Atrial Fibrillation In Young Patients Research Articles

Impact of patent foramen ovale with left-to-right shunt on atrial fibrillation ablation in young patients

ObjectiveThe CABANA study shows that atrial fibrillation (AF) paitents younger than 65 years benefit more from the AF radiofrequency catheter ablation (RFCA) procedure. The aim of this study is to investigate the impact of inherent patent foramen ovale (PFO) with a Left-to-Right Shunt on the RFCA procedure in young AF patients. MethodsBased on the presence or absence of inherent PFO, the AF patients were divided into the PFO groups and the non-PFO group. Clinical follow-up was also investigated. ResultsA total of 285 AF patients were enrolled. PFO was detected by TEE in 42 patients. The age of patients at initial AF onset was younger in the PFO group than in the non-PFO group (58.3 ± 8.9 vs. 62.3 ± 9.6 years, P = 0.012). There were more AF patients aged <55 years in the PFO group than in the non-PFO group. For the 9 AF patients with PFO who experienced AF recurrence and the left-to-right shunts decreased in size in 5 of the patients aged <65 years. The LAD decreased in those patients. In the PeAF patients, 53/64 patients aged <65 years and 23/40 patients aged older than 65 years were free of AF (82.8 % vs. 57.5 %, respectively; P = 0.005). ConclusionSuccess is not affected when AF is combined PFO compared with AF without PFO. Young patients have better PeAF RFCA outcomes. AF in young patients with left atria enlargement and a serious AF burden, may lead to reduced EF and render PFO easy to detect.

Whole exome sequencing in young atrial fibrillation patients

Abstract Background Up to 10% of atrial fibrillation (Afib) patients develop the condition in the young age and in the absence of any related risk factors. Recent publications emphasized the importance of genetic testing in this population. However, the yield of the investigation is highly variable and ranges from 1 to 24% precents. Purpose The purpose of this study is to evaluate the prevalence of causative genetic variants in young Afib patients without risk factors and evaluate any structural changes of the heart. Methods We performed whole exome sequencing in 54 young (age of Afib onset less than 65 years) Afib patients without any Afib related risk factors (original cohort). Using ACMG guidelines we performed analysis of 349 previously described cardiomyopathy and arrhythmia associated genes. If a pathogenic (P) or likely pathogenic (LP) variant was found, a cardiac magnetic resonance imaging (CMR) was performed to exclude any structural abnormalities of the heart. We also extracted 107 young Afib patients without any risk factors from UK Biobank (UK Biobank cohort) and performed analysis of the same genes in the subgroup. Results The prevalence of P and LP variants was 24% (13 cases) in the original cohort and 8% (9 cases) in the UK Biobank cohort (p=0.006). We observed variants in cardiac structural and developmental genes only in both cohorts (Table 1 and 2). In the original cohort there were nine (17%) patients with P and LP variant in TTN gene. Moreover, five patients were positive for the same TTN variant NM_001267550.2:c.13696C&amp;gt;T p.(Gln4566Ter). In six (46%) original cohort patients we observed structural changes of the heart on CMR – in five patients there was dilation of one or both ventricles and in one there was increased T1 mapping intensity of septal wall segments. Conclusions 1. There is a high prevalence of pathogenic and likely pathogenic causative genetic variants in young atrial fibrillation patients without any risk factors. 2. All variants are localized in cardiac structural or developmental genes only. 3. There is a high grade of structural changes of the heart observed on cardiac magnetic resonance imaging in patients with monogenic atrial fibrillation.Table 1.WES data in original cohortTable 2.WES data in UK Biobank cohort

Abstract 13597: Treatment Patterns and Outcomes for Young Adults With Atrial Fibrillation: The KP YOUNG-AF Study

