About Atrial Fibrillation Research Articles

ECG-based estimation of respiration-induced autonomic modulation of AV nodal conduction during atrial fibrillation.

Introduction: Information about autonomic nervous system (ANS) activity may offer insights about atrial fibrillation (AF) progression and support personalized AF treatment but is not easily accessible from the ECG. In this study, we propose a new approach for ECG-based assessment of respiratory modulation in atrioventricular (AV) nodal refractory period and conduction delay. Methods: A 1-dimensional convolutional neural network (1D-CNN) was trained to estimate respiratory modulation of AV nodal conduction properties from 1-minute segments of RR series, respiration signals, and atrial fibrillatory rates (AFR) using synthetic data that replicates clinical ECG-derived data. The synthetic data were generated using a network model of the AV node and 4 million unique model parameter sets. The 1D-CNN was then used to analyze respiratory modulation in clinical deep breathing test data of 28 patients in AF, where an ECG-derived respiration signal was extracted using a novel approach based on periodic component analysis. Results: We demonstrated using synthetic data that the 1D-CNN can estimate the respiratory modulation from RR series alone with a Pearson sample correlation of r = 0.805 and that the addition of either respiration signal (r = 0.830), AFR (r = 0.837), or both (r = 0.855) improves the estimation. Discussion: Initial results from analysis of ECG data suggest that our proposed estimate of respiration-induced autonomic modulation, a resp, is reproducible and sufficiently sensitive to monitor changes and detect individual differences. However, further studies are needed to verify the reproducibility, sensitivity, and clinical significance of a resp.

Accuracy and comprehensibility of chat-based artificial intelligence for patient information on atrial fibrillation and cardiac implantable electronic devices.

Natural language processing chatbots (NLPC) can be used to gather information for medical content. However, these tools contain a potential risk of misinformation. This study aims to evaluate different aspects of responses given by different NLPCs on questions about atrial fibrillation (AF) and clinical implantable electronic devices (CIED). Questions were entered into three different NLPC interfaces. Responses were evaluated with regard to appropriateness, comprehensibility, appearance of confabulation, absence of relevant content, and recommendations given for clinically relevant decisions. Moreover, readability was assessed by calculating word count and Flesch Reading Ease score. 52, 60, and 84% of responses on AF and 16, 72, and 88% on CIEDs were evaluated to be appropriate for all responses given by Google Bard, (GB) Bing Chat (BC) and ChatGPT Plus (CGP), respectively. Assessment of comprehensibility showed that 96, 88, and 92% of responses on AF and 92 and 88%, and 100% on CIEDs were comprehensible for all responses created by GB, BC, and CGP, respectively. Readability varied between different NLPCs. Relevant aspects were missing in 52% (GB), 60% (BC), and 24% (CGP) for AF, and in 92% (GB), 88% (BC), and 52% (CGP) for CIEDs. Responses generated by an NLPC are mostly easy to understand with varying readability between the different NLPCs. The appropriateness of responses is limited and varies between different NLPCs. Important aspects are often missed to be mentioned. Thus, chatbots should be used with caution to gather medical information about cardiac arrhythmias and devices.

Is there a reduced confidence towards direct oral anticoagulants compared to vitamin K antagonists in patients scheduled for an elective electrical cardioversion? The results of the BLITZ-AF study

ObjectiveTo study the confidence of cardiologists in performing an electrical cardioversion in patients on oral anticoagulation (OA) with or without transoesophageal echocardiography (TOE). MethodsData about atrial fibrillation (AF) patients admitted to cardiology wards for elective cardioversion (ECV) were extrapolated from the BLITZ-AF study. Percentage of vitamin K antagonists (VKAs), direct oral anticoagulants (DOAC) and heparin prescription were analysed in relation to the use of TOE before ECV. ResultsOverall rate of TOE was 33.7% (240/713); it was used before ECV in 124/313 (39.6%) of DOACs patients and in 96/372 (25.8%) of the patients on VKAs, showing a significant reduced resort to TOE in VKAs patients (p = 0.0001). Among non-valvular patients TOE was more frequently performed in males, at younger ages and in patients on heparin when compared to patients treated with OA. TOE was also more frequently performed in tertiary hospitals and in hospitals with cardiology wards and electrophysiology labs, when compared to hospital provided only with cardiology wards. At multivariable analysis there was a significant less recourse to TOE in patients on VKAs (OR 0.47; 95% CI: 0.33–0.67) and higher recourse in the heparin group (OR: 3.85; 95% CI:1.59–9.28) with respect to patients on DOACs; a higher recourse to TOE was observed also in tertiary hospitals (OR 4.25; 95% CI 2.69–6.69) and in hospitals with cardiology wards and electrophysiology (EP) labs (OR 1.87; 95% CI 1.23–2.82). Conclusionour study shows the reluctance in cardioverting patients on DOACs respect to VKAs without a previous TOE, despite adequate anticoagulant treatment.

