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Broman MT, Nadadur RD, Perez-Cervantes C, Burnicka-Turek O, Lazarevic S, Gams A, Laforest B, Steimle JD, Iddir S, Wang Z, Smith L, Mazurek SR, Olivey HE, Zhou P, Gadek M, Shen KM, Khan Z, Theisen JWM, Yang XH, Ikegami K, Efimov IR, Pu WT, Weber CR, McNally EM, Svensson EC, Moskowitz IP. A Genomic Link From Heart Failure to Atrial Fibrillation Risk: FOG2 Modulates a TBX5/GATA4-Dependent Atrial Gene Regulatory Network. Circulation 2024; 149:1205-1230. [PMID: 38189150 DOI: 10.1161/circulationaha.123.066804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The relationship between heart failure (HF) and atrial fibrillation (AF) is clear, with up to half of patients with HF progressing to AF. The pathophysiological basis of AF in the context of HF is presumed to result from atrial remodeling. Upregulation of the transcription factor FOG2 (friend of GATA2; encoded by ZFPM2) is observed in human ventricles during HF and causes HF in mice. METHODS FOG2 expression was assessed in human atria. The effect of adult-specific FOG2 overexpression in the mouse heart was evaluated by whole animal electrophysiology, in vivo organ electrophysiology, cellular electrophysiology, calcium flux, mouse genetic interactions, gene expression, and genomic function, including a novel approach for defining functional transcription factor interactions based on overlapping effects on enhancer noncoding transcription. RESULTS FOG2 is significantly upregulated in the human atria during HF. Adult cardiomyocyte-specific FOG2 overexpression in mice caused primary spontaneous AF before the development of HF or atrial remodeling. FOG2 overexpression generated arrhythmia substrate and trigger in cardiomyocytes, including calcium cycling defects. We found that FOG2 repressed atrial gene expression promoted by TBX5. FOG2 bound a subset of GATA4 and TBX5 co-bound genomic locations, defining a shared atrial gene regulatory network. FOG2 repressed TBX5-dependent transcription from a subset of co-bound enhancers, including a conserved enhancer at the Atp2a2 locus. Atrial rhythm abnormalities in mice caused by Tbx5 haploinsufficiency were rescued by Zfpm2 haploinsufficiency. CONCLUSIONS Transcriptional changes in the atria observed in human HF directly antagonize the atrial rhythm gene regulatory network, providing a genomic link between HF and AF risk independent of atrial remodeling.
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Affiliation(s)
- Michael T Broman
- Department of Medicine, Section of Cardiology (M.T.B., B.L., S.R.M.), University of Chicago, IL
| | - Rangarajan D Nadadur
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Carlos Perez-Cervantes
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Ozanna Burnicka-Turek
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Sonja Lazarevic
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Anna Gams
- Department of Biomedical Engineering, George Washington University (A.G., I.R.E.), Washington, DC
| | - Brigitte Laforest
- Department of Medicine, Section of Cardiology (M.T.B., B.L., S.R.M.), University of Chicago, IL
| | - Jeffrey D Steimle
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Sabrina Iddir
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Zhezhen Wang
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Linsin Smith
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Stefan R Mazurek
- Department of Medicine, Section of Cardiology (M.T.B., B.L., S.R.M.), University of Chicago, IL
| | - Harold E Olivey
- Department of Biology, Indiana University Northwest, Gary (H.E.O.)
| | - Pingzhu Zhou
- School of Medicine, Shanghai University, China (P.Z.)
| | - Margaret Gadek
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Kaitlyn M Shen
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Zoheb Khan
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Joshua W M Theisen
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Xinan H Yang
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
| | - Kohta Ikegami
- Division of Molecular and Cardiovascular Biology, Cincinnati Children's Hospital Medical Center, OH (K.I.)
| | - Igor R Efimov
- Department of Biomedical Engineering, George Washington University (A.G., I.R.E.), Washington, DC
| | - William T Pu
- Harvard Stem Cell Institute, Harvard University, Cambridge, MA (W.T.P.)
- Department of Cardiology, Boston Children's Hospital, MA (W.T.P.)
| | - Christopher R Weber
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
| | | | | | - Ivan P Moskowitz
- Departments of Pediatrics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
- Pathology (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., C.R.W., I.P.M.), University of Chicago, IL
- Human Genetics (R.D.N., C.P.-C., O.B.-T., S.L., J.D.S., S.I., Z.W., L.S., M.G., K.M.S., Z.K., J.W.M.T., X.H.Y., I.P.M.), University of Chicago, IL
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Huang Y, Lin Q, Zhou Y, Zhu J, Ma Y, Wu K, Ning Z, Zhang Z, Liu N, Li M, Liu Y, Tu T, Liu Q. Amino acid profile alteration in age-related atrial fibrillation. J Transl Med 2024; 22:259. [PMID: 38461346 PMCID: PMC10925006 DOI: 10.1186/s12967-024-05028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/24/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Amino acids (AAs) are one of the primary metabolic substrates for cardiac work. The correlation between AAs and both atrial fibrillation (AF) and aging has been documented. However, the relationship between AAs and age-related AF remains unclear. METHODS Initially, the plasma AA levels of persistent AF patients and control subjects were assessed, and the correlations between AA levels, age, and other clinical indicators were explored. Subsequently, the age-related AF mouse model was constructed and the untargeted myocardial metabolomics was conducted to detect the level of AAs and related metabolites. Additionally, the gut microbiota composition associated with age-related AF was detected by a 16S rDNA amplicon sequencing analysis on mouse fecal samples. RESULTS Higher circulation levels of lysine (Student's t-test, P = 0.001), tyrosine (P = 0.002), glutamic acid (P = 0.008), methionine (P = 0.008), and isoleucine (P = 0.014), while a lower level of glycine (P = 0.003) were observed in persistent AF patients. The feature AAs identified by machine learning algorithms were glutamic acid and methionine. The association between AAs and age differs between AF and control subjects. Distinct patterns of AA metabolic profiles were observed in the myocardial metabolites of aged AF mice. Aged AF mice had lower levels of Betaine, L-histidine, L-alanine, L-arginine, L-Pyroglutamic acid, and L-Citrulline compared with adult AF mice. Aged AF mice also presented a different gut microbiota pattern, and its functional prediction analysis showed AA metabolism alteration. CONCLUSION This study provided a comprehensive network of AA disturbances in age-related AF from multiple dimensions, including plasma, myocardium, and gut microbiota. Disturbances of AAs may serve as AF biomarkers, and restoring their homeostasis may have potential benefits for the management of age-related AF.
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Affiliation(s)
- Yunying Huang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yong Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Jiayi Zhu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yingxu Ma
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Keke Wu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Zuodong Ning
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Zixi Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Na Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Mohan Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
- Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Yaozhong Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Tao Tu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China.
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China.
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China.
| | - Qiming Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China.
- Cardiovascular Disease Research Center of Hunan Province, Changsha, 410011, Hunan, People's Republic of China.
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, 410011, Hunan, People's Republic of China.
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Ahn HJ, An HY, Ryu G, Lim J, Sun C, Song H, Choi SY, Lee H, Maurer T, Nachun D, Kwon S, Lee SR, Lip GYH, Oh S, Jaiswal S, Koh Y, Choi EK. Clonal haematopoiesis of indeterminate potential and atrial fibrillation: an east Asian cohort study. Eur Heart J 2024; 45:778-790. [PMID: 38231881 DOI: 10.1093/eurheartj/ehad869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/12/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND AND AIMS Both clonal haematopoiesis of indeterminate potential (CHIP) and atrial fibrillation (AF) are age-related conditions. This study investigated the potential role of CHIP in the development and progression of AF. METHODS Deep-targeted sequencing of 24 CHIP mutations (a mean depth of coverage = 1000×) was performed in 1004 patients with AF and 3341 non-AF healthy subjects. Variant allele fraction ≥ 2.0% indicated the presence of CHIP mutations. The association between CHIP and AF was evaluated by the comparison of (i) the prevalence of CHIP mutations between AF and non-AF subjects and (ii) clinical characteristics discriminated by CHIP mutations within AF patients. Furthermore, the risk of clinical outcomes-the composite of heart failure, ischaemic stroke, or death-according to the presence of CHIP mutations in AF was investigated from the UK Biobank cohort. RESULTS The mean age was 67.6 ± 6.9 vs. 58.5 ± 6.5 years in AF (paroxysmal, 39.0%; persistent, 61.0%) and non-AF cohorts, respectively. CHIP mutations with a variant allele fraction of ≥2.0% were found in 237 (23.6%) AF patients (DNMT3A, 13.5%; TET2, 6.6%; and ASXL1, 1.5%) and were more prevalent than non-AF subjects [356 (10.7%); P < .001] across the age. After multivariable adjustment (age, sex, smoking, body mass index, diabetes, and hypertension), CHIP mutations were 1.4-fold higher in AF [adjusted odds ratio (OR) 1.38; 95% confidence interval 1.10-1.74, P < .01]. The ORs of CHIP mutations were the highest in the long-standing persistent AF (adjusted OR 1.50; 95% confidence interval 1.14-1.99, P = .004) followed by persistent (adjusted OR 1.44) and paroxysmal (adjusted OR 1.33) AF. In gene-specific analyses, TET2 somatic mutation presented the highest association with AF (adjusted OR 1.65; 95% confidence interval 1.05-2.60, P = .030). AF patients with CHIP mutations were older and had a higher prevalence of diabetes, a longer AF duration, a higher E/E', and a more severely enlarged left atrium than those without CHIP mutations (all P < .05). In UK Biobank analysis of 21 286 AF subjects (1297 with CHIP and 19 989 without CHIP), the CHIP mutation in AF is associated with a 1.32-fold higher risk of a composite clinical event (heart failure, ischaemic stroke, or death). CONCLUSIONS CHIP mutations, primarily DNMT3A or TET2, are more prevalent in patients with AF than non-AF subjects whilst their presence is associated with a more progressive nature of AF and unfavourable clinical outcomes.
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Affiliation(s)
- Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hong Yul An
- Genome Opinion Incorporation, Seoul 04799, Republic of Korea
| | - Gangpyo Ryu
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Cancer Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jiwoo Lim
- Genome Opinion Incorporation, Seoul 04799, Republic of Korea
| | - Choonghyun Sun
- Genome Opinion Incorporation, Seoul 04799, Republic of Korea
| | - Han Song
- Genome Opinion Incorporation, Seoul 04799, Republic of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Taylor Maurer
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Daniel Nachun
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Chest and Heart Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Siddhartha Jaiswal
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Genome Opinion Incorporation, Seoul 04799, Republic of Korea
- Cancer Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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Ahn HJ, Cha MJ, Lee E, Lee SR, Choi EK, Han S, Nam GB, Choi JI, Pak HN, Oh IY, Shin DG, On YK, Park SW, Kim YH, Oh S. The higher recurrence rate after catheter ablation in younger patients with atrial fibrillation suggesting different pathophysiology. J Interv Card Electrophysiol 2023; 66:1609-1619. [PMID: 36648614 DOI: 10.1007/s10840-022-01461-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Young atrial fibrillation (AF) patients have been underrepresented in studies of radiofrequency catheter ablation (RFCA) and the outcome of RFCA has not been widely addressed. We investigated age-related differences in clinical features, the recurrence of atrial tachyarrhythmia, and its predictors of patients who underwent RFCA for AF. METHODS This is a multicenter prospective study of 2799 patients who underwent RFCA for AF in 2017-2020. The patients were divided into two groups - group A (age < 60 years, n = 1269) and group B (age ≥ 60 years, n = 1530) - and a recurrence of any atrial tachyarrhythmia 1 year after RFCA following a 90-day blanking period was compared. RESULTS The mean age was 51.6 ± 6.7 and 66.8 ± 5.2 years for groups A and B, respectively. Higher body mass index, smaller left atrium, and more prevalent cardiomyopathy and obstructive sleep apnea were observed in group A. Overall, 1-year atrial tachyarrhythmia-free survival was 85.6% and lower in young patients (83.1% in group A vs. 87.7% in group B, log-rank p < 0.01): adjusted hazard ratio (aHR) of recurrence (95% confidence interval (CI)), 1.45 (1.13-1.86) for group A compared to group B (p < 0.01). The association between younger age and higher recurrence was continuously observed in patients under 60 years. Any non-PV ablation was associated with a lower recurrence of atrial tachyarrhythmia in group B (aHR 0.68 (0.47-0.96), p < 0.05), but not in group A. CONCLUSIONS AF patients younger than 60 years had a higher 1-year AF recurrence after RFCA. Young AF patients might have distinctive pathophysiology of AF requiring more integrated management.
