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Dicorato MM, Basile P, Naccarati ML, Carella MC, Dentamaro I, Falagario A, Cicco S, Forleo C, Guaricci AI, Ciccone MM, Santobuono VE. Predicting New-Onset Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Review. J Clin Med 2025; 14:2018. [PMID: 40142825 PMCID: PMC11942920 DOI: 10.3390/jcm14062018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 03/13/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a condition characterized by left ventricular hypertrophy, with physiopathological remodeling that predisposes patients to atrial fibrillation (AF). The electrocardiogram is a basic diagnostic tool for evaluating heart electrical activity. Key electrocardiographic features that correlate with AF onset are P-wave duration, P-wave dispersion, and electromechanical delay in left atrium (LA). Clinical markers, including age, body mass index, New York Heart Association functional class, and heart failure symptoms, are also strong predictors of AF in HCM. Risk scores have been created using multiple variables to better predict AF development. Increasing knowledge of genetic subsets in HCM and cardiovascular pathology in general has provided novel insight in this context. Structural and mechanical LA remodeling, including fibrosis, altered LA function, and changes in atrial size, further contribute to AF risk prediction. Cardiovascular magnetic resonance (CMR) and echocardiographic measures provide accurate information about atrial structure and function. Machine learning models are increasingly being utilized to refine risk prediction, incorporating a wide range of variables. This review highlights the multifaceted approach required to understand and predict AF development in HCM. Such an approach is imperative to enhance prognostic accuracy and improve the quality of life of these patients. Further research is necessary to refine patient outcomes and develop customized management strategies for HCM-associated AF.
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Affiliation(s)
- Marco Maria Dicorato
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Paolo Basile
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Maria Ludovica Naccarati
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Maria Cristina Carella
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Ilaria Dentamaro
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Alessio Falagario
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Sebastiano Cicco
- Internal Medicine Unit “Guido Baccelli”—Arterial Hypertension Unit “Anna Maria Pirrelli”, Department of Precision and Regenerative Medicine and Jonic Area (DiMePReJ), University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy;
| | - Cinzia Forleo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Andrea Igoren Guaricci
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Marco Matteo Ciccone
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
| | - Vincenzo Ezio Santobuono
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (M.M.D.); (P.B.); (M.L.N.); (M.C.C.); (I.D.); (A.F.); (C.F.); (A.I.G.); (M.M.C.)
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Birză MR, Negru AG, Frent ȘM, Florescu AR, Popa AM, Manzur AR, Lascu A, Mihaicuța S. New Insights of Cardiac Arrhythmias Associated with Sleep-Disordered Breathing: From Mechanisms to Clinical Implications-A Narrative Review. J Clin Med 2025; 14:1922. [PMID: 40142730 PMCID: PMC11942725 DOI: 10.3390/jcm14061922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Revised: 03/01/2025] [Accepted: 03/07/2025] [Indexed: 03/28/2025] Open
Abstract
Although most research has concentrated on the link between sleep apnea and atrial fibrillation, obstructive sleep apnea (OSA) is also associated with ventricular arrhythmias. These cardiac arrhythmias can be triggered by repeated episodes of hypoxemia, hypercapnia, acidosis, intrathoracic pressure fluctuations, reoxygenation, and other mechanisms that occur during apnea and hypopnea. Studies show that OSA reduces the effectiveness of arrhythmia treatments, such as antiarrhythmic medications and radiofrequency current ablation. Several non-randomized studies indicate that treating sleep apnea syndrome with continuous positive airway pressure (CPAP) may help maintain sinus rhythm following electrical cardioversion and increase the success rates of catheter ablation. This review aims to thoroughly examine the role of OSA in the development of cardiac arrhythmias. Screening for OSA and arrhythmias in patients with OSA provides vital information on the need for additional interventions, such as CPAP therapy, anticoagulation, antiarrhythmic drug therapy, catheter ablation for specific arrhythmias, or device therapy. New therapies for OSA treatment have the potential to significantly influence arrhythmia development in patients with sleep-disordered breathing. However, further research is required to validate these findings and formulate comprehensive treatment protocols.
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Affiliation(s)
- Mariela Romina Birză
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (M.R.B.); (Ș.M.F.); (A.-R.F.); (A.M.P.); (A.R.M.); (S.M.)
| | - Alina Gabriela Negru
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ștefan Marian Frent
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (M.R.B.); (Ș.M.F.); (A.-R.F.); (A.M.P.); (A.R.M.); (S.M.)
| | - Andreea-Roxana Florescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (M.R.B.); (Ș.M.F.); (A.-R.F.); (A.M.P.); (A.R.M.); (S.M.)
| | - Alina Mirela Popa
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (M.R.B.); (Ș.M.F.); (A.-R.F.); (A.M.P.); (A.R.M.); (S.M.)
| | - Andrei Raul Manzur
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (M.R.B.); (Ș.M.F.); (A.-R.F.); (A.M.P.); (A.R.M.); (S.M.)
| | - Ana Lascu
- Discipline of Pathophysiology, Department III of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Splaiul Tudor Vladimirescu nr. 14, 300173 Timisoara, Romania;
| | - Stefan Mihaicuța
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania; (M.R.B.); (Ș.M.F.); (A.-R.F.); (A.M.P.); (A.R.M.); (S.M.)
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Kim YG, Lee HS, Kim H, Kim M, Jeong JH, Choi YY, Shim J, Choi JI, Kim YH. Increased Mortality Associated with Amiodarone Compared to Other Antiarrhythmic Drugs in New-Onset Atrial Fibrillation. J Clin Med 2025; 14:1168. [PMID: 40004699 PMCID: PMC11856129 DOI: 10.3390/jcm14041168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Revised: 02/03/2025] [Accepted: 02/05/2025] [Indexed: 02/27/2025] Open
Abstract
Background and Aims: Antiarrhythmic drugs (AADs) are the primary treatment for maintaining sinus rhythm in patients with atrial fibrillation (AF). While amiodarone is mainly used in patients with structural heart disease, its effects on all-cause mortality compared to other AADs remain unclear. Methods: This study utilized nationwide healthcare insurance data involving patients with new-onset AF from 2013 to 2019. We identified patients who were prescribed with AADs ≥ six months within the first year of diagnosis (medication possession ratio ≥ 0.5). All-cause mortality was assessed between amiodarone and other AAD users up to three years post-AAD-prescription. Results: Among 770,977 new-onset AF patients, 12,243 were amiodarone users and 33,036 were prescribed with other AADs. Significant differences in mean age and prevalence of medical conditions such as heart failure, myocardial infarction, chronic kidney disease, diabetes, and dyslipidemia were noted. After propensity score matching, 12,017 amiodarone users were compared to an equal number of other AAD users with similar baseline characteristics. Multivariate analysis indicated a 2.9-fold increase in all-cause mortality for amiodarone users (hazard ratio = 2.88; 95% confidence interval = 2.64-3.15; p < 0.001). This increased risk was more pronounced among women compared with men (hazard ratio = 3.38 vs. 2.56; p for interaction = 0.004). Amiodarone was associated with increased mortality in AF patients with heart failure and myocardial infarction. Conclusions: Amiodarone, compared with non-amiodarone AADs, was associated with increased risk of all-cause mortality in AAD-naive new-onset AF patients. Increased all-cause mortality associated with amiodarone was consistent throughout various subgroups. Significant interaction was observed with the sex category, with women being more vulnerable to amiodarone.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02708, Republic of Korea; (Y.G.K.); (H.S.L.); (J.H.J.); (Y.Y.C.); (J.S.); (Y.-H.K.)