Atrial fibrillation in UK South Asian hospitalized ischemic stroke patients: The BRAINS study.

South Asian diaspora comprise one of the largest ethnic minority groups in the world yet data about atrial fibrillation (AF) in this demographic is understudied. Our aim is to identify differences in AF prevalence and treatment between South Asians and white British stroke patients. The UK arm of a prospective ongoing large international repository on stroke was analysed. Ethnic differences in AF prevalence and management in those with ischemic stroke were analysed. Of the 3515 individuals recruited with ischemic stroke, 1482 (men: 972, women: 510) were South Asian and 2033 (men:1141, women:892) of white British ethnicity. AF was present in 462 white British and 193 South Asians stroke patients, with South Asians displaying a lower prevalence of AF (South Asians: 13.0% vs white British 22.7%, P<0.001). Despite adjustment for traditional AF risk factors, South Asians had a significantly lower OR of AF compared to white British stroke patients (OR: 0.40, 95%CI: 0.33:0.49, P<0.001). Among confirmed AF cases, 31.8% of South Asians and 41.4% of white British were untreated at admission (P = 0.02). Antiplatelet treatment was significantly higher among South Asians at both admission (South Asian: 47.4% vs. white British: 29.9%, P<0.001) and discharge (South Asian: 49.5% vs. white British: 34.7%, P = 0.001), although anticoagulation treatment was similar across both ethnic groups at admission (South Asian: 28.5% vs white British: 28.1%, P = 0.93), and discharge (South Asian: 45.1% vs white British: 43.1%, P = 0.64). Stroke patients of South Asian descent are at significantly lower risk of AF but more likely to be on antiplatelet treatment compared to their white British counterparts.

Does YouTube Provide Qualified Patient Education Videos About Atrial Fibrillation?

ObjectivePatients utilize the internet as a pathway to acquire knowledge of specific diseases. However, there are limited oversight and review mechanisms to ensure the authenticity of online information. This study aimed to evaluate the quality of video-based resources used to obtain information about atrial fibrillation (AF).MethodsMultiple AF-specific keywords were used to perform a systematic search of YouTube. Two independent reviewers reviewed the top 50 results of each keyword search. To record data, the Journal of the American Medical Association (JAMA) score, modified DISCERN score, AF-specific score (AFSS), and essential score (Escore) were used. The Kruskal-Wallis test was used for intergroup comparisons.ResultsA total of 74 videos that met the inclusion criteria were included in the analysis. In terms of video quality, 68% were poor, 19% were moderate, and 13% were exceptional. Videos submitted by publishers with a medical background were much less popular (p < 0.05) than those submitted by publishers without a medical background. The video quality did not differ among those included in this study.ConclusionsSome videos on YouTube that are of real value are not as popular as those with low-quality content submitted by news agencies/media publishers. Furthermore, videos submitted by those with a medical background do not receive as much attention as others. It is important to acknowledge that video platforms should establish content and quality auditing mechanisms for videos. Furthermore, publishers should ensure that viewers receive accurate and complete knowledge and use more concise and accessible images or animations that are tailored to the audience.

Efficacy and safety of high-power short duration atrial fibrillation ablation in elderly patients.

