Prevalence Of Atrial Fibrillation In Patients Research Articles

Frequency and Clinical Implications of Atrial Fibrillation in Patients with Accessory Pathways

Abstract:
 Atrial fibrillation (AF) is a common arrhythmia associated with various cardiac conditions. This study investigates the frequency of AF in patients with accessory pathways, anomalous electrical connections that can lead to supraventricular tachycardia.
 Objective:
 The primary objectives are to determine the prevalence of AF in patients with accessory pathways, identify associated factors, and assess the impact on clinical outcomes. A comprehensive dataset of 400 patients undergoing supraventricular tachycardia ablation at Hayatabad Medical Complex from 2020 to 2022 was analyzed.
 Method:
 A retrospective study design was employed, utilizing patient records with documented accessory pathway(s) and complete clinical-electrophysiological data. Demographic information, clinical presentation, electrocardiographic and electrophysiological data, ablation procedures, and clinical outcomes were systematically collected. Analytical approaches included frequency calculation, comparative analysis, regression analysis, and outcome assessment.
 Result:
 Out of 400 patients, 3.5% presented with AF at the time of accessory pathway ablation. Age was identified as a significant predictor of AF occurrence, with a mean age of 63.2 years in AF cases compared to 55.8 years in non-AF cases. Recurrence of arrhythmias was observed in 57.1% of patients with AF, emphasizing the need for ongoing monitoring and management.
 Conclusion:
 This study contributes valuable insights into the relatively low prevalence of AF in patients with accessory pathways. While certain factors, including age, may be associated with AF, they do not serve as definitive predictors. Tailored management and adherence to guidelines are crucial for optimizing outcomes in this unique patient population. Future research may explore genetic factors and refine risk stratification models for a deeper understanding of AF in patients with accessory pathways.

Targeted screening of atrial fibrillation using automated blood pressure measurement device with atrial fibrillation detection function, in patients with type 2 diabetes mellitus in primary care setting

ObjectiveThe prevalence of atrial fibrillation (AF) in type 2 diabetes mellitus (DM) patients under primary care in Hong Kong was yet to be explored. We aimed to evaluate the prevalence of AF in patients with DM so as to provide evidence-based recommendations to incorporate AF screening as a component in regular diabetic risk and complication assessment. The performance of automated BP machine Microlife WatchBP Office AFIB as a screening tool for the detection of AF was also evaluated.MethodThis was a cross-sectional study. Patients with type 2 DM who attended the regular diabetic risk and complication assessment in the participating clinics from 24 August 2021 to 27 January 2022 were recruited. Blood pressure measurement by Microlife WatchBP Office AFIB and 12-lead ECGs were performed for AF screening.ResultsAmong 2015 DM patients in primary care, the prevalence of AF was found to be 1.9% (95% confidence interval [CI] 1.3–2.6). The prevalence of AF increased with age, from 0.5% in patients aged < 65 years, to 2.2% in patients aged 65–74 years and 4.3% in patients aged ≥ 75 years. The sensitivity and specificity of Microlife WatchBP Office AFIB to detect AF were 80% (95% Cl 61.8–92.3) and 97.9%. (95% CI 97.3–98.5), respectively. The positive and negative predictive values were 32.8% (95% CI 21.9–45.1) and 99.7% (95% CI 99.5–99.9) respectively.ConclusionsAF screening with the use of Microlife WatchBP Office AFIB is a simple procedure and can be considered as a standard assessment in the regular comprehensive diabetic risk and complication assessment in primary care setting.

The importance of active rhythm monitoring in patients with renal infarction: Korean national health insurance registry