Introduction: Young adults with atrial fibrillation (AF) may be most vulnerable to adverse outcomes such as cardiac remodeling and stroke, due to exposeure to AF for a longer time over their life course. Research Question What are contemporary treatment patterns and outcomes for young adults with AF treated with rate or rhythm control strategies? Methods: We identified patients aged 21-60 years with incident AF diagnosed from 2010-2018 within a large, integrated healthcare system caring for &gt;4.5M, and categorized them by treatment strategy within their first year after AF diagnosis: no treatment, rate control (AV nodal blockers only), or rhythm control (cardioversion, anti-arrhythmic drugs, or ablation). We examined crude outcomes of new onset heart failure (HF), stroke or transient ischemic attack (TIA), and use of oral anticoagulants (OAC), and examined multivariable associations between treatment strategy and outcomes using Cox regression. Results: Among 11,824 young adults with incident AF (mean [SD] age 51 [8.5] years; 32% female), 31% were treated with rhythm control, 50% with rate control, and 19% with no treatment. Those with no treatment were younger with fewer comorbidities. Crude rates (per 100 person-years) of incident HF and OAC were higher among rhythm control patients (HF: 4.45 for rhythm control, 2.51 for rate control, 0.56 for no treatment; OAC: 41.8 for rhythm control, 15.2 for rate control, 3.8 for no treatment), but rates of stroke/TIA were lower (0.71 for rhythm control, 0.92 for rate control, 0.51 for no treatment) (Figure). In adjusted analyses, no significant association was found for rhythm control (vs no rhythm treatment) for HF or stroke/TIA, but OAC use was higher (HR 1.66, 95%CI:1.57-1.70). Conclusions: Less than one third of young adults with AF received initial rhythm control therapy. Adverse outcomes were not associated with treatment strategy, but future studies should further examine long-term outcomes from sustained AF in young patients.

Abstract 12398: Prognostic Impact of Early Ablation in Patients With Decompensated Heart Failure Accompanied by Atrial Fibrillation

Introduction: Atrial fibrillation (AF) and heart failure (HF) frequently coexist, which leads to worse clinical outcomes. Catheter ablation (CA) of AF in younger patients with HF with reduced EF (HFrEF) has become an established treatment option. However, clinical impact of early CA of AF in patients hospitalized for acute decompensated heart failure (ADHF) is uncertain. Hypothesis: This study aims to investigate the prognostic impact of early CA of AF in patients who were hospitalized for ADHF. Methods: Consecutive 234 patients with ADHF requiring in-hospital care accompanying with AF were retrospectively analyzed 2 years after discharge. Patients who underwent CA within 3 months after HF admission (CA group; n=51) and those who did not (optimal medical therapy [OMT] group; n=183) were compared with regards to clinical outcomes. Results: The median age of the studied population was 83 year-old; 72±12 in the CA group and 84±9 in the OMT group. Persistent AF was observed in 92.2% in the CA group and 63.9% in the OMT group. During 2 years after admission, recurrence of AF was observed in 19.6% in the CA group and 82.0% in the OMT group. In the crude study, all-cause mortality and HF mortality were significantly lower in the CA group than in the OMT group (all-cause: hazard ratio (HR) [95%CI]: 0.07 [0.01-0.53], p=0.00074; HF: HR 0.19 [0.07-0.48], p=0.000078; respectively) (Figure A and Figure B). Since the OMT group had severer characteristics including age, sex or NYHA class, a propensity-matched analysis was performed (n=33, each group). All-cause mortality tended to be lower in the CA group (HR 0.19 [0.02-1.67], p=0.13) (Figure C), however, it did not reach to a statistical significance. On the other hand, HF readmission rate was still significantly lower in the CA group even after the propensity-matched analysis (HR 0.17 [0.04-0.59], p=0.0054) (Figure D). Conclusions: CA of AF early after ADHF admission was associated with a better long-term prognosis in patients with HF and AF.

Epicardial adipose tissue, pulmonary veins anatomy, and the P-wave/PR interval ratio in young patients with atrial fibrillation

Atrial fibrillation (AF) is uncommon in the youngest population. Epicardial adipose tissue (EAT) volume has been proposed as an independent AF risk factor. The aim of this retrospective study was to evaluate the impact of the EAT, the anatomy of the pulmonary veins (PVs), and electrocardiogram (ECG) features in these young patients with AF. Sixty-two patients divided in 2 groups, one with history of paroxysmal AF treated with ablation and the other, a control group, all younger than 30 years of age, were included. Computed tomography scans were performed in both groups to estimate the PVs anatomy and EAT volume. Twelve-lead ECGs were performed in all patients. Patients underwent follow-up in our outpatient clinic (35.9 ± 18.3 months). In the AF group, the EAT volume around the left atrium was 22.25 ± 9.3 cm3 compared with 12.61 ± 3.37 cm3, showing a statistically significance difference (P = .003). Family history resulted to be another significant risk factor (P = .009). During follow-up, 67.7% of the patients treated were still free of events. The anatomy and morphology of the right-sided PVs seemed to play a more consistent role in the patients with AF recurrences (P= .04). The P/PR ratio, a new ECG index, seemed predict AF recurrences after ablation (P = .03). The abundance of EAT seems related to the risk of developing AF in young patients. The recurrence of AF is about 33% and does not seem related to the EAT volume, but rather to the anatomy of the PVs. A higher P/PR ratio might suggest recurrences.

