AF Patients Research Articles

Clinical Outcomes in Elderly Atrial Fibrillation Patients at Increased Bleeding Risk Treated with Very-Low-Dose versus Regular-Dose Non-Vitamin K Antagonist Oral Anticoagulants: a Nationwide Cohort Study.

The ELDERCARE-AF trial showed that edoxaban at a very-low-dosage (VLD) of 15mg/day was more effective than a placebo at preventing stroke/systemic embolism without significantly increasing the risk of serious bleeding. We aimed to compare the effectiveness and safety for VLD non-vitamin K antagonist oral anticoagulants (NOACs) (edoxaban 15mg once daily, dabigatran 110 or 150 once daily, apixaban 2.5mg once daily, or rivaroxaban 10mg (without the diagnosis of chronic kidney disease) or less than 10mg once daily) versus regular-dosage (RD) NOACs (edoxaban 60/30mg once daily or other labeling-dosage NOACs) among a real-world cohort of elderly AF population similar to the ELDERCARE-AF cohort. In this nationwide retrospective cohort study from Taiwan National Health Insurance Research Database (NHIRD), we identified a total of 7294 and 4151 consecutive AF patients aged 80 years or older with a CHADS2 score≥2 who met the enrollment criteria (generally similar to ELDERCARE-AF) taking VLD and RD NOACs from June 1, 2012, to December 31, 2019, respectively. Propensity-score stabilized weighting (PSSW) was used to balance covariates across study groups. Patients were followed up from the first date of prescription for NOACs until the first occurrence of any study outcome, death, or until the end date of the study period (December 31, 2020). After PSSW, VLD NOAC was associated with a comparable risk of ischemic stroke/systemic embolism and major bleeding but a higher risk of major adverse limb events (MALEs) requiring lower limb revascularization or amputation (Hazard ratio [HR]:1.54, 95% confidential interval [CI]:1.09-2.18; p=0.014), venous thrombosis (HR:3.75,95%CI:1.56-8.97; p=0.003), and all-cause mortality (HR:1.21,95%CI:1.15-1.29; p<0.001) compared to RD NOACs. VLD NOACs showed worse outcomes in most net clinical benefits (NCOs). The main result was consistent based on on-treatment analysis or accounting for death as a competing risk. In general, the advantage of NCOs for the RD NOACs over VLD NOACs persisted in most high-risk subgroups, consistent with the main analysis (P for interaction>0.05). Use of VLD NOACs was associated with a greater risk of arterial and venous thrombosis, death as well as the composite outcomes, when compared to that of RD NOAC in high-risk elderly AF patients at increased bleeding risk. Thromboprophylaxis with RD NOAC is still preferable over VLD NOAC for the majority of elderly AF patients at increased bleeding risk.

Can a best practice advisory improve anticoagulation prescribing to reduce stroke risk in patients with atrial fibrillation?

BackgroundAtrial fibrillation (AF) is the most common cardiac rhythm disorder and a risk factor for stroke. Randomized trials have demonstrated that anticoagulation can reduce strokes in AF patients. Yet, widespread underutilization of this therapy continues. To address this practice gap, we designed a study to implement and evaluate the effectiveness of a best practice advisory (BPA) for an Atrial Fibrillation Decision Support Tool (AFDST) embedded within our electronic health record. MethodsOur intervention is provider-facing, focused on decision support. Clinical setting is ambulatory patients being seen by primary care physicians. We prospectively enrolled 608 patients in our health system who are currently receiving less than optimal anticoagulation therapy as determined by the AFDST and randomized them to one of two arms – 1) usual care, in which the AFDST is available for use; or 2) addition of a BPA to the AFDST notifying clinicians that their patient stands to gain significant benefit from a change in current therapy. Primary outcome was effectiveness of the BPA measured by change to “appropriate thromboprophylaxis” based on the AFDST recommendation at 3 months post-enrollment. Secondary endpoints included Reach and Adoption from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, & Maintenance) framework for implementation studies. ResultsAmong 562 patients with a minimum follow-up of 3 months, addition of a BPA to the AFDST resulted in significant improvement in anticoagulation therapy, 5 % (12/248) versus 11 % (33/314) p = 0.02, odds ratio 2.31 (95 % CI, 1.17–4.87). ConclusionsA BPA added to an AF decision support tool improved anticoagulation therapy among AF patients in a primary care academic health system setting.

