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Vetta G, Parlavecchio A, Caminiti R, Crea P, Magnocavallo M, Della Rocca DG, Lavalle C, Vetta F, Marano G, Ruggieri C, Lofrumento F, Dattilo G, Ferraù L, Dell'Aera C, Giammello F, La Spina P, Musolino RF, Luzza F, Carerj S, Micari A, Di Bella G. Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke. J Electrocardiol 2022; 74:46-53. [PMID: 35964522 DOI: 10.1016/j.jelectrocard.2022.07.071] [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: 05/01/2022] [Revised: 07/06/2022] [Accepted: 07/23/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended. OBJECTIVE To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG. METHODS We prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF. RESULTS Among 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68-0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8-32.8; p < 0.0001). CONCLUSIONS NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
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Affiliation(s)
- Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | | | - Giovanni Marano
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Chiara Ruggieri
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Lofrumento
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Luzza
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Scipione Carerj
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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O'Neill L, Sim I, O'Hare D, Whitaker J, Mukherjee RK, Niederer S, Wright M, Ezzat V, Rosenthal E, Jones MI, Frigiola A, O'Neill MD, Williams SE. Provocation and localization of atrial ectopy in patients with atrial septal defects. J Interv Card Electrophysiol 2022; 65:227-237. [PMID: 35737208 PMCID: PMC9550781 DOI: 10.1007/s10840-022-01273-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022]
Abstract
Background Atrial fibrillation (AF) is associated with atrial septal defects (ASDs), but the mechanism of arrhythmia in these patients is poorly understood. We hypothesised that right-sided atrial ectopy may predominate in this cohort. Here, we aimed to localise the origin of spontaneous and provoked atrial ectopy in ASD patients. Methods Following invasive calibration of P-wave axes, 24-h Holter monitoring was used to determine the chamber of origin of spontaneous atrial ectopy. Simultaneous electrogram recording from multiple intra-cardiac catheters was used to determine the chamber of origin of isoprenaline-provoked ectopy. Comparison was made to a group of non-congenital heart disease AF patients. Results Amongst ASD patients, a right-sided origin for spontaneous atrial ectopy was significantly more prevalent than a left-sided origin (24/30 patients with right-sided ectopy vs. 14/30 with left-sided ectopy, P = 0.015). Amongst AF patients, there was no difference in the prevalence of spontaneous right vs. left-sided ectopy. For isoprenaline-provoked ectopy, there was no significant difference in the proportions of patients with right-sided or left-sided ectopy in either group. Conclusions When spontaneous atrial ectopy occurs in ASD patients, it is significantly more prevalent from a right-sided than left-sided origin. Isoprenaline infusion did not reveal the predilection for right-sided ectopy during electrophysiology study.
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Affiliation(s)
- Louisa O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK.
| | - Iain Sim
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Daniel O'Hare
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK
| | - John Whitaker
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Rahul K Mukherjee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Steven Niederer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Matthew Wright
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK
| | | | | | | | | | - Mark D O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Steven E Williams
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4thFloor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK.,The University of Edinburgh, Edinburgh, UK
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Role of the autonomic nervous system and premature atrial contractions in short-term paroxysmal atrial fibrillation forecasting: Insights from machine learning models. Arch Cardiovasc Dis 2022; 115:377-387. [DOI: 10.1016/j.acvd.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
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Sasaki K, Nakajima I, Higuma T, Yamada M, Kasagawa A, Togashi D, Harada T, Akashi YJ. Revisit to the Prognostic Value of Premature Atrial Contraction Burden in 24-h Holter Electrocardiography for Predicting Undiagnosed Atrial Fibrillation - A Propensity Score-Matched Study. Circ J 2021; 85:1265-1272. [PMID: 33790146 DOI: 10.1253/circj.cj-20-1277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The optimum cut-off value of premature atrial contraction (PAC) burden (CV-PACb) in 24-h Holter electrocardiography (24-h ECG) for predicting atrial fibrillation (AF) is debatable, with few validation data.Methods and Results:We retrospectively analyzed 61 patients already diagnosed with AF (AD-AF) and 147 patients never diagnosed with AF (ND-AF), aged ≥50 years, free of heart disease, and who had undergone 24-h ECG and transthoracic echocardiography (TTE). Receiver operating characteristic analysis demonstrated that 0.4% was the optimal CV-PACb differentiating AD-AF from ND-AF, with 69% sensitivity and 72% specificity (area under the curve [AUC] 0.72; 95% confidence interval [CI] 0.65-0.79); however, the left atrial volume index was not significant (AUC 0.60; 95% CI 0.51-0.68). To verify the CV-PACb, new propensity-matched cohorts (i.e., subjects with a PAC burden ≥0.4% and <0.4%; n=69 in each group) were compared based on new detection of AF at a median follow-up of 50 months (interquartile range 12-60 months) Multivariable Cox regression analysis revealed that among 24-h ECG and TTE findings, only PAC burden ≥0.4% was independently associated with incident AF (hazard ratio 5.28; 95% CI 1.28-26.11; P=0.023). CONCLUSIONS A high PAC burden (≥0.4%) in 24-h ECG was a reliable indicator to identify undiagnosed AF, whereas TTE parameters did not show any predictive value.
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Affiliation(s)
- Kenichi Sasaki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Ikutaro Nakajima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Marika Yamada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Akira Kasagawa
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Daisuke Togashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
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Parsi A, Glavin M, Jones E, Byrne D. Prediction of paroxysmal atrial fibrillation using new heart rate variability features. Comput Biol Med 2021; 133:104367. [PMID: 33866252 DOI: 10.1016/j.compbiomed.2021.104367] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 02/01/2023]
Abstract
Paroxysmal atrial fibrillation (PAF) is a cardiac arrhythmia that can eventually lead to heart failure or stroke if left untreated. Early detection of PAF is therefore crucial to prevent any further complications and avoid fatalities. An implantable defibrillator device could be used to both detect and treat the condition though such devices have limited computational capability. With this constraint in mind, this paper presents a novel set of features to accurately predict the presence of PAF. The method is evaluated using ECG signals from the widely used atrial fibrillation prediction database (AFPDB) from PhysioNet. We analysed 106 signals from 53 pairs of ECG recordings. Each pair of signals contains one 5-min ECG segment that ends just before the onset of a PAF event and another 5-min ECG segment at least 45 min distant from the PAF event, to represent a non-PAF event. Seven novel features are extracted through the Poincaré representation of R-R interval signals, and are prioritised through feature ranking schemes. The features are used with four standard classification techniques for PAF prediction and compared to the existing state of the art from the literature. Using only the seven proposed features, classification performance outperforms those of the classical state-of-the-art feature set, registering sensitivity and specificity measurements of over 96%. The results further improve when the features are combined with several of the classical features, with an accuracy increasing to 98% using a linear kernel SVM. The results show that the proposed features provide a useful representation of the PAF condition and achieve good prediction with off-the-shelf classification techniques that would be suitable for ICU deployment.
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Affiliation(s)
- Ashkan Parsi
- National University of Ireland (NUI) Galway, Galway, H91 TK33, Ireland.
| | - Martin Glavin
- National University of Ireland (NUI) Galway, Galway, H91 TK33, Ireland.
| | - Edward Jones
- National University of Ireland (NUI) Galway, Galway, H91 TK33, Ireland.
| | - Dallan Byrne
- National University of Ireland (NUI) Galway, Galway, H91 TK33, Ireland.
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Meng L, Tsiaousis G, He J, Tse G, Antoniadis AP, Korantzopoulos P, Letsas KP, Baranchuk A, Qi W, Zhang Z, Liu E, Xu G, Xia Y, Li G, Roever L, Lip GY, Fragakis N, Liu T. Excessive Supraventricular Ectopic Activity and Adverse Cardiovascular Outcomes: a Systematic Review and Meta-analysis. Curr Atheroscler Rep 2020; 22:14. [PMID: 32440839 DOI: 10.1007/s11883-020-0832-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Excessive supraventricular ectopic activity (ESVEA), in the form of frequent premature atrial contractions (PACs) and runs of PACs, is commonly observed in clinical practice and is frequently considered to be benign. Yet, recent studies have demonstrated a link between ESVEA and adverse cardiovascular outcomes. The aim of this meta-analysis was to examine the association between ESVEA and the risk of atrial fibrillation (AF), stroke, and mortality. RECENT FINDINGS A systematic search was performed in PubMed, EMBASE, and the Cochrane Library up to December 2017 to identify studies assessing adverse cardiovascular outcomes in patients with ESVEA, recorded on ambulatory electrocardiography. ESVEA was defined as a burden of PACs > 30 PACs/h or any runs of ≥20 PACs. The risk estimates for EVSEA and each clinical endpoint were pooled and analyzed separately. RESULTS Five studies comprising 7545 participants were included in this meta-analysis. The pooled analysis showed that ESVEA doubled the risk of AF (HR 2.19, 95% CI 1.70-2.82). ESVEA was also associated with a higher incidence of stroke (HR 2.23, 95% CI 1.24-4.02). Finally, ESVEA was associated with higher all-cause mortality (HR 1.61, 95% CI 1.25-2.07). Our meta-analysis found that ESVEA is closely associated with AF, stroke, and all-cause mortality. Further studies are required to examine the implication of therapeutic strategies in patients with ESVEA, in order to prevent potential subsequent adverse cardiovascular outcomes.