Diagnosis of atrial fibrillation in young patients with ischemic stroke: A systematic review and meta-analysis

IntroductionThe recommended cardiac rhythm evaluation to determine the etiology of ischemic stroke (IS) is similar in all patients regardless of their age and includes an electrocardiogram and at least a 24-hour heart rhythm monitoring. However, it is known that the main causes of IS vary according to patients’ age. There is a higher preponderance of arterial dissections and patent foramen ovale in younger patients, while atrial fibrillation (AF) is more common in older patients. AimsTo determine the proportion of AF in young IS reported in the literature and determine if young IS patients found to have AF had known structural cardiac pathology. MethodsSystematic review of the literature searching PubMed and Embase for articles published since their inception to August 2020. Inclusion criteria were studies including at least 10 patients, aged 14-50 years-old, clinical or radiological diagnosis of IS and quantification of patients found to have AF. We conducted a meta-analysis using a random-effects model and calculated pooled proportions with 95% confidence intervals. Results8331 articles were screened, 154 were selected for full-text review. 43 studies were included in our final analysis (902800 patients). The proportion of AF in young IS overall was 3.1% [95%CI 2.4-3.7], I2 93.88%. Sub-analysis revealed a proportion of AF of 3.8% [95% CI 0.3-7.3] in lower-middle-income economies, versus 5.4% [95% CI 3-7.9] in upper-middle-income economies, and 2.2% [95% CI 1.6-2.8] in high-income economies. Only 3 studies mentioned the proportion of patients with AF that had structural cardiac pathology. ConclusionThe proportion of AF in young IS was low. More studies are needed to better understand if young IS patients diagnosed with AF had a priori known structural cardiac pathology that could increase the probability of finding AF. This could lead to a reevaluation of the need for 24 hours cardiac rhythm evaluation in young patients without cardiac pathology.

Systolic, diastolic blood pressure and pulse pressure and risk of stroke in young aged patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background It is well-known that higher blood pressure (BP) is associated with a higher risk of stroke with atrial fibrillation (AF). However, there is limited data about the effect of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) on the risk of ischemic stroke in young and low-risk AF patients Methods Using the Korean Health Insurance Service database, patients who were newly diagnosed with AF between January 2009 and December 2016 and had health screening examination data within 2-year after AF diagnosis were included. Patients aged between 20 and 39 years were finally included in this analysis. During follow-up, incident ischemic stroke was evaluated as a primary outcome. Hazard ratio (HR) and the corresponding 95% confidence intervals (CI) were calculated using multivariable Cox proportional hazard models. Results A total of 15,980 patients were included in this analysis (mean age 32.4±4.8 years, 66.9% of men). Mean CHA2DS2-VASc score was 0.7±0.8 and oral anticoagulation rate was 5.6%. During a median 5.2-year of follow-up, 73 patients had an incident ischemic stroke (incidence rate, 0.9 per 1,000 person-years). After multivariable adjustment, SBP ranging from 140 to 159 mmHg and 160 mmHg or higher were associated with a significantly higher risk of ischemic stroke by 8.4-fold and 11.6-fold compared to SBP under 100 mmHg (Figure). DBP 95mmHg or higher was associated with a higher risk of ischemic stroke by 4.2-fold than DBP under 65 mmHg (Figure). Patients with PP ranging from 50 to 59 mmHg and 60 mmHg or higher showed a significantly higher risk of ischemic stroke than those with PP ranging from 40 to 49 mmHg (HR [95% CI]; 1.81 [1.04-3.18] and 3.15 [1.49-6.64], respectively). Also, lower PP than 30 mmHg was associated with a higher risk of stroke (3.96 [1.36-11.53]). Conclusion Optimal BP control might be crucial to preventing ischemic stroke in these young and low-risk AF patients.