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02708, Republic of Korea; (Y.G.K.); (H.S.L.); (J.H.J.); (Y.Y.C.); (J.S.); (Y.-H.K.)
| | - Hoseob Kim
- Department of Data Science, Hanmi Pharm Co., Ltd., Seoul 05545, Republic of Korea; (H.K.); (M.K.)
| | - Mina Kim
- Department of Data Science, Hanmi Pharm Co., Ltd., Seoul 05545, Republic of Korea; (H.K.); (M.K.)
| | - Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02708, Republic of Korea; (Y.G.K.); (H.S.L.); (J.H.J.); (Y.Y.C.); (J.S.); (Y.-H.K.)
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02708, Republic of Korea; (Y.G.K.); (H.S.L.); (J.H.J.); (Y.Y.C.); (J.S.); (Y.-H.K.)
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02708, Republic of Korea; (Y.G.K.); (H.S.L.); (J.H.J.); (Y.Y.C.); (J.S.); (Y.-H.K.)
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02708, Republic of Korea; (Y.G.K.); (H.S.L.); (J.H.J.); (Y.Y.C.); (J.S.); (Y.-H.K.)
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02708, Republic of Korea; (Y.G.K.); (H.S.L.); (J.H.J.); (Y.Y.C.); (J.S.); (Y.-H.K.)
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Testa C, Salvi M, Zucchini I, Cattabiani C, Giallauria F, Petraglia L, Leosco D, Lauretani F, Maggio M. Atrial Fibrillation as a Geriatric Syndrome: Why Are Frailty and Disability Often Confused? A Geriatric Perspective from the New Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:179. [PMID: 40003404 PMCID: PMC11855129 DOI: 10.3390/ijerph22020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 01/22/2025] [Accepted: 01/24/2025] [Indexed: 02/27/2025]
Abstract
Atrial Fibrillation can be considered a geriatric syndrome for its prevalence and incidence, its impact on patients' quality of life, and Health Systems' economy. The European Society of Cardiology 2024 guidelines introduce a recommendation for maintaining vitamin K antagonist therapy over switching to direct oral anticoagulants in clinically stable elderly patients with atrial fibrillation. This article explores the implications of this indication for the geriatric clinical context. The focus will also be devoted to the need for the stratification of older patients with atrial fibrillation, making an appropriate distinction between frailty and disability.
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Affiliation(s)
- Crescenzo Testa
- Geriatric Clinic Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.T.); (I.Z.); (C.C.); (M.M.)
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Marco Salvi
- Geriatric Clinic Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.T.); (I.Z.); (C.C.); (M.M.)
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Irene Zucchini
- Geriatric Clinic Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.T.); (I.Z.); (C.C.); (M.M.)
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Cattabiani
- Geriatric Clinic Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.T.); (I.Z.); (C.C.); (M.M.)
| | - Francesco Giallauria
- Department of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, Italy; (F.G.); (L.P.); (D.L.)
| | - Laura Petraglia
- Department of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, Italy; (F.G.); (L.P.); (D.L.)
| | - Dario Leosco
- Department of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, Italy; (F.G.); (L.P.); (D.L.)
| | - Fulvio Lauretani
- Geriatric Clinic Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.T.); (I.Z.); (C.C.); (M.M.)
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Marcello Maggio
- Geriatric Clinic Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.T.); (I.Z.); (C.C.); (M.M.)
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
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Hytting J, Celik S, Bodeström Eriksson L, Mallios P, Digerfeldt C, Waldemar A, Wijkman M, Singull M, Hubbert L. Prevalence of abnormal thyroid hormone levels in acute new-onset atrial fibrillation. Front Cardiovasc Med 2025; 11:1518297. [PMID: 39866801 PMCID: PMC11757249 DOI: 10.3389/fcvm.2024.1518297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 12/23/2024] [Indexed: 01/28/2025] Open
Abstract
Introduction Known risk factors for new-onset atrial fibrillation/flutter (NOAF) include thyrotoxicosis and subclinical hypothyroidism. While prior research has predominantly explored the link between thyrotoxicosis and NOAF, the presence of subclinical hypothyroidism among patients presenting with acute NOAF in the emergency department (ED) remains an underexplored area of inquiry. This study aimed to assess the prevalence of undiagnosed thyrotoxicosis and subclinical hypothyroidism in patients with acute NOAF diagnosed in the ED. Methods This registry-based cohort study was conducted in the ED at Vrinnevi Hospital in Sweden during the years 2018, 2020, and 2022, with a 1-year follow-up period. Patients ≥18 years diagnosed with NOAF in the ED, with no ongoing thyroid hormone substitution or previous documented thyroid abnormality within the past 2 years, were included. The primary outcome was the diagnosis of thyrotoxicosis or subclinical hypothyroidism either in the ED or during a 1-year follow-up period. Results 486 patients with NOAF were included in the study (43.6% females). 329 (67.7%) underwent thyroid function testing in the ED or by the end of the 1-year follow-up. In total, 16 (4.9%) patients presented with subclinical hypothyroidism while 4 (1.2%) patients presented with clinical or subclinical thyrotoxicosis. Discussion This study found that subclinical hypothyroidism was more prevalent (4.9%) than thyrotoxicosis (1.2%) among patients presenting with acute NOAF. These findings contrast with previous research that has predominantly linked thyrotoxicosis with acute NOAF, suggesting the need for further studies including both subclinical hypothyroidism and thyrotoxicosis in patients with NOAF.
