Appearance Of Atrial Fibrillation Research Articles

#1313 Dicumarinics and the direct thrombin or factor Xa inhibitors (NOAs) their usefulness in advanced chronic renal disease

Abstract Background and Aims Our population with advanced chronic kidney disease (ACKD), is more prone to thrombotic and hemorrhagic processes so the indication of anticoagulation before the appearance of atrial fibrillation (AF) is complex. Since AF is the most common cardiac arrhythmia, its main complications are thromboembolism and stroke. New treatments are being developed, such as the new oral anticoagulants (NOAs), but their safety in ACKD is still uncertain. To see anticoagulation needs, safety and major adverse effects (major or minor bleeding) in population with ACKD and taking dicumarinics or NOAs. Method Retrospective study of 234 patients followed in our ACKD practice, at least two revisions, with a mean follow-up 25.5 months, in which we recorded cause of anticoagulation, type and major adverse effects. Results 26% of patients have indication for anticoagulation (66 patients), of which 55 remain anticoagulated during follow-up (45% Dicumarinics, 44% NOAs). The indication for anticoagulation was 23% AF (56 patients) and 3% mechanical prostheses (7 patients). Table 1 shows the characteristics of the overall population and the comparison between anticoagulated patients with different types of anticoagulation and non-anticoagulated patients. Non-anticoagulated patients are younger and have less ischemic heart disease, with no differences in the non-anticoagulated population. Throughout follow-up, we found a higher incidence of bleeding with NOAs (compared to the rest) and higher mortality in patients with dicumarinics (compared to the rest). There were no differences in age, sex and ischemic heart disease between the two anticoagulant treatments. Conclusion Our CKD population has a high need for anticoagulation but also a high risk of bleeding. NOAs can be used in ACKD although they are associated with a higher incidence of bleeding than dicumarinics but lower mortality. More studies are needed to conclude which is the best approach for these patients.

The influence of a transferred infection of COVID-19 on the development of atrial fibrillation and changes in its course depending on clinical and anamnestic data

The aim – to study the influence of clinical and anamnestic characteristics, namely: arterial hypertension, coronary heart disease, diabetes, previous myocardial infarction, acute cerebrovascular accident, metabolic cardiomyopathy, of myocarditis in the anamnesis and chronic heart failure on the development of atrial fibrillation (AF) de novo or the deterioration of the course of an already existing arrhythmia in patients after suffering a coronavirus infection (CI).Materials and methods. The study involved 116 patients with AF who were hospitalized in the department of clinical arrhythmology and electrophysiology from September 20.09.2020 to 21.12.2021 and had a history of coronavirus infection (CI). The 1st group – 36 people (31 %) in whom AF occurred after CI. The 2nd group – 25 patients in whom the form of AF has changed. The 3rd group – 55 patients in whom the form of AF did not change. In the 3rd group, two subgroups were formed: 3A – 35 patients in whom, although the form of AF did not change, the frequency or duration of arrhythmia paroxysms increased, and 3B – 20 patients without significant changes in the course of AF. As the first control group (C1), 49 patients with AF without a history of CI were examined. The second control group (C2) was formed by 22 patients after a CI in whom AF did not develop.Results and discussion. In patients of the 1st group, hypertension occurred 1.4 times more often (p<0.001) than in the subjects of the 2С comparison group. The presence of hypertension, especially of the 3rd stage, increased the probability of the appearance of AF after a previous CI, which probably contributed to the emergence of a new, more serious form of AF and worsened the course of this arrhythmia. CHD was probably more common in patients of group 2, compared to group 3. Coronary heart disease was also statistically more frequent in patients of subgroup 3A – in patients in whom the form of AF did not change, but the course of the arrhythmia worsened – the frequency and duration of paroxysms increased, in contrast to the subgroup 3B, in whose patients the course of AF did not fundamentally change. In patients with AF who underwent CI and had a history of аcute violation of cerebral circulation, its course worsened, compared to group 3B, in which the course of this arrhythmia did not change (p<0.001). Myocarditis in the anamnesis was probably much more common in patients of the 1st group, in comparison with the C2 group. There was a significant difference between the frequency of myocarditis in the anamnesis in patients of the 2nd group, in which the form of AF after CI changed to a more severe one, and in the patients of the 3rd group, in which the form of this arrhythmia did not change. Diabetes significantly and reliably affected the deterioration of the course of AF in patients who had this arrhythmia before CI, and contributed to a change in the form of AF to a more unpleasant one (2nd group) in comparison with patients without a change in the form of this arrhythmia (3rd group). Metabolic cardiomyopathy was reliably significantly more common in patients of the 1st group compared to the C2 group. There is a big difference between the frequency of metabolic cardiomyopathy in patients of the 2nd group in comparison with the patients of the 3rd group. In the patients of the 2nd group, in whom the form of AF changed to a more threatening one. There were statistically more people with heart failure IIA, and a higher stage of HF in the digital form in equal to persons of the 3rd group, which included patients in whom the form of AF did not change.Conclusions. In patients with atrial fibrillation who suffered a coronavirus infection, the most common concomitant diseases were found to be: HF I–IIA stage – 92 % (in more than half of the cases – in 51.4 % it was HF IIA stage), arterial hypertension – 83 %, coronary heart disease – 60 %, myocarditis – 28 %, diabetes was recorded in 12 % of patients. Arterial hypertension, especially of the 3rd stage, myocarditis in the anamnesis, heart failure of the II A stage caused the appearance of paroxysms of AF de novo after the transferred coronavirus infection in the cohort of patients studied by us. The aforementioned factors, as well as ischemic heart disease, myocardial infarction, and acute cerebrovascular accident in the anamnesis, have been established as markers of the transformation of the paroxysmal form of atrial fibrillation into persistent, or persistent atrial fibrillation into a permanent form of this arrhythmia after being infected with COVID-19.

