Jacquelyn A Quin
- Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eileen M Stock
- Cooperative Studies Program, Perry Point/Baltimore Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Ellen J DeMatt
- Cooperative Studies Program, Perry Point/Baltimore Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Kousick Biswas
- Cooperative Studies Program, Perry Point/Baltimore Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Brack Hattler
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Aurora, Colorado
| | - Elaine Tseng
- Cardiothoracic Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Surgery, University of California in San Francisco, San Francisco, California
| | - Marco A Zenati
- Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Kantharia BK. Heart failure and atrial fibrillation: Is atrial fibrillation ablation in heart failure pointless or mandatory? J Cardiovasc Electrophysiol 2024; 35:530-537. [PMID: 37548071 DOI: 10.1111/jce.16021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
A vast amount of now well-established clinical and epidemiological data indicates a close, interdependent, and symbiotic association between atrial fibrillation (AF) and heart failure (HF). Both AF and HF, when co-exist in a patient, have serious treatment and prognostic implications. Based on the prevailing knowledge of the topic, various societies have issued a number of guidelines regarding the management of patients with AF and HF. Overall, it is the rhythm control strategy that has shown beneficial effect over the rate control strategy with improvement in symptoms of AF and HF. While antiarrhythmic drugs (AADs) and catheter ablation (CA) may be utilized as rhythm control strategy for AF, both AADs and CA have limitations of their own. Furthermore, with the progress made in various pharmacotherapeutic agents in HF, one could question the utility of CA in HF (i.e., whether ablation is mandatory or pointless in patients who have HF). The purpose of this review is to discuss this very point, focusing on the beneficial, neutral, or detrimental outcome of CA based on the category and class of HF.
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Affiliation(s)
- Bharat K Kantharia
- Icahn School of Medicine at Mount Sinai, Cardiovascular and Heart Rhythm Consultants, New York, New York, USA
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11
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Grymonprez M, Petrovic M, De Backer TL, Steurbaut S, Lahousse L. The Impact of Polypharmacy on the Effectiveness and Safety of Non-vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Thromb Haemost 2024; 124:135-148. [PMID: 37369234 PMCID: PMC10824584 DOI: 10.1055/s-0043-1769735] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/17/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Polypharmacy may affect outcomes in patients with atrial fibrillation (AF) using non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) due to interactions or reduced adherence, but comparative data are lacking. Therefore, the impact of polypharmacy on AF-related outcomes and benefit-risk profiles of NOACs in patients with polypharmacy were investigated. METHODS AF patients initiating anticoagulation between 2013 and 2019 were included using Belgian nationwide data. Inverse probability of treatment weighted Cox regression was used to investigate outcomes. RESULTS Among 254,478 AF patients, 167,847 (66.0%) used ≥5 drugs. Polypharmacy was associated with higher stroke or systemic embolism (stroke/SE) (adjusted hazard ratio [aHR]: 1.08, 95% confidence interval [CI]: 1.02-1.15), all-cause mortality (aHR: 1.45, 95% CI: 1.40-1.50), and major bleeding risks (aHR: 1.29, 95% CI: 1.23-1.35). Among patients with polypharmacy, NOACs were associated with lower stroke/SE (aHR: 0.68, 95% CI: 0.63-0.73), all-cause mortality (aHR: 0.80, 95% CI: 0.77-0.84), major bleeding (aHR: 0.92, 95% CI: 0.87-0.97), and intracranial bleeding risks (aHR: 0.77, 95% CI: 0.69-0.85), but higher gastrointestinal bleeding risks (aHR: 1.10, 95% CI: 1.01-1.19) compared to VKAs. Major bleeding risks were lower with apixaban (aHR: 0.79, 95% CI: 0.74-0.85), but nonsignificantly different with other NOACs compared to VKAs. Lower major bleeding risks were observed with dabigatran (aHR: 0.91, 95% CI: 0.85-0.97) and apixaban (aHR: 0.77, 95% CI: 0.73-0.81) compared to rivaroxaban, and with apixaban compared to dabigatran (HR: 0.83, 95% CI: 0.77-0.90) and edoxaban (HR: 0.77, 95% CI: 0.70-0.85). CONCLUSION Polypharmacy was associated with increased thromboembolic, bleeding, and mortality risks in AF patients. NOACs had better benefit-risk profiles than VKAs in patients with polypharmacy.
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Affiliation(s)
- Maxim Grymonprez
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Stephane Steurbaut
- Centre for Pharmaceutical Research, Research group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
- Department of Hospital Pharmacy, UZ Brussel, Jette, Belgium
| | - Lies Lahousse
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, CA, The Netherlands
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12
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Kapoor A, Patel P, Chennupati S, Mbusa D, Sadiq H, Rampam S, Leung R, Miller M, Vargas KR, Fry P, Lowe MM, Catalano C, Harrison C, Catanzaro JN, Crawford S, Smith AM. Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study. JMIR Cardio 2024; 8:e49590. [PMID: 38265849 PMCID: PMC10851125 DOI: 10.2196/49590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The gap in anticoagulation use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal-based messaging linked to educational materials may help bridge this gap, but the most effective messaging approach is unknown. OBJECTIVE This study aims to compare the responsiveness of patients with AF to an AF or anticoagulation educational message between 2 portal messaging approaches: sending messages targeted at patients with upcoming outpatient appointments 1 week before their scheduled appointment (targeted) versus sending messages to all eligible patients in 1 blast, regardless of appointment scheduling status (blast), at 2 different health systems: the University of Massachusetts Chan Medical School (UMass) and the University of Florida College of Medicine-Jacksonville (UFL). METHODS Using the 2 approaches, we sent patient portal messages to patients with AF and grouped patients by high-risk patients on anticoagulation (group 1), high-risk patients off anticoagulation (group 2), and low-risk patients who may become eligible for anticoagulation in the future (group 3). Risk was classified based on the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age between 65 and 74 years, and sex category (CHA2DS2-VASc) score. The messages contained a link to the Upbeat website of the Heart Rhythm Society, which displays print and video materials about AF and anticoagulation. We then tracked message opening, review of the website, anticoagulation use, and administered patient surveys across messaging approaches and sites using Epic Systems (Epic Systems Corporation) electronic health record data and Google website traffic analytics. We then conducted chi-square tests to compare potential differences in the proportion of patients opening messages and other evaluation metrics, adjusting for potential confounders. All statistical analyses were performed in SAS (version 9.4; SAS Institute). RESULTS We sent 1686 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on anticoagulation (723/1156, 62.5% vs 382/668, 57.2%; P=.005) and trended the same in patients off anticoagulation; subsequent website reviews did not differ by messaging approach. More patients off anticoagulation at baseline started anticoagulation with the targeted approach than the blast approach (adjusted percentage 9.3% vs 2.1%; P<.001). CONCLUSIONS Patients were more responsive in terms of message opening and subsequent anticoagulation initiation with the targeted approach.
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Affiliation(s)
- Alok Kapoor
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- University of Massachusetts Memorial Health Care, Worcester, MA, United States
| | - Parth Patel
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Soumya Chennupati
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Daniel Mbusa
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Hammad Sadiq
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Sanjeev Rampam
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Robert Leung
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- University of Massachusetts Memorial Health Care, Worcester, MA, United States
| | - Megan Miller
- College of Pharmacy, University of Florida, Jacksonville, FL, United States
| | | | - Patrick Fry
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | | | - Christina Catalano
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | - Charles Harrison
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | | | - Sybil Crawford
- University of Massachusetts Chan Medical School, Worcester, MA, United States
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Desai R, Katukuri N, Goguri SR, Kothawala A, Alle NR, Bellamkonda MK, Dey D, Ganesan S, Biswas M, Sarkar K, Prattipati P, Chauhan S. Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients. World J Diabetes 2024; 15:24-33. [PMID: 38313858 PMCID: PMC10835500 DOI: 10.4239/wjd.v15.i1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/22/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events (MACCE). However, the relationship between prediabetes and MACCE in atrial fibrillation (AF) patients has not been extensively studied. Therefore, this study aimed to establish a link between prediabetes and MACCE in AF patients. AIM To investigate a link between prediabetes and MACCE in AF patients. METHODS We used the National Inpatient Sample (2019) and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes, excluding diabetics. The primary outcome was MACCE (all-cause inpatient mortality, cardiac arrest including ventricular fibrillation, and stroke) in AF-related hospitalizations. RESULTS Of the 2965875 AF-related hospitalizations for MACCE, 47505 (1.6%) were among patients with prediabetes. The prediabetes cohort was relatively younger (median 75 vs 78 years), and often consisted of males (56.3% vs 51.4%), blacks (9.8% vs 7.9%), Hispanics (7.3% vs 4.3%), and Asians (4.7% vs 1.6%) than the non-prediabetic cohort (P < 0.001). The prediabetes group had significantly higher rates of hypertension, hyperlipidemia, smoking, obesity, drug abuse, prior myocardial infarction, peripheral vascular disease, and hyperthyroidism (all P < 0.05). The prediabetes cohort was often discharged routinely (51.1% vs 41.1%), but more frequently required home health care (23.6% vs 21.0%) and had higher costs. After adjusting for baseline characteristics or comorbidities, the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort [18.6% vs 14.7%, odds ratio (OR) 1.34, 95% confidence interval 1.26-1.42, P < 0.001]. On subgroup analyses, males had a stronger association (aOR 1.43) compared to females (aOR 1.22), whereas on the race-wise comparison, Hispanics (aOR 1.43) and Asians (aOR 1.36) had a stronger association with MACCE with prediabetes vs whites (aOR 1.33) and blacks (aOR 1.21). CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients. Therefore, there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.