48 hours Holter monitoring in detecting occult atrial fibrillation in young patients with possible cardioembolic stroke

Background and objective: &#x0D; Atrial fibrillation (AF) is a common cause of ischemic stroke. AF is usually paroxysmal and could escape detection via single lead electrocardiogram ECG recorder. Holter monitoring is useful in this scenario. The objective of this study was to assess the role of 48 hours Holter monitoring in identifying clinically inapparent AF in young patients with ischemic stroke&#x0D; Methods: &#x0D; A retrospective cross-sectional study was conducted with patient data from November 2019 to February 2021. It was conducted in Neurology department of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Study contained medical records of 60 patients which were admitted in this time period. Forty-eight hours Holter monitoring was carried out for all the patients. Patient medical records were examined according to predetermined risk factors and criteria. Statistical analysis was done on SPSS version 25.0.&#x0D; Results: &#x0D; Ten out of 60 cases had positive results for AF during Holter’s monitoring. Fifty cases had negative results for AF during Holter monitoring. While the p value of the data obtained remained non-significant, results depict efficacy of Holter’s monitoring in detection of AF to some extent.&#x0D; Conclusion:&#x0D; Holter monitoring can identify AF, providing aid in prevention of secondary ischemic stroke. However, instead of 48 hours monitoring, a through 72 hours or extended monitoring will increase the effectiveness of this monitoring. In future, a study could be conducted where a large number of cases should be included so that statistical significance of data could be increased.

One-year outcomes of catheter ablation for atrial fibrillation in young patients

BackgroundAtrial fibrillation (AF) is relatively less frequent in younger patients (age < 50). Recently, studies have suggested that early restoration of sinus rhythm may lead to improved outcomes compared with rate control, however the efficacy of catheter ablation for AF in young is scarce.MethodsWe included all hospitalized patients between 18 and 50 years with a diagnosis of AF from the Nationwide Readmission Database 2016–2017 from the Healthcare Cost and Utilization Project. Demographic and comorbidity data were collected and analyzed. Outcomes assessed included one-year AF readmission rates, all-cause readmission, ischemic stroke, and all-cause mortality. Subgroup analyses were performed for all demographic and comorbidity variables.ResultsOverall, 52,598 patients (medium age 44, interquartile range 38–48, female 25.7%) were included in the study, including 2,146 (4.0%) who underwent catheter ablation for AF. Patients who underwent catheter ablation had a significantly lower rate of readmission for AF or any cause at one year (adjusted hazard ratios (HR) of 0.52 [95% confidence interval (CI): 0.43–0.63] and HR of 0.81 [95% CI: 0.72–0.89], respectively). There was no difference in 1-year readmission for stroke or all-cause mortality between the two groups. Subgroup analyses showed a consistent reduction in the risk of AF readmission among major demographic and comorbidity subgroups.ConclusionCatheter ablation in young patients with AF was associated with a reduction in 1-year AF related and all-cause readmissions. These data merit further prospective investigation for validation, through dedicated registries and multicenter collaborations to include young AF from diverse population.

The higher recurrence rate after catheter ablation in younger patients with atrial fibrillation suggesting different pathophysiology.

Young atrial fibrillation (AF) patients have been underrepresented in studies of radiofrequency catheter ablation (RFCA) and the outcome of RFCA has not been widely addressed. We investigated age-related differences in clinical features, the recurrence of atrial tachyarrhythmia, and its predictors of patients who underwent RFCA for AF. This is a multicenter prospective study of 2799 patients who underwent RFCA for AF in 2017-2020. The patients were divided into two groups - group A (age < 60years, n = 1269) and group B (age ≥ 60years, n = 1530) - and a recurrence of any atrial tachyarrhythmia 1year after RFCA following a 90-day blanking period was compared. The mean age was 51.6 ± 6.7 and 66.8 ± 5.2years for groups A and B, respectively. Higher body mass index, smaller left atrium, and more prevalent cardiomyopathy and obstructive sleep apnea were observed in group A. Overall, 1-year atrial tachyarrhythmia-free survival was 85.6% and lower in young patients (83.1% in group A vs. 87.7% in group B, log-rank p < 0.01): adjusted hazard ratio (aHR) of recurrence (95% confidence interval (CI)), 1.45 (1.13-1.86) for group A compared to group B (p < 0.01). The association between younger age and higher recurrence was continuously observed in patients under 60years. Any non-PV ablation was associated with a lower recurrence of atrial tachyarrhythmia in group B (aHR 0.68 (0.47-0.96), p < 0.05), but not in group A. AF patients younger than 60years had a higher 1-year AF recurrence after RFCA. Young AF patients might have distinctive pathophysiology of AF requiring more integrated management.

Current Status of Catheter Ablation for Atrial Fibrillation in Japan.