Abstract 17674: Serum Brain-Derived Neurotropic Factor Levels Predict the Recurrences of Atrial Fibrillation Following Catheter Ablation

Background: Brain-derived neurotropic factor (BDNF) is a growth factor with roles within the nervous system and cardiovascular system. It has been reported that serum BDNF is decreased in diseases related to persistent stress, such as chronic inflammation. Atrial fibrillation (AF) is also considered to be one of the diseases related to chronic inflammation, although the relationship between serum BDNF and AF remains unclear. Methods: This prospective study included 68 consecutive patients (44 men; 69 [58-69] years) who underwent first session of paroxysmal AF ablation. Before and 3 months after the ablation, blood samples were obtained to measure the several biomarkers that are known to be related to AF in addition to serum BDNF. AF recurrence was defined as the appearance of AF after 3 month blanking period following the ablation. Results: The serum BDNF levels before ablation were significantly increased after AF ablation (3.5 [1.6-16.6] ng/ml vs. 22.1 [16.2-27.4] ng/ml, p<0.001). During follow-up period of 10±2 months, AF recurrence occurred in 5 (7%) patients. The serum BDNF at 3 months post-ablation were significantly lower in patients with recurrent AF than in those without (19.6 [13.8-20.8] ng/ml vs. 22.0 [17.5-27.1] ng/ml, p=0.019). Furthermore, the serum BDNF at 3 months post-ablation was an independent predictor of AF recurrence (odds ratio 0.912, 95% confidence interval 0.835-0.996, p=0.040). According to the ROC curve analysis, the serum BDNF at 3 months post-ablation <22.0 ng/ml was associated with AF recurrence with 100% sensitivity and 54% specificity (area under the curve=0.817, p=0.019). Kaplan-Meier survival curve showed that the recurrence rate of AF was higher in the group L (the serum BDNF at 3 months post-ablation <22.0 ng/ml) than the group H at 3 months post-ablation >22.0 ng/ml) (p = 0.02) [figure 1]. Conclusions: Lower serum BDNF levels at 3 months after blanking period following the AF ablation might be a predictor of AF recurrence.

Development of atrial fibrillation and changes in its course after an infection COVID-19 depending on age, gender and anthropometric characteristics