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Affiliation(s)
- Lei Meng
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Georgios Tsiaousis
- Third Cardiology Department, Hippokrateion Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Jinli He
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Antonios P Antoniadis
- Third Cardiology Department, Hippokrateion Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | | | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Adrian Baranchuk
- Divisions of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Wenwei Qi
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Zhiwei Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Enzhao Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Gang Xu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Yunlong Xia
- Departments of Cardiovascular Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, England, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nikolaos Fragakis
- Third Cardiology Department, Hippokrateion Hospital, Aristotle University Medical School, Thessaloniki, Greece.
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
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Shelemekhov AE, Batalov RE, Rogovskaya JV, Gusakova AM, Popov SV, Khlynin MS. [Catheter treat-ment of patients with atrial fibrillation and myocardial inflammation]. ACTA ACUST UNITED AC 2020; 60:102-110. [PMID: 32375622 DOI: 10.18087/cardio.2020.3.n891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/24/2019] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
The review presents current data on atrial fibrillation, therapeutic approaches, and possibilities of interventional treatment and addresses inflammatory heart damage and its interrelation with arrhythmia.The review presents current data on atrial fibrillation, therapeutic approaches, and possibilities of interventional treatment and addresses inflammatory heart damage and its interrelation with arrhythmia.
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Affiliation(s)
- A E Shelemekhov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russia
| | - R E Batalov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russia
| | - Ju V Rogovskaya
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russia
| | - A M Gusakova
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russia
| | - S V Popov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russia
| | - M S Khlynin
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russia
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Jalali A, Lee M. Atrial Fibrillation Prediction With Residual Network Using Sensitivity and Orthogonality Constraints. IEEE J Biomed Health Inform 2020; 24:407-413. [DOI: 10.1109/jbhi.2019.2957809] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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9
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Cipriani A, Vio R, Mastella G, Ciarmatori N, Del Monte A, Trovato D, Iliceto S, Schiavon M, Bertaglia E, Corrado D, Zorzi A. Burden of premature atrial beats in middle-aged endurance athletes with and without lone atrial fibrillation versus sedentary controls. Eur J Prev Cardiol 2019; 27:1555-1563. [PMID: 31604380 DOI: 10.1177/2047487319880042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The burden of premature atrial beats (PABs) at 24-h electrocardiographic (ECG) monitoring correlates with the risk of atrial fibrillation. It is unknown whether prolonged and intense exercise increases the burden of PABs, thus contributing to the higher prevalence of atrial fibrillation observed in middle-aged athletes. METHODS We compared the burden of PABs at 24-h ECG monitoring off therapy in 134 healthy middle-aged (30-60-year-old) competitive athletes who had practised 9 (7-11) h of endurance sports for 8 (4-15) consecutive years, 134 age- and gender-matched healthy sedentary individuals, and 66 middle-aged patients (20 athletes and 46 non-athletes) with 'lone' paroxysmal atrial fibrillation. RESULTS More than 50 PABs/24 h or ≥1 run of ≥3 PABs were recorded in 23/134 (17%) healthy athletes and in 29/134 (22%) sedentary controls (p = 0.61). Healthy athletes with frequent or repetitive PABs were older (median 50 years vs. 43 years, p < 0.01) and had practised sport for a longer time (median 10 years vs. 6 years, p = 0.03). At multivariable analysis only age (odds ratio 1.11, 95% confidence interval 1.04-1.20, p < 0.01) remained an independent predictor of a higher burden of PABs. Also among patients with 'lone' paroxysmal atrial fibrillation, there was no difference in the prevalence of >50 PABs/24 h or ≥1 run of ≥3 PABs between athletes (40%) and controls (48%, p = 0.74). CONCLUSIONS Middle-aged endurance athletes, with or without paroxysmal atrial fibrillation, did not show a higher burden of PABs at 24-h ECG monitoring than sedentary controls. Age, but not intensity and duration of sports activity, predicted a higher burden of PABs among healthy athletes.
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Affiliation(s)
- Alberto Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Riccardo Vio
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Giulio Mastella
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Nicolò Ciarmatori
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Alvise Del Monte
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Domenico Trovato
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Sabino Iliceto
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Maurizio Schiavon
- Physical Activity and Sports Medicine Unit, AULSS 6 Euganea, Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - Alessandro Zorzi
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
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Durmaz E, Ikitimur B, Kilickiran Avci B, Atıcı A, Yurtseven E, Tokdil H, Ebren C, Polat F, Karaca O, Karadag B, Ongen Z. The clinical significance of premature atrial contractions: How frequent should they become predictive of new-onset atrial fibrillation. Ann Noninvasive Electrocardiol 2019; 25:e12718. [PMID: 31603280 PMCID: PMC7358836 DOI: 10.1111/anec.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022] Open
Abstract
Background Although previous studies reported frequent premature atrial contractions(fPACs) increased the risk of adverse cardiovascular outcomes, especially atrial fibrillation(AF), there is a substantial inconsistency between reports concerning the definition of fPAC. In this study, we aimed to investigate the relationship between fPAC and cardiovascular outcomes, especially AF. We further searched for a cutoff value of fPAC for prediction of AF. Methods We retrospectively analyzed the ambulatory 24‐hr Holter monitoring records and 392 patients included. Frequent PAC was defined as more than 720 PAC/24 hr as used for frequent ventricular premature beats. Patients’ baseline characteristics, echocardiographic variables and medical history were recorded. Results There were 189 patients with fPAC and 203 patients without fPAC. Patients with fPAC had more comorbidities in terms of hypertension, diabetes mellitus, coronary artery disease and congestive heart failure. CHA2DS2‐VaSc was higher in patients with fPAC. Mean follow‐up duration was 31 months, and the number of patients with new‐onset AF during follow‐up was significantly higher in fPAC group (22% vs. 5%, p < .001). fPAC was significantly and independently associated with new‐onset AF and predicted AF with a cutoff value of 3,459 PAC/24 hr, and the risk of AF was 11‐fold higher than those with <3,000 PAC/24 hr. In addition, an increased CHA2DS2‐VaSc score was also associated with new‐onset atrial fibrillation. Conclusion In our study, we have demonstrated that fPAC is significantly associated with new‐onset AF, and this association is the strongest among those patients who have more than 3,000 PAC in 24 hr.
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Affiliation(s)
- Eser Durmaz
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Baris Ikitimur
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burcak Kilickiran Avci
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Adem Atıcı
- Cardiology Department, Goztepe Research and Training Hospital, Istabul, Turkey
| | - Ece Yurtseven
- Cardiology Department, Koc University Hospital, Istanbul, Turkey
| | - Hasan Tokdil
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cansu Ebren
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fuat Polat
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Orhan Karaca
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bilgehan Karadag
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeki Ongen
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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PhysOnline: An Open Source Machine Learning Pipeline for Real-Time Analysis of Streaming Physiological Waveform. IEEE J Biomed Health Inform 2019; 23:59-65. [DOI: 10.1109/jbhi.2018.2832610] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Ebrahimzadeh E, Kalantari M, Joulani M, Shahraki RS, Fayaz F, Ahmadi F. Prediction of paroxysmal Atrial Fibrillation: A machine learning based approach using combined feature vector and mixture of expert classification on HRV signal. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 165:53-67. [PMID: 30337081 DOI: 10.1016/j.cmpb.2018.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/17/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Paroxysmal Atrial Fibrillation (PAF) is one of the most common major cardiac arrhythmia. Unless treated timely, PAF might transform into permanent Atrial Fibrillation leading to a high rate of morbidity and mortality. Therefore, increasing attention has been directed towards prediction of PAF, to enable early detection and prevent further progression of the disease. Notwithstanding the pharmacological and electrical treatments, a validated method to predict the onset of PAF is yet to be developed. We aim to address this issue through integrating classical and modern methods. METHODS To increase the predictivity, we have made use of a combination of features extracted through linear, time-frequency, and nonlinear analyses performed on heart rate variability. We then apply a novel approach to local feature selection using meticulous methodologies, developed in our previous works, to reduce the dimensionality of the feature space. Subsequently, the Mixture of Experts classification is employed to ensure a precise decision-making on the output of different processes. In the current study, we analyzed 106 signals from 53 pairs of ECG recordings obtained from the standard database called Atrial Fibrillation Prediction Database (AFPDB). Each pair of data contains one 30-min ECG segment that ends just before the onset of PAF event and another 30-min ECG segment at least 45 min distant from the onset. RESULTS Combining the features that are extracted using both classical and modern analyses was found to be significantly more effective in predicting the onset of PAF, compared to using either analyses independently. Also, the Mixture of Experts classification yielded more precise class discrimination than other well-known classifiers. The performance of the proposed method was evaluated using the Atrial Fibrillation Prediction Database (AFPDB) which led to sensitivity, specificity, and accuracy of 100%, 95.55%, and 98.21% respectively. CONCLUSION Prediction of PAF has been a matter of clinical and theoretical importance. We demonstrated that utilising an optimized combination of - as opposed to being restricted to - linear, time-frequency, and nonlinear features, along with applying the Mixture of Experts, contribute greatly to an early detection of PAF, thus, the proposed method is shown to be superior to those mentioned in similar studies in the literature.
