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Myers LC, Peltan ID, Thai KK, Kipnis P, Desai M, Devis Y, Clancy H, Lu YW, Brown SM, Go AS, Neugebauer RS, Liu VX, Walkey AJ. Predicting stroke risk after sepsis hospitalization with new-onset atrial fibrillation. J Hosp Med 2024. [PMID: 38594918 DOI: 10.1002/jhm.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/20/2023] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND New-onset atrial fibrillation (AF) during sepsis is common, but models designed to stratify stroke risk excluded patients with secondary AF. We assessed the predictive validity of CHA2DS2VASc scores among patients with new-onset AF during sepsis and developed a novel stroke prediction model incorporating presepsis and intrasepsis characteristics. METHODS We included patients ≥40 years old who survived hospitalizations with sepsis and new-onset AF across 21 Kaiser Permanente Northern California hospitals from January 1, 2011 to September 30, 2017. We calculated the area under the receiver operating curve (AUC) for CHA2DS2VASc scores to predict stroke or transient ischemic attack (TIA) within 1 year after a hospitalization with new-onset AF during sepsis using Fine-Gray models with death as competing risk. We similarly derived and validated a novel model using presepsis and intrasepsis characteristics associated with 1-year stroke/TIA risk. RESULTS Among 82,748 adults hospitalized with sepsis, 3992 with new-onset AF (median age: 80 years, median CHA2DS2VASc of 4) survived to discharge, among whom 70 (2.1%) experienced stroke or TIA outcome and 1393 (41.0%) died within 1 year of sepsis. The CHA2DS2VASc score was not predictive of stroke risk after sepsis (AUC: 0.50, 95% confidence interval [CI]: 0.48-0.52). A newly derived model among 2555 (64%) patients in the derivation set and 1437 (36%) in the validation set included 13 variables and produced an AUC of 0.61 (0.49-0.73) in derivation and 0.54 (0.43-0.65) in validation. CONCLUSION Current models do not accurately stratify risk of stroke following new-onset AF secondary to sepsis. New tools are required to guide anticoagulation decisions following new-onset AF in sepsis.
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Affiliation(s)
- Laura C Myers
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Ithan D Peltan
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Khanh K Thai
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Patricia Kipnis
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Manisha Desai
- Biomedical Informatics Department, Stanford University, Palo Alto, California, USA
| | - Ycar Devis
- Section of Pulmonary, Critical Care, Allergy, Sleep Medicine, Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather Clancy
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yun W Lu
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Samuel M Brown
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alan S Go
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Department of Epidemiology and Biostatistics and Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Romain S Neugebauer
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vincent X Liu
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Allan J Walkey
- Section of Pulmonary, Critical Care, Allergy, Sleep Medicine, Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
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2
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Li S, Lip GYH, Ko D, Walkey A. Anticoagulation for Secondary Atrial Fibrillation. N Engl J Med 2024; 390:1237-1240. [PMID: 38598582 DOI: 10.1056/nejmclde2311699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
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3
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Li B, Lin M, Wu L. Drug-induced AF: Arrhythmogenic Mechanisms and Management Strategies. Arrhythm Electrophysiol Rev 2024; 13:e06. [PMID: 38706787 PMCID: PMC11066853 DOI: 10.15420/aer.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/12/2024] [Indexed: 05/07/2024] Open
Abstract
AF is a prevalent condition that is associated with various modifiable and unmodifiable risk factors. Drug-induced AF, despite being commonly under-recognised, can be relatively easy to manage. Numerous cardiovascular and non-cardiovascular agents, including catecholaminergic agents, adenosine, anti-tumour agents and others, have been reported to induce AF. However, the mechanisms underlying drug-induced AF are diverse and not fully understood. The complexity of clinical scenarios and insufficient knowledge regarding drug-induced AF have rendered the management of this condition complicated, and current treatment guidelines follow those for other types of AF. Here, we present a review of the epidemiology of drug-induced AF and highlight a range of drugs that can induce or exacerbate AF, along with their molecular and electrophysiological mechanisms. Given the inadequate evidence and lack of attention, further research is crucial to underscore the clinical significance of drug-induced AF, clarify the underlying mechanisms and develop effective treatment strategies for the condition.