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Affiliation(s)
- Jakob Hytting
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden
| | - Serkan Celik
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden
| | - Linus Bodeström Eriksson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden
| | - Panagiotis Mallios
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden
| | - Christofer Digerfeldt
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden
| | - Annette Waldemar
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden
| | - Magnus Wijkman
- Department of Medicine and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden
| | - Martin Singull
- Department of Mathematics, Linkoping University, Linkoping, Sweden
| | - Laila Hubbert
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Norrkoping, Sweden
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Clua-Espuny JL, Hernández-Pinilla A, Gentille-Lorente D, Muria-Subirats E, Forcadell-Arenas T, de Diego-Cabanes C, Ribas-Seguí D, Diaz-Vilarasau A, Molins-Rojas C, Palleja-Millan M, Satué-Gracia EM, Martín-Luján F. Evidence Gaps and Lessons in the Early Detection of Atrial Fibrillation: A Prospective Study in a Primary Care Setting (PREFATE Study). Biomedicines 2025; 13:119. [PMID: 39857703 PMCID: PMC11759169 DOI: 10.3390/biomedicines13010119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 12/27/2024] [Accepted: 12/28/2024] [Indexed: 01/27/2025] Open
Abstract
Background/Objectives: In Europe, the prevalence of AF is expected to increase 2.5-fold over the next 50 years with a lifetime risk of 1 in 3-5 individuals after the age of 55 years and a 34% rise in AF-related strokes. The PREFATE project investigates evidence gaps in the early detection of atrial fibrillation in high-risk populations within primary care. This study aims to estimate the prevalence of device-detected atrial fibrillation (DDAF) and assess the feasibility and impact of systematic screening in routine primary care. Methods: The prospective cohort study (NCT05772806) included 149 patients aged 65-85 years, identified as high-risk for AF. Participants underwent 14 days of cardiac rhythm monitoring using the Fibricheck® app (CE certificate number BE16/819942412), alongside evaluations with standard ECG and transthoracic echocardiography. The primary endpoint was a new AF diagnosis confirmed by ECG or Holter monitoring. Statistical analyses examined relationships between AF and clinical, echocardiographic, and biomarker variables. Results: A total of 18 cases (12.08%) were identified as positive for possible DDAF using FibriCheck® and 13 new cases of AF were diagnosed during follow-up, with a 71.4-fold higher probability of confirming AF in FibriCheck®-positive individuals than in FibriCheck®-negative individuals, resulting in a post-test odds of 87.7%. Significant echocardiographic markers of AF included reduced left atrial strain (<26%) and left atrial ejection fraction (<50%). MVP ECG risk scores ≥ 4 strongly predicted new AF diagnoses. However, inconsistencies in monitoring outcomes and limitations in current guidelines, particularly regarding AF burden, were observed. Conclusions: The study underscores the feasibility and utility of AF screening in primary care but identifies critical gaps in diagnostic criteria, anticoagulation thresholds, and guideline recommendations.
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Affiliation(s)
- Josep L. Clua-Espuny
- Ebrictus Research Group, Research Support Unit Terres de l’Ebre, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 43500 Tortosa, Spain
- Primary Health-Care Centre Tortosa Est, Institut Català de la Salut, Primary Care Service (SAP) Terres de l’Ebre, 43500 Tortosa, Spain
| | - Alba Hernández-Pinilla
- Servicio de Atención Primaria Camp de Tarragona, Institut Català de la Salut, 43761 Tarragona, Spain;
| | - Delicia Gentille-Lorente
- Servicio de Cardiología, Hospital Virgen de la Cinta de Tortosa, Institut Català de la Salut, 43500 Tortosa, Spain;
| | - Eulàlia Muria-Subirats
- Primary Health-Care Centre Amposta, Institute Català de la Salut, Primary Care Service (SAP) Terres de l’Ebre, 43870 Amposta, Spain;
| | - Teresa Forcadell-Arenas
- Primary Health-Care Centre Tortosa Oest, Institute Català de la Salut, Primary Care Service (SAP) Terres de l’Ebre, 43500 Tortosa, Spain;
| | - Cinta de Diego-Cabanes
- Primary Health-Care Centre Salou, Institute Català de la Salut, Department of Primary Care Camp de Tarragona, 43840 Salou, Spain;
| | - Domingo Ribas-Seguí
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (D.R.-S.); (A.D.-V.)
| | - Anna Diaz-Vilarasau
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (D.R.-S.); (A.D.-V.)
| | - Cristina Molins-Rojas
- Primary Health-Care Centre Sant Pere I Sant Pau, Institute Català de la Salut, Department of Primary Care Camp de Tarragona, 43007 Tarragona, Spain;
| | - Meritxell Palleja-Millan
- Unitat de Suport a la Recerca Camp de Tarragona-Reus, Institut de Recerca en Atenció Primària Jordi Gol, 43201 Reus, Spain;
| | - Eva M. Satué-Gracia
- Unitat de Suport a la Recerca, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43201 Reus, Spain; (E.M.S.-G.); (F.M.-L.)
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43201 Reus, Spain; (E.M.S.-G.); (F.M.-L.)
- Departament de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43206 Reus, Spain
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7
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Lavalle C, Pierucci N, Mariani MV, Piro A, Borrelli A, Grimaldi M, Rossillo A, Notarstefano P, Compagnucci P, Dello Russo A, Perna F, Pelargonio G, LA Fazia VM, Della Rocca DG, Miraldi F, Forleo GB. Italian Registry in the Setting of Atrial Fibrillation Ablation with Rivaroxaban - IRIS. Minerva Cardiol Angiol 2024; 72:625-637. [PMID: 38814252 DOI: 10.23736/s2724-5683.24.06546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Catheter ablation (CA) of atrial fibrillation is routinely used to obtain rhythm control. Evidence suggest that catheter ablation should be done during uninterrupted oral anticoagulation. METHODS Italian Registry in the setting of atrial fibrillation ablation with rivaroxaban (IRIS) is an Italian multicenter, non-interventional, prospective study which enrolled 250 consecutive atrial fibrillation patients eligible for catheter ablation on rivaroxaban. The decision for rivaroxaban management was left to the physician: uninterrupted or shortly interrupted prior to Catheter ablation. Patients received a follow-up visit at 1 month and 12 months after the procedure. RESULTS The primary outcome, represented by all-cause death and systemic embolism at 1 month and 12 months was characterized by one transient ischemic attack and one myocardial infarction in the first 30 days. Both events happened in patients with shortly interrupted strategy (P=0.147), and both in patients who underwent radiofrequency ablation (P=0.737). In the primary safety outcome represented by major bleeding we did not register any event in the 12-month follow-up. The secondary outcome constituted by minor bleeding registered 1 event, after the first 30 days since CA. CONCLUSIONS IRIS is the biggest real-life data registry regarding CA ablation on rivaroxaban in Italian setting, proving the safety and efficacy of rivaroxaban.
