Incidence Of Atrial Fibrillation Research Articles

Long-term changes in frailty and incident atrial fibrillation, heart failure, coronary heart disease, and stroke: A prospective follow-up study.

People with frailty have increased prevalence and incidence of atrial fibrillation (AF). The study aimed to further investigate the association of long-term changes in frailty with risk of new-onset AF. Its associations with heart failure (HF), coronary heart disease (CHD), and stroke were also evaluated as a secondary aim. Over 50,000 participants from UK Biobank cohort were included, with frailty index (FI) data and free of AF, HF, CHD or stroke in baseline and follow-up assessments. Frailty status of the participants was categorized into non-frail, pre-frail and frail based on their FI scores. FI in baseline and follow-ups are used to calculate the trajectories of frailty (ΔFI). During a median of 5.1 years of follow-up from the final assessment, 1729 cases of AF were recorded. Frailty trajectory analysis showed that even a 0.01 point/year increase in ΔFI was associated with 14% (95% CI 1.08-1.20) higher risk of AF, independent of baseline FI after adjusting for potential confounders. Compared with maintained non-frail participants, those with sustained frail status had the highest risk of incident AF (HR 1.95, 1.61-2.36). The risk declined by 30% (95% CI 0.53-0.94) when frail participants regressed to non-frail or pre-frail status, compared with sustained frail participants. These associations were similar in HF and CHD, however, not significant in stroke. In middle-aged and elderly individuals, frailty remission or non-frailty maintenance was associated with lower risk of AF, HF and CHD compared to persistent frailty, regardless of prior frailty status and established risk factors.

The predictive value of estimated glucose disposal rate and its association with myocardial infarction, heart failure, atrial fibrillation and ischemic stroke.

The relationship between the incidence of major cardiovascular diseases (CVDs) and estimated glucose disposal rate (eGDR), a proxy measurement for insulin resistance (IR), is not well understood in the general population. The predictive value of eGDR and other proxies of IR for CVD incidents have not been examined in previous studies. This study aimed to investigate the association between eGDR and various CVD events, including myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF) and ischemic stroke. Additionally, the predictive values of eGDR, triglyceride-glucose (TyG) index, TyG-waist circumference (WC), TyG-body mass index (BMI), TyG-waist-to-height ratio (WHtR), triglyceride (TG)-to-high density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) and the metabolic score for insulin resistance (METS-IR) for CVD events were compared. The study population was extracted from the UK Biobank, and the CVD events were documented by linking to hospital records. Cox proportional hazards model and the restricted cubic spline model were used to assess the association between eGDR and the risk of CVDs with adjustment for potential confounders. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to compare the predictive values of eGDR, TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR. A total of 360 953 participants were included in this study. During a median follow-up of 13.8 years, 12 698 MI, 10 360 HF, 23 638 AF and 6512 ischemic stroke events were documented. Compared with participants in the lowest quartile category of eGDR, those in the highest quartile category had the adjusted hazard ratio (HR) and 95% confidence interval (CI) of 0.59 (0.51-0.67) for MI, 0.66 (0.56-0.76) for HF, 0.88 (0.80-0.98) for AF and 0.73 (0.61-0.89) for ischemic stroke. eGDR outperformed TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR in terms of predicting MI (AUC: 0.661), HF (AUC: 0.690), AF (AUC: 0.653) and ischemic stroke (AUC: 0.646). eGDR was inversely associated with the incidence of MI, HF, AF and ischemic stroke in the general population. eGDR could serve as a more valuable predictive indicator than TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR for CVD events in clinical practice.

Incidence of atrial fibrillation and its causes in immediate postoperative isolated tricuspid regurgitation surgery: The experience of a developing country about 60 cases

Incidence of atrial fibrillation and its causes in immediate postoperative isolated tricuspid regurgitation surgery: The experience of a developing country about 60 cases

Elevated plasma trimethyllysine is associated with incident atrial fibrillation

Elevated plasma trimethyllysine is associated with incident atrial fibrillation

Association of Hematopoietic Loss of Y Chromosome With Atrial Fibrillation Incidence and Sex Disparity

Association of Hematopoietic Loss of Y Chromosome With Atrial Fibrillation Incidence and Sex Disparity

Concomitant Pulmonary Vein Isolation for induced Atrial fibrillation to reduce future risk of atrial fibrillation following Ablation for Isolated Atrial Flutter.

