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Andrade JG, Deyell MW, Bennett R, Macle L. Assessment and management of asymptomatic atrial fibrillation. Heart 2024; 110:675-682. [PMID: 37507214 DOI: 10.1136/heartjnl-2023-322428] [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] [Indexed: 07/30/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia encountered in practice. It is currently estimated that AF affects approximately 2% of the general population; however, the true prevalence of AF is likely to be at least 3%-4% when asymptomatic AF is considered. For clinically apparent AF, the investigations and management are relatively well established. The identification of minimally symptomatic patients is challenging, and furthermore, the optimal management is less certain. Although there is some debate about the ideal treatment pathway for asymptomatic AF, in most cases, the investigations and comprehensive management follow the same recommendations as clinically apparent AF. In contrast, beyond risk factor optimisation, the ideal management of subclinical or device-detected AF remains undefined. The purpose of the current review is to discuss the assessment and management of asymptomatic AF.
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Affiliation(s)
- Jason G Andrade
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marc W Deyell
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada
| | - Richard Bennett
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada
| | - Laurent Macle
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
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Jang J, Park S, Kim S, Kim SH, Oh YS, Sa YK, Hwang Y, Jang SW, Ihm SH, Choi Y. Clinical outcomes with the use of sodium-glucose cotransporter-2 inhibitors in patients with atrial fibrillation and type 2 diabetes mellitus: a multi-centre, real-world cohort study. Eur J Prev Cardiol 2024; 31:320-329. [PMID: 37798123 DOI: 10.1093/eurjpc/zwad322] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
AIMS Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been shown to improve cardiovascular outcomes and reduce the incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). We investigated the clinical outcomes with and without the use of SGLT2is in patients with T2DM and concomitant AF. METHODS AND RESULTS We derived patient data from a clinical data warehouse constructed from the electronic medical records of seven medical centres. Data for 11 012 patients diagnosed with both AF and T2DM were analysed. New SGLT2i users were classified into the SGLT2i group and those who were not prescribed SGLT2is were classified into the control group. We performed a 1:2 propensity score (PS)-matching analysis. The primary endpoint was a composite of all-cause death or hospitalization due to heart failure (HF) events in 3 years. The PS-matched population consisted of 1115 patients in the SGLT2i group and 2050 patients in the control group. Incidence of the primary endpoint was significantly lower in the SGLT2i group [8.4 vs. 14.6%, hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.55-0.87]. Sodium-glucose cotransporter-2 inhibitors use was associated with significantly lower all-cause mortality (HR 0.43, 95% CI 0.29-0.67) and HF hospitalization (HR 0.77, 95% CI 0.59-0.99). Adverse renal events, defined as >50% increase in serum creatinine level or initiation of dialysis, occurred less often in the SGLT2i group (HR 0.50, 95% CI 0.38-0.66, P < 0.001). CONCLUSION Use of SGLT2is in patients with T2DM and concomitant AF was associated with reduced mortality or HF hospitalization events.
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Affiliation(s)
- Jaehyuk Jang
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonboro, Uijeongbu, Gyeonggido 11765, South Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Soyoon Park
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Soohyun Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Sung-Hwan Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Yong-Seog Oh
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Young Kyoung Sa
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Youmi Hwang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Sung-Won Jang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang-Hyun Ihm
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Bucheon St.Mary's Hospital, The Catholic University of Korea, Bucheon, South Korea
| | - Young Choi
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
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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 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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Kim S, Choi Y, Lee K, Kim SH, Kim H, Shin S, Park S, Oh YS. Comparison of the 11-Day Adhesive ECG Patch Monitor and 24-h Holter Tests to Assess the Response to Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation. Diagnostics (Basel) 2023; 13:3078. [PMID: 37835822 PMCID: PMC10572592 DOI: 10.3390/diagnostics13193078] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Accurate assessment of the response to the antiarrhythmic drug (AAD) in atrial fibrillation (AF) is crucial to achieve adequate rhythm control. We evaluated the effectiveness of extended cardiac monitoring using an adhesive ECG patch in the detection of drug-refractory paroxysmal AF. Patients diagnosed with paroxysmal AF and receiving AAD therapy were enrolled. The subjects simultaneously underwent 11-day adhesive ECG patch monitoring and a 24-h Holter test. The primary study outcome was a detection rate of drug-refractory AF or atrial tachycardia (AT) lasting ≥30 s. A total of 59 patients were enrolled and completed the study examinations. AF or AT was detected in 28 (47.5%) patients by an 11-day ECG patch monitor and in 8 (13.6%) patients by a 24-h Holter test (p < 0.001). The 11-day ECG patch monitor identified an additional 20 patients (33.8%) with drug-refractory AF not detected by the 24-h Holter, and as a result, the treatment plan was changed in 11 patients (10 catheter ablations, one medication change). In conclusion, extended cardiac rhythm monitoring using an adhesive ECG patch in patients with paroxysmal AF under AAD therapy led to over a threefold higher detection of drug-refractory AF episodes, compared to the 24-h Holter test.
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Affiliation(s)
- Soohyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kichang Lee
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - Sung-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hwajung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
| | - Soyoon Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Gunawardene M, Hartmann J, Willems S. [Asymptomatic atrial fibrillation : Screening and therapy]. Herzschrittmacherther Elektrophysiol 2023; 34:122-130. [PMID: 36912974 DOI: 10.1007/s00399-023-00933-8] [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: 01/23/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide and poses a significant burden to the health care system. AF screening of the general population or of a specific higher-risk population could not only lead to earlier detection of AF but also to a prompt initiation of an adequate therapy to prevent complications such as stroke or death and consecutively to a potential reduction of health care costs, especially in asymptomatic AF patients. To conduct screening programs, accessible new technology devices such as "wearables", smartwatches, and implantable event recorders provide an innovative solution. However, as data regarding screening are inconclusive, routine AF screening of the population is currently not recommended by the European Society of Cardiology. Recently published studies have indicated that anticoagulation and early rhythm control of asymptomatic AF could avoid occurrence of clinical endpoints. This article reports on the scientific results of the current literature as well as gaps of evidence and discusses possible treatment options of asymptomatic AF.
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Affiliation(s)
- Melanie Gunawardene
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
| | - Jens Hartmann
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Stephan Willems
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
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