The aim – to analyze the probability of the development of atrial fibrillation (AF) «de novo», as well as to determine the course of an already existing rhythm disturbance after a transferred infection of COVID-19 in patients with different age, gender and anthropometric characteristics.Materials and methods. The study involved 116 patients with AF who were hospitalized in the department of clinical arrhythmology and electrophysiology from September 20.09.2020 to 21.12.2021 and had a history of coronavirus infection (CI). The 1st group – 36 people (31 %) in whom AF occurred after CI. The 2nd group – 25 patients in whom the form of AF has changed. The 3rd group – 55 patients in whom the form of AF did not change. In the 3rd group, two subgroups were formed: 3A – 35 patients in whom, although the form of AF did not change, the frequency or duration of arrhythmia paroxysms increased, and 3B – 20 patients without significant changes in the course of AF. As the first control group (C1), 49 patients with AF without a history of CI were examined. The second control group (C2) was formed by 22 patients after a CI in whom AF did not develop.Results and discussion. C1 patients were older than C2 patients by 10.4 years, p<0.0001. Individuals of groups 2 and 3 were probably older by an average of 2.5 years than the patients of the first control group. Group 2 patients were statistically significantly older (by 3.6 years) than group 3 patients. A large difference in age (by 12.9 years, p<0.001) of patients of the 1st group compared to the second control group was noted. That is, the older age of the patients was the cause of both «de novo» AF after a CI and the worsening of the course of this arrhythmia in those patients who had it before the infection of COVID-19. There were more women than men in the 2nd and 3rd compared to each other (where the ratio was 1.16:1.0) and compared to the control group (where the ratio was 0.44:1.0). Among the patients of the 3rd group, the frequency and duration of paroxysms increased in subgroup 3A, where there were statistically more women than in subgroup 3B and in the first control group. In addition, there were significantly more women than men in subgroup 3A (ratio 1.5:1.0, p<0.0001), which is a significant difference in the ratio of female to male patients in patients of subgroup 3B, where their ratio was 1.0:1.0. Therefore, female gender is a risk factor for the deterioration of the course of AF after infection with COVID-19.Excess body weight was found in 60 % of cases in patients who underwent CI and had AF. Patients of the 1st group, in contrast to C2, more often had excess body weight (BMI from 25 kg/m2 to 29 kg/m2). In subgroup 3A, unlike subgroup 3B, the average value of BMI was higher by 9 %. Excess weight contributes to the appearance of AF after CI and worsens the course of this arrhythmia.Conclusions. Excess body weight or obesity was found in 60 % of cases – i.e. in the vast majority of OG patients who underwent CI and had AF. The older age of patients (mostly over 60 years old), excess body weight and female gender in patients after a COVID-19 infection were risk factors for the occurrence of «de novo» AF and worsened the course of this already existing rhythm disorder.

Dysrhythmia in acute coronary syndrome patients undergoing coronary artery bypass grafting surgery at hanoi heart hospital

Objectives: Many studies have demonstrated arrhythmias were common in acute coronary syndrome and coronary artery bypass grafting surgery. Although the most of these arrhythmias were transient and have a benign course, but it may represent a significant source of morbidity and mortality. This study aimed to establish the temporal change pattern of arrhythmias observed to determine the incidence and characteristics of dysrhythmia.
 Methods: A prospective method was used to study 52 consecutive patients with acute coronary syndrome who were assessed using 24-hour Holter recordings before CABG and 1 week, 3 months, and 6 months after the surgery from June 2016 to August 2018 at Hanoi Heart Hospital.
 Results: New appearance of atrial fibrillation after coronary artery bypass grafting surgery increased by time, at 7 days was 17.3%, after 3 and 6 months were 10 - 18.4%. Percentage of ventricular dysrhythmias was highest before surgery 8.67%, decreased after surgery and lowest after 6 months. The rate of short ventricular tachycardia at 7 days after surgery was highest (11.8%), followed by the preoperative period (3.8%), decreased and disappeared after 6 months. Ventricular arrhythmias with Lown (grade > 3) preoperative was 44.2%, increased at 7 days postop was 51.9% and decreased postop 3 - 6 month (28 - 20%).
 Conclusion: New appearances of atrial fibrillation after coronary artery bypass grafting surgery increased by time. Dysrhythmia was acutely affected by myocardial ischemia and coronary artery bypass grafting surgery.

Effect of Prolonged and Substantial Weight Loss on Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Background. Overweight and obesity are associated with atrial fibrillation (AF), and bariatric surgery (BS), able to induce sustained and prolonged weight loss, might represent the ideal treatment in the prevention of AF. Previous studies could not definitely establish a role for weight loss and BS in preventing incident AF so far. During the last few years, several studies on the effect of bariatric surgery on cardiovascular diseases have been published, and we performed a systematic review and meta-analysis to evaluate the role of weight loss through BS in the prevention of incident AF in obesity. Methods. This meta-analysis followed the PRISMA guideline. Eligible studies were controlled trials evaluating the appearance of atrial fibrillation in patients undergoing weight loss through BS as compared with patients receiving medical treatment. Quality of studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale, and risk-of-bias was evaluated employing the Egger's test. All analyses were run by a random-effects model according to Hartung and Knapp and sensitivity analyses were performed. Heterogeneity was assessed through Q and I2 statistics for each comparison, and potential publication bias was formally investigated. Results. Ten studies were included in the meta-analysis, and the overall result was statistically significant [OR = 0.665 (0.475-0.929), p = 0.017], with significant heterogeneity (Q = 48.98, p < 0.001; I2 = 81.6%), but with no publication bias. In sensitivity analyses, the amount of weight loss, percentage of patients with diabetes and value of the Newcastle-Ottawa Quality Assessment Scale, were all associated with significance of effect. Since age was different in one study, a sensitivity analysis was performed by excluding this study; OR was similar [OR = 0.608 (0.454-0.814), p < 0.001]; heterogeneity was reduced but still significant (Q = 35.74, p < 0.001, I2 = 77.6%) and again no publication bias was detected. Conclusions. Bariatric surgery as compared to medical treatment is associated with reduced appearance of incident AF.