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Affiliation(s)
- Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy -
| | - Marco V Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy
| | | | - Massimo Grimaldi
- Department of Cardiology, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | | | | | - Paolo Compagnucci
- Department of Biomedical Science and Public Health, Clinic of Cardiology and Arrhythmology, Ospedali Riuniti University Hospital, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Department of Biomedical Science and Public Health, Clinic of Cardiology and Arrhythmology, Ospedali Riuniti University Hospital, Marche Polytechnic University, Ancona, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Vincenzo M LA Fazia
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Domenico G Della Rocca
- Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Heart Rhythm Management Center, University Hospital of Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Fabio Miraldi
- Department of Cardio-Thoracic-Vascular and Organ Transplantation Surgery, Umberto I Polyclinic Hospital, Rome, Italy
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8
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Li X, Yu H, Lai S, Liao Y, Yang Y, Tian K, Zhong Y, Chen X. Validation Strategy for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation in Long-Term Maintaining Sinus Rhythm: A Randomized Controlled Study. Cardiol Res Pract 2024; 2024:3672210. [PMID: 39445173 PMCID: PMC11496574 DOI: 10.1155/2024/3672210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/30/2024] [Accepted: 09/27/2024] [Indexed: 10/25/2024] Open
Abstract
Background: Data comparing the outcomes of loose versus rigorous validation strategies for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF) are limited. We aimed to prospectively assess the effectiveness of loose versus rigorous validation for PVI in patients with PAF with a maintained sinus rhythm. Methods: Patients (n = 117) with PAF were randomized to receive either loose validation (n = 59) or rigorous validation (n = 58) after PVI. The presence of dormant conduction in loose validation was assessed only by adenosine administration followed by isoproterenol infusion. The complete absence of pulmonary vein (PV) potentials in rigorous validation was confirmed by the combination of the Lasso catheter with isoproterenol plus adenosine. Dormant conduction, revealed by validation after PVI, was ablated until all reconnections were eliminated. Results: The procedure time in the rigorous validation group was greater than that in the loose validation group (161.3 ± 52.7 min vs. 142.5 ± 37.6 min, p=0.03, respectively). After successful PVI, the detection of dormant PV reconnections in the rigorous validation group was significantly greater than that in the loose validation group (69.0% vs. 37.3%, p=0.001). However, after reisolation of the sites of dormant PV conduction, the postablation recurrence rates in 1.3 years were similar between the groups (79.2% vs. 83.6%, p=0.67). Conclusion: Rigorous validation can reveal dormant conduction in more than two-thirds of patients with PAF undergoing PVI. However, rigorous validation and additional ablation of the resulting connections do not improve long-term outcomes when a protocol that includes electrophysiological confirmation and pharmacological validation is used.
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Affiliation(s)
- Xinyu Li
- Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Houdeng Yu
- Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Shihuang Lai
- Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yaqi Liao
- Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yihong Yang
- Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Kejun Tian
- Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yiming Zhong
- Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xinguang Chen
- Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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9
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Zhang Y, Tang L, Zhang K, Meng X, Liu T, Chen Y, Huang X. Causal association between common rheumatic diseases and arrhythmia: a Mendelian randomization study. Front Cardiovasc Med 2024; 11:1419466. [PMID: 39411172 PMCID: PMC11473426 DOI: 10.3389/fcvm.2024.1419466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 09/23/2024] [Indexed: 10/19/2024] Open
Abstract
Background Observational studies have suggested a link between rheumatic diseases and arrhythmias. However, these studies have been limited by confounding factors and reverse causality, leaving the causal relationship between rheumatic diseases and arrhythmias uncertain. This study addresses this inquiry using genetic evidence. Methods Selected single nucleotide polymorphisms (SNPs) from genome-wide association study (GWAS) data were employed as instrumental variables. Inverse variance weighting (IVW), MR-Egger regression, and the weighted median method were utilized in the two-sample Mendelian randomization analysis. Horizontal pleiotropy was identified and rectified through the MR-PRESSO test and MR-Egger regression. The stability and reliability of the Mendelian randomization results were appraised using the remain-one method, Cochran Q-test, and funnel plot. Odds ratios (OR) were utilized to assess the causal relationship between six rheumatic diseases and five types of arrhythmias. Results The Inverse Variance Weighted (IVW) method indicated a significant association between rheumatoid arthritis (RA) and an elevated risk of right bundle branch block (RBBB) (OR: 1.10, 95% CI: 1.02-1.18, p = 0.009). Additionally, gout was significantly correlated with an augmented risk of RBBB (OR: 1.28, 95% CI: 1.09-1.51, p = 0.003). Conversely, dermatomyositis (DM) exhibited a negative association with the risk of atrioventricular block (AVB) (OR: 0.94, 95% CI: 0.90-0.99, p = 0.020). No significant associations were observed between other rheumatic diseases and arrhythmias. Conclusion A two-sample Mendelian Randomization (MR) study provides data indicating that in European populations, a genetically predicted gout or rheumatoid arthritis (RA) may increase the incidence of right bundle branch block (RBBB). To clarify and investigate the processes behind these causal links, more research is necessary. Because racial genetic variability exists, care should be used when interpreting our findings.
