Abstract Atrial Fibrillation Research Articles

Differences in oral anticoagulant prescriptions between specialists and non-specialists in patients with cardioembolic stroke caused by non-valvular atrial fibrillation.

Atrial fibrillation (AF) is a common disease encountered in daily practice; however, few patients with AF received oral anticoagulant (OAC) therapy. This study focused on differences in OAC prescriptions and influencing factors between specialists (neurological and cardiovascular) and non-specialists. A retrospective comparative analysis was conducted on 480 patients with acute cardioembolic stroke caused by non-valvular AF who were admitted to our hospital between January 1, 2015, and December 31, 2020. All patients had visited our hospital or other hospitals for their underlying diseases. Overall, 232 (specialist group SG) and 248 patients (non-specialist group NSG) were examined by specialists and non-specialists, respectively. The NSG had a significantly lower percentage of OAC prescriptions on admission than the SG (P < 0.01), even after propensity score matching. Factors influencing OAC prescription in the SG were age, hypertension, paroxysmal AF, dementia, CHADS2 score, and antiplatelet drug use, while those in the NSG were a history of cerebral infarction, paroxysmal AF, dementia, and antiplatelet drug use [SG: age, odds ratio (OR) 0.919, 95% confidence interval (CI) 0.865-0.976; hypertension, OR 0.266, 95% CI 0.099-0.713; paroxysmal AF, OR 0.189, 95% CI 0.055-0.658; dementia, OR 0.253, 95% CI 0.085-0.758; CHADS2 score, OR 2.833, 95% CI 1.682-4.942; and antiplatelet drug use, OR 0.072, 95% CI 0.025-0.206; NSG: cerebral infarction, OR 5.940, 95% CI 1.581-22.309; paroxysmal AF, OR 0.077, 95% CI 0.010-0.623; dementia, OR 0.077, 95% CI 0.014-0.438; and antiplatelet drug use, OR 0.024, 95% CI 0.004-0.152]. In conclusion, the OAC prescription rate was higher in patients with non-valvular AF whose family physicians were specialists at the time of cerebral infarction onset. In addition, in the SG, advanced age and hypertension were associated with not prescribing OAC, whereas a higher CHADS2 score was associated with the prescription of OACs. In the NSG, a history of cerebral infarction was associated with the prescription of OACs. Further, paroxysmal AF, antiplatelet drug use, and dementia were associated with non-OAC therapy in both the groups.

Abstract 11404: Disparities in Anticoagulation for Atrial Fibrillation: A Systematic Review of Recent Literature

Atrial fibrillation (AF) causes 1 in 7 strokes as it is the most prevalent arrhythmia in the United States. 1 Previous work has shown that even with significant recurring AF and high CHA 2 DS 2 VASc scores, there are various disparities that occur within the prescription, type, and quality of anticoagulation control. One previous systematic review published in 2018 discusses disparities within anticoagulation for AF. Given the importance of health equity for this highly efficacious intervention, we aimed to review recent data on disparities with respect to anticoagulation for AF published after 12/31/17. This systematic review used the PubMed database to identify 19 articles that discuss disparities within anticoagulation for AF. We limited our search to articles published after 12/31/17. The search string consisted of 7 phrases that combined AF, anticoagulation, and disparities involving sex, race, ethnicity, income, socioeconomic (SE) status, etc. Articles were excluded if they focused on anticoagulation for conditions other than AF, if they did not discuss anticoagulation as a treatment for AF, and/or lack of inclusion of data referring to disparity as defined above. We found 7 articles on race and anticoagulation, 6 articles on anticoagulation and sex/gender, 3 articles that discussed SE status and anticoagulation, and 5 articles that discuss other types of disparity related to anticoagulation. Results showed that black populations were much less likely to be given anticoagulation than other patients. Black patients were more likely to be given warfarin over DOACs. Women were less anticoagulated than men even when their stroke risk was higher. Some studies in this review found that there were not statistically meaningful differences in anticoagulation use in women and men. Lower income and less educated patients were less likely to receive DOAC compared to warfarin. Compared to a prior systematic review, focusing on articles after 2017 revealed much more information about DOAC use. Disparities first noted in the warfarin era have persisted with DOACs. Given that we have identified disparities in anticoagulation with respect to race, sex, and SE status, more work is needed to identify mechanisms of these disparities and identify potential solutions.