Use of Anticoagulant Therapy in Patients with Acute Myocardial Infarction and Atrial Fibrillation.

The incidence of atrial fibrillation (AF) in acute coronary syndrome (ACS) ranges from 2.3–23%. This difference in the incidence of AF is explained by the different ages of the patients in different studies and the different times of application of both reperfusion and drug therapies in acute myocardial infarction (AMI). About 6–8% of patients who underwent percutaneous intervention within AMI have an indication for oral anticoagulant therapy with vitamin K antagonists or new oral anticoagulants (NOAC).The use of oral anticoagulant therapy should be consistent with individual risk of bleeding as well as ischemic risk. Both HAS-BLED and CHA2DS2VASc scores are most commonly used for risk assessment. Except in patients with mechanical valves and antiphospholipid syndrome, NOACs have an advantage over vitamin K antagonists (VKAs). One of the advantages of NOACs is the use of fixed doses, where there is no need for successive INR controls, which increases the patient’s compliance in taking these drugs. The use of triple therapy in ACS is indicated in the case of patients with AF, mechanical valves as well as venous thromboembolism. The results of the studies showed that when choosing a P2Y12 receptor blocker, less potent P2Y12 blockers such as Clopidogrel should be chosen, due to the lower risk of bleeding. It has been proven that the presence of AF within AMI is associated with a higher degree of reinfarction, more frequent stroke, high incidence of heart failure, and there is a correlation with an increased risk of sudden cardiac death. With the appearance of AF in ACS, its rapid conversion into sinus rhythm is necessary, and in the last resort, good control of heart rate in order to avoid the occurrence of adverse clinical events.

The importance of matrix metalloproteinases in the development of atrial fibrillation in obesity

One of the trends in modern cardiology is the study of the matrix metalloproteinase (MMP) system. Currently, an increase in plasma concentrations of some MMPs and their tissue inhibitors is considered as one of the earliest biochemical markers of myocardial fibrosis in various diseases of the cardiovascular system. Discusses the importance of MMP in the development of atrial fibrillation (AF). To study the effect of the MMP system on the development of AF in obese patients. The study included 105 patients with a body mass index of more than 30 kg/m2. Depending on the presence of AF, the patients were divided into 2 groups. The criterion for inclusion of patients in group 1 was the presence of documented AF paroxysm in 55 obese patients. The comparison group (group 2) consisted of 50 obese patients without heart rhythm disorders. When patients were included in the study, in order to assess the severity of visceral obesity, all patients underwent a general clinical examination, echocardiography. To determine the activity of the MMP system, venous blood was taken from patients. Significantly higher values of MMP-9 were detected in patients with obesity and paroxysmal AF 315.753.4 ng/ml than in patients with obesity without heart rhythm disorders 220.954.7 ng/ml (p=0.002); the values of tissue inhibitor of metalloproteinase 1 were 185.342.2 and 119.242.6 ng/ml, respectively (p=0.007). In patients with obesity and paroxysmal AF, a correlation of moderate strength between the level of MMP-9 and the volume of left atrium and a direct dependence of moderate strength between the ratio of waist volume to height and the plasma values of MMP-9 was revealed. The MMP-9 index (AUC 0.92) had a high diagnostic value for determining the probability of having a paroxysmal form of AF in obese patients. With an increase in the level of MMP-9 more than 295 ng/ml, it is possible to predict the presence of paroxysmal AF in obese patients with a sensitivity of 74.5% and a specificity of 94%. In patients with obesity and paroxysmal AF, a significant increase in the parameters of the MMP system (MMP-9 and tissue inhibitor of metalloproteinase 1) was revealed when compared with obese patients without heart rhythm disorders (p0.05). With an increase in MMP-9 of more than 285 ng/ml in obese patients, the appearance of AF with a sensitivity of 74.5% and a specificity of 94% can be predicted.

Is the minimal mitral regurgitation a marker of high blood pressure, and can predispose to the appearance of atrial fibrillation?

