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Leung ANW, Bhat A. Use of Anticoagulation for Thromboembolic Prophylaxis in Patients With Atrial High-Rate Episodes on Device Monitoring: A Narrative Review. Am J Cardiol 2024; 211:183-190. [PMID: 37944778 DOI: 10.1016/j.amjcard.2023.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
Ischemic stroke and systemic thromboembolism are primary drivers of significant morbidity and mortality in patients with atrial fibrillation (AF). Although stroke is commonly the first index presentation of clinically silent AF, the growing use of continuous rhythm monitoring through cardiac implanted electronic devices has enabled earlier and increased detection of AF in patients who are otherwise asymptomatic before stroke development. Atrial high-rate episodes (AHREs) are atrial tachyarrhythmias frequently detected by cardiac implanted electronic devices; these events represent subclinical AF and other atrial tachyarrhythmias that can lead to stroke development and AF. Although the presence of AHREs increases the risk of developing both clinical AF and stroke compared with absence of AHREs, there has been a significant clinical variability in anticoagulation initiation in these subjects. In this narrative review, we explore the current evidence and published research surrounding the association between AHREs and stroke development in addition to the utility of anticoagulation in this population for thromboembolic prophylaxis.
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Affiliation(s)
- Alice Ngar Wing Leung
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, Western Sydney University, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
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2
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Lazarus A, Gentils M, Klaes S, Ibnouhsein I, Rosier A, Moubarak G, Bonnet JL, Singh JP, Defaye P. Filtering of remote monitoring alerts transmitted by cardiac implantable electronic devices and reclassification of atrial fibrillation events by a new algorithm. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:149-154. [PMID: 37850045 PMCID: PMC10577488 DOI: 10.1016/j.cvdhj.2023.08.019] [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] [Indexed: 10/19/2023] Open
Abstract
Background Cardiac implantable electronic devices (CIEDs) are an important means of atrial fibrillation (AF) detection. However, the AF burden measurements and notifications transmitted by CIEDs are not directly related to the clinical classification of paroxysmal, persistent, or permanent AF. Moreover, AF alerts are the most frequent form of notification, imposing a time-consuming review on caregivers. Objective The purpose of this study was to compare the incidence of standard AF burden-related notifications in remotely monitored (RM) patients with the incidence of events detected after filtering by a new proprietary algorithm implementing the standard European Society of Cardiology classification of AF. Methods Between 2017 and 2022, all RM patients with daily AF burden measurements available for ≥30 days and ≥1 AF burden-related alerts were enrolled at 68 medical centers. The incidence of CIED-transmitted alerts was compared to that of AF episodes detected by a new proprietary algorithm and classified as "first recorded episode of AF", "paroxysmal AF", "increased paroxysmal AF", "persistent AF", or "end of persistent AF back to paroxysmal AF or back to sinus rhythm." Results Between January 2017 and September 2022, this retrospective study analyzed data from 4162 recipients of an Abbott, Biotronik, Boston Scientific, or Medtronic CIED, RM over mean follow-up of 605 ± 386 days. The algorithm broke down 67,883 AF burden-related alerts into 9728 (14.3%) clinically relevant AF events. Conclusion A new AF alert algorithm successfully identified clinically significant AF events in RM CIED recipients and would markedly limit the total number of transmitted alerts that require review by caregivers.
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Affiliation(s)
- Arnaud Lazarus
- Clinique Medico-Chirurgicale Ambroise Paré, Neuilly Sur Seine, France
| | | | | | | | - Arnaud Rosier
- Implicity, Paris, France
- Jacques Cartier Private Hospital, Massy, France
| | - Ghassan Moubarak
- Clinique Medico-Chirurgicale Ambroise Paré, Neuilly Sur Seine, France
| | | | - Jagmeet P. Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pascal Defaye
- Grenoble Alpes University and University Hospital, Grenoble, France
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3
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Lip GYH, Proietti M, Potpara T, Mansour M, Savelieva I, Tse HF, Goette A, Camm AJ, Blomstrom-Lundqvist C, Gupta D, Boriani G. Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal. Europace 2023; 25:euad226. [PMID: 37622590 PMCID: PMC10451006 DOI: 10.1093/europace/euad226] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Stroke prevention in patients with atrial fibrillation (AF) is one pillar of the management of this common arrhythmia. Substantial advances in the epidemiology and associated pathophysiology underlying AF-related stroke and thrombo-embolism are evident. Furthermore, the introduction of the non-vitamin K antagonist oral anticoagulants (also called direct oral anticoagulants) has clearly changed our approach to stroke prevention in AF, such that the default should be to offer oral anticoagulation for stroke prevention, unless the patient is at low risk. A strategy of early rhythm control is also beneficial in reducing strokes in selected patients with recent onset AF, when compared to rate control. Cardiovascular risk factor management, with optimization of comorbidities and attention to lifestyle factors, and the patient's psychological morbidity are also essential. Finally, in selected patients with absolute contraindications to long-term oral anticoagulation, left atrial appendage occlusion or exclusion may be considered. The aim of this state-of-the-art review article is to provide an overview of the current status of AF-related stroke and prevention strategies. A holistic or integrated care approach to AF management is recommended to minimize the risk of stroke in patients with AF, based on the evidence-based Atrial fibrillation Better Care (ABC) pathway, as follows: A: Avoid stroke with Anticoagulation; B: Better patient-centred, symptom-directed decisions on rate or rhythm control; C: Cardiovascular risk factor and comorbidity optimization, including lifestyle changes.
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Affiliation(s)
- Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Irina Savelieva
- Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George’s University of London, Cranmer Terrace London SW17 0RE, UK
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Andreas Goette
- Medizinische Klinik II: Kardiologie und Intensivmedizin, St. Vincenz-Krankenhaus Paderborn, Am Busdorf 2, 33098 Paderborn, Germany
| | - A John Camm
- Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George’s University of London, Cranmer Terrace London SW17 0RE, UK
| | - Carina Blomstrom-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo 71, 41125 Modena, Italy
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4
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Biton S, Aldhafeeri M, Marcusohn E, Tsutsui K, Szwagier T, Elias A, Oster J, Sellal JM, Suleiman M, Behar JA. Generalizable and robust deep learning algorithm for atrial fibrillation diagnosis across geography, ages and sexes. NPJ Digit Med 2023; 6:44. [PMID: 36932150 PMCID: PMC10023682 DOI: 10.1038/s41746-023-00791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
To drive health innovation that meets the needs of all and democratize healthcare, there is a need to assess the generalization performance of deep learning (DL) algorithms across various distribution shifts to ensure that these algorithms are robust. This retrospective study is, to the best of our knowledge, an original attempt to develop and assess the generalization performance of a DL model for AF events detection from long term beat-to-beat intervals across geography, ages and sexes. The new recurrent DL model, denoted ArNet2, is developed on a large retrospective dataset of 2,147 patients totaling 51,386 h obtained from continuous electrocardiogram (ECG). The model's generalization is evaluated on manually annotated test sets from four centers (USA, Israel, Japan and China) totaling 402 patients. The model is further validated on a retrospective dataset of 1,825 consecutives Holter recordings from Israel. The model outperforms benchmark state-of-the-art models and generalized well across geography, ages and sexes. For the task of event detection ArNet2 performance was higher for female than male, higher for young adults (less than 61 years old) than other age groups and across geography. Finally, ArNet2 shows better performance for the test sets from the USA and China. The main finding explaining these variations is an impairment in performance in groups with a higher prevalence of atrial flutter (AFL). Our findings on the relative performance of ArNet2 across groups may have clinical implications on the choice of the preferred AF examination method to use relative to the group of interest.
