The role of obesity and sleep apnea in atrial fibrillation

P-wave terminal force in lead V1 is associated with recurrence after catheter ablation in patients with paroxysmal atrial fibrillation and normal left atrial size

Background

A previous investigation reported that an abnormal P-wave terminal force in lead V1 (PTFV1) is a marker for electrical remodeling of the left atrium (LA). We aimed to assess the relationship of PTFV1 with LA tachyarrhythmia (LATA) recurrence after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) and normal LA size.

Methods

Patients with PAF and normal LA size (LA volume index < 34 ml/m2) who underwent RFCA were consecutively included between January 2018 and December 2020 and divided into two groups based on the presence (recurrence group) or absence (nonrecurrence group) of LATA recurrence. PTFV1 was measured according to preprocedural electrocardiography. The association between PTFV1 and the recurrence of LATA was investigated.

Results

A total of 385 patients were included. After a median follow-up period of 745 (467, 977) days, 109 (28.3%) patients experienced LATA recurrence. PTFV1 was greater in the recurrence group. Multivariate Cox regression analysis demonstrated that the hazard ratio and 95% confidence interval for PTFV1 per 1,000 μV*ms increase and PTFV1 > 4,000 μV*ms were 1.22 (1.13-1.32, p < 0.001) and 2.32 (1.54-3.48, p < 0.001), respectively.

Conclusion

PTFV1 is an independent predictor for LATA recurrence after RFCA in patients with PAF and normal LA size.

A prediction model of atrial fibrillation recurrence after first catheter ablation by a nomogram: HASBLP score

Background

At present, catheter ablation is an effective method for rhythm control in patients with atrial fibrillation (AF). However, AF recurrence is an inevitable problem after catheter ablation. To identify patients who are prone to relapse, we developed a predictive model that allows clinicians to closely monitor these patients and treat them with different personalized treatment plans.

Materials and methods

A total of 1,065 patients who underwent AF catheter ablation between January 2015 and December 2018 were consecutively included in this study, which examines the results of a 2-year follow-up. Patients with AF were divided into development cohort and validation cohort. Univariate and multivariate analyses were carried out on the potential risk factors. Specific risk factors were used to draw the nomogram according to the above results. Finally, we verified the performance of our model compared with CHADS2 and CHA₂DS₂-Vasc scores by receiver operating characteristic (ROC) curve and calibration curve and plotted the decision analysis curve (DAC).

Results

A total of 316 patients experienced AF recurrence. After univariate and multivariate analyses, AF history (H), age (A), snoring (S), body mass index (BMI) (B), anteroposterior diameter of left atrial (LA) (L), and persistent AF (P) were included in our prediction model. Our model showed a better performance compared with CHADS2 and CHA2DS2-Vasc scores, and the area under ROC curve (95%CI) was 0.7668 (0.7298–0.8037) vs. 0.6225 (0.5783–0.6666) and 0.6267 (0.5836–0.6717).

Conclusion

We established a nomogram (HASBLP score) for predicting AF recurrence after the first catheter ablation at a 2-year follow-up, which can be used as a tool to guide future follow-up of patients. However, its usefulness needs further validation.

A systematic review and meta-analysis on the impact of pre-existing and new-onset atrial fibrillation on outcomes before and after liver transplantation

BACKGROUND AND AIMS

Atrial Fibrillation (AF) is the most commonly diagnosed cardiac arrhythmia. It is associated with significant morbidity and mortality, as it is a major risk factor for cerebral vascular accidents (CVA). Our aim was to determine the prevalence of pre-existing and new-onset AF among patients undergoing liver transplantation (LT) and its impact on post-transplant outcomes.

METHODS

Medline and Embase were searched. Single-arm analysis was conducted using the generalized linear mixed model to determine the prevalence of pre-existing and new-onset AF. Logistic regression was performed to analyze risk factors. Comparative meta-analysis in odds ratio was conducted for binary outcomes.

RESULTS

Twenty articles were included, with 17 studies on pre-existing AF, and 7 including data on new-onset AF post-LT. The prevalence of pre-existing AF was 3.3% (CI 2.3-4.7) (14 studies, 45,070 patients) in pooled analysis. Significantly higher prevalence of pre-existing AF patients from North America was noted when compared to Europe (4.5%, CI 3.4-5.8 vs 1.5%, CI 0.8-2.7; p = 0.001). Body mass index (BMI), history of hypertension, diabetes, coronary artery disease (CAD), and cerebrovascular accidents (CVA) were risk factors for pre-existing AF. Pre-existing AF was significantly associated with major adverse cardiac or cerebrovascular events (MACCE) postoperatively (OR 8.02, 95%CI 5.40-11.90, p < 0.001). New-onset AF post-LT had an incidence of 6.8% (CI 4.9-9.3), and was associated with increased risk of mortality (OR 2.31, 95% CI 1.76-3.02, p < 0.001) and graft failure (OR 2.98, CI 1.99-4.47, p < 0.001).