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Affiliation(s)
- Elias Ebrahimzadeh
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran; Biomedical Engineering Department, School of Electrical Engineering, Payame Noor University of North Tehran, Tehran, Iran; Seaman Family MR Research Center, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Maede Kalantari
- Department of Biomedical Engineering, Faculty of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammadamin Joulani
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Farahnaz Fayaz
- Biomedical Engineering Department, School of Electrical Engineering, Payame Noor University of North Tehran, Tehran, Iran
| | - Fereshteh Ahmadi
- Biomedical Engineering Department, School of Electrical Engineering, Payame Noor University of North Tehran, Tehran, Iran
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Prasitlumkum N, Rattanawong P, Limpruttidham N, Kanitsoraphan C, Sirinvaravong N, Suppakitjanusant P, Chongsathidkiet P, Chung EH. Frequent premature atrial complexes as a predictor of atrial fibrillation: Systematic review and meta-analysis. J Electrocardiol 2018; 51:760-767. [PMID: 30177309 DOI: 10.1016/j.jelectrocard.2018.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Frequent premature atrial complexes (PACs) are associated with higher morbidity and mortality. Recent studies suggest that frequent PACs are associated with new onset atrial fibrillation (AF). However, a systematic review and meta-analysis of the literature has not been done. We assessed the association between frequent PACs and new onset AF by a systematic review and a meta-analysis. METHODS We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published cohort (prospective or retrospective) that compared new onset AF among patients with and without frequent PACs documented by Holter monitoring or 12-lead electrocardiogram. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. RESULTS Twelve studies from 2009 to 2017 were included in this meta-analysis involving 109,689 subjects (9217frequent and 100,472 non-frequent PACs). Frequent PACs were associated with increased risk of new onset AF (pooled risk ratio = 2.76, 95% confidence interval: 2.05-3.73, p < 0.000, I2 = 90.6%). CONCLUSION Frequent PACs are associated with up to three-fold increased risk of new onset AF. Our study suggests that frequent PACs in general population is an independent predictor of new onset AF.
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Affiliation(s)
- Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA.
| | - Pattara Rattanawong
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nath Limpruttidham
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Natee Sirinvaravong
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Eugene H Chung
- University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
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Marinheiro R, Parreira L, Amador P, Sá C, Duarte T, Caria R. Excessive atrial ectopic activity as an independent risk factor for ischemic stroke. Int J Cardiol 2017; 249:226-230. [DOI: 10.1016/j.ijcard.2017.08.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/08/2017] [Accepted: 08/21/2017] [Indexed: 11/28/2022]
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15
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Sorajja D, Shen WK. On the road to atrial fibrillation. Heart Rhythm 2017; 14:1862-1863. [PMID: 29110995 DOI: 10.1016/j.hrthm.2017.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona
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Alhede C, Lauridsen TK, Johannessen A, Dixen U, Jensen JS, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, Pehrson S, Englund A, Hartikainen J, Hansen PS, Nielsen JC, Jons C. Antiarrhythmic medication is superior to catheter ablation in suppressing supraventricular ectopic complexes in patients with atrial fibrillation. Int J Cardiol 2017; 244:186-191. [DOI: 10.1016/j.ijcard.2017.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
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17
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Nguyen KT, Vittinghoff E, Dewland TA, Dukes JW, Soliman EZ, Stein PK, Gottdiener JS, Alonso A, Chen LY, Psaty BM, Heckbert SR, Marcus GM. Ectopy on a Single 12-Lead ECG, Incident Cardiac Myopathy, and Death in the Community. J Am Heart Assoc 2017; 6:JAHA.117.006028. [PMID: 28775064 PMCID: PMC5586444 DOI: 10.1161/jaha.117.006028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation and heart failure are 2 of the most common diseases, yet ready means to identify individuals at risk are lacking. The 12-lead ECG is one of the most accessible tests in medicine. Our objective was to determine whether a premature atrial contraction observed on a standard 12-lead ECG would predict atrial fibrillation and mortality and whether a premature ventricular contraction would predict heart failure and mortality. METHODS AND RESULTS We utilized the CHS (Cardiovascular Health) Study, which followed 5577 participants for a median of 12 years, as the primary cohort. The ARIC (Atherosclerosis Risk in Communities Study), the replication cohort, captured data from 15 792 participants over a median of 22 years. In the CHS, multivariable analyses revealed that a baseline 12-lead ECG premature atrial contraction predicted a 60% increased risk of atrial fibrillation (hazard ratio, 1.6; 95% CI, 1.3-2.0; P<0.001) and a premature ventricular contraction predicted a 30% increased risk of heart failure (hazard ratio, 1.3; 95% CI, 1.0-1.6; P=0.021). In the negative control analyses, neither predicted incident myocardial infarction. A premature atrial contraction was associated with a 30% increased risk of death (hazard ratio, 1.3; 95% CI, 1.1-1.5; P=0.008) and a premature ventricular contraction was associated with a 20% increased risk of death (hazard ratio, 1.2; 95% CI, 1.0-1.3; P=0.044). Similarly statistically significant results for each analysis were also observed in ARIC. CONCLUSIONS Based on a single standard ECG, a premature atrial contraction predicted incident atrial fibrillation and death and a premature ventricular contraction predicted incident heart failure and death, suggesting that this commonly used test may predict future disease.
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Affiliation(s)
- Kaylin T Nguyen
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Jonathan W Dukes
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Elsayed Z Soliman
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Phyllis K Stein
- Division of Cardiology, Washington University School of Medicine, St Louis, MO
| | - John S Gottdiener
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA.,Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Susan R Heckbert
- Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle, WA.,Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
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Diederichsen SZ, Haugan KJ, Køber L, Højberg S, Brandes A, Kronborg C, Graff C, Holst AG, Nielsen JB, Krieger D, Svendsen JH. Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in individuals at risk (the LOOP study): Rationale and design of a large randomized controlled trial. Am Heart J 2017; 187:122-132. [PMID: 28454796 DOI: 10.1016/j.ahj.2017.02.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/06/2017] [Indexed: 02/05/2023]
Abstract
Atrial fibrillation (AF) increases the rate of stroke 5-fold, and AF-related strokes have a poorer prognosis compared with non-AF-related strokes. Atrial fibrillation and stroke constitute an intensifying challenge, and health care organizations are calling for awareness on the topic. Previous studies have demonstrated that AF is often asymptomatic and consequently undiagnosed. The implantable loop recorder (ILR) allows for continuous, long-term electrocardiographic monitoring with daily transmission of arrhythmia information, potentially leading to improvement in AF detection and stroke prevention. METHODS The LOOP study is an investigator-initiated, randomized controlled trial with 6,000 participants randomized 3:1 to a control group or to receive an ILR with continuous electrocardiographic monitoring. Participants are identified from Danish registries and are eligible for inclusion if 70years or older and previously diagnosed as having at least one of the following conditions: hypertension, diabetes mellitus, heart failure, or previous stroke. Exclusion criteria include history of AF and current oral anticoagulation treatment. When an AF episode lasting ≥6minutes is detected, oral anticoagulation will be initiated according to guidelines. Expected follow-up is 4years. The primary end point is time to stroke or systemic embolism, whereas secondary end points include time to AF diagnosis and death. CONCLUSION The LOOP study will evaluate health benefits and cost-effectiveness of ILR as a screening tool for AF to prevent stroke in patients at risk. Secondary objectives include identification of risk factors for the development of AF and characterization of arrhythmias in the population. The trial holds the potential to influence the future of stroke prevention.
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Affiliation(s)
- Søren Zöga Diederichsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ketil Jørgen Haugan
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Højberg
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Kronborg
- Centre of Health Economics Research (COHERE), Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Anders Gaarsdal Holst
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; The Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark
| | - Jonas Bille Nielsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Derk Krieger
- University Hospital Zurich, Switzerland; Mediclinic City Hospital, Dubai, United Arabic Emirates
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.