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Affiliation(s)
- Shany Biton
- Faculty of Biomedical Engineering, Technion-IIT, Israel
| | - Mohsin Aldhafeeri
- Department of Cardiology, Centre hospitalier Universitaire de Nancy, Nancy, France
| | - Erez Marcusohn
- Department of Cardiology, Rambam Medical Center and Technion The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Kenta Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tom Szwagier
- Mines Paris, PSL Research University, Paris, France
| | - Adi Elias
- Department of Cardiology, Rambam Medical Center and Technion The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Julien Oster
- IADI, U1254, Inserm, Université de Lorraine, Nancy, France.,CIC-IT 1433, Université de Lorraine, Inserm, CHRU de Nancy, Nancy, France
| | - Jean Marc Sellal
- Department of Cardiology, Centre hospitalier Universitaire de Nancy, Nancy, France.,IADI, U1254, Inserm, Université de Lorraine, Nancy, France
| | - Mahmoud Suleiman
- Department of Cardiology, Rambam Medical Center and Technion The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Mariani MV, Pierucci N, Piro A, Trivigno S, Chimenti C, Galardo G, Miraldi F, Vizza CD. Incidence and Determinants of Spontaneous Cardioversion of Early Onset Symptomatic Atrial Fibrillation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1513. [PMID: 36363470 PMCID: PMC9693621 DOI: 10.3390/medicina58111513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 04/12/2024]
Abstract
Atrial fibrillation (AF) is the most frequent chronic arrhythmia worldwide, and it is associated with significant morbidity and mortality, making it a considerable burden both to patients and the healthcare system. Nowadays, an early attempt to restore sinus rhythm in acute symptomatic AF through electrical or pharmacological cardioversion is the most common approach in the Emergency Department (ED). However, considering the high percentage of spontaneous cardioversion of paroxysmal AF reported by many studies, this approach may not be the ideal choice for all patients. In this manuscript we performed a review of the most relevant studies found in literature with the aim of identifying the main determinants of spontaneous cardioversion, focusing on those easy to detect in the ED. We have found that the most relevant predictors of spontaneous cardioversion are the absence of Heart Failure (HF), a small atrial size, recent-onset AF, rapid Atrial Fibrillatory Rate and the relationship between a previous AF episode and Heart Rate/Blood Pressure. A number of those are utilized, along with other easily determined parameters, in the recently developed "ReSinus" score which predicts the likelihood of AF spontaneous cardioversion. Such identification may help the physician decide whether immediate cardioversion is necessary, or whether to adopt a "watch-and-wait" strategy in the presence of spontaneous cardioversion determinants.
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Affiliation(s)
- Marco Valerio Mariani
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Nicola Pierucci
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Agostino Piro
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Sara Trivigno
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Cristina Chimenti
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gioacchino Galardo
- Medical Emergency Unit, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Fabio Miraldi
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Carmine Dario Vizza
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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6
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Johansen MC, Wang W, Zhang M, Knopman DS, Ndumele C, Mosley TH, Selvin E, Shah AM, Solomon SD, Gottesman RF, Chen LY. Risk of Dementia Associated With Atrial Cardiopathy: The ARIC Study. J Am Heart Assoc 2022; 11:e025646. [PMID: 35946474 PMCID: PMC9496312 DOI: 10.1161/jaha.121.025646] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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 The contribution of atrial cardiopathy to dementia risk is uncharacterized. We aimed to evaluate the association of atrial cardiopathy with incident dementia and potential mediation by atrial fibrillation (AF) and stroke. Methods and Results We conducted a prospective cohort analysis of participants in the ARIC (Atherosclerosis Risk in Communities) study attending visit 5 (2011-2013). We used Cox regression to determine the association between atrial cardiopathy and risk of dementia. Structural equation modeling methods were used to determine potential mediation by AF and/or stroke. Atrial cardiopathy was defined if ≥1 of the following at visit 5: P-wave terminal force >5000 mV·ms in ECG lead V1, NT-proBNP (N-terminal pro-brain natriuretic peptide) >250 pg/mL or left atrial volume index ≥34 mL/m2 by transthoracic echocardiography. We repeated our analysis necessitating ≥2 markers to define atrial cardiopathy. The prevalence of atrial cardiopathy was 34% in the 5078 participants (mean age 75 years, 59% female, 21% Black adults), with 763 participants developing dementia. Atrial cardiopathy was significantly associated with dementia (adjusted HR, 1.35 [95% CI, 1.16-1.58]), with strengthening of the effect estimate when necessitating ≥2 biomarkers (adjusted HR, 1.54 [95% CI, 1.25-1.89]). There was an increased risk of dementia among those with atrial cardiopathy when excluding those with AF (adjusted HR, 1.31 [95% CI, 1.12-1.55]) or stroke (adjusted HR, 1.28 [95% CI, 1.09-1.52]). The proportion of the effect mediated by AF was 4% (P=0.005), and 9% was mediated by stroke (P=0.048). Conclusions Atrial cardiopathy was significantly associated with an increased risk of dementia, with only a small percent mediation of the effect by AF or stroke.
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Affiliation(s)
- Michelle C. Johansen
- Department of NeurologyThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Michael Zhang
- Cardiovascular Division, Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | | | - Chiadi Ndumele
- Department of CardiologyThe Johns Hopkins University School of MedicineBaltimoreMN
| | | | - Elizabeth Selvin
- Department of EpidemiologyThe Bloomberg School of Public HealthBaltimoreMD
| | - Amil M. Shah
- Department of CardiologyHarvard Medical SchoolBostonMA
| | | | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research ProgramBethesdaMD
| | - Lin Yee Chen
- Cardiovascular Division, Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
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7
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McIntyre WF, Wang J, Benz AP, Johnson L, Connolly SJ, Van Gelder IC, Lopes RD, Gold MR, Hohnloser SH, Lau CP, Israel CW, Wong JA, Conen D, Healey JS. Estimated incidence of previously undetected atrial fibrillation on a 14-day continuous electrocardiographic monitor and associated risk of stroke. Europace 2022; 24:1058-1064. [DOI: 10.1093/europace/euab324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
There is uncertainty about whether and how to perform screening for atrial fibrillation (AF). To estimate the incidence of previously undetected AF that would be captured using a continuous 14-day ECG monitor and the associated risk of stroke.
Methods and results
We analysed data from a cohort of patients >65 years old with hypertension and a pacemaker, but without known AF. For each participant, we simulated 1000 ECG monitors by randomly selecting 14-day windows in the 6 months following enrolment and calculated the average AF burden (total time in AF). We used Cox proportional hazards models adjusted for CHA2DS2-VASc score to estimate the risk of subsequent ischaemic stroke or systemic embolism (SSE) associated with burdens of AF > and <6 min. Among 2470 participants, the median CHA2DS2-VASc score was 4.0, and 44 patients experienced SSE after 6 months following enrolment. The proportion of participants with an AF burden >6 min was 3.10% (95% CI 2.53–3.72). This was consistent across strata of age and CHA2DS2-VASc scores. Over a mean follow-up of 2.4 years, the rate of SSE among patients with <6 min of AF was 0.70%/year, compared to 2.18%/year (adjusted HR 3.02; 95% CI 1.39–6.56) in those with >6 min of AF.
Conclusions
Approximately 3% of individuals aged >65 years with hypertension may have more than 6 min of AF detected by a 14-day ECG monitor. This is associated with a stroke risk of over 2% per year. Whether oral anticoagulation will reduce stroke in these patients is unknown.
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Affiliation(s)
- William F McIntyre
- Population Health Research Institute, 237 Barton St E C3-109, Hamilton, ON L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jia Wang
- Population Health Research Institute, 237 Barton St E C3-109, Hamilton, ON L8L 2X2, Canada
| | - Alexander P Benz
- Population Health Research Institute, 237 Barton St E C3-109, Hamilton, ON L8L 2X2, Canada
| | - Linda Johnson
- Population Health Research Institute, 237 Barton St E C3-109, Hamilton, ON L8L 2X2, Canada
| | - Stuart J Connolly
- Population Health Research Institute, 237 Barton St E C3-109, Hamilton, ON L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke Medicine, Durham, NC, USA
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Stefan H Hohnloser
- Department of Electrophysiology, J.W. Goetshe University, Frankfurt, Germany
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Carsten W Israel
- Division of Cardiology, Department of Medicine, Evangelical Hospital Bielefeld, Bielefeld, Germany
| | - Jorge A Wong
- Population Health Research Institute, 237 Barton St E C3-109, Hamilton, ON L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David Conen
- Population Health Research Institute, 237 Barton St E C3-109, Hamilton, ON L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeff S Healey
- Population Health Research Institute, 237 Barton St E C3-109, Hamilton, ON L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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8
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Cryptogenic Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Vitolo M, Imberti JF, Maisano A, Albini A, Bonini N, Valenti AC, Malavasi VL, Proietti M, Healey JS, Lip GY, Boriani G. Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis. Eur J Intern Med 2021; 92:100-106. [PMID: 34154879 DOI: 10.1016/j.ejim.2021.05.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Atrial High Rate Episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device. The risks of stroke/Thromboembolic (TE) events and incident clinical Atrial Fibrillation (AF) associated with AHRE varies markedly. OBJECTIVES To assess the relationship between AHRE and TE events, and between AHRE and incident clinical AF. METHODS This systematic review and meta-analysis was conducted following the PRISMA recommendations. PubMed, Scopus, and Google Scholar were searched from inception to 18/02/2021 for studies reporting TE events and incident clinical AF in patients with AHRE, as compared with patients without. RESULTS Ten out of 8081 records fulfilled the inclusion criteria, for a total of 37 266 patients. Seven out of ten studies excluded patients with prior history of clinical AF (4961 patients), embracing the most recent definition of AHRE. The risk ratio (RR) for TE events in AHRE patients was 2.13 (95% CI: 1.53-2.95, I2: 0%). The incidence of clinical AF was reported in four studies excluding patients with a history of clinical AF (3574 patients). The RR for incident clinical AF was 3.34 (95%CI: 1.89-5.90, I2: 73%). CONCLUSIONS AHRE are significantly associated with systemic thromboembolism and incident clinical AF. Further studies are needed to improve patients' risk stratification and management.