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Affiliation(s)
- Yuchen Zhang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Tang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke Zhang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xinai Meng
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tian Liu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanjia Chen
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xingfu Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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10
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Jeong JH, Baek YS, Park J, Park HW, Choi EK, Park JK, Kang KW, Kim J, Lee YS, Kim JB, Choi JI, Joung B, Shim J. Impact of Atrial Fibrillation with Rapid Ventricular Response on Atrial Fibrillation Recurrence: From the CODE-AF Registry. J Clin Med 2024; 13:5469. [PMID: 39336961 PMCID: PMC11432096 DOI: 10.3390/jcm13185469] [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: 08/26/2024] [Revised: 09/08/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: Relatively little has been established about the association of rapid ventricular response (RVR) with further recurrence of atrial fibrillation (AF). This study investigated the impact of RVR on the recurrence of AF. Methods: Data were obtained from a multicenter, prospective registry of non-valvular AF patients. RVR was defined as AF with a ventricular rate > 110 bpm. The primary endpoint was the recurrence of AF, defined as the first AF detected on 12-lead electrocardiography during follow-up. Secondary endpoints included manifestation of AF during follow-up and major adverse cardiovascular events (MACEs), a composite of thromboembolic events, major bleeding, myocardial infarction, and death. Results: Among 5533 patients, 493 (8.9%) presented RVR. Patients with RVR were younger, had smaller left atrial diameters, and more frequently had paroxysmal AF. During the mean follow-up duration of 28.6 months, the RVR group exhibited significantly lower recurrence of AF (hazard ratio: 0.58, 95% confidence interval: 0.53-0.65, p < 0.001). There was no significant difference in the occurrence of MACEs between patients with RVR and those without RVR (0.96, 0.70-1.31, p = 0.800). AF with RVR was identified as an independent negative predictor of AF recurrence (0.61, 0.53-0.71, p < 0.001). Conclusions: In patients with AF, those with RVR had a significantly lower recurrence of AF without an increase in MACEs. RVR is a favorable marker that may benefit from early rhythm control.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Yong-Soo Baek
- Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju 61469, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jin-Kyu Park
- Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Ki-Woon Kang
- Division of Cardiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Jun Kim
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Young Soo Lee
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu, Daegu 42472, Republic of Korea
| | - Jin-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
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11
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Nabil MA, Rychlik L, Nicholson A, Cheung P, Olsovsky GD, Molden J, Tripuraneni A, Hajivandi SS, Banchs JE. Dietary interventions in the management of atrial fibrillation. Front Cardiovasc Med 2024; 11:1418059. [PMID: 39149585 PMCID: PMC11324562 DOI: 10.3389/fcvm.2024.1418059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
Atrial fibrillation (AF) represents the most common cardiac arrhythmia with significant morbidity and mortality implications. It is a common cause of hospital admissions, significantly impacts quality of life, increases morbidity and decreases life expectancy. Despite advancements in treatment options, prevalence of AF remains exceptionally high. AF is a challenging disease to manage, not just clinically but also financially. Evidence suggests lifestyle modification, including dietary changes, plays a significant role in the treatment of AF. This review aims to analyze the existing literature on the effects of dietary modifications on the incidence, progression, and outcomes of atrial fibrillation. It examines various dietary components, including alcohol, caffeine, omega-3 polyunsaturated fatty acids and minerals, and their impact on AF incidence, progression, and outcomes. The evidence surrounding the effects of dietary patterns, such as the Mediterranean and low carbohydrate diets, on AF is also evaluated. Overall, this review underscores the importance of dietary interventions as part of a comprehensive approach to AF management and highlights the need for further research in this emerging field.
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Affiliation(s)
- Muhammad Ahad Nabil
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Round Rock, TX, United States
| | - Leanne Rychlik
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Temple, TX, United States
| | - Audrey Nicholson
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Round Rock, TX, United States
| | - Peter Cheung
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Round Rock, TX, United States
| | - Gregory D Olsovsky
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Temple, TX, United States
| | - Jaime Molden
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Temple, TX, United States
| | - Ajay Tripuraneni
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Temple, TX, United States
| | - Shayan-Salehi Hajivandi
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Round Rock, TX, United States
| | - Javier E Banchs
- Department of Medicine, Division of Cardiology, Baylor Scott & White Health, Temple, TX, United States
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12
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Liang J, Tang L, Yang J, Li Y, Yang X, Hou C. Gastroesophageal reflux disease and risk for arrhythmias: a Mendelian randomization analysis. Front Cardiovasc Med 2024; 11:1411784. [PMID: 39135614 PMCID: PMC11317468 DOI: 10.3389/fcvm.2024.1411784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024] Open
Abstract
Background Clinical observations and epidemiological studies suggest a potential linkage between gastroesophageal reflux disease (GERD) and arrhythmias, yet the underlying mechanism remains elusive. This study investigates the causal relationship between GERD and four types of arrhythmia through a genetic lens, employing Mendelian randomization analysis to elucidate the directionality of these associations. Methods Selected single nucleotide polymorphisms (SNPs) from genome-wide association study (GWAS) data were utilized as instrumental variables. The inverse variance weighting (IVW) method, MR-Egger regression analysis, and the weighted median method were employed in two-sample Mendelian randomization analysis. Horizontal pleiotropy was detected and corrected using the MR-PRESSO test and MR-Egger regression. The stability and reliability of the Mendelian randomization results were assessed using the leave-one-out method, Cochran's Q test, and funnel plots. The causal relationship between GERD and four types of arrhythmias was evaluated using the odds ratio (OR). Results IVW results indicated that GERD could increase the risk of arrhythmias. A one standard deviation increases in the logarithmically transformed GERD score resulted in a 34% increase in the risk of arrhythmia (OR = 1.34; 95% CI 1.19-1.51; p = 1.66E-06). No significant correlation was found between GERD and other arrhythmias. Conclusion A causal relationship exists between GERD and arrhythmias, suggesting that GERD increases the risk of developing these arrhythmias.
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Affiliation(s)
- JunHao Liang
- Cardiology, Dongguan Hospital of Guangzhou University of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - LuYi Tang
- Cardiology, Dongguan Hospital of Guangzhou University of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - JinHui Yang
- Cardiology, Dongguan Hospital of Guangzhou University of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - Yi Li
- Cardiology, Qidong City People’s Hospital, Nantong, Jiangsu, China
| | - XiQiao Yang
- Cardiology, Dongguan Hospital of Guangzhou University of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - ChiJun Hou
- Cardiology, Dongguan Hospital of Guangzhou University of Traditional Chinese Medicine, Dongguan, Guangdong, China
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13
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Luo W, Yv H, Yu X, Wu X. Investigating the Causal Link between Rheumatoid Arthritis and Atrial Fibrillation in East Asian Populations: A Mendelian Randomization Approach. Cardiol Res Pract 2024; 2024:3274074. [PMID: 39040846 PMCID: PMC11262875 DOI: 10.1155/2024/3274074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/08/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
Background Rheumatoid arthritis (RA) has been associated with atrial fibrillation (AF) in observational studies, yet the causal relationship remains elusive. In this study, we employed Mendelian randomization (MR) to investigate the impact of RA on AF risk specifically in East Asian populations. Methods Utilizing genome-wide association study (GWAS) data on RA (n = 212,453) and AF (n = 36,792), we applied the following five MR methods: inverse variance weighted (IVW), MR-RAPS, maximum likelihood, weighted median (WM), and Bayesian weighted Mendelian randomization (BWMR). We evaluated heterogeneity, sensitivity, and pleiotropy. Results Five genetic instrumental variants for RA were identified. All MR methods consistently indicated a causal association between RA and AF (IVW: OR = 1.20, 95% CI: 1.01-1.41, p < 0.03; MR-RAPS: OR = 1.21, 95% CI: 1.03-1.42, p < 0.02; maximum likelihood: OR = 1.20, 95% CI: 1.04-1.39, p < 0.01; WM: OR = 1.25, 95% CI: 1.03-1.52, p < 0.03; and BWMR: OR = 1.20, 95% CI: 1.02-1.42, p < 0.03). Sensitivity and pleiotropy analyses confirmed the robustness and validity of the results. Conclusions This study establishes a causal link between RA and AF in East Asians. Our results underscore the need for in-depth mechanistic investigations to unravel the underlying pathways. Clinicians should consider AF risk in RA management, emphasizing collaborative care between rheumatologists and cardiologists. Moving forward, future research should explore therapeutic interventions and address the shared biological mechanisms.