Abstract 13619: Obese Patients With New Onset Atrial Fibrillation/Flutter Have Higher Rates of Hospitalization, Cardioversion, and Ablation

Atrial fibrillation (AF) is the most common arrhythmia and can lead to frequent healthcare encounters. Obesity is a rapidly growing epidemic, and greater than one third of all adults in the USA are obese. Additionally, obese patients have over twice the prevalence of AF compared to the non-obese. Despite the frequency of these conditions, there is limited research assessing the relationship between obesity and healthcare resource utilization (HRU) in AF patients. We hypothesized that obese patients with new onset atrial fibrillation/flutter (AFL) would have higher AF/AFL related hospitalizations and procedures compared to non-obese patients. We utilized MarketScan® claims data to select patients with new onset atrial fibrillation or atrial flutter in 2017 and 2018 and classified them according to diagnosis codes as obese or non-obese. We then stratified by the diagnosis of obesity. There were 95,314 patients with new onset atrial fibrillation/flutter, which included 72,218 (76%) who were non-obese and 23,096 (24%) who were obese. There were significantly more males than females (64.4% vs. 35.6%). The average age was similar at 54.4 (+/- 0.04) in the non-obese and 54.6 (+/- 0.06) in the obese cohort. The rate of hospitalizations (35.9% vs. 24.8%, p&lt;0.001), cardioversions (16% vs. 10%, p&lt;0.001), and ablation procedures (10% vs. 7%, p&lt;0.0001) were significantly higher in the obese versus non-obese cohort. Obese patients with new onset AF/AFL had significantly higher HRU than non-obese patients. This increased health resource utilization increases the cost of care in such patients and future studies should concentrate on understanding the reasons for this difference.

Genetic and Metabolic Determinants of Atrial Fibrillation in a General Population Sample: The CHRIS Study.

Atrial fibrillation (AF) is a supraventricular arrhythmia deriving from uncoordinated electrical activation with considerable associated morbidity and mortality. To expand the limited understanding of AF biological mechanisms, we performed two screenings, investigating the genetic and metabolic determinants of AF in the Cooperative Health Research in South Tyrol study. We found 110 AF cases out of 10,509 general population individuals. A genome-wide association scan (GWAS) identified two novel loci (p-value < 5 × 10−8) around SNPs rs745582874, next to gene PBX1, and rs768476991, within gene PCCA, with genotype calling confirmed by Sanger sequencing. Risk alleles at both SNPs were enriched in a family detected through familial aggregation analysis of the phenotype, and both rare alleles co-segregated with AF. The metabolic screening of 175 metabolites, in a subset of individuals, revealed a 41% lower concentration of lysophosphatidylcholine lysoPC a C20:3 in AF cases compared to controls (p-adj = 0.005). The genetic findings, combined with previous evidence, indicate that the two identified GWAS loci may be considered novel genetic rare determinants for AF. Considering additionally the association of lysoPC a C20:3 with AF by metabolic screening, our results demonstrate the valuable contribution of the combined genomic and metabolomic approach in studying AF in large-scale population studies.

Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis.

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in the general population. Stroke prevention is one of the leading management objectives in the treatment of AF patients. The variables associated with the non-initiation of thromboprophylaxis in patients with thrombotic risk consulting for an episode of AF in Emergency Departments (ED) were investigated. This was a multipurpose, analytical, non-interventionist, multicenter Spanish study with a prospective 30-day follow-up. All patients ≥ 18years of age consulting to the ED for the casual finding of AF in an electrocardiogram (ECG) performed 12h prior to the consultation or with symptoms related to AF were enrolled from September 1, 2016 to February 28, 2017. Patients not previously received thromboprophylaxis were selected. Multivariate analysis was performed to calculate the odds ratio (OR) and the 95% confidence interval (CI). A total of 634 patients, not received thromboprophylaxis and at high thrombotic risk, were included. Of these, 251 (39.6%) did not receive thromboprophylaxis at ED discharge. In the multivariate analysis, non-initiation of anticoagulation at discharge from the ED was mostly related to cognitive impairment (OR 3.95; (95% CI 2.02-7.72), cancer history (OR 2.12; (95%CI 1.18-3.81), AF duration < 48h (OR 2.49; (95% CI 1.48-4.21) and patients with re-establishment of sinus rhythm (OR 3.65; (95% CI 1.47-9.06). Reinforcement of the use of CHA2DS2-VASC as a stroke risk scale and empowerment of ED physicians is a must to improve this gap in care.