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Affiliation(s)
- Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Anna Maisano
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Alessandro Albini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vincenzo L Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy..
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10
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Sgreccia D, Manicardi M, Malavasi VL, Vitolo M, Valenti AC, Proietti M, Lip GYH, Boriani G. Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients. J Clin Med 2021; 10:3979. [PMID: 34501434 PMCID: PMC8432492 DOI: 10.3390/jcm10173979] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In atrial fibrillation (AF) patients, the presence of symptoms can guide the decision between rate or rhythm control therapy, but it is still unclear if AF-related outcomes are determined by symptomatic status of their clinical presentation. METHODS We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). We included studies with a total number of patients enrolled equal to or greater than 200, with a minimum follow-up period of six months. RESULTS From the initial 5476 results retrieved after duplicates' removal, a total of 10 studies were selected. Overall, 81,462 patients were included, of which 21,007 (26%) were asymptomatic, while 60,455 (74%) were symptomatic. No differences were found between symptomatic and asymptomatic patients regarding the risks of all-cause death (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.81-1.32), and cardiovascular death (OR 0.87, 95% CI 0.54-1.39). No differences between symptomatic and asymptomatic groups were evident for stroke (OR 1.22, 95% CI 0.77-1.93) and stroke/TE (OR 1.06, 95% CI 0.86-1.31) risks. CONCLUSIONS Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status.
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Affiliation(s)
- Daria Sgreccia
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy; (D.S.); (M.M.); (V.L.M.); (M.V.); (A.C.V.)
| | - Marcella Manicardi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy; (D.S.); (M.M.); (V.L.M.); (M.V.); (A.C.V.)
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy; (D.S.); (M.M.); (V.L.M.); (M.V.); (A.C.V.)
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy; (D.S.); (M.M.); (V.L.M.); (M.V.); (A.C.V.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK; (M.P.); (G.Y.H.L.)
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy; (D.S.); (M.M.); (V.L.M.); (M.V.); (A.C.V.)
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK; (M.P.); (G.Y.H.L.)
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK; (M.P.); (G.Y.H.L.)
- Department of Clinical Medicine, Aalborg University, DK-9100 Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy; (D.S.); (M.M.); (V.L.M.); (M.V.); (A.C.V.)
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11
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Boriani G, Vitolo M, Diemberger I, Proietti M, Valenti AC, Malavasi VL, Lip GYH. Optimizing indices of AF susceptibility and burden to evaluate AF severity, risk and outcomes. Cardiovasc Res 2021; 117:1-21. [PMID: 33913486 PMCID: PMC8707734 DOI: 10.1093/cvr/cvab147] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/15/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) has heterogeneous patterns of presentation concerning symptoms,
duration of episodes, AF burden, and the tendency to progress towards the terminal step of
permanent AF. AF is associated with a risk of stroke/thromboembolism traditionally
considered dependent on patient-level risk factors rather than AF type, AF burden, or
other characterizations. However, the time spent in AF appears related to an incremental
risk of stroke, as suggested by the higher risk of stroke in patients with clinical AF vs.
subclinical episodes and in patients with non-paroxysmal AF vs. paroxysmal AF. In patients
with device-detected atrial tachyarrhythmias, AF burden is a dynamic process with
potential transitions from a lower to a higher maximum daily arrhythmia burden, thus
justifying monitoring its temporal evolution. In clinical terms, the appearance of the
first episode of AF, the characterization of the arrhythmia in a specific AF type, the
progression of AF, and the response to rhythm control therapies, as well as the clinical
outcomes, are all conditioned by underlying heart disease, risk factors, and
comorbidities. Improved understanding is needed on how to monitor and modulate the effect
of factors that condition AF susceptibility and modulate AF-associated outcomes. The
increasing use of wearables and apps in practice and clinical research may be useful to
predict and quantify AF burden and assess AF susceptibility at the individual patient
level. This may help us reveal why AF stops and starts again, or why AF episodes, or
burden, cluster. Additionally, whether the distribution of burden is associated with
variations in the propensity to thrombosis or other clinical adverse events. Combining the
improved methods for data analysis, clinical and translational science could be the basis
for the early identification of the subset of patients at risk of progressing to a longer
duration/higher burden of AF and the associated adverse outcomes.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinico Scientifici Maugeri, Milan, Italy
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Clinical Factors Associated with Atrial Fibrillation Detection on Single-Time Point Screening Using a Hand-Held Single-Lead ECG Device. J Clin Med 2021; 10:jcm10040729. [PMID: 33673209 PMCID: PMC7917757 DOI: 10.3390/jcm10040729] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Our aim was to assess the prevalence of unknown atrial fibrillation (AF) among adults during single-time point rhythm screening performed during meetings or social recreational activities organized by patient groups or volunteers. A total of 2814 subjects (median age 68 years) underwent AF screening by a handheld single-lead ECG device (MyDiagnostick). Overall, 56 subjects (2.0%) were diagnosed with AF, as a result of 12-lead ECG following a positive/suspected recording. Screening identified AF in 2.9% of the subjects ≥ 65 years. None of the 265 subjects aged below 50 years was found positive at AF screening. Risk stratification for unknown AF based on a CHA2DS2VASc > 0 in males and >1 in females (or CHA2DS2VA > 0) had a high sensitivity (98.2%) and a high negative predictive value (99.8%) for AF detection. A slightly lower sensitivity (96.4%) was achieved by using age ≥ 65 years as a risk stratifier. Conversely, raising the threshold at ≥75 years showed a low sensitivity. Within the subset of subjects aged ≥ 65 a CHA2DS2VASc > 1 in males and >2 in females, or a CHA2DS2VA > 1 had a high sensitivity (94.4%) and negative predictive value (99.3%), while age ≥ 75 was associated with a marked drop in sensitivity for AF detection.
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 4849] [Impact Index Per Article: 1616.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Atrial high rate episodes (AHREs) are defined as asymptomatic atrial tachyarrhythmias detected by cardiac implantable electronic devices with atrial sensing, providing automated continuous monitoring and tracings storage, occurring in subjects with no previous clinical atrial fibrillation (AF) and with no AF detected at conventional electrocardiogram recordings. AHREs are associated with an increased thrombo-embolic risk, which is not negligible, although lower than that of clinical AF. The thrombo-embolic risk increases with increasing burden of AHREs, and moreover, AHREs burden shows a dynamic pattern, with tendency to progression along with time, with potential transition to clinical AF. The clinical management of AHREs, in particular with regard to prophylactic treatment with oral anticoagulants (OACs), remains uncertain and heterogeneous. At present, in patients with confirmed AHREs, as a result of device tracing analysis, an integrated, individual and clinically-guided assessment should be applied, taking into account the patients’ risk of stroke (to be reassessed regularly) and the AHREs burden. The use of OACs, preferentially non-vitamin K antagonists OACs, may be justified in selected patients, such as those with longer AHREs durations (in the range of several hours or ≥24 h), with no doubts on AF diagnosis after device tracing analysis and with an estimated high/very high individual risk of stroke, accounting for the anticipated net clinical benefit, and informed patient’s preferences. Two randomized clinical trials on this topic are currently ongoing and are likely to better define the role of anticoagulant therapy in patients with AHREs.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
- Corresponding author. Tel: +39 059 4225836, Fax: +39 059 4224498,
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, dr Subotica 8, 11000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Visegradska 26, 11000 Belgrade, Serbia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
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Chocron A, Oster J, Biton S, Mandel F, Elbaz M, Zeevi YY, Behar JA. Remote Atrial Fibrillation Burden Estimation Using Deep Recurrent Neural Network. IEEE Trans Biomed Eng 2020; 68:2447-2455. [PMID: 33275575 DOI: 10.1109/tbme.2020.3042646] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The atrial fibrillation burden (AFB) is defined as the percentage of time spent in atrial fibrillation (AF) over a long enough monitoring period. Recent research has suggested the added prognostic value of using the AFB compared to a binary diagnosis. We evaluate, for the first time, the ability to estimate the AFB over long-term continuous recordings, using a deep recurrent neutral network (DRNN) approach. METHODS The models were developed and evaluated on a large database of p = 2,891 patients, totaling t = 68,800 hours of continuous electrocardiography (ECG) recordings from the University of Virginia. Specifically, 24h beat-to-beat time series were obtained from a single portable ECG channel. The network, denoted ArNet, was benchmarked against a gradient boosting (XGB) model, trained on 21 features including the coefficient of sample entropy (CosEn) and AFEvidence that is derived from the number of irregular points revealed by the Lorenz plot. The generalizations of ArNet and XGB were also evaluated on the independent PhysioNet LTAF test database. RESULTS the absolute AF burden estimation error [Formula: see text], median and interquartile, on the test set, was 1.2 (0.1-6.7) for ArNet and 2.8 (0.9-11.7) for XGB for AF individuals. Generalization results on LTAF were consistent with [Formula: see text] of 2.7 (1.1-14.7) for ArNet and 3.6 (1.0-16.7) for XGB. CONCLUSION This research demonstrates the feasibility of AFB estimation from 24h beat-to-beat interval time series utilizing DRNNs. SIGNIFICANCE The novel data-driven approach enables robust remote diagnosis and phenotyping of AF.