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Affiliation(s)
- Weijun Luo
- Department of CardiologyLishui People's HospitalThe Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of CardiologyFirst Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
| | - Hui Yv
- Department of CardiologyLishui People's HospitalThe Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of CardiologyFirst Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
| | - Xiao Yu
- Department of CardiologyLishui People's HospitalThe Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of CardiologyFirst Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
| | - Xianjun Wu
- Department of CardiologyLishui People's HospitalThe Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of CardiologyFirst Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
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14
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Liu L, Yi Y, Yan R, Hu R, Sun W, Zhou W, Zhou H, Si X, Ye Y, Li W, Chen J. Impact of age-related gut microbiota dysbiosis and reduced short-chain fatty acids on the autonomic nervous system and atrial fibrillation in rats. Front Cardiovasc Med 2024; 11:1394929. [PMID: 38932988 PMCID: PMC11199889 DOI: 10.3389/fcvm.2024.1394929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Objective Aging is the most significant contributor to the increasing prevalence of atrial fibrillation (AF). Dysbiosis of gut microbiota has been implicated in age-related diseases, but its role in AF development remains unclear. This study aimed to investigate the correlations between changes in the autonomic nervous system, short-chain fatty acids (SCFAs), and alterations in gut microbiota in aged rats with AF. Methods Electrophysiological experiments were conducted to assess AF induction rates and heart rate variability in rats. 16S rRNA gene sequences extracted from fecal samples were used to assess the gut microbial composition. Gas and liquid chromatography-mass spectroscopy was used to identify SCFAs in fecal samples. Results The study found that aged rats exhibited a higher incidence of AF and reduced heart rate variability compared to young rats. Omics research revealed disrupted gut microbiota in aged rats, specifically a decreased Firmicutes to Bacteroidetes ratio. Additionally, fecal SCFA levels were significantly lower in aged rats. Importantly, correlation analysis indicated a significant association between decreased SCFAs and declining heart rate variability in aged rats. Conclusions These findings suggest that SCFAs, as metabolites of gut microbiota, may play a regulatory role in autonomic nervous function and potentially influence the onset and progression of AF in aged rats. These results provide novel insights into the involvement of SCFAs and autonomic nervous system function in the pathogenesis of AF. These results provide novel insights into the involvement of SCFAs and autonomic nervous system function in the pathogenesis of AF.
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Affiliation(s)
- Li Liu
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yingqi Yi
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Rong Yan
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Rong Hu
- Translational Medicine Research Center, Guizhou Medical University, Guiyang, China
| | - Weihong Sun
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Wei Zhou
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Haiyan Zhou
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaoyun Si
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yun Ye
- Department of Cardiovascular Medicine, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Wei Li
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jingjing Chen
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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15
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Wang L, Lu YW. Gastroesophageal reflux disease may causally associate with the increased atrial fibrillation risk: evidence from two-sample Mendelian randomization analyses. Front Cardiovasc Med 2024; 11:1393383. [PMID: 38887451 PMCID: PMC11182450 DOI: 10.3389/fcvm.2024.1393383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024] Open
Abstract
Background The risk of atrial fibrillation (AF) is increased in individuals with gastroesophageal reflux disease (GERD), according to observational research. The causal significance of this association is still unclear. This study sought to assess GERD's role as a potential contributing factor in AF. Methods With the use of a two-sample Mendelian randomization (MR) technique, we assessed the causal relationship between GERD and AF. The association of genetic variants with GERD was examined using data from a recent genome-wide association study (GWAS) that included 602,604 people. Data on the association between genetic variations and AF was obtained from a second GWAS with 1,030,836 participants. The effect sizes were examined based on the inverse-variance weighted method. Additional statistical techniques, including MR-Egger, simple mode, weighted mode, MR Pleiotropy Residual Sum, outlier, and weighted median were used in the sensitivity analysis. Results MR analyses in inverse-variance weighted models, using 76 single nucleotide polymorphisms (SNPs) as markers, revealed a relationship between genetically predicted GERD and a greater AF incidence [odds ratio (OR): 1.165, 95% CI 1.102-1.231; P = 7.637 × 10-8]. According to MR-Egger, there was no evidence of gene pleiotropy that could be found (intercept = 0.003, P = 0.581). The findings of the sensitivity study, which used several MR methods, were found to be reliable. Conclusion The MR analysis revealed a correlation between GERD and increased AF incidence, supporting the idea that treating patients with GERD as early as possible might reduce their chance of developing AF.
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Affiliation(s)
| | - Yi Wei Lu
- Cardiac Department, Aerospace Center Hospital, Beijing, China
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16
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DiCaro MV, Lei K, Yee B, Tak T. The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review. J Clin Med 2024; 13:3223. [PMID: 38892933 PMCID: PMC11172971 DOI: 10.3390/jcm13113223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Obstructive sleep apnea (OSA) is an increasingly relevant cause of cardiovascular morbidity worldwide. Although the association between OSA and the cardiovascular system is well-known, the extent of its effects is still a topic of interest, including pathophysiologic mechanisms, cardiovascular sequelae, and OSA therapies and their effects. Commonly described mechanisms of cardiovascular etiologies revolve around sympathetic activation, inflammation, and intermittent hypoxia resulting from OSA. Ultimately, these effects lead to manifestations in the cardiovascular system, such as arrhythmias, hypertension, and heart failure, among others. The resulting sequelae of OSA may also have differential effects based on gender and age; several studies suggest female gender to have more susceptibility to cardiovascular mortality, as well as an increase in age. Furthermore, several therapies for OSA, both established and emerging, show a reduction in cardiovascular morbidity and may even reduce cardiovascular burden. Namely, the establishment of CPAP has led to improvement in hypertension and cardiac function in patients with heart failure and even reduced the progression of early stages of atherosclerosis. Effective management of OSA decreases abnormal neural sympathetic activity, which results in better rhythm control and blood pressure control, both in waking and sleep cycles. With newer therapies for OSA, its effects on the cardiovascular system may be significantly reduced or even reversed after long-term management. The vast extent of OSA on the cardiovascular system, as well as current and future therapeutic strategies, will be described in detail in this review.