Abstract Background/Introduction Several studies reported that approximately 50% of renal infraction (RI) is caused by cardioembolic disease, particularly associated with atrial fibrillation (AF). However, in the Korean national health insurance database (NHIS), from 2013 to 2019, the prevalence of AF in patients with RI was only 15%. So, we aimed to analyze the incidence of newly developed AF in RI patients. Method This nationwide population-based retrospective cohort study included 5,200 patients with RI using the NHIS database from 2002 to 2012. We analyzed the incidence rate of AF during 12 months among the patients without previous history of AF. We selected clinical events after three months of RI diagnosis to exclude cases diagnosed by initial screening or with previously missed diagnosis of AF. The definition of RI, AF, and comorbidities use the ICD-10-CM codes. Result During the total follow-up period (median 2.5 years, interquartile range 1.04-4.25), AF occurred in 19.1% of RI patients (n=993). Most cases (n=837, 16.1%) occurred within a year, and the incidence of AF was 3.965 per 10,000 person-year. Patients with newly developed AF had a higher proportion of older age than those without AF (64.1 vs. 57.3 years, P&amp;lt;0.001). The prevalence of comorbidities, including hypertension (HTN), ischemic heart disease (IHD), and heart failure (HF), was higher in those with AF. The independent predictors of AF were age (adjusted hazard ratio [aHR] 1.05, 95% CI 1.04-1.05, P&amp;lt;0.001), male (aHR 1.26, 95% CI 1.09-1.45, P=0.002), body mass index (BMI) (aHR 1.04, 95% CI 1.02-1.06, P &amp;lt;0.001), current smoker (aHR 1.20, 95% CI 1.03-1.40, P =0.023), IHD (aHR 1.20, 95% CI 1.00-1.45, P =0.050) and HF (aHR 1.70, 95% CI 1.25-2.33, P =0.001). Additionally, the incidence of all-cause death was 14.264 per 10,000 person-year during the follow-up period. Conclusion Even if AF is not diagnosed in the initial screening after diagnosis of RI, the physician should consider active rhythm monitoring to detect subclinical AF for optimal management in these patients. Especially it might be helpful to reduce the burden of recurrent embolic events in those with risk factors, such as older age, male, higher BMI, current smoker, IHD, or HF.Cox regression analysisAtrial fibrillation cumulative incidence

Nutritional Status and Sleep Quality Are Associated with Atrial Fibrillation in Patients with Obstructive Sleep Apnea: Results from Tokyo Sleep Heart Study.

The prevalence of obstructive sleep apnea (OSA) in patients with atrial fibrillation (AF) has been observed to be much higher than in control participants without AF. Limited data exist regarding the prevalence of AF in patients with OSA. The clinical characteristics, nutritional status, and sleep parameters associated with AF in patients with OSA remain unclear. In this study, we aimed to determine the prevalence and factors associated with AF in patients with OSA from a large Japanese sleep cohort (Tokyo Sleep Heart Study). This was a single-center explorative cross-sectional study. Between November 2004 and June 2018, we consecutively recruited 2569 patients with OSA who underwent an overnight full polysomnography at our hospital. They were assessed using a 12-lead ECG and echocardiography. The clinical characteristics, sleep parameters, and medical history were also determined. Of the OSA patients, 169 (6.6%) had AF. Compared with the non-AF patients, OSA patients with AF were older and male, and they had higher prevalence of a history of alcohol consumption, hypertension, chronic kidney disease, and undernutrition, as well as a reduced ejection fraction. With regard to the sleep study parameters, OSA patients with AF had reduced slow-wave sleep and sleep efficiency, as well as higher periodic limb movements. There were no significant differences in the apnea-hypopnea index or hypoxia index between the two groups. The logistic regression analysis demonstrated that age (OR = 4.020; 95% CI: 1.895-8.527; p < 0.001), a history of alcohol consumption (OR = 2.718; 95% CI: 1.461-5.057; p = 0.002), a high CONUT score (OR = 2.129; 95% CI: 1.077-4.209; p = 0.030), and reduced slow-wave sleep (OR = 5.361; 95% CI: 1.505-19.104; p = 0.010) were factors significantly related to AF. The prevalence of AF in patients with OSA was 6.6%. Age, a history of alcohol consumption, undernutrition, and reduced sleep quality were independent risk factors for the presence of AF in patients with OSA, regardless of the severity of OSA.

Patients with Rapid Atrial Fibrillation in Congestive Heart Failure with Bilateral Pleural Effusion Complication: Case Report and Literature Review