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Affiliation(s)
- Hyo- Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Euijae Lee
- Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seongwook Han
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Gi-Byung Nam
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il-Young Oh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Gu Shin
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Young Keun On
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Weon Park
- Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - Young-Hoon Kim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Thoracoscopic ablation delays progression from paroxysmal to persistent atrial fibrillation. J Thorac Cardiovasc Surg 2023; 165:1387-1394. [PMID: 33992460 DOI: 10.1016/j.jtcvs.2021.03.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The study objective was to determine whether mini-invasive transthoracoscopic atrial fibrillation ablation can delay the progression of atrial fibrillation from paroxysmal to persistent. METHODS Patients aged 18 to 80 years with paroxysmal nonvalvular atrial fibrillation and a history of stroke or systemic thromboembolism were consecutively enrolled from September 2014 to June 2019. In the treatment group, patients underwent transthoracoscopic atrial fibrillation ablation plus left atrial appendage excision (atrial fibrillation ablation plus left atrial appendage excision group). Patients unwilling to receive surgical intervention were treated with antiarrhythmic drugs and oral anticoagulants and recruited as a control group (atrial fibrillation plus antiarrhythmic drugs group). The primary end point was the progression of atrial fibrillation from paroxysmal to persistent. RESULTS This study included 49 patients in the atrial fibrillation plus antiarrhythmic drugs group (29 men) and 77 patients in the atrial fibrillation ablation plus left atrial appendage excision group (48 men). In the atrial fibrillation ablation plus left atrial appendage excision group, after a median follow-up of 951 days (interquartile range, 529-1366 days), 8 patients (10.4%) progressed to persistent atrial fibrillation. In the atrial fibrillation plus antiarrhythmic drugs group, after a median follow-up of 835 days (interquartile range, 548-1214 days), 14 patients (28.6%) progressed to persistent atrial fibrillation. The atrial fibrillation ablation plus left atrial appendage excision group had a significantly lower incidence of atrial fibrillation progression than the atrial fibrillation plus antiarrhythmic drugs group during follow-up (3.9 vs 12.3 per 100 person-years, log-rank 8.6, P = .003). CONCLUSIONS Patients with paroxysmal nonvalvular atrial fibrillation who chose to undergo transthoracoscopic atrial fibrillation ablation had a lower incidence of progression to persistent atrial fibrillation than patients who chose conservative therapy. This strategy might be especially suitable for patients with paroxysmal nonvalvular atrial fibrillation at high risk of stroke and high risk of bleeding.
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Han S, Jia R, Cen Z, Guo R, Zhao S, Bai Y, Xie M, Cui K. Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:978637. [PMID: 36815025 PMCID: PMC9939510 DOI: 10.3389/fcvm.2023.978637] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
Objective It has long been debated whether rhythm control vs. rate control strategies have differing effects on mortality and morbidity for atrial fibrillation (AF). Recently, several randomized controlled studies (RCTs) and observational trials described that an early rhythm management method was linked to a lower likelihood of negative clinical outcomes in individuals with AF. We wanted to see if an early rhythm management method may help patients with AF. Methods We performed a systematic search to retrieve studies assessing the outcomes of early rhythm control vs. rate control in AF by using PubMed, Web of Science, Cochrane Library, and Embase published between 01/01/2000 and 15/04/2022. Results Finally, two RCTs, one retrospective analysis of RCTs, and four observational studies were identified. Compared with rate control, early rhythm control has been linked to lower all-cause mortality. [risk ratio (RR), 0.76; 95% CI 0.69-0.83; P < 0.00001; I 2 = 77%]. The early rhythm control group was also associated with a lower risk of cardiovascular mortality (RR, 0.68; 95% CI 0.63-0.74; P < 0.00001; I 2 = 33), stroke (RR, 0.77; 95% CI 0.67-0.87; P < 0.001; I 2 = 64), and heart failure hospitalization (RR, 0.74; 95% CI 0.59-0.93; P = 0.0009; I 2 = 93%). We found no significant difference in nights spent in hospital per year, acute coronary syndrome, major bleeding, and cardiac arrest/ventricular arrhythmia between the groups. Conclusion In this meta-analysis, early rhythm therapy was linked to a lower risk of all-cause mortality, cardiovascular mortality, stroke, and heart failure hospitalization compared with the rate control group. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022333592.
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Affiliation(s)
- Shaojie Han
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruikun Jia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhifu Cen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shenyu Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yixuan Bai
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Xie
- Department of Cardiology, Chengdu Seventh People’s Hospital, Chengdu, Sichuan, China,Min Xie,
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Kaijun Cui,
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Patlolla SH, Schaff HV, Nishimura RA, Stulak JM, Chamberlain AM, Pislaru SV, Nkomo VT. Incidence and Burden of Tricuspid Regurgitation in Patients With Atrial Fibrillation. J Am Coll Cardiol 2022; 80:2289-2298. [PMID: 36480971 DOI: 10.1016/j.jacc.2022.09.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is considered a risk factor for isolated tricuspid valve regurgitation (TR) in the absence of other known etiologies. OBJECTIVES This study sought to identify the incidence of clinically significant isolated TR and its impact in patients with AF. METHODS A population-based record linkage system was used to identify adult patients with new-onset AF. Patients with evidence of moderate or greater tricuspid valve disease, left-sided valve disease, pulmonary hypertension, prior cardiac surgery, impaired left ventricular systolic/diastolic function at baseline were excluded. The remaining patients (n = 691) were followed over time to identify development of moderate or greater TR and assess its impact on subsequent survival. RESULTS A total of 232 patients (33.6%) developed moderate or greater TR. Among these, 73 patients (10.6%) had isolated TR without significant underlying structural heart disease. Incidence rate of any moderate or greater TR was 3.9 cases and that of isolated TR was 1.3 cases per 100 person-years. Permanent/persistent AF and female sex were associated with increased risk of developing TR, whereas rhythm control was associated with lower risk of TR. Over a median clinical follow-up of 13.3 years (IQR: 10.0-15.9 years), development of any moderate or greater TR (HR: 2.92; 95% CI: 2.29-3.73; P < 0.001) and isolated significant TR (HR: 1.51; 95% CI: 1.03-2.22; P = 0.03) were associated with an adjusted increased risk of subsequent mortality. CONCLUSIONS In this population-based cohort of patients with AF, nearly one-third developed moderate or greater TR over time. Incident significant TR and incident isolated significant TR portend a worse survival in patients with AF.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alanna M Chamberlain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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8
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The Complex Relation between Atrial Cardiomyopathy and Thrombogenesis. Cells 2022; 11:cells11192963. [PMID: 36230924 PMCID: PMC9563762 DOI: 10.3390/cells11192963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Heart disease, as well as systemic metabolic alterations, can leave a ‘fingerprint’ of structural and functional changes in the atrial myocardium, leading to the onset of atrial cardiomyopathy. As demonstrated in various animal models, some of these changes, such as fibrosis, cardiomyocyte hypertrophy and fatty infiltration, can increase vulnerability to atrial fibrillation (AF), the most relevant manifestation of atrial cardiomyopathy in clinical practice. Atrial cardiomyopathy accompanying AF is associated with thromboembolic events, such as stroke. The interaction between AF and stroke appears to be far more complicated than initially believed. AF and stroke share many risk factors whose underlying pathological processes can reinforce the development and progression of both cardiovascular conditions. In this review, we summarize the main mechanisms by which atrial cardiomyopathy, preceding AF, supports thrombogenic events within the atrial cavity and myocardial interstitial space. Moreover, we report the pleiotropic effects of activated coagulation factors on atrial remodeling, which may aggravate atrial cardiomyopathy. Finally, we address the complex association between AF and stroke, which can be explained by a multidirectional causal relation between atrial cardiomyopathy and hypercoagulability.
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9
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Tilly MJ, Lu Z, Geurts S, Ikram MA, Stricker BH, Kors JA, de Maat MPM, de Groot NMS, Kavousi M. Atrial fibrillation patterns and their cardiovascular risk profiles in the general population: the Rotterdam study. Clin Res Cardiol 2022:10.1007/s00392-022-02071-6. [PMID: 35948741 DOI: 10.1007/s00392-022-02071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical guidelines categorize atrial fibrillation (AF) based on the temporality of AF events. Due to its dependence on event duration, this classification is not applicable to population-based cohort settings. We aimed to develop a simple and standardized method to classify AF patterns at population level. Additionally, we compared the longitudinal trajectories of cardiovascular risk factors preceding the AF patterns, and between men and women. METHODS Between 1990 and 2014, participants from the population-based Rotterdam study were followed for AF status, and categorized into 'single-documented AF episode', 'multiple-documented AF episodes', or 'long-standing persistent AF'. Using repeated measurements we created linear mixed-effects models to assess the longitudinal evolution of risk factors prior to AF diagnosis. RESULTS We included 14,061 participants (59.1% women, mean age 65.4 ± 10.2 years). After a median follow-up of 9.4 years (interquartile range 8.27), 1,137 (8.1%) participants were categorized as 'single-documented AF episode', 208 (1.5%) as 'multiple-documented AF episodes', and 57 (0.4%) as 'long-standing persistent AF'. In men, we found poorer trajectories of weight and waist circumference preceding 'long-standing persistent AF' as compared to the other patterns. In women, we found worse trajectories of all risk factors between 'long-standing persistent AF' and the other patterns. CONCLUSION We developed a standardized method to classify AF patterns in the general population. Participants categorized as 'long-standing persistent AF' showed poorer trajectories of cardiovascular risk factors prior to AF diagnosis, as compared to the other patterns. Our findings highlight sex differences in AF pathophysiology and provide insight into possible risk factors of AF patterns.
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Affiliation(s)
- Martijn J Tilly
- Department of Epidemiology, Erasmus MC University Medical Center, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Zuolin Lu
- Department of Epidemiology, Erasmus MC University Medical Center, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC University Medical Center, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC University Medical Center, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Rafaqat S, Rafaqat S, Khurshid H, Rafaqat S. Electrolyte’s imbalance role in atrial fibrillation: Pharmacological management. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe contribution of the perpetuation of atrial fibrillation is caused by electrical remodeling in which calcium, sodium and potassium channels could refer to changes in the ion channel protein expression, development of fibrosis, gene transcription and ion channel redistribution. Calcium and magnesium could influence the risk of atrial fibrillation which is the leading cause of cardiac death, heart failure and ischemic stroke. The elevated serum concentration of calcium had a higher range of in-patient’s mortality, increased total cost of hospitalization and increased length of hospital stay as compared to those without hypercalcemia in atrial fibrillation patients. Moreover, chloride channels could affect homeostasis, atrial myocardial metabolism which may participate in the development of atrial fibrillation. Up to a 50% risk of incidence of AF are higher in which left ventricular hypertrophy, sudden cardiovascular death and overall mortality relate to a low serum magnesium level. Additionally, magnesium prevents the occurrence of AF after cardiac surgery, whereas greater levels of serum phosphorus in the large population-based study and the related calcium–phosphorus products were linked with a greater incidence of AF. Numerous clinical studies had shown the high preoperative risk of AF that is linked with lower serum potassium levels. The conventional risk factor of increased risk of new onset of AF events could independently link with high dietary sodium intake which enhances the fibrosis and inflammation in the atrium but the mechanism remains unknown. Many drugs were used to maintain the electrolyte imbalance in AF patients.