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Affiliation(s)
| | | | | | - Tahir Tak
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89102, USA; (M.V.D.); (K.L.); (B.Y.)
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17
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Pierucci N, Mariani MV, Laviola D, Silvetti G, Cipollone P, Vernile A, Trivigno S, La Fazia VM, Piro A, Miraldi F, Vizza CD, Lavalle C. Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications. J Clin Med 2024; 13:2980. [PMID: 38792520 PMCID: PMC11121906 DOI: 10.3390/jcm13102980] [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: 04/11/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed field ablation (PFA), a revolutionary technique gaining prominence in interventional electrophysiology because of its efficacy and safety. PFA employs non-thermal electric fields to create irreversible electroporation, disrupting cell membranes selectively within myocardial tissue, thus preventing the non-selective damage associated with traditional thermal ablation methods like radiofrequency or cryoablation. Clinical studies have consistently shown PFA's ability to achieve pulmonary vein isolation-a cornerstone of AF treatment-rapidly and with minimal complications. Notably, PFA reduces procedure times and has shown a lower incidence of esophageal and phrenic nerve damage, two common concerns with thermal techniques. Emerging from oncological applications, the principles of electroporation provide a unique tissue-selective ablation method that minimizes collateral damage. This review synthesizes findings from foundational animal studies through to recent clinical trials, such as the MANIFEST-PF and ADVENT trials, demonstrating PFA's effectiveness and safety. Future perspectives point towards expanding indications and refinement of techniques that promise to improve AF management outcomes further. PFA represents a paradigm shift in AF ablation, offering a safer, faster, and equally effective alternative to conventional methods. This synthesis of its development and clinical application outlines its potential to become the new standard in AF treatment protocols.
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Affiliation(s)
- Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Domenico Laviola
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Giacomo Silvetti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Pietro Cipollone
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Antonio Vernile
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Sara Trivigno
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | | | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Fabio Miraldi
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
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18
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Choi J, Lee SR, Choi EK, Lee KY, Ahn HJ, Kwon S, Kim B, Han KD, Oh S, Lip GYH. Association between types of antihypertensive medication and the risk of atrial fibrillation: a nationwide population study. Front Cardiovasc Med 2024; 11:1372505. [PMID: 38784173 PMCID: PMC11111936 DOI: 10.3389/fcvm.2024.1372505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Background Patients with hypertension are at a high risk of atrial fibrillation (AF). Recent research has indicated the varying effects of antihypertensive medications on developing AF. Objectives We investigated the relationship between different types of antihypertensive medications and the risk of AF occurrence. Methods We analyzed data from 113,582 subjects with national health screening examinations between 2009 and 2014. The study population was categorized according to antihypertensive medication type. The primary outcome was the incidence of AF. Results Among 113,582 subjects (mean age 59.4 ± 12.0 years, 46.7% men), 93,557 received monotherapy [angiotensin receptor blockers (ARB), angiotensin-converting enzyme inhibitors (ACEi), beta-blockers, calcium channel blockers (CCB), or diuretics], while 34,590 received combination therapy (ARB/beta-blockers, ARB/CCB, ARB/diuretics, or ARB/CCB/diuretics). During a mean follow-up duration of 7.6 ± 2.1 years, 3.9% of patients were newly diagnosed with AF. In monotherapy, ACEi and CCB had similar AF risks as ARB, while beta-blockers and diuretics showed higher AF risks than ARB. In combination therapy, ARBs/CCBs and ARBs/diuretics had the lowest AF risk, whereas ARBs/beta-blockers had the highest compared to ARB/CCB. Among the specific ARBs, the AF risk varied insignificantly, except for telmisartan and candesartan. Conclusions In hypertensive patients receiving monotherapy, ACEi and CCB showed a similar AF risk as ARBs, while beta-blockers and diuretics were associated with a higher risk. Among those receiving combination therapy, ARBs/CCBs and ARBs/diuretics had the lowest AF risk, whereas ARBs/beta-blockers showed the highest risk. Various types of ARBs have different associations with AF risk.
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Affiliation(s)
- JungMin Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Yeon Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bongseong Kim
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y. H. Lip
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Liverpool Center for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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19
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Li T, Rong L, Gao Y, Cheng W. The causal relationship between obesity, obstructive sleep apnea and atrial fibrillation: a study based on mediated Mendelian randomization. Front Cardiovasc Med 2024; 11:1406192. [PMID: 38707891 PMCID: PMC11066229 DOI: 10.3389/fcvm.2024.1406192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Background Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with obesity and obstructive sleep apnea syndrome (OSA). Obesity and OSA may increase the risk of AF by affecting cardiovascular health. Methods The study used the Mendelian randomization (MR) approach, combined with two-sample and multivariable analyses, to assess the relationships between obesity, OSA, and AF. The study utilized GWAS data and applied various statistical methods for the analysis. Results The study found that obesity increased the risk of OSA, which in turn significantly increased the risk of AF. Through mediating MR analysis, it was found that OSA played a certain role in the causal relationship between obesity and AF, with about 6.4% of the risk of AF being mediated by OSA. Conclusion This study highlights the relationships among obesity, OSA, and AF, providing useful guidance for future clinical researches.
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Affiliation(s)
| | | | | | - Wei Cheng
- Department of Cardiology, Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
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20
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Sizova ZM, Zakharova VL, Shindryaeva NN, Lapidus NI, Melnik MV, Shikh EV, Grebenshchikova LY, Beloborodova AV, Polovikov IP. Atrial fibrillation and COVID-19: an analysis of the ambulatory database. Front Cardiovasc Med 2024; 11:1384826. [PMID: 38689861 PMCID: PMC11058836 DOI: 10.3389/fcvm.2024.1384826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
Atrial fibrillation (AF) is the most common heart rhythm disorder in clinical practice. It worsens the quality of life of patients, leads to an increase in the mortality rate because of its association with a high risk of thromboembolic complications. The current pandemic of a new coronavirus infection, which began in March 2020, was marked by an increase in cardiovascular diseases, including an increase in the number of patients with AF. That is why it is extremely relevant to find answers to questions about the association and mutual influence of AF and coronavirus infection to reduce the risk of vascular complications. However, most research in this area has focused on hospital patients. In this study, an electronic database of outpatients with AF, including patients with a history of COVID-19 infection was analyzed in order to assess the most significant risk factors for complications.