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Early, de novo atrial fibrillation after coronary artery bypass grafting: Facts and features. Am Heart J 2017; 184:62-70. [PMID: 27892888 DOI: 10.1016/j.ahj.2016.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022]
Abstract
Knowledge of the mechanism underlying post-operative atrial fibrillation (PoAF) is essential for development of preventive measures. The incidence and characteristics of both PoAF and supraventricular premature beats triggering PoAF, their interrelationship and alterations over time have never been examined. The goal of this study is therefore to examine the correlation between the incidence and characteristics of supraventricular premature beats (SVPBs) and PoAF episodes in patients undergoing CABG in the first five post-operative days. METHODS PoAF episodes (N=327) and SVPBs (N=141,873) were characterized in 29 patients (63±9 years; 22 (76%) male) undergoing coronary artery bypass grafting and compared with a control group of patients without PoAF by using continuous cardiac rhythm monitoring during the first 5 days after surgery. RESULTS Most patients (N=18, 62%) had multiple PoAF episodes; the median number of PoAF episodes per patient was 3 and varied between 1 and 139. The majority of PoAF episodes developed on the second and third post-operative day (55%). The averaged median duration of PoAF episodes per patient was 469±1085 min. Patients with PoAF had a higher SVPBs burden compared to subjects without PoAF (0.9% vs 0.2%, P<.001). SVPBs initiating PoAF had shorter coupling intervals than SVPBs which did not initiate PoAF episodes (58% vs 64% (P<.001) and were preceded by heart rate acceleration. CONCLUSION PoAF episodes are mainly repetitive though transient in nature. There was a considerable inter-individual variation in both AF and SVPB characteristics, despite a similar underlying clinical profile. The SVPB burden is higher in patients with PoAF and the mode of onset is characterized by short coupled SVPBs. Determination of individual post-operative dysrhythmia profiles enables identification of patients at risk for developing PoAF.
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20
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Nguyen KT, Vittinghoff E, Dewland TA, Mandyam MC, Stein PK, Soliman EZ, Heckbert SR, Marcus GM. Electrocardiographic Predictors of Incident Atrial Fibrillation. Am J Cardiol 2016; 118:714-9. [PMID: 27448684 DOI: 10.1016/j.amjcard.2016.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) is likely secondary to multiple different pathophysiological mechanisms that are increasingly but incompletely understood. Motivated by the hypothesis that 3 previously described electrocardiographic predictors of AF identify distinct AF mechanisms, we sought to determine if these electrocardiographic findings independently predict incident disease. Among Cardiovascular Health Study participants without prevalent AF, we determined whether left anterior fascicular block (LAFB), a prolonged QTC, and atrial premature complexes (APCs) each predicted AF after adjusting for each other. We then calculated the attributable risk in the exposed for each electrocardiographic marker. LAFB and QTC intervals were assessed on baseline 12-lead electrocardiogram (n = 4,696). APC count was determined using 24-hour Holter recordings obtained in a random subsample (n = 1,234). After adjusting for potential confounders and each electrocardiographic marker, LAFB (hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.1 to 3.9, p = 0.023), a prolonged QTC (HR 2.5, 95% CI 1.4 to 4.3, p = 0.002), and every doubling of APC count (HR 1.2, 95% CI 1.1 to 1.3, p <0.001) each remained independently predictive of incident AF. The attributable risk of AF in the exposed was 35% (95% CI 13% to 52%) for LAFB, 25% (95% CI 0.6% to 44%) for a prolonged QTC, and 34% (95% CI 26% to 42%) for APCs. In conclusion, in a community-based cohort, 3 previously established electrocardiogram-derived AF predictors were each independently associated with incident AF, suggesting that they may represent distinct mechanisms underlying the disease.
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Affiliation(s)
- Kaylin T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Mala C Mandyam
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Phyllis K Stein
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Elsayed Z Soliman
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, Washington
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California.
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Diagnosing Paroxysmal Atrial Fibrillation: Are Biomarkers the Solution to This Elusive Arrhythmia? BIOMED RESEARCH INTERNATIONAL 2015; 2015:910267. [PMID: 26229966 PMCID: PMC4502272 DOI: 10.1155/2015/910267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 02/09/2015] [Accepted: 02/12/2015] [Indexed: 01/02/2023]
Abstract
Atrial fibrillation (AF) is the commonest sustained arrhythmia globally and results in significantly increased morbidity and mortality including a fivefold risk of stroke. Paroxysmal atrial fibrillation (PAF) constitutes approximately half of all AF cases and is thought to represent an early stage of the disease. This intermittent form of atrial arrhythmia can be a challenge to identify and as a result many affected individuals are not prescribed appropriate antithrombotic therapy and hence are at risk of stroke and thromboembolism. Despite these adverse outcomes there have been relatively few diagnostic advances in the field since the introduction of the Holter monitor in 1949. This review aims to establish the available evidence for electrophysiological, molecular, and morphological biomarkers to improve the detection of PAF with reference to the underlying mechanisms for the condition.
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Schlatzer C, Schwarz EI, Sievi NA, Clarenbach CF, Gaisl T, Haegeli LM, Duru F, Stradling JR, Kohler M. Intrathoracic pressure swings induced by simulated obstructive sleep apnoea promote arrhythmias in paroxysmal atrial fibrillation. Europace 2015; 18:64-70. [DOI: 10.1093/europace/euv122] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023] Open
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Alcaraz R, Martínez A, Rieta JJ. The P Wave Time-Frequency Variability Reflects Atrial Conduction Defects before Paroxysmal Atrial Fibrillation. Ann Noninvasive Electrocardiol 2014; 20:433-45. [PMID: 25418673 DOI: 10.1111/anec.12240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The study of atrial conduction defects associated with the onset of paroxysmal atrial fibrillation (PAF) can be addressed by analyzing the P wave from the surface electrocardiogram (ECG). Traditionally, signal-averaged ECGs have been mostly used for this purpose. However, this alternative hinders the possibility to quantify every single P wave, its variability over time, as well as to obtain complimentary and evolving information about the arrhythmia. This work analyzes the time progression of several time and frequency P wave features as potential indicators of atrial conduction variability several hours preceding the onset of PAF. METHODS The longest sinus rhythm interval from 24-hour Holter recordings of 46 PAF patients was selected. Next, the 2 hours before the onset of PAF were extracted and divided into two 1-hour periods. Every single P wave was automatically delineated and characterized by 16 time and frequency metrics, such as its duration, absolute energy in several frequency bands and high-to-low-frequency energy ratios. Finally, the P wave variability over each 1-hour period was estimated from the 16 features making use of a least-squares linear fitting. As a reference, the same parameters were also estimated from a set of 1-hour ECG segments randomly chosen from a control group of 53 healthy subjects age-, gender-, and heart rate-matched. RESULTS All the analyzed metrics provided an increasing P wave variability trend as the onset of PAF approximated, being P wave duration and P wave high-frequency energy the most significant individual metrics. The linear fitting slope α associated with P wave duration was (2.48 ± 1.98)×10(-2) for healthy subjects, (23.8 ± 14.1)×10(-2) for ECG segments far from PAF and for (81.8 ± 48.7)×10(-2) ECG segments close to PAF p = 6.96×10(-22) . Similarly, the P wave high-frequency energy linear fitting slope was (2.42 ± 4.97)×10(-9) , (54.2 ± 107.1)×10(-9) and (274.2 ± 566.1)×10(-9) , respectively (p = 2.85×10(-20) ). A univariate discriminant analysis provided that both P wave duration and P wave high-frequency energy could discern among the three ECG sets with diagnostic ability around 80%, which was improved up to 88% by combining these metrics in a multivariate discriminant analysis. CONCLUSION Alterations in atrial conduction can be successfully quantified several hours before the onset of PAF by estimating variability over time of several time and frequency P wave features.
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Affiliation(s)
- Raúl Alcaraz
- Innovation in Bioengineering Research Group, University of Castilla-La Mancha, Cuenca, Spain
| | - Arturo Martínez
- Innovation in Bioengineering Research Group, University of Castilla-La Mancha, Cuenca, Spain
| | - José J Rieta
- Biomedical Synergy, Electronic Engineering Department, Universidad Politécnica de Valencia, Valencia, Spain
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Martínez A, Alcaraz R, Rieta JJ. Gaussian modeling of the P-wave morphology time course applied to anticipate paroxysmal atrial fibrillation. Comput Methods Biomech Biomed Engin 2014; 18:1775-84. [PMID: 25298113 DOI: 10.1080/10255842.2014.964219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper introduces a new algorithm to quantify the P-wave morphology time course with the aim of anticipating as much as possible the onset of paroxysmal atrial fibrillation (PAF). The method is based on modeling each P-wave with a single Gaussian function and analyzing the extracted parameters variability over time. The selected Gaussian approaches are associated with the amplitude, peak timing, and width of the P-wave. In order to validate the algorithm, electrocardiogram segments 2 h preceding the onset of PAF episodes from 46 different patients were assessed. According to the expected intermittently disturbed atrial conduction before the onset of PAF, all the analyzed Gaussian metrics showed an increasing variability trend as the PAF onset approximated. Moreover, the Gaussian P-wave width reported a diagnostic accuracy around 80% to discern between healthy subjects, patients far from PAF, and patients less than 1 h close to a PAF episode. This discriminant power was similar to those provided by the most classical time-domain approach, i.e., the P-wave duration. However, this newly proposed parameter presents the advantage of being less sensitive to a precise delineation of the P-wave boundaries. Furthermore, the linear combination of both metrics improved the diagnostic accuracy up to 86.69%. In conclusion, morphological P-wave characterization provides additional information to the metrics based on P-wave timing.