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Larsen BS, Aplin M, Høst N, Dominguez H, Christensen H, Christensen LM, Havsteen I, Prescott E, Jensen GB, Vejlstrup N, Bertelsen L, Sajadieh A. Atrial cardiomyopathy in patients with ischaemic stroke: a cross-sectional and prospective cohort study-the COAST study. BMJ Open 2022; 12:e061018. [PMID: 35545392 PMCID: PMC9096525 DOI: 10.1136/bmjopen-2022-061018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Despite workup for the aetiology of ischaemic stroke, about 25% of cases remain unexplained. Paroxysmal atrial fibrillation is typically suspected but often not detected. Even if atrial fibrillation (AF) is detected, the quantitative threshold of clinically relevant AF remains unclear. Emerging evidence suggests that left atrial (LA) functional and structural abnormalities may convey a risk of ischaemic stroke in which AF is only one of several features. These abnormalities have been termed 'atrial cardiomyopathy'. This study uses cardiac magnetic resonance (CMR) to evaluate atrial cardiomyopathy among patients with stroke of undetermined aetiology compared with those with an attributable mechanism and controls without established cardiovascular disease. METHODS AND ANALYSIS This cross-sectional and prospective cohort study included 100 patients with recent ischaemic stroke and 50 controls with no established cardiovascular disease. The study will assess LA structural and functional abnormalities with CMR. Inclusion began in March 2019, and follow-up is planned to be complete in January 2023. There are two scheduled follow-ups: (1) 18 months after individual inclusion, counting from the index diagnostic MRI of the brain, (2) end of study follow-up at 18 months after inclusion of the last patient, assessing the incidence of recurrent ischaemic stroke, AF and cardiovascular death. The primary endpoint is the extent of CMR-assessed atrial fibrosis in the LA at baseline. The study is powered to detect a difference of 6% fibrosis between stroke of undetermined aetiology and stroke of known mechanism with a SD of 9%, a significance level of 0.05, and power of 80%. ETHICS AND DISSEMINATION This study has been approved by the Danish National Committee on Health Research Ethics (H-18055313). All participants in the study signed informed consent. Results from the study will be published in peer-reviewed journals regardless of the outcome. TRIAL REGISTRATION NUMBER NCT03830983.
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Affiliation(s)
- Bjørn Strøier Larsen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mark Aplin
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Helena Dominguez
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Louisa Marguerite Christensen
- Department of Neurology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Inger Havsteen
- Department of Radiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Gorm Boje Jensen
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
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12
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Mareev YV, Polyakov DS, Vinogradova NG, Fomin IV, Mareev VY, Belenkov YN, Ageev FT, Artemjeva EG, Badin YV, Bakulina EV, Galyavich AS, Ionova TS, Kamalov GM, Kechedzhieva SG, Koziolova NA, Malenkova VY, Malchikova SV, Smirnova EA, Tarlovskaya EI, Shcherbinina EV, Yakushin SS. Epidemiology of atrial fibrillation in a representative sample of the European part of the Russian Federation. Analysis of EPOCH-CHF study. KARDIOLOGIIA 2022; 62:12-19. [PMID: 35569159 DOI: 10.18087/cardio.2022.4.n1997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/04/2022] [Indexed: 06/15/2023]
Abstract
Aim To study true prevalence of atrial fibrillation (AF) in a representative sample from the European part of the Russian Federation; to describe characteristics of patients with AF; and to provide the frequency of anticoagulant treatment.Material and methods Cross-sectional data of the EPOCH epidemiological study (2017) were used. Data were collected in 8 constituent entities of the Russian Federation; the sample size was 11 453 people. The sample included all respondents who had given their consent for participation and were older than 10 years. Statistical tests were performed in the R system for statistical data analysis.Results The prevalence of AF in the representative sample from the European part of the Russian Federation was 2.04 %. The AF prevalence increased with age and reached a maximum value of 9.6% in the age group of 80 to 89 years. The AF prevalence among females was 1.5 times higher than among men. With age standardization, the AF prevalence was 18.95 and 21.33 per 1,000 people for men and women, respectively. The AF prevalence increased in the presence of concurrent cardiovascular diseases (CVDs) or diabetes mellitus as well as with an increased number of comorbidities in the same person and reached 70.3 and 60.0 % in patients with 4 and 5 comorbidities, respectively. Patients with AF had a greater number of comorbidities and higher CHA2DS2VASc scores (5.0 vs. 2.0, p<0.001) compared to patients with CVDs without AF. Only 22.6 % of patients with CVD and AF took anticoagulants. Only 23.9% of patients with absolute indications for the anticoagulant treatment received anticoagulants.Conclusion The AF prevalence in the European part of the Russian Federation was 2.04 %; it increased with age and in patients with concurrent CVDs or diabetes mellitus. Most of AF patients (93.2 %) required a mandatory treatment with oral anticoagulants.
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Affiliation(s)
- Yu V Mareev
- National Medical Research Center for Therapy and Preventive Medicine; Medical Research and Educational Center, Lomonosov Moscow State University
| | | | - N G Vinogradova
- Privolzhsky Research Medical University; Municipal Clinical Hospital #38 of the Nizhny Novgorod Region
| | - I V Fomin
- Privolzhsky Research Medical University
| | - V Yu Mareev
- Medical Research and Educational Center, Lomonosov Moscow State University; School of Fundamental Medicine, Lomonosov Moscow State University
| | | | - F T Ageev
- Scientific Medical Research Center of Cardiology
| | | | | | | | | | | | | | | | | | | | | | - E A Smirnova
- Academician Pavlov Ryazan State Medical University
| | | | | | - S S Yakushin
- Academician Pavlov Ryazan State Medical University
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13
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Wang RS, Huang SH, Sun CA, Lin IL, Wang BL, Huang YC, Chien WC. Atrial Fibrillation's Influence on Short Sleep Duration Increases the Risk of Fatness in Management Executives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095438. [PMID: 35564833 PMCID: PMC9103176 DOI: 10.3390/ijerph19095438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022]
Abstract
This study explored whether atrial fibrillation (AF)’s influence on short sleep duration (SD) increases the subsequent risk of fatness in management executives. This study included 25,953 healthy individuals working as management executives with ages ranging from 35 to 65 years (19,100 men and 6853 women) who participated in a qualifying physical filter program from 2006 to 2017 in Taiwan. Men and women who slept < 4 h had a 4.35-fold and 5.26-fold higher risk of developing AF than those who slept 7−8 h normally. Men and women who slept < 4 h had a 6.44-fold and 9.62-fold higher risk of fatness than those who slept 7−8 h. Men and women with AF had a 4.52-fold and 6.25-fold higher risk of fatness than those without AF. It showed that AF induced by short SD increases the risk of fatness. A short SD can predict an increased risk of fatness among management executives in Taiwan.
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Affiliation(s)
- Richard S. Wang
- Program of Data Analytics and Business Computing, Stern School of Business, New York University, New York, NY 10003, USA;
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
| | - Shi-Hao Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan;
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
- Big Data Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - I-Long Lin
- Department of Computer Science and Engineering, Tatung University, Taipei 104327, Taiwan;
| | - Bing-Long Wang
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (B.-L.W.); (Y.-C.H.); (W.-C.C.)
| | - Yao-Ching Huang
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (B.-L.W.); (Y.-C.H.); (W.-C.C.)
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (B.-L.W.); (Y.-C.H.); (W.-C.C.)
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14
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Management of atrial fibrillation: two decades of progress - a scientific statement from the European Cardiac Arrhythmia Society. J Interv Card Electrophysiol 2022; 65:287-326. [PMID: 35419669 DOI: 10.1007/s10840-022-01195-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. The aim of this review was to evaluate the progress made in the management of AF over the two last decades. RESULTS Clinical classification of AF is usually based on the presence of symptoms, the duration of AF episodes and their possible recurrence over time, although incidental diagnosis is not uncommon. The majority of patients with AF have associated cardiovascular diseases and more recently the recognition of modifiable risk factors both cardiovascular and non-cardiovascular which should be considered in its management. Among AF-related complications, stroke and transient ischaemic accidents (TIAs) carry considerable morbidity and mortality risk. The use of implantable devices such as pacemakers and defibrillators, wearable garments and subcutaneous cardiac monitors with recording capabilities has enabled to access the burden of "subclinical AF". The recent introduction of non-vitamin K antagonists has led to improve the prevention of stroke and peripheral embolism. Agents capable of reversing non-vitamin K antagonists have also become available in case of clinically relevant major bleeding. Transcatheter closure of left atrial appendage represents an option for patients unable to take oral anticoagulation. When treating patients with AF, clinicians need to select the most suitable strategy, i.e. control of heart rate and/or restoration and maintenance of sinus rhythm. The studies comparing these two strategies have not shown differences in terms of mortality. If an AF episode is poorly tolerated from a haemodynamic standpoint, electrical cardioversion is indicated. Otherwise, restoration of sinus rhythm can be obtained using intravenous pharmacological cardioversion and oral class I or class III antiarrhythmic is used to prevent recurrences. During the last two decades after its introduction in daily practice, catheter ablation has gained considerable escalation in popularity. Progress has also been made in AF associated with heart failure with reduced or preserved ejection fraction. CONCLUSIONS Significant progress has been made within the past 2 decades both in the pharmacological and non-pharmacological managements of this cardiac arrhythmia.
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15
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Mertz V, Cottin Y, Bentounes SA, Pastier-Debeaumarché J, Didier R, Herbert J, Zeller M, Lip GYH, Fauchier L. Prognosis of Atrial Fibrillation with or without Comorbidities: Analysis of Younger Adults from a Nationwide Database. J Clin Med 2022; 11:jcm11071981. [PMID: 35407589 PMCID: PMC8999868 DOI: 10.3390/jcm11071981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To assess the prognosis of AF patients with or without cardiac or extra-cardiac concomitant conditions. Participants and Methods: All consecutive patients diagnosed with AF admitted to French hospitals between 2011 and 2020 were identified. Patients were classified into four groups: (1) > 60 yo; (2) with known cardiac disease (KCD group); (3) with extra-cardiac comorbidities (ECC); and 4) AF without KCD or ECC (“Lone AF”). Results: Altogether 2,435,541 patients were identified, from which 2,203,702 patients aged >60 years and 231,839 patients aged <60 years (with KCD (55.2%), with ECC (14.7%) and with “Lone AF” (30.1%)). During follow-up, the incidences of all-cause and CV deaths were 13.7%, 5.7%, 6.2%, and 2.3%, and 4.2%, 1.7%, 0.8%, and 0.3% in the older than 60 yo group, KCD group, ECC group and “Lone AF” AF group, respectively. In the age and sex-adjusted analysis (patients < 60 yo), patients with AF and KCD had worse outcomes than patients with “Lone AF” for all major cardiac events. Conclusion: There are three distinct prognostic criteria based on the presence or lack of HD or extra-cardiac concomitant comorbidities. Patients in the so-called “Lone AF” group remain severe in terms of CV events but still with a lower incidence than the patients with associated KCD or ECC. The presence of KCD or ECC makes it possible to distinguish a profile in terms of events that are very different between the patients.
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Affiliation(s)
- Valentin Mertz
- Service de Cardiologie, CHU Dijon Bourgogne, 21000 Dijon, France; (V.M.); (J.P.-D.); (R.D.)
| | - Yves Cottin
- Service de Cardiologie, CHU Dijon Bourgogne, 21000 Dijon, France; (V.M.); (J.P.-D.); (R.D.)
- Department of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, France
- Correspondence:
| | - Sid Ahmed Bentounes
- Service de Cardiologie, CHU Trousseau et Université François Rabelais, 37000 Tours, France; (S.A.B.); (J.H.); (L.F.)
- Service D’information MéDicale, D’épidémiologie et D’économie de la Santé, Faculté de Médecine, Centre Hospitalier Universitaire, Université de Tours, 37000 Tours, France
| | | | - Romain Didier
- Service de Cardiologie, CHU Dijon Bourgogne, 21000 Dijon, France; (V.M.); (J.P.-D.); (R.D.)
| | - Julien Herbert
- Service de Cardiologie, CHU Trousseau et Université François Rabelais, 37000 Tours, France; (S.A.B.); (J.H.); (L.F.)