A significant proportion of patients with isolated atrial flutter (AFL) will develop atrial fibrillation (AF) following cavotricuspid isthmus (CTI) ablation. To determine whether concomitant pulmonary vein isolation (PVI) could reduce the incidence of new-onset atrial fibrillation (NOAF) in the setting of inducible AF following CTI ablation. A total of 275 consecutive patients with isolated AFL who successfully underwent CTI ablation were included. Patients were stratified into the induced AF group (55 patients) and the non-induced AF group (220 patients) based on the inducibility of AF. Subsequently, the induced AF group was randomly divided into PVI group (28 patients) and non-PVI (27 patients) group. During 27.0±6.0 months of follow-up, the PVI group [(7.1% vs. 51.9%, p<0.001), HR 0.103, 95%CI. for HR (0.038, 0.278), p<0.001] and non-induced AF group [(13.2% vs. 51.9%, p<0.001), HR 0.207, 95%CI. for HR (0.073, 0.586), p<0.001] exhibited substantially lower incidence and risk of NOAF compared to the non-PVI group. Kaplan-Meier analysis showed that history of hypertension, cardiovascular disease, heart failure and larger BMI, larger LAd, lower LVEF were identified predictors of NOAF. Inducibility of AF during CTI ablation is positively associated with an increased risk of NOAF, while concomitant PVI for induced AF can significantly reduce the incidence of NOAF.

Relationship between glycemic variability and the incidence of postoperative atrial fibrillation following cardiac Surgery: A retrospective study from MIMIC-IV database.

This study aimed to explore the association between glycemic variability (GV) and postoperative atrial fibrillation (POAF) incidence. In this retrospective study, we included patients undergoing cardiac surgeries. GV was calculated as the coefficient of variation of blood glucose and categorized into tertiles based on its distribution. The primary endpoint was the incidence of POAF. Logistic regression and restricted cubic splines were used to assess the relationship between GV and POAF. 5365 patients were included, with a median age of 68.3 years, and 25.5 % were female. 1056 (19.7 %) patients developed new-onset POAF. Compared with the low GV group, moderate GV group (odds ratio [OR], 1.82; 95 % confidence interval [CI]: 1.49-2.22) and high GV group (OR, 2.25; 95 % CI, 1.80-2.82) were significantly associated with a higher incidence of POAF. The area under the receiver operating characteristic curve of GV in predicting POAF incidence was 0.77 (95 % CI: 0.76-0.79). There is a threshold-based nonlinear relationship between GV and the incidence of POAF: when GV was < 24 %, the likelihood of POAF increases with higher GV, whereas when GV ≥ 24 %, further increases did not significantly affect the risk of POAF. Increased GV is associated with higher incidence of POAF.

Associations of glycemic status with dynamic disease trajectories of atrial fibrillation and dementia.

Atrial fibrillation (AF) has been associated with elevated dementia risk, while few studies have examined the role of the optimal glycemic status in disease trajectories of AF and dementia. We aim to evaluate associations between glycemic status with disease trajectories of AF and dementia, as well as major dementia subtypes, including Alzheimer's disease and vascular dementia. Population-based cohort study. UK Biobank. A total of 458 368 participants who were free of prevalent dementia and AF at baseline, with complete glycemic status assessment. Based on clinical recommendations, we categorized glycemic status as low-normal (glycated hemoglobin [HbA1c] <5.5 %), normal (HbA1c 5.5 to 5.9 %), pre-diabetes (HbA1c 6.0 to 6.4 %), diabetes with HbA1c<7 %, and diabetes with HbA1c≥7 %. Outcomes including AF, dementia (all-cause and sub-type dementia), and death were ascertained via linkage to external registry databases. A multi-state survival analysis was conducted to evaluate disease trajectories of AF and dementia. Better glycemic status was consistently associated with decreased hazards of trajectories of AF and dementia, including progression from AF to the comorbidity of AF and dementia. Among people with diabetes, those with HbA1c<7 % had a 31 % lower hazard (hazard ratio [HR], 0.69; 95 % confidence intervals [CI], 0.51-0.93) of progression from incident AF to dementia comorbidity, compared to those with HbA1c≥7 %. Similar risk reductions were found in individuals with pre-diabetes, normal HbA1c, and low-normal HbA1c, respectively. Strong dose-response associations were observed, with each 1 % increment in HbA1c related to a 28 % higher hazard of progression from AF to dementia comorbidity (HR,1.28; 95 % CI, 1.19-1.37). The glycemic status was most relevant for associations with disease trajectories of AF and vascular dementia, compared to trajectories of AF and Alzheimer's disease. The better glycemic status was consistently associated with lower hazards of disease trajectories of AF and dementia, including the reduced risk of progression from incident AF to comorbidity of AF and dementia. These findings support the significance of reaching optimal glycemic status to alleviate the huge disease burden of both AF and dementia simultaneously.