Highlights: In the setting of AF in patient with AHF, conventional treatment strategies do not convert the rhythm into sinus rhythm. Newly emerged therapies such as catheter ablation, or atrioventricular node ablation with biventricular pacing might be more beneficial rather than the conventional rhythm and rate control strategies Abstract: Atrial fibrillation (AF) is the most common form of arrhythmia. The prevalence of AF in patients with systolic left ventricular dysfunction and CHF is around 35% in the patient population with NYHA II-IV. In this case, we will discuss a case report of a patient with AF with complications of CHF and Bilateral Pleural Effusion. Case Summary. A female patient, 62 years old, came to the emergency room of dr. Soegiri Hospital with complaints of sudden shortness of breath since morning. There were crackles in the right lung field during the auscultation and the chest x-ray shows cardiomegaly with a CTR&gt; 50% with bilateral effusion and atelectasis. On the electrocardiogram examination performed at the ICCU, an irregular rhythm was obtained with an HR of 100x/minute, with p waves that cannot be distinguished, normal QRS waves, and T waves that cannot be assessed. The patient was diagnosed with congestive heart failure (CHF) with rapid atrial fibrillation (AF) accompanied by complications of bilateral pleural effusion with a differential diagnosis of acute decompensated heart failure (ADHF) with pneumonia and acute lung edema (ALO). Discussion. Patients with AF and CHF have a poorer prognosis than patients with a single diagnosis of AF or CHF alone. A rhythm control strategy consisting of antiarrhythmic drugs and electrical cardioversion in stable patients with AF and CHF adds no benefit to a heart rate control strategy.

Prevalence and clinical characteristics of atrial fibrillation in hospitalized patients with coronary artery disease and hypertension: a cross-sectional study from 2008 to 2018.

The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF. This cross-sectional study was conducted in Chinese People's Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or without AF from August 2008 to July 2018. We examined the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns, and blood pressure (BP) control of patients with both HT-CAD and AF. Multivariate logistic regression was used to investigate the associations of cardiovascular risk factors with AF in patients with HT-CAD. The overall prevalence of AF in patients with HT-CAD was 4.87% (1011/20,747), and this increased with age; to be specific, the prevalence in women and men increased from 0.78% (2/255) and 1.02% (26/2561) at the age of <50 years to 8.73% (193/2210) and 10.28% (298/2900) at the age of ≥70 years, respectively. HT-CAD patients who had AF had a higher prevalence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, gender (male), body mass index, heart failure, and chronic kidney disease were independently associated with the risk of AF in patients with HT-CAD. For those with both HT-CAD and AF, 73.49% (743/1011) had a CHA 2 DS 2 -VASc score of ≥4, and only about half of them had the BP controlled at <140/90 mmHg, which indicated a high risk of thromboembolism and stroke. The use of oral anticoagulation increased during the study period (10.00% [20/200] in 2008 to 2011 vs. 30.06% [159/529] in 2015 to 2018, P < 0.01), but remained at a relatively low level. AF is highly prevalent among patients with HT-CAD. Patients with both HT-CAD and AF have a higher prevalence of cardiovascular-related comorbidities, lower BP control rate, and lower use of oral anticoagulation.

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension.

Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. An extensive literature search was performed using the terms 'atrial fibrillation' and 'cirrhosis'. Guideline documents and consensus statements were explored. The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new-onset AF in the post-operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre-transplant and post-transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.

Prolonged electrocardiography registration does not lead to increased diagnosis of atrial fibrillation in pulmonary embolism patients, but sex affects generic health-related quality of life: Findings from a randomized clinical trial

Pulmonary embolism (PE) is the third most common cause of cardiovascular death. Atrial fibrillation (AF) is the most common arrhythmia and is commonly detected in patients after embolic stroke. In this study, we set out to study if undiagnosed AF could be detected in patients with PE. In survivors of PE, persisting symptoms and exercise limitations are common. The disease burden of PE on quality of life (QoL) has received scarce attention. The primary aim was to study the prevalence of AF in patients with newly diagnosed PE. The secondary aim was to study QoL in PE patients. Patients with newly diagnosed acute PE were randomized 1:1 to long-term electrocardiogram (ECG) screening for AF (handheld ECG or ECG patch) or standard-of-care. The study participants were asked to complete RAND-36 questionnaires upon inclusion. In total 89 PE patients (mean age 74.6 years) were included, and 40 out of these patients were randomized to AF screening. The study was terminated early due to futility when analysis 1 year after inclusion did not find any patients with newly detected AF.RAND-36 showed that QoL was affected in PE patients. Interestingly, sex differences were found; women had a significantly lower QoL in the dimensions of vitality (P = .006), general health (P = .039), and mental health (P = .041). Screening for AF in PE patients did not yield a significant proportion of new cases. QoL is more affected in female patients with PE, and increased awareness of this is suggested.