- Service D’information MéDicale, D’épidémiologie et D’économie de la Santé, Faculté de Médecine, Centre Hospitalier Universitaire, Université de Tours, 37000 Tours, France
| | - Marianne Zeller
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires, University of Bourgogne Franche Comté, 21000 Dijon, France;
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK;
| | - Laurent Fauchier
- Service de Cardiologie, CHU Trousseau et Université François Rabelais, 37000 Tours, France; (S.A.B.); (J.H.); (L.F.)
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16
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Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review. Cardiol Res Pract 2022; 2022:9295326. [PMID: 35449606 PMCID: PMC9017557 DOI: 10.1155/2022/9295326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/15/2021] [Accepted: 01/29/2022] [Indexed: 12/15/2022] Open
Abstract
In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel’s triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann’s bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard “ready-made” procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications.
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17
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Baysal E, Okşul M, Burak C, Yalin K, Soysal AU, Yalman H, Bozyel S, Guler TE, Tanboga HI, Aksu T. Decreasing time between first diagnosis of paroxysmal atrial fibrillation and cryoballoon ablation positively affects long-term consequences. J Interv Card Electrophysiol 2022; 65:365-372. [DOI: 10.1007/s10840-022-01167-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/22/2022] [Indexed: 12/17/2022]
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18
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Detection of atrial fibrillation by implantable loop recorders following cryptogenic stroke: A retrospective study of predictive factors and outcomes. J Electrocardiol 2022; 71:54-58. [DOI: 10.1016/j.jelectrocard.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/09/2022] [Accepted: 01/17/2022] [Indexed: 11/19/2022]
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19
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Roston TM, Islam S, Hawkins NM, Laksman ZW, Sanatani S, Krahn AD, Sandhu R, Kaul P. A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes. CJC Open 2022; 4:65-74. [PMID: 35072029 PMCID: PMC8767123 DOI: 10.1016/j.cjco.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background Previous studies on lone/unexplained atrial fibrillation and atrial flutter (AF) did not exclude patients with contemporary secondary AF triggers. We characterized unexplained AF using a strict definition, and compared it to secondary AF. Methods In this population-based study, unexplained AF was defined by the lack of any identifiable triggering medical/surgical diagnosis. Comparisons by AF type (unexplained vs secondary), age-of-onset (≤ / > 65 years), and sex were undertaken. Data were acquired by linking 6 population databases maintained by the Alberta Ministry of Health over a 9-year period (April 2006 to March 2015). The primary composite outcome of stroke, transient ischemic attack, thromboembolism, and/or death was assessed. Results There were 33,150 incident AF diagnoses identified, including 1145 patients (3.5%) with unexplained AF, 931 (81.2%) of whom were aged ≤ 65 years (2.8% of diagnoses, and 79% male). Patients with unexplained AF less often received rate/rhythm-control drugs (P < 0.0001), but they more often underwent electrical cardioversion (P < 0.0001) vs secondary AF patients. Men were younger at unexplained AF diagnosis (45 [interquartile range: 34-59] vs 58 [interquartile range: 40-69] years; P < 0.001). After adjusting for age at diagnosis, there were no sex-based differences in the primary outcome. Event-free survival in young unexplained AF (age ≤ 65 years) was 99.4% at 1 year and 98.3% at 3 years. At 3 years, hospitalization(s)/emergency visit(s) for noncardiovascular reasons and for AF occurred in 56.6% and 23.8% of these patients, respectively. Conclusions Using a strict contemporary definition of unexplained AF, this study shows that the condition is rare, predominantly male, and has excellent event-free survival. However, the high rate of acute hospital utilization after diagnosis is concerning.
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Affiliation(s)
- Thomas M. Roston
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunjidatul Islam
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Nathaniel M. Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W. Laksman
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Roopinder Sandhu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author: Dr Padma Kaul, 4-120 Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, Alberta T6G 2E1, Canada. Tel.: +1-780-492-1140 ; fax: +1-780-492-0613.
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20
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A Reiffel J. The Importance of Atrial Fibrillation's Associated Comorbidities as Clinical Presentation and Outcome Contributors. J Atr Fibrillation 2021; 14:20200517. [PMID: 34950378 DOI: 10.4022/jafib.20200517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) has a heterogeneous clinical presentation. It can occur: (a) in the presence or absence of detectable heart disease, and, (b) with or without relatedsymptoms. Its prognosis in terms of thromboembolismand mortality is most benign when applied to young individuals (aged less than 60 years) without clinical orechocardiographic evidence of cardiopulmonary disease [termed "lone AF"]. However, by virtue of aging or because of the development of concomitant cardiovascular disorders, patientsmove out of the lone AF category over time, accompanied by increased risks for thromboembolism and mortality. Thus, underlying and/or associated comorbidities must play an important role in the presentation and consequences of patients with AF. While, no doubt, most clinicians likely appreciate that the majority of the AF patients they see have associated cardiovascular, pulmonary, metabolic, endocrinologic, genetic, and/or other disorders, it is not clear how much they appreciate that these disorders directly relate to the presenting symptoms and to the risks from AF in addition to their role as risk factors (or markers) for AF. This issue is the subject of this review manuscript.
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Affiliation(s)
- James A Reiffel
- Columbia Memorial Hospital and New York Presbyterian Westchester Division
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21
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Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with increased morbidity and mortality resulting from thromboembolism and heart failure. AF often presents initially as paroxysmal and may progress to a sustained form over time. Sustained forms of AF may be associated with increased symptoms and cardiovascular morbidity, and AF progression may be associated with increased risk of clinically adverse events and outcomes. The present review discusses the clinical factors of arrhythmia progression and risk stratification available to assess the probability of AF progression. Furthermore, currently available treatment options for preventing AF progression are explored and evaluated.
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Affiliation(s)
- Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
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22
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Yoon GS, Choi SH, Kwon SW, Park SD, Shin SH, Woo SI, Kwan J, Kim DH, Baek YS. Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression. J Int Med Res 2021; 49:3000605211057822. [PMID: 34791909 PMCID: PMC8619754 DOI: 10.1177/03000605211057822] [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: 11/24/2022] Open
Abstract
Objective To examine the combination of heart rate recovery (HRR) and heart rate variability (HRV) in predicting atrial fibrillation (AF) progression. Methods Data from patients with a first detected episode of AF who underwent treadmill exercise testing and 24-h Holter electrocardiography were retrospectively analysed. Autonomic dysfunction was verified using HRR values. Sympathetic and parasympathetic modulation was analysed by HRV. AF progression was defined as transition from the first detected paroxysmal episode to persistent/permanent AF. Results Of 306 patients, mean LF/HF ratio and HRR did not differ significantly by AF progression regardless of age (< or ≥65 years). However, when the LF/HF ratio was divided into tertiles, in patients aged <65 years, the mid LF/HF (1.60–2.40) ratio was significantly associated with lower AF progression rates and longer maintenance of normal sinus rhythm. For patients aged <65 years, less metabolic equivalents were related to higher AF progression rates. For patients aged ≥65 years, a low HRR was associated with high AF progression rates. Conclusion In relatively younger age, high physical capacity and balanced autonomic nervous system regulation are important predictors of AF progression. Evaluation of autonomic function assessed by age could predict AF progression.
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Affiliation(s)
- Gwang-Seok Yoon
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Seong-Huan Choi
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Sung Woo Kwon
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Sung-Hee Shin
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Seong-Ill Woo
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Jun Kwan
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
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Chung SC, Sofat R, Acosta-Mena D, Taylor JA, Lambiase PD, Casas JP, Providencia R. Atrial fibrillation epidemiology, disparity and healthcare contacts: a population-wide study of 5.6 million individuals. LANCET REGIONAL HEALTH-EUROPE 2021; 7:100157. [PMID: 34405204 PMCID: PMC8351189 DOI: 10.1016/j.lanepe.2021.100157] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: We aimed to evaluate atrial fibrillation occurrence, reasons for healthcare visits, mortality, causes of death and examined patterns by relative deprivation in the UK. Methods: To study the atrial fibrillation (AF) incidence, mortality and case-fatality, we implemented a prospective cohort study with the linked electronic health records of 5.6 million population in the United Kingdom Clinical Practice Research Datalink from 1998 to 2016. A matched case-control study was used to investigate causes of hospitalisation and death comparing individuals with and without incident AF. Results: During a median follow-up of 10.3 years, 199,433(3.6%) patients developed incident AF. Increased risk of hospitalisation for heart failure, cardiovascular conditions and infection was present among patients who later developed AF. Following an AF diagnosis, patients were frequently admitted to the hospital for heart failure, lower respiratory tract infection, chronic obstructive pulmonary disease and ischemic heart disease. One in 5 AF patients died during the first year after diagnosis, and the mortality increased to 42.7% at the fifth year. The excess deaths in AF cases compared to controls may result from cardiovascular diseases, infection and metabolic disorders. Individuals from areas with higher deprivation in socioeconomic and living status had both higher AF incidence and fatality. Interpretation: We observed an elevated risk of hospitalisation for cardiovascular or respiratory diseases among incident AF patients, and the considerable disparity in AF burden by socioeconomic deprivation informs priorities for prevention and provision of patient care. Funding: The study was supported by the GlaxoSmithKline, University College London Hospital and National Institute for Health Research. The funders did not have any role in study design, data collection, data analysis, interpretation, and writing of the report.
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Affiliation(s)
| | | | | | | | | | - Juan P Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, US
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24
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Olivia C, Hastie C, Farshid A. Adherence to guidelines regarding anticoagulation and risk factors for progression of atrial fibrillation in a nurse‐led clinic. Intern Med J 2021; 51:1136-1142. [DOI: 10.1111/imj.14874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Celine Olivia
- School of Clinical Medicine Australian National University Medical School Canberra ACT Australia
| | - Cheryl Hastie
- Department of Cardiology The Canberra Hospital Canberra ACT Australia
| | - Ahmad Farshid
- School of Clinical Medicine Australian National University Medical School Canberra ACT Australia
- Department of Cardiology The Canberra Hospital Canberra ACT Australia
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25
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Kotadia ID, Sim I, Mukherjee R, O’Hare D, Chiribiri A, Birns J, Bhalla A, O’Neill M, Williams SE. Secondary Stroke Prevention Following Embolic Stroke of Unknown Source in the Absence of Documented Atrial Fibrillation: A Clinical Review. J Am Heart Assoc 2021; 10:e021045. [PMID: 34212774 PMCID: PMC8403300 DOI: 10.1161/jaha.121.021045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately one-third of ischemic strokes are classified as cryptogenic strokes. The risk of stroke recurrence in these patients is significantly elevated with up to one-third of patients with cryptogenic stroke experiencing a further stroke within 10 years. While anticoagulation is the mainstay of treatment for secondary stroke prevention in the context of documented atrial fibrillation (AF), it is estimated that up to 25% of patients with cryptogenic stroke have undiagnosed AF. Furthermore, the historical acceptance of a causal relationship between AF and stroke has recently come under scrutiny, with evidence to suggest that embolic stroke risk may be elevated even in the absence of documented atrial fibrillation attributable to the presence of electrical and structural changes constituting an atrial cardiomyopathy. More recently, the term embolic stroke of unknown source has garnered increasing interest as a subset of patients with cryptogenic stroke in whom a minimum set of diagnostic investigations has been performed, and a nonlacunar infarct highly suspicious of embolic etiology is suspected but in the absence of an identifiable secondary cause of stroke. The ongoing ARCADIA (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke) randomized trial and ATTICUS (Apixiban for Treatment of Embolic Stroke of Undetermined Source) study seek to further define this novel term. This review summarizes the relationship between AF, embolic stroke, and atrial cardiomyopathy and provides an overview of the clinical relevance of cardiac imaging, electrocardiographic, and serum biomarkers in the assessment of AF and secondary stroke risk. The implications of these findings on therapeutic considerations is considered and gaps in the literature identified as areas for future study in risk stratifying this cohort of patients.