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Affiliation(s)
- Arturo Martínez
- a Innovation in Bioengineering Research Group , University of Castilla-La Mancha , Cuenca , Spain
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Qureshi W, Shah AJ, Salahuddin T, Soliman EZ. Long-term mortality risk in individuals with atrial or ventricular premature complexes (results from the Third National Health and Nutrition Examination Survey). Am J Cardiol 2014; 114:59-64. [PMID: 24819898 DOI: 10.1016/j.amjcard.2014.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
Premature ectopic beats are frequently detected on routine 12-lead screening electrocardiograms (ECGs). However, their prognostic importance in subjects without known cardiovascular disease (CVD) is not well established. We evaluated prognostic value of atrial premature complexes (APCs) and ventricular premature complexes (VPCs) detected by a single 12-lead electrocardiography. A prospective cohort of 7,504 participants selected from nationally representative community-dwelling subjects living in the United States, enrolled in the Third National Health and Nutrition Examination Survey III from 1988 to 1994 with follow-up through December 2006 without known CVD. The main outcomes were all-cause mortality, CVD-related mortality, and ischemic heart disease (IHD)-related mortality. Of 7,504 participants (mean age 60 ± 14 years, 47% women, 49% whites), 89 (1.2%) had APCs and 110 (1.5%) had VPCs on 12-lead ECGs. During a follow-up of up to 18 years, 2,386 deaths occurred, of which 963 were due to CVD and 511 were due to IHD. In a multivariate analysis adjusted for demographics, clinical variables, and electrocardiographic measures, APCs were significantly associated with all-cause mortality (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.08 to 1.80), CVD death (HR 1.78, 95% CI 1.26 to 2.44), and IHD death (HR 2.40, 95% CI 1.59 to 3.47). For VPCs, however, there were no significant associations with all-cause mortality (HR 1.05, 95% CI 0.80 to 1.36), CVD death (HR 0.96, 95% CI 0.62 to 1.43), and IHD death (HR 0.89, 95% CI 0.47 to 1.52). In conclusion, APCs, but not VPCs, on routine screening ECGs are predictive of adverse events in community-dwelling subjects without known CVD.
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Martínez A, Alcaraz R, Rieta JJ. Morphological variability of the P-wave for premature envision of paroxysmal atrial fibrillation events. Physiol Meas 2013; 35:1-14. [PMID: 24345763 DOI: 10.1088/0967-3334/35/1/1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Dewland TA, Vittinghoff E, Mandyam MC, Heckbert SR, Siscovick DS, Stein PK, Psaty BM, Sotoodehnia N, Gottdiener JS, Marcus GM. Atrial ectopy as a predictor of incident atrial fibrillation: a cohort study. Ann Intern Med 2013; 159:721-8. [PMID: 24297188 PMCID: PMC4115459 DOI: 10.7326/0003-4819-159-11-201312030-00004] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) prediction models have unclear clinical utility given the absence of AF prevention therapies and the immutability of many risk factors. Premature atrial contractions (PACs) play a critical role in AF pathogenesis and may be modifiable. OBJECTIVE To investigate whether PAC count improves model performance for AF risk. DESIGN Prospective cohort study. SETTING 4 U.S. communities. PATIENTS A random subset of 1260 adults without prevalent AF enrolled in the Cardiovascular Health Study between 1989 and 1990. MEASUREMENTS The PAC count was quantified by 24-hour electrocardiography. Participants were followed for the diagnosis of incident AF or death. The Framingham AF risk algorithm was used as the comparator prediction model. RESULTS In adjusted analyses, doubling the hourly PAC count was associated with a significant increase in AF risk (hazard ratio, 1.17 [95% CI, 1.13 to 1.22]; P < 0.001) and overall mortality (hazard ratio, 1.06 [CI, 1.03 to 1.09]; P < 0.001). Compared with the Framingham model, PAC count alone resulted in similar AF risk discrimination at 5 and 10 years of follow-up and superior risk discrimination at 15 years. The addition of PAC count to the Framingham model resulted in significant 10-year AF risk discrimination improvement (c-statistic, 0.65 vs. 0.72; P < 0.001), net reclassification improvement (23.2% [CI, 12.8% to 33.6%]; P < 0.001), and integrated discrimination improvement (5.6% [CI, 4.2% to 7.0%]; P < 0.001). The specificity for predicting AF at 15 years exceeded 90% for PAC counts more than 32 beats/h. LIMITATION This study does not establish a causal link between PACs and AF. CONCLUSION The addition of PAC count to a validated AF risk algorithm provides superior AF risk discrimination and significantly improves risk reclassification. Further study is needed to determine whether PAC modification can prospectively reduce AF risk. PRIMARY FUNDING SOURCE American Heart Association, Joseph Drown Foundation, and National Institutes of Health.
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ELAYI CLAUDES, DI BIASE LUIGI, BAI RONG, BURKHARDT JDAVID, MOHANTY PRASANT, SANTANGELI PASQUALE, SANCHEZ JAVIER, HONGO RICHARD, GALLINGHOUSE GJOSEPH, HORTON RODNEY, BAILEY SHANE, BEHEIRY SALWA, NATALE ANDREA. Administration of Isoproterenol and Adenosine to Guide Supplemental Ablation After Pulmonary Vein Antrum Isolation. J Cardiovasc Electrophysiol 2013; 24:1199-206. [DOI: 10.1111/jce.12252] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 06/09/2013] [Accepted: 06/11/2013] [Indexed: 11/28/2022]
Affiliation(s)
- CLAUDE S. ELAYI
- Department of Cardiovascular Medicine, University of Kentucky; Lexington Kentucky USA
| | - LUIGI DI BIASE
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Department of Cardiology; University of Foggia; Foggia Italy
- Department of Biomedical Engineering, University of Texas; Austin Texas USA
| | - RONG BAI
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - J. DAVID BURKHARDT
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - PRASANT MOHANTY
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - PASQUALE SANTANGELI
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - JAVIER SANCHEZ
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - RICHARD HONGO
- California Pacific Medical Center; California San Francisco USA
| | | | - RODNEY HORTON
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - SHANE BAILEY
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - SALWA BEHEIRY
- California Pacific Medical Center; California San Francisco USA
| | - ANDREA NATALE
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Department of Biomedical Engineering, University of Texas; Austin Texas USA
- California Pacific Medical Center; California San Francisco USA
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Suzuki S, Sagara K, Otsuka T, Kano H, Matsuno S, Takai H, Uejima T, Oikawa Y, Koike A, Nagashima K, Kirigaya H, Yajima J, Tanabe H, Sawada H, Aizawa T, Yamashita T. Usefulness of frequent supraventricular extrasystoles and a high CHADS2 score to predict first-time appearance of atrial fibrillation. Am J Cardiol 2013; 111:1602-7. [PMID: 23499279 DOI: 10.1016/j.amjcard.2013.01.335] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 11/16/2022]
Abstract
Frequent supraventricular extrasystoles (SVEs) are associated with the subsequent first-time appearance of atrial fibrillation (AF) and ischemic stroke. The aim of this study was to investigate the combined role of SVEs and an AF-related risk score for ischemic stroke, the CHADS2 score, on the occurrence of new AF in patients in sinus rhythm. The Shinken Database 2004-2010 lists 3,263 patients who underwent 24-hour Holter monitoring. A total of 2,589 patients were analyzed, after excluding 674 patients previously diagnosed with AF. Frequent SVEs were defined as ≥102 beats/day (the top quartile) and the presence of a clinical background for a CHADS2 score ≥2 points as a high CHADS2 score. During the mean follow-up period of 571.4 ± 606.4 days, new AF occurred in 38 patients (9.4 per 1,000 patient-years). The incidence of new AF was 2.7 and 37.7 per 1,000 patient-years for patients with nonfrequent SVEs (<102 beats/day) and low CHADS2 scores and those with frequent SVEs and high CHADS2 scores, respectively. Multivariate Cox regression analysis showed that the hazard ratio for frequent SVEs and a high CHADS2 score compared with nonfrequent SVEs and a low CHADS2 score was 9.49 (95% confidence interval 3.20 to 28.15, p <0.001), even after adjustment for gender, age, medications, and echocardiographic parameters. In conclusion, frequent SVEs and a high CHADS2 score independently and synergistically predict the first-time appearance of AF in patients in sinus rhythm, indicating an approximately 10-fold higher risk. Patients meeting these criteria should have more aggressive early intervention for preventing AF.