Data about atrial fibrillation (AF) ablation using high-power short duration (HPSD) radiofrequency ablation in the elderly population is still scarce. The aim of our study was to investigate the efficacy and safety of HPSD ablation in patients over 75 years compared to younger patients. Consecutive patients older than 75 years with paroxysmal or persistent AF undergoing a first-time AF ablation using 50 W HPSD ablation approach were analyzed in this retrospective observational analysis and compared to a control group <75 years. Short-term endpoints included intraprocedural reconnection of at least one pulmonary vein(PV)and intrahospital and AF recurrence during 3 months blanking period, as well as a long-term endpoint of freedom from atrial arrhythmias of antiarrhythmic drugs after 12 months. A total of 540 patients underwent a first AF ablation with HPSD (66 ± 10 years; 58% male; 47% paroxysmal AF). Mean age was 78 ± 2.4 and 63 ± 6.3 years (p < .001), respectively. Elderly patients were significantly more often women (p < .001).The procedure, fluoroscopy, and ablation were comparable. Elderly patients revealed significantly more often extra-PV low-voltage areas requiring additional left atrial ablations (p < .001). Overall complication rates were low; however, elderly patients revealed higher major complication rates mainly due to unmasking sick sinus syndrome (p = .003). Freedom from arrhythmia recurrences was comparable (68% vs. 76%, log-rank p = .087). Only in the subgroup of paroxysmal AF, AF recurrences were more common after 12 months (69% vs. 82%; log-rank p = .040; hazard ratio: 1.462, p = .044) in the elderly patients. In multivariable Cox regression analysis of the whole cohort persistent AF, female gender, diabetes mellitus and presence of left atrium low-voltage areas, but not age >75 years were associated with AF recurrences. HPSD AF ablation of patients >75 years in experienced centers is safe and effective. Therefore, age alone should not be the reason to withhold AF ablation from vital elderly patients due to only a slightly worse outcome and safety profile. In paroxysmal AF, elderly patients have more recurrences compared to the younger control group.

Assessing the Knowledge of Patients with Atrial Fibrillation Using Oral Anticoagulants Medications

Aims: To evaluate patients’ knowledge about atrial fibrillation (AF) and anticoagulants as well as to find out a relationship between the level of patients’ knowledge and sociodemographic variables. Methodology: A descriptive cross-sectional study was performed on patients with atrial fibrillation aged more than 18 years. The study started on October 13th, 2021, to April 25th, 2022. The sample consists of 90 AF patients on oral anticoagulants who were admitted at Al-Nasiriya Heart Center in Thi-Qar City. Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ) was used for the collection of data after getting written approval from its author. Results: Only 6 out of 90 patients had good knowledge of AF, with a significant relationship between the level of patients’ knowledge and their socio-demographic characteristics such as age, level of education, and occupation. Conclusion: 62.2% of patients exhibited poor knowledge about AF. Patients who were aged less than 30, those with high education, and those who were employers demonstrated improved knowledge than other patients. Keywords: Knowledge, Atrial Fibrillation, Anticoagulants.

Knowledge about atrial fibrillation and anticoagulation affects the risk of clinical outcomes

BackgroundKnowledge about atrial fibrillation (AF) and oral anticoagulation (OAC) is insufficient among AF patients. ObjectiveWe examined the association between this knowledge and event rate. MethodsWe studied 174 anticoagulated patients with AF aged 69±10.7 years (median CHA2DS2 -VASc 4). Knowledge was assessed at baseline using the Jessa AF Knowledge Questionnaire (JAKQ). The primary endpoint was a composite of ischemic cerebrovascular events, major or non-major clinically relevant bleeding, and death, recorded during a median follow-up of 42 months. ResultsThe primary endpoint occurred in 48 (27.5%) patients (10.5 per 100 patient-years) including 12 ischemic cerebrovascular events (2.2 per 100 patient-years) and 29 bleeding episodes (5.8 per 100 patient- years). Lower baseline JAKQ scores were associated with the primary outcome (p=0.007), solely when patients who bled during follow-up were compared with the remainder (p=0.007). Patients who were aware of the importance of a regular anticoagulant intake despite the absence of AF symptoms, had, however, a lower risk of cerebrovascular events (p<0.0001). The subjects who experienced bleeding or the primary endpoint were less likely to understand the essence of AF (p=0.03), to know safe painkillers used in combination with OAC (p<0.001), and what to do when the anticoagulant was forgotten (p=0.02). Worse knowledge about AF and OAC, longer OAC therapy, and higher CHA2DS2 -VASc score were independent predictors for the primary endpoint. ConclusionsOur study shows a prognostic value of low knowledge about AF and OAC supporting the need for improved education of AF patients.