Practical aspects of antithrombotic therapy in patients with atrial fibrillation and coronary artery disease

Atrial fibrillation (AF) is the most common cardiac arrhythmia, which is associated with an increased risk of cardiovascular death. The latter is partly due to the common combination with coronary artery disease (CAD). If indicated, patients with AF need continuous direct oral anticoagulant therapy to prevent thromboembolic events. In addition, patients with CAD who require urgent or elective percutaneous coronary intervention require dual antiplatelet therapy. Therefore, physicians often face a dilemma when choosing the most appropriate antithrombotic therapy regimen for AF patients undergoing percutaneous coronary intervention. Integrating two medication approaches to treat a single patient with a combination of AF and CAD is challenging and must strike a balance between high efficacy and safety. This article provides an overview of studies on this issue.

Left atrial thrombosis in patients with atrial fibrillation during uninterrupted oral anticoagulation

Atrial fi brillation (AF) is the most common arrhythmia in adults and requires permanent anticoagulation in the presence of risk factors. Left atrial (LA) thrombus is found in a signifi cant minority of patients despite anticoagulant treatment. We aimed to estimate the prevalence of LA thrombosis on uninterrupted oral anticoagulation (OAC) in AF patients and to determine associated demographic, clinical, echocardiographic and tomographic parameters. Material and methods: We present retrospective study of 702 hospitalizations in 582 patients (397 males, 68.2%) with AF and/or atrial fl utter on uninterrupted OAC for at least 3 weeks, assessed for LA thrombosis with transoesophageal echocardiography and/or cardiac computed tomography. Probability value of p ‹ 0.05 was considered signifi cant for all statistical analyses. Results: The prevalence of LA thrombosis was 6.2%, without signifi cant difference between patients on direct OAC (DOAC) or acenocoumarol (VKA). Non-paroxysmal arrhythmia was signifi cantly associated with LA thrombus, OR 0.369, 95% CI 0.159-0.857, p = 0.02. The proportion of patients on VKA with subtherapeutic INR was signifi cantly higher (30.7%), than the proportion of patients receiving too low dose of DOAC (9.7%), OR 4.1, 95%, CI 2 CI 2.7-6.23, р ‹ 0.001. No association was found between the LA appendage morphology type and the presence of LA thrombus. During a median follow-up of 30 days new stroke/transitory ischemic attack (TIA)/systemic embolism (SE) was registered in seven patients (1.34%), none of them with LA thrombus. Conclusion: The prevalence of LA thrombosis in the studied cohort is comparable to the published data and seemingly had no association with the OAC type. The incidence of stroke/TIA/SE was low on uninterrupted oral anticoagulation during short-term follow-up and there was no association between the presence of LA thrombus and thromboembolic event on follow-up.