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Affiliation(s)
- Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan.
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Su L, Borov S, Zrenner B. 12-lead Holter electrocardiography. Review of the literature and clinical application update. Herzschrittmacherther Elektrophysiol 2013; 24:92-96. [PMID: 23778563 DOI: 10.1007/s00399-013-0268-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/03/2013] [Indexed: 06/02/2023]
Abstract
This brief review is focused on 12-lead Holter electrocardiogram (ECG) recording including a review of the literature and the description of the advantages of its application. The standard 12-lead ECG provides a bedside snapshot of the electrical activity of the heart including vector information, but a snapshot of a few beats for some seconds might miss the whole story. Traditional Holter ECG displaying two or three leads may record all heart beats during a prolonged period, but the limited vector information might be a cause of shortcomings in the ECG diagnosis. The 12-lead Holter ECG overcomes these disadvantages and should be preferred for detecting episodes of arrhythmias, localize their origin or the localization of myocardial ischemia. The 12-lead Holter ECG monitoring is efficient in the evaluation of the effect of drugs or interventional therapeutic procedures, i.e., efficiency of biventricular pacing in patients with heart failure and permanent atrial fibrillation (AF). The automatic analysis of parameters in 12-lead Holter ECG is also providing information for risk stratification. In order to obtain a precise diagnosis based on the criteria established on standard ECG, the "real" 12-lead ECG with ten electrodes is advocated.
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Affiliation(s)
- Li Su
- Department of Cardiology, The Second affiliated Hospital of the Chongqing Medical University, Nr.74 Linjiang Road, Yuzhong District, 400010, Chonqing, PR China.
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Brooks AG, Rangnekar G, Ganesan AN, Salna I, Middeldorp ME, Kuklik P, Baumert M, Roberts-Thomson KC, Sanders P. Characteristics of ectopic triggers associated with paroxysmal and persistent atrial fibrillation: Evidence for a changing role. Heart Rhythm 2012; 9:1367-74. [DOI: 10.1016/j.hrthm.2012.03.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Indexed: 10/28/2022]
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Chong BH, Pong V, Lam KF, Liu S, Zuo ML, Lau YF, Lau CP, Tse HF, Siu CW. Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events. Europace 2012; 14:942-947. [DOI: 10.1093/europace/eur389] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Cliff B, Younis N, Hama S, Soran H. The role of the renin-angiotensin system blocking in the management of atrial fibrillation. J Drug Assess 2012; 1:55-64. [PMID: 27536429 PMCID: PMC4980732 DOI: 10.3109/21556660.2012.672353] [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] [Accepted: 02/29/2012] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To review current available evidence for the role of renin-angiotensin system blockade in the management of atrial fibrillation. METHOD We conducted a PubMed and Medline literature search (January 1980 through July 2011) to identify all clinical trials published in English concerning the use of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers for primary and secondary prevention of atrial fibrillation. We also discussed renin-angiotensin system and its effects on cellular electrophysiology. CONCLUSION The evidence from the current studies discussed does not provide a firm definitive indication for the use of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers in the primary or secondary prevention of atrial fibrillation. Nevertheless, modest benefits were observed in patients with left ventricular dysfunction. In view of the possible benefits and the low incidence of side-effects with angiotensin converting enzyme inhibitors and angiotensin II receptor blockers, they can be given to patients with recurrent AF, specifically those with hypertension, heart failure and diabetes mellitus.
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Affiliation(s)
- Brett Cliff
- University Department of Medicine, Central Manchester University Hospitals NHS Foundation Trust, ManchesterUK
| | - Naveed Younis
- Department of Diabetes and Endocrinology, South Manchester University Hospitals NHS Foundation Trust, ManchesterUK
| | - Salam Hama
- Cardiovascular Research Group, School of Biomedicine, Core Technology Facility (3rd Floor), University of Manchester, ManchesterUK
| | - Handrean Soran
- University Department of Medicine, Central Manchester University Hospitals, ManchesterUK
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De Mattia L, Brieda M, Dametto E, Del Bianco F, Nicolosi GL. Paroxysmal atrial fibrillation triggered by a monomorphic ventricular couplet in a patient with acute coronary syndrome. Indian Pacing Electrophysiol J 2012; 12:19-23. [PMID: 22368378 PMCID: PMC3273953 DOI: 10.1016/s0972-6292(16)30460-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Atrial fibrillation is a common arrhythmia in patients suffering from acute myocardial infarction, however its pathophysiological mechanisms are not fully understood. We describe the unusual case of a 76-year old woman admitted for non-ST-segment elevation myocardial infarction, who developed multiple episodes of paroxysmal atrial fibrillation triggered by monomorphic ventricular couplets. Beta-blocking and amiodarone therapy resulted efficacious in preventing arrhythmic recurrences. We then discuss the possible arrhythmogenic mechanisms, with special emphasis on the unique electrophysiological, hemodynamic, cellular and anatomical milieu created by acute myocardial ischemia.
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Affiliation(s)
- Luca De Mattia
- Department of Cardiology ARC, Azienda Ospedali Riuniti del Pordenonese, Pordenone, Italy
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35
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Mohebbi M, Ghassemian H. Prediction of paroxysmal atrial fibrillation based on non-linear analysis and spectrum and bispectrum features of the heart rate variability signal. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 105:40-49. [PMID: 20732724 DOI: 10.1016/j.cmpb.2010.07.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 07/17/2010] [Accepted: 07/29/2010] [Indexed: 05/29/2023]
Abstract
In this paper, an effective paroxysmal atrial fibrillation (PAF) prediction algorithm is presented, which is based on analysis of the heart rate variability (HRV) signal. The proposed method consists of a preprocessing step for QRS detection and HRV signal extraction. In the next step, several features which can be used as markers for the prediction of PAF are extracted from the HRV signal. These features consist of spectrum features, bispectrum features, and non-linear features including sample entropy and Poincaré plot-extracted features. The spectrum features are able to discriminate the sympathetic and parasympathetic contents of the HRV signal, which are affected before PAF attacks. The bispectrum features are used in order to reveal information not presented on the spectral domain, and to detect quadratic phase coupled harmonics arising from non-linearities of the HRV signal. Moreover, the non-linear analysis can map the heart rate irregularities in the feature space and it leads to better understanding of the system dynamics before PAF attacks. In the final step, a support vector machine (SVM)-based classifier has been used for PAF prediction. The performance of the proposed method in prediction of PAF episodes was evaluated using the Atrial Fibrillation Prediction Database (AFPDB). The obtained sensitivity, specificity, and positive predictivity were 96.30%, 93.10%, and 92.86%, respectively. The proposed methodology presents better results than the other existing approaches. The other important advantage of the proposed method when compared to the other approaches is that we do not need the both records of a subject to specify which episode preceding PAF events.
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Affiliation(s)
- Maryam Mohebbi
- Biomedical Engineering Department, Faculty of Electrical and Computer Engineering, Tarbiat Modares University, Tehran, Iran
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Garadah T, Gabani S, Alawi MA, Abu-Taleb A. Prevalence and Predisposing Factors of Atrial Fibrillation in a Multi-Ethnic Society: The Impact of Racial Differences in Bahrain. Open J Cardiovasc Surg 2011; 4:9-16. [PMID: 26949337 PMCID: PMC4767129 DOI: 10.4137/ojcs.s8032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background The prevalence and epidemiological data of atrial fibrillation (AF) among multi-ethnic populations is less well studied worldwide. Aim Evaluation of the prevalence and predisposing factors of AF in patients who were admitted to acute medical emergencies (ER) in Bahrain over the period of one year. Methods Two hundred and fifty three patients with onset of AF were studied. The mean difference of biochemical data and clinical characteristics between Middle Eastern (ME) and sub continental (SC) patients was evaluated. The odds ratio of different predisposing factors for the development of clinical events in AF patients was assessed using multiple logistic regression analysis. Results Out of 7,450 patients that were admitted to ER over one year, 253 had AF based on twelve leads Electrocardiogram (ECG), with prevalence of 3.4%. In the whole study, the mean age was 59.45 ± 18.27 years, with 164 (65%) male. There were 150 ME patients (59%), and 107 (41%) SC, 55 (22%) were Indian (IND) and 48 (19%) were South Asian (SA). In the whole study clinical presentation was of 48% for palpitation, pulmonary edema was of 14%, angina pectoris on rest of 12%, 10% had embolic phenomena, 6% had dizziness, and 7% were asymptomatic. The odds ratio of different variables for occurrence of clinical events in the study was positive of 2.2 for history of hypertension, 1.8 for sickle cell disease, 1.2 for high body mass index (BMI) >30, 1.1 for mitral valve disease. The ME patients, compared with SC, were older, had significantly higher body mass index, higher history of rheumatic valve disease, sickle cell disease with high level of uric acid and lower hemoglobin. The history of hypertension, DM and smoking was higher among the SC patients. The rate of thyroid disease was equal in both groups. Conclusion The prevalence of atrial fibrillation was 3.4% with male predominance of 65%. Patients of sub continental origin were younger with a significantly high history of hypertension and ischemic heart disease. The patients of Middle Eastern origin had significantly high rate of rheumatic heart disease, and sickle cell disease. The history of hypertension was the most important independent clinical predictor of adverse events in patients presented with AF.