Lifeday coverage of oral anticoagulants and one-year relative survival in patients with atrial fibrillation: a population-based study in Estonia

BackgroundRoutine oral anticoagulation (OAC) is recommended for almost all high-risk patients with atrial fibrillation, yet registries show that OACs are still underused. Our aim was to study the lifeday coverage (LDC) of OAC prescriptions and its relationship with one-year mortality rates of AF patients aged ≥ 65 in Estonia for the years 2019 and 2020.MethodsMedical data for AF patients aged ≥ 65 years from 2018 and alive as of 01.01.2019 (cohort I) and new AF documentation from 2019 and alive as of 01.01.2020 (cohort II) was obtained from the Health Insurance Fund’s electronic database. The data was linked to the nationwide Estonian Medical Prescription Centre’s database of prescribed OACs. For LDC analysis, daily doses of guideline-recommended OACs were used. The patients were categorized into three LDC groups: 0%, 1–79%, and ≥ 80%. The data was linked to the Estonian Causes of Death Registry to establish the date of death and mortality rate for the whole Estonian population aged ≥ 65.ResultsThere were 34,018 patients in cohort I and 9,175 patients with new AF documentation (cohort II), previously not included in cohort I. Of the patients, 77.7% and 68.6% had at least one prescription of OAC in cohorts I and II respectively. 57.4% in cohort I and 44.5% in cohort II had an LDC of ≥ 80%. The relative survival estimates at 1 year for LDC lifeday coverage groups 0%, 1–79%, and ≥ 80% were 91.2%, 98.2%, and 98.5% (cohort I), and 91.9%, 95.2%, and 97.6% (cohort II), respectively.ConclusionsDespite clear indications for OAC use, LDC is still insufficient and anticoagulation is underused for stroke prevention in Estonia. Further education of the medical community and patients is needed to achieve higher lifeday coverage of prescribed OACs.

Abstract P3126: Atrial Fibrillation Is Associated With Decreased Claudin-5 In Cardiomyocyte

Background: Although it is critically important to understand the underlying molecular and electrophysiological changes that predispose to the induction and maintenance of atrial fibrillation (Af), the underlying mechanism of Af is still poorly defined. Af is characterized as the electrophysiological and membrane integrity abnormality of the atrial cells, and claudin-5, a tight junction protein, may be involved in the pathophysiology of Af, however, the role of claudin-5 in Af is unknown. Methods and Results: Cardiac tissues from the left atrial appendage were obtained from AF patients with rheumatic valvular heart disease undergoing modified radiofrequency ablation maze procedure with approval from local human research ethic review and normal left atrial appendages were obtained from non-AF donors. Western blot, immunofluorescence and transmission electron microscope showed the expression of claudin-5 significantly decreased in cardiomyocytes from left atrium of AF patients compared to non-AF donors. Then proteomics analysis was performed to screen the specific protein expression and signal pathway changed in AF heart tissue vs. non-AF heart tissue, and showed that 83 proteins were downregulated and 102 proteins were upregulated in the left atrial appendage of AF patients. Among them, DAG, CACNA2D2, MYL2 were downregulated and MCU was upregulated. KEGG pathway analysis showed these changes would lead to hypertrophic and dilated cardiomyopathy. Finally, claudin-5 shRNA AAV was injected in mouse left ventricle to knockdown claudin-5 in cardiomyocytes to observe whether change of claudin-5 affects the protein expression in KEGG pathway analysis. We found claudin-5 deficiency caused severe ventricular dilation, ST elevation and arrythmia, and the protein level of DAG, CACNA2D2 and MYL2 were downregulated and MCU was upregulated. Co-immunoprecipitation also confirmed the specific protein-protein interaction between these targeted proteins and claudin-5. Conclusion: We demonstrated that the decrease of claudin-5 in the left atrium of AF patients with rheumatic valvular heart disease. The mechanism of AF might be associated with claudin-5 downregulation-induced decrease of DAG, CACNA2D2, MYL2 and increase of MCU in cardiomyocytes.