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Affiliation(s)
- Bingxun Li
- Department of Cardiology, Peking University First HospitalBeijing, China
| | - Mingjie Lin
- Department of Cardiology, Qilu Hospital of Shandong University Qingdao BranchQingdao, China
| | - Lin Wu
- Department of Cardiology, Peking University First HospitalBeijing, China
- Key Laboratory of Medical Electrophysiology of the Ministry of Education and Institute of Cardiovascular Research, Southwest Medical UniversityLuzhou, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking UniversityBeijing, China
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4
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Vats V, Kulkarni V, Shafique MA, Haseeb A, Arain M, Armaghan M, Arshad F, Maryam A, Shojai Rahnama B, Moradi I, Ahuja K, Kamal A, Salameh Z, Ahmed M, Mehmood D. Analyzing the impact of sleep duration on atrial fibrillation risk: a comprehensive systematic review and meta-analysis. Ir J Med Sci 2024:10.1007/s11845-024-03669-7. [PMID: 38526766 DOI: 10.1007/s11845-024-03669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Recent studies have suggested an association between sleep duration and cardiovascular diseases; however, the link to AF is inconclusive. This study aimed to explore the relationship between sleep duration and AF by conducting a systematic review and meta-analysis of primary studies to provide evidence of the link between insufficient sleep and AF. METHODS A review of the existing literature was conducted to identify the primary studies that examined the association between AF and sleep duration. The inquiry spanned databases, including PubMed, Embase, MEDLINE, and Google Scholar, from their inception through October 2023. RESULTS Meta-analysis revealed a statistically significant association (p < 0.01) between shorter sleep duration and the incidence of AF (hazard ratio (HR), 1.18; 95% CI, 1.03-1.34; I2 = 89%). Conversely, longer sleep duration did not exhibit a statistically significant association with the incidence of AF (HR, 1.03; 95% CI, 0.92-1.14; I2 = 66%, p = 0.02). The sensitivity analysis demonstrated reduced heterogeneity after excluding specific studies. CONCLUSION Insufficient sleep duration was associated with an increased risk of AF, whereas a longer sleep duration did not show a significant correlation. Standardized methods for sleep assessment and AF diagnosis as well as adjustments for confounding factors are suggested for future studies to improve the clarity and understanding of these associations.
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Affiliation(s)
- Vaibhav Vats
- Department of Medicine, Smt. Kashibai Navale Medical College & General Hospital, Pune, India
| | - Vrunda Kulkarni
- Department of Medicine, Smt. Kashibai Navale Medical College & General Hospital, Pune, India
| | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mustafa Arain
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Faraz Arshad
- Department of Medicine, Shaikh Zayed Hospital, Lahore, Pakistan
| | | | | | - Iman Moradi
- Saint George's University, True Blue, Grenada
| | | | | | | | - Mahlail Ahmed
- Jinnah Medical and Dental College, Karachi, Pakistan
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5
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D'Anna L, Ornello R, Foschi M, Romoli M, Abu-Rumeileh S, Dolkar T, Vittay O, Dixon L, Bentley P, Brown Z, Hall C, Jamil S, Jenkins H, Kwan J, Patel M, Rane N, Roi D, Singh A, Venter M, Kalladka D, Malik A, Halse O, Sacco S, Banerjee S, Lobotesis K. Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation. J Thromb Thrombolysis 2024; 57:445-452. [PMID: 38127260 PMCID: PMC10961279 DOI: 10.1007/s11239-023-02923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/23/2023]
Abstract
We aim to compare the outcomes in patients with atrial fibrillation detected after stroke (AFDAS) and their counterparts with known AF (KAF) presenting with large vessel occlusion (LVO) treated with mechanical thrombectomy (MT). This observational, prospective study included consecutive patients with acute LVO ischemic stroke of the anterior circulation with AFDAS, KAF and without AF. The primary study outcome was functional independence at 90 days after stroke. The secondary study outcomes were variation of the NIHSS score at 24 h, rate of successful reperfusion, death at 90 days and rate of immediate complications post-procedure. Overall, our cohort included 518 patients with acute ischemic stroke and LVO treated with MT, with 289 (56.8%) without a diagnosis of AF; 107 (21%) with AFDAS; 122 (22.2%) with KAF. There was no significant difference in terms of functional independence at 90 days after stroke between the three groups. Regarding the secondary study outcome, the rate of symptomatic intracranial haemorrhage (sICH) and/or parenchymal hematoma (PH) were significantly higher in the group of patients without AF (respectively, P = 0.030 and < 0.010). Logistic regression analysis showed that the subtypes of AF were not statistically significantly associated with functional independence at 90 days after stroke and with the likelihood of any ICH. Our results suggest that the subtypes of AF are not associated with clinical and safety outcomes of MT in patients with acute stroke and LVO. Further studies are needed to confirm our findings.