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Henriksson M, Martin-Yebra A, Butkuviene M, Rasmussen JG, Marozas V, Petrenas A, Savelev A, Platonov PG, Sornmo L. Modeling and Estimation of Temporal Episode Patterns in Paroxysmal Atrial Fibrillation. IEEE Trans Biomed Eng 2020; 68:319-329. [PMID: 32746005 DOI: 10.1109/tbme.2020.2995563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The present study proposes a model-based, statistical approach to characterizing episode patterns in paroxysmal atrial fibrillation (AF). Thanks to the rapid advancement of noninvasive monitoring technology, the proposed approach should become increasingly relevant in clinical practice. METHODS History-dependent point process modeling is employed to characterize AF episode patterns, using a novel alternating, bivariate Hawkes self-exciting model. In addition, a modified version of a recently proposed statistical model to simulate AF progression throughout a lifetime is considered, involving non-Markovian rhythm switching and survival functions. For each model, the maximum likelihood estimator is derived and used to find the model parameters from observed data. RESULTS Using three databases with a total of 59 long-term ECG recordings, the goodness-of-fit analysis demonstrates that the proposed alternating, bivariate Hawkes model fits SR-to-AF transitions in 40 recordings and AF-to-SR transitions in 51; the corresponding numbers for the AF model with non-Markovian rhythm switching are 40 and 11, respectively. Moreover, the results indicate that the model parameters related to AF episode clustering, i.e., aggregation of temporal AF episodes, provide information complementary to the well-known clinical parameter AF burden. CONCLUSION Point process modeling provides a detailed characterization of the occurrence pattern of AF episodes that may improve the understanding of arrhythmia progression.
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18
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Boriani G, Imberti JF, Vitolo M. Atrial fibrillation and remote monitoring through cardiac implantable electronic devices in heart failure patients. Eur J Heart Fail 2020; 22:554-556. [DOI: 10.1002/ejhf.1745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 12/26/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
| | - Jacopo F. Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
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Talboom-Kamp EP, Holstege MS, Chavannes NH, Kasteleyn MJ. Effects of use of an eHealth platform e-Vita for COPD patients on disease specific quality of life domains. Respir Res 2019; 20:146. [PMID: 31291945 PMCID: PMC6621945 DOI: 10.1186/s12931-019-1110-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Integrated disease management with self-management for Chronic Obstructive Pulmonary Disease (COPD) is effective to improve clinical outcomes. eHealth can improve patients' involvement to be able to accept and maintain a healthier lifestyle. Eventhough there is mixed evidence of the impact of eHealth on quality of life (QoL) in different settings. AIM The primary aim of the e-Vita-COPD-study was to investigate the effect of use of eHealth patient platforms on disease specific QoL of COPD patients. METHODS We evaluated the impact of an eHealth platform on disease specific QoL measured with the clinical COPD questionnaire (CCQ), including subscales of symptoms, functional state and mental state. Interrupted time series (ITS) design was used to collect CCQ data at multiple time points. Multilevel linear regression modelling was used to compare trends in CCQ before and after the intervention. RESULTS Of 742 invited COPD patients, 244 signed informed consent. For the analyses, we only included patients who actually used the eHealth platform (n = 123). The decrease of CCQ-symptoms was 0.20% before the intervention and 0.27% after the intervention; this difference in slopes was statistically significant (P = 0.027). The decrease of CCQ-mental was 0.97% before the intervention and after the intervention there was an increase of 0.017%; this difference was statistically significant (P = 0.01). No significant difference was found in the slopes of CCQ (P = 0.12) and CCQ-function (P = 0.11) before and after the intervention. CONCLUSION The e-Vita eHealth platform had a potential beneficial impact on the CCQ-symptoms of COPD patients, but not on functional state. The CCQ-mental state remained stable after the intervention, but this was a deterioration compared to the improving situation before the start of the eHealth platform. Therefore, health care providers should be aware that, although symptoms improve, there might be a slight increase in anxiety and depression after introducing an eHealth intervention to support self-management. TRIAL REGISTRATION Our study is registered in the Dutch Trial Register (national registration of clinical trails, mandatory for publication) with number NTR4098 and can be found at http://www.trialregister.nl/trial/3936 . Date registered: 2013-07-31. First participant: 2014-01-01.
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Affiliation(s)
- Esther P.W.A. Talboom-Kamp
- Public Health and Primary Care Department, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, University of Leiden, Leiden, Netherlands
- Saltro Diagnostic Center, Utrecht, Netherlands
| | - Marije S. Holstege
- Department of Research, Treatment and Advice Center Omring GRZPLUS, Hoorn, The Netherlands
- Department of Research and Development, Evean, Purmerend, The Netherlands
| | - Niels H. Chavannes
- Public Health and Primary Care Department, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, University of Leiden, Leiden, Netherlands
| | - Marise J. Kasteleyn
- Public Health and Primary Care Department, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, University of Leiden, Leiden, Netherlands
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Serban C, Arinze JT, Starreveld R, Lanters EAH, Yaksh A, Kik C, Acardag Y, Knops P, Bogers AJJC, de Groot NMS. The impact of obesity on early postoperative atrial fibrillation burden. J Thorac Cardiovasc Surg 2019; 159:930-938.e2. [PMID: 31043315 DOI: 10.1016/j.jtcvs.2019.03.073] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obesity has been linked to the development of postoperative atrial fibrillation. This study is aimed at investigating the role of body mass index in the evolution of de novo, early postoperative atrial fibrillation by assessing differences between obese and nonobese patients undergoing cardiac surgery. METHODS Patients with early de novo postoperative atrial fibrillation were included. Continuous cardiac rhythms were recorded during the first 5 postoperative days in obese (N = 67, 66 ± 9 years; 51 [76%] male) and nonobese (N = 89, 69 ± 9; 75 [84%] male) patients without a history of atrial fibrillation undergoing cardiac surgery. Postoperative atrial fibrillation burden was defined as the ratio between total duration of all atrial fibrillation episodes and total recording time (atrial fibrillation burden, %). RESULTS A total of 1191 (median: 5/patient) postoperative atrial fibrillation episodes were identified in the obese group compared with 1218 (median: 4/patient) in the nonobese group. The median duration and number of prolonged (>60 minutes) postoperative atrial fibrillation episodes were higher in obese patients (250 vs 145 minutes, P = .003, and median of 2 vs 1 episode, P = .031). Obesity was associated with a larger early postoperative atrial fibrillation burden (obese patients: median, 7%; interquartile range, 2.5-19.7 vs nonobese patients: median, 3.2%; interquartile range, 0.5-8.8, P = .001) mainly on the third postoperative day (P = .021). CONCLUSIONS Obesity predisposes to a larger number of prolonged atrial fibrillation episodes in the early postoperative period after cardiac surgery for coronary artery disease or valvular heart disease. The higher atrial fibrillation burden in the early postoperative period occurred particularly on the third day. Future studies will determine whether obesity prevention may play a key role in reducing the incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery.