Long-term glucosamine supplementation aggravates atrial fibrillation susceptibility by impairing AMPK signaling.

Glucosamine, a widely used dietary supplement, has been linked to potential cardiovascular risks, including atrial fibrillation (AF). This study aimed to investigate the effects of long-term glucosamine supplementation on AF susceptibility and the underlying mechanisms. C57BL/6 J mice were treated with low-dose (15 mg/kg/day) or high-dose (250 mg/kg/day) glucosamine via drinking water for 6 weeks. AF susceptibility was assessed through transesophageal electrical stimulation. Atrial remodeling was characterized through electrophysiological and echocardiography studies, histological analysis, and molecular examination. AMP-activated protein kinase (AMPK) activator 5-aminoimidazole-4-carboxamide-1-beta-4-ribofuranoside (AICAR) was used to validation the underlying mechanism in mice and isolated neonatal atrial cardiomyocytes. Long-term high-dose glucosamine supplementation increased AF susceptibility in mice, as indicated by an elevated AF incidence and duration. Glucosamine induced notable electrical remodeling, evidenced by intra-atrial conduction slowing (P wave duration, amplitude, and area), likely attributable to reduced conduction velocity, as confirmed by two-dimensional electrical mapping. Structural remodeling including increased left atrial weight, cardiomyocyte hypertrophy and fibrosis was evident in the atria of glucosamine-treated mice, despite unaffected cardiac function. Mechanistically, glucosamine suppressed atrial AMPK signaling, leading to lipid and glycogen accumulation. Intriguingly, despite impaired atrial AMPK signaling, high-dose glucosamine improved systemic insulin sensitivity. Pharmacological activation of AMPK with AICAR mitigated glucosamine-induced AF susceptibility and associated pathological changes both in vivo and in vitro. Our findings demonstrate that long-term glucosamine supplementation enhances AF susceptibility, potentially by impairing atrial AMPK signaling, underscoring the importance of caution in the utilization of glucosamine.

Dapagliflozin Mediates the Protective Effect against atrial fibrillation/atrial flutter and the Reduction in All-Cause Mortality Risk.

This study aimed to investigate the association between dapagliflozin and the incidence of atrial fibrillation (AF) and atrial flutter (AFL), along with its impact on all-cause mortality in patients with diabetes mellitus (DM). Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis conducted a comprehensive search across PubMed, Embase, and ClinicalTrials.gov databases up to June 2021. We focused on randomized controlled trials (RCTs) that compared dapagliflozin with a placebo. Trial sequential analysis (TSA) was utilized to assess the reliability of the findings. All statistical analyses were performed using Review Manager software. The final analysis included nine studies, encompassing a total of 30,235 patients. The findings indicated a statistically significant reduction in the incidence of AF / AFL in the dapagliflozin group compared to the placebo group (relative risk (RR) = 0.73, 95 % confidence interval (CI) = 0.59 to 0.89, p=0.002), although this result was not corroborated by TSA. The occurrences of AF and all-cause mortality were also lower in the dapagliflozin group than in the placebo group (RR = 0.71, 95 % CI = 0.57 to 0.89, p=0.003 and RR = 0.90, 95 % CI = 0.82 to 0.98, p=0.02, respectively). However, TSA did not confirm these outcomes. Dapagliflozin appears to offer a significant protective effect against AF / AFL and may reduce the risk of all-cause mortality in patients with DM. However, further research is needed to confirm these findings due to the lack of confirmation by TSA.