Prevalence and risk factors for persistent atrial fibrillation in obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a common cause of atrial fibrillation (AF). The prevalence rate of OSA in AF is highest at 80%. There is limited data if who will develop AF in OSA patients. This study aimed to evaluate the prevalence of AF in patients with OSA and find clinical factors predictive of AF in patients with OSA. This was a cross-sectional study. We enrolled consecutive patients diagnosed with obstructive sleep apnea diagnosed by polysomnography. The primary outcome was persistent AF identified by electrocardiogram. Prevalence and predictors of AF in patients with OSA were analyzed. During the study period, there were 199 patients with OSA enrolled in the study. Of those, 31 patients (15.57%) had AF. There were five factors in the final model predictive for AF in OSA patients. Among those factors, three factors were independently associated with AF in OSA including age, tiredness, and glomerular filtration rate. The latter two factors were protective factors, while age was a predictor for AF with an adjusted odds ratio (95% confidence interval) of 1.052 (1.004, 1.103). The prevalence of AF in patients with OSA was 15.57%. Elderly patients with renal deterioration are at risk of AF but AF risk was decreasing in patients with tiredness.

Prevalence of atrial fibrillation and procedural outcome in patients undergoing catheter ablation for premature ventricular complexes.

Atrial fibrillation (AF) and premature ventricular complexes (PVC) are common arrhythmias. We aimed to investigate AF prevalence in patients with PVC and its impact on PVC ablation outcomes. Consecutive patients undergoing PVC ablation at a single institution between 2016 and 2019 were included and prospectively followed for 2 years. Patients with severe valvular heart disease, hyperthyroidism, malignancy, alcohol use disorder and advanced renal/hepatic diseases were excluded. Twelve-lead electrocardiograms were used to diagnose AF and assess PVC morphology. All PVCs were targeted for ablation using 4-mm irrigated-tip catheters at standardized radiofrequency power guided by 3-D mapping and intracardiac echocardiography. Patients were followed with remote monitoring, device interrogations and office visits every 6 months for 2 years. Detection of any PVCs in follow-up was considered as recurrence. A total of 394 patients underwent PVC ablation and 96 (24%) had concurrent AF. Patients with PVC and AF were significantly older (68.2 ± 10.8 vs. 58.3 ± 15.8 years, p < .001), had lower LV ejection fraction (43.3 ± 13.3% vs. 49.6 ± 12.4%, p < .001), higher CHA2 DS2 -VASc (2.8 ± 1.3 vs. 2.0 ± 1.3, p < .001) than those without. PVCs with ≥2 morphologies were detected in 60.4% and 13.7% patients with vs without AF (p < .001). At 2-year follow-up, PVC recurrence rate was significantly higher in patients with vs without AF (17.7% vs. 9.4%, p = .02). AF was documented in 1/4 of patients undergoing PVC ablation and was associated with lower procedural success at long-term follow-up. This was likely attributed to older age, worse LV function and higher prevalence of multiple PVC morphologies in patients with concurrent AF.

Abstract 13613: Prevalence of Atrial Fibrillation and Procedure-Outcome in Patients Undergoing Catheter Ablation for Premature Ventricular Contractions

Introduction: Atrial fibrillation (AF) and premature ventricular contractions (PVC) are common arrhythmias encountered in clinical practice. Theoretically, retrograde atrial conduction can occur in the presence of PVC, causing atrial ectopy. However, the clinical significance of this association is not defined yet. Hypothesis: We investigated the prevalence of AF in patients with PVC and its impact on PVC ablation. Methods:: Consecutive patients undergoing PVC ablation at our institution between 2016 and 2019 were included in this analysis. Patients with structural heart disease, hyperthyroidism, malignancy, alcoholism and advanced renal or hepatic disease were excluded. For all patients, 12-lead ECG was used to diagnose AF and assess PVC morphology. During the index procedure, all PVC morphologies were targeted for ablation. Patients were followed up with remote monitoring as well as ICD interrogations and office visits every 6 months for 2 years. Detection of any PVC in the electrogram was considered as recurrence. Results: A total of 394 patients undergoing PVC ablation were included of which 96 (24%) had the documented evidence of AF. Baseline characteristics of the study population without (group 1, n=298) versus with AF (group 2, n=96) is provided in table 1. Clinical parameters were comparable between the groups except age, which was higher in group 2. PVCs with multiple (≥2) morphology were detected at the index procedure in 41 (13.7%) and 58 (60.4%) patients in group 1 and 2 respectively (p &lt;0.001). At 2 years of follow-up, recurrence rate following PVC-ablation was significantly higher in group 2 compared to group 1 (17 (18%) vs 27 (9%), p=0.026). Conclusions: In this consecutive series, AF was documented in 1/4 th of the population undergoing PVC ablation and presence of AF was associated with lower procedural success at long term, which could be attributed to older age and significantly higher prevalence of multiple morphology’ PVCs in the group 2 population.