Catheter ablation for atrial fibrillation (AF) has been an established and frequently utilized approach in a variety of clinical settings. Nevertheless, real-world data about the clinical course of AF patients after initial catheter ablation remain limited, and these are mainly derived from particular registries or selected high-volume centers.In this study, we used health check-ups and insurance claims database from a Japanese insurance organization. The study population was comprised of 1777 patients who underwent catheter ablation for AF before June 2016. During the 3-year follow-up period, 396 (22.3%) patients underwent at least one repeated AF ablation, while 74 (4.2%) underwent two or more repeated ablations. In multivariate Cox regression analysis, longer time after AF diagnosis (7-11 months and ≥12 months versus 1-6 months) (HR, 1.05; 95% CI, 1.01-1.08 and HR, 1.04; 95% CI 1.02-1.07) was independently associated with repeated ablation. The discontinuation rates of OACs and AADs after the first ablation were 26.7% and 63.0% at 3 months and 75.2% and 89.1% at 1 year after the initial ablation, respectively. The former was independently associated with shorter time after AF diagnosis and lower diastolic blood pressure, whereas the latter was independently associated with older age, smaller CHADS2 score, and shorter time after AF diagnosis.We presented real-world data regarding the clinical course of young Japanese AF patients after initial catheter ablation based on a claims database in Japan.

Clinical characteristics and long-term outcomes of catheter ablation in young adults with atrial fibrillation.

We aim to describe the long-term safety and efficacy of catheter ablation (CA) in young patients (<30 years) with atrial fibrillation (AF). This was a retrospective study of patients aged 18-30 who underwent CA for AF, and clinical characteristics and long-term outcomes are reported. Survival analyses were performed between the study group and a propensity-matched older cohort (>30 years, mean age: 58±10 years). From January 2000 to January 2019, a 1st CA (radiofrequency energy n=72, cryoballoon n=10), was performed in 82 patients (mean age 26±4 years, paroxysmal n=61, persistent n=14, longstanding persistent n=7), among 6336 consecutive patients with AF. During a follow-up of 5±5 years, 56% and 30% of the patients with paroxysmal and non-paroxysmal AF were arrhythmia free without antiarrhythmic drug (AAD) therapy after a single CA (P=0.02). After 1.5±0.8 CA procedures, 76% and 75% of the patients with paroxysmal AF and non-paroxysmal AF were arrhythmia free without AADs (P=0.54). Compared to a propensity-matched group of older patients, young patients were as likely to remain in sinus rhythm after CA (P=0.47), however after fewer repeat CAs (1.5±0.8 vs 1.9±0.9, P<0.009). There were no long-term adverse outcomes associated with CA. CA is a safe and effective treatment of AF in young patients with comparable outcomes to the older patients, however after fewer procedures.

Risk factors of major bleeding in elderly atrial fibrillation patients from the ANAFIE registry

Abstract Background Bleeding is associated with shorter life expectancy during anticoagulant treatment in atrial fibrillation (AF) patients. Prior studies showed bleeding during anticoagulant treatment occurred more frequently in elderly AF patients than in younger AF patients. HAS-BLED score is a risk assessment tool for bleeding. However, since it was developed from the database of patients with warfarin, it has not been clarified whether this score is applicable in the era of direct oral anticoagulant (DOACs), especially for elderly AF patients. Purpose All Nippon AF In the Elderly (ANAFIE) registry was designed to obtain real-world information regarding patients with non-valvular AF (NVAF) aged ≥75 years, including current status of anticoagulant therapy and prognosis. The present study aimed to determine factors that associate with major bleeding for elderly NVAF patients using the dataset of ANAFIE registry conducted in Japan. Methods Total of 32,099 patients aged ≥75 years with NVAF were enrolled in ANAFIE registry, and followed for 2 years. Incidence rates of major bleeding for total population, &amp;lt;85 years old group and ≥85 years old group were estimated using Kaplan-Meier method. Cox proportional hazards model was used to determine independent predictors of major bleeding. The factors included in the model were selected by backward elimination procedure. Results Mean age was 81.5 years. 23,738 (74.0%) was &amp;lt;85 years old and 8,361 (26.0%) was ≥85 years old. 92.5% of whole population used anticoagulants including warfarin (27.6%) or DOACs (72.3%). Major bleeding occurred in 279 patients at 12 months with 189 in &amp;lt;85 years and 90 in ≥85 years old group. The cumulative incidence rate of major bleeding at 12 months by Kaplan-Meier method was 0.9% in whole patients, and was slightly higher in ≥85 years than in &amp;lt;85 years old group (1.1% vs 0.8%). In multivariate analysis of the whole patients, history of major bleeding (hazard ratio [HR]: 2.17), severe hepatic dysfunction (HR: 3.62), malignancy (HR: 1.52), falling within a year (HR: 2.07), antiplatelet use (HR: 1.37) and warfarin use (HR: 1.81) emerged as independent predictors of major bleeding. Severe hepatic dysfunction (HR: 9.17), HbA1c &amp;lt;6.0% (HR: 2.19) and dementia (HR: 2.00) were associated with major bleeding in patients only in aged ≥85 years. On the other hand, proton pump inhibitor use (HR: 1.36), creatinine clearance &amp;lt;30 mL/min (HR: 1.53) and polypharmacy (HR: 1.61) were associated with major bleeding only in those aged &amp;lt;85 years. Conclusion Among elderly (≥75 years old) Japanese NVAF patients in the era of DOACs, prior major bleeding, severe hepatic dysfunction, malignancy, falling within a year, antiplatelet use and warfarin use were identified as independent predictors of major bleeding. Impact of some predictors differed between the 2 age groups (&amp;lt;85 years vs ≥85 years). Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.