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Affiliation(s)
- Irum D. Kotadia
- King’s College LondonLondonUnited Kingdom
- Guy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - Iain Sim
- King’s College LondonLondonUnited Kingdom
| | | | | | | | - Jonathan Birns
- Guy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - Ajay Bhalla
- Guy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - Mark O’Neill
- King’s College LondonLondonUnited Kingdom
- Guy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - Steven E. Williams
- King’s College LondonLondonUnited Kingdom
- Centre for Cardiovascular ScienceUniversity of EdinburghUnited Kingdom
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26
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Kloosterman M, Oldgren J, Conen D, Wong JA, Connolly SJ, Avezum A, Yusuf S, Ezekowitz MD, Wallentin L, Ntep-Gweth M, Joseph P, Barrett TW, Tanosmsup S, McIntyre WF, Lee SF, Parkash R, Amit G, Grinvalds A, Van Gelder IC, Healey JS. Characteristics and outcomes of atrial fibrillation in patients without traditional risk factors: an RE-LY AF registry analysis. Europace 2021; 22:870-877. [PMID: 32215649 DOI: 10.1093/europace/euz360] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Data on patient characteristics, prevalence, and outcomes of atrial fibrillation (AF) patients without traditional risk factors, often labelled 'lone AF', are sparse. METHODS AND RESULTS The RE-LY AF registry included 15 400 individuals who presented to emergency departments with AF in 47 countries. This analysis focused on patients without traditional risk factors, including age ≥60 years, hypertension, coronary artery disease, heart failure, left ventricular hypertrophy, congenital heart disease, pulmonary disease, valve heart disease, hyperthyroidism, and prior cardiac surgery. Patients without traditional risk factors were compared with age- and region-matched controls with traditional risk factors (1:3 fashion). In 796 (5%) patients, no traditional risk factors were present. However, 98% (779/796) had less-established or borderline risk factors, including borderline hypertension (130-140/80-90 mmHg; 47%), chronic kidney disease (eGFR < 60 mL/min; 57%), obesity (body mass index > 30; 19%), diabetes (5%), excessive alcohol intake (>14 units/week; 4%), and smoking (25%). Compared with patients with traditional risk factors (n = 2388), patients without traditional risk factors were more often men (74% vs. 59%, P < 0.001) had paroxysmal AF (55% vs. 37%, P < 0.001) and less AF persistence after 1 year (21% vs. 49%, P < 0.001). Furthermore, 1-year stroke occurrence rate (0.6% vs. 2.0%, P = 0.013) and heart failure hospitalizations (0.9% vs. 12.5%, P < 0.001) were lower. However, risk of AF-related re-hospitalization was similar (18% vs. 21%, P = 0.09). CONCLUSION Almost all patients without traditionally defined AF risk factors have less-established or borderline risk factors. These patients have a favourable 1-year prognosis, but risk of AF-related re-hospitalization remains high. Greater emphasis should be placed on recognition and management of less-established or borderline risk factors.
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Affiliation(s)
- Mariëlle Kloosterman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jonas Oldgren
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - David Conen
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Jorge A Wong
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Stuart J Connolly
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Alvaro Avezum
- Division of Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Salim Yusuf
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Michael D Ezekowitz
- Department of Medicine, Medical College and Lankenau Medical Center, Wynnewood, PA, USA
| | - Lars Wallentin
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Marie Ntep-Gweth
- Department of Medicine, Hôpital Central de Yaoundé, Yaounde, Cameroon
| | - Philip Joseph
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Tyler W Barrett
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - William F McIntyre
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Ratika Parkash
- Department of Medicine, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Amit
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Alex Grinvalds
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeff S Healey
- Population Health Research Institute, Department of Medicine, McMaster University, 30 Birge St. Room C3-121, Hamilton, Ontario L8L 0A6, Canada
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27
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Jakob D, Klesen A, Darkow E, Kari FA, Beyersdorf F, Kohl P, Ravens U, Peyronnet R. Heterogeneity and Remodeling of Ion Currents in Cultured Right Atrial Fibroblasts From Patients With Sinus Rhythm or Atrial Fibrillation. Front Physiol 2021; 12:673891. [PMID: 34149453 PMCID: PMC8209389 DOI: 10.3389/fphys.2021.673891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Cardiac fibroblasts express multiple voltage-dependent ion channels. Even though fibroblasts do not generate action potentials, they may influence cardiac electrophysiology by electrical coupling via gap junctions with cardiomyocytes, and through fibrosis. Here, we investigate the electrophysiological phenotype of cultured fibroblasts from right atrial appendage tissue of patients with sinus rhythm (SR) or atrial fibrillation (AF). Using the patch-clamp technique in whole-cell mode, we observed steady-state outward currents exhibiting either no rectification or inward and/or outward rectification. The distributions of current patterns between fibroblasts from SR and AF patients were not significantly different. In response to depolarizing voltage pulses, we measured transient outward currents with fast and slow activation kinetics, an outward background current, and an inward current with a potential-dependence resembling that of L-type Ca2+ channels. In cell-attached patch-clamp mode, large amplitude, paxilline-sensitive single channel openings were found in ≈65% of SR and ∼38% of AF fibroblasts, suggesting the presence of “big conductance Ca2+-activated K+ (BKCa)” channels. The open probability of BKCa was significantly lower in AF than in SR fibroblasts. When cultured in the presence of paxilline, the shape of fibroblasts became wider and less spindle-like. Our data confirm previous findings on cardiac fibroblast electrophysiology and extend them by illustrating differential channel expression in human atrial fibroblasts from SR and AF tissue.
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Affiliation(s)
- Dorothee Jakob
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Klesen
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elisa Darkow
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Fabian A Kari
- Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.,CIBSS Centre for Integrative Biological Signaling Studies, University of Freiburg, Freiburg, Germany
| | - Ursula Ravens
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rémi Peyronnet
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
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28
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Large extracellular vesicles in the left atrial appendage in patients with atrial fibrillation-the missing link? Clin Res Cardiol 2021; 111:34-49. [PMID: 34061226 PMCID: PMC8766378 DOI: 10.1007/s00392-021-01873-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/14/2021] [Indexed: 11/06/2022]
Abstract
Atrial fibrillation (AF) is the most frequent arrhythmic disease in humans, which leads to thrombus formation in the left atrial appendage and stroke through peripheral embolization. Depending on their origin, large extracellular vesicles (lEVs) can exert pro-coagulant functions. In the present study, we investigated how different types of AF influence the levels of large EV subtypes in three distinct atrial localizations. Blood samples were collected from the right and left atrium and the left atrial appendage of 58 patients. 49% of the patients had permanent AF, 34% had non-permanent AF, and 17% had no history of AF. Flow cytometric analysis of the origin of the lEVs showed that the proportion of platelet-derived lEVs in the left atrial appendage was significantly higher in permanent AF patients compared to non-permanent AF. When we grouped patients according to their current heart rhythm, we also detected significantly higher levels of platelet-derived lEVs in the left atrial appendage (LAA) in patients with atrial fibrillation. In vitro studies revealed, that platelet activation with lipopolysaccharide (LPS) leads to higher levels of miR-222-3p and miR-223-3p in platelet-derived lEVs. Treatment with lEVs from LPS- or thrombin-activated platelets reduces the migration of endothelial cells in vitro. These results suggest that permanent atrial fibrillation is associated with increased levels of platelet-derived lEVs in the LAA, which are potentially involved in LAA thrombus formation.
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29
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Ponamgi SP, Siontis KC, Rushlow DR, Graff-Radford J, Montori V, Noseworthy PA. Screening and management of atrial fibrillation in primary care. BMJ 2021; 373:n379. [PMID: 33846159 DOI: 10.1136/bmj.n379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.
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Affiliation(s)
- Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | | | - David R Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Victor Montori
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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30
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Darkow E, Nguyen TT, Stolina M, Kari FA, Schmidt C, Wiedmann F, Baczkó I, Kohl P, Rajamani S, Ravens U, Peyronnet R. Small Conductance Ca 2 +-Activated K + (SK) Channel mRNA Expression in Human Atrial and Ventricular Tissue: Comparison Between Donor, Atrial Fibrillation and Heart Failure Tissue. Front Physiol 2021; 12:650964. [PMID: 33868017 PMCID: PMC8047327 DOI: 10.3389/fphys.2021.650964] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/01/2021] [Indexed: 12/25/2022] Open
Abstract
In search of more efficacious and safe pharmacological treatments for atrial fibrillation (AF), atria-selective antiarrhythmic agents have been promoted that target ion channels principally expressed in the atria. This concept allows one to engage antiarrhythmic effects in atria, but spares the ventricles from potentially proarrhythmic side effects. It has been suggested that cardiac small conductance Ca2+-activated K+ (SK) channels may represent an atria-selective target in mammals including humans. However, there are conflicting data concerning the expression of SK channels in different stages of AF, and recent findings suggest that SK channels are upregulated in ventricular myocardium when patients develop heart failure. To address this issue, RNA-sequencing was performed to compare expression levels of three SK channels (KCNN1, KCNN2, and KCNN3) in human atrial and ventricular tissue samples from transplant donor hearts (no cardiac disease), and patients with cardiac disease in sinus rhythm or with AF. In addition, for control purposes expression levels of several genes known to be either chamber-selective or differentially expressed in AF and heart failure were determined. In atria, as compared to ventricle from transplant donor hearts, we confirmed higher expression of KCNN1 and KCNA5, and lower expression of KCNJ2, whereas KCNN2 and KCNN3 were statistically not differentially expressed. Overall expression of KCNN1 was low compared to KCNN2 and KCNN3. Comparing atrial tissue from patients with AF to sinus rhythm samples we saw downregulation of KCNN2 in AF, as previously reported. When comparing ventricular tissue from heart failure patients to non-diseased samples, we found significantly increased ventricular expression of KCNN3 in heart failure, as previously published. The other channels showed no significant difference in expression in either disease. Our results add weight to the view that SK channels are not likely to be an atria-selective target, especially in failing human hearts, and modulators of these channels may prove to have less utility in treating AF than hoped. Whether targeting SK1 holds potential remains to be elucidated.
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Affiliation(s)
- Elisa Darkow
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Freiburg im Breisgau, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Biology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thong T Nguyen
- Genome Analysis Unit, Amgen Research, Amgen Inc., South San Francisco, CA, United States
| | - Marina Stolina
- Department of Cardiometabolic Disorders, Amgen Research, Amgen Inc., Thousand Oaks, CA, United States
| | - Fabian A Kari
- Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg im Breisgau, Germany
| | - Constanze Schmidt
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany
| | - Felix Wiedmann
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Freiburg im Breisgau, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,CIBSS Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sridharan Rajamani
- Translational Safety and Bioanalytical Sciences, Amgen Research, Amgen Inc., South San Francisco, CA, United States
| | - Ursula Ravens
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Freiburg im Breisgau, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Rémi Peyronnet
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Freiburg im Breisgau, Germany.,Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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31
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Särnholm J, Skúladóttir H, Rück C, Klavebäck S, Ólafsdóttir E, Pedersen SS, Braunschweig F, Ljótsson B. Internet-Delivered Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: Uncontrolled Pilot Trial. JMIR Cardio 2021; 5:e24524. [PMID: 33650972 PMCID: PMC8411432 DOI: 10.2196/24524] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. AF is associated with a poor quality of life (QoL) and, in many patients, current medical treatments are inadequate in alleviating AF symptoms (eg, palpitations). Patients often present with symptom preoccupation in terms of symptom fear, avoidance, and control behaviors. Internet-delivered cognitive behavior therapy is effective for treating other somatic disorders but has never been evaluated in patients with AF. OBJECTIVE The aim of this study is to evaluate the efficacy and feasibility of AF-specific internet-delivered cognitive behavior therapy. METHODS We conducted an uncontrolled pilot study in which 19 patients with symptomatic paroxysmal AF underwent internet-delivered cognitive behavior therapy. Participants completed self-assessments at pretreatment, posttreatment, and at a 6-month follow-up along with handheld electrocardiogram measurements with symptom registration. The treatment lasted 10 weeks and included exposure to physical sensations, reduction in avoidance behavior, and behavioral activation. RESULTS We observed large within-group improvements in the primary outcome, AF-specific QoL (Cohen d=0.80; P<.001), and in symptom preoccupation (Cohen d=1.24; P<.001) at posttreatment; the results were maintained at the 6-month follow-up. Treatment satisfaction and adherence rates were also high. We observed an increased AF burden, measured by electrocardiogram, at the 6-month follow-up, but a significant decrease was observed in the overestimation of AF symptoms at posttreatment and 6-month follow-up. Exploratory mediation analysis showed that a reduction in symptom preoccupation mediated the effects of internet-delivered cognitive behavior therapy on AF-specific QoL. CONCLUSIONS This study presents preliminary evidence for the potential efficacy and feasibility of a novel approach in treating patients with symptomatic AF with internet-delivered cognitive behavior therapy. TRIAL REGISTRATION ClinicalTrials.gov NCT02694276; https://clinicaltrials.gov/ct2/show/NCT02694276.