Hypertrophic cardiomyopathy and atrial fibrillation: the Cardiomyopathy/Myocarditis registry of the EURObservational Research Programme of the European Society of Cardiology

Abstract Background Current guidelines for AF management underline a complex approach to detecting and treating atrial fibrillation (AF). Hypertrophic cardiomyopathy (HCM) is commonly associated with AF. Purpose To assess the clinical characteristic and prognosis in patients with HCM and AF. Methods and results Overall, 1739 adult patients with HCM (711/40.9% female; median age at diagnosis: 55.5 years) were enrolled in the EURObservational Research Programme – Cardiomyopathy/Myocarditis Long-Term Registry. Baseline clinical characteristics and adverse cardiovascular endpoints at 1-year follow-up were analysed. Results At baseline, AF was found in 478 (27.5%) subjects (paroxysmal: 54.7%, persistent: 17.6%, permanent: 27.7%). Newly diagnosed AF was identified during 1-year follow-up in 48 (2.8%) subjects with HCM. The presence of AF was associated with higher age (59.6±13.8 vs 50.8±16.1, p&amp;lt;0.001); BMI (27.7±5.1 vs 26.6±4.6 kg/m2, p&amp;lt;0.001); more advanced NYHA class (NYHA I/II and III/IV: 75.1 and 24.9 vs 86.2 and 13.8%, p&amp;lt;0.001); more frequent history of diabetes (14.6 vs 8.4%, p&amp;lt;0.001); arterial hypertension 43.4 vs 34.6%, p&amp;lt;0.001); renal impairment (15.4 vs 6.35%, p&amp;lt;0.001); and history of sustained VT (10.8 vs 6.35%, p&amp;lt;0.001). AF patients were characterized by lower left ventricular ejection fraction (LV EF) (59±12 vs 63±11%, P&amp;lt;0.001), left atrium (LA) dilatation (48.9±9.1 vs 42.4±7.7%, p&amp;lt;0.001), increased pulmonary artery systolic pressure (37.8±13.7 vs 29.6±12.6 mmHg, p&amp;lt;0.001), distribution of LV hypertrophy (p=0.032) and more advanced LV diastolic dysfunction (p&amp;lt;0.001). On multivariate logistic regression analysis, independent predictors of AF in the HCM population were: age at enrolment (OR 1.068, P&amp;lt;0.001); LVEF (OR 0.978, p&amp;lt;0.001); and LA diameter (OR 1.094, p&amp;lt;0.001). Oral anticoagulation (OAC) was administered in 69.5% of patients with AF (vitamin K antagonist: 48.5%; direct OAC: 21%). ICD was implanted in 26.8% in AF and 16.9% in non-AF subjects (p&amp;lt;0.001). PVI was performed in 9.9% of AF patients only. The annual incidence of stroke/TIA was higher in AF than in the non-AF population (2.64 vs 0.85%, p=0.009). There was a trend towards increased death from any cause in the AF population (3.39 vs 1.74%, p=0.05). There were no differences in SCD-risk score between AF and non-AF subjects. Conclusion The study reveals a high prevalence of AF in patients with HCM that corresponds with more advanced symptoms, increased prevalence of comorbidities, structural and functional heart remodelling along with inadequate anticoagulation and a significant increase in the risk of stroke. The clinical characteristics of HCM-AF patients indicate that the ESC recommended complex AF approach “CC To ABC” is appropriate in this population. Funding Acknowledgement Type of funding sources: None.

Systemic lupus erythematosus increases risk of incident atrial fibrillation: A systematic review and meta-analysis.