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Affiliation(s)
- Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK.
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tsering Dolkar
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Orsolya Vittay
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Luke Dixon
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Paul Bentley
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Zoe Brown
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Charles Hall
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Sohaa Jamil
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Harri Jenkins
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Joseph Kwan
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Maneesh Patel
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Neil Rane
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Dylan Roi
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Abhinav Singh
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Marius Venter
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Dheeraj Kalladka
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Abid Malik
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Omid Halse
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Soma Banerjee
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Kyriakos Lobotesis
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
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6
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Romiti GF, Bonini N, Boriani G. The detrimental interplay between atrial fibrillation and COVID-19: new evidence and unsolved questions. Acta Cardiol 2024:1-3. [PMID: 38334106 DOI: 10.1080/00015385.2024.2313938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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7
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 76] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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8
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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9
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Welker CC, Ramakrishna H. Postoperative Atrial Fibrillation: Guidelines Revisited. J Cardiothorac Vasc Anesth 2023; 37:2413-2415. [PMID: 37573211 DOI: 10.1053/j.jvca.2023.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Carson C Welker
- Department of Anesthesia and Perioperative Medicine (Welker and Ramakrishna), Mayo Clinic, Rochester, MN
| | - Harish Ramakrishna
- Department of Anesthesia and Perioperative Medicine (Welker and Ramakrishna), Mayo Clinic, Rochester, MN.
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10
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Sabogal RC. Exploring the Applicability of Pre-Anesthetic Cardiac POCUS in Unexpected Conditions: Could it be Helpful? POCUS J 2023; 8:237-242. [PMID: 38099178 PMCID: PMC10721308 DOI: 10.24908/pocus.v8i2.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Formal preoperative echocardiography has traditionally been recommended when there is substantial cardiovascular disease without recent follow up, unexplained dyspnea, a functional class less than 4 METS or a Duke Activity Status Index less than 34. However, it is important to note that certain patients may present with a variety of cardiac abnormalities due to their preexisting condition or multiple treatments, and these individuals warrant consideration. The objective of pre-anesthetic cardiac POCUS is to provide clinical information in a timely manner. Although it does not aim to replace conventional echocardiography, cardiac POCUS can undoubtedly assist anesthesia practitioners in identifying asymptomatic and potentially hazardous conditions, allowing for more accurate risk allocation and individualized patient care.