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Affiliation(s)
- Taysir Garadah
- Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain; College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Saleh Gabani
- Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain; College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Mohamed Al Alawi
- Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
| | - Ahmed Abu-Taleb
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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Schmid M, Khattab AA, Gloekler S, Meier B. Future epidemic impact of atrial fibrillation and a new interventional strategy for stroke prophylaxis. Future Cardiol 2011; 7:219-26. [DOI: 10.2217/fca.10.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The rising incidence of atrial fibrillation (AF) and its most fatal consequences, cerebral ischemic attacks, will be of increasing relevance in the future. One third to one half of AF patients are ineligible for oral anticoagulation and even after stroke, only approximately every second patient receives oral anticoagulation. Apart from that, the risk of bleeding is indefinite and escalates with age, arterial hypertension, cerebrovascular disease and renal insufficiency. Anticoagulation with new oral compounds may be easier to handle but a significant risk of major bleeding remains. Since over 90% of all thrombi in AF are located in the left atrial appendage (LAA), the idea of excluding this source of emboli, thereby reducing the risk of stroke by approximately 90% without anticoagulation, has arisen. Since 2001, devices for transcatheter occlusion of the LAA have been available, offering a minimally invasive intervention. Currently, two dedicated occluders are approved in Europe, the Amplatzer Cardiac Plug and the WATCHMAN device. Percutaneous occlusion of the LAA is technically feasible and safe and should be considered as an alternative for patients with AF and contraindications or disfavor against oral anticoagulation.
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Affiliation(s)
- Michael Schmid
- Department of Cardiology, University Hospital, Bern, Switzerland
| | - Ahmed A Khattab
- Department of Cardiology, University Hospital, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, University Hospital, Bern, Switzerland
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Dangayach NS, Kane K, Moonis M. Paroxysmal atrial fibrillation in cryptogenic stroke. Ther Clin Risk Manag 2011; 7:33-7. [PMID: 21339941 PMCID: PMC3039012 DOI: 10.2147/tcrm.s15079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Paroxysmal atrial fibrillation (PAF) is perhaps the most underdiagnosed mechanism of apparent cryptogenic stroke (CS). Various studies have shown that increasing the duration of monitoring can increase the diagnosis of PAF in CS. METHODS We compared demographic and risk factors for ischemic stroke across different TOAST (Trial of ORG 10172 in Acute Stroke Treatment) stroke subtypes to look for clinical differences between other subtypes and CS and subsequently performed periodic Holter monitoring and imaging studies in apparent CS patients. RESULTS Of the 298 patients with ischemic stroke, 17% had CS. Periodic holter monitoring enabled diagnosis of PAF in 29% of patients. Five of 51 patients with CS had recurrent ischemic stroke and all 5 were demonstrated as PAF on repeated Holter monitoring. CONCLUSIONS Long-term periodic rhythm monitoring in patients with apparent CS showed PAF in a significant percentage of CS patients, which altered subsequent treatment.
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Affiliation(s)
| | - Kevin Kane
- University of Massachusetts Medical School
| | - Majaz Moonis
- University of Massachusetts Memorial Health Center, Worcester, MA, USA
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Carson W, Tseng YZ. Negative sequence voltages in spontaneous atrial fibrillation or flutter. Int J Cardiol 2008; 130:357-66. [PMID: 18241942 DOI: 10.1016/j.ijcard.2007.10.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 10/04/2007] [Accepted: 10/27/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND The patho-physiology of initiation of atrial fibrillation (af) or flutter (AF) is not known. Would it be possible that the real explanation is hidden in physics territory but not in medicine? Could it be possible that the heart behaves like a biological generator in physics? Can an abnormal inscription direction (AID) or an abnormal slow conduction (ASC) of the P loop explain the genesis of af or AF? METHODS A total of 160 emergency Frank vectorcardiographic tracings was recorded by one physician from 55 patients with acute myocardial infarction. RESULTS Thirty (54%) patients had abnormal inscription direction of the P loop. Seven (13%) among 55 patients developed af or AF. Six of the seven had AID of the P loop. All seven had right or left atrial enlargement. They were among 50 patients (91%) with abnormal atrium enlargement. Four among the seven had ASC of the P loop. There were 27 patients (49%) among the total 55 with ASC of the P loop. CONCLUSIONS The heart is a biological generator, which has also inherited the same problems as generators. The types of figure-of-eight or clockwise rotation of the P loop, which are linked with the partial or complete negative sequence in physics have been documented. Based on negative sequence voltages in physics, a new theory of af, AF, or atrial premature contraction has been proposed.
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Affiliation(s)
- Wangden Carson
- Cardiovascular Laboratory, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, No.1, Chang-Teh Street, Taipei, Taiwan, ROC 100
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40
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Drewitz I, Rostock T, Hoffmann B, Steven D, Servatius H, Meinertz T, Willems S. [Current strategies in the treatment of atrial fibrillation]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2008; 103:788-802. [PMID: 19165430 DOI: 10.1007/s00063-008-1123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Imke Drewitz
- Universitäres Herzzentrum GmbH, Klinik für Kardiologie, Angiologie, Hamburg, Germany.
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Guzzetti S, Costantino G, Vernocchi A, Sada S, Fundarò C. First diagnosis of colorectal or breast cancer and prevalence of atrial fibrillation. Intern Emerg Med 2008; 3:227-31. [PMID: 18320149 DOI: 10.1007/s11739-008-0124-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 01/02/2008] [Indexed: 02/02/2023]
Abstract
Aim of the present study was to assess the prevalence of atrial fibrillation (AF) in patients with two different types of cancer. Recent epidemiologic and clinical studies support the hypothesis that AF is promoted and maintained by a broad spectrum of modulating factors. A total of 2,339 patients admitted to the Surgery Department of "Luigi Sacco Hospital, Milan," over the period 1987-2004 were eligible for the study. One thousand three hundred and seventeen patients were admitted consecutively with a first diagnosis of colorectal or breast cancer (cases). The remaining 1,022 were patients admitted to undergo non-neoplastic surgery (controls). Routine pre-surgery electrocardiogram available in patient charts was analysed by a cardiologist who was not aware of the present study to evaluate the presence of atrial fibrillation or other arrhythmias. Overall, AF was present in 3.6% cases and 1.6% controls. This corresponded to at least two times higher likelihood of having AF in cases compared to controls. Prevalence of AF increased with age both in cases and controls. Our study describes an increased prevalence of AF in two different types of cancer. Autonomic, endocrine, coagulation, and inflammatory alterations were previously described in both AF and cancer, and can provide the physiopathological basis to our clinical observation.
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Affiliation(s)
- Stefano Guzzetti
- Medicina Interna I, Ospedale Luigi Sacco, Polo Universitario dell'Università degli Studi di Milano, Via GB Grassi, 74, 20157, Milan, Italy.
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Prevention of Atrial Fibrillation by Way of Abrogation of the Renin-Angiotensin System: A Systematic Review and Meta-Analysis. Am J Ther 2008; 15:36-43. [DOI: 10.1097/mjt.0b013e31804beb59] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Wallmann D, Tüller D, Wustmann K, Meier P, Isenegger J, Arnold M, Mattle HP, Delacrétaz E. Frequent Atrial Premature Beats Predict Paroxysmal Atrial Fibrillation in Stroke Patients. Stroke 2007; 38:2292-4. [PMID: 17585079 DOI: 10.1161/strokeaha.107.485110] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
For patients having suffered ischemic stroke, the current diagnostic strategies often fail to detect atrial fibrillation as a potential cause of embolic events. The aim of the study was to identify paroxysmal atrial fibrillation in stroke patients. We hypothesized that patients with frequent atrial premature beats (APBs) recorded in 24-hour ECG will show more often atrial fibrillation when followed by repeated long-term ECG recordings than patients without or infrequent APBs.
Methods—
127 patients with acute ischemic stroke and without known AF were enrolled in a prospective study to detect paroxysmal AF. Patients were stratified according to the number of APBs recorded in a 24-hour ECG (≥70 APBs versus <70 APBs). Subsequently, they all underwent serial 7-day event-recorder monitoring at 0, 3, and 6 months.