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Affiliation(s)
- Corina Serban
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johnmary T Arinze
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Roeliene Starreveld
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eva A H Lanters
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ameeta Yaksh
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yalin Acardag
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Malavasi VL, Fantecchi E, Gianolio L, Pesce F, Longo G, Marietta M, Cascinu S, Lip GYH, Boriani G. Atrial fibrillation in patients with active malignancy and use of anticoagulants: Under-prescription but no adverse impact on all-cause mortality. Eur J Intern Med 2019; 59:27-33. [PMID: 30385084 DOI: 10.1016/j.ejim.2018.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/13/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023]
Abstract
Prescription of anticoagulants (ACs) in patients with cancer and atrial fibrillation (AF) is challenging and the impact on survival is not defined. In this study data prospectively collected in Oncology Units were retrospectively evaluated. Among 4664 patients admitted for malignancy, 394 patients (8.4%) had documented AF (mean age of 74 ± 9) and AC was prescribed to 155 patients (40%). Neither the type of cancer, the stage of the disease (metastatic or not) nor the ongoing treatments were significantly associated with prescription of AC, which was independently associated with BMI (OR 1.10; CI 95% 1.03-1.17; p = .003), valvular heart disease (OR 3.76; CI95% 1.59-8.87; p = .002), and previous venous thromboembolism (OR 6.67; 95%CI 2.67-16.70; p < .001). During a median follow-up of 212 days, survival from all-cause death was 37%, 28% and 18% at 6 months, 1 and 2 years, respectively. Only variables related to neoplastic disease or to patient clinical complexity were independently associated with mortality. A CHA2DS2VASc ≥ 4 was significantly associated with mortality (HR 1.33; 95%CI 1.06-1.67; p = .013). Treatment with ACs was not significantly related to mortality, neither in the whole cohort of patients, nor in patients with metastatic malignancies. In conclusion the prescription of ACs in patients with AF and active cancer was suboptimal, with one fourth of the patients not treated with ACs and one third using LMWH at prophylactic, non-therapeutic doses. Only few variables (BMI, valvular heart disease and previous venous thromboembolism) predicted prescription of ACs. Prescription of ACs was not associated with all-cause mortality, even in the subgroup with metastasis.
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Affiliation(s)
- Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Elisa Fantecchi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Laura Gianolio
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Francesca Pesce
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Longo
- Oncology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Marietta
- Hematology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Stefano Cascinu
- Oncology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
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Lip GY, Banerjee A, Boriani G, Chiang CE, Fargo R, Freedman B, Lane DA, Ruff CT, Turakhia M, Werring D, Patel S, Moores L. Antithrombotic Therapy for Atrial Fibrillation. Chest 2018; 154:1121-1201. [DOI: 10.1016/j.chest.2018.07.040] [Citation(s) in RCA: 481] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 02/08/2023] Open
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Mairesse GH, Moran P, Van Gelder IC, Elsner C, Rosenqvist M, Mant J, Banerjee A, Gorenek B, Brachmann J, Varma N, Glotz de Lima G, Kalman J, Claes N, Lobban T, Lane D, Lip GYH, Boriani G. Screening for atrial fibrillation: a European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE). Europace 2018; 19:1589-1623. [PMID: 29048522 DOI: 10.1093/europace/eux177] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/06/2017] [Indexed: 01/21/2023] Open
Affiliation(s)
- Georges H Mairesse
- Department of Cardiology, Cliniques du Sud-Luxembourg, 137 rue des déportés, B6700 Arlon, Belgium
| | - Patrick Moran
- Health Information and Quality Authority, George's Lane, Dublin 7, D07 E98Y, Ireland
| | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - Christian Elsner
- University Clinic Of Schleswig Holstein, Maria Goeppert Strasse 7a-b, Luebeck, 23538, Germany
| | | | - Jonathan Mant
- Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, CB1 8RN, United Kingdom
| | - Amitava Banerjee
- University College London, Farr Institute of Health Informatics Research, 222 Euston Road, London, West Midlands NW1 2DA, United Kingdom
| | - Bulent Gorenek
- Eskisehir Osmangazi University, ESOGÜ Meselik Yerleskesi, 26480 ESKISEHIR, Turkey
| | - Johannes Brachmann
- Klinikum Coburg, Chefarzt der II. Medizinischen Klinik, Ketschendorfer Str. 33, Coburg, DE-96450, Germany
| | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, Ohio 44195, USA
| | - Gustavo Glotz de Lima
- Instituto de Cardiologia do RS / FUC, Eletrofisiologia Dept., Av. Princesa Isabel 370, Porto Alegre, 90620-001, Brazil
| | - Jonathan Kalman
- The Royal Melbourne Hospital, Melbourne Heart Center, Royal Parade Suite 1, Parkville, Victoria, 3050, Australia
| | - Neree Claes
- University of Hasselt, Patient Safety in General Practice and Hospitals, Diepenbeek, Belgium, Antwerp Management School, Clinical Leadership, Antwerp, Belgium
| | - Trudie Lobban
- Arrhythmia Alliance & AF Association, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton, Oxfordshire OX7 5SR, UK
| | - Deirdre Lane
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
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Steinberg JS, O’Connell H, Li S, Ziegler PD. Thirty-Second Gold Standard Definition of Atrial Fibrillation and Its Relationship With Subsequent Arrhythmia Patterns. Circ Arrhythm Electrophysiol 2018; 11:e006274. [DOI: 10.1161/circep.118.006274] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/20/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan S. Steinberg
- Heart Research Follow-up Program, University of Rochester School of Medicine and Dentistry, NY (J.S.S.)
- SMG Arrhythmia Center, Summit Medical Group, Short Hills, NJ (J.S.S.)
| | - Heather O’Connell
- Medtronic Cardiac Rhythm Heart Failure (CRHF), Minneapolis, MN (H.O., S.L., P.D.Z.)
| | - Shelby Li
- Medtronic Cardiac Rhythm Heart Failure (CRHF), Minneapolis, MN (H.O., S.L., P.D.Z.)
| | - Paul D. Ziegler
- Medtronic Cardiac Rhythm Heart Failure (CRHF), Minneapolis, MN (H.O., S.L., P.D.Z.)
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Romanov A, Pokushalov E, Ponomarev D, Strelnikov A, Shabanov V, Losik D, Karaskov A, Steinberg JS. Pulmonary vein isolation with concomitant renal artery denervation is associated with reduction in both arterial blood pressure and atrial fibrillation burden: Data from implantable cardiac monitor. Cardiovasc Ther 2018; 35. [PMID: 28423234 DOI: 10.1111/1755-5922.12264] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 03/23/2016] [Accepted: 04/13/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Renal artery denervation (RDN) has provided incremental atrial fibrillation (AF) suppression after pulmonary vein isolation (PVI) in patients with AF in the setting of drug-resistant hypertension. OBJECTIVE To assess the relationship between changes of mean blood pressure (BP) and AF recurrences/AF burden after PVI combined with RDN. METHODS All patients from two randomized studies with symptomatic paroxysmal AF and/or persistent AF and resistant hypertension who underwent PVI-only (n=37) or PVI with RDN (n=39), and implantable cardiac monitor (ICM) implantation were eligible for this study. Mixed-effects linear models were used to investigate the effect of RDN on mean BP and mean AF burden and associations between the two during the 12-month follow-up. RESULTS Concomitant RDN was associated with a significant reduction in both mean AF burden (2.43 [95% CI: 1.76-3.09] % vs 6.95 [95% CI: 5.44-8.45] %) and mean BP (104 [95% CI: 103-106] mm Hg vs 112 [95% CI: 110-113] mm Hg). Decrease in mean BP was positively correlated with decline in mean AF burden: reduction of 5-10 mm Hg was accompanied by a 7.0% decreased mean AF burden, with greater reduction (up to 20 mm Hg) associated with on average 17.7% lower mean AF burden. CONCLUSIONS Renal artery denervation when added to PVI decreases AF recurrences, AF burden, and mean BP. Reduction in mean BP is associated with both AF burden and recurrences. Further large-scale studies are needed to define the mechanistic pathway(s) of the antiarrhythmic effects of RDN.
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Affiliation(s)
- Alexander Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Dmitry Ponomarev
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Artem Strelnikov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Vitaliy Shabanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Denis Losik
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
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Romanov A, Pokushalov E, Bayramova S, Ponomarev D, Shabanov V, Losik D, Stenin I, Elesin D, Mikheenko I, Steinberg JS. Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: Three-year outcomes of the PREVENT AF I study. J Cardiovasc Electrophysiol 2018; 29:872-878. [PMID: 29570894 DOI: 10.1111/jce.13485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The PREVENT AF I study demonstrated that prophylactic pulmonary vein isolation (PVI) in patients with pure typical atrial flutter (AFL) resulted in substantial reduction of new-onset atrial fibrillation (AF) during 1-year follow-up as assessed by continuous implantable cardiac monitor (ICM). The objective of this study was to assess 3-year outcomes. METHODS AND RESULTS Fifty patients with documented AFL were randomized to either cavotricuspid isthmus (CTI) ablation alone (n = 25) or CTI with concomitant PVI (n = 25). The primary endpoint of the study was the occurrence of any atrial tachyarrhythmia with the monthly burden exceeding 0.5% on the ICM. At the end of 3 years, freedom from any atrial tachyarrhythmia was 48% (95% confidence interval [CI]: 32-72%) in the CTI plus PVI group as compared to 20% (95% CI: 9-44%) in the CTI-only group (P = 0.01). Freedom from redo procedures was also higher: 92% (95% CI: 82-100%) versus 68% (95% CI: 52-89%), respectively (P = 0.027). The 3-year AF burden favored the combined ablation group: 6.2% versus 16.8% (P = 0.03). In the CTI-only group, 12 (48%) patients were hospitalized compared to 4 (16%) in the PVI + CTI group (P = 0.03). Two patients in the CTI-only group developed stroke with no serious adverse events in the PVI + CTI group. CONCLUSION Prophylactic PVI in patients with only typical AFL resulted in a significant reduction of new-onset AF and burden during long-term follow-up as assessed by ICM, with consequent reduction in hospitalizations and need to perform repeat ablation for AF.