Stroke in Athletes with Atrial Fibrillation: A Narrative Review.

Atrial fibrillation (AF) is the most common sustained arrhythmia, linked with a significantly heightened risk of stroke. While moderate exercise reduces AF risk, high-level endurance athletes paradoxically exhibit a higher incidence. However, their stroke risk remains uncertain due to their younger age, higher cardiovascular fitness, and lower rate of comorbidities. Several key studies highlight that AF may increase the risk of stroke in endurance athletes, particularly those over 65. However, the overall risk within this population remains relatively low. Notably, older male athletes show a higher AF incidence but experience lower stroke risk than their non-athletic counterparts. Regular physical activity prior to a first stroke appears to reduce mortality, though recurrent stroke risk in athletes with AF mirrors that of non-athletes, despite an elevated AF incidence. Management of AF in athletes is complex, with limited evidence guiding anti-thrombotic strategies. In this setting, specific recommendations are sparse, particularly in sports where bleeding risk is heightened. Individualized management, emphasizing shared decision-making, is critical to balance stroke prevention with athletic performance. Rhythm control strategies, such as catheter ablation, may be a reasonable first-line treatment option for athletes, particularly in those desiring to avoid long-term medication. This review synthesizes the current literature on the incidence, predictors, and management of stroke in athletes with AF.

MASLD Is Associated With an Increased Long‐Term Risk of Atrial Fibrillation: An Updated Systematic Review and Meta‐Analysis

ABSTRACTBackgroundStudies have reported an association between metabolic dysfunction‐associated steatotic liver disease (MASLD) and an increased risk of developing atrial fibrillation (AF). However, the magnitude of the risk and whether this risk varies with the severity of MASLD remains uncertain.MethodsIn this systematic review and meta‐analysis, we searched three large electronic databases using predefined keywords to identify cohort studies (published up to 30 September 2024) in which MASLD was diagnosed by liver biopsy, imaging methods, International Classification of Diseases (ICD) codes, or blood‐based scores. The primary outcome was the occurrence of AF based on ICD codes, medical records, or electrocardiograms. Meta‐analysis was performed using random‐effects modelling.ResultsWe identified 16 retrospective cohort studies with aggregate data on ~19.5 million individuals followed for a median of 7.2 years. MASLD was significantly associated with an increased risk of developing incident AF (random‐effects hazard ratio 1.20, 95% CI 1.10–1.32; I2 = 92%). This risk did not appear to further increase with the severity of liver fibrosis (n = 3 studies; random‐effects hazard ratio 1.22, 95% CI 1.18–1.26; I2 = 10%). The risk of AF remained significant even after adjusting for age, sex, body mass index, hypertension, Type 2 diabetes or other cardiometabolic risk factors. Sensitivity analyses did not modify these findings. The funnel plot and Egger's test showed no significant publication bias.ConclusionsThis updated and comprehensive meta‐analysis provides evidence that MASLD is significantly associated with an increased long‐term risk of developing incident AF. Further research is required to better decipher the link between MASLD and increased AF incidence.

Associations of Handgrip Strength, Walking Pace, and Genetic Risks With Incident Arrhythmias.

He, P, Ye, Z, Liu, M, Zhang, Y, Zhou, C, Zhang, Y, Yang, S, and Qin, X. Associations of handgrip strength, walking pace, and genetic risks with incident arrhythmias. J Strength Cond Res XX(X): 000-000, 2024-We quantified the associations of handgrip strength and walking pace with incident arrhythmias using Cox proportional hazards models with hazards ratios (HRs). The study included 487,673 subjects, with an average age of 56.4 years, 54.8% female, and free of baseline arrhythmias from the UK Biobank prospective study. Handgrip strength was assessed by a dynamometer. Low handgrip strength was defined as less than 27 kg in men and 16 kg in women. Walking pace was self-reported as slow, average, or brisk. The arrhythmia categories involved incident atrial fibrillation (AF), incident ventricular arrhythmias, and incident bradyarrhythmia, respectively. Over a median follow-up duration of 12.4 years, 28,967 (5.9%), 4,061 (0.8%), and 11,741 (2.4%) subjects developed incident AF, incident ventricular arrhythmias, and incident bradyarrhythmia, respectively. Compared with those with low handgrip strength, the adjusted HRs (95% confidence interval [CI]) of incident AF, ventricular arrhythmias, and bradyarrhythmia in subjects with normal handgrip strength were 0.76 (95% CI: 0.73.-0.79), 0.75 (95% CI: 0.67.-0.84), and 0.80 (95% CI: 0.74.-0.85), respectively. Compared with those with a slow walking pace, subjects with a brisk walking pace had significantly lower risks of incident AF (HR, 0.56; 95% CI: 0.53.-0.58), ventricular arrhythmias (HR, 0.52; 95% CI: 0.45.-0.59), and bradyarrhythmia (HR, 0.63; 95% CI: 0.59.-0.68). In addition, the inverse associations of handgrip strength and walking pace with AF were significantly stronger among those with a lower genetic risk of AF (both p interaction <0.001). In conclusion, handgrip strength and walking pace were inversely associated with incident arrhythmias. The inverse associations for incident AF were stronger in those with a lower genetic risk of AF.