Exploring patients' needs and perceptions regarding a specialised lifestyle oriented atrial fibrillation outpatient clinic: a qualitative study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Netherlands Organisation for Health Research and Development (ZonMw). Background Atrial Fibrillation (AF) symptom management can be challenging with current treatment strategies. Most risk factors for AF are related to lifestyle and therefore, healthy behaviour among AF patients can improve treatment outcomes. Behaviour change techniques and an integrated care approach have been demonstrated to effectively reduce cardiovascular hospitalisation in AF patients. Furthermore, involving patients in healthcare decision making increases patient participation and improves treatment outcomes. However, needs and perceptions of patients on an AF specialised outpatient clinic have not been studied yet. Patient behaviour can be explained with the Integrated Behavioural Model. This model theorizes that the strongest predictor in behaviour is behavioural intention, which is affected by determinants such as attitude, perceived norm and personal agency. These determinants can be used to understand and influence behaviour. Therefore, the Integrated Behavioural Model attributes to gather insights into patients’ perspectives and needs and may improve AF treatment outcomes. Purpose This study aims to identify patients’ needs and perceptions regarding a specialised AF outpatient clinic, to identify essential aspects required for behaviour change techniques to modify important AF risk factors, and to explore the role of the nurse practitioner in risk factor management. Methods Study participants were recruited at the specialised AF outpatient clinic of a third-line hospital. Semi-structured interviews were conducted using an interview guide that included topics described in scientific literature regarding risk factor modification and the integrated Behavioural Model. Additionally, perceptions regarding a lifestyle oriented AF outpatient clinic were asked. Transcripts were analyzed using a thematic analysis. Results A total of 11 patients were recruited. Qualitative analysis resulted in three main themes: AF symptoms and treatment, current lifestyle behaviours, and expectations for a specialised outpatient clinic. Overall, patients indicated to experience multiple complaints related to AF despite medical therapy and 64% confirmed that AF impairs their Quality of Life. Inadequate knowledge about AF, anxiety, and a worsened stamina are important barriers to execute a healthy lifestyle. Nonetheless, determinants such as social norm facilitate healthy behaviour. In order to improve their lifestyle, patients highlighted they prefer easy accessible health professionals who guide them in symptom management, increase their knowledge about AF and its risk factors, and to improve their lifestyle. Conclusion This study confirms that health professionals are important facilitators to increase healthy lifestyle among AF patients. Greater emphasis should be given to an integrated, multidisciplinary care approach to develop a comprehensive intervention programme aimed at changing unhealthy behaviour.

Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation

To date, evidence on optimal anticoagulant options in patients with AF who concurrently have active cancer remains elusive. To describe anticoagulant patterns and clinical outcomes among patients with a concomitant diagnosis of AF and cancer. Data were obtained from the University of Utah and Huntsman Cancer Institute (HCI) Hospitals. Patients were included if they had diagnosis of AF and cancer. Outcome was type and pattern of anticoagulant. Clinical outcomes were stroke, bleeding and all-cause mortality. From October 1999 to December 2020, there were 566 AF patients who concurrently had active cancer. Mean age ± standard deviation was 76.2 ± 10.7 and 57.6% were males. Comparing to warfarin, patients who received direct oral anticoagulant (DOACs) were associated with similar risk of stroke (adjusted hazard ratio, aHR 0.8, 95% confidence interval [CI] 0.2–2.7, P = 0.67). On contrary, those who received low-molecular-weight heparin (LMWH) were associated with significantly higher risk of stroke comparing to warfarin (aHR 2.4, 95% CI 1.0–5.6, P = 0.04). Comparing to warfarin, DOACs and LMWH was associated with similar risk of overall bleeding with aHR 1.1 (95% CI 0.7–1.6, P = 0.73) and aHR 1.1 (95% CI 0.6–1.7, P = 0.83), respectively. Patients who received LMWH but not DOACs were associated with increased risk of death as compared to warfarin, aHR 4.5 (95% CI 2.8–7.2, P < 0.001) and 1.2 (95% CI 0.7–2.2, P = 0.47). In patients with active cancer and AF, LMWH, compared to warfarin, was associated with an increased risk of stroke and all-cause mortality. Furthermore, DOACs was associated with similar risk of stroke, bleeding and death as compared to warfarin.

Flecainide for conversion and maintenance of sinus rhythm after mitral valve replacement in rheumatic atrial fibrillation