Pathophysiologic Peculiarities of Different Factors’ Influence on Development and Course of IHD Complicated with Atrial Fibrillation

Over the last years, mortality because of cardiovascular diseases (CVD) increased significantly in Ukraine. If we speak about atrial fibrillation (AF) itself, the number of recurrent arrhythmias cases as the main cause of hospitalization of patients with AF increased at 66% over the last 20 years.&#x0D; Independent development factors of AF are heart failure, aortic and mitral valve diseases, arterial hypertension, left atrial enlargement, and also obesity and obstructive sleep apnea, etc.&#x0D; In 2013 A.A. Novykov from Kherson region and several other researchers proved the influence of chaotic changes of meteofactors in cases of overt or hidden functional cardiovascular disorders (CVD) that can significantly influence its hemodynamic stability, functional ability, particularly its rhythmic activity.&#x0D; The main problem in the treatment of one or another nosological entity of CVD today is not the adjustment of a medication for its treatment, but the finding of pathogenetic links in the development of the disease itself. Especially this occurs, when the patient gets several organs or systems disabled simultaneously.&#x0D; Several scientists and practicing physicians are interested in the development of new approaches to diagnosis and treatment of AF in patients with ischemic heart disease (IHD) considering the peculiarities of clinical course and comorbidity. After all, the finding of complications’ causes in comorbid pathology in patients with IHD will contribute to treatment optimization and prevention of other complications, especially those resulting from the anticoagulant therapy, for example when a functional liver state or metabolic processes are impaired.

Low Level of Knowledge of Atrial Fibrillation and Anticoagulant Treatment among Patients with Atrial Fibrillation Scheduled for Cardiac Surgery

Objective: We investigated the knowledge about atrial fibrillation (AF) and oral anticoagulants (OACs) in AF patients scheduled for cardiac surgery compared with nonsurgical AF patients. Methods: We recruited 144 consecutive patients with documented AF scheduled for cardiac surgery on admission (aged 68.9±8.4, male 60.4 %). The control group represented 200 age- and sex-matched AF patients without indications for surgery. Using the validated Jessa AF Knowledge Questionnaire (JAKQ), we tested their knowledge of AF and the use of OAC. Results: The mean score on the JAKQ was 47±20 % in the surgery group and 59±18 % in the control group (p&lt;0.001), without any questions in which the former group scored better. A higher level of knowledge was observed in patients taking vitamin K antagonists (VKA) in the past, and individuals free of heart failure, previous stroke, or peripheral artery disease. Patients had poor knowledge of the safety issues, including 27.5% of surgical patients who knew about possible painkillers use during anticoagulation compared with 43.8% in the control group (p=0.002). Patients scheduled for valvular surgery (n=88, 61.5%) scored better compared with those (n=26, 18.2%) for coronary artery bypass graft (CABG) surgery (49±19% vs. 35±18 %, p=0.002 respectively). Conclusion: The level of knowledge about AF and its treatment, including the safety issues, is poor among AF patients admitted for cardiac surgery. More educational efforts should be taken in this vulnerable patient subset.

P662Association of baseline disability and major adverse outcomes in patients with atrial fibrillation: an analysis from the SPORTIF trials