CONCLUSION

AF is relatively more common among patients undergoing LT compared to the general non-transplant population. Additionally, it is associated with adverse outcomes including MACCE, thus warranting clinical attention. Thorough cardiac assessment, and close surveillance of post-operative AF may be clinically prudent.

Atrial Fibrillation's Influence on Short Sleep Duration Increases the Risk of Fatness in Management Executives

This study explored whether atrial fibrillation (AF)’s influence on short sleep duration (SD) increases the subsequent risk of fatness in management executives. This study included 25,953 healthy individuals working as management executives with ages ranging from 35 to 65 years (19,100 men and 6853 women) who participated in a qualifying physical filter program from 2006 to 2017 in Taiwan. Men and women who slept < 4 h had a 4.35-fold and 5.26-fold higher risk of developing AF than those who slept 7−8 h normally. Men and women who slept < 4 h had a 6.44-fold and 9.62-fold higher risk of fatness than those who slept 7−8 h. Men and women with AF had a 4.52-fold and 6.25-fold higher risk of fatness than those without AF. It showed that AF induced by short SD increases the risk of fatness. A short SD can predict an increased risk of fatness among management executives in Taiwan.

Sleep duration and atrial fibrillation risk in the context of predictive, preventive, and personalized medicine: the Suita Study and meta-analysis of prospective cohort studies

Background

Short and long sleep durations are common behaviors that could predict several cardiovascular diseases. However, the association between sleep duration and atrial fibrillation (AF) risk is not well-established. AF is preventable, and risk prevention approaches could reduce its occurrence. Investigating whether sleep duration could predict AF incidence for possible preventive interventions and determining the impact of various lifestyle and clinical characteristics on this association to personalize such interventions are essential. Herein, we investigated the association between sleep duration and AF risk using a prospective cohort study and a meta-analysis of epidemiological evidence.

Methods

Data of 6898 people, aged 30-84 years, from the Suita Study, were analyzed. AF was diagnosed during the follow-up by ECG, medical records, checkups, and death certificates, while a baseline questionnaire was used to assess sleep duration. The Cox regression was used to compute the hazard ratios (HRs) and 95% confidence intervals (CIs) of AF risk for daily sleep ≤ 6 (short sleep), ≥ 8 (long sleep), and irregular sleep, including night-shift work compared with 7 h (moderate sleep). Then, we combined our results with those from other eligible prospective cohort studies in two meta-analyses for the short and long sleep.

Results

In the Suita Study, within a median follow-up period of 14.5 years, short and irregular sleep, but not long sleep, were associated with the increased risk of AF in the age- and sex-adjusted models: HRs (95% CIs) = 1.36 (1.03, 1.80) and 1.62 (1.16, 2.26) and the multivariable-adjusted models: HRs (95% CIs) = 1.34 (1.01, 1.77) and 1.63 (1.16, 2.30), respectively. The significant associations between short and irregular sleep and AF risk remained consistent across different ages, sex, smoking, and drinking groups. However, they were attenuated among overweight and hypertensive participants. In the meta-analyses, short and long sleep durations were associated with AF risk: pooled HRs (95% CIs) = 1.21 (1.02, 1.42) and 1.18 (1.03, 1.35). No signs of significant heterogeneity across studies or publication bias were detected.

Conclusion

Short, long, and irregular sleep could be associated with increased AF risk. In the context of predictive, preventive, and personalized medicine, sleep duration should be considered in future AF risk scores to stratify the general population for potential personalized lifestyle modification interventions. Sleep management services should be considered for AF risk prevention, and these services should be individualized according to clinical characteristics and lifestyle factors.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-022-00275-4.

Predictors of the atrial fibrillation following catheter ablation of typical atrial flutter

Background:

Despite technical refinements and improved long-term efficacy of the ablation procedure for treating AFL (AFL), the subsequent occurrence of AF (AF) following this procedure remains a significant clinical problem.

Objectives:

To determine long-term incidence and predictors of AF after catheter ablation of typical AFL.

Material and Methods:

Between March 2005 and February 2010, a total of 84 consecutive patients who underwent catheter ablation of documented typical AFL were enrolled.

Results:

Cavotricuspid isthmus ablation was successful in terminating and preventing the re-induction of AFL in all 84 patients (100%). The mean follow-up duration for study was 26± 22 months. During the follow-up period, early AF occurred in 5% after successful catheter ablation of AFL and late AF in 11% of the patients. The clinical variables associated with the occurrence of AF after catheter ablation of AFL were female, a history of AF before AFL ablation, body mass index (BMI), and left atrial abnormality. However, logistic multivariate analysis demonstrated that only BMI was independently associated with the late AF (OR 1.36, 95% CI 1.11-1.70, P = 0.004).