BackgroundDespite successful mitral valve replacement (MVR), many patients remain in AF. Flecainide can be useful in these patients but has not been used because of underlying structural heart disease. MethodsWe assessed oral flecainide for conversion and maintenance of SR in 25 patients of chronic rheumatic AF following MVR (age 34.4 yrs, mean AF duration: 3.6 yrs). Non-converters underwent DC cardioversion at 24 h and 4 weeks. Patients received flecainide and bb/diltiazem at discharge. ResultsSingle oral dose of Flecainide achieved SR in 6/25 (24%) while 19/25 achieved SR after DCC; at24 h 21/25 (84%) were in SR. With mean flecainide dose (93.10 ± 9.40 mg), successful maintenance of SR at 6 months was seen in 16/23 (69.5%). No significant changes in PR interval, QRS duration or QTc were noted; flecainide was well tolerated. Patients in SR had significantly better functional status, QOL scores and higher LA strain at 6 months (25.25 vs 17.43%, p < .0001). Baseline LA diameter ≤ 61 mm predicted SR at 6 months (sensitivity/specificity 93.7% and 85.71%) while the values for AF duration ≤ 4 years and LA strain > 21% for predicting SR were 87.5/71.43% and 100/85.71% respectively. ConclusionOral flecainide was safe and effective in post MVR rheumatic AF patients; maintenance of SR was achieved in 76% of initial converters and 64% of overall population, with better LA strain values. More studies are needed to validate these results.

MAPPING THE JOURNEYS OF ATRIAL FIBRILLATION PATIENTS AND CITIZENS USING WEARABLE DEVICES FOR REMOTE CARDIAC MONITORING

AbstractAtrial Fibrillation (AF) is one of the most prevalent cardiac diseases in the world. How might we design patient journeys improving quality of life using wearable cardiac devices for continuous out of hospital monitoring and support? Most of the studies to date have emphasised the technical aspects of implementing such devices with less focus on human factors. As such, remote cardiac monitoring appears to be burdened by poor patient adherence. This research study proposed a journey map based on Roger's technology adoption model to understand the challenges faced by AF patients and non/asymptomatic patients in using wearable devices to monitor their health. Data from semi-structured interviews conducted in Denmark with 12 participants aged 24 to 65 years was used. Interview results show that citizens prefer tracking heart activity only in conjunction with other measures such as steps or sleep and do not feel motivated to track their heart activity on a daily basis. Patients view wearables as a valuable tool to check if their health is all right, although apprehension that devices can cause unnecessary worry can lead to their rejection. Finally, recommendations for the design of patient journeys when using wearables were made.

The significance of high sensitive troponin i and left atrial mechanical dispersion in middle-aged patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is a progressive disease and can initiates and maintains in the absence of left atrial (LA) enlargement¹´². Echocardiographic parameters of LA mechanics had been proposed for best dealing with patients in AF³ . Combining different laboratory biomarkers with echocardiographic parameters can improve prediction, detection and treatment of AF in clinical practice. However, there is limited data about the significance of combination of novel echocardiographic and laboratory biomarkers in prediction of AF in middle-aged patients without LA enlargement. Purpose To investigate middle- aged AF patients with normal standart 2D echocardiography (2DE) to establish novel echocardiographic and laboratory biomarkers as predictors of reccurent AF. Methods Prospective consecutive patients with symptomatic AF (n= 936), were screened for participation in the study. A total of 70 patients met the inclusion criteria- stable sinus rhythm for more than 3 weeks, age between 40–60 years, without over heart disease and normal 2DE. They were separated in two groups: with new-onset AF (n=33) and recurrent episode of AF (n=37); 30 healthy subjects were enrolled in the control group. All patients underwent 2DE with speckle- tracking analyses and biomarker assays were collected, including baseline high sensitive troponin I (hsTnI), galectin-3, uric acid and hsCRP. Results There were significant differences between all groups in echocardiographic parameters of LA mechanics: LA reservoir, conduit and contractile strain and strain rate respectively, LA stiffness index- table 1. There were significant differences in laboratory markers- hsTnI and uric acid between groups. Moreover, pro-fibrotic biomarker Galectin-3 was higher only in patients with reccurent AF as was LA mechanical dispersion from speckle-tracking analysis. There were no differences in hsCRP between groups. Binary regression analysis demonstrated that hsTnI (OR 1,880; p&amp;lt; 0,025; 1,084- 3,260 95,0% CI) and LA mechanical dispersion (OR 1,012; p&amp;lt; 0,034; 1,001- 1,024 95,0% CI) are predictors of reccurent AF- ROC curve image . Conclusion As a progressive disease AF facilitates its own persistence through LA structural and functional remodeling. Left atrial dispersion along with baseline hsTnI may have additive value for prediction of reccurent AF episodes, reflecting this process in middle-aged patients without LA enlargement.

The effect of treatment strategy on long-term follow-up results in patients with nonvalvular atrial fibrillation in Turkey: AFTER-2 subgroup analysis.