Abstract Introduction The modified Rankin Scale (mRS) is usually used to evaluate the degree of disability in patients who have suffered a stroke. Some data suggest that pre-stroke mRS may be associated with clinical outcomes. No data exist about atrial fibrillation (AF) patients. Purpose To evaluate if baseline level of disability, evaluated as mRS, is associated with major adverse outcomes in patients with AF Methods Data from the SPORTIF III and V trials were used to evaluate study aims. mRS was categorized as follows: i) mRS 0 = No Disability; ii) mRS 1 = Operational Limitation; iii) mRS ≥2 = Disability. Stroke/systemic embolism (SE), death and composite of stroke/SE/acute myocardial infarction (AMI)/death were considered as major adverse outcomes. Results Among 7329 patients enrolled in SPORTIF trials, 7325 (99.9%) had data about baseline mRS, with 5587 (76.3%) with mRS 0, 1156 (15.8%) with mRS 1 and 582 (7.9%) with mRS ≥2. Mean (SD) and median [IQR] CHA2DS2-VASc was progressively higher across the three mRS categories (both p&lt;0.001). An adjusted linear regression analysis confirmed that mRS was associated with an increasing CHA2DS2-VASc (unstandardized B: 0.354, 95% confidence interval [CI]: 0.317–0.390, p&lt;0.001]. After a mean (SD) 1.55 (0.40) years of follow-up 184 (2.5%) stroke/SE, 392 (5.4%) death and 597 (8.2%) composite events were recorded. Log-rank test showed that cumulative risk of stroke/SE (p=0.005), death (p&lt;0.001) and composite outcome (p&lt;0.001) was progressively higher across the mRS categories [Figure]. Cox adjusted regression analysis found no independent association between mRS categories and stroke/SE occurrence, but baseline disability (mRS ≥2) was independently associated with death (hazard ratio [HR]: 2.17, 95% CI: 1.65–2.86 compared with no disability). Both operational limitation (mRS 1) and disability (mRS ≥2) were associated with the composite outcome (HR: 1.28, 95% CI: 1.04–1.59 and HR: 1.91, 95% CI: 1.51–2.42, respectively) compared to no disability. Kaplan-Meier curves Conclusions In a large cohort of AF patients derived from a randomized controlled trial, baseline disability was associated with an increased risk of death and composite outcome of stroke/SEAMI/death. Acknowledgement/Funding None

Assessment of Condition and Medication Knowledge Gaps Among Atrial Fibrillation Patients: A Systematic Review and Meta-analysis.

Background: Patient education facilitates construction of a correct illness representation, improves beliefs about medications, and improves knowledge, factors that have been associated with better adherence. Objective: Our objective was to characterize the published literature about atrial fibrillation (AF) patients' disease and medication knowledge to identify knowledge gaps and misconceptions to inform AF patient education strategies. Methods: Following PRISMA guidelines, we searched PubMed, EMBASE, CINAHL, and PsychINFO from inception to May 2018 for studies that assessed AF patients' knowledge about their condition and medications. For quantitative studies, we extracted the proportion of participants who provided correct answers to the questions asked about their condition, medications, or risk of stroke. We classified data for related questions into knowledge domains. A random-effects meta-analysis was conducted for each knowledge domain. A domain was considered a knowledge gap if the pooled mean proportion of participants who demonstrated knowledge of it was ≤50%, regardless of CI. Qualitative data were summarized narratively. Results: A total of 21 studies were included. AF- and stroke-related knowledge gaps and misconceptions included the following: AF can be asymptomatic, AF can predispose to heart failure, women are at a higher risk of stroke, the definition of ischemic stroke, and patients' awareness of their diagnosis. Medication-related knowledge gaps were antithrombotic-drug interactions, antithrombotic-food interactions, vitamin K content of foods, the term INR (international normalized ratio) and its interpretation, and the required actions in case of a missed dose. Conclusion and Relevance: This systematic review identified several AF patient knowledge gaps about their condition and its treatment that can inform the development of AF patient education programs.

Value of adenosine test to reveal dormant conduction or adenosine-induced atrial fibrillation after pulmonary vein isolation