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Affiliation(s)
- Rupak Desai
- Independent Researcher, Independent Researcher, Atlanta, GA 30079, United States
| | - Nishanth Katukuri
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Sumaja Reddy Goguri
- Department of Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Telangana 505001, India
| | - Azra Kothawala
- Department of Medicine, Jawaharlal Nehru Medical College, Belgaum 590010, India
| | - Naga Ruthvika Alle
- Department of Medicine, Narayana Medical College, Andhra Pradesh, Nellore 524003, India
| | - Meena Kumari Bellamkonda
- Department of Medicine, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijaywada 521286, India
| | - Debankur Dey
- Department of Medicine, Medical College Kolkata, Kolkata 700073, India
| | - Sharmila Ganesan
- Department of Medicine, P.E.S. Institute of Medical Sciences and Research, Andhra Pradesh 517425, India
| | - Minakshi Biswas
- Department of Medicine, Shaheed Ziaur Rahman Medical College, Bogra 5800, Bangladesh
| | - Kuheli Sarkar
- Department of Medicine, College of Medicine and J.N.M Hospital, Kalyani 741235, India
| | - Pramoda Prattipati
- Department of Medicine, Jawaharlal Nehru Medical College India, Karnataka, Belagavi 590010, India
| | - Shaylika Chauhan
- Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States
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14
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Zhen S, Chu F, Kodesh A, Kim J. Ischaemic stroke in a patient with non-valvular atrial fibrillation (NVAF) despite non-vitamin K oral anticoagulant (NOAC) therapy. BMJ Case Rep 2024; 17:e258761. [PMID: 38199668 PMCID: PMC10806926 DOI: 10.1136/bcr-2023-258761] [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] [Indexed: 01/12/2024] Open
Abstract
Primary stroke prevention in non-valvular atrial fibrillation (NVAF) is primarily with non-vitamin K oral anticoagulant (NOAC) therapy. However, 20-36% of ischaemic strokes seem to occur in patients with atrial fibrillation while already on anticoagulation. We present a case of an ischaemic stroke in an elderly female in her 70s with medical history significant for hypertension and NVAF. She had a CHA2DS2-VASc score of 3 and was on apixaban for thromboprophylaxis. She presented with neurological deficits consistent with a left middle cerebral artery stroke, confirmed via head imaging; the most likely stroke aetiology was determined to be cardioembolic in the setting of NVAF. She was treated with continuation of her apixaban at the same dosage She displayed improved function, although with residual expressive aphasia at her 2-month neurology follow-up. Cardioembolic ischaemic stroke in NVAF despite current NOAC therapy does not have current management guidelines.
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Affiliation(s)
- Simon Zhen
- Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Fion Chu
- Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Afek Kodesh
- Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Jisoon Kim
- Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
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15
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Rajiah PS. Imaging Evaluation Following Transcatheter Left Atrial Appendage Closure. Semin Roentgenol 2024; 59:121-134. [PMID: 38388091 DOI: 10.1053/j.ro.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 02/24/2024]
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16
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Ikenouchi T, Miyazaki S, Nitta J, Sekiguchi Y, Kobori A, Nakamura K, Inamura Y, Murakami M, Sagawa Y, Sasaki Y, Inaba O, Yamauchi Y, Naito S, Hirakawa A, Sasano T. Characteristics of two different cryoballoon systems for treatment of paroxysmal atrial fibrillation: study protocol for a multicenter randomized controlled trial (CONTRAST-CRYO Trial). J Interv Card Electrophysiol 2024; 67:5-12. [PMID: 38087145 DOI: 10.1007/s10840-023-01718-2] [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: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Single-shot pulmonary vein isolation (PVI) utilizing cryothermal energy is an effective and safe treatment for atrial fibrillation (AF) patients. A novel cryoballoon system, POLARx™, has been recently introduced. The aim of this study was to compare the efficacy, safety, and biophysical parameters of PVI between the novel cryoballoon system, POLARx™, and the standard cryoballoon system, Arctic Front Advance Pro™ (AFA-Pro), in patients with paroxysmal AF. METHODS The CONTRAST-CRYO trial is a prospective, multicenter, open-label, randomized controlled study performed at seven large cardiac centers. This study was approved by the central ethics committee or the local ethics committee of each participating hospital and has been registered at UMIN Clinical Trials Registry (UMIN000049948). The trial will assign 200 patients with paroxysmal AF undergoing PVI to POLARx™ and AFA-Pro in a 1:1 randomization. The primary endpoint is the one-shot acute success rate of the right inferior pulmonary vein. Second endpoints include freedom from documented atrial fibrillation, atrial flutter, or atrial tachycardia without antiarrhythmic drugs at 12 months after the procedure, freedom from re-do procedures, the incidence of procedure-related adverse events, freezing duration, and the biophysical parameters during applications for each PV, total procedure and fluoroscopy time, and PVI durability during re-do procedures. CONCLUSION The CONTRAST-CRYO trial is a prospective, multicenter, randomized study designed to elucidate the difference in the efficacy, safety, and biophysical parameters between POLARx™ and AFA-Pro in paroxysmal AF patients undergoing PVI. The findings from this trial may provide a valuable indication for selecting the optimal cryoballoon system. CLINICAL TRIAL REGISTRATION UMIN000049948.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe-shi, Hyogo, Japan
| | - Kohki Nakamura
- Devision of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi-shi, Gunma, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama-shi, Japan
| | - Masato Murakami
- Department of Cardiology, Shonankamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Yokohama-shi, Kanagawa, Japan
| | - Yasuhiro Sasaki
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe-shi, Hyogo, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama-shi, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Yokohama-shi, Kanagawa, Japan
| | - Shigeto Naito
- Devision of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi-shi, Gunma, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan
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17
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Malhotra P. Use of Computed Tomography for Left Atrial Appendage Occlusion Procedure Planning and Post-Procedure Assessment. Interv Cardiol Clin 2024; 13:19-28. [PMID: 37980064 DOI: 10.1016/j.iccl.2023.08.006] [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] [Indexed: 11/20/2023]
Abstract
Transcatheter left atrial appendage occlusion (LAAO) is an alternative to systemic anticoagulation in patients with non-valvular atrial fibrillation with increased risk for thromboembolic events. Pre- and post-procedural imaging is essential for technical success, allowing practitioners to identify contraindications, select appropriate devices, and recognize procedural complications. Although transesophageal echocardiography has traditionally served as the preeminent imaging modality in LAAO, cardiac computed tomography imaging has emerged as a noninvasive surrogate given its excellent isotropic spatial resolution, multiplanar reconstruction capability, rapid temporal resolution, and large field of view.
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Affiliation(s)
- Pankaj Malhotra
- Department of Imaging, Mark Taper Imaging Center, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Taper M335, Los Angeles, CA 90048, USA; Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
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18
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Klinkhammer B, Glotzer TV. Management of Arrhythmias in the Cardiovascular Intensive Care Unit. Crit Care Clin 2024; 40:89-103. [PMID: 37973359 DOI: 10.1016/j.ccc.2023.06.003] [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] [Indexed: 11/19/2023]
Abstract
Arrhythmias in the cardiovascular intensive care unit (CVICU) can be difficult to manage because of the complex hemodynamic and respiratory states of critically ill patients. Treating physicians must be educated to prevent, diagnose, and treat a multitude of tachyarrhythmias and bradyarrhythmias. In this review article, the authors outline a pragmatic approach to patient assessment, arrhythmia diagnosis, and management of the most common arrhythmias seen in the CVICU.
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Affiliation(s)
- Brent Klinkhammer
- Division of Cardiac Electrophysiology, Hackensack University Medical Center, Hackensack, NJ 07601, USA; Hackensack Meridian School of Medicine, Hackensack, NJ 07601, USA
| | - Taya V Glotzer
- Division of Cardiac Electrophysiology, Hackensack University Medical Center, Hackensack, NJ 07601, USA; Hackensack Meridian School of Medicine, Hackensack, NJ 07601, USA.
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19
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Reynolds CA, Issa TZ, Manning DW. Patients Who Have Pre-Existing Atrial Fibrillation Require Increased Postoperative Care Following Total Joint Arthroplasty. J Arthroplasty 2024; 39:60-67. [PMID: 37479195 DOI: 10.1016/j.arth.2023.07.011] [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: 11/11/2022] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Approximately 9% of total joint arthroplasty (TJA) patients have pre-existing atrial fibrillation (AF). This study examined the effect of pre-existing AF on TJA outcomes. METHODS We conducted a 1:3 propensity match of 545 TJA patients who have pre-existing AF to TJA patients who do not have AF at a tertiary care center between January 1st, 2012, and January 1st, 2021. Bivariate and multivariate regressions were performed. Changes over time were evaluated. RESULTS Patients undergoing total knee arthroplasty (TKA) who have pre-existing AF, experienced more post-operative AFs (P < .001), acute kidney injuries (P = .026), post-operative complications (POC) (P < .001), and 30-day readmissions (P = .036). Patients undergoing total hip arthroplasty (THA) who have pre-existing AF experienced more post-operative AFs (P < .001), pulmonary embolisms (P < .001), increased estimated blood losses (P = .007), more blood transfusions (P = .002), more POCs (P < .001), and longer lengths of stay (LOS) (P < .002). Over time, POC and LOS decreased in both groups, but remained increased in TJA patients who have pre-existing AF. Multivariate analyses of TKA patients showed an increased odds ratio (OR) of any POCs (P < .001), while THA patients had an increased OR of any POCs (P = .01), and LOS (P = .002). CONCLUSION Patients who have pre-existing AF undergoing TJA have more POCs. TKA patients have more readmissions. THA patients have longer LOS. These findings demonstrate the importance of enhanced peri-operative medical management in patients who have pre-existing AF undergoing TJA.
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Affiliation(s)
- Christopher A Reynolds
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tariq Z Issa
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David W Manning
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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20
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O’Brien B, Reilly J, Coffey K, González-Suárez A, Buchta P, Buszman PP, Lukasik K, Tri J, van Zyl M, Asirvatham S. Epicardial Pulsed Field Ablation of Ganglionated Plexi: Computational and Pre-Clinical Evaluation of a Bipolar Sub-Xiphoid Catheter for the Treatment of Atrial Fibrillation. Bioengineering (Basel) 2023; 11:18. [PMID: 38247895 PMCID: PMC10813135 DOI: 10.3390/bioengineering11010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Epicardial pulsed field ablation (PFA) of ganglionated plexi (GPs) is being explored as a potential treatment for atrial fibrillation. Initial work using open-chest access with a monopolar ablation device has been completed. This study describes the early development work for a device that can be used with subxiphoid access and deliver bipolar ablation pulses. Electric field computational models have been used for the initial guidance on pulse parameters. An in vivo assessment of these ablation parameters has been performed in an open-chest canine study, while subxiphoid access and navigation of the device has been demonstrated in a porcine model. Results from this acute study have demonstrated the promising potential of this approach.