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Affiliation(s)
- Rodolfo C Sabogal
- Department of Anesthesiology and Critical Care, Universidad de Cartagena, Universidad de AntioquiaCartagenaColombia
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11
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Rooney SR, Kaufman R, Murugan R, Kashani KB, Pinsky MR, Al-Zaiti S, Dubrawski A, Clermont G, Miller JK. Forecasting imminent atrial fibrillation in long-term electrocardiogram recordings. J Electrocardiol 2023; 81:111-116. [PMID: 37683575 PMCID: PMC10841237 DOI: 10.1016/j.jelectrocard.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Despite the morbidity associated with acute atrial fibrillation (AF), no models currently exist to forecast its imminent onset. We sought to evaluate the ability of deep learning to forecast the imminent onset of AF with sufficient lead time, which has important implications for inpatient care. METHODS We utilized the Physiobank Long-Term AF Database, which contains 24-h, labeled ECG recordings from patients with a history of AF. AF episodes were defined as ≥5 min of sustained AF. Three deep learning models incorporating convolutional and transformer layers were created for forecasting, with two models focusing on the predictive nature of sinus rhythm segments and AF epochs separately preceding an AF episode, and one model utilizing all preceding waveform as input. Cross-validated performance was evaluated using area under time-dependent receiver operating characteristic curves (AUC(t)) at 7.5-, 15-, 30-, and 60-min lead times, precision-recall curves, and imminent AF risk trajectories. RESULTS There were 367 AF episodes from 84 ECG recordings. All models showed average risk trajectory divergence of those with an AF episode from those without ∼15 min before the episode. Highest AUC was associated with the sinus rhythm model [AUC = 0.74; 7.5-min lead time], though the model using all preceding waveform data had similar performance and higher AUCs at longer lead times. CONCLUSIONS In this proof-of-concept study, we demonstrated the potential utility of neural networks to forecast the onset of AF in long-term ECG recordings with a clinically relevant lead time. External validation in larger cohorts is required before deploying these models clinically.
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Affiliation(s)
- Sydney R Rooney
- Department of Pediatrics, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA.
| | - Roman Kaufman
- Auton Lab, Carnegie Mellon University, Newell Simon Hall 3128, Forbes Ave, Pittsburgh, PA 15213, USA.
| | - Raghavan Murugan
- Program for Critical Care Nephrology, Department of Critical Care Medicine. University of Pittsburgh School of Medicine, 3550 Terrace Street, Alan Magee Scaife Hall, Suite 600, Pittsburgh, PA 15213, USA.
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street Alan Magee Scaife Hall, Suite 600, Pittsburgh, PA, 15213 Pittsburgh, PA, USA.
| | - Salah Al-Zaiti
- Department of Acute & Tertiary Care, University of Pittsburgh Medical Center, School of Nursing, 3500 Victoria Street, Victoria Building, Pittsburgh, PA 15261, USA.
| | - Artur Dubrawski
- Auton Lab, Carnegie Mellon University, Newell Simon Hall 3128, Forbes Ave, Pittsburgh, PA 15213, USA.
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street Alan Magee Scaife Hall, Suite 600, Pittsburgh, PA, 15213 Pittsburgh, PA, USA.
| | - J Kyle Miller
- Auton Lab, Carnegie Mellon University, Newell Simon Hall 3128, Forbes Ave, Pittsburgh, PA 15213, USA.
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12
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Zhang JL, Yang R, Zhu Y, Shao Y, Ji Y, Wang FF. Association between the neutrophil-to-lymphocyte ratio and risk of in-hospital heart failure and arrhythmia in patients with acute myocardial infarction. Front Cardiovasc Med 2023; 10:1275713. [PMID: 37928759 PMCID: PMC10623153 DOI: 10.3389/fcvm.2023.1275713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023] Open
Abstract
Background This study was to probe into the relationship between the neutrophil-to-lymphocyte ratio (NLR) and both in-hospital and long-term heart failure risk in patients with acute myocardial infarction (AMI). Methods 990 patients with AMI, including 386 with non-ST-segment elevation myocardial infarction (NSTEMI) and 604 with segment elevation myocardial infarction (STEMI) were recruited between January 2019 and March 2022. The in-hospital acute heart failure (AHF) and arrhythmia events were recorded. Results The NLR was significantly greater in the AHF group in STEMI and NSTEMI patients, with a higher frequency of arrhythmia in comparison to the non-AHF group. A high NLR was related to a high level of myocardial injury markers, accompanied with more AHF and arrhythmia events. Multivariate logistic regression analyses revealed that high NLR is independently linked with increased in-hospital AHF and arrhythmia risk. Receiver operating characteristic curve analyses revealed that the prognostic value of NLR for in-hospital AHF was 0.704 in STEMI patients and 0.766 in NSTEMI patients. However, during a median follow-up of 28 months with 32 heart failure patients, there was no significant difference between the low NLR group (n = 18) and the high NLR group (n = 14). Further analysis showed that the two groups did not significantly differ in the occurrence of heart failure within 12 months of discharge. Conclusion Our results indicate that NLR is an independent risk factor of in-hospital AHF in AMI patients. However, NLR has no value in predicting long-term heart failure.