BackgroundRecent studies investigating the implications of additional ablation guided by dormant pulmonary vein (PV) conduction testing using adenosine showed conflicting results, and the data about atrial fibrillation (AF) recurrence after trigger site elimination in adenosine-induced AF are still lacking. MethodsOf 846 patients with paroxysmal AF (PAF) who underwent PV isolation (PVI), adenosine test after PVI was performed in 148 patients. ResultsPVI was successfully achieved in 846 patients. We excluded 58 patients due to loss to the follow-up. A higher rate of AF recurrence was found in the group without adenosine test (136/644, 21%) compared to the group with adenosine test (20/144, 13%, log-rank P=0.047). In multivariate analysis model for AF freedom during the follow-up period, the only significant clinical predictor of AF freedom was adenosine test (hazard ratio [HR] 1.97; 95% confidence interval [CI]: 1.2–3.23; P=0.007).Among 148 patients with adenosine test, 114 (77%) patients showed neither dormant conductions nor AF-induced, 22 (15%) showed positive dormant conductions only, and 12 (8%) revealed adenosine-induced AF (6 of them also showed dormant conduction). After additional ablation in positive dormant conduction group and adenosine-induced AF group, AF recurrence was noted in 4/21 (19%) patients in positive dormant conduction group and 2/11 (18%) patients in adenosine-induced AF group, which was not different from that of patients in negative dormant conduction/ no AF-induced group (14/112, 12%, log-rank P=0.67). ConclusionsAdenosine test after PVI to confirm the absence of dormant conduction and triggers initiating AF is beneficial to improve the outcomes after catheter ablation of PAF.

Cardiologists' experiences and perceptions of patient involvement and communication related to shared decision-making regarding atrial fibrillation treatment.

To feel involved in decisions about atrial fibrillation (AF) treatment, patients need supportive communication from cardiologists. Shedding light on cardiologists' perceptions of patient involvement in AF care settings is thus of importance. We examine (1) how cardiologists describe patient involvement and communication related to shared decisionmaking regarding AF treatment, and (2) their perceptions of efforts to involve patients in the treatment decisions. Ten cardiologists were interviewed in four Swedish hospitals. A qualitative content analysis was performed on the interview data. Cardiologists' perceptions of patient involvement in treatment decisions are framed in terms of (1) ideology, (2) experience, and (3) responsibility. By taking into account patients' feelings in the consultations, and by actively encouraging patients to be involved, the cardiologists contributed to patient involvement. One key to improving compliance with legislation aimed at increasing patient involvement in treatment decisions could lie in paying attention to physician-patient communication and the conditions for patient involvement in decision-making about treatment.

Comment on "management of atrial fibrillation in critically ill patients".

Dr. Arrigo and his team added important knowledge thanks to their recently published review about atrial fibrillation (AF) in critically ill patients [1]. I would like to address several issues in the light of most recent literature. Critically ill patients do have increased risk of cardiac embolism despite short exposure time of AF, especially septic patients [2]. This can be best assessed by past stroke, CHADS2 (or CHA2DS2-VASc) score [3]. However, best anticoagulation is not known in critically ill patients with increased bleeding risk. In their review, Dr. Arrigo and colleagues state that unfractionated heparin (short half-life and easy to antagonize) is their first choice [1]. First, the dosage used may not be adequate and recommended posology may reach biological target more often. Even with strict protocolization, unfractionated heparin has significant inter- and intraindividual variability and short therapeutic interval. Second, bridging with heparin has been associated with more haemorrhage (and as much thrombosis) compared with procedures under oral anticoagulants by vitamin K antagonists [4]. Thus, best anticoagulation is not mandatory, the more logical choice, and is not known for critically ill patients. The first risk that comes to intensive care physicians mind is hemodynamic compromise, as opposed to ambulatory setting patients whose major risk is cardioembolic. Rhythm control is recommended for poorly tolerated AF by means of antiarrhythmic drugs and/or direct current cardioversion [5]. Though, variable conversion rates are reported in the literature. We were surprised by the very infrequent conversion rates of direct current cardioversion about 30% reported in series without drug enhancement [6, 7]. We reported 80% immediate success rate of direct current cardioversion, mostly with drug enhancement [3]. However, side effects of antiarrhythmic drugs (amiodarone and/or magnesium, without vernakalant) were common, 19% [3]. We still consider direct current cardioversion as first line treatment for poorly tolerated AF, even in critically ill patients, provided obvious triggering factor is controlled [5].

Atrial Fibrillation at an Internal Medicine Ward: Clinical and Prognostic Implications.