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Affiliation(s)
- Barry O’Brien
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - John Reilly
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - Ken Coffey
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - Ana González-Suárez
- Translational Medical Device Laboratory, School of Medicine, University of Galway, H91 YR71 Galway, Ireland
- Valencian International University, Valencia, Spain
| | - Piotr Buchta
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Silesian Center for Heart Diseases, 41-800 Zabrze, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Kostkowice, Poland
| | - Piotr P. Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Kostkowice, Poland
- Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| | - Karolina Lukasik
- Center for Cardiovascular Research and Development, American Heart of Poland, Kostkowice, Poland
| | - Jason Tri
- Mayo Clinic, Rochester, MN 55905, USA
| | - Martin van Zyl
- Royal Jubilee Hospital, University of British Columbia, Victoria, BC, Canada
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Siegal DM, Verbrugge FH, Martin AC, Virdone S, Camm J, Pieper K, Gersh BJ, Goto S, Turpie AGG, Angchaisuksiri P, Fox KAA. Country and health expenditure are major predictors of withholding anticoagulation in atrial fibrillation patients at high risk of stroke. Open Heart 2023; 10:e002506. [PMID: 38097360 PMCID: PMC10729201 DOI: 10.1136/openhrt-2023-002506] [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: 09/26/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Guidelines for patients with atrial fibrillation (AF) at high thromboembolic risk recommend oral anticoagulants (OACs) for preventing stroke and systemic embolism (SE). The reasons for guideline non-adherence are still unclear. AIM The aim is to identify clinical, demographic and non-patient characteristics associated with withholding OAC in patients with AF at high stroke risk. METHODS Patients in the Global Anticoagulant Registry in the FIELD-AF, newly diagnosed with AF between March 2010 and August 2016, and with CHA2DS2-VASc Score≥2 (excluding sex), were grouped by OAC treatment at enrolment. Factors associated with OAC non-use were analysed by multivariable logistic regression. RESULTS Of 40 416 eligible patients, 12 126 (30.0%) did not receive OACs at baseline. Globally, OAC prescription increased over time, from 60.4% in 2010-2011 to 74.7% in 2015-2016. Country of enrolment was the major predictor for OAC withholding (χ2-df=2576). Clinical predictors of OAC non-use included type of AF (χ2-df=404), history of bleeding (χ2-df=263) and vascular disease (χ2-df=99). OACs were used most frequently around the age of 75 years and decreasingly with younger as well as older age beyond 75 years (χ2-df=148). Non-cardiologists (χ2-df=201) and emergency room physicians (χ2-df=14) were less likely to prescribe OACs. OAC prescription correlated positively with country health expenditure. CONCLUSIONS Approximately one out of three AF patients did not receive OAC, while eligible according to the guidelines. Country of enrolment was the major determinant of anticoagulation strategy, while higher country health expenditure was associated with lower likelihood of withholding anticoagulation.
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Affiliation(s)
- Deborah M Siegal
- Medicine, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Anne-Celine Martin
- Cardiology, European Hospital Georges-Pompidou, Paris, Île-de-France, France
| | - Saverio Virdone
- Department of Statistics, Thrombosis Research Institute, London, UK
| | - John Camm
- Cardiology, St George's Hospital, London, UK
| | | | | | - Shinya Goto
- Medicine, Tokai University School of Medicine Graduate School of Medicine, Isehara, Japan
| | | | | | - Keith A A Fox
- Cardiology, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
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22
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Dryden L, Song J, Valenzano TJ, Yang Z, Debnath M, Lin R, Topolovec-Vranic J, Mamdani M, Antoniou T. Evaluation of Machine Learning Approaches for Predicting Warfarin Discharge Dose in Cardiac Surgery Patients: Retrospective Algorithm Development and Validation Study. JMIR Cardio 2023; 7:e47262. [PMID: 38055310 PMCID: PMC10733832 DOI: 10.2196/47262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Warfarin dosing in cardiac surgery patients is complicated by a heightened sensitivity to the drug, predisposing patients to adverse events. Predictive algorithms are therefore needed to guide warfarin dosing in cardiac surgery patients. OBJECTIVE This study aimed to develop and validate an algorithm for predicting the warfarin dose needed to attain a therapeutic international normalized ratio (INR) at the time of discharge in cardiac surgery patients. METHODS We abstracted variables influencing warfarin dosage from the records of 1031 encounters initiating warfarin between April 1, 2011, and November 29, 2019, at St Michael's Hospital in Toronto, Ontario, Canada. We compared the performance of penalized linear regression, k-nearest neighbors, random forest regression, gradient boosting, multivariate adaptive regression splines, and an ensemble model combining the predictions of the 5 regression models. We developed and validated separate models for predicting the warfarin dose required for achieving a discharge INR of 2.0-3.0 in patients undergoing all forms of cardiac surgery except mechanical mitral valve replacement and a discharge INR of 2.5-3.5 in patients receiving a mechanical mitral valve replacement. For the former, we selected 80% of encounters (n=780) who had initiated warfarin during their hospital admission and had achieved a target INR of 2.0-3.0 at the time of discharge as the training cohort. Following 10-fold cross-validation, model accuracy was evaluated in a test cohort comprised solely of cardiac surgery patients. For patients requiring a target INR of 2.5-3.5 (n=165), we used leave-p-out cross-validation (p=3 observations) to estimate model performance. For each approach, we determined the mean absolute error (MAE) and the proportion of predictions within 20% of the true warfarin dose. We retrospectively evaluated the best-performing algorithm in clinical practice by comparing the proportion of cardiovascular surgery patients discharged with a therapeutic INR before (April 2011 and July 2019) and following (September 2021 and May 2, 2022) its implementation in routine care. RESULTS Random forest regression was the best-performing model for patients with a target INR of 2.0-3.0, an MAE of 1.13 mg, and 39.5% of predictions of falling within 20% of the actual therapeutic discharge dose. For patients with a target INR of 2.5-3.5, the ensemble model performed best, with an MAE of 1.11 mg and 43.6% of predictions being within 20% of the actual therapeutic discharge dose. The proportion of cardiovascular surgery patients discharged with a therapeutic INR before and following implementation of these algorithms in clinical practice was 47.5% (305/641) and 61.1% (11/18), respectively. CONCLUSIONS Machine learning algorithms based on routinely available clinical data can help guide initial warfarin dosing in cardiac surgery patients and optimize the postsurgical anticoagulation of these patients.
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Affiliation(s)
| | | | | | - Zhen Yang
- Unity Health Toronto, Toronto, ON, Canada
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McCusker RJ, Wheelwright J, Smith TJ, Myler CS, Sinz E. Diagnosis and Treatment of New-Onset Perioperative Atrial Fibrillation. Adv Anesth 2023; 41:179-204. [PMID: 38251618 DOI: 10.1016/j.aan.2023.06.007] [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] [Indexed: 01/23/2024]
Abstract
This article reviews medical and surgical risk factors for developing atrial fibrillation (AF), the most common sustained dysrhythmia in the United States. Evidence for assessment and management of patients with AF, including AF newly identified in the preoperative clinic, immediately preoperatively, intraoperatively, and unstable AF, is presented. A stepwise approach to guide anesthetic decision-making in the assessment of newly identified preoperative AF is proposed. Anesthetic considerations, including the potential impacts of anesthetic and vasopressor selection, and current evidence related to rate control and rhythm control via pharmacologic or electrical cardioversion as well as anticoagulation strategies are discussed.
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24
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Dong Y, Zhai Z, Zhu B, Xiao S, Chen Y, Hou A, Zou P, Xia Z, Yu J, Li J. Development and Validation of a Novel Prognostic Model Predicting the Atrial Fibrillation Recurrence Risk for Persistent Atrial Fibrillation Patients Treated with Nifekalant During the First Radiofrequency Catheter Ablation. Cardiovasc Drugs Ther 2023; 37:1117-1129. [PMID: 35731452 PMCID: PMC10721663 DOI: 10.1007/s10557-022-07353-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study aimed to establish and assess a prediction model for patients with persistent atrial fibrillation (AF) treated with nifekalant during the first radiofrequency catheter ablation (RFCA). METHODS In this study, 244 patients with persistent AF from January 17, 2017 to December 14, 2017, formed the derivation cohort, and 205 patients with persistent AF from December 15, 2017 to October 28, 2018, constituted the validation cohort. The least absolute shrinkage and selection operator regression was used for variable screening and the multivariable Cox survival model for nomogram development. The accuracy and discriminative capability of this predictive model were assessed according to discrimination (area under the curve [AUC]) and calibration. Clinical practical value was evaluated using decision curve analysis. RESULTS Body mass index, AF duration, sex, left atrial diameter, and the different responses after nifekalant administration were identified as AF recurrence-associated factors, all of which were selected for the nomogram. In the development and validation cohorts, the AUC for predicting 1-year AF-free survival was 0.863 (95% confidence interval (CI) 0.801-0.926) and 0.855 (95% CI 0.782-0.929), respectively. The calibration curves showed satisfactory agreement between the actual AF-free survival and the nomogram prediction in the derivation and validation cohorts. In both groups, the prognostic score enabled stratifying the patients into different AF recurrence risk groups. CONCLUSIONS This predictive nomogram can serve as a quantitative tool for estimating the 1-year AF recurrence risk for patients with persistent AF treated with nifekalant during the first RFCA.
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Affiliation(s)
- Youzheng Dong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Zhenyu Zhai
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Bo Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Shucai Xiao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Yang Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Anxue Hou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Pengtao Zou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Zirong Xia
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.
| | - Jianhua Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.
| | - Juxiang Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.
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Leelaviwat N, Kewcharoen J, Poomprakobsri K, Trongtorsak A, Del Rio‐Pertuz G, Abdelnabi M, Benjanuwattra J, Navaravong L. Periodontal disease and risk of atrial fibrillation or atrial flutter: A systematic review and meta-analysis. J Arrhythm 2023; 39:992-996. [PMID: 38045467 PMCID: PMC10692853 DOI: 10.1002/joa3.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 12/05/2023] Open
Abstract
Background We conducted a study to evaluate the risk of atrial fibrillation (AF) and atrial flutter (AFL) in periodontal disease (PD) patients. Methods Cohort studies that evaluate the risk of AF or AFL in PD patients were included. The risk was expressed in the pooled odd ratio (OR) with 95% confidence interval (CI). Results A total of four cohort studies were included. We found that patients with PD have a significantly higher risk of AF/AFL compared to those without PD with the pooled OR of 1.33 (95% CI 1.29-1.38; p = 0.357, I 2 = 3.0%). Conclusions PD increases the risk of AF and AFL.