Patients with systemic lupus erythematosus (SLE) might have increased risk of atrial fibrillation (AF) as a result of initiating chronic and systematic inflammation. However, the prevalence of AF in patients with SLE have not been well quantified. The aim of this systematic review and meta-analysis was to collect and identify available clinical data to explore this possible correlation. Articles were searched based on electronic databases (PubMed, Scopus, ScienceDirect, Cochrane Library, Web of Science). Review Manager 5.4 was used to perform meta-analysis of all selected studies and subgroup analyses (pooled separately by geographical distribution). Pooled risk ratio (RR) and 95% confidence intervals (95% CI) were calculated by random-effect model or fix-effect model. Six cohort studies were involved in this meta-analysis, including 311 844 participants, 78 134 cases of SLE and 347 883 non-SLE controls. Pooled studies indicated increased risk of AF development in patients with SLE compared to participants without SLE (I2 = 96%, RR=1.85; 95% CI: 1.23-2.79; P=.003). Four clinical trials including only European/ American populations were analyzed in subgroups. Heterogeneity analysis showed that I2 = 9% and there was an increase in the risk of AF development in European/ American patients with SLE (RR=1.79; 95% CI: 1.61-1.98; P < .001), while in 2 Korean studies, the heterogeneity was 98% and there was no correlation between AF and SLE (RR=1.81, 95% CI: 0.39-8.43). Five clinical studies were involved in subgroup analysis after excluding the Beak study, with I2 = 96% and they suggested that SLE increased the risk of AF development (RR=2.13, 95% CI: 1.42-3.21, P=.002). This meta-analysis suggested that SLE may be a risk factor for AF development and the results may vary with geographic distribution.

Embolic Stroke of Undetermined Source: Role of Implantable Loop Recorder in Secondary Prevention.

Atrial fibrillation (AF) is the most important cause of embolic stroke of undetermined source (ESUS). Implantable loop recorder (ILR) demonstrated the highest sensitivity for detecting it. This register was created to confirm the high prevalence of AF in patients after ESUS and to verify possible benefits on clinical outcomes such as TIA (Transient Ischaemic Attack)/stroke recurrence and death using ILR. A total of 278 patients admitted to "Molinette" Hospital in Stroke Unit department between 2011 and 2016, diagnosed with ESUS, underwent ILR implantation if they had at least one risk factor for AF. A total of 165 patients admitted to other departments in the same center for the same pathology, without ILR, represent the control group. We used propensity score to select 132 patients from each group (matching age, sex, CHADS-VASC, and HAS-BLEED baseline characteristics). The detection rate of AF episodes was significantly higher in the ILR group (p < 0.001). No significant protective role of ILR for clinical endpoints was found on univariate analysis, although a trend towards significance has been pointed for the composite outcome of death and ischemic events recurrence (OR 0.52, CI 0.26-1.04, p = 0.06). A protective role of ILR was found for deaths (OR 0.4, CI 0.17-0.94, p 0.03) and for the composite outcome (OR 0.41, CI 0.19-0.87, p 0.02) on multivariate analysis in the best subsets. With our statistical models, we identified a significant clinical benefit from ILR monitoring, evidenced by a trend of less death and TIA/stroke recurrence and relevant ILR protection for prediction of TIA/stroke recurrence.

P18 ATRIAL FIBRILLATION IN BETA–THALASSAEMIA: PHYSIOPATHOLOGY AND CLINICAL MANAGEMENT

Abstract Beta–thalassaemia is an inherited blood disorder with worldwide distribution characterized by a defective synthesis of haemoglobin. Transfusions and iron–chelation therapy have radically improved the prognosis of beta–thalassaemic patients, while also allowing the development of new chronic complications, cardiac and non–cardiac (diabetes, dystyroidism, autonomic disorders and many others), among which atrial fibrillation (AF) stands out. Prevalence of AF in patients with beta–thalassemia is dramatically higher than in general population, ranging from 2 to 33%. Studies on this topic are lacking and the scarse available evidence comes from a few observational studies. The underlying pathophysiology of AF in thalassaemic is not yet well understood; responsible mechanisms are many (Figure 1) and different from those recognized in general population. Atrial iron overload appears to be the main “risk factor”, although this arrhythmia may develop even before cardiac siderosis. Clinical presentation is early and mainly paroxysmal, and patients are highly symptomatic. Furthermore, the numerous treatments available for AF (pharmacological and interventional), extensively studied in the general population, are largely unexplored in beta–thalassemia. A specific management is required for these patients (Figure 2); in particular, rhythm control should be preferred over rate control, and the most important antiarrhythmic therapy resides in iron–chelating drugs. Thromboembolic risk is also higher than in the general population and the choice of anticoagulant therapy should be considered early (well pondering the serious consequences of a haemorrhage in this setting), but the risk scores available for patients with AF are not validated in the beta–thalassemia.