Abstract Background Leonardo da Vinci intuited that the cardiac valves were the key to the functioning of the heart. Minimal mitral regurgitation (MMR) in young's is often interpreted as haemodynamically insignificant, it is attributed that it starts from birth or named para-physiologic effect. Pathophysiological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF). Purpose The aim of this study is to know if the presence of MMR is a consequence of the High Blood Pressure (BP), and whether in the own evolution can contribute to the appearance of the AF. Methods For this cross-sectional retrospective study, data were collected from 436 patients. Female-Male: 249–187 from the 20 to the 89 years old, mean age (±SD) 59.6 (16.5) – 59.7 (16.1), divided and analyzed in each one of them all 7 decades. All patients had MMR. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The measures of BP were registered in mmHg. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The Central Haemodynamic Parameters (CHP) were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (between the normal levels and the observed values) was assessed according to the normal range by age. Results In all patients female - male, the mean (±SD) of SBP/DBP 142.7 (24.5)/83.7 (13.6) – 137.7 (20.2)/82.4 (11.3) was higher than normal levels of BP accepted by ESC/ESH. All measures of CHP and SBP/DBP increased with age in each decade, in female from the 20s 120.3 (18.9)/76.7 (14.1) to the 80s 160.4 (21.1)/86.0 (25), and in male from the 20s 133.7 (16.7)/78.9 (6.4) to the 70s 142.8 (23.5)/78.8 (12.4), but slightly decreased in the 80s 138.4 (20.4)/76.6 (8.0). The difference of Augmentation index (surrogate value of arterial stiffness) in all decades was higher too, for both genders. In the adult total sample, in female - male the AF reached 26.5% - 27.8%, beginning after 33 years old, and strongly increased its prevalence after the 60s to a top of 50.0% - 43.8% at 80s. Conclusions MMR can be an early marker of high BP levels, the prevalence increasing with age, and it would be a predisposing condition to evolving to AF. The appearance of MMR principally among younger can indicate that the brachial BP found is higher than “normal”, needing any time to modify the original ventricular geometry toward myocardial remodelling, Therefore, it should be reassessed the optimal levels of BP to avoid its complication. Funding Acknowledgement Type of funding sources: None.

Short-term outcomes of surgical atrial ablation and septal myectomy

Background. Hypertrophic cardiomyopathy is one of the most common types of cardiomyopathy. The appearance of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy is associated with significant clinical worsening. Outcomes of surgical ablation and septal myectomy in these patients are limited.Aim. This retrospective study aimed to evaluate short-term outcomes of concomitant surgical ablation and septal myectomy in patients with obstructive hypertrophic cardiomyopathy and atrial fibrillation.Methods. Fifty-five patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent concomitant surgical ablation and septal myectomy between 2014 and 2019 were analysed. Patients with paroxysmal atrial fibrillation predominantly underwent left atrial ablation, and those with nonparoxysmal atrial fibrillation predominantly underwent the Maze IV procedure. Surgical ablation was performed using cryoablation alone (83.6%) or in combination with radiofrequency energy (16.4%).Results. Hospital mortality was 1.8%. Incidence of major adverse events was 3.6%. Sinus node dysfunction and atrioventricular block occurred in 7.3% and 1.8% of patients, respectively. Bleeding requiring revision occurred in 2 (3.6%) patients. Forty-nine (89.1%) patients had stable sinus rhythm and five (9.1%) were on dual-chamber pacemaker stimulation at the time of discharge.Conclusion. Concomitant septal myectomy and surgical ablation are feasible and safe in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.Received 5 April 2021. Revised 16 May 2021. Accepted 17 May 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authorsConception and study design: A.S. Zalesov, A.V. Bogachev-ProkophievData collection and analysis: A.S. Zalesov, S.A. Budagaev, A.V. SapeginStatistical analysis: A.S. Zalesov, A.V. Afanasyev, R.M. SharifulinDrafting the article: A.S. ZalesovCritical revision of the article: A.V. Bogachev-Prokophiev, S.I. Zheleznev, I.I. DeminFinal approval of the version to be published: A.S. Zalesov, A.V. Bogachev-Prokophiev, A.V. Afanasyev, R.M. Sharifulin, A.V. Sapegin, S.A. Budagaev, S.I. Zheleznev, I.I. Demin

Narrative review on Morbus Fabry: diagnosis and management of cardiac manifestations.

Fabry disease (FD) is an X-linked lysosomal storage disorder due to reduced or undetectable α-galactosidase A (AGAL-A) enzyme activity caused by pathogenic variants in the AGAL-A gene (GLA). Tissue and organ changes are caused by widespread progressive accumulation of globotriaosylceramide (Gb3) and globotriaosylsphingosine (lysoGb3). The classical form of FD is multisystemic with cutaneous (angiokeratomas), neurological (peripheral neuropathy, premature stroke), renal (proteinuria and renal insufficiency), and cardiac involvement. Later onset variants may be limited to the heart. The objective of this review is to summarize the current knowledge on cardiac manifestations of FD and effects of targeted therapy. Cardiac involvement is characterized by progressive hypertrophy, fibrosis, arrhythmias, heart failure and sudden cardiac death (SCD). Targeted therapy is based on enzyme replacement therapy (ERT). Recently, small molecular chaperone, migalastat, became available for patients carrying amenable pathogenic GLA variants. The management of cardiac complications requires a complex approach. Several measures differ from standard clinical guidelines. Betablockers should be used with caution due to bradycardia risk, amiodarone avoided if possible, and anticoagulation used from the first appearance of atrial fibrillation. In Fabry cardiomyopathy SCD calculators are inappropriate. The awareness of FD manifestations is essential for early identification of patients and timely treatment initiation.