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Affiliation(s)
- Natnicha Leelaviwat
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
| | - Jakrin Kewcharoen
- Division of CardiologyLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Kiddee Poomprakobsri
- Advanced Education Program in Implant DentistryLoma Linda University School of DentistryLoma LindaCaliforniaUSA
| | - Angkawipa Trongtorsak
- Department of Cardiovascular MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | | | - Mahmoud Abdelnabi
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
| | | | - Leenhapong Navaravong
- Division of Cardiovascular MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
- Intermountain Heart Institute—Utah ValleyProvoUtahUSA
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26
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Bangash AB, Li Y, Huang W, Zhong J, Zheng H, Zhang D, Zeng A, Wang R, Zhao W, Wang M, Zhao Y, Yu L, Liu Q, Jiang R, Jiang C, Zhang J. Left atrial appendage occlusion using the LAmbre device in atrial fibrillation patients with a history of ischemic stroke: 1-Year outcomes from a multicenter study in China. Pacing Clin Electrophysiol 2023; 46:1478-1483. [PMID: 37943004 DOI: 10.1111/pace.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/07/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Patients with non-valvular atrial fibrillation (NVAF) and previous stroke have a significantly higher risk of stroke recurrence. This study aimed to examine the safety and efficacy of the LAmbre left atrial appendage occlusion device in NVAF patients with a history of stroke. METHODS We examined 103 consecutive NVAF patients in 11 Chinese medical centers who had a history of stroke or transient ischemic attacks (TIA) and underwent placement of the LAmbre device. Follow-up was conducted 1, 3, 6, and 12 months after the procedure. The primary endpoints were the incidence of new ischemic or hemorrhagic stroke, TIA, systemic embolism, or cardiac death. Secondary endpoints were serious perioperative or device-related complications and cerebral, gastrointestinal, or other bleeding events requiring transfusion of at least 2 units of packed red blood cells. RESULTS Mean patient age was 67.63 ± 7.14 years; mean CHA2DS2-VASc score was 4.72 ± 1.18 and mean HAS-BLED score was 1.90 ± 1.00. LAmbre device placement was successful in 101 patients (98.05%). Mean follow-up was 12.2 months. Five patients (4.95%) developed a new pericardial effusion after the procedure; none required treatment. Eighty-six patients (85.15%) exhibited no peri-device leak (PDL). However, 13 (12.8%) had a small (0-3 mm) PDL and two (2.3%) had a moderate PDL (3-5 mm). One recurrent stroke occurred during follow-up (1.1%). No other complications occurred. CONCLUSIONS This multicenter study shows the safety and efficacy of LAmbre left atrial appendage occlusion for NVAF patients with a history of stroke or TIA.
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Affiliation(s)
- Abdul Basit Bangash
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yuechun Li
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingquan Zhong
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hongmei Zheng
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Dayong Zhang
- Department of Cardiology, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan, China
| | - Anning Zeng
- Department of Cardiology, The People's Hospital of Qiannan, Duyun, Guizhou, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenbiao Zhao
- Department of Cardiology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Maojing Wang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yu Zhao
- Department of Cardiology, Dongguan Tungwah Hospital, Dongguan, Guangdong, China
| | - Lu Yu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qiang Liu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ruhong Jiang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jinhua Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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27
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Kumthekar R, Webster G. Prediction of Sudden Death Risk in Patients with Congenital Heart Diseases. Card Electrophysiol Clin 2023; 15:493-503. [PMID: 37865522 DOI: 10.1016/j.ccep.2023.07.004] [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] [Indexed: 10/23/2023]
Abstract
Risk stratification for sudden death should be discussed with patients with congenital heart disease at each stage of personal and cardiac development. For most patients, risk is low through teenage years and the critical factors to consider are anatomy, ventricular function, and symptoms. By adulthood, these are supplemented by screening for atrial arrhythmias, ventricular arrhythmias, and pulmonary hypertension. Therapies include medication, ablation, and defibrillator placement.
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Affiliation(s)
- Rohan Kumthekar
- Division of Cardiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH, USA
| | - Gregory Webster
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 21, Chicago, IL 60611, USA.
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Montero-Balosa MC, Limón-Mora JA, Leal-Atienza A, Luque-Romero LG, Aguado-Romeo MJ, Isabel-Gómez R, Molina-López MT. Effectiveness and safety of oral anticoagulant therapy in a real-world cohort with atrial fibrillation: The SIESTA-A study protocol. PLoS One 2023; 18:e0294822. [PMID: 38019815 PMCID: PMC10686507 DOI: 10.1371/journal.pone.0294822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Oral anticoagulants (OACs) are first-line drugs for stroke prevention in patients with atrial fibrillation (AF). The introduction of new lines of therapy with direct oral anticoagulants (DOACs) has led to a decreased use of vitamin K antagonists (VKAs). Comparative analyses of DOACs in clinical trials are scarce and the comparator has mostly been warfarin. Their impact on health outcomes in observational studies has not always been consistent. The aim of this study is to evaluate the effectiveness and safety of DOACs and VKAs in patients with AF using Real-World Data (RWD). METHODS AND ANALYSIS Population-based retrospective cohort study using RWD from actual practice. Period: January 2012-December 2020. Inclusion criteria: patients with AF who had not taken OACs in the previous 12 months. Exclusion criteria: <40 years, with severe mitral stenosis, or valvular heart disease or aortic and/or mitral valve procedures. Data source: The Andalusian Population Health Database, Spain. Outcome measures: a) Effectiveness: ischaemic stroke, transient ischaemic attack, systemic and pulmonary embolism, and death; b) Safety: gastrointestinal and intracranial haemorrhaging; Independent variables: age, sex, comorbidities, medication and health resource use, CHA2DS2-VASC, HAS-BLED, and analytical tests. Statistical analysis: crude incidence analysis, survival models, Kaplan-Meier, Cox regression analysis adjusted for possible confounding and paired analysis by propensity score matching.
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Affiliation(s)
- M. C. Montero-Balosa
- Servicio de Farmacia de Atención Primaria, Distrito Aljarafe y Sevilla Norte, Servicio Andaluz de Salud, Sevilla, Spain
| | - J. A. Limón-Mora
- Coordinación de Gestión y Evaluación, Servicio Andaluz de Salud, Sevilla, Spain
| | - A. Leal-Atienza
- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Consejería de Salud y Consumo, Sevilla, Spain
| | - L. G. Luque-Romero
- Unidad de Investigación, Distrito Aljarafe y Sevilla Norte, Servicio Andaluz de Salud, Sevilla, Spain
| | - M. J. Aguado-Romeo
- Centro de Transfusión de Tejidos y Células de Sevilla, Red Andaluza de Medicina Transfusional de Tejidos y Células, Consejería de Salud y Consumo, Sevilla, Spain
| | - R. Isabel-Gómez
- Agencia de Evaluación de Tecnologías Sanitarias de Andalucía, Consejería de Salud y Consumo, Sevilla, Spain
| | - M. T. Molina-López
- Servicio de Farmacia de Atención Primaria, Distrito Sevilla, Servicio Andaluz de Salud, Sevilla, Spain
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Kapadia M, Jagadish PS, Hutchinson M, Lee H. Atrial fibrillation, electroconvulsive therapy, stroke risk, and anticoagulation. Egypt Heart J 2023; 75:94. [PMID: 38010438 PMCID: PMC10682349 DOI: 10.1186/s43044-023-00409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/17/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a therapy used to treat refractory mental health conditions, ranging from depression to catatonia, and it has gained renewed prominence in practice and the literature of late. Given that ECT involves the application of direct current to the body, there exists a risk of a change in cardiac rhythm during therapy. When atrial fibrillation is induced, ECT carries a potential risk of stroke. These risks have not been previously analyzed or summarized in the literature to allow physicians to make educated decisions about periprocedural risk and anticoagulation needs. METHODS To better describe this risk, the authors reviewed PubMed for articles that described the post-ECT cardioversion of AF to sinus rhythm, new development of AF post-ECT, and new stroke after either rhythm change. RESULTS Included were 14 studies describing 19 unique patients. Most patients had no rhythm change during at least one of many ECT sessions. Five patients converted from AF to sinus rhythm during at least one session, while AF followed ECT in seventeen patients during at least one ECT session. Four patients experienced both ECT-related cardioversion from AF to sinus rhythm as well as conversion from sinus rhythm to AF. Although no patients with a rhythm change experienced a stroke, one unanticoagulated patient who remained in AF developed a stroke post-ECT. CONCLUSIONS Electroconvulsive therapy is demonstrated to be associated with rhythm changes-from atrial fibrillation to sinus rhythm as well as from sinus rhythm to atrial fibrillation. Thus, stroke risk during and after ECT remains a possibility. The anticoagulation of patients with AF who undergo ECT should be based on individual stroke risk factors, using validated stroke risk models, rather than prescribed routinely.
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Affiliation(s)
- Meera Kapadia
- Department of Internal Medicine at McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, 77030, USA
| | - Pooja S Jagadish
- Division of Cardiology, Department of Medicine, University of Arizona-Tucson, 1501 N. Campbell Ave., PO Box 245046, Tucson, AZ, 85724-5035, USA.
| | - Marcus Hutchinson
- Department of Medicine, University of Arizona-Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724-5035, USA
| | - Hong Lee
- Division of Cardiology, Department of Medicine, University of Arizona-Tucson, 1501 N. Campbell Ave., PO Box 245046, Tucson, AZ, 85724-5035, USA
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Radauskaite G, Račkauskas G, Danilenko S, Marinskis G, Aidietis A. Results of a 4-Year Follow Up of Patients with Paroxysmal and Persistent Atrial Fibrillation after Cryoablation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2036. [PMID: 38004085 PMCID: PMC10673237 DOI: 10.3390/medicina59112036] [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: 10/23/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Cryoablation is an established treatment method for atrial fibrillation (AF). We present the long-term results of cryoablation in 94 patients with paroxysmal and persistent AF treated in our center. Materials and Methods: This was an observational, retrospective study of 94 patients who underwent a cryoablation procedure for paroxysmal or persistent AF from 2015 to 2017. The follow up was 51 ± 3 months. The absence of arrhythmia was checked at 6, 12, 24, and 48 months after the procedure with 24 h Holter monitoring. We evaluated echocardiography parameters before and 48 months after cryoablation. The quality of life was assessed by calculating EHRA scores at each visit. Results: The mean history of pre-procedural AF duration was 55.3 ± 8.6 months. Paroxysmal AF was present in 42% of patients and persistent AF in 58%. Comparing the EHRA classes, a statistically significant difference was observed between the score assessed before the procedure and the score after one year, as well as when comparing the rates before the procedure and four years after the procedure (p < 0.000). The recurrence of AF was observed in 22.3% of patients 1 year after the procedure, in 26.6% of patients 2 years after the procedure, and in 34% of patients 4 years after the procedure; 9.3% of them were left in permanent AF. During the observation period, 28% of patients underwent a repeated pulmonary vein isolation procedure, and 6% of patients had a permanent pacemaker implanted. Five hematomas (5%) and one instance of phrenic nerve palsy (1%) were observed during the procedure. Conclusions: The rate of arrhythmia recurrence increased every year after cryoablation. Quality of life improved after the procedure, despite the recurrence of AF. A quarter of patients had to undergo a repeat pulmonary vein isolation procedure.
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Affiliation(s)
- Greta Radauskaite
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.R.); (G.M.); (A.A.)
- Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
| | - Gediminas Račkauskas
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.R.); (G.M.); (A.A.)
- Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
| | - Svetlana Danilenko
- Department of Mathematical Statistics, Vilnius Gediminas Technical University, 10223 Vilnius, Lithuania;
- Department of Human and Medical Genetics, Vilnius University, 01513 Vilnius, Lithuania
| | - Germanas Marinskis
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.R.); (G.M.); (A.A.)
- Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
| | - Audrius Aidietis
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.R.); (G.M.); (A.A.)
- Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
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31
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Shimizu W, Uchiyama S, Atarashi H, Inoue H, Kitazono T, Yamashita T, Ikeda T, Kamouchi M, Kaikita K, Fukuda K, Origasa H, Shimokawa H. Effectiveness and safety of reduced-dose rivaroxaban for elderly patients with non-valvular atrial fibrillation: A subanalysis of the EXPAND study. Int J Cardiol 2023; 391:131290. [PMID: 37619876 DOI: 10.1016/j.ijcard.2023.131290] [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: 03/15/2023] [Revised: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Establishing the appropriate rivaroxaban dose in older patients with non-valvular atrial fibrillation (NVAF) is important because of the high risk of adverse events. In this EXPAND study subanalysis, we examined the safety and efficacy of standard-dose (15 mg/day) and non-recommended reduced-dose (10 mg/day) rivaroxaban in patients aged ≥65 years with NVAF and preserved renal function. METHODS The entire analysis population (ALL cohort [n = 3982]; ≥65 years) was divided into early elderly (ELD) (65-74 years [n = 1444]) and late ELD (≥75 years [n = 2386]) sub-cohorts. Each sub-cohort was divided into reduced-dose and standard-dose groups. Kaplan-Meier survival curves with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were used to assess efficacy (thromboembolic events) and safety (hemorrhagic events) outcomes. RESULTS The aHR for major bleeding did not differ between the dosages in any of the cohorts (aHRs: 0.86-0.93). There were no significant differences in the occurrence of stroke + systemic embolism (SE) or stroke + SE + myocardial infarction (MI) + cardiovascular (CV) death among the cohorts. The aHR for MI/unstable angina + interventional/CV surgery + CV death was higher with 10-mg/day rivaroxaban than 15-mg/day rivaroxaban in the ALL cohort (aHR: 1.56 [95% CI 1.02-2.37], p = 0.039) and the late ELD sub-cohort (aHR: 1.86 [95% CI 1.01-3.42], p = 0.045). CONCLUSIONS Reduced-dose rivaroxaban may increase the risk of coronary artery events. The use of rivaroxaban 15 mg/day in patients with NVAF aged ≥75 years with preserved renal function was supported.
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Affiliation(s)
- Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Shinichiro Uchiyama
- Clinical Research Center for Medicine, Center for Brain and Cerebral Vessels, Sanno Medical Center, Tokyo, Japan
| | | | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Center for Cohort Study, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Koji Fukuda
- Division of Heart Rhythm, International University of Health and Welfare Hospital, International University of Health and Welfare, Tochigi, Japan
| | | | - Hiroaki Shimokawa
- Graduate School, International University of Health and Welfare, Chiba, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
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McIntyre WF, Vadakken ME, Connolly SJ, Mendoza PA, Lengyel AP, Rai AS, Latendresse NR, Grinvalds AJ, Ramasundarahettige C, Acosta JG, Um KJ, Roberts JD, Conen D, Wong JA, Devereaux PJ, Belley-Côté EP, Whitlock RP, Healey JS. Atrial Fibrillation Recurrence in Patients With Transient New-Onset Atrial Fibrillation Detected During Hospitalization for Noncardiac Surgery or Medical Illness : A Matched Cohort Study. Ann Intern Med 2023; 176:1299-1307. [PMID: 37782930 DOI: 10.7326/m23-1411] [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] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is often detected for the first time in patients who are hospitalized for another reason. Long-term risks for AF recurrence in these patients are unclear. OBJECTIVE To estimate risk for AF recurrence in patients with new-onset AF during a hospitalization for noncardiac surgery or medical illness compared with a matched population without AF. DESIGN Matched cohort study. (ClinicalTrials.gov: NCT03221777). SETTING Three academic hospitals in Hamilton, Ontario, Canada. PARTICIPANTS The study enrolled patients hospitalized for noncardiac surgery or medical illness who had transient new-onset AF. For each participant, an age- and sex-matched control participant with no history of AF from the same hospital ward was recruited. All participants left the hospital in sinus rhythm. MEASUREMENTS 14-day electrocardiographic (ECG) monitor at 1 and 6 months and telephone assessment at 1, 6, and 12 months. The primary outcome was AF lasting at least 30 seconds on the monitor or captured by ECG 12-lead during routine care at 12 months. RESULTS Among 139 participants with transient new-onset AF (70 patients with medical illness and 69 surgical patients) and 139 matched control participants, the mean age was 71 years (SD, 10), the mean CHA2DS2-VASc score was 3.0 (SD, 1.5), and 59% were male. The median duration of AF during the index hospitalization was 15.8 hours (IQR, 6.4 to 49.6 hours). After 1 year, recurrent AF was detected in 33.1% (95% CI, 25.3% to 40.9%) of participants in the transient new-onset AF group and 5.0% (CI, 1.4% to 8.7%) of matched control participants; after adjustment for the number of ECG monitors worn and for baseline clinical differences, the adjusted relative risk was 6.6 (CI, 3.2 to 13.7). After exclusion of participants who had electrical or pharmacologic cardioversion during the index hospitalization (n = 40) and their matched control participants and limiting to AF events detected by the patch ECG monitor, recurrent AF was detected in 32.3% (CI, 23.1% to 41.5%) of participants with transient new-onset AF and 3.0% (CI, 0% to 6.4%) of matched control participants. LIMITATIONS Generalizability is limited, and the study was underpowered to evaluate subgroups and clinical predictors. CONCLUSION Among patients who have transient new-onset AF during a hospitalization for noncardiac surgery or medical illness, approximately 1 in 3 will have recurrent AF within 1 year. PRIMARY FUNDING SOURCE Peer-reviewed grants.
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Affiliation(s)
- William F McIntyre
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - Maria E Vadakken
- Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
| | - Stuart J Connolly
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - Pablo A Mendoza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada (P.A.M.)
| | - Alexandra P Lengyel
- Population Health Research Institute, and Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (A.P.L.)
| | - Anand S Rai
- Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
| | - Nicole R Latendresse
- Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
| | - Alex J Grinvalds
- Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
| | | | - J Gabriel Acosta
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (J.G.A.)
| | - Kevin J Um
- Division of Cardiology, Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada (K.J.U., J.D.R.)
| | - Jason D Roberts
- Division of Cardiology, Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada (K.J.U., J.D.R.)
| | - David Conen
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - Jorge A Wong
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - P J Devereaux
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - Emilie P Belley-Côté
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; Population Health Research Institute; and Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (E.P.B.)
| | - Richard P Whitlock
- Department of Health Research Methods, Evidence, and Impact, McMaster University; Population Health Research Institute; Michael G. DeGroote School of Medicine, McMaster University; Division of Critical Care, Department of Medicine, McMaster University; and Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada (R.P.W.)
| | - Jeff S Healey
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 11] [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: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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Inoue K, Guo R, Lee ML, Ebrahimi R, Neverova NV, Currier JW, Bashir MT, Leung AM. Iodine-Induced Hyperthyroidism and Long-term Risks of Incident Atrial Fibrillation and Flutter. J Clin Endocrinol Metab 2023; 108:e956-e962. [PMID: 37146179 PMCID: PMC10584637 DOI: 10.1210/clinem/dgad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
CONTEXT Although iodine-induced hyperthyroidism is a potential consequence of iodinated radiologic contrast administration, its association with long-term cardiovascular outcomes has not been previously studied. OBJECTIVE To investigate the relationships between hyperthyroidism observed after iodine contrast administration and incident atrial fibrillation/flutter. METHODS Retrospective cohort study of the U.S. Veterans Health Administration (1998-2021) of patients age ≥18 years with a normal baseline serum thyrotropin (TSH) concentration, subsequent TSH <1 year, and receipt of iodine contrast <60 days before the subsequent TSH. Cox proportional hazards regression was employed to ascertain the adjusted hazard ratio (HR) with 95% CI of incident atrial fibrillation/flutter following iodine-induced hyperthyroidism, compared with iodine-induced euthyroidism. RESULTS Iodine-induced hyperthyroidism was observed in 2500 (5.6%) of 44 607 Veterans (mean ± SD age, 60.9 ± 14.1 years; 88% men) and atrial fibrillation/flutter in 10.4% over a median follow-up of 3.7 years (interquartile range 1.9-7.4). Adjusted for sociodemographic and cardiovascular risk factors, iodine-induced hyperthyroidism was associated with an increased risk of atrial fibrillation/flutter compared with those who remained euthyroid after iodine exposure (adjusted HR 1.19, 95% CI 1.06-1.33). Females were at greater risk for incident atrial fibrillation/flutter than males (females, HR 1.81, 95% CI 1.12-2.92; males, HR 1.15, 95% CI 1.03-1.30; P for interaction = .04). CONCLUSION Hyperthyroidism following a high iodine load was associated with an increased risk of incident atrial fibrillation/flutter, particularly among females. The observed sex-based differences should be confirmed in a more sex-diverse study sample, and the cost-benefit analysis of long-term monitoring for cardiac arrhythmias following iodine-induced hyperthyroidism should be evaluated.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Rong Guo
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Martin L. Lee
- Veterans Affairs Health Services Research & Development Center for the Study of Health Care Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Ramin Ebrahimi
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Natalia V. Neverova
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Jesse W. Currier
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Muhammad T. Bashir
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Endocrinology, Diabetes, and Metabolism, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
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35
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Dougherty AH. Mixology: seeking the right prescription for atrial fibrillation. J Interv Card Electrophysiol 2023; 66:1303-1304. [PMID: 36369500 DOI: 10.1007/s10840-022-01415-6] [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: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Anne Hamilton Dougherty
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.246, TX, Houston, 77030, USA.