Evaluation of Patients with Angiographically-Confirmed Coronary Artery Disease to Investigate the Association Between Epicardial Fat Thickness and Atrial Fibrillation.

BackgroundEpicardial fat thickness (EFT) is increasingly recognized as an independent risk factor of the presence, severity, and recurrence of atrial fibrillation (AF). We investigated the associations between EFT and AF prevalence and identified its correlation with other risk factors.Material/MethodsA total of 199 participants who underwent coronary angiography and had confirmed coronary artery disease (CAD) were enrolled in this study.The EFT was measured by echocardiography and the association of EFT with other AF risk factors was evaluated by multivariate logistic regression analysis.ResultsThe EFT was significantly higher in patients with comorbidity of AF and CAD than those with CAD alone (6.86±1.96 mm vs 5.91±1.71 mm, P<0.001). Logistic regression analysis indicated that EFT was a predictive factor of the occurrence of AF in CAD, after adjusting for body mass index (BMI), systolic blood pressure (SBP), left circumflex artery (LCX) stenosis, LA diameter, B-type natriuretic peptide (BNP), creatinine (Cr), and blood urea nitrogen (BUN). LA diameter, SBP, and LCX stenosis are also independent risk factors for CAD complicated by AF. Correlation analysis revealed significant positive linear correlations between EFT and BMI (P<0.01), EFT, and LA diameter (P<0.05), as well as positive correlations between LA diameter and BNP, Cr, or BUN.ConclusionsEpicardial fat thickness is a strong predictor for AF prevalence in patients with CAD, independent of other AF risk factors such as LA diameter, BMI, and SBP, while LA diameter, SBP, and LCX stenosis are also independent AF risk factors for CAD.

Atrial Fibrillation and Aortic Ectasia as Complications of Primary Aldosteronism: Focus on Pathophysiological Aspects.

Primary aldosteronism (PA) is the most common cause of secondary hypertension. A growing body of evidence has suggested that, beyond its well-known effects on blood pressure and electrolyte balance, aldosterone excess can exert pro-inflammatory, pro-oxidant and pro-fibrotic effects on the kidney, blood vessels and heart, leading to potentially harmful pathophysiological consequences. In clinical studies, PA has been associated with an increased risk of cardiovascular, cerebrovascular, renal and metabolic complication compared to essential hypertension, including atrial fibrillation (AF) and aortic ectasia. An increased prevalence of AF in patients with PA has been demonstrated in several clinical studies. Aldosterone excess seems to be involved in the pathogenesis of AF by inducing cardiac structural and electrical remodeling that in turn predisposes to arrhythmogenicity. The association between PA and aortic ectasia is less established, but several studies have demonstrated an effect of aldosterone on aortic stiffness, vascular smooth muscle cells and media composition that, in turn, might lead to an increased risk of aortic dilation and dissection. In this review, we focus on the current evidence regarding the potential role of aldosterone excess in the pathogenesis of AF and aortic ectasia.

Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management.

Simple SummaryAtrial fibrillation in patients with β-thalassemia has a higher incidence compared to the general population. Its pathophysiology is peculiar and strictly related to anemia, iron overload, hemolysis, inflammation, atrial dilatation, fibrosis, and remodeling. The clinical presentation is that of a highly symptomatic disease with frequent recurrencies, significantly impacting over quality of life and prognosis. Furthermore, the risk of thromboembolic events and stroke is considerable. The available treatments are drug therapy and transcatheter ablation. Moreover, particular attention should be paid to anticoagulant therapy for thromboembolic prophylaxis.Thalassemia is an inherited blood disorder with worldwide distribution. Transfusion and chelation therapy have radically improved the prognosis of β-thalassemic patients in the developed world, but this has led to the development of new chronic cardiac complications like atrial fibrillation (AF). Prevalence of AF in patients with β-thalassemia is higher than in the general population, ranging from 2 to 33%. Studies are lacking, and the little evidence available comes from a small number of observational studies. The pathophysiology is not well understood but, while iron overload seems to be the principal mechanism, AF could develop even in the absence of iron deposition. Furthermore, the clinical presentation is mainly paroxysmal, and patients are highly symptomatic. The underlying disease, the pathophysiology, and the clinical presentation require a different management of AF in β-thalassemia than in the general population. Rhythm control should be preferred over rate control, and the most important antiarrhythmic therapy is represented by chelation drugs. Thromboembolic risk is high, but the available risk scores are not validated in β-thalassemia, and the choice of anticoagulation therapy should be considered early. The main purpose of this review is to summarize the actual knowledge about AF in β-thalassemia, with a specific focus on the clinical management of these complex patients.