Conclusions:

Catheter ablation of flutter circuit will not prevent later manifestation of AF in 16% of the patients undergoing catheter ablation of the typical AFL. BMI was the only independent predictor of AF following catheter ablation of the typical AFL.

Association of body mass index, diabetes, hypertension, and blood pressure levels with risk of permanent atrial fibrillation

BACKGROUND

After an initial episode of atrial fibrillation (AF), AF may recur and become permanent. AF progression is associated with higher morbidity and mortality. Understanding the risk factors for permanent AF could help identify people who would benefit most from interventions.

OBJECTIVE

To determine whether body mass index (BMI), diabetes, hypertension, and blood pressure levels are associated with permanent AF among people whose initial AF episode terminated.

DESIGN

Population-based inception cohort study.

PARTICIPANTS

Enrollees in Group Health, an integrated health care system, aged 30-84 with newly diagnosed AF in 2001-2004, whose initial AF terminated within 6 months and who had at least 6 months of subsequent follow-up (N = 1,385).

MAIN MEASURES

Clinical characteristics were determined from medical records. Permanent AF was determined from medical records and ECG and administrative databases. Permanent AF was defined as AF present on two separate occasions 6-36 months apart, without any documented sinus rhythm between the two occasions. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs).

KEY RESULTS

Five-year cumulative incidence of permanent AF was 24 %. Compared with normal BMI (18.5-24.9 kg/m(2)), BMI levels of 25.0-29.9 (overweight), 30.0-34.9 (obese 1), 35.0-39.9 (obese 2), and ≥ 40.0 kg/m(2) (obese 3) were associated with HRs of permanent AF of 1.26 (95 % CI: 0.92, 1.72); 1.35 (0.96, 1.91); 1.50 (0.97, 2.33); and 1.79 (1.13, 2.84), adjusted for age, sex, diabetes, hypertension, blood pressure, coronary heart disease, valvular heart disease, heart failure, and prior stroke. Diabetes, hypertension, and blood pressure were not associated with permanent AF.

CONCLUSIONS

For people whose initial AF episode terminates, benefits of having lower BMI may include a lower risk of permanent AF. Risk of permanent AF was similar for people with and without diabetes or hypertension and across blood pressure levels.

The Relationship Between Atrial Fibrillation and Chronic Kidney Disease : Epidemiologic and Pathophysiologic Considerations for a Dual Epidemic

Atrial fibrillation (AF) presently affects over 2 million Americans, and the magnitude and population burden from AF continues to increase concomitant with the aging of the U.S.

POPULATION

Chronic kidney disease (CKD) is present in 13% of individuals in the U.S., and the prevalence of CKD is also rapidly increasing. The increasing population burden of CKD and AF will profoundly affect the clinical and public health, since CKD and AF are both associated with lower quality of life, increased hospitalization rates, and a greater risk of heart failure, stroke, and total mortality. AF and CKD often co-exist, each condition predisposes to the other, and the co-occurrence of these disorders worsens prognosis relative to either disease alone. The shared epidemiology of CKD and AF may be explained by the strong pathophysiologic connections between these diseases. In order to promote a better understanding of CKD and AF, we have reviewed their shared epidemiology and pathophysiology and described the natural history of patients affected by both diseases.

Regulation of adipose tissue energy availability through blood flow control in the metabolic syndrome

Maintenance of blood flow rate is a critical factor for tissue oxygen and substrate supply. The potentially large mass of adipose tissue deeply influences the body distribution of blood flow. This is due to increased peripheral resistance in obesity and the role of this tissue as the ultimate destination of unused excess of dietary energy. However, adipose tissue cannot grow indefinitely, and the tissue must defend itself against the avalanche of nutrients provoking inordinate growth and inflammation. In the obese, large adipose tissue masses show lower blood flow, limiting the access of excess circulating substrates. Blood flow restriction is achieved by vasoconstriction, despite increased production of nitric oxide, the vasodilatation effects of which are overridden by catecholamines (and probably also by angiotensin II and endothelin). Decreased blood flow reduces the availability of oxygen, provoking massive glycolysis (hyperglycemic conditions), which results in the production of lactate, exported to the liver for processing. However, this produces local acidosis, which elicits the rapid dissociation of oxyhemoglobin, freeing bursts of oxygen in localized zones of the tissue. The excess of oxygen (and of nitric oxide) induces the production of reactive oxygen species, which deeply affect the endothelial, blood, and adipose cells, inducing oxidative and nitrosative damage and eliciting an increased immune response, which translates into inflammation. The result of the defense mechanism for adipose tissue, localized vasoconstriction, may thus help develop a more generalized pathologic response within the metabolic syndrome parameters, extending its effects to the whole body.