We performed a subanalysis of the data from the AFTER-2 registry. In our study, we aimed to compare the long-term follow-up results of nonvalvular atrial fibrillation (NVAF) patients in Turkey according to their treatment strategies. All consecutive patients older than 18years of age who presented to cardiology outpatient clinics, had at least one AF attack and did not have rheumatic mitral valve stenosis or prosthetic heart valve disease were included in our prospective study. The patients were divided into two groups as rhythm control and rate control. Stroke, hospitalization and death rates were compared between the groups. A total of 2592 patients from 35 centers were included in the study. Of these patients, 628 (24.2%) were in the rhythm control group and 1964 (75.8%) in the rate control group. New-onset ischemic cerebrovascular disease or transient ischemic attack (CVD/TIA) was detected at a lower rate in the rhythm control group (3.2% vs. 6.2% p = 0.004). However, there was no significant difference in one-year and five-year mortality rates (9.6% versus 9.0%, p = 0.682 and 31.8% versus 28.6%, p = 0.116, respectively). Hospitalization were found to be significantly higher in patients with rhythm control group (18% vs. 13%, p = 0.002). It was found that rhythm control strategy is preferred in AF patients in Turkey. We found a lower rate of ischemic CVD/TIA in patients in the rhythm control group. Although no difference was observed in mortality rates, we found a higher rate of hospitalization in the rhythm control group.

Effect of atrial fibrillation on outcomes in patients with anterior circulation occlusion stroke receiving endovascular therapy.

Atrial fibrillation is one of the major risk factors of ischemic stroke. Endovascular thrombectomy (EVT) has become the standard treatment for acute ischemic stroke with large vessel occlusion. However, data regarding the impact of AF on the outcome of patients with acute ischemic stroke treated with mechanical thrombectomy are controversial. The aim of our study was to determine whether atrial fibrillation modifies the functional outcome of patients with anterior circulation acute ischemic stroke receiving EVT. We reviewed 273 eligible patients receiving EVT from January 2019 to January 2022 from 3 comprehensive Chinese stroke centers, of whom 221 patients were recruited. Demographics, clinical, radiological and treatment characteristics, safety outcomes, and functional outcomes were collected. Modified Rankin scale (mRS) score ≤ 2 at 90 days was defined as a good functional outcome. In our cohort, 79 patients (35.74%) were eventually found to have AF. Patients with AF were elder (70.08 ± 11.72 vs. 61.82 ± 13.48 years, p = 0.000) and less likely to be males (54.43 vs. 73.94%, p = 0.03). The significant reperfusion rate (modified thrombolysis in cerebral infarction 2b-3) was 73.42 and 83.80% in patients with and without AF, respectively (p = 0.064). The good functional outcome (90-day modified Rankin scale: 0 to 2) rate was 39.24 and 44.37% in patients with and without AF, respectively (p = 0.460) after adjusting multiple confounding factors. There was no difference in the presence of symptomatic intracerebral hemorrhage between the two groups (10.13 vs. 12.68%, p = 0.573). Despite their older age, AF patients achieved similar outcomes as non-AF patients with anterior circulation occlusion treated with endovascular therapy.

Prediction of post-operative atrial fibrillation in patients after cardiac surgery using heart rate variability

PurposePost-operative atrial fibrillation (PoAF) occurs in ~ 30% of patients after cardiac surgery. The etiology of PoAF is complex, but a disbalance in autonomic systems plays an important role. The goal of this study was to assess whether pre-operative heart rate variability analysis can predict the risk of PoAF.MethodsPatients without a history of AF with an indication for cardiac surgery were included. Two-hour ECG recordings one day before surgery was used for the HRV analysis. Univariate and multivariate logistic regression, including all HRV parameters, their combination, and clinical variables, were calculated to find the best predictive model for post-operative AF.ResultsOne hundred and thirty-seven patients (33 women) were enrolled in the study. PoAF occurred in 48 patients (35%, AF group); the remaining 89 patients were in the NoAF group. AF patients were significantly older (69.1 ± 8.6 vs. 63.4 ± 10.5 yrs., p = 0.002), and had higher CHA2DS2-VASc score (3 ± 1.4 vs. 2.5 ± 1.3, p = 0.01). In the multivariate regression model, parameters independently associated with higher risk of AF were pNN50, TINN, absolute power VLF, LF and HF, total power, SD2, and the Porta index. A combination of clinical variables with HRV parameters in the ROC analysis achieved an AUC of 0.86, a sensitivity of 0.95, and a specificity of 0.57 and was more effective in PoAF prediction than a combination of clinical variables alone.ConclusionA combination of several HRV parameters is helpful in predicting the risk of PoAF. Attenuation of heart rate variability increases the risk for PoAF.