Postoperative atrial fibrillation in coronary artery bypass grafting herald poor outcome.

Introduction:Atrial fibrillation in postoperative period is common. Although the event of atrial fibrillation is associated with reduced cardiac output and its consequences and cerebrovascular events, its effect on outcome is not clearly documented. This study is done to evaluate the effect of atrial fibrillation on outcome of the operation.Materials and Methods:This is a retrospective case-control study. A total of 263 patients received coronary artery bypass grafting during this period. The data for demographics, comorbidities, preoperative medications, operative details, and echocardiographic parameters of left ventricular functions were acquired. A total of 24 patients had atrial fibrillation (Group I), while 239 remained in normal sinus rhythm (Group II). The outcome is measured as combined of death and postoperative myocardial infarction (MI).Results:The groups are comparable in demographic, preoperative medications, operative, and left ventricular parameters. Of the 24 (9.12%) patients who had postoperative atrial fibrillation, 11 were discharged on medical management. Nine patients reverted to sinus rhythm at discharge. Atrial fibrillation persisted in 8 patients 1 week after discharge and 3 patients after 1 month. The requirement of intraaortic balloon pump (IABP) was statistically significant in group I (5 in group I vs. 10 in group II, n = 0.001). There were 4 deaths in group 1 and 7 in group 2 (P = 0.002), however, the combined end point was achieved in 4 (16.6%) vs. 22 (9.2%), respectively, P = 0.1.Conclusion:The appearance of atrial fibrillation heralds increased requirement of IABP, MI, and death in patients undergoing coronary artery bypass grafting.

Advanced interatrial block is associated with worst prognosis in patients with previous coronary acute syndrome

Abstract Background The interatrial block (IAB) has been directly related to the appearance of several atrial tachyarrhythmias. The objective of this study is to establish whether the duration of p wave could predict the appearance of atrial fibrillation (AF), death or stroke in patients with a previous acute coronary syndrome (ACS). Methods We have reviewed all ECG of patients with an ACS admitted to our hospital from July 2006 to June 2014 looking for advanced IAB defined as (P-wave duration was ≥120 ms and presented biphasic morphology), excluding those patients with previous AF and who received anticoagulant therapy. These patients were part of the population of the BACS &amp; BAMI (Biomarkers in Acute Coronary Syndrome &amp; Biomarkers in Acute Myocardial Infarction) studies. For all patients we have determined their cardiovascular risk factors. The primary outcome was a combined endpoint that included death, stroke and development of AF. Cox regression was used for the analysis. Results A total of 423 patients were included, the mean age was 67.8 years (± 14), and 72.3% were male. Only 12 patients (2.8%) presented advanced IAB. After a median follow-up of 54.7 months, there were 51 events (21 deaths (41.2%) were observed, 17 patients (33.3%) had experienced stroke, and 13 patients (25.5%) had developed AF). Patients with development of primary endpoint were older with higher rates of cardiovascular risk factors, advance IAB and diuretic treatment at discharge. After a multivariate Cox regression analysis, advanced IAB [HR=2.65 (1.03–6.86); p=0.044], age [HR=1.06 (1.03–1.09) per year; p&amp;lt;0.001] and diuretic treatment at discharge of ACS [HR=1.87 (1.03–3.39); p=0.039] were independent predictors of worse prognosis. Conclusion Advanced IAB in ECG at admission with ACS could be a predictor of stroke, development of AF or death in follow up. Funding Acknowledgement Type of funding source: None

High incidence of subclinical atrial fibrillation in patients with syncope monitored with implantable cardiac monitor

ObjectiveThe use of implantable cardiac monitors (ICM) is highly useful in syncope workup. Latest-generation devices can detect asymptomatic episodes of atrial fibrillation. The main objective of this study was to determine the incidence of subclinical atrial fibrillation (AF) detected in a patient population undergoing prolonged electrocardiographic monitoring with an ICM for the etiological workup of syncope. MethodsProspective observational study carried out in a tertiary hospital from April 2014 to October 2019. All consecutive adult patients monitored with a latest-generation ICM for syncope with no prior history of AF were included in the analysis. ResultsOf a total of 509 ICMs implanted during the study period, 208 patients fulfilled the inclusion criteria. 42 patients (20.2%) were found to have AF on ICM. The incidence of AF was 11.7 cases per 100 person-years (95% CI: 8.7–15.9 per 100 person-years). The median burden of AF was 0.2% (IQR 0–0.8%). Age, the presence of hypertension, chronic kidney disease, the size of the septum and left atrium on electrocardiogram and the presence of broad QRS on baseline electrocardiogram were predictors for the appearance of AF in the univariate analysis. ConclusionThe incidental finding of atrial fibrillation in patients with syncope monitored with ICM is common. The burden of AF is low, and it is generally subclinical. These findings create added value for the use of ICM in the workup for syncope, although further studies are needed to determine the clinical benefit of documenting subclinical AF.