Results—
Serial extended ECG monitoring identified AF in 26% of patients with frequent APBs but only in 6.5% when APBs were infrequent (
P
=0.0021). A multivariate analysis showed that the presence of frequent APBs in the initial 24-hour ECG was the only independent predictor of paroxysmal AF during follow-up (odds ratio 6.6, 95% confidence intervals 1.6 to 28.2,
P
=0.01).
Conclusions—
In patients with acute ischemic stroke, frequent APBs (≥70/24 hours) are a marker for individuals who are at greater risk to develop or have paroxysmal AF. For such patients, we propose a diagnostic workup with repeated prolonged ECG monitoring to diagnose paroxysmal AF.
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Affiliation(s)
- Dieter Wallmann
- Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
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Weber S, Ndrepepa G, Schneider M, Deisenhofer I, Zrenner B, Schmitt C. Electrophysiological Differences of the Spontaneous Onset of Paroxysmal and Persistent Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:295-303. [PMID: 17367348 DOI: 10.1111/j.1540-8159.2007.00669.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Information about the spatiotemporal organization of atrial activity at the onset of atrial fibrillation (AF) is still limited. METHODS AF mapping was performed in 30 patients with AF (mean age 53 +/- 9 years, 26 males) by deploying a noncontact mapping balloon in the left atrium (LA). Twenty-four patients had paroxysmal AF and six patients had persistent AF. Three types of AF episodes were analyzed: nonsustained AF (lasting <or= 30 seconds), sustained AF (lasting > 30 seconds, with spontaneous conversion or requiring internal cardioversion and subsequent stable sinus rhythm), and persistent AF episodes (stable sinus rhythm lasting <or= 1 minute after cardioversion). RESULTS A total of 101 spontaneous AF onset episodes were analyzed. Analysis of AF onset showed that there was a progressive shortening of the initial cycle lengths from nonsustained episodes to sustained episodes and to persistent AF episodes. There was an earlier and more rapid reduction in the cycle lengths from persistent episodes to sustained episodes and to nonsustained episodes of AF (P < 0.05 for persistent vs sustained and for sustained vs nonsustained episodes). The development of multiwavelet activity and disorganization of conduction occurred earlier in persistent and sustained episodes than in nonsustained AF episodes. LA size was greater in patients with persistent AF episodes compared with patients with sustained or nonsustained AF episodes. CONCLUSIONS Electrophysiological events that develop at the onset of AF seem to be different in different types of AF. A more rapid degeneration into the fibrillatory activity was observed in persistent and sustained AF than in nonsustained AF episodes.
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Affiliation(s)
- Stefan Weber
- Klinik und Poliklinik für Innere Medizin II, Universität Regensburg, Germany.
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45
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Childers R. Electrophysiology of the electrocardiographic changes of atrial fibrillation. J Electrocardiol 2006; 39:S174-9. [PMID: 17015065 DOI: 10.1016/j.jelectrocard.2006.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 05/31/2006] [Indexed: 10/24/2022]
Abstract
The history of atrial fibrillation is described in terms of its electrocardiographic delineation, characteristics and clinical associations. The variant configurations are described and their relationship to rhythm duration and cardioversion success. The inter-relationship of fibrillation with flutter and their diagnostic differences are reviewed. The electrophysiologic basis of atrial remodeling is exemplified, together with its relationship to failure of rate adaptation of the atrial refractory period. Electric countershock causes an acute abbreviation of the atrial refractory period as does the induction of hyperthyroidism in the experimental animal. Current theories of the mechanism of fibrillation and the issue of originating pulmonary venous foci are reviewed. The lack of protection from ventricular fibrillation that exists with preexcitation via an accessory pathway is discussed in terms of the teleological role of orthograde downstream refractory periods.
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Affiliation(s)
- Rory Childers
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Abstract
PURPOSE OF REVIEW Device therapy for atrial fibrillation remains contentious despite the recognized benefit of atrial pacing in sinus node dysfunction. There are various new specialized pacing algorithms that aim to provide rhythm or rate control in atrial fibrillation. We review the various options for device therapy and the evidence available concerning their effectiveness. RECENT FINDINGS Randomized trials on preventative algorithms for atrial fibrillation have not shown consistent benefit. Anti-tachycardia pacing for atrial fibrillation has inherent problems illustrated in this review and has failed to demonstrate objective improvement except in the case of atrial flutter. Several large randomized trials have demonstrated an adverse outcome with right ventricular apical pacing. These studies have shown an increase in atrial fibrillation with ventricular pacing. Recent studies have emphasised the importance of right ventricular apical pacing in burden of atrial fibrillation and therefore we discuss the likely confounding effect on previous trials and speculate on future directions. SUMMARY The use of a device with atrial fibrillation prevention algorithms in a patient with a bradycardia indication for pacing is not unreasonable but there is no hard evidence of benefit. Patients with sinus node dysfunction should be paced in the atrium alone. There is no indication for use of a device for atrial fibrillation without a conventional indication for pacing.
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47
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Abstract
The recognition of the ubiquitous role of short coupled ectopics in the initiation of paroxysmal atrial fibrillation has renewed interest in their localization with the ultimate aim of facilitating their neutralization by catheter ablation. The P-waves resulting from such ectopics are partly or completely concealed by the QRST of the preceding beat and therefore their morphology has been underutilized for localization purposes. Subtraction has been the most commonly used technique for QRST suppression and though an averaged template offers a higher signal-to-noise ratio, the immediately preceding QRST provides the best match between template and target and allows simple, nearly real-time, and accurate subtraction without distorting the underlying P-wave. Algorithms derived from clinical tachycardias as well as pacemapping have permitted a rational analysis and accurate prediction (81%) of the correct pulmonary vein of origin. Other nonpulmonary sources may also be similarly localized, particularly with the help of a catalogue of pacemaps from various sites. Incessant arrhythmia and frequent aberrancy limit the effectiveness of QRST suppression by subtraction. Further improvements in the localizing resolution of the P-wave may depend upon knowledge of the relationship between recording electrodes and the underlying atria.
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Affiliation(s)
- Dipen Shah
- Hopital Cantonal de Geneve, Geneva, Switzerland.
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48
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Thong T, McNames J, Aboy M, Goldstein B. Prediction of paroxysmal atrial fibrillation by analysis of atrial premature complexes. IEEE Trans Biomed Eng 2004; 51:561-9. [PMID: 15072210 DOI: 10.1109/tbme.2003.821030] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Currently, no reliable method exists to predict the onset of paroxysmal atrial fibrillation (PAF). We propose a predictor that includes an analysis of the R-R time series. The predictor uses three criteria: the number of premature atrial complexes (PAC) not followed by a regular R-R interval, runs of atrial bigeminy and trigeminy, and the length of any short run of paroxysmal atrial tachycardia. An increase in activity detected by any of these three criteria is an indication of an imminent episode of PAF. Using the Physionet database of the Computers in Cardiology 2001 Challenge, the predictor achieved a sensitivity of 89% and a specificity of 91%.
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Affiliation(s)
- Tran Thong
- OGI School of Science & Engineering, Oregon Health and Science University, Beaverton, OR 97006, USA.
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Wallmann D, Tüller D, Kucher N, Fuhrer J, Arnold M, Delacretaz E. Frequent atrial premature contractions as a surrogate marker for paroxysmal atrial fibrillation in patients with acute ischaemic stroke. Heart 2003; 89:1247-8. [PMID: 12975433 PMCID: PMC1767912 DOI: 10.1136/heart.89.10.1247] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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50
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Abstract
INTRODUCTION Pacing has been proposed as a nonpharmacologic treatment option to prevent atrial tachyarrhythmias (ATs) in drug-refractory patients. This article reviews the current state of pacing to prevent ATs. METHODS AND RESULTS Different pacing modalities have been assessed with regard to their ability to prevent AT: conventional DDDR pacing with elevated lower rate limit, biatrial pacing, dual-site right atrial pacing, atrial septal pacing, and pacing with the use of dedicated pacing algorithms. Small studies suggest a benefit of conventional pacing for AT prevention in patients with bradycardia, but a randomized trial did not reveal any AT reduction by conventional pacing in patients without bradycardia. AT prevention by biatrial or dual-site right atrial pacing has been reported in small studies, but randomized trials did not show a clear benefit of these pacing techniques. Small studies showed a reduced AT recurrence rate in patients with septal pacing at the triangle of Koch or at Bachmann's bundle. Two large randomized trials with preventive pacing algorithms showed a significant AT reduction compared to conventional pacing, but this was not confirmed in four trials. CONCLUSION Pacing seems to be able to suppress ATs in a minority of patients; however, prospective identification of responders to different pacing modalities does not appear to be feasible at the present time.
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Affiliation(s)
- Carsten W Israel
- Department of Medicine, J.W. Goethe University Hospital, Frankfurt, Germany
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