Neurohumoral Markers of Cardiac Autonomic Denervation after Surgical Ablation of Long-Standing Persistent Atrial Fibrillation.

Although the autonomic nervous system has an evident impact on cardiac electrophysiology and radiofrequency ablation (RFA) is the conventional technique for treating persistent atrial fibrillation, the specific effects of RFA have been insufficiently studied to date. Here, we investigated whether RFA affects neurohumoral transmitter levels and myocardial 123I-metaiodobenzylguanidine (123I-MIBG) uptake. To perform this task, we compared two groups of patients with acquired valvular heart disease: patients who had undergone surgical AF ablation and patients with sinus rhythm. The decrease in norepinephrine (NE) level in the coronary sinus had a direct association with the heart-to-mediastinum ratio (p = 0.02) and a negative correlation with 123I-MIBG uptake defects (p = 0.01). The NE level decreased significantly after the main surgery, both in patients with AF (p = 0.0098) and sinus rhythm (p = 0.0039). Furthermore, the intraoperative difference between the norepinephrine levels in the ascending aorta and coronary sinus (ΔNE) of -400 pg/mL was determined as a cut-off value to evaluate RFA efficacy, as denervation failed in all patients with ΔNE < -400 pg/mL. Hence, ΔNE can be utilized to predict the efficacy of the "MAZE-IV" procedure and to assess the risk of AF recurrence after RFA.

Ventricular arrhythmias and cardiac arrest in atrial fibrillation patients with pacemakers and implantable cardioverter-defibrillators

BackgroundAtrial fibrillation (AF) has been linked to ventricular arrhythmias (VAs) and sudden death, but few studies have specifically explored this association. ObjectiveWe investigated whether AF is associated with an increased risk of ventricular tachycardia (VT), ventricular fibrillation (VF) and cardiac arrests (CA) in patients with cardiac implantable electronic devices (CIEDs). MethodsAll patients with pacemakers and implantable cardioverter-defibrillators (ICDs) hospitalised between 2010 and 2020 were identified from the French National database. Patients with a prior history of VT/VF/CA were excluded. Results701,195 patients were identified initially. After excluding 55,688 patients, 581,781 (90.1%) and 63,726 (9.9%) remained in the pacemaker and ICD groups respectively. 248,046 (42.6%) pacemaker patients had AF and 333,735 (57.4%) had no AF, whereas in the ICD group 20,965 (32.9%) had AF and 42,761 (67.1%) had no AF. The incidence of VT/VF/CA was higher in AF patients compared to non-AF patients both in pacemaker (1.47%/year vs. 0.94%/year) and ICD (5.30%/year vs. 4.21%/year) groups. After multivariable analysis, AF was independently associated with an increased risk of VT/VF/CA in pacemaker (HR 1.236 [95% CI 1.198–1.276]) and ICD (HR 1.167 [95% CI 1.111–1.226]) patients. This risk was still significant in the 1:1 propensity score-matched analysis of the pacemaker (n = 200,977 per subgroup) and ICD cohorts (n = 18,349 per subgroup), HR 1.230 [95% CI 1.187–1.274] and HR 1.134 [95% CI 1.071–1.200] respectively and in the competing risk analysis (pacemaker: HR 1.195 (95% CI 1.154–1.238], ICD: HR 1.094 [95% CI 1.034–1.157]). ConclusionCIED patients with AF have a higher risk of VT/VF/CA compared to CIED patients without AF.

Digitally enabled acute care for atrial fibrillation: conception, feasibility and early outcomes of an AF virtual ward

BackgroundAtrial fibrillation (AF) represents a growing healthcare challenge, mainly driven by acute hospitalisations. Virtual wards could be the way forward to manage acute AF patients through remote monitoring, especially with...

Is atrial fibrillation a risk factor for hearing loss?