Obesity, self-reported symptom severity, and quality of life in people with atrial fibrillation: A community-based cross-sectional survey

Background and aimsIntentional weight loss may reduce symptom severity of atrial fibrillation (AF) in relatively young AF patients with overweight. We examined whether symptom severity and quality of life (QoL) are associated with weight status in the general population with AF. Methods and resultsPatients with electrocardiogram-confirmed AF completed validated questionnaires: the EuroQol 5 Dimensions QoL questionnaire and the Toronto Atrial Fibrillation Severity Scale (AFSS). The AFSS assessed the AF burden scoring on AF-related symptoms and the total AF burden measured as a combination of duration, frequency, and severity of an irregular heartbeat. Generalized liner models examined the association of body mass index (BMI) with AF severity and QoL adjusting for confounders. Between 2018 and 2019, 882 of 1901 (46%) mailed questionnaires were returned completed. Participants had a mean (SD) age of 74 (10) years old and a BMI of 27.4 (5.6) kg/m2. Sixteen percent reported having never experienced an irregular heartbeat. A 5 kg/m2 higher BMI was associated with a 0.65 (95%CI: 0.25 to 1.06) higher symptom score, where 3 points represent a clinically relevant change in state. A 5 kg/m2 higher BMI was associated with a −1.61 (95%CI: −2.72 to −0.50) lower QoL score. The coefficient of the total AF burden for a 5 kg/m2 higher BMI was 0.17 (95% CI: −0.01 to 0.68). ConclusionBMI was positively associated with symptoms and negatively associated with one of the two measures of QoL, but not with the total AF burden. However, the strength of association was small and not clinically meaningful.

Prevalence of ischemic stroke and atrial fibrillation in young patients with migraine national inpatient sample analysis

ObjectiveTo estimate the prevalence of ischemic stroke (IS) and atrial fibrillation (AF) in young patients with migraine and to identify the independent predictors of IS in a large cohort of hospitalized patients. MethodsA cohort of patients with migraine with aura (MA) and migraine without aura (MO) was identified from the National Inpatient Sample database for the years 2012 to 2015. Ischemic stroke was identified by the International Classification of Diseases–9-CM codes. Binary logistic regression and Chi-square tests were utilized. ResultsA total number of 834,875 young patients (18-44 years) were included in this study with a mean age of 33 years. The prevalence of IS was 1.3% and was significantly higher in patients with MA (3.7% versus 1.2%, P <0.001). The prevalence of AF was 0.9% and it was significantly higher in patients with MA (1.2% versus 0.8%, P <0.001). Migraine with aura was an independent predictor of IS (OR 3.23, 95% CI 3.05-3.42, P <0.001) and AF (OR 1.63, 95% CI 1.42-1.88, P <0.001). Other predictors of IS were hypertension (OR 2.2, 95% CI 2.12-2.3, P <0.001), diabetes mellitus (DM) (OR 1.37, 95% CI 1.31-1.42, P <0.001), peripheral vascular disease (PVD) (OR 12.08, 95% CI 11.23-12.98, P <0.001) and smoking (OR 1.37, 95% CI 1.31-1.42, P <0.001). ConclusionIn this relatively large study, the overall prevalence of IS in young migraine patients was low at 1.3%. The prevalence of IS and AF was significantly higher in patients with MA. Presence of PVD confers a high risk of IS in young patients with migraine. Migraine aura was observed to be an independent predictor of IS and AF in patients with history of migraine. Optimal control of vascular risk factors in migraine patients appears to be indicated despite the overall low risk.