The Association Between Atrial Fibrillation and Endurance Physical Activity: How Much is too Much?

Atrial fibrillation (AF) is the most common arrhythmia in middle-aged athletes. Physical exercise performed in a regular basis has been shown to be beneficial for cardiovascular health. Moderate physical exercise, aside from producing a nice, peaceful and well-being sensation, has been associated with a reduced risk of AF. However, more strenuous endurance exercise, like the one experiencing marathon runners, seems to increase the risk of AF in healthy athletes without organic heart disease. On the other hand, low physical activity was found to be a risk factor for the appearance of AF. Nevertheless, the relationship of exercise to AF is complex, influenced by the intensity and the duration of the physical activity, and seems to have a U-shaped relationship with the greatest levels of physical activity possibly increasing AF incidence. There is cumulative data associating moderate physical activity to reduced AF incidence, hence physicians should recommend moderate exercise training to patients with AF. This may not only reduce AF risk, but would also contribute to an overall cardiovascular benefit. However, since there is also important data suggesting significant increased incidence of AF in elite athletes with long-term endurance physical activity, it may be a serious concern to go to the extreme. In most things in life it is much better and wiser to be well balanced, always in equilibrium.

Предикторна цінність ехокардіографічних показників щодо виникнення фібриляції передсердь у хворих з гострим коронарним синдромом

Предикторна цінність ехокардіографічних показників щодо виникнення фібриляції передсердь у хворих з гострим коронарним синдромом

Women Who Have Ischemic Strokes Have a Higher Burden of Left Atrial Fibrosis Than Men.

Background and Purpose- Women with atrial fibrillation (AF) have a higher risk of stroke than men who have AF. Atrial fibrosis is a marker of atrial disease that precedes the appearance of AF increasing the risk of ischemic stroke. We aimed to determine whether female sex is independently associated with left atrial fibrosis in stroke patients. Methods- We prospectively included a consecutive sample of ischemic stroke patients aged over 50 years of age. Late gadolinium enhancement cardiac magnetic resonance imaging was performed to quantify the severity of left atrial fibrosis and the wall pattern of its distribution. A multivariable linear regression analysis was performed to determine whether female sex was independently associated with left atrial fibrosis after adjusting for potential confounders namely AF and age. Results- One hundred twenty-four patients were deemed eligible; 117 patients were included (7 were excluded because of cardiomyopathy identified by cardiac magnetic resonance imaging). All had usable cardiac magnetic resonance imaging data. Fifty-three patients (45.3%) were women. Women were older and were less frequently treated with angiotensin-converting-enzyme inhibitors. Ninety-one patients had any degree of atrial fibrosis. Women had a higher percentage of atrial fibrosis than men-median (interquartile range)-18% (17) versus 10% (20). In a multivariable linear regression model adjusted for demographics, medications, AF, comorbidities, and cardiac parameters, female sex was found to be independently associated with left atrial fibrosis. Women were found to have more 4.70% of left atrial fibrosis than men (95% CI, 0.70-8.71%; P=0.02) after controlling for confounders. Conclusions- Female sex was found to be independently associated with left atrial fibrosis after controlling for confounders such as AF and age. Further studies are needed to understand if this contributes to the increased stroke risk related to AF in women compared with men.