Background: Little is known about atrial fibrillation (AF) appearing during hospitalization in an Internal Medicine ward. Purpose: We aimed to investigate characteristics and prognostic significance of in-hospital onset AF. Methods: We studied 249 consecutive unselected patients admitted to this medical department with paroxysmal or persistent AF (out-of-hospital group) or AF developed during hospitalization (in-hospital group). Demographic, clinical, laboratory, electrocardiographic and echocardiographic data and all-cause mortality following discharge were recorded and compared between the groups Results: Diabetes mellitus (p=0.05), renal dysfunction (p<0.001), chronic lung disease (p=0.03) and history of stroke (p=0.01) were found more common in the in-hospital group (56 patients), compared to the out-of-hospital group (193 patients). Patients from the in-hospital group were more likely to have recurrent episodes of AF during hospitalization (p=0.002), were more frequently treated with amiodarone (p<0.001), discharged in sinus rhythm (p=0.04) and with medications for rhythm control (p=0.04). Time from onset to termination of AF (p<0.001) and hospital stay (p<0.001) were longer in the in-hospital group. On a median of 39-months follow-up, survival rate was lower in the in-hospital vs. out-of-hospital group (69.6% vs. 81.3%, p=0.025). Older age was significantly associated with shorter survival in the in-hospital group [odds ratio (OR)=1.87, 95% confidence interval (CI) 1.15-3.03, p=0.009]. In the out-of-hospital group, advanced age (OR=2.17, 95%CI 1.51-3.10, p<0.001), no prior AF episode (OR=3.41, 95%CI 1.56-7.46, p=0.002), diabetes mellitus (OR=2.22, 95%CI 1.12-4.39, p=0.006) and renal dysfunction (OR=2.44, 95%CI 1.10-5.38, p=0.049) were significantly associated with shorter survival. Conclusion: Patients developing in-hospital AF differed from subjects hospitalized for AF with respect to the severity of the clinical profile and prognosis.

The Clinical Characteristics of Atrial Fibrillation after Repair of Tetralogy of Fallot

Background: Atrial tachyarrhythmias caused by right atrial enlargement are one of the main concerns in patients after repair of tetralogy of Fallot (TOF). However, few reports exist about atrial fibrillation (AF) in TOF patients. Methods and Results: We retrospectively reviewed the clinical characteristics of AF in 6 patients and compared those with 36 with atrial tachycardia and/or intraatrial reentrant tachycardia (AT/IART). The age at the onset of AF was 35±9 years. Three had persistent AF and 3 had paroxysmal AF. All 3 with persistent AF showed New York Heart Association (NYHA) class III, and the cardiothoracic ratio in persistent AF was higher than paroxysmal AF (73±7 vs. 55±4%, p=0.047). Two with paroxysmal AF and IART underwent the catheter ablation for IART and resulted in no recurrence of AF. The age at the repair (16±10 vs. 6±9 years, p=0.02), and the proportion of NYHA≥II (80 vs. 31%, p=0.02) were higher in AF patients than lone AT/IART. There were no differences in cardiac performance between AF and AT/IART. Conclusion: The AF-TOF patients are more clinically symptomatic than those of AT/IART, although no obvious hemodynamic differences. The mechanisms of AF in TOF may differ from those of the hearts without congenital heart disease.

Optimizing the treatment of atrial fibrillation: contributions by remote monitoring

Despite more than a decade of intensified clinical research, our knowledge about atrial fibrillation (AF) is still far from satisfactory, and particularly the optimal treatment remains unclear. In fact, even the very basic question if attempts should be made to convert AF into sinus rhythm and to maintain it, or to simply limit the ventricular rate by drugs that slow atrioventricular conduction (and which strategy in whom?) is not yet answered satisfactory. Results of the AFFIRM1 and AF-CHF2 trials were disappointing to a high degree showing no advantage of trying to maintain sinus rhythm or even a trend towards a higher mortality for ‘rhythm control’. This leads to the misinterpretation that AF seems to be harmless even in the context of heart failure. To avoid this, it should be pointed out that a post hoc analysis of the AFFIRM trial demonstrated that patients who were in sinus rhythm (no matter to which treatment group they were allocated) had a better … *Corresponding author. Tel: +49 69 6301 7387; fax: +49 69 6301 3813, E-mail address : C.W.Israel{at}em.uni-frankfurt.de