Impact of haemodialysis in the development of atrial fibrillation: a retrospective cross-sectional study

Abstract Background Chronic kidney disease (CKD) is a very common co-morbidity in patients with cardiovascular disease, particularly in those with atrial fibrillation (AF). There is an increasing number of patients on haemodialysis who have AF and its impact is not fully understood. Purpose To assess the prevalence of AF in patients on haemodialysis, trying to identify predictors of AF development. Methods Unicentric, retrospective study including all patients admitted to the Nephrology ward from October 2020 to December 2020 who had CKD. Cardiovascular risk factors, known cardiac disease, time on haemodialysis, type of vascular access and demographic data were analysed. The control group was comprised of hospitalized CKD patients who were not on renal replacement therapies. Results A total of 126 patients were included, 57 on dialysis. Mean age for the renal replacement therapy group was 71.07±15.68 years and for the control group was 72.59±14.74 years old (p=0.575). There was an increased proportion of patients with type 2 diabetes mellitus in the control group (39 vs 20, p=0.021). No statistically significant differences were found regarding hypertension, heart failure, coronary disease or sleep apnoea between groups. The prevalence of AF was similar in both the haemodialysis and the control group (26.3% vs 24.6%, p=0.829). Age, heart failure and coronary disease were significant risk factors for AF, irrespective of the studied group (p&amp;lt;0.05). There was also a significant correlation between time on dialysis and a greater likelihood of presenting AF (p&amp;lt;0.05). There was no correlation with type of vascular access. Using the Youden index, an age of 80.5 years was determined as the cut-off for an increased prevalence of AF, irrespective of the study group (sensitivity of 66.7%; Specificity of 78.8%). Using ROC curves, an area under the curve (AUC) of 0.74 was obtained for age and the likelihood of AF (figure 1). Regarding time on dialysis, a cut-off point of 4.5 years was obtained with an AUC of 0.67 (sensitivity of 73% and specificity of 68.7%) (figure 2). Conclusion AF is very common in patients with end-stage renal disease, with a prevalence estimated to be 4 times greater than the general population. Our results suggested that, while haemodialysis may not be a risk factor for AF by itself, a longer time on haemodialysis may contribute to its onset. Age was also a contributing factor. Further prospective studies with more homogeneous groups are needed to clarify its role as an independent risk factor for AF. Funding Acknowledgement Type of funding sources: None. Figure 1. Age as predictor of AFFigure 2. Time on dyalisis as predictor of AF

Patients with reflex syncope have a higher prevalence of atrial fibrillation than general population which is predicted by the type of the tilt table test response

Abstract Introduction Reflex syncope is the result of an imbalance between the sympathetic and parasympathetic nervous system. The autonomic nervous system has been associated to some forms of atrial fibrillation (AF). Objective The aim of this study was to assess the prevalence of AF in patients with reflex syncope and a positive tilt table test and to identify the type of tilt test response in patients with AF in comparison to patients without AF. Methods We retrospectively studied consecutive patients that underwent a tilt table test at our institution between 2016 and 2019. We selected those patients with a positive test. Patients with an implanted pacemaker at the time of the tilt test and patients followed in a different institution were excluded. Previous diagnoses of AF episodes were assessed. We analysed the clinical characteristics and the tilt table test results according to previous history of AF. Results We studied 49 patients with a positive tilt test. Seven (14.3%) patients had previously diagnosed paroxysmal AF at the time of the tilt table test. Patients with AF were older, had more frequently hypertension, and the tilt test response was more frequently a vasodepressor than mixed or cardioinhibitory response (71.4% vs. 28.6%) (Table). In univariate analysis, age and hypertension were associated with AF, respectively, OR 1.08 (95% CI 1.01–1.17), p=0.034 and OR 10.80 (95% CI 1.19–98.36), p=0.035. A vasodepressor response was also associated with AF (OR 6.25, 95% CI 1.06–36.74, p=0.043). Conclusions Patients with reflex syncope and a positive tilt table test had a higher prevalence of AF than the general population. A vasodepressor response was associated with AF as were age and hypertension, demonstrating the possible impact of the autonomic nervous system and the multifactorial nature of AF. Funding Acknowledgement Type of funding sources: None.