In the present study, we sought to evaluate the results of hearing loss in AF patients.This study involved 50 patients with AF, as determined by means of electrocardiogram, and 50 patients without AF. The pure-tone audiometry (PTA) threshold values were measured at low, medium and high frequencies for both ears. The signal-to-noise ratio (SNR) DPOAEs and TEOAEs were also analyzed for both ears separately.Both the airway and bone conduction PTA thresholds at 3, 4 and 6 kHz (kilohertz) were significantly lower in the AF group than in the control group (p<0.05). The AF patients exhibited worse hearing and worse TEOAE results at 1, 2, 3 and 4 kHz. In fact, the TEOAE amplitudes of the AF group were significantly lower in both the right and left ears at 2, 3 and 4 kHz when compared with the control group (p<0.05). Moreover, the DPOAE amplitudes in the AF group were statistically significantly lower at 3.4 kHz in both ears when compared with the control group (p<0.05).In light of these findings, we believe that AF is a risk factor for hearing.

Improving handover in recovery

Background: An anaesthetist’s responsibility for patient safety continues into the recovery area where the patient remains at risk of surgical and anaesthetic complications. The multidisciplinary team is of vital importance, with recovery nurses taking a leading role in patient care. A clear handover between professionals should ensure continuity, quality, and safety of patient care.1 The Royal College of Anaesthetists provides guidance about this handover.2 Studies have shown that the use of checklists in anaesthesia can decrease human error, and improve teamwork and quality of care.3 In this project, we aimed to evaluate the quality of handovers in the recovery area at Inverclyde Royal Hospital and identify how these may be improved. Methods: An online questionnaire was sent to all theatre staff via Microsoft Forms with questions about the quality of the current handover process. Using this information, a ‘Recovery handover checklist’ was created and presented at the anaesthetic departmental meeting. We then trialled using a distraction-free ‘pause’ and the checklist, displayed in every recovery bay, to structure handovers over a 4-month period. A second online questionnaire was sent to all theatre staff with questions about the impact of this change. The length of handover was timed before and after the change. Results: The initial questionnaire received 20 respondents, including recovery nurses, anaesthetists, anaesthetic nurses, and theatre nurses. Some 65% of respondents thought current handover was not adequate. Fifty-five percent thought not all relevant information was handed over. Eighty-five percent thought there were distractions during handover. The follow-up questionnaire received 38 respondents, again from the full multidisciplinary team. Some 71% of respondents thought the ‘pause’ for handover had been useful and 76% would be keen to continue this. Eighty-two percent thought that there were fewer distractions during handover. However, 73% of recovery nurses thought that staff are only sometimes pausing before handover. There was no increase in average time taken for handover after the changes. Conclusion: Most of the multidisciplinary team at our hospital have found the introduction of a distraction-free ‘pause’ and checklist for handover in recovery useful. This new handover process has not increased the length of time taken for handover. Further work should include promotion of the checklist so that it is used more consistently in our department. 1.Arora V, Johnson J. Jt Comm J Qual Patient Saf 2006; 32: 646–552.Royal College of Anaesthetists. Novice Guide 2019. https://www.rcoa.ac.uk/documents/novice-guide/typical-day-novice (accessed 20/03/23)3.Saxena S, Krombach JW, Nahrwold DA, Pirracchio R. Anaesth Crit Care Pain Med 2020; 39: 65–73

L1 cell adhesion molecule may be a protective molecule for atrial fibrillation in patients with valvular heart disease

BackgroundAtrial fibrillation (AF) is the most prevalent sustained arrhythmia. L1 cell adhesion molecule (L1CAM) served as a crucial regulator of signaling pathways. This research sought to examine the clinical value and functions of soluble L1CAM in the serum of AF patients. MethodsIn total, 118 patients (valvular heart disease patients [VHD, total: n = 93; AF: n = 47; sinus rhythm (SR): n = 46] and healthy controls [n = 25]) were recruited in this retrospective study. Plasma levels of L1CAM were detected by enzyme-linked immunosorbent assays. The Pearson's correlation approach, as applicable, was used for analyzing the correlations. The L1CAM was shown to independently serve as a risk indicator of AF in VHD after being analyzed by the multivariable logistic regression. To examine the specificity and sensitivity of AF, receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used. A nomogram was developed for the visualisation of the model. We further evaluate the prediction model for AF using calibration plot and decision curve analysis. ResultsThe plasma level of L1CAM was substantially decreased in AF patients as opposed to healthy control and SR patients (healthy control = 46.79 ± 12.55 pg/ml, SR = 32.86 ± 6.11 pg/ml, AF = 22.48 ± 5.39 pg/ml; SR vs. AF, P < 0.001; control vs. AF, P < 0.001). L1CAM was significantly and negatively correlated with LA and NT-proBNP (LA: r = −0.344, P = 0.002; NT-proBNP: r = −0.380, P = 0.001). Analyses using logistic regression showed a substantial correlation between L1CAM and AF in patients with VHD (For L1CAM, Model 1: OR = 0.704, 95%CI = 0.607–0.814, P < 0.001; Model 2: OR = 0.650, 95% CI = 0.529–0.798, P < 0.001; Model 3: OR = 0.650, 95% CI = 0.529–0.798, P < 0.001). ROC analysis showed that inclusion of L1CAM in the model significantly improved the ability of other clinical indicators to predict AF. The predictive model including L1CAM, LA, NT-proBNP and LVDd had excellent discrimination and a nomogram was developed. The model had good the calibration and clinical utility. ConclusionL1CAM was shown to independently serve as a risk indicator for AF in VHD. In AF patients with VHD, the prognostic and predictive effectiveness of models incorporating L1CAM was satisfactory. Collectively, L1CAM may be a protective molecule for atrial fibrillation in patients with valvular heart disease.