NEW-ONSET ATRIAL FIBRILLATION IN SETTINGS OF ACUTE CORONARY SYNDROME. CURRENT ISSUES

The present review is focuses on new onset atrial fibrillation (AF) in conditions of acute coronary syndrome (ACS). Literature sources from PubMed and Scopus was used. AF is common in the general population and in the ACS population, at that new onset AF, and AF, which was by the time of ACS development are determined. Appearance of AF is more likely amongst the elderly patients with congestive heart failure, with signs of the hemodynamic instability and with the left atrium dilatation. It is well-known about the predictors of adverse outcome in ACS. According to some literature data new onset AF leads to worsening of prognosis, and in line with other sources a reason of its association with high level of mortality is due to the severity of ACS and appearance of AF is not independent predictor of death. The absence of subjective symptoms at the time of paroxysm of new onset AF does not allow estimating its duration and distinguishing between the new onset AF, persistent and constant AF. It is possible to trace the relationship between the myocardial ischemia and AF appearance. Inefficient reperfusion during percutaneous coronary intervention or thrombolytic therapy is accompanied by the onset of AF, on the contrary, when effective patency of coronary artery is achieved, AF appears significantly less often. New onset AF in ACS, in particular, accompanied by cardiogenic shock, requires emergency pharmacological or electrical cardioversion. In some cases, active cardioversion is not necessary, because of spontaneous cardiac rhythm conversion. In conclusions, it is necessary to point out, that ambiguity and multifactority of this problem demands investigation of arrhythmogenesis mechanisms and development of special risk stratification instruments for the new onset AF in ACS.

The predictive role of E/e′ on ischemic stroke and atrial fibrillation in Japanese patients without atrial fibrillation

BackgroundThe predictive role of E/e′ on ischemic stroke (IS) and atrial fibrillation (AF) in Japanese patients without AF are unclear. Methods and resultsShinken database includes all the new patients visiting the Cardiovascular Institute Hospital in Tokyo, Japan. E/e′ has been routinely measured since 2007. Patients without AF for whom E/e′ was measured at the initial visit between 2007 and 2014 (n=11 477, mean age 57.2 years old, men 59.5%) were divided into E/e′ tertiles (<8.04, 8.04–11.00, >11.00). During the mean follow-up period of 1.8 years, 58 IS and 140 new appearances of AF were observed. High E/e′ tertile was associated with more prevalence of atherothrombotic risks. The cumulative incidence of IS events and new appearance of AF at 6 years in low, middle, and high E/e′ tertiles were 0.5%, 1.4%, and 3.0%/year (log-rank test, p<0.001), and 2.5%, 2.9%, and 4.2%/year (log-rank test, p=0.007), respectively. In multivariate analysis, high E/e′ tertile was independently associated with IS (HR, 2.857, 95%CI 1.257–6.495, p=0.012). Although high E/e′ tertile was independently associated with new appearance of AF when adjusted for coexistence of atherothrombotic risk factors (HR, 1.694, 95%CI, 1.097–2.616, p=0.017), the association was attenuated after adjustment for left atrial dimension. ConclusionsE/e′ was significantly associated with incidence of IS and new appearance of AF in non-AF patients.

Coexistence of tachyarrhythmias in patients with tetralogy of Fallot

The expanding population of adult patients with tetralogy of Fallot (ToF) requires knowledge of its long-term sequelae. The purpose of this study was to examine the coexistence and order of appearance of atrial fibrillation (AF), other supraventricular tachycardias (SVTs), ventricular tachycardia (VT), and ventricular fibrillation (VF), and their impact on survival during long-term follow-up. Adult, corrected ToF patients [N = 225; 128 male; mean ± SD (minimum-maximum) age 41 ± 12 (19-79) years] were included in the study. Medical correspondence, ECGs, and Holter recordings were reviewed for documented AF, other SVTs, VT, and VF. During follow-up of 35 ± 9 (16-64) years, sustained tachyarrhythmias, including SVT (n=50, 22%), AF (n=29, 13%), VT (n=20, 9%), and VF (n=9, 4%), were observed in 71 patients (32%), of whom 27 (38%) had coexistence of different tachyarrhythmias. In 18 patients with coexisting SVT and AF, SVT most often preceded AF in 13 (72%). Age at SVT onset was similar between those with and those without subsequent AF development (40 ± 17 years vs 35 ± 16 years; P = .283). However, age at SVT and AF onset were positively correlated (rho 0.585; P = .011). Prevalence of SVT/AF was associated with VT/VF prevalence (odds ratio [OR] 4.59; P < .001). Although 11% of patients with SVT/AF subsequently develop VT/VF, onset of SVT/AF could not predict future VT/VF development (OR 1.81; P = .233). Adult ToF patients are initially at risk for SVT development, followed by AF, VT, and VF at 46 (43-50), 56 (53-59), 57 (54-61), and 62 (61-63) years after ToF correction (P < .001), respectively. Survival time decreased when sustained tachyarrhythmias developed (P = .024). Age at onset of SVT, AF, and VT was positively correlated with age at death (SVT: rho 0.734; P = .004; AF: rho 0.783; P = .007, VT: rho 0.755; P= .050). Coexistence of different (supra)ventricular tachyarrhythmias is frequently observed in adult ToF patients. In these patients, a specific order of these tachyarrhythmias was observed. Tachyarrhythmias are associated with decreased survival time, and, more importantly, age at tachyarrhythmia development positively correlates with age at death.