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Affiliation(s)
- Jia-li Zhang
- Department of Gastroenterology Centre, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Rui Yang
- Department of Clinical Pharmacy, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yi Zhu
- Department of Cardiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yan Shao
- Department of Gastroenterology Centre, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yuan Ji
- Department of Cardiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Fang-fang Wang
- Department of Cardiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
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Jones-O'Connor M, Zakaria S. "Irregularly Irregular" - The Patterns, Challenges, and Outcomes of Atrial Fibrillation in the ICU. Crit Care Med 2023; 51:1255-1257. [PMID: 37589515 DOI: 10.1097/ccm.0000000000005917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Maeve Jones-O'Connor
- Both authors: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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14
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Iglesias-Álvarez D, Fu X, Martínez-Cereijo JM, Agra-Bermejo RM, Veiras-Del Río S, Selas-Cobos S, Rial-Munin MV, Eiras-Mariño M, Martínez-Salgado A, Taboada-Muñiz M, Reija-López L, Souaf S, García-Carro J, Fernández-González ÁL, Adrio-Nazar B, González-Juanatey JR, Eiras S, Rodríguez-Mañero M. Clinical Profiling and Biomarkers for Post-Operative Atrial Fibrillation Prediction in Patients Undergoing Cardiac Surgery. J Clin Med 2023; 12:jcm12103565. [PMID: 37240672 DOI: 10.3390/jcm12103565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Post-operative atrial fibrillation (POAF) is the most common arrhythmia in the post-operative period after cardiac surgery. We aim to investigate the main clinical, local, and/or peripheral biochemical and molecular predictors for POAF in patients undergoing coronary and/or valve surgery. Between August 2020 and September 2022, consecutive patients undergoing cardiac surgery without previous history of AF were studied. Clinical variables, plasma, and biological tissues (epicardial and subcutaneous fat) were obtained before surgery. Pre-operative markers associated with inflammation, adiposity, atrial stretch, and fibrosis were analyzed on peripheral and local samples with multiplex assay and real-time PCR. Univariate and multivariate logistic regression analyses were performed in order to identify the main predictors for POAF. Patients were followed-up until hospital discharge. Out of 123 consecutive patients without prior AF, 43 (34.9%) developed POAF during hospitalization. The main predictors were cardiopulmonary bypass time (odds ratio (OR) 1.008 (95% confidence interval (CI), 1.002-1.013), p = 0.005), and plasma pre-operative orosomucoid levels (OR 1.008 (1.206-5.761). After studying differences regarding sex, orosomucoid was the best predictor for POAF in women (OR 2.639 (95% CI, 1.455-4.788), p = 0.027) but not in men. The results support the pre-operative inflammation pathway as a factor involved in the risk of POAF, mainly in women.
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Affiliation(s)
- Diego Iglesias-Álvarez
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Xiaoran Fu
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- CIBERCV-Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - José Manuel Martínez-Cereijo
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Rosa María Agra-Bermejo
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Sonia Veiras-Del Río
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Salomé Selas-Cobos
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - María Victoria Rial-Munin
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - María Eiras-Mariño
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Adrián Martínez-Salgado
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Manuel Taboada-Muñiz
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Laura Reija-López
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Souhayla Souaf
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Javier García-Carro
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | | | - Belén Adrio-Nazar
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- CIBERCV-Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Sonia Eiras
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- CIBERCV-Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Moisés Rodríguez-Mañero
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- CIBERCV-Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
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