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36
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Verma A, Haines DE, Boersma LV, Sood N, Natale A, Marchlinski FE, Calkins H, Sanders P, Packer DL, Kuck KH, Hindricks G, Tada H, Hoyt RH, Irwin JM, Andrade J, Cerkvenik J, Selma J, DeLurgio DB. Influence of monitoring and atrial arrhythmia burden on quality of life and health care utilization in patients undergoing pulsed field ablation: A secondary analysis of the PULSED AF trial. Heart Rhythm 2023; 20:1238-1245. [PMID: 37211146 DOI: 10.1016/j.hrthm.2023.05.018] [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: 04/09/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Freedom from atrial arrhythmia (AA) recurrence ≥30 seconds after pulsed field ablation (PFA) in patients with atrial fibrillation (AF) was reported in PULSED AF (Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF; ClinialTrials.gov Identifier: NCT04198701). AA burden may be a more clinically meaningful endpoint. OBJECTIVE The purpose of this study was to determine the influence of monitoring strategies on AA detection and AA burden association with quality of life (QoL) and health care utilization (HCU) after PFA. METHODS Patients underwent 24-hour Holter monitoring at 6 and 12 months and weekly, and symptomatic transtelephonic monitoring (TTM). AA burden post-blanking was calculated as the greater of (1) percentage of AA on total Holter time; or (2) percentage of weeks with ≥1 TTM with AA out of all weeks with ≥1 TTM. RESULTS Freedom from all AAs varied by >20% when differing monitoring strategies were used. PFA resulted in zero burden in 69.4% of paroxysmal atrial fibrillation (PAF) and 62.2% of persistent atrial fibrillation (PsAF) patients. Median burden was low (<9%). Most PAF and PsAF patients had ≤1 week of AA detection on TTM (82.6% and 75.4%) and <30 minutes of AA per day of Holter monitoring (96.5% and 89.6%), respectively. Only PAF patients with <10% AA burden averaged a clinically meaningful (>19 point) QoL improvement. PsAF patients experienced clinically meaningful QoL improvements irrespective of burden. Repeat ablations and cardioversions significantly increased with higher AA burden (P <.01). CONCLUSION The ≥30-second AA endpoint is dependent on the monitoring protocol used. PFA resulted in low AA burden for most patients, which was associated with clinically relevant improvement in QoL and reduced AA-related HCU.
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Affiliation(s)
- Atul Verma
- McGill University Health Centre, Montreal, Quebec, Canada.
| | | | - Lucas V Boersma
- St. Antonius Hospital, Nieuwegein and Amsterdam UMC, The Netherlands
| | - Nitesh Sood
- Southcoast Health Center, Fall River, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | - Jason Andrade
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | - David B DeLurgio
- Emory Heart & Vascular Center at Saint Joseph's, Atlanta, Georgia
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37
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Pitman BM, Zanker A, Lim M, McLoughney J, Spinelli J, Tarone R, McInnes K, Heath KM, Gieve M, Evans S, Young GD, Roberts-Thomson KC, Wong CX, Sanders P, Lau DH. Factors affecting electrogram sensing in an insertable cardiac monitor: Insights from surface electrocardiogram mapping analysis. Heart Rhythm 2023; 20:1297-1306. [PMID: 37321384 DOI: 10.1016/j.hrthm.2023.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fidelity of electrogram sensing may reduce false alerts from an insertable cardiac monitor (ICM). OBJECTIVE The purpose of this study was to assess the effect of vector length, implant angle, and patient factors on electrogram sensing using surface electrocardiogram (ECG) mapping. METHODS Twelve separate precordial single-lead surface ECGs were acquired from 150 participants at 2 interelectrode distances (75 and 45 mm), at 3 vector angles (vertical, oblique, and horizontal), and in 2 postures (upright and supine). A subset of 50 patients also received a clinically indicated ICM implant in 1:1 ratio (Reveal LINQ [Medtronic, Minneapolis, MN]/BIOMONITOR III [Biotronik, Berlin, Germany]). All ECGs and ICM electrograms were analyzed by blinded investigators using DigitizeIt software (V2.3.3, Braunschweig, Germany). The P-wave visibility threshold was set at > 0.015 mV. Logistic regression was used to identify factors affecting P-wave amplitude. RESULTS A total of 1800 tracings from 150 participants (44.5% [n = 68] female; median age 59 [35-73] years) were assessed. The median P- and R-wave amplitudes were 45% and 53% larger with vector lengths of 75 and 45 mm, respectively (P < .001 for both). The oblique orientation yielded the best P- and R-wave amplitudes, while posture change did not affect P-wave amplitude. Mixed effects modeling found that visible P-waves occur more frequently with a vector length of 75 mm than with 45 mm (86% vs 75%, respectively; P < .0001). A longer vector length improved both P-wave amplitude and visibility in all body mass index categories. There was a moderate correlation of P- and R-wave amplitudes from the ICM electrograms to those from surface ECG recordings (intraclass correlation coefficient 0.74 and 0.80, respectively). CONCLUSION Longer vector length and oblique implant angle yielded the best electrogram sensing and are relevant considerations for ICM implantation procedures.
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Affiliation(s)
- Bradley M Pitman
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Zanker
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew Lim
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua McLoughney
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jade Spinelli
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rachel Tarone
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kristie McInnes
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kyle M Heath
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mahsa Gieve
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shaun Evans
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Glenn D Young
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Christopher X Wong
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia.
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38
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Boriani G, Auricchio A, Botto GL, Joseph JM, Roberts GJ, Grammatico A, Nabutovsky Y, Piccini JP. Insertable cardiac monitoring results in higher rates of atrial fibrillation diagnosis and oral anticoagulation prescription after ischaemic stroke. Europace 2023; 25:euad212. [PMID: 37490349 PMCID: PMC10403249 DOI: 10.1093/europace/euad212] [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: 03/21/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023] Open
Abstract
AIMS After an ischaemic stroke, atrial fibrillation (AF) detection allows for improved secondary prevention strategies. This study aimed to compare AF detection and oral anticoagulant (OAC) initiation in patients with an insertable cardiac monitor (ICM) vs. external cardiac monitor (ECM) after ischaemic stroke. METHODS AND RESULTS Medicare Fee-for-Service (FFS) insurance claims and Abbott Labs device registration data were used to identify patients hospitalized with an ischaemic stroke in 2017-2019 who received an ICM or ECM within 3 months. Patients with continuous Medicare FFS insurance and prescription drug enrolment in the prior year were included. Patients with prior AF, atrial flutter, cardiac devices, or OAC were excluded. Insertable cardiac monitor and ECM patients were propensity score matched 1:4 on demographics, comorbidities, and stroke hospitalization characteristics. The outcomes of interest were AF detection and OAC initiation evaluated with Kaplan-Meier and Cox proportional hazard regression analyses. A total of 5702 Medicare beneficiaries (ICM, n = 444; ECM, n = 5258) met inclusion criteria. The matched cohort consisted of 2210 Medicare beneficiaries (ICM, n = 442; ECM, n = 1768) with 53% female, mean age 75 years, and mean CHA₂DS₂-VASc score 4.6 (1.6). Insertable cardiac monitor use was associated with a higher probability of AF detection [(hazard ratio (HR) 2.88, 95% confidence interval (CI) (2.31, 3.59)] and OAC initiation [HR 2.91, CI (2.28, 3.72)] compared to patients monitored only with ECM. CONCLUSION Patients with an ischaemic stroke monitored with an ICM were almost three times more likely to be diagnosed with AF and to be prescribed OAC compared to patients who received ECM only.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Giovanni Luca Botto
- Department of Cardiology—Electrophysiology, ASST Rhodense, Civile Hospital Rho and Salvini Hospital Garbagnate Milanese Hospital, Milan, Italy
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Hobensack M, Zhao Y, Scharp D, Volodarskiy A, Slotwiner D, Reading Turchioe M. Characterising symptom clusters in patients with atrial fibrillation undergoing catheter ablation. Open Heart 2023; 10:e002385. [PMID: 37541744 PMCID: PMC10407417 DOI: 10.1136/openhrt-2023-002385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVE This study aims to leverage natural language processing (NLP) and machine learning clustering analyses to (1) identify co-occurring symptoms of patients undergoing catheter ablation for atrial fibrillation (AF) and (2) describe clinical and sociodemographic correlates of symptom clusters. METHODS We conducted a cross-sectional retrospective analysis using electronic health records data. Adults who underwent AF ablation between 2010 and 2020 were included. Demographic, comorbidity and medication information was extracted using structured queries. Ten AF symptoms were extracted from unstructured clinical notes (n=13 416) using a validated NLP pipeline (F-score=0.81). We used the unsupervised machine learning approach known as Ward's hierarchical agglomerative clustering to characterise and identify subgroups of patients representing different clusters. Fisher's exact tests were used to investigate subgroup differences based on age, gender, race and heart failure (HF) status. RESULTS A total of 1293 patients were included in our analysis (mean age 65.5 years, 35.2% female, 58% white). The most frequently documented symptoms were dyspnoea (64%), oedema (62%) and palpitations (57%). We identified six symptom clusters: generally symptomatic, dyspnoea and oedema, chest pain, anxiety, fatigue and palpitations, and asymptomatic (reference). The asymptomatic cluster had a significantly higher prevalence of male, white and comorbid HF patients. CONCLUSIONS We applied NLP and machine learning to a large dataset to identify symptom clusters, which may signify latent biological underpinnings of symptom experiences and generate implications for clinical care. AF patients' symptom experiences vary widely. Given prior work showing that AF symptoms predict adverse outcomes, future work should investigate associations between symptom clusters and postablation outcomes.
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Affiliation(s)
- Mollie Hobensack
- Columbia University School of Nursing, New York City, New York, USA
| | - Yihong Zhao
- Columbia University School of Nursing, New York City, New York, USA
| | - Danielle Scharp
- Columbia University School of Nursing, New York City, New York, USA
| | | | - David Slotwiner
- Cardiology, NewYork-Presbyterian Queens Hospital, Flushing, New York, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York City, New York, USA
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Aldaas OM, Darden D, Mylavarapu PS, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. Association of isoproterenol infusion during catheter ablation of atrial fibrillation with outcomes: insights from the UC San Diego AF Ablation Registry. J Interv Card Electrophysiol 2023; 66:1243-1252. [PMID: 36508065 PMCID: PMC10258224 DOI: 10.1007/s10840-022-01448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND High-dose isoproterenol infusion is a useful provocative maneuver to elicit triggers of atrial fibrillation (AF) during ablation. We evaluated whether the use of isoproterenol infusion to elicit triggers of AF after ablation is associated with differential outcomes. METHODS We performed a retrospective study of all patients who underwent de novo radiofrequency catheter ablation of AF enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AAD). RESULTS Of 314 patients undergoing AF ablation, 235 (74.8%) received isoproterenol while 79 (25.2%) did not. Among those who received isoproterenol, 11 (4.7%) had additional triggers identified. There were no statistically significant differences in procedure time (p = 0.432), antiarrhythmic drug use (p = 0.289), procedural complications (p = 0.279), recurrences of atrial arrhythmias on or off AAD [adjusted hazard ratio (AHR) 0.92 (95% CI 0.58-1.46); p = 0.714], all-cause hospitalizations [AHR 1.00 (95% CI 0.60-1.67); p = 0.986], or all-cause mortality [AHR 0.14 (95% CI 0.01-3.52); p = 0.229] between groups. CONCLUSIONS In this registry analysis, use of isoproterenol is safe but was not associated with a reduction in recurrence of atrial arrhythmias.