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Affiliation(s)
- Josefin Särnholm
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Helga Skúladóttir
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Sofia Klavebäck
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Ólafsdóttir
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Frieder Braunschweig
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
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32
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Witkowska A, Suwalski P. Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation. J Thorac Dis 2021; 13:2000-2009. [PMID: 33841986 PMCID: PMC8024848 DOI: 10.21037/jtd-20-1876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts' opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder.
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Affiliation(s)
- Anna Witkowska
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Medical Postgraduate Education, Warsaw, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Medical Postgraduate Education, Warsaw, Poland
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33
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Hagengaard L, Polcwiartek C, Andersen MP, Sessa M, Krogager ML, Gislason G, Schou M, Torp-Pedersen C, Søgaard P, Kragholm KH. Incident atrial fibrillation and risk of psychoactive drug redemptions and psychiatric hospital contacts: a Danish Nationwide Register-based Follow-up Study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:76-82. [PMID: 32502251 DOI: 10.1093/ehjqcco/qcaa048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/21/2020] [Accepted: 06/02/2020] [Indexed: 11/12/2022]
Abstract
AIMS To investigate whether incident atrial fibrillation or flutter (AF) diagnosis increases the risk of psychiatric outcomes compared with the general population. METHODS AND RESULTS First-time AF patients and population controls naive to psychiatric disease or filled prescriptions for psychotropic drugs were identified in Danish nationwide registries during 2005-14. AF patients were matched 1:2 with exposure density matching. Patients and controls were compared for 1-year cumulative incidences of depression, anxiety, and stress disorders, and for filled drug prescriptions for antidepressant, anxiolytic, selected antipsychotics, and hypnotics. Lastly, we examined 1-year cumulative incidences of a composite endpoint of the above-mentioned diagnoses or drug redemptions. We included 146 377 AF patients and 292 754 matched controls, 55% men and median age 74 (25-75% 65-82) years. AF patients had significantly higher cumulative incidences of composite endpoints. Furthermore, filled prescriptions for anxiolytics and hypnotics were significantly higher for AF patients compared with healthy population controls. The cumulative incidence of the composite endpoint was significantly higher in AF patients relative to controls 11.1% vs. 8.3%. For the composite endpoint, a significantly higher risk was apparent both in unadjusted (HR: 2.76, 95% CI: 2.67-2.85) and adjusted (HR: 2.51, 95% CI: 2.43-2.60) models for AF patients vs. controls in the first 3 months after study inclusion. CONCLUSION First-time AF patients were significantly more likely to have psychiatric outpatient or hospital contacts and to fill prescriptions for psychotropic drugs compared with healthy population controls. The risk was significantly elevated only during the first 3 months after AF diagnosis.
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Affiliation(s)
- Louise Hagengaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Christoffer Polcwiartek
- Department of Clinical Medicine, Aalborg University, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Experimental Medicine, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Maria Lukacs Krogager
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Departmant of Cardiology, Hjørring Regional Hospital, Hjørring, Denmark
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Yang WY, Du X, Fawzy AM, He L, Li HW, Dong JZ, Lip GYH, Ma CS. Associations of atrial fibrillation progression with clinical risk factors and clinical prognosis: A report from the Chinese Atrial Fibrillation Registry study. J Cardiovasc Electrophysiol 2020; 32:333-341. [PMID: 33269504 DOI: 10.1111/jce.14826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND An understanding of the risk factors for atrial fibrillation (AF) progression and the associated impacts on clinical prognosis are important for the future management of this common arrhythmia. We aimed to investigate the rate of progression from paroxysmal (PAF) to more sustained subtypes of AF (SAF), the associated risk factors for this progression, and its impact on adverse clinical outcomes. METHODS AND RESULTS Using data from the Chinese trial Fibrillation Registry study, we included 8290 PAF patients. Half of them underwent initial AF ablation at enrollment. The main outcomes were ischemic stroke/systemic embolism (IS/SE), cardiovascular hospitalization, cardiovascular death, and all-cause mortality. The median follow-up duration was 1091 (704, 1634) days, and progression from PAF to SAF occurred in 881 (22.5%) nonablated patients, while 130 (3.0%) ablated patients had AF recurrence and developed SAF. The incidence rate of AF progression for the cohort was 3.87 (95% confidence interval [CI] = 3.64-4.12) per 100 patient-years, being higher in nonablated compared to ablated patients. Older age, longer AF history, heart failure, hypertension, coronary artery disease, respiratory diseases, and larger atrial diameter were associated with a higher incidence of AF progression, while antiarrhythmic drug use and AF ablation were inversely related to it. For nonablated patients, AF progression was independently associated with an increased risk of IS/SE (hazard ratio [HR] = 1.52, 95% CI = 1.15-2.01) and cardiovascular hospitalizations (HR = 1.40, 95% CI = 1.23-1.58). CONCLUSION AF progression was common in its natural course. It was related to comorbidities and whether rhythm control strategies were used, and was associated with an increased risk of IS/SE and cardiovascular hospitalization.
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Affiliation(s)
- Wang-Yang Yang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China.,Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Ameenathul M Fawzy
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Hong-Wei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - 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
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
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Geng M, Lin A, Nguyen TP. Revisiting Antiarrhythmic Drug Therapy for Atrial Fibrillation: Reviewing Lessons Learned and Redefining Therapeutic Paradigms. Front Pharmacol 2020; 11:581837. [PMID: 33240090 PMCID: PMC7680856 DOI: 10.3389/fphar.2020.581837] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Since the clinical use of digitalis as the first pharmacological therapy for atrial fibrillation (AF) 235 years ago in 1785, antiarrhythmic drug therapy has advanced considerably and become a cornerstone of AF clinical management. Yet, a preventive or curative panacea for sustained AF does not exist despite the rise of AF global prevalence to epidemiological proportions. While multiple elevated risk factors for AF have been established, the natural history and etiology of AF remain incompletely understood. In the present article, the first section selectively highlights some disappointing shortcomings and current efforts in antiarrhythmic drug therapy to uncover reasons why AF is such a clinical challenge. The second section discusses some modern takes on the natural history of AF as a relentless, progressive fibro-inflammatory "atriomyopathy." The final section emphasizes the need to redefine therapeutic strategies on par with new insights of AF pathophysiology.
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Affiliation(s)
| | | | - Thao P. Nguyen
- Division of Cardiology, Department of Medicine, The Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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36
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Singleton MJ, Imtiaz-Ahmad M, Kamel H, O'Neal WT, Judd SE, Howard VJ, Howard G, Soliman EZ, Bhave PD. Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study. J Am Heart Assoc 2020; 9:e016380. [PMID: 32495723 PMCID: PMC7429041 DOI: 10.1161/jaha.120.016380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Atrial fibrillation (AF) is associated with a 5-fold increased stroke risk. While most patients with AF warrant anticoagulation, optimal treatment remains uncertain for patients with AF without cardiovascular comorbidities because the risk of stroke in this population has not been well-characterized. Methods and Results Participants (N=28 253; 55% women, mean age 64.6±9.4 years), from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003-present) were classified into 1 of 4 groups based on the presence or absence of AF and the presence or absence of cardiovascular comorbidities. Cox proportional hazards analysis was used to compare the risk of stroke between groups. During 244 560 person-years of follow-up (median 8.7 years), 1206 strokes occurred. Compared with patients with neither AF nor cardiovascular comorbidities, we did not find an increased stroke risk (hazard ratio [HR], 1.23; 95% CI, 0.62-2.18 [P=0.511]) among participants with AF alone. Participants without AF but with cardiovascular comorbidities had both an elevated stroke risk (HR, 1.77; 95% CI, 1.48-2.18 [P<0.0001]) and an increased risk of cardioembolic stroke (HR, 2.34; 95% CI, 1.48-3.90 [P=0.0002]). Conclusions In this large cohort of participants with AF without cardiovascular comorbidities, we found that AF itself, without cardiovascular comorbidities, did not confer increased risk of stroke. Cardiovascular comorbidities, however, were associated with an increased risk of both stroke of any type and cardioembolic stroke, even in the absence of AF.
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Affiliation(s)
| | | | - Hooman Kamel
- Department of Neurology Weill Cornell Medical College New York NY
| | - Wesley T O'Neal
- Division of Cardiology Department of Internal Medicine Emory University School of Medicine Atlanta GA
| | - Suzanne E Judd
- Department of Biostatistics University of Alabama at Birmingham AL
| | | | - George Howard
- Department of Biostatistics University of Alabama at Birmingham AL
| | - Elsayed Z Soliman
- Department of Internal Medicine and Epidemiological Cardiology Research Center Wake Forest School of Medicine Winston-Salem NC
| | - Prashant D Bhave
- Section of Cardiology Wake Forest School of Medicine Winston-Salem NC
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Istolahti T, Eranti A, Huhtala H, Lyytikäinen LP, Kähönen M, Lehtimäki T, Eskola M, Anttila I, Jula A, Bayés de Luna A, Nikus K, Hernesniemi J. The prevalence and prognostic significance of interatrial block in the general population. Ann Med 2020; 52:63-73. [PMID: 32077319 PMCID: PMC7877939 DOI: 10.1080/07853890.2020.1731759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: Partial and advanced interatrial block (IAB) in the electrocardiographic (ECG) represents inter-atrial conduction delay. IAB is associated with atrial fibrillation (AF) and stroke in the general population.Material and methods: A representative sample of Finnish subjects (n = 6354) aged over 30 years (mean: 52.2 years, standard deviation: 14.6) underwent a health examination including a 12-lead ECG. Five different IAB groups based on automatic measurements were compared to normal P waves using multivariate-adjusted Cox proportional hazard model. Follow-up lasted up to 15 years.Results: The prevalence of advanced and partial IAB was 1.0% and 9.7%, respectively. In the multivariate model, both advanced (hazard ratio (HR): 1.63 (95% confidence interval (CI): 1.00-2.65)) and partial IAB (HR: 1.39 (1.09-1.77)) were associated with increased risk of AF. Advanced IAB was associated with increased risk of stroke or transient ischaemic attack (TIA) independently of associated AF (HR: 2.22 (1.20-4.13)). Partial IAB was also associated with increased risk of being diagnosed with coronary heart disease (HR: 1.26 (1.01-1.58)).Discussion: IAB is a rather frequent finding in the general population. IAB is a risk factor for AF and is associated with an increased risk of stroke or TIA independently of associated AF.Key messagesBoth partial and advanced interatrial block are associated with increased risk of atrial fibrillation in the general population.Advanced interatrial block is an independent risk factor for stroke and transient ischaemic attack.The clinical significance of interatrial block is dependent on the subtype classification.