Effects of atrial fibrillation on ventricular remodeling in the human heart

Abstract Atrial fibrillation (AF) is often found in patients with heart failure (HF). Clinical data indicated that the arrhythmic component of AF alone could contribute to left-ventricular (LV) dysfunction. However, the effects of non-tachycardic AF with arrhythmic excitation of the human LV, are unknown. We investigated human LV myocardium from patients with sinus rhythm (SR) or normofrequent AF (mean EF&amp;gt;50%, matched clinical data, derived from septal resections during AVR). In histological analysis we detected no difference between SR (n=17 patients) and AF patients (n=18) regarding the amount and distribution of fibrosis. We isolated human LV cardiomyocytes (CM) and studied cellular Ca-handling (Fura-2). Systolic Ca-transient amplitude of LV CM was reduced in patients suffering from AF (n=8 AF patients vs. 11 SR), while diastolic Ca-levels and Ca-transient kinetics were not significantly changed. These results were confirmed in LV CM from non-failing donors (NF) with AF (n=4 AF patients vs. 8 SR). For the standardized investigation of a normofrequent arrhythmia, we simulated AF in vitro by using arrhythmic (60 bpm, 40% beat-to-beat variability) or rhythmic (60 bpm) field stimulation. Human LV CM from NF SR patients (n=8) showed an impaired Ca-transient amplitude after 24h arrhythmic culture pacing without changes in diastolic Ca and Ca-transient kinetics. For studying a model suitable for more standardized chronic pacing, we utilized human iPSC cardiomyocytes (iPSC-CM) from healthy donors (n=6). After 7 days, arrhythmically paced iPSC-CM exhibited a reduced systolic Ca-transient amplitude, a trend towards a prolonged Ca-elimination time and a reduced sarcoplasmic reticulum Ca-load. Confocal line-scans of arrhythmically paced cells (Fluo-4 AM) showed an increased diastolic Ca-leak from the sarcoplasmic reticulum, possibly underlying the reduced Ca-load. Coupled with the Ca changes, cytosolic Na was elevated after arrhythmia. We found an increased late INa, which could explain the detrimentally altered Ca/Na-interplay. Accordingly, Patch-clamp experiments revealed a prolonged action potential duration after arrhythmia. We further elucidated the underlying mechanisms of this electrophysiological remodeling by showing that oxidative stress (H2O2, LPO) is increased in the LV of patients suffering from AF (n=6 AF patients vs. 6 SR), which was associated with an enhanced NOX2/-4 activity. Consecutively, Ca2+/calmodulin-dependent protein kinase IIδ (CaMKII) was found to be more oxidized (CaMKII-Met281/282) in the LV of AF patients (n=7 AF patients vs. 7 SR) leading to an increased CaMKII activity, which adversely regulated EC-coupling protein phosphorylation including RyR2 hyperphosphorylation. Normofrequent arrhythmia/AF impairs human ventricular EC-coupling via increased oxidative stress and enhanced CaMKII. Thus, this translational study provides the first mechanistic characterization and the potential negative impact of isolated AF on the human LV. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Else Kröner-Fresenius-Stiftung (EKFS) and Deutsche Gesellschaft für Innere Medizin

Risk factors of atrial fibrillation and their modification: a new look at a long-term problem

Atrial fibrillation (AF) is one of the most common arrhythmias diagnosed in clinical practice. Today, AF is associated with an increased risk of mortality, acute brain disorders, and heart failure. The results of many studies suggest that the incidence of AF is directly related to such risk factors (RF) as age, obesity, hypertension, diabetes mellitus, obstructive sleep apnea, alcohol, tobacco smoking etc. Recently published studies have described the positive impact of lifestyle changes on the incidence of AF. Therefore, it is believed that early detection of RF could prevent or delay the onset of AF. New data suggest the need to review the management of patients with AF. In 2020, the American Heart Association has presented a scientific statement that highlighted the relationship between modified RF and AF, discussed the implementation of strategies for effective modification of RF, as well as identified areas for new research. The data allow us to conclude that the correction of RF helps to reduce the incidence of AF. Future research is needed to establish the effects and generalizability of systematic lifestyle and RF modification for AF: to study the role of pericardial/epicardial fat accumulation in risk and progression of AF; determination of the most effective weight loss techniques for long-term success in reducing AF; effects of high-intensity/short-duration interval training on left atrium structural and electric remodeling; the degree of glycemic control for AF.

Mendelian randomization study on atrial fibrillation and cardiovascular disease subtypes

Atrial fibrillation (AF) has been associated with numerous diseases. However, whether AF is a cause or consequence of these diseases is uncertain. To clarify, we assessed the causal role of AF on ischemic heart disease (IHD), stroke, other cardiovascular disease (CVD) subtypes, type 2 diabetes mellitus (T2DM), and late-onset AD using bi-directional two-sample Mendelian randomization (MR) among people primarily of European descent. Genetically predicted log odds of AF was associated with any stroke (odds ratio (OR) 1.22, 95% CI 1.18 to 1.27), particularly cardioembolic stroke and possibly subdural hemorrhage, with sensitivity analyses showing similar positive findings. Genetically predicted AF was also associated with arterial thromboembolism (1.32, 1.13 to 1.53), and heart failure (1.26, 1.21 to 1.30). No association of genetically predicted AF with IHD, T2DM, cognitive function, or late-onset AD was found. Conversely, genetically predicted IHD, heart failure and possibly ischemic stroke, particularly cardioembolic stroke, were positively associated with AF. Atrial fibrillation plays a role in any stroke, arterial thromboembolism, and heart failure, corroborating current clinical guidelines on the importance of preventing these complications by effective AF management. In addition, patients with IHD, heart failure or possibly ischemic stroke might be predisposed to developing AF, with implications for management.