Why are antithrombotic drugs not prescribed to octogenarian patients with atrial fibrillation at risk of stroke?

ObjectiveIn non-valvular atrial fibrillation (NVAF) patients at risk of stroke, anticoagulant drugs are less likely to be received by older patients than younger patients. In this study, an attempt is made to discover whether the reasons reported by physicians for denying anticoagulant drugs prescription differ between older and younger atrial fibrillation patients. Materials and methodsA retrospective, cross-sectional, multicentre study was conducted from October 2014 to July 2015. The study comprised patients aged ≥18 years diagnosed with NVAF, with a moderate to high stroke risk (CHADS2 score ≥2). Patients were stratified according to age (<80 and ≥80 years). ResultsA total of 1309 NVAF patients were evaluated, of whom 40.1% were ≥80 years old. Older patients were predominantly women with higher mean time since diagnosis of AF, with a higher rate of permanent NVAF, and with higher thromboembolic risk. In patients for whom physicians decided not to prescribe any anticoagulant agents, the following reasons were significantly more frequent in patients aged ≥80 years compared to younger patients: cognitive impairment, perceived high bleeding risk, falls, difficult access to monitoring, non-neoplastic terminal illness, and perceived low thromboembolic risk. Uncontrolled hypertension was a significantly more frequent reason for non-prescription of anticoagulant agents in patients aged <80 year. ConclusionsOctogenarian patients with NVAF and a moderate to high risk of stroke had a different as regards reasons for not being prescribed anticoagulant agents, which should be taken into account in order to improve.

P1816 Cerebral microembolism in low-risk patients with paroxysmal atrial fibrillation before and after pulmonary vein isolationCerebral microembolism in low-risk patients with paroxysmal atrial fibrillation

Abstract BACKGROUND Invasive treatment of atrial fibrillation (AF) becomes more suitable and effective therapy. There are no consistent data describing the occurrence of potential neurological complications in low-risk patients with paroxysmal AF. AIM to determine the occurrence, consequences and risk factors for brain white matter hiperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients before and after pulmonary vein isolation (PVI) treatment. METHODS Eighty patients with symptomatic paroxysmal AF (median age: 58 years (IQR 50-63), K/M: 30/50), CHA2DS2-Vasc ≤ 3 (CHA2DS2-Vasc: 2 (IQR 1-2.5)) were included in the study. Before and after a minimum of 6-month period after PVI-RF treatment (med. 9,9 months, IQR 7.6-11.8 months) a clinical evaluation with brain MRI and Mini Mental State Examination (MMSE) test were determined. Severity of brain WMH in MRI was assessed in the Fazekas scale (pic 1). The efficacy of PVI-RF treatment analyzed in a 7-day Holter monitoring was confirmed in 43 (53.8%) patients. RESULTS Baseline WMH lesions were found in 55 (68.8%) patients. Patients with baseline WMH lesion obtained similar results in the MMSE test, compared to patients with a normal brain image in the MRI study. There was a statistically significant more frequent occurrence of cerebral WMH lesions among older patients, with a higher CHA2DS2-Vasc score, with left atrial (LA) dilatation and dysfunction. Factors affecting the severity of the WMH were: the co-occurrence of the patent foramen ovale (PFO) and coronary artery disease (CAD). After PVI-RF treatment there were no significant changes in the presence and severity of WMH lesions. Similarly, there were no significant changes in the cognitive abilities assessed with MMSE test compared to the pre-procedural evaluation. There were also similar factors predisposing to brain WMH changes: older age, higher CHA2DS2-Vasc score and higher BMI. In turn, the degree of the brain WMH severity after observation period was dependent on age, higher CHA2DS2-Vasc score, presence of PFO and CAD and the initial LA function. CONCLUSIONS Cerebral microembolism assessed in MRI is often found in low-risk patients with paroxysmal AF, and its presence and severity are associated with LA dilatation and dysfunction, age and higher CHA2DS2-Vasc score. Additional factors affecting the severity of WMH lesions are: the co-occurrence of PFO and CAD. PVI-RF procedure and its efficacy does not influence on MRI lesions. In the population of relatively young AF patients with no significant cardiovascular disease burden, cerebral microembolism is not related to cognitive impairment. Abstract P1816 Figure. pic 1

Young-onset atrial fibrillation: Sex differences in clinical profile, progression rate and cardiovascular outcome