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Affiliation(s)
- Tiia Istolahti
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland
| | - Antti Eranti
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Ismo Anttila
- Department of Emergency Services, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, Finland
| | - Antoni Bayés de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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Iñiguez Vázquez I, Matesanz Fernández M, Romay Lema EM, Seoane Pillado MT, Monte Secades R, Pértega Díaz S, Casariego Vales E. Predictor of enhanced mortality in patients with multimorbidity and atrial fibrillation in an acute hospital setting. QJM 2020; 113:330-335. [PMID: 31738421 DOI: 10.1093/qjmed/hcz302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/07/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) admitted to hospital commonly have comorbidities. Few studies have attempted to determine factors prognostic of mortality in hospitalized AF patients with multimorbidity. AIM To identify factors associated with mortality in hospitalized AF patients. DESIGN Retrospective cohort study. METHODS Patients with multimorbidity (≥2 chronic diseases), with or without AF, discharged from Lugo hospital (Spain) between 1 January 2000 and 31 December 2015. Data were extracted from hospital medical records. RESULTS Of 74 220 patients (170 978 hospitalizations), 52 939 had multimorbidity (14 181 had AF; 38 758 no AF) and were included in our study. Patients with AF were older (mean ± standard deviation 78.6 ± 10.0 vs. 71.9 ± 14.2 years) and had a higher mortality rate (27.1 vs. 20.5%) than those without AF. Gender (female), age, stroke and congestive heart failure (CHF), but not AF, were independently associated with mortality. AF significantly increased the mortality risk in women [relative risk (RR) 1.091; 95% confidence interval (CI) 1.021-1.165; P = 0.010] and in those aged >80 years (RR 1.153; 95% CI, 1.1-1.2; P < 0.001). CHF independently increased the risk of mortality across all age groups (RR 1.496; 95% CI 1.422-1.574; P < 0.001). CONCLUSIONS Hospitalized patients with AF have a higher mortality rate than those without AF. The prognostic significance of AF changes with age and gender while CHF is associated with the greatest risk of death.
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Affiliation(s)
- I Iñiguez Vázquez
- Department of Internal Medicine, Lucus Augusti University Hospital, 27003 Lugo, Spain
| | - M Matesanz Fernández
- Department of Internal Medicine, Lucus Augusti University Hospital, 27003 Lugo, Spain
| | - E M Romay Lema
- Department of Internal Medicine, Lucus Augusti University Hospital, 27003 Lugo, Spain
| | - M T Seoane Pillado
- Health Sciences Department, La Coruña University, 15006 La Coruña, Spain
| | - R Monte Secades
- Department of Internal Medicine, Lucus Augusti University Hospital, 27003 Lugo, Spain
| | - S Pértega Díaz
- Health Sciences Department, La Coruña University, 15006 La Coruña, Spain
| | - E Casariego Vales
- Department of Internal Medicine, Lucus Augusti University Hospital, 27003 Lugo, Spain
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Change in Atrial Fibrillation Burden over Time in Patients with Nonpermanent Atrial Fibrillation. Cardiol Res Pract 2020; 2020:9583409. [PMID: 32377430 PMCID: PMC7183533 DOI: 10.1155/2020/9583409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction The natural course of atrial fibrillation (AF) is not well defined. We aimed to investigate the change in AF burden over time and its associated risk factors among AF patients. Methods Fifty-four participants with recently documented paroxysmal or persistent AF were enrolled. Main exclusion criteria were permanent AF or previous catheter ablation for AF. AF burden was calculated as time in AF divided by total recording time using yearly continuous 7-day Holter-ECG recordings. A relative change ≥10% or an absolute change >0.5% in AF burden between two yearly Holter-ECG recordings was considered significant. Results Mean age was 67 years, 72% were men. The proportion of patients with no recorded AF increased from 53.7% at baseline to 78.6% (p=0.1) after 4 years of follow-up. In 7-day Holter-ECG recordings performed after baseline, 23.7% of participants had a decrease and 23.7% an increase in AF burden. In separate mixed effect models, AF burden over time was associated with prior stroke (β 42.59, 95% CI (23.40; 61.77); p < 0.0001), BNP (β 0.05, CI (0.02; 0.09); p=0.005) end-diastolic (β 0.49, CI (0.23; 0.74); p=0.0003) as well as end-systolic (β 0.25, CI (0.05; 0.46); p=0.02) left atrial volume, left atrial ejection fraction (β −0.43, CI (−0.76;−0.10); p=0.01), E-wave (β 36.67, CI (12.96; 60.38); p=0.003), and deceleration time (β −0.1, CI (−0.16; −0.05); p=0.002). In a multivariable model, a history of prior stroke (β 29.87, CI (2.61; 57.13); p=0.03) and BNP levels (β 0.05, CI (0.01; 0.08); p=0.007) remained significantly associated with AF burden. Conclusions Few patients with paroxysmal or persistent AF have AF episodes on yearly 7-day Holter-ECG recordings, and AF progression is rare. AF burden was independently associated with a history of prior stroke and BNP levels.
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Fredriksson T, Gudmundsdottir KK, Frykman V, Friberg L, Al-Khalili F, Engdahl J, Svennberg E. Brief episodes of rapid irregular atrial activity (micro-AF) are a risk marker for atrial fibrillation: a prospective cohort study. BMC Cardiovasc Disord 2020; 20:167. [PMID: 32276611 PMCID: PMC7149874 DOI: 10.1186/s12872-020-01453-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/29/2020] [Indexed: 01/15/2023] Open
Abstract
Background Short supraventricular tachycardias with atrial fibrillation (AF) characteristics are associated with an increased risk of developing AF over time. The aim of this study is to determine if presence of very short-lasting episodes of AF-like activity (micro-AF) can also be used as a marker of undiagnosed silent atrial fibrillation. Methods In the STROKESTOP II study, a Swedish mass screening study for AF among 75- and 76-year-olds, participants with NT-proBNP ≥125 ng/L performed intermittent ECG recordings 30 s, four times daily for 2 weeks. Participants with micro-AF (sudden onset of irregular tachycardia with episodes of ≥5 consecutive supraventricular beats and total absence of p-waves, lasting less than 30 s) were invited to undergo extended AF screening using continuous event recording for 2 weeks. A control group of individuals without micro-AF was examined using the same ECG modalities. Results Out of 3763 participants in STROKESTOP II who had elevated NT-proBNP levels and were free of AF, n = 221 (6%) had micro-AF. The majority of participants with micro-AF (n = 196) accepted further investigation with continuous ECG monitoring which showed presence of AF in 26 of them. In the control group (n = 250), continuous monitoring detected 7 new AF cases. Thus, AF was significantly more common in the micro AF group (13%) compared to the control group (3%), p < 0.001. Conclusions Presence of short-lasting episodes of AF-like activity (micro-AF) indicates increased likelihood for undetected AF. Continuous screening therefore seems recommendable if a finding of AF would change clinical management. Trail registration ClinicalTrials.gov, identifier: NCT02743416, registered April 19, 2016.
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Affiliation(s)
- Tove Fredriksson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden.
| | - Katrin Kemp Gudmundsdottir
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Viveka Frykman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Leif Friberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Faris Al-Khalili
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Johan Engdahl
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Emma Svennberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
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Drum SN, Donath L, Dehlin C, Kashou A, Noseworthy PA, Zacher J. Atrial Fibrillation: Should Lifelong Athletes Be Worried? Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Impact of re-definition of paroxysmal and persistent atrial fibrillation in the 2012 and 2016 European Society of Cardiology atrial fibrillation guidelines on outcomes after pulmonary vein isolation. J Interv Card Electrophysiol 2020; 60:115-123. [PMID: 32124151 PMCID: PMC7846547 DOI: 10.1007/s10840-020-00710-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE In the 2016 European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF), the definition of AF type has been modified compared with the 2010 guidelines and its 2012 focused update. We compared the difference of single procedure outcomes using the definitions before and after 2016 on a cohort of patients with AF undergoing AF ablation. METHODS Consecutive AF ablation patients with paroxysmal or persistent AF were retrospectively reclassified applying the 2010, 2012, and 2016 ESC definitions on AF type. RESULTS We included a total of 628 patients. Applying the 2010 ESC AF guidelines definition, 68% of patients were paroxysmal while according to the 2016 ESC AF guidelines, the proportion increased to 87%. Applying the 2010 ESC guidelines definition, recurrence rates of paroxysmal and persistent AF patients differ significantly (log-rank p < 0.001). Applying the 2012 focused update and the 2016 ESC AF guidelines, recurrence rates do not differ significantly. In a cox regression model applying the 2010 guidelines, persistent AF is the only independent predictor of AF recurrence in our cohort. However, when applying the 2016 guidelines, persistent AF is no longer a predictor of AF recurrence. CONCLUSIONS The revised definition of AF types in the 2016 ESC AF guidelines leads to a marked shift from persistent to paroxysmal AF. It appears that the old definition provided a better separator to predict rhythm outcome after AF ablation.
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Prognostic impact of new-onset atrial fibrillation associated with worsening heart failure in aging patients with severely decompensated acute heart failure. Int J Cardiol 2020; 302:88-94. [PMID: 31813678 DOI: 10.1016/j.ijcard.2019.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUNDS The prevalence of atrial fibrillation (AF) has been increasing in aging societies. The prognostic impact of AF associated with worsening heart failure (HF) remains obscure. METHODS AND RESULTS We analyzed 1170 acute heart failure (AHF) patients who required intensive care. Patients were assigned to two groups according to the prevalence of AF: no episode of AF (n = 940) and pre-existing AF (Group-1, n = 230). Patients with no episode of AF (n = 940) were further divided into two groups according to presence of new-onset of AF after admission (Group-2a, n = 258) or not (Group-2b, n = 682). Kaplan-Meier curve analysis showed that prognosis, including all-cause mortality and HF-events within 1000 days, was significantly poorer in the Group-1 compared to the Group-2b. However, a multivariate Cox regression model showed that the Group-1 was not an independent predictor of 1000-day mortality and HF-events. Furthermore, Kaplan-Meier curve analysis showed that prognosis, including all-cause mortality and HF-events within 1000 days, was significantly poorer in the Group-2a than in the Group-2b. A multivariate Cox regression model revealed that the Group-2a was an independent predictor of 1000-day mortality (HR: 1.403, 95% CI: 1.018-1.934) and HF-events (HR: 1.352, 95% CI: 1.071-1.708). A multivariate logistic regression model showed that only age (≥75 years old) was independently associated with new-onset of AF after admission (odds ratio: 1.556, 95% CI: 1.130-2.143). CONCLUSIONS New-onset AF associated with worsening HF increases with age and is independently-associated with adverse outcome in patients with AHF.
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Dretzke J, Chuchu N, Chua W, Fabritz L, Bayliss S, Kotecha D, Deeks JJ, Kirchhof P, Takwoingi Y. Prognostic models for predicting incident or recurrent atrial fibrillation: protocol for a systematic review. Syst Rev 2019; 8:221. [PMID: 31462304 PMCID: PMC6712856 DOI: 10.1186/s13643-019-1128-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 08/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the arrhythmia most commonly diagnosed in clinical practice. It is associated with significant morbidity and mortality. Prevalence of AF and complications of AF, estimated by hospitalisations, have increased dramatically in the last decade. Being able to predict AF would allow tailoring of management strategies and a focus on primary or secondary prevention. Models predicting recurrent AF would have particular clinical use for the selection of rhythm control therapy. There are existing prognostic models which combine several predictors or risk factors to generate an individualised estimate of risk of AF. The aim of this systematic review is to summarise and compare model performance measures and predictive accuracy across different models and populations at risk of developing incident or recurrent AF. METHODS Methods tailored to systematic reviews of prognostic models will be used for study identification, risk of bias assessment and synthesis. Studies will be eligible for inclusion where they report an internally or externally validated model. The quality of studies reporting a prognostic model will be assessed using the Prediction Study Risk Of Bias Assessment Tool (PROBAST). Studies will be narratively described and included variables and predictive accuracy compared across different models and populations. Meta-analysis of model performance measures for models validated in similar populations will be considered where possible. DISCUSSION To the best of our knowledge, this will be the first systematic review to collate evidence from all studies reporting on validated prognostic models, or on the impact of such models, in any population at risk of incident or recurrent AF. The review may identify models which are suitable for impact assessment in clinical practice. Should gaps in the evidence be identified, research recommendations relating to model development, validation or impact assessment will be made. Findings will be considered in the context of any models already used in clinical practice, and the extent to which these have been validated. SYSTEMATIC REVIEW REGISTRATION PROSPERO ( CRD42018111649 ).