Non-valvular Atrial Fibrillation in CKD: Role of Vitamin K Antagonists and Direct Oral Anticoagulants. A Narrative Review.

Atrial fibrillation (AF) is the most common arrhythmia in chronic kidney disease (CKD), with a close bidirectional relationship between the two entities. The presence of CKD in AF increases the risk of thromboembolic events, mortality and bleeding. Vitamin K antagonists (VKA) have been the mainstay of treatment for the prevention of thromboembolic events in AF until recently, with confirmed benefits in AF patients with stage 3 CKD. However, the risk-benefit profile of VKA in patients with AF and stages 4–5 CKD is controversial due to the lack of evidence from randomized controlled trials. Treatment with VKA in CKD patients has been associated with conditions such as poorer anticoagulation quality, increased risk of bleeding, faster progression of vascular/valvular calcification and higher risk of calciphylaxis. Direct oral anticoagulants (DOACs) have shown equal or greater efficacy in stroke/systemic embolism prevention, and a better safety profile than VKA in post-hoc analysis of the pivotal randomized controlled trials in patients with non-valvular AF and stage 3 CKD, yet evidence of its risk-benefit profile in more advanced stages of CKD is scarce. Observational studies associate DOACs with a good safety/effectiveness profile compared to VKA in non-dialysis CKD patients. Further, DOACs have been associated with a lower risk of acute kidney injury and CKD development/progression than VKA. This narrative review summarizes the evidence of the efficacy and safety of warfarin and DOACs in patients with AF at different CKD stages, as well as their effects on renal function, vascular/valvular calcification and bone health.

Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias

Atrial fibrillation (AF) is associated with various major adverse cardiac events such as ischemic stroke, heart failure, and increased overall mortality. However, its association with lethal ventricular arrhythmias such as ventricular tachycardia (VT), ventricular flutter (VFL), and ventricular fibrillation (VF) is controversial. We conducted this study to determine whether AF can increase the risk of VT, VFL, and VF. We utilized the Korean National Health Insurance Service database for this nationwide population-based study. This study enrolled people who underwent a nationwide health screen in 2009 for whom clinical follow-up data were available until December 2018. Primary outcome endpoint was the occurrence of VT, VFL, or VF in people who were and were not diagnosed with new-onset AF in 2009. We analyzed a total of 9,751,705 people. In 2009, 12,689 people were diagnosed with new-onset AF (AF group). The incidence (events per 1000 person-years of follow-up) of VT, VFL, and VF was 2.472 and 0.282 in the AF and non-AF groups, respectively. After adjustment for covariates, new-onset AF was associated with 4.6-fold increased risk (p < 0.001) of VT, VFL, and VF over 10 years of follow-up. The risk of VT, VFL, and VF was even higher if identification of AF was based on intensified criteria (≥ 2 outpatient records or ≥ 1 inpatient record; hazard ratio = 5.221; p < 0.001). In conclusion, the incidence of VT, VFL, and VF was significantly increased in people with new-onset AF. The potential risk of suffering lethal ventricular arrhythmia in people with AF should be considered in clinical practice.

Abstract P382: Transcriptomic Analysis Of Human Left Atrial Tissue Reveals Mitochondrial Gene Co-expression

Atrial fibrillation (AF) risk is heritable. High rate electrical activity in AF requires increased energy. Atrial mitochondrial structure and function are altered in AF patients in an effort to generate adequate ATP through oxidative phosphorylation. Genomic studies have identified putative AF risk genes, but the association of AF risk genes with expression of mitochondrial genes is unclear. We tested the hypothesis that putative AF risk genes are co-expressed with mitochondrial genes that play a role in atrial energy production. RNA-seq was performed on left atrial appendage (LAA) tissues obtained from 251 cardiac surgery patients. RNA coexpression profiles were evaluated for 222 putative AF risk genes. Genes encoding proteins that localize to the mitochondria were identified using MitoCarta 2.0. Changes in metabolic pathways were detected using Ingenuity Pathway Analysis (IPA). Our analysis identified 128 AF risk genes that coexpressed with at least one mitochondrial gene. The highest level of mitochondrial gene coexpression was evident with PCCB, in which 30% (253 of 848) of coexpressed genes were mitochondrial. CASQ2 (24%, 104 of 431) and ASAH1 (20%, 37 of 182) also showed high levels of mitochondrial gene coexpression. The IPA Oxidative Phosphorylation Pathway was significantly altered (p&lt;0.05) for 26 AF risk genes, with CASQ2 (9.42E-79), MYH6 (4.73E-78), YWHAE (4.96E-75), and TTN (4.30E-71) the most strongly associated (Table). Additionally, 12 AF risk genes coexpressed with genes encoded by mitochondrial DNA (mtDNA) (Table). ASAH1, CASQ2, MYH6, NACA, NUCKS1, PLN, TTN, and YWHAE coexpressed with all 13 mtDNA encoded components of the electron transport chain. Many AF risk genes show significant coexpression with mitochondrial genes. We propose that genetic risk scores based on these AF risk genes may identify a subset of AF patients that would benefit from AF therapies that enhance metabolic activity.