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Affiliation(s)
- Alexander Romanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Evgeny Pokushalov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Sevda Bayramova
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Dmitry Ponomarev
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Vitaliy Shabanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Denis Losik
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Ilya Stenin
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Dmitry Elesin
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Igor Mikheenko
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Jonathan S Steinberg
- Heart Research Follow-up Program, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.,The SMG Arrhythmia Center, Summit Medical Group, Short Hills, NJ, USA
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Russo V, Papa AA, Rago A, Ciardiello C, Marano M, Proietti R, Politano L, Nigro G. Interatrial block to predict atrial fibrillation in myotonic dystrophy type 1. Neuromuscul Disord 2018; 28:327-333. [PMID: 29567351 DOI: 10.1016/j.nmd.2018.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/03/2018] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
Abstract
Paroxysmal atrial fibrillation frequently occurs in Myotonic dystrophy type 1 (DM1) patients. Interatrial block is recognized as predictor of atrial arrhythmias, particularly atrial fibrillation (AF). The aim of this study was to evaluate the role of interatrial block in predicting the onset of atrial fibrillation during 2-year follow-up in DM1 patients who underwent pacemaker implantation for conduction system disorders. The study prospectively enrolled 70 DM1 patients (aged 36-69; 31 M) who underwent pacemaker implantation for cardiac rhythm abnormalities in accordance with the current guidelines. All DM1 patients underwent 12-lead surface ECG, 2D color Doppler echocardiogram and device interrogation at implantation, one month after and every six months thereafter for a minimum of 2-year follow-up. 12-lead surface ECGs were analyzed to diagnose interatrial block (IAB), defined as a P-wave duration ≥120 ms without (partial IAB) or with (advanced IAB) biphasic morphology (±) in the inferior leads. Device interrogation was performed to evaluate the development of new onset atrial high rate electrograms compatible with paroxysmal atrial fibrillation episodes. Interatrial block was detected in 22 patients (31.4%): 18 partial (25.7%) and 4 advanced (5.7%). During follow-up, AF episodes were detected in 18 DM1 patients (25.7%). The study population was divided into 2 groups according to the presence of AF (AF+ Group vs AF- Group). The AF+ Group was older and showed higher prevalence of IAB than the AF- Group. IAB was found to be independent predictor of AF in DM1 population (P < 0.001). A cut-off value of 121 ms for IAB had a sensitivity of 83.3% and specificity of 90.3% in identifying DM1 patients at high risk of developing AF. Interatrial block represents an independent predictor of AF occurrence in our DM1 population with conduction disturbances who had previously undergone pacemaker implantation.
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Affiliation(s)
- Vincenzo Russo
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Andrea Antonio Papa
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy; Department of Experimental Medicine, Cardiomyology and Medical Genetics, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Anna Rago
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | | | | | | | - Luisa Politano
- Department of Experimental Medicine, Cardiomyology and Medical Genetics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gerardo Nigro
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
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28
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Russo V, Papa AA, Rago A, Ciardiello C, Nigro G. Effect of dual-chamber minimal ventricular pacing on paroxysmal atrial fibrillation incidence in myotonic dystrophy type 1 patients: A prospective, randomized, single-blind, crossover study. Heart Rhythm 2018. [PMID: 29524476 DOI: 10.1016/j.hrthm.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common finding in the myotonic dystrophy type 1 (DM1) population. Pacemakers (PMs) may facilitate the diagnosis and management of frequent subclinical asymptomatic AF episodes. OBJECTIVE The purpose of this study was to evaluate the effect of minimal ventricular pacing on paroxysmal AF incidence in DM1 patients during a 24-month follow-up period. METHODS We enrolled 70 DM1 patients (age 43.4 ± 13.8 years; 39 women) who underwent dual-chamber PM implantation. Patients were randomized to minimizing ventricular pacing features (ON) or not (OFF). Patients crossed over to the opposite pacing programming 12 months later. We counted the number of DM1 patients with at least 1 episode of AF, the AF total duration, and the burden recorded by PM diagnostics during the MVP ON and OFF phases. RESULTS Twenty-five DM1 patients (41.7%) showed at least 1 AF episode. Seven patients (11.7%) demonstrated AF episodes during MVP ON phase and 25 patients (41.7%) during MVP OFF phase (P <.001). Thirty-five patients had no AF during MVP ON or OFF phase, 3 patients had AF episodes only during MVP ON phase, 21 patients had AF episodes only during MVP OFF phase, and 4 patients had AF episodes during MVP ON and OFF phases. Activation of the MVP algorithm was associated with a 44% reduction in relative risk of developing AF. Furthermore, during the MVP ON phases, the study population showed a shorter total AF duration and a lower AF burden. CONCLUSION MVP is an efficacy strategy for reducing the risk of AF in DM1 patients who have undergone PM implantation.
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Affiliation(s)
- Vincenzo Russo
- Department of Cardiology, University of the Study of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
| | - Andrea Antonio Papa
- Department of Cardiology, University of the Study of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy.
| | - Anna Rago
- Department of Cardiology, University of the Study of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
| | | | - Gerardo Nigro
- Department of Cardiology, University of the Study of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
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From chronic disease management to person-centered eHealth; a review on the necessity for blended care. CLINICAL EHEALTH 2018. [DOI: 10.1016/j.ceh.2018.01.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Uittenbogaart SB, Lucassen WAM, van Etten-Jamaludin FS, de Groot JR, van Weert HCPM. Burden of atrial high-rate episodes and risk of stroke: a systematic review. Europace 2017; 20:1420-1427. [DOI: 10.1093/europace/eux356] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/18/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Steven B Uittenbogaart
- General Practice, Department of Cardiology, Academic Medical Center, Meibergdreef 15, 1105 AZ, DD Amsterdam, Netherlands
| | - Wim A M Lucassen
- General Practice, Department of Cardiology, Academic Medical Center, Meibergdreef 15, 1105 AZ, DD Amsterdam, Netherlands
| | - Faridi S van Etten-Jamaludin
- Medical Library, Department of Cardiology, Academic Medical Center, Meibergdreef 15, 1105 AZ, DD Amsterdam, Netherlands
| | - Joris R de Groot
- Heart Center, Department of Cardiology, Academic Medical Center, Meibergdreef 15, 1105 AZ, DD Amsterdam, Netherlands
| | - Henk C P M van Weert
- General Practice, Department of Cardiology, Academic Medical Center, Meibergdreef 15, 1105 AZ, DD Amsterdam, Netherlands
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Clinical Impact of Asymptomatic Presentation Status in Patients With Paroxysmal and Sustained Atrial Fibrillation. Chest 2017; 152:1266-1275. [DOI: 10.1016/j.chest.2017.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/17/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022] Open
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Paquet M, Cerasuolo JO, Thorburn V, Fridman S, Alsubaie R, Lopes RD, Cipriano LE, Salamone P, Melling CWJ, Khan AR, Sedeño L, Fang J, Drangova M, Montero-Odasso M, Mandzia J, Khaw AV, Racosta JM, Paturel J, Samoilov L, Stirling D, Balint B, Jaremek V, Koschinsky ML, Boffa MB, Summers K, Ibañez A, Mrkobrada M, Saposnik G, Kimpinski K, Whitehead SN, Sposato LA. Pathophysiology and Risk of Atrial Fibrillation Detected after Ischemic Stroke (PARADISE): A Translational, Integrated, and Transdisciplinary Approach. J Stroke Cerebrovasc Dis 2017; 27:606-619. [PMID: 29141778 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It has been hypothesized that ischemic stroke can cause atrial fibrillation. By elucidating the mechanisms of neurogenically mediated paroxysmal atrial fibrillation, novel therapeutic strategies could be developed to prevent atrial fibrillation occurrence and perpetuation after stroke. This could result in fewer recurrent strokes and deaths, a reduction or delay in dementia onset, and in the lessening of the functional, structural, and metabolic consequences of atrial fibrillation on the heart. METHODS The Pathophysiology and Risk of Atrial Fibrillation Detected after Ischemic Stroke (PARADISE) study is an investigator-driven, translational, integrated, and transdisciplinary initiative. It comprises 3 complementary research streams that focus on atrial fibrillation detected after stroke: experimental, clinical, and epidemiological. The experimental stream will assess pre- and poststroke electrocardiographic, autonomic, anatomic (brain and heart pathology), and inflammatory trajectories in an animal model of selective insular cortex ischemic stroke. The clinical stream will prospectively investigate autonomic, inflammatory, and neurocognitive changes among patients diagnosed with atrial fibrillation detected after stroke by employing comprehensive and validated instruments. The epidemiological stream will focus on the demographics, clinical characteristics, and outcomes of atrial fibrillation detected after stroke at the population level by means of the Ontario Stroke Registry, a prospective clinical database that comprises over 23,000 patients with ischemic stroke. CONCLUSIONS PARADISE is a translational research initiative comprising experimental, clinical, and epidemiological research aimed at characterizing clinical features, the pathophysiology, and outcomes of neurogenic atrial fibrillation detected after stroke.