Atrial Fibrillation and Cancer-Epidemiology, Mechanisms, and Management.

Atrial fibrillation (AF) and cancer are increasingly recognized as interrelated conditions, with cancer patients showing elevated incidences of AF, and there is evidence that AF may sometimes precede cancer diagnoses. This comprehensive review investigates the epidemiology, pathophysiology, and management challenges associated with AF in cancer patients. Epidemiologically, several cancers are more closely related to increased rates of AF, including lung, colorectal, gastrointestinal, and hematologic malignancies. Mechanistically, both AF and cancer share pathophysiological pathways centered on inflammation, oxidative stress, and common cardiovascular risk factors, such as hypertension, obesity, and diabetes. The inflammatory microenvironment in tumors, marked by increased cytokines and growth factors, promotes atrial remodeling and AF susceptibility. Elevated reactive oxygen species (ROS) levels, driven by the metabolic demands of cancer, further contribute to atrial fibrosis and structural changes. Moreover, many anticancer treatments exacerbate AF risk. Management of AF in cancer patients presents many unique challenges and requires a multidisciplinary approach. Rate and rhythm control strategies are complicated by potential drug-drug interactions and limited data surrounding early implementation of rhythm control strategies in cancer patients. Interventional approaches such as catheter ablation, though effective in maintaining sinus rhythm, carry significant perioperative risk in patients with malignancy. Stroke prevention with anticoagulants is essential but requires cautious administration to avoid heightened bleeding risks, particularly in patients undergoing chemotherapy. Further, the limited applicability of standard risk stratification tools like CHA2DS2-VASc in this population complicate decisions regarding anticoagulation. This review highlights the bidirectional relationship between AF and cancer, the difficulties in management, and the critical need for further research in this field.

Impact of Mild Hypothermia As Adjunctive Therapy in Patients With ST-Elevation Myocardial Infarction: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.

The prevention of reperfusion injury remains an unmet need in ST-elevation myocardial infarction (STEMI) patients. Several randomized controlled trials (RCTs) evaluated mild hypothermia as adjunctive therapy during STEMI, with conflicting results. To summarize the evidence about the efficacy and safety of mild hypothermia in patients with STEMI, as well as its conclusiveness through a trial sequential analysis (TSA). PubMed and Scopus electronic databases were screened for eligible studies until August 12, 2024. Efficacy endpoints were all-cause death, infarct size (IS), left ventricular ejection fraction (LVEF), the occurrence of microvascular obstruction (MVO), thrombolysis in myocardial infarction (TIMI) flow grade 3, and the resolution of ST-segment elevation (i.e., > 50-70% from baseline) after the procedure. Safety endpoints included: the incidence of atrial fibrillation (AF), infections, any bleeding, major bleeding, acute and subacute stent thrombosis (STh), cardiogenic shock/pulmonary oedema, and ventricular fibrillation/tachycardia. "Door-to-balloon time" was indicated as the procedural endpoint. Two pre-specified subgroup analyses were planned according to the mean ischemic time and the site of hypothermia induction (intra-coronary vs. extra-coronary). A TSA was run to explore whether the effect estimate of each efficacy outcome could be influenced by further studies. Ten RCTs were included. Hypothermia did not provide a benefit for any of the specified efficacy endpoints. Furthermore, it enhanced the risk of infection, the risk of STh in patients with a mean ischemic time of less than 4 h, and the risk of AF in patients undergoing extra-coronary hypothermia. Finally, it was also associated with an increased "door-to-balloon time", and a trend toward an increased risk of any bleeding. No significant difference was found for the other endpoints. TSA showed conclusive evidence of an absence of benefit of hypothermia on IS, MVO, LVEF, and TIMI three flow. Mild hypothermia is not beneficial and causes relevant delays in clinical management of STEMI patients, raising safety issues mainly related to the occurrence of STh, AF, and infections.