Abstract MP208: A Shared Fog2 / Tbx5-dependent Gene Regulatory Network Identified By Transcription Factor-dependent Non-coding RNA Profiling Modulates Cardiac Rhythm

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting over 33 million individuals throughout the world. AF is highly heritable and recent genome-wide association studies (GWAS) have cumulatively identified over 100 loci associated with AF risk. Genome-wide association studies (GWAS) often identify transcription factor (TF) loci in association with complex human diseases, implying that a significant transcriptional component underlies human disease risk and etiology. The transcription factors ZFPM2 (FOG2), GATA4, and TBX5 have all been implicated in human AF risk by genetic studies. We hypothesized that FOG2, GATA4, and TBX5 functionally interact to regulate a gene regulatory network essential for atrial rhythm control. We generated a novel mouse model of spontaneous AF based on FOG2 overexpression. FOG2 ChIP-seq identified FOG2 genomic localization at loci co-occupied by GATA4, a known FOG2 binding partner. However, we found that FOG2 OE caused gene expression alterations that correlated more highly with TBX5-dependent rather than GATA4-dependent gene expression, including a module of calcium handling genes required for atrial rhythm homeostasis. We applied TF-dependent non-coding transcriptional profiling to examine the FOG2 dependent atrial GRN, which identified 805 candidate regulatory regions with accessible chromatin and FOG2 dependent ncRNAs. TBX5 removal and FOG2 OE caused highly correlated dysregulation of ncRNA expression at open chromatin regions genome-wide, suggesting a functional interaction between TBX5 and FOG2. Furthermore, FOG2 OE only affected enhancer activity by altered ncRNA abundance at locations of TBX5 co-binding. The shared TBX5/FOG2 genomic interaction predicted a potential genetic interaction, and we found that cardiac rhythm abnormalities caused by Tbx5 haploinsufficiency were rescued by Fog2 haploinsufficiency. Taken together, TF-dependent ncRNA-profiling revealed an interconnected cardiac rhythm gene regulatory network (GRN) between FOG2, TBX5 and GATA4. These data nominate a specific model in which FOG2 is recruited by GATA4 to modulate a co-bound TBX5-dependent atrial gene regulatory network for calcium handling and atrial rhythm homeostasis.

Atrial Fibrillation Population Screening.

Atrial fibrillation (AF) is associated with adverse outcomes. Screening may lead to earlier recognition and treatment of asymptomatic AF. However, most evidence regarding AF applies to clinical AF, with symptoms or electrocardiographic diagnosis. Whether this evidence can be translated toward subclinical AF, without symptoms and detected by novel, more continuous screening devices is uncertain. The diagnostic yield of screening is determined by the screening population, tool, duration and frequency. Longer and more frequent screening in a higher risk population leads to more effective screening. New devices based on photoplethysmography and single-lead electrocardiography increase convenience and the likelihood of cost-effectiveness.

Long noncoding RNA and atrial fibrillation.