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Affiliation(s)
- Maryse Paquet
- Stroke, Dementia and Heart Disease Laboratory, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joshua O Cerasuolo
- Stroke, Dementia and Heart Disease Laboratory, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Victoria Thorburn
- Stroke, Dementia and Heart Disease Laboratory, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sebastian Fridman
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rasha Alsubaie
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Renato D Lopes
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lauren E Cipriano
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Ivey Business School, Western University, London, Ontario, Canada
| | - Paula Salamone
- Laboratory of Experimental, Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - C W James Melling
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Ali R Khan
- Robarts Research Institute, Department of Medical Biophysics & Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lucas Sedeño
- Laboratory of Experimental, Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Jiming Fang
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Maria Drangova
- Robarts Research Institute, Department of Medical Biophysics & Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, Ontario, Canada; Division of Geriatric Medicine and Dentistry, Department of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Jennifer Mandzia
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alexander V Khaw
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Juan M Racosta
- Autonomic Disorders Laboratory, Clinical Neurological Sciences Department, Schulich School of Medicine & Dentistry, London Health Sciences Center, Western University, London, ON, Canada
| | - Justin Paturel
- Autonomic Disorders Laboratory, Clinical Neurological Sciences Department, Schulich School of Medicine & Dentistry, London Health Sciences Center, Western University, London, ON, Canada
| | - Lucy Samoilov
- Stroke, Dementia and Heart Disease Laboratory, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Devin Stirling
- Stroke, Dementia and Heart Disease Laboratory, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Brittany Balint
- Stroke, Dementia and Heart Disease Laboratory, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Victoria Jaremek
- Stroke, Dementia and Heart Disease Laboratory, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marlys L Koschinsky
- Robarts Research Institute, Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Michael B Boffa
- Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kelly Summers
- Department of Microbiology and Immunology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Agustín Ibañez
- Laboratory of Experimental, Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Universidad Autónoma del Caribe, Barranquilla, ColombiaCenter for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile; Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Macquarie University, Sydney, New South Wale, Australia
| | - Marko Mrkobrada
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Gustavo Saposnik
- Stroke Outcomes Research Center, Division of Neurology, Department of Medicine, St. Michael's Hospital and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Kurt Kimpinski
- Autonomic Disorders Laboratory, Clinical Neurological Sciences Department, Schulich School of Medicine & Dentistry, London Health Sciences Center, Western University, London, ON, Canada
| | - Shawn N Whitehead
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Luciano A Sposato
- Stroke, Dementia and Heart Disease Laboratory, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences at London Health Sciences Centre, Department of Epidemiology and Biostatistics, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Kiuchi MG. Why is systolic blood pressure drop ≥10mmHg post RSD in patients with resistant hypertension considered responsiveness to the treatment? Should we interpret as science or arbitrariness? HIPERTENSION Y RIESGO VASCULAR 2017; 35:42-43. [PMID: 28587812 DOI: 10.1016/j.hipert.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M G Kiuchi
- Division of Cardiac Pacing, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil; Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria.
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Sharma M, Masih R, Mascarenhas DA. Do All Patients with Atrial Fibrillation Need Long-Term Anticoagulation? Clin Pract 2017; 7:955. [PMID: 28811871 PMCID: PMC5538221 DOI: 10.4081/cp.2017.955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide with an estimated number of 2.7-6.1 million cases in the United States (US) alone. The incidence of AF is expected to increase 2.5 fold over the next 50 years in the US. The management of AF is complex and includes mainly three aspects; restoration of sinus rhythm, control of ventricular rate and prevention of systemic thromboembolism. AF as a cause of systemic embolization has been well known for many years, and majority of patients are on oral anticoagulants (OACs) to prevent this. Many times, a patient may not be in AF chronically, nor is the AF burden (the amount of time patient is in AF out of the total monitored time) calculated. We present three cases of new onset transient AF triggered by temporary stressors. We were able to restore normal sinus rhythm (NSR) with chemical cardioversion. As per 2014 American College of Cardiology (ACC)/American Heart Association (AHA) recommendations, we started all three patients on OACs based on CHA2DS2VASc score ≥2. However, the patients refused long term OACs after restoration of NSR and correction of the temporary enticing stressors. In any case, the decision to start OACs would have had its own risks. Here we describe how antiarrhythmic drugs were used to maintain NSR, all while they were continuously monitored to determine the need to continue OACs.
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Affiliation(s)
- Munish Sharma
- Department of Internal Medicine, Easton Hospital, Easton, PA
| | - Rohit Masih
- Department of Internal Medicine, Easton Hospital, Easton, PA
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Boriani G, Lip GYH, Ricci RP, Proclemer A, Landolina M, Lunati M, Padeletti L, Zanotto G, Molon G, Biffi M, Rordorf R, Quartieri F, Gasparini M. The increased risk of stroke/transient ischemic attack in women with a cardiac implantable electronic device is not associated with a higher atrial fibrillation burden. Europace 2016; 19:1767-1775. [DOI: 10.1093/europace/euw333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022] Open
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Facchin D, Baccillieri M, Gasparini G, Zoppo F, Allocca G, Brieda M, Verlato R, Proclemer A. Findings of an observational investigation of pure remote follow-up of pacemaker patients: is the in-clinic device check still needed? Int J Cardiol 2016; 220:781-6. [DOI: 10.1016/j.ijcard.2016.06.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/24/2016] [Indexed: 12/18/2022]
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Atrial fibrillation burden and atrial fibrillation type: Clinical significance and impact on the risk of stroke and decision making for long-term anticoagulation. Vascul Pharmacol 2016; 83:26-35. [PMID: 27196706 DOI: 10.1016/j.vph.2016.03.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/04/2016] [Accepted: 03/24/2016] [Indexed: 12/20/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia increasing the risk of morbidity and adverse outcomes (stroke, heart failure, death). AF is found in 1-2% of the general population, with increasing prevalence with aging. Its exact epidemiological profile is incomplete and underestimated, because 10-40% of AF patients (particularly the elderly) can be asymptomatic ("clinically silent or subclinical AF"), with occasional electrocardiographic diagnosis. The research interest on silent AF has increased by the evidence that its outcome is no less severe, in terms of risks of stroke and death, than that for symptomatic patients. Data collected from more than 18,000 patients indicate that cardiac implantable electrical devices (CIEDs) are validated tools for detecting silent AF and measuring the time spent in AF, defined as "AF burden." A maximum daily AF burden of ≥5-6min, but particularly ≥1h, is associated with a significant increase in the risk of stroke, and may be clinically relevant to improve current risk stratification based on risk scores and for "personalizing" prescription of oral anticoagulants. An in-depth study of the temporal relationship between AF and ischemic stroke showed that data from CIEDs reveal a complex scenario, by which AF is certainly a risk factor for cardioembolic stroke, with a cause-effect relationship related to atrial thrombi, but can also be a simple "marker of risk," with a noncausal association with stroke. In such cases, stroke is possibly related to atheroemboli from the aorta, the carotid arteries, or other sources.