Association of atrial fibrillation with lamotrigine: Anobservational cohort study.

Drug-induced atrial fibrillation (AF) is recognized as an important causal association. Lamotrigine (LTG) is a widely prescribed neurological agent with Class IB antiarrhythmic properties at therapeutically relevant concentrations. The United States Food and Drug Administration has issued a warning for a higher risk of LTG proarrhythmic events in patients with structural heart disease (SHD) and/or myocardial ischemia. This study evaluated the incidence of AF with LTG use. A retrospective observational study was performed using a large healthcare claims database of adult participants analyzing 2 years AF incidence. The analytic cohort included adult participants with bipolar I disorder (BPD), partial seizures (PSZ), or generalized tonic-clonic seizures (GTSZ). Exposure to LTG was compared with commonly prescribed alternative agents as the control comparators (CTR). Participants were free from supraventricular or ventricular arrhythmias during the 6 months baseline period prior to the index LTG or CTR date. Kaplan-Meier estimator calculated 2 years cumulative AF incidence, with participants censored at last enrollment, treatment switching, or discontinuation. The AF association hazard ratios (HR) for LTG versus CTR were adjusted for baseline characteristics. The analytic cohort with BPD, PSZ, and GTSZ consisted, respectively, of 150,470 LTG versus 204,704 CTR, 9565 LTG versus 21,595 CTR, and 5505 LTG versus 15,513 CTR patients. In a predominantly middle-aged female population at baseline, the prevalence of cardiovascular conditions was low. The 12 months cumulative incidence of AF for LTG versus CTR was 0.764% versus 0.642% among BPD, 0.833% versus 0.646% among PSZ, and 0.585% versus 0.338% among GTSZ, respectively. The adjusted 365-day HR [95% confidence interval CI] of AF for LTG versus CTR in the BPD, PSZ, and CTSZ groups was 1.257 [1.088-1.453], 1.651 [1.104-2.468], and 1.451 [0.770-2.734], respectively. In adult AF-naïve participants, LTG has a strong association with increased AF risk compared with commonly prescribed alternatives.

Preoperative interatrial block is associated with postoperative atrial fibrillation after cardiac surgery.

Atrial fibrillation is common complication after heart surgery potentially leading to chronic atrial fibrillation, heart failure, and mortality. The aim of this study was to explore the relationship between preoperative interatrial block and the occurrence of postoperative atrial fibrillation. Perioperative 12-channel ECGs of patients in sinus rhythm, scheduled for heart surgery including bypass and/or valve surgery were analysed. Patients with pre-existing atrial fibrillation, amiodarone therapy, atrioventricular block II or III, or pacemaker were excluded from the study. Clinical parameters in patients with vs without atrial fibrillation were compared. To evaluate the association between interatrial block and postoperative atrial fibrillation univariable and multivariable regression analysis was performed. Out of 2374 patients, 1350 were amenable to analysis. Postoperative atrial fibrillation was documented in 505 (37.4%). In multivariable regression analysis prediction models with and without interatrial block were established. Step-wise regression analysis identified interatrial block (2.64[2.02; 3.46], p < 0.001), age (1.11[1.03; 1.20], p = 0.007), EuroScore II (1.05[1.03; 1.07], p < 0.001), pulmonary hypertension (1.91[1.24; 2.97], p = 0.006), history of cardiogenic shock (2.05[1.11; 3.87], p = 0.032), statins (1.66[1.21; 2.27], p = 0.002), COPD (2.11[1.25; 3.65], p = 0.009), and cardiopulmonary bypass time (1.78[1.04; 3.05], p = 0.047) as independent predictors for postoperative atrial fibrillation. Preoperative interatrial block was associated with higher incidence of postoperative atrial fibrillation. Inclusion of ECG-derived preoperative conduction disturbances can enhance risk stratification of postoperative atrial fibrillation after heart surgery.