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Affiliation(s)
- Omar M Aldaas
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Douglas Darden
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Praneet S Mylavarapu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - David Krummen
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
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Romano LR, Scalzi G, Malizia B, Aquila I, Polimeni A, Indolfi C, Curcio A. Impact of Percutaneous Mitral Valve Repair on Left Atrial Strain and Atrial Fibrillation Progression. J Cardiovasc Dev Dis 2023; 10:320. [PMID: 37623333 PMCID: PMC10456079 DOI: 10.3390/jcdd10080320] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Transcatheter edge-to-edge repair (TEER) currently represents a valuable therapeutic option for patients with severe mitral regurgitation (MR) considered at high surgical risk. Besides symptoms and left ventricular (LV) echocardiographic improvements upon TEER, it has been postulated that left atrial (LA) function plays a prognostic role. The aims of our study were to evaluate LA changes after TEER, measured by two-dimensional speckle-tracking echocardiography analysis (2D-STE), their association with atrial fibrillation (AF) occurrence, and relative arrhythmic burden. We considered in a single-center study 109 patients affected by symptomatic severe MR undergoing TEER from February 2015 to April 2022. By 2D-STE, LA reservoir (R_s), conduct (D_s), and contractile (C_s) strains were assessed along with four-chamber emptying fraction (LAEF-4CH) before, 1, 6, and 12 months following TEER. Statistical analysis for comparison among baseline, and follow-ups after TEER was carried out by ANOVA, MANOVA, and linear regression. Successful TEER significantly improved LV dimensions and LA performances, as indicated by all strain components, and LAEF-4CH after 1 year. Strikingly, a significant reduction in arrhythmic burden was observed, since only one case of subclinical AF detected by a previously implanted cardiac electronic device was found in the cohort of sinus rhythm patients (n = 48) undergone TEER; in addition, ventricular rate was reduced in the AF cohort (n = 61) compared to baseline, together with few episodes of nonsustained ventricular tachycardias (5/61, 8.2%) after MR improvement. Overall, TEER was associated with improved cardiac performance, LA function amelioration, and reduced arrhythmic burden.
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Affiliation(s)
- Letizia Rosa Romano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giuseppe Scalzi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Biagio Malizia
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Iolanda Aquila
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alberto Polimeni
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87100 Cosenza, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
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Miyoshi M, Abe I, Kodama N, Zhan Y, Kira S, Ishii Y, Harada T, Takano M, Takahashi M, Sato H, Tawara K, Kondo H, Fukui A, Fukuda T, Akioka H, Shinohara T, Teshima Y, Yufu K, Nakagawa M, Daa T, Shimada T, Takahashi N. Association between interatrial septum adiposity and atrial fibrillation: transesophageal echocardiography imaging and autopsy study. Sci Rep 2023; 13:9828. [PMID: 37330552 PMCID: PMC10276811 DOI: 10.1038/s41598-023-36677-1] [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: 11/29/2022] [Accepted: 06/08/2023] [Indexed: 06/19/2023] Open
Abstract
Recent clinical evidence has suggested that interatrial septal (IAS) adiposity contributes to atrial fibrillation (AF). The present study aimed to confirm the usefulness of transesophageal echocardiography (TEE) to estimate IAS adiposity in patients with AF. The histological IAS analysis based on autopsy samples sought to clarify characteristics that underlie the contribution of IAS adiposity to AF. The imaging study analyzed the TEE results in patients with AF (n = 184) in comparison with transthoracic echocardiography (TTE) and computed tomography (CT) results. The autopsy study histologically analyzed IAS in subjects with (n = 5) and without (n = 5) history of AF. In the imaging study, the ratio of interatrial septum adipose tissue (IAS-AT) volume per epicardial adipose tissue (EpAT) volume was greater in patients with persistent AF compared (PerAF) to those with paroxysmal AF (PAF). Multivariable analysis revealed that both TEE-assessed IAS thickness and TTE-assessed left atrial dimension were predicted by CT-assessed IAS-AT volume. In the autopsy study, the histologically-assessed IAS section thickness was greater in the AF group than that in the non-AF group and was positively correlated with the IAS-AT area percentage. In addition, the size of adipocytes in IAS-AT was smaller, compared to EpAT and subcutaneous adipose tissue (SAT). IAS-AT infiltrated into the IAS myocardium, as if adipose tissue split the myocardium (designated as myocardial splitting by IAS-AT). The number of island-like myocardium pieces as a result of myocardial splitting by IAS-AT was greater in the AF group than in the non-AF group and was positively correlated with the IAS-AT area percentage. The present imaging study confirmed the usefulness of TEE to estimate IAS adiposity in patients with AF without radiation exposure. The autopsy study suggested that the myocardial splitting by IAS-AT may contribute to atrial cardiomyopathy leading to AF.
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Affiliation(s)
- Miho Miyoshi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Ichitaro Abe
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan.
| | - Nozomi Kodama
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Yinge Zhan
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Shintaro Kira
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Yumi Ishii
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Taisuke Harada
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Masayuki Takano
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Masaki Takahashi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Katsunori Tawara
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Tomoko Fukuda
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Mikiko Nakagawa
- Medical Education Center, Oita University Faculty of Medicine, Oita, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Oita University Faculty of Medicine, Oita, Japan
| | - Tatsuo Shimada
- Oita Medical Technology School, College of Judo Therapy and Acupuncture-Moxibustion, Oita, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan.
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Babbili A, Thotamgari SR, Thakre A, Patel S, Grewal US, Dominic P. Impact of Atrial Fibrillation on Patients With Carcinoid Syndrome: A National Inpatient Sample Analysis. Am J Cardiol 2023; 196:67-69. [PMID: 37094490 PMCID: PMC10226372 DOI: 10.1016/j.amjcard.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Akhilesh Babbili
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Sahith Reddy Thotamgari
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Anuj Thakre
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Sagar Patel
- Department of Internal Medicine, Landmark Medical Center, Woonscoket, Rhode Island
| | | | - Paari Dominic
- Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
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Sehrawat O, Kashou AH, Van Houten HK, Cohen K, Joe Henk H, Gersh BJ, Abraham NS, Graff-Radford J, Friedman PA, Siontis KC, Noseworthy PA, Yao X. Contemporary trends and barriers to oral anticoagulation therapy in Non-valvular atrial fibrillation during DOAC predominant era. IJC HEART & VASCULATURE 2023; 46:101212. [PMID: 37168417 PMCID: PMC10164915 DOI: 10.1016/j.ijcha.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023]
Abstract
There is a need to reassess contemporary oral anticoagulation (OAC) trends and barriers against guideline directed therapy in the United States. Most previous studies were performed before major guideline changes recommended direct oral anticoagulant (DOAC) use over warfarin or have otherwise lacked patient level data. Data on overuse of OAC in low-risk group is also limited. To address these knowledge gaps, we performed a nationwide analysis to analyze current trends. This is a retrospective cohort study assessing non-valvular AF identified using a large United States de-identified administrative claims database, including commercial and Medicare Advantage enrollees. Prescription fills were assessed within a 90-day follow-up from the patient's index AF encounter between January 1, 2016, and December 31, 2020. Among the 339,197 AF patients, 4.4%, 8.0%, and 87.6% were in the low-, moderate-, and high-risk groups (according to CHA2DS2-VASc score). An over (29.6%) and under (52.2%) utilization of OAC was reported in low- and high-risk AF patients. A considerably high frequency for warfarin use was also noted among high-risk group patients taking OAC (33.1%). The results suggest that anticoagulation use for stroke prevention in the United States is still comparable to the pre-DOAC era studies. About half of newly diagnosed high-risk non-valvular AF patients remain unprotected against stroke risk. Several predictors of OAC and DOAC use were also identified. Our findings may identify a population at risk of complications due to under- or over-treatment and highlight the need for future quality improvement efforts.
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Affiliation(s)
- Ojasav Sehrawat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Anthony H. Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Holly K. Van Houten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Ken Cohen
- Optum Center for Research and Innovation, Minnetonka, MN, United States
| | - Henry Joe Henk
- UnitedHealthcare, 9700 Health Care Lane, Minnetonka, MN 55343, USA
| | - Bernard J. Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Neena S. Abraham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | | | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Peter A. Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Corresponding author at: Department of Cardiovascular Medicine Mayo Clinic, 200 First Street SW |, Rochester, MN 55905, United States.
| | - Xiaoxi Yao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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Saraf K, Morris GM. Left Atrial Appendage Closure: What the Evidence Does and Does Not Reveal-A View from the Outside. Card Electrophysiol Clin 2023; 15:169-181. [PMID: 37076229 DOI: 10.1016/j.ccep.2023.01.005] [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: 04/21/2023]
Abstract
This review summarizes the evidence for left atrial appendage closure (LAAC) as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation. LAAC reduces hemorrhagic stroke and mortality versus warfarin, but is inferior for ischemic stroke reduction based on randomized data. Whilst a feasible treatment in OAC-ineligible patients, questions remain over procedural safety, and the improvement in complications observed in nonrandomized registries is uncorroborated by contemporary randomized trials. Management of device-related thrombus and peridevice leak remain unclear, and robust randomized data versus direct OACs are required before recommendations can be made for widespread adoption in OAC-eligible populations.
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Affiliation(s)
- Karan Saraf
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester M139PL, UK; Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester M139WL, UK
| | - Gwilym M Morris
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester M139PL, UK; Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester M139WL, UK.