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Affiliation(s)
| | | | - Natalya N. Shindryaeva
- Sechenov First Moscow Medical State University, Moscow, Russia
- City Polyclinic No 2 of the Moscow Healthcare Department, Moscow, Russia
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21
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Song W, Wu L, Sun C, Kong X, Wang H. New-onset atrial fibrillation following arteriovenous fistula increases adverse clinical events in dialysis patients with end-stage renal disease. Front Cardiovasc Med 2024; 11:1386304. [PMID: 38682103 PMCID: PMC11045994 DOI: 10.3389/fcvm.2024.1386304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/18/2024] [Indexed: 05/01/2024] Open
Abstract
Background End-stage renal disease (ESRD) patients have a high potential cardiovascular burden, and cardiovascular disease (CVD) is the leading cause of death in maintenance haemodialysis (MHD) patients. Arteriovenous fistula (AVF) is the preferred vascular access for MHD patients, but AVF significantly affects the haemodynamics of the cardiovascular system, leading to or exacerbating CVD, including atrial fibrillation (AF). This study aimed to evaluate the impact of AVF on cardiac function, especially of the left atrium (LA), in patients with ESRD and to further explore the relationship between AVF establishment and the occurrence of AF. Methods We selected 1,107 ESRD patients on haemodialysis using AVF and 550 patients with tunneled-cuffed catheters (TCC) admitted between January 2016 and December 2022 for follow-up to compare the rate of AF between the two groups. A total of 153 patients in the AVF group with complete information (clinical data, echocardiographic and biochemical indices, and other data) were enrolled and retrospectively analysed for risk factors for the development of AF and were followed up for adverse clinical outcomes (including all-cause death, cardiac death, readmission due to heart failure, and stroke). Results The incidence of new-onset AF was higher in the AVF group than the TCC group after dialysis access was established (16.30% vs. 5.08%, P < 0.001). Echocardiography showed that the LA anteroposterior diameter increased (P < 0.001) and the incidence of AF increased from 11.76% to 26.14% (P = 0.001) after AVF establishment. Multivariate logistic regression analysis showed that age and LA enlargement were independent risk factors for new-onset AF after AVF establishment (P < 0.05). Adverse clinical outcomes were more common in patients with AF than in patients without AF (P < 0.001). Multivariate Cox risk regression analysis suggested that new-onset AF (HR = 4.08, 95% CI: 2.00-8.34, P < 0.001) and left ventricular systolic dysfunction (HR = 2.42, 95% CI: 1.20-4.88, P = 0.01) after AVF establishment were independent risk factors for adverse clinical outcomes. Conclusion LA enlargement after AVF establishment is associated with a significant increase in the incidence of AF, in addition, AF which is as an important influential factor in patients with MHD combined other systemic diseases might increase adverse clinical events. Clinical Trial Registration (NCT06199609).
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Affiliation(s)
- Wenhui Song
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Lizhou Wu
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chong Sun
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xianglei Kong
- Department of Nephrology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Nephrology, Jinan, China
| | - Haiyan Wang
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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22
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Mariani MV, Pierucci N, Trivigno S, Cipollone P, Piro A, Chimenti C, Della Rocca DG, Miraldi F, Vizza CD, Lavalle C. Probability Score to Predict Spontaneous Conversion to Sinus Rhythm in Patients with Symptomatic Atrial Fibrillation When Less Could Be More? J Clin Med 2024; 13:1470. [PMID: 38592704 PMCID: PMC10934271 DOI: 10.3390/jcm13051470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The probability of spontaneous conversion (SCV) to sinus rhythm (SR) in patients presenting to the emergency department (ED) with hemodynamically stable, symptomatic atrial fibrillation (AF) is not well known. Objective: To develop and validate a score to determine the probability of SCV to SR in patients presenting to the ED with hemodynamically stable, symptomatic AF. Methods: This retrospective, observational study enrolled consecutive patients admitted with AF to the ED. Variables associated to SCV during a 6 h "wait-and-see" approach were used to develop and validate a score to determine the probability of SCV to SR in AF patients. The study was divided in two phases: (1) score development and (2) validation of the predictive score. Results: Out of 748 eligible patients, 446 patients were included in the derivation cohort, whereas 302 patients were included in the validation cohort. In the derivation cohort, based on multivariable logistic analysis, a probability score weight was developed including: previous SCV (3 points), AF-related symptom duration < 24 h (5 points), age ≥ 65 years (3 points) and female sex (2 points). The score allowed us to divide patients in three groups based on the probability of SCV to SR during the 6 h observation period. The probability prediction model showed an area under the curve (AUC) of 0.707 and 0.701 in the derivation and validation cohorts, respectively. Conclusions: The proposed score allowed us to predict SCV probability with good accuracy and may help physicians in tailoring AF management in an effective and timely manner.
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Affiliation(s)
- Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Sara Trivigno
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Pietro Cipollone
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | | | - Fabio Miraldi
- Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
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23
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Mariani MV, Pierucci N, Fanisio F, Laviola D, Silvetti G, Piro A, La Fazia VM, Chimenti C, Rebecchi M, Drago F, Miraldi F, Natale A, Vizza CD, Lavalle C. Inherited Arrhythmias in the Pediatric Population: An Updated Overview. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:94. [PMID: 38256355 PMCID: PMC10819657 DOI: 10.3390/medicina60010094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Pediatric cardiomyopathies (CMs) and electrical diseases constitute a heterogeneous spectrum of disorders distinguished by structural and electrical abnormalities in the heart muscle, attributed to a genetic variant. They rank among the main causes of morbidity and mortality in the pediatric population, with an annual incidence of 1.1-1.5 per 100,000 in children under the age of 18. The most common conditions are dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Despite great enthusiasm for research in this field, studies in this population are still limited, and the management and treatment often follow adult recommendations, which have significantly more data on treatment benefits. Although adult and pediatric cardiac diseases share similar morphological and clinical manifestations, their outcomes significantly differ. This review summarizes the latest evidence on genetics, clinical characteristics, management, and updated outcomes of primary pediatric CMs and electrical diseases, including DCM, HCM, arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), and short QT syndrome (SQTS).
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Affiliation(s)
- Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Francesca Fanisio
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Domenico Laviola
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Giacomo Silvetti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Vincenzo Mirco La Fazia
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, 00165 Rome, Italy;
| | - Fabio Miraldi
- Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Andrea Natale
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
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