Incidence of atrial fibrillation in patients with an insertable cardiac monitor and symptomatic heart failure.

We aim to evaluate the incidence of atrial fibrillation (AF) in a large real-world cohort of patients implanted with an insertable cardiac monitor (ICM) who had a clinical history of symptomatic heart failure (HF) with reduced or preserved left ventricular ejection fraction (LVEF). Patients with an ICM and a history of HF events were identified from the Optum® de-identified Electronic Health Record dataset merged with an ICM device dataset collected during 2007-2021. All ICM-detected AF episodes that were available with ≥30-s of ECG at onset were adjudicated using artificial intelligence (AI model). Episodes with AI model probability of AF≥0.9 were analysed. The Kaplan-Meier incidence of AF as a function of episode duration, history of AF, and LVEF were assessed. A total of 1020 patients with ICM were identified of whom 911 had ≥180days of follow-up and were included. According to the AI model, 358 patients had 8407 episodes of true AF. Incidence of AF at 42months was 45.6% (44.1% vs. 46.8% in reduced vs. preserved LVEF). Incidence of new-onset AF was 23.2% (23.3% vs. 22.2% in reduced vs. preserved LVEF) in patients with no clinical history of AF. Patients with new-onset AF had a higher HF event rate compared with patients who had no clinical history of AF and did not develop AF during follow-up [OR=2.73 (1.47-5.09); P=0.002]. Patients with preserved LVEF had more longer duration paroxysmal AF compared with those with reduced LVEF (44.5% vs. 33.9%, P=0.02). AF was observed in almost half of patients with ICM and symptomatic HF. One-fourth of the patients had new onset AF and a higher rate of HF events compared with patients without AF. AF incidence was similar in patients with preserved and reduced LVEF.

Assessment of Inflammatory Biomarkers and Incident Atrial Fibrillation in Older Adults.

Available evidence supports the importance of inflammation in atrial fibrillation (AF) pathogenesis, yet general anti-inflammatory therapies have failed to show benefit for prevention of the arrhythmia. Better understanding of the specific inflammatory pathways involved is necessary to advance therapeutics. We evaluated 9 circulating markers of inflammation measured by immunoassays and incidence of AF in a population-based older cohort. Biomarkers included measures of general inflammation and the NLR (nucleotide-binding oligomerization domain-like receptor) family pyrin domain containing 3 inflammasome, TNF-α (tumor necrosis factor α), monocyte activation markers, and sIL-2 (soluble interleukin-2). Among 5726 participants (median age 72 years), 1836 developed AF over median follow-up of 11.5 years. After adjustment for conventional risk factors, 5 biomarkers were positively associated with incident AF: IL-6 (interleukin-6), hazard ratio (HR), 1.14 (95% CI, 1.07-1.21); hs-CRP (high-sensitivity C-reactive protein), HR, 1.05 (95% CI, 1.01-1.09); white blood cell count, HR, 1.18 (95% CI, 1.04-1.35); sTNFR1 (soluble TNF receptor 1), HR, 1.21 (95% CI, 1.05-1.39); and sIL-2Rα (sIL-2 receptor α), HR, 1.16 (95% CI, 1.05-1.29) (all per doubling of biomarker). sCD14, sCD163, IL-18, and IL-1 receptor antagonist showed no association with AF. Upon concurrent adjustment for all biomarkers, only IL-6 remained significantly associated with the arrhythmia, HR, 1.17 (95% CI, 1.07-1.26). Among older adults, IL-6, hs-CRP, white blood cell count, sTNFR1, and sIL-2Rα were positively associated with incident AF, but only IL-6 retained significance on concurrent adjustment. These findings newly document associations for sTNFR1 and sIL-2Rα and lend support to a preeminent role for IL-6 in development of this arrhythmia. The efficacy of IL-6 blockade for AF prevention awaits completion of appropriate clinical trials.

Association between NT-proBNP levels and risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies

Background and aimsN-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established biomarker in clinical practice, particularly for heart failure, but its role in predicting atrial fibrillation (AF) risk is not fully...