Atrial fibrillation (AF), a common arrhythmia that usually occurs in patients with heart disease, is one of the leading causes for mortality and disability worldwide. Current drug therapy for AF patients lacks sufficient efficacy and has side effects. Radiofrequency ablation is more effective than traditional drug therapy, but this invasive procedure is associated with potential risks and postoperative recurrence, limiting the clinical benefits for AF patients. Therefore, it is necessary to expand our understanding about the underlying molecular mechanism of AF and to explore the new therapeutic strategies. Long noncoding RNA (lncRNA) is a set of noncoding RNA longer than 200 nucleotides. Growing evidence indicates that lncRNA is involved in numerous pathophysiological processes of AF, such as structural remodeling, electrical remodeling, renin-angiotensin system, abnormal calcium regulation, etc. In addition, lncRNA involved in structural remodeling and electrical remodeling has the potential to be a novel target for the diagnosis and treatment of AF, and lncRNA involved in autonomic nerve remodeling may bring new enlightenment for the prognosis and recurrence of AF.

Anticoagulant therapy in patients with nonvalvular atrial fibrillation in real clinical practice: the problem of therapy safety and treatment adherence

Atrial fibrillation (AF) is the most common arrhythmia in the adult population, and the number of patients with this arrhythmia will increase in the future. As a result, the number of patients taking anticoagulants (ACs), which are considered "high alert medication" is constantly increasing. &#x0D; The aim. To highlight the problems of ACs use in patients with non-valvular AF in real clinical practice, to consider the therapy safety and treatment adherence. &#x0D; The main body. Approval of new oral ACs has provided more options to clinicians and patients, but even with their use, errors are possible that increase the risk of bleeding. Mistakes can be made by both patients and doctors. The introduction of training as a mandatory element in the complex therapy of AF helps to reduce the number of errors that the patient could make. The clinical condition, the availability of monitoring and the patient's wishes for treatment may change over time, and this may lead to the need to switch the AC, which is potentially dangerous in terms of side effects. The risk of bleeding increases regardless of the direction of change of AC - the very fact of transition is important. Doctor`s errors play a significant role in the risk increase at this stage, and it is important to raise their awareness of the rules for the ACs switch to avoid bleeding. The article presents the rules of transition from one oral AC to another, following which doctors will minimize the risk of side effects in clinical practice.&#x0D; Conclusion. The use of AC for patients with AF is life-saving, but if used improperly, life-threatening side effects can occur. According to research, in many cases, the development of the latter could be prevented primarily through patient education and the proper doctor training.

Atrial Fibrillation Ablation in Heart Failure Patients.

Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each other, as each can be either the cause of or the result of the other. Successfully treating one of the two entities means laying the basis for treating the other one as well. Management of patients with AF and HF can be challenging and should primarily adhere to available guidelines. Concerning AF, medication is limited and causes many side effects, leading to low medical adherence. Several smaller studies, summarized in a big meta-analysis, provide evidence that ablation of AF in HF patients is crucial for improving quality of life, reducing HF hospitalizations, and reducing death, provided the LVEF is at least 25% or higher. In advanced HF, alternative treatment options (including assist devices, heart transplant) might still be the better option. Early rhythm control should be taken into consideration, as there is evidence that it is associated with better cardiovascular outcome.

Update Atrial Fibrillation - Current Management strategies

Atrial fibrillation (AF) is the most common arrhythmia. The European Society of Cardiology released a new version of the guideline to streamline AF-management and current studies highlight the importance of early treatment.Oral anticoagulation to prevent thromboembolic events remains essential in AF-management for patients at risk. NOAK therapy, if possible, is recommend as first line treatment. In general rhythm or rate control strategies are available. Symptomatic patients and patients with heart failure should be offered an early rhythm control. Catheter ablation is effective for rhythm control and and should be offered early in AF treatment additional to treatment of risk factors and comorbidities.

A Review and Comparison of the State-of-the-Art Techniques for Atrial Fibrillation Detection and Skin Hydration

Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmia, with a prevalence of 1–2% in the community, increasing the risk of stroke and myocardial infarction. Early detection of AF, typically causing an irregular and abnormally fast heart rate, can help reduce the risk of strokes that are more common among older people. Intelligent models capable of automatic detection of AF in its earliest possible stages can improve the early diagnosis and treatment. Luckily, this can be made possible with the information about the heart's rhythm and electrical activity provided through electrocardiogram (ECG) and the decision-making machine learning-based autonomous models. In addition, AF has a direct impact on the skin hydration level and, hence, can be used as a measure for detection. In this paper, we present an independent review along with a comparative analysis of the state-of-the-art techniques proposed for AF detection using ECG and skin hydration levels. This paper also highlights the effects of AF on skin hydration level that is missing in most of the previous studies.