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Olsen FJ, Biering-Sørensen T, Krieger DW. An update on insertable cardiac monitors: examining the latest clinical evidence and technology for arrhythmia management. Future Cardiol 2016; 11:333-46. [PMID: 26021639 DOI: 10.2217/fca.15.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Continuous cardiac rhythm monitoring has undergone compelling progress over the past decades. Cardiac monitoring has emerged from 12-lead electrocardiograms being performed at the discretion of the treating physician to in-hospital telemetry, Holter monitoring, prolonged external event monitoring and most recently toward insertable device monitoring for several years. Significant advantages and disadvantages pertaining to these monitoring options will be addressed in this review. Insertable cardiac monitors have several advantages over external monitoring techniques and may signify a clinical turning point in the field of arrhythmia management. However, their role in the detection of paroxysmal atrial fibrillation after cryptogenic strokes has yet to evolve. This will be the main focus of this review. Issues surrounding patient selection, clinical relevance and determination of cost-effectiveness for prolonged cardiac monitoring require further studies. Furthermore, insertable cardiac monitoring has not only the potential to augment diagnostic capabilities but also to improve the management of paroxysmal atrial fibrillation.
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Affiliation(s)
- Flemming J Olsen
- 1Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- 1Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Derk W Krieger
- 4Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI, Rasmussen LH, Dan GA, Kalarus Z, Tavazzi L, Maggioni AP, Lip GYH. 'Real-world' management and outcomes of patients with paroxysmal vs. non-paroxysmal atrial fibrillation in Europe: the EURObservational Research Programme-Atrial Fibrillation (EORP-AF) General Pilot Registry. Europace 2016; 18:648-57. [PMID: 26826133 DOI: 10.1093/europace/euv390] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/27/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Atrial fibrillation (AF) has different presentations (first detected, paroxysmal, persistent, permanent), with uncertain impact on outcome. The aim of this study was to investigate clinical presentation, management, and outcome of paroxysmal and non-paroxysmal AFs within the EURObservational Research Programme-Atrial Fibrillation General Pilot Registry. METHODS AND RESULTS Overall 2589 patients with available 1-year follow-up data were evaluated according to AF type. Patients with paroxysmal AF (26.8%) were younger, had lower prevalence of heart disease (particularly valvular), and major co-morbidities, as well as lower CHADS2, CHA2DS2-VASc, and HAS-BLED scores. Patients with first-detected AF (29.9%) had characteristics similar to persistent AF patients (25.9%), but lower use of oral anticoagulants. Patients with permanent AF represented 17.4% of the cohort. At 1 year, the rate of stroke/transient ischaemic attack and thromboembolism was low (0.6-1.0%) and did not differ between paroxysmal and non-paroxysmal AFs. All-cause mortality was higher in non-paroxysmal vs. paroxysmal AF (log rank test, P = 0.0018). Using a multivariable Cox model, non-paroxysmal AF was not an independent predictor of death during follow-up. Independent predictors of death were age, chronic heart failure, chronic kidney disease, diabetes, restrictive cardiomyopathy, and physical activity. CONCLUSION In this 'real-world' contemporary observational registry, patients with non-paroxysmal AF had a worse outcome, in terms of all-cause mortality, which was related to a more severe clinical profile. The risk of stroke at 1 year was relatively low, perhaps reflecting the high rates of anticoagulation use in this cohort.
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Affiliation(s)
- Giuseppe Boriani
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna 40138, Italy Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Viale del Pozzo, 71, 41124 Modena, Italy
| | - Cecile Laroche
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna 40138, Italy
| | - Elisa Fantecchi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna 40138, Italy Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Viale del Pozzo, 71, 41124 Modena, Italy
| | | | - Lars Hvilsted Rasmussen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Gheorghe-Andrei Dan
- Department of Cardiology, Colentina University Hospital, Stefan cel Mare 19-21, Sector 2, Bucharest, Romania
| | - Zbigniew Kalarus
- Department of Cardiology, Silesian Center for Heart Disease, ul. M Curie-Sklodowskiej 9, Zabrze 41-800, Poland
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Aldo P Maggioni
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France ANMCO Research Center, Firenze, Italy
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK
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O'Donnell M, Kasner SE. Cryptogenic Stroke. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ferrari R, Bertini M, Blomstrom-Lundqvist C, Dobrev D, Kirchhof P, Pappone C, Ravens U, Tamargo J, Tavazzi L, Vicedomini GG. An update on atrial fibrillation in 2014: From pathophysiology to treatment. Int J Cardiol 2015; 203:22-9. [PMID: 26490502 DOI: 10.1016/j.ijcard.2015.10.089] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022]
Abstract
Atrial fibrillation (AF) is the most frequently encountered cardiac arrhythmia. The trigger for initiation of AF is generally an enhanced vulnerability of pulmonary vein cardiomyocyte sleeves to either focal or re-entrant activity. The maintenance of AF is based on a "driver" mechanism in a vulnerable substrate. Cardiac mapping technology is providing further insight into these extremely dynamic processes. AF can lead to electrophysiological and structural remodelling, thereby promoting the condition. The management includes prevention of stroke by oral anticoagulation or left atrial appendage (LAA) occlusion, upstream therapy of concomitant conditions, and symptomatic improvement using rate control and/or rhythm control. Nonpharmacological strategies include electrical cardioversion and catheter ablation. There are substantial geographical variations in the management of AF, though European data indicate that 80% of patients receive adequate anticoagulation and 79% adequate rate control. High rates of morbidity and mortality weigh against perceived difficulties in management. Clinical research and growing experience are helping refine clinical indications and provide better technical approaches. Active research in cardiac electrophysiology is producing new antiarrhythmic agents that are reaching the experimental clinical arena, inhibiting novel ion channels. Future research should give better understanding of the underlying aetiology of AF and identification of drug targets, to help the move toward patient-specific therapy.
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Affiliation(s)
- R Ferrari
- Department of Cardiology, LTTA Centre, University Hospital of Ferrara, Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
| | - M Bertini
- Department of Cardiology, LTTA Centre, University Hospital of Ferrara, Ferrara, Italy
| | | | - D Dobrev
- Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - P Kirchhof
- University of Birmingham, Centre for Cardiovascular Sciences, Birmingham, UK; Department of Cardiology and Angiology, University of Münster, Germany
| | - C Pappone
- Policlinico San Donato, Department of Arrhythmology, University of Milan, Italy
| | - U Ravens
- Department of Pharmacology and Toxicology, Technical University of Dresden, Dresden, Germany
| | - J Tamargo
- Department of Pharmacology, School of Medicine Universidad Complutense, Madrid, Spain
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - G G Vicedomini
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
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Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 2015; 128:509-18.e2. [PMID: 25534423 DOI: 10.1016/j.amjmed.2014.11.026] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Atrial fibrillation is often asymptomatic, but outcomes require further characterization. The study objective was to investigate the clinical presentation, management, and outcomes in asymptomatic and symptomatic patients with atrial fibrillation who were prospectively enrolled in the EurObservational Research Programme - Atrial Fibrillation (EORP-AF) Pilot General Registry. METHODS A total of 3119 patients were enrolled, and 1237 (39.7%) were asymptomatic (European Heart Rhythm Association [EHRA] score I). Among symptomatic patients, 963 (51.2%) had mild symptoms (EHRA score II) and 919 (48.8%) had severe or disabling symptoms (EHRA III-IV). Permanent atrial fibrillation was 3-fold more common in asymptomatic patients than in symptomatic patients. RESULTS On multivariate analysis, male gender (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.384-1.921), older age (OR, 1.019; 95% CI, 1.012-1.026), previous myocardial infarction (OR, 1.681; 95% CI, 1.350-2.093), and limited physical activity (OR, 1.757; 95% CI, 1.495-2.064) were associated significantly with asymptomatic (EHRA I) atrial fibrillation. Fully asymptomatic atrial fibrillation (absence of current and previous symptoms) was present in 520 patients (16.7%) and was associated independently with male gender, age, and previous myocardial infarction. Appropriate guideline-based prescription of oral anticoagulants was lower in these patients, and aspirin was prescribed more frequently. Mortality at 1 year was more than 2-fold higher in asymptomatic patients compared with symptomatic patients (9.4% vs 4.2%, P < .0001) and was associated independently with older age and comorbidities, including chronic kidney disease and chronic heart failure. CONCLUSIONS Asymptomatic atrial fibrillation is common in daily cardiology practice and is associated with elderly age, more comorbidities, and high thromboembolic risks. A higher 1-year mortality was found in asymptomatic patients compared with symptomatic patients.
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Kudenchuk PJ. New approaches to managing nonvalvular atrial fibrillation: what are the thromboembolic implications? J Thromb Thrombolysis 2015; 39:345-52. [DOI: 10.1007/s11239-015-1181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lip GYH. Atrial fibrillation …. more than simply being irregularly irregular. Int J Clin Pract 2014; 68:408-9. [PMID: 24674702 DOI: 10.1111/ijcp.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- G Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
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