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Guo Y, Romiti GF, Sagris D, Proietti M, Bonini N, Zhang H, Lip GYH. Mobile health-technology integrated care in secondary prevention atrial fibrillation patients: a post-hoc analysis from the mAFA-II randomized clinical trial. Intern Emerg Med 2023; 18:1041-1048. [PMID: 36929347 PMCID: PMC10326104 DOI: 10.1007/s11739-023-03249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/26/2023] [Indexed: 03/18/2023]
Abstract
AF patients with history of thromboembolic events are at higher risk of thromboembolic recurrences, despite appropriate antithrombotic treatment. We aimed to evaluate the effect of mobile health (mHealth) technology-implemented 'Atrial fibrillation Better Care' (ABC) pathway approach (mAFA intervention) in secondary prevention AF patients. The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster randomized trial enrolled adult AF patients across 40 centers in China. The main outcome was the composite outcome of stroke or thromboembolism, all-cause death, and rehospitalization. Using Inverse Probability of Treatment Weighting (IPTW), we evaluated the effect of the mAFA intervention in patients with and without prior history of thromboembolic events (i.e., ischemic stroke or thromboembolism). Among the 3324 patients enrolled in the trial, 496 (14.9%, mean age: 75.1 ± 11.4 years, 35.9% females) had a previous episode of thromboembolic event. No significant interaction was observed for the effect of mAFA intervention in patients with vs. without history of thromboembolic events [Hazard ratio, (HR): 0.38, 95% confidence interval (CI):0.18-0.80 vs. HR 0.55, 95% CI 0.17-1.76, p for interaction = 0.587); however, a trend towards lower efficacy of mAFA intervention among AF patients in secondary prevention was observed for secondary outcomes, with significant interaction for bleeding events (p = 0.034) and the composite of cardiovascular events (p = 0.015). A mHealth-technology-implemented ABC pathway provided generally consistent reduction of the risk of primary outcome in both primary and secondary prevention AF patients. Secondary prevention patients may require further specific approaches to improve clinical outcomes such as bleeding and cardiovascular events.Trial registration: WHO International Clinical Trials Registry Platform (ICTRP) Registration number ChiCTR-OOC-17014138.
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Affiliation(s)
- Yutao Guo
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Dimitrios Sagris
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Niccolò Bonini
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, PoliclinicoDi Modena, Modena, Italy
| | - Hui Zhang
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Gregory Y H Lip
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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47
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Yuan Y, Nie B, Gao B, Guo C, Li L. Natriuretic peptides as predictors for atrial fibrillation recurrence after catheter ablation: A meta-analysis. Medicine (Baltimore) 2023; 102:e33704. [PMID: 37171306 PMCID: PMC10174372 DOI: 10.1097/md.0000000000033704] [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] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Catheter ablation (CA) has become the first-line treatment strategy for atrial fibrillation (AF) but remains with a substantial recurrence rate. The aim of this meta-analysis was to determine the association between baseline natriuretic peptide levels and AF recurrence after CA. METHODS We systematically searched PubMed, EMBASE, Web of Science, and Wiley-Cochrane Library for relevant studies published up until May 2022. Overall effect analysis and subgroup analysis were performed with Review Manager software. RESULTS Finally, 61 studies that met the inclusion criteria were included in our meta-analysis. Compared with the nonrecurrence group, the recurrence group had increased baseline level of atrial natriuretic peptide (ANP) (standardized mean difference [SMD] = 0.39, 95% confidence interval [CI]: 0.21-0.56), brain natriuretic peptide (BNP) (SMD = 0.51, 95% CI: 0.31-0.71), N-terminal pro-BNP (SMD = 0.71, 95% CI: 0.49-0.92), and midregional N-terminal pro-ANP (SMD = 0.91, 95% CI: 0.27-1.56). CONCLUSIONS Increased baseline natriuretic peptide levels, including ANP, BNP, N-terminal pro-BNP, and midregional N-terminal pro-ANP, are associated with a higher risk of AF recurrence after CA. Nonetheless, further studies are needed to elucidate the predictive value of baseline natriuretic peptides in AF patients undergoing CA.
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Affiliation(s)
- Yujing Yuan
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Boyuan Nie
- Department of Day Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Binbin Gao
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Caixia Guo
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Li Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, People's Republic of China
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48
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Choi H, Bae MH, Park YJ, Park HK, Lee E, Kim MS, Park JS, Kim HJ, Park BE, Kim HN, Kim N, Lee JH, Jang SY, Yang DH, Park HS, Cho Y. Predictors of stroke or systemic embolism in patients with non-valvular atrial fibrillation with CHA 2 DS 2 -VASc score of 0. Ann Noninvasive Electrocardiol 2023; 28:e13036. [PMID: 36625408 PMCID: PMC10023890 DOI: 10.1111/anec.13036] [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: 08/16/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Anticoagulant therapy has been important for stroke prevention in patients with atrial fibrillation (AF). However, it was not recommended due to its relatively higher risk of bleeding than its lower risk of stroke in patients with a CHA2 DS2 -VASc score of 0. HYPOTHESIS This study aimed to evaluate the predictors of stroke in AF patients with very low risk of stroke. METHODS Between 1990 and 2020, 542 patients with non-valvular AF (NVAF) with a CHA2 DS2 -VASc score of 0 followed up for at least 6 months were enrolled. Patients with only being woman as a risk factor were included as a CHA2 DS2 -VASc score of 0 in this study. The primary outcome was stroke or systemic embolism. RESULTS The primary outcome rate was 0.78%/year. In Cox hazard model, age of ≥50 years at diagnosis (hazard ratio [HR] 6.710, 95% confidence interval [CI] 1.811-24.860, p = .004), LVEDD of ≥46 mm (HR 4.513, 95% CI 1.038-19.626, p = .045), and non-paroxysmal AF (HR 5.575, 95% CI 1.621-19.175, p = .006) were identified as independent predictors of stroke or systemic embolism. Patients with all three independent predictors had a higher risk of stroke or systemic embolism (4.21%/year), whereas those without did not have a stroke or systemic embolism. CONCLUSION The annual stroke or systemic embolism rate in NVAF patients with CHA2 DS2 -VASc score of 0 was 0.78%/year, and age at AF diagnosis, LVEDD, and non-paroxysmal AF were independent predictors of stroke or systemic embolism in patients considered to have a very low risk of stroke.
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Affiliation(s)
- Hyohun Choi
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Myung Hwan Bae
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- School of MedicineKyungpook National UniversityDaeguKorea
| | - Yoon Jung Park
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Hyuk Kyoon Park
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Eunkyu Lee
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Myeong Seop Kim
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Jong Sung Park
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Hyeon Jeong Kim
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Bo Eun Park
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Hong Nyun Kim
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- School of MedicineKyungpook National UniversityDaeguKorea
| | - Namkyun Kim
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- School of MedicineKyungpook National UniversityDaeguKorea
| | - Jang Hoon Lee
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- School of MedicineKyungpook National UniversityDaeguKorea
| | - Se Yong Jang
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- School of MedicineKyungpook National UniversityDaeguKorea
| | - Dong Heon Yang
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- School of MedicineKyungpook National UniversityDaeguKorea
| | - Hun Sik Park
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- School of MedicineKyungpook National UniversityDaeguKorea
| | - Yongkeun Cho
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- School of MedicineKyungpook National UniversityDaeguKorea
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49
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Huang PS, Cheng JF, Chen JJ, Wu CK, Wang YC, Hwang JJ, Tsai CT. CHA2DS2VASc score predicts risk of end stage renal disease in patients with atrial fibrillation: Long-term follow-up study. Heliyon 2023; 9:e13978. [PMID: 36879966 PMCID: PMC9984850 DOI: 10.1016/j.heliyon.2023.e13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Background End stage renal disease (ESRD) is an increasing worldwide epidemic disease. CHA2DS2-VASc score is a well-established predictor of cardiovascular outcome among atrial fibrillation (AF) patients. Objective The aim of this study was to test whether CHA2DS2-VASc score is a good predictor for incident ESRD events. Methods This is a retrospective cohort study (from January 2010 to December 2020) with median follow-up of 61.7 months. Clinical parameters and baseline characteristics were recorded. The endpoint was defined as ESRD with dialysis dependent. Results The study cohort comprised 29,341 participants. Their median age was 71.0 years, 43.2% were male, 21.5% had diabetes mellitus, 46.1% had hypertension, and mean CHA2DS2-VASc score was 2.89. CHA2DS2-VASc score was incrementally associated with the risk of ESRD status during follow-up. Using the univariate Cox model, we found a 26% increase in ESRD risk with an increase of one point in the CHA2DS2-VASc score (HR 1.26 [1.23-1.29], P < 0.001). And using the multi-variate Cox model adjusted by initial CKD stage, we still observed a 5.9% increase in risk of ESRD with a one-point increase in the CHA2DS2-VASc score (HR 1.059 [1.037-1.082], P < 0.001). The CHA2DS2-VASC score and the initial stage of CKD were associated with the risk of ESRD development in patients with AF. Conclusions Our results first confirmed the utility of CHA2DS2-VASC score in predicting progression to ESRD in AF patients. The efficiency is best in CKD stage 1.
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Affiliation(s)
- Pang-Shuo Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Fang Cheng
- Division of Multidiciplinary Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jien-Jiun Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
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50
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Tankut SS, Huang DT, Zareba W, Aktas MK, Rosero SZ, Steinberg J, Henchen J, Kutyifa V, Strawderman RL, Goldenberg I. Insertable cardiac monitor-guided early intervention to reduce atrial fibrillation burden following catheter ablation: Study design and clinical protocol (ICM-REDUCE-AF trial). Ann Noninvasive Electrocardiol 2023; 28:e13043. [PMID: 36718801 PMCID: PMC10023887 DOI: 10.1111/anec.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Percutaneous catheter ablation (CA) to achieve pulmonary vein isolation is an effective treatment for drug-refractory paroxysmal and persistent atrial fibrillation (AF). However, recurrence rates after a single AF ablation procedure remain elevated. Conventional management after CA ablation has mostly been based on clinical AF recurrence. However, continuous recordings with insertable cardiac monitors (ICMs) and patient-triggered mobile app transmissions post-CA can now be used to detect early recurrences of subclinical AF (SCAF). We hypothesize that early intervention following CA based on personalized ICM data can prevent the substrate progression that promotes the onset and maintenance of atrial arrhythmias. METHODS This is a randomized, double-blind (to SCAF data), single-tertiary center clinical trial in which 120 patients with drug-refractory paroxysmal or persistent AF are planned to undergo CA with an ICM. Randomization will be to an intervention arm (n = 60) consisting of ICM-guided early intervention based on SCAF and patient-triggered mobile app transmissions versus a control arm (n = 60) consisting of a standard intervention protocol based on clinical AF recurrence validated by the ICM. Primary endpoint is AF burden, which will be assessed from ICMs at 15 months post-AF ablation. Secondary endpoints include healthcare utilization, functional capacity, and quality of life. CONCLUSION We believe that ICM-guided early intervention will provide a novel, personalized approach to post-AF ablation management that will result in a significant reduction in AF burden, healthcare utilization, and improvements in functional capacity and quality of life.
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Affiliation(s)
- Sinan S. Tankut
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - David T. Huang
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wojciech Zareba
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Mehmet K. Aktas
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Spencer Z. Rosero
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Jonathan Steinberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Summit Medical GroupShort HillsNew JerseyUSA
| | - Jennifer Henchen
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Valentina Kutyifa
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Robert L. Strawderman
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
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