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Affiliation(s)
- Janine Dretzke
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Naomi Chuchu
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- UHB NHS Foundation Trust, Birmingham, UK
| | - Susan Bayliss
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- UHB NHS Foundation Trust, Birmingham, UK
| | - Jonathan J. Deeks
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- UHB NHS Foundation Trust, Birmingham, UK
- SWBH NHS Trust, Birmingham, UK
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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Morovatdar N, Ebrahimi N, Rezaee R, Poorzand H, Bayat Tork MA, Sahebkar A. Sleep Duration and Risk of Atrial Fibrillation: a Systematic Review. J Atr Fibrillation 2019; 11:2132. [PMID: 31384362 DOI: 10.4022/jafib.2132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/14/2018] [Accepted: 12/26/2018] [Indexed: 12/25/2022]
Abstract
Background Little is known about a possible association between sleep duration and the incidence of atrial fibrillation (AF), in healthy people. In this systematic review, we conducted a literature search to examine possible association between sleep duration and the incidence of AF. Methods Scientific databases (PubMed, Web of Knowledge and Embase) were searched using relevant Medical Subject Headings and keywords, to retrieve studies written in English and published until November 2017. Only observational studies were included. Since sleep duration categories were not consistent, it was feasible to run a meta-analysis. Results Six eligible studies were included. Long sleep duration (≥ 8 hours) was found to be associated with an increased risk of AF (adjusted hazard ratio (aHR) = 1.13; 95% CI: 1.00-1.27 and aHR= 1.5, 95% CI: 1.07-2.10) in two studies. One study reported that sleep duration less than 6 hours was associated with an increased risk of AF (aHR= 1.58, 95% CI: 1.18 -2.13) compared to sleeping for 6-7 hours. In two studies, mean sleep duration was lower in AF groups compared to the non-AF group. Insomnia was associated with an increased risk of AF in another study (aHR= 1.33, 95% CI: 1.25-1.41). Conclusions Unhealthy sleep duration, defined as either less than 6 hours or more than 8 hours, may be associated with an increased risk of AF.
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Affiliation(s)
- Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Ebrahimi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoorak Poorzand
- Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Incidence and predictors of atrial fibrillation progression: A systematic review and meta-analysis. Heart Rhythm 2019; 16:502-510. [DOI: 10.1016/j.hrthm.2018.10.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 01/07/2023]
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Kvist LM, Vinter N, Urbonaviciene G, Lindholt JS, Diederichsen ACP, Frost L. Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers. Open Heart 2019; 6:e000942. [PMID: 30997131 PMCID: PMC6443120 DOI: 10.1136/openhrt-2018-000942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/11/2018] [Accepted: 02/03/2019] [Indexed: 11/18/2022] Open
Abstract
Aim We examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF). Methods Based on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 1338 randomly selected Danish men aged 65–74 years with no exclusion criteria. The participants were screened with single-lead ECG during a CT scan assessed by radiographers and 12-lead ECG assessed by cardiac nurses. The diagnostic accuracy was evaluated compared with that produced by a 12-lead ECG assessed by two consenting cardiologists. Results The study identified 68 participants with ongoing AF, of whom 60 had self-reported AF and 8 had AF detected in the screening. Single-lead ECG assessed for AF by radiographers had a sensitivity of 60.3% (95% CI 47.7 to 72.0), specificity of 97.2% (95% CI 96.2 to 98.1), positive predictive value (PPV) of 53.9% (95% CI 42.1 to 65.5) and negative predictive value (NPV) of 97.9% (95% CI 96.9 to 98.6). 12-lead ECG assessed by cardiac nurses had a sensitivity of 97.1% (95% CI 89.8 to 99.6), specificity of 100% (95% CI 99.7 to 100), PPV of 100% (95% CI 94.6 to 100) and NPV of 99.8% (95% CI 99.4 to 100). Conclusions Single-lead ECG assessed by radiographers had a moderate sensitivity and PPV but a very high specificity and NPV. Using radiographers may be acceptable for opportunistic screening, in particular if radiographers are thoroughly trained. Thus, 12-lead ECG assessed by cardiac nurses is a potential diagnostic method for the detection of AF.
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Affiliation(s)
| | - Nicklas Vinter
- Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Grazina Urbonaviciene
- Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense Universitetshospital, Odense, Denmark
| | | | - Lars Frost
- Department of Medicine, Silkeborg Regional Hospital and Cardiovascular Research Centre Viborg and Silkeborg Hospital and Institute of Clinical Medicine, Aarhus University Hospital Denmark, Silkeborg, Denmark
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Manninger M, Ebner J, Zweiker D, Sieghartsleitner R, Mastnak B, Bisping E, Lercher P, Riedlbauer R, Rotman B, Brussee H, Scherr D. Is there a difference in rhythm outcome between patients undergoing first line versus second line paroxysmal atrial fibrillation ablation? PLoS One 2018; 13:e0208994. [PMID: 30532216 PMCID: PMC6285381 DOI: 10.1371/journal.pone.0208994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 11/28/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Catheter ablation of atrial fibrillation (AF) is an established second line therapy for patients with symptomatic paroxysmal AF (PAF) and may be considered as a first line therapy in selected patients who are highly symptomatic, considering patient choice, benefit, and risk, according to recent guidelines. Our study investigated whether a first line vs. second line ablation approach may result in improved sinus rhythm maintenance after ablation. METHODS A total of 153 patients undergoing pulmonary vein isolation for PAF were included in the study (age 55±12 years, 29% female). Seventy-nine patients underwent first line AF ablation and 74 patients underwent second line AF ablation after failed antiarrhythmic drug therapy. There was no significant difference in baseline characteristics such as age, history of AF, left atrial size or LVEF between groups. Success was defined as atrial tachyarrhythmia free survival during a 12-month follow-up by means of serial ECG Holter monitoring. RESULTS There was no significant difference in cumulative arrhythmia-free survival between those patients who received AF ablation as a first or second line therapy. Single procedure success was 78% in the first line group vs. 81% in the second line group; multiple procedure success was 90 vs. 91%, (n.s.). Complication rate was 1.3% vs. 1.4% (n.s.). CONCLUSION Success of AF ablation did not differ between patients who receive ablation as first vs. second line therapy. Based on these data, a trial of AAD therapy before AF ablation may be justified in most patients with symptomatic PAF eligible for rhythm control.
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Affiliation(s)
- Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jakob Ebner
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - David Zweiker
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Raphael Sieghartsleitner
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bernadette Mastnak
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Egbert Bisping
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Lercher
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Rita Riedlbauer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Brigitte Rotman
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Helmut Brussee
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Limburg, The Netherlands
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Zhao L, Liu C, Wei S, Shen Q, Zhou F, Li J. A New Entropy-Based Atrial Fibrillation Detection Method for Scanning Wearable ECG Recordings. ENTROPY 2018; 20:e20120904. [PMID: 33266628 PMCID: PMC7512487 DOI: 10.3390/e20120904] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/18/2018] [Accepted: 11/23/2018] [Indexed: 01/03/2023]
Abstract
Entropy-based atrial fibrillation (AF) detectors have been applied for short-term electrocardiogram (ECG) analysis. However, existing methods suffer from several limitations. To enhance the performance of entropy-based AF detectors, we have developed a new entropy measure, named EntropyAF, which includes the following improvements: (1) use of a ranged function rather than the Chebyshev function to define vector distance, (2) use of a fuzzy function to determine vector similarity, (3) replacement of the probability estimation with density estimation for entropy calculation, (4) use of a flexible distance threshold parameter, and (5) use of adjusted entropy results for the heart rate effect. EntropyAF was trained using the MIT-BIH Atrial Fibrillation (AF) database, and tested on the clinical wearable long-term AF recordings. Three previous entropy-based AF detectors were used for comparison: sample entropy (SampEn), fuzzy measure entropy (FuzzyMEn) and coefficient of sample entropy (COSEn). For classifying AF and non-AF rhythms in the MIT-BIH AF database, EntropyAF achieved the highest area under receiver operating characteristic curve (AUC) values of 98.15% when using a 30-beat time window, which was higher than COSEn with AUC of 91.86%. SampEn and FuzzyMEn resulted in much lower AUCs of 74.68% and 79.24% respectively. For classifying AF and non-AF rhythms in the clinical wearable AF database, EntropyAF also generated the largest values of Youden index (77.94%), sensitivity (92.77%), specificity (85.17%), accuracy (87.10%), positive predictivity (68.09%) and negative predictivity (97.18%). COSEn had the second-best accuracy of 78.63%, followed by an accuracy of 65.08% in FuzzyMEn and an accuracy of 59.91% in SampEn. The new proposed EntropyAF also generated highest classification accuracy when using a 12-beat time window. In addition, the results from time cost analysis verified the efficiency of the new EntropyAF. This study showed the better discrimination ability for identifying AF when using EntropyAF method, indicating that it would be useful for the practical clinical wearable AF scanning.
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Affiliation(s)
- Lina Zhao
- School of Control Science and Engineering, Shandong University, Jinan 250061, China
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Chengyu Liu
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
- Correspondence: (C.L.); (S.W.); Tel./Fax: +86-25-8379-3993 (C.L.); +86-531-8839-2827 (S.W.)
| | - Shoushui Wei
- School of Control Science and Engineering, Shandong University, Jinan 250061, China
- Correspondence: (C.L.); (S.W.); Tel./Fax: +86-25-8379-3993 (C.L.); +86-531-8839-2827 (S.W.)
| | - Qin Shen
- Department of Cardiovascular Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Fan Zhou
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Jianqing Li
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
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Atrial fibrillation reduction by renal sympathetic denervation: 12 months' results of the AFFORD study. Clin Res Cardiol 2018; 108:634-642. [PMID: 30413869 PMCID: PMC6529371 DOI: 10.1007/s00392-018-1391-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
Aim The purpose of this pilot study was to assess whether renal sympathetic denervation (RDN) decreases atrial fibrillation (AF) burden in hypertensive patients with symptomatic AF at 6- and 12-month follow-up, as measured using an implantable cardiac monitor (ICM). Methods and results A total of 20 patients with symptomatic paroxysmal or persistent AF (EHRA ≥ II) and primary hypertension with a mean office systolic blood pressure (BP) of > 140 mmHg were enrolled. After enrolment, an ICM was implanted 3 months pre-RDN to monitor AF burden. Quality of life (QOL) was assessed using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. Mean age was 64 ± 7 years and 55% were females. AF burden in min/day decreased from a median (IQR) of 1.39 (0–11) pre-RDN to 0.67 (0–31.6) at 6 months (p = 0.64) and to 0.94 (0–6.0) at 12 months (pre-RDN vs. 12 months; p = 0.03). QOL improved significantly at both 6 months (+ 11 ± 15 points, p = 0.006) and 12 months (+ 10 ± 19, p = 0.04) as compared to pre-RDN. Office BP decreased significantly at 12-month follow-up (− 20 ± 19/− 7 ± 10 mmHg), p < 0.01) as compared to pre-RDN. Ambulatory BP decreased − 7 ± 16/− 3 ± 9 mmHg (p > 0.05) at 12-month follow-up as compared to pre-RDN. Conclusion This pilot study suggests that RDN might be able to decrease AF burden in min/day as measured using an ICM, with a positive effect on QOL. Large-scale randomized trials are needed to prove the definite value of RDN in hypertensive patients with atrial fibrillation. Electronic supplementary material The online version of this article (10.1007/s00392-018-1391-3) contains supplementary material, which is available to authorized users.
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