BackgroundWomen are underrepresented in major atrial fibrillation (AF) trials. In addition, data regarding clinical profile and outcome in young AF patients is limited. Therefore we aimed to investigate the clinical profile, AF progression rate and cardiovascular outcome between sexes in patients with young-onset AF. MethodsA total of 497 patients with AF-onset <60 years of age were included. Data on clinical profile and cardiovascular outcome were prospectively collected. ResultsOf 497 patients, 125 (25%) patients were women. Women had more often familial AF (34% versus 22%, P = 0.012) and obesity (26% versus 18%, P = 0.03). Men had more often coronary artery disease (11% versus 5%, P = 0.04), a longer PR interval [163 (148–180) versus 150 (138–167) ms, P < 0.001] and higher left ventricular mass index [82 (71–96) versus 72 (61–83) g/m2, P < 0.001]. During a median follow-up of 7.0 (2.7–10.0) years AF progression rate was comparable (HR 2.03 for men versus women, 95%CI 0.92–4.48; P = 0.08), and no difference in cardiovascular events was observed between women and men (Log rank P-value = 0.07). ConclusionsIn young patients with AF, clinical patient profile is different between the sexes but did not result in differences in cardiovascular outcome.

Age-Dependent Prognostic Impact of Paroxysmal Versus Sustained Atrial Fibrillation on the Incidence of Cardiac Death and Heart Failure Hospitalization (the Fushimi AF Registry)

Data regarding the relation of the type of atrial fibrillation (AF) to the incidence of cardiac events remain scarce. This study sought to investigate the association of AF type with the incidences of cardiac death and heart failure (HF) hospitalization between paroxysmal and sustained (persistent/permanent) AF in the overall population and in age subgroups (≤74, 75 to 84, and ≥85 years), using the data from a Japanese community-based prospective survey, the Fushimi AF Registry. The participants started to be enrolled since March 2011, and follow-up data were available for 4,304 patients by the end of November 2017. Patients with sustained AF (n = 2,187, 50.8%) had more co-morbidities with higher mean CHA2DS2-VASc score than those with paroxysmal AF (n = 2,117, 49.2%) (sustained vs paroxysmal: 3.57 ± 1.69 vs 3.17 ± 1.67, p <0.001). During a median follow-up of 1,307 (interquartile range: 709 to 2,156) days, the composite of cardiac death and HF hospitalization occurred more frequently in those with sustained AF (event rate: 5.1 vs 2.8 per 100 person-years; p <0.001). On multivariate analysis, sustained AF was independently associated with higher incidence of this composite end point (adjusted hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.12 to 1.63, p = 0.002). In age subgroups, this association was observed only in the younger AF patients (≤74 years) (adjusted HR: 2.03, 95% CI: 1.44 to 2.86, p <0.001), but not in the older subgroups (p = 0.018 for interaction). In conclusion, sustained AF was associated with higher incidence of the composite of cardiac death and HF hospitalization than paroxysmal AF, with different relations seen depending on age subgroups.

Quality of management of oral anticoagulation as assessed by time in therapeutic range in elderly and younger patients

In Tunisia, where new oral anticoagulants and warfarin are not available yet, acenocumarol continues to be underused in the elderly patients with atrial fibrillation (AF), mainly due to the over estimation of the bleeding risk and the difficulties to comply with treatment. The aim of the present prospective study was to investigate whether age influences the quality of anticoagulation by acenocumarol. Sixty patients having non-valvular atrial fibrillation on acenocumarol were followed up prospectively in our department of cardiology during one year. They underwent regular PT and INR measurements. Patients were divided into two groups: younger than 65 years (group 1: 40%) and older than 65 years (group 2: 60%). The thromboembolic and hemorrhagic risk were significantly higher in elderly compared to younger patients (CHA 2 DS 2 VASc score = 3.43 ± 1.18 vs. 2.09 ± 1.23 P = 0.0001; HASBLED score = 2.16 ± 0.87 vs. 1.37 ± 0.77 P = 0.001). The mean INR and the dose of acenocumarol did not differ between both groups (mean INR = 2.58 ± 0.29 in group 1 versus 2.7 ± 0.56 in group 2, P = 0.22; mean dose = 2.48 ± 0.96 mg versus 2.24 ± 0.88, P = 0.35). The mean TTR was also similar in the two groups: 56% ± 16 in the non-elderly group and 51% ± 16 in the elderly group (P =0.24). Hemorrhagic complications were similar in both groups (5% versus 8.3%; P = 0.87). Our results suggest that in elderly AF patients, oral anticoagulation with acenocumarol has similar safety and efficiency than in younger AF patients.