Utility of ST2 soluble biomarker in patients with atrial fibrillation and pulmonary veins isolation

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): No fundings related Background Atrial fibrillation (AF) is the more frequent arrhythmia in clinical practice and the efficacy of pulmonary vein ablation has being widely demonstrated. There is still a lack of information about the predictive value of electroanatomical voltage maps or biomarkers to predict recurrence. Purpose ST2 soluble (ST2S) biomarker has being previously analyzed by our group in patients with AF and electrical cardioversion demonstrating utility to predict recurrence . So we sought to analyze the clinical utility of ST2S biomarker in patients with AF that underwent to an electrophysiology study and pulmonary isolation (PVI) to compare the predictive value of this biomarker. Results This was a prospective, observational clinical trial that included a total of 156 patients with AF who were referred to our hospital for a PVI from September 2016 to September 2019. We also included 40 matched control patients for the initial analysis. All the patients with AF underwent an electroanatomical voltage map in sinus rhythm and PVI. From the 156 PVI: 68 had paroxysmal AF and 88 persistent. ST2S mean value in AF patients was of (13178.5 pg/ml) and had no significant difference with matched controls (11016.2 pg/ml) in baseline analysis. There was no association of ST2S baseline values and recurrence in AF patients. When we analyzed by type of AF, persistent AF patients had a significantly higher level of the biomarker and there was also a significant elevation of the biomarker according to heart rate (&amp;gt;100 bpm) (p 0.038). We observed an elevation of the ST2S levels at 3 and 6 months follow-up with no difference according to recurrence. The levels of ST2S were lower in the cases with a lower voltage map area and in the cases with a wider lower map area but there was no a significant association nor with recurrence. In multivariant analysis only AF rhythm and LA index volume was a significant predictor or recurrence at 3 months follow-up. Conclusions We consider that even though there is an association with AF patients and ST2S biomarker levels, specially in those with persistent AF, in patients undergoing an PVI, ST2S values had a generalized elevation at follow-up probably related to inflammation and were not predictive of recurrence.

Association of cardiac rhythm with cognitive performance in atrial fibrillation patients

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation, Background Atrial fibrillation (AF) is strongly associated with an increased risk of cognitive decline and dementia. AF-induced cerebral hypoperfusion, caused by loss of atrial contraction and RR interval variation, is discussed as one possible underlying mechanism. However, the short-term association between heart rhythm and cognitive performance is not clear. Here, we aimed to investigate the association of rhythm (AF vs. sinus rhythm, SR) with cognitive performance in AF patients. Methods We enrolled patients from a prospective, multicenter cohort study. At study visits, patients underwent 5-minute resting ECG recordings and extensive cognitive testing including the Montreal Cognitive Assessment (MoCA) and cognitive construct score (CoCo). Multivariable adjusted mixed effect linear regression models were used to investigate the association between acute heart rhythm on ECG (AF vs. SR) and cognitive performance. Further, we investigated the association between heart rhythm and the Geriatric Depression Score (GDS) as well as the European Quality of Life Visual Analogue Scale (EQ-VAS 100). Results 5206 ECGs from 1648 AF patients were available for analysis. 46% of ECGs were in AF. Mean age of the patients was 72 years and 27% were females. After adjustment for pre-defined covariables, we did not identify an independent association between heart rhythm (AF vs. SR) and cognitive performance in any test. However, patients with present AF on ECG had reported worse GDS and EQ-VAS 100 scores. Conclusion In our large cohort of AF patients, there was no acute association between heart rhythm (AF or SR) and cognitive performance.