Course Of Atrial Fibrillation Research Articles

Association of iron deficiency anemia with the development of paroxysms of atrial fibrillation within a year after pharmacological cardioversion with amiodarone

BACKGROUND: Anemia is a common problem with atrial fibrillation. There is a limited number of studies examining the role of iron deficiency anemia in the course of atrial fibrillation. AIM: To evaluate the association of iron deficiency anemia with the development of recurrent atrial fibrillation within 12 months in patients after pharmacological cardioversion with amiodarone. MATERIAL AND METHODS: The study included 198 patients over 18 years of age [120 (60.6%) men and 78 (39.4%) women, median age 71 (63.2; 77) years] with paroxysmal non-valvular atrial fibrillation and duration of paroxysm 48 h, after successful pharmacological cardioversion with amiodarone. The group with anemia included 99 patients (all had iron deficiency anemia), the group without anemia included 99 people. Patients with anemia were older; the groups were comparable in other main indicators. The development of recurrent atrial fibrillation over 1 year of follow-up was assessed by the Kaplan–Meier method and the Cox proportional hazards model. Differences were considered statistically significant at a p value 0.05. RESULTS: In the iron deficiency anemia group, symptomatic relapses of atrial fibrillation developed in 40.4% of patients during 1 year of observation; in the group without anemia — in 25.3% of patients (p=0.003). Kaplan–Meier analysis showed that iron deficiency anemia is associated with an increased risk of developing recurrent atrial fibrillation within 1 year after pharmacological cardioversion with amiodarone, relative risk 1.87 (p=0.014). Comparison of the risks associated with iron deficiency anemia and iron deficiency (regardless of the presence of anemia) showed a greater risk of recurrent atrial fibrillation associated with iron deficiency than with anemia (for interaction p=0.014). CONCLUSION: A comparison of the risks of developing recurrent atrial fibrillation in patients with iron deficiency itself and in patients with iron deficiency anemia showed a greater influence on the prognosis of recurrent atrial fibrillation by the presence of iron deficiency.

INFLUENCE OF ARTERIAL HYPERTENSION ON THE OCCURRENCE AND COURSE OF ATRIAL FIBRILLATION IN PATIENTS AFTER CORONAVIRUS DISEASE (COVID-19)

Objective: To determine the influence of arterial hypertension on the occurrence and course of atrial fibrillation (AF) in patients after suffering from the coronavirus disease (COVID-19). Design and method: The study included 187 patients aged 62.5±0.9 years (47% men, 53% women). The first three groups formed 116 patients who had AF and underwent COVID-19. The first group (G1) consisted of 36 patients who developed AF for the first time after COVID-19. The second group (G2) was represented by 25 patients in whom the transformation of the paroxysmal form of AF into persistent, or persistent AF into its permanent form occurred. The third group (G3) consisted of 55 patients in whom the form of AF did not change. Two control groups (CG) were also formed: control group 1 (CG1) - 49 patients with AF who did not have a history of COVID-19, and control group 2 (CG2) - 22 patients with extrasystole who experienced COVID-19, but who did not develop AF. Results: Arterial hypertension was a common comorbidity in patients with AF who underwent COVID-19. In patients who developed AF after COVID-19 (G1), arterial hypertension occurred 1.4 times more often (83,3% vs 59,1%, p<0.001) than in patients who suffered from COVID-19, but this type of arrhythmia did not develop (comparison CG 2). The presence of hypertension worsened the course of AF in patients who had this arrhythmia before COVID-19. Thus, in patients of G2, in whom AF transformation took place, in comparison with patients in whom the form of AF did not change G3 (88,4% vs 80,0%, p<0,05), hypertension occurred more often. Conclusions: Arterial hypertension is one of the most common diseases in patients with atrial fibrillation after the coronavirus infection, which contributed to the emergence of new paroxysms of AF and worsened the course of already existing arrhythmia.

Case report: the effect of endovascular closure of an open oval window on the course of atrial fibrillation and the processes of reverse remodeling of the heart chambers

The volume of the left atrium is one of the key factors associated with both the development of primary atrial fibrillation and its progression. Open atrial communication is considered as a factor predisposing to dilation and remodeling of the heart cavities. We present a clinical case of endovascular closure of an open oval window in a patient with a persistent form of AF, a moderately reduced left ventricular ejection fraction, who had previously undergone radiofrequency ablation, and persistent manifestations of heart failure. A 58-year-old patient was hospitalized in November 2019 with clinical manifestations of increasing heart failure. History: persistent form of atrial fibrillation with pronounced ventricular tachysystole. In April 2019, the patient underwent radiofrequency ablation, during which signs of open oval window were revealed. The initial left ventricular ejection fraction is 41%, the anterior–posterior left atrium size is 47 mm, the NT-proBNP level is 912 pg/m. In the subsequent period, steady sine waves were recorded.

Soluble ST2 biomarker utility in the comprehension of the clinical course of atrial fibrillation

Abstract Background Atrial fibrillation (AF) is the more frequent arrhythmia in clinical practice and probably one of the more analyzed. Despite this, the clinical pattern classification not always correlates with the clinical course of AF. There are still a lack of biomarkers to predict recurrence and the clinical course of this disease. Purpose ST2 soluble (ST2S) biomarker has being previously analyzed by our group in patients with AF and electrical cardioversion (ECV) demonstrating utility to predict recurrence. We sought to analyze the clinical outcome of patients with AF who underwent an ECV or pulmonary vein isolation (PVI) and its correlation with the ST2S biomarker at mid-term follow-up. Methods We performed a prospective, observational clinical trial that included 250 patients with AF who were referred to our hospital for a clinical procedure including ECV or PVI from September 2016 to 2019. A total of 40 matched controlled patients were also included for the initial analysis. ST2S was analyzed from blood samples at baseline, 3- and 6-months follow-up. Results From 250 patients with AF: 94 underwent an ECV and 156 patients an PVI. Mean age was of 58.5 ±10.4 years. From the 156 PVI: 68 had paroxysmal and 88 persistent AF. Clinical follow-up was continued for 1 year and recurrence was of 65.9% in ECV and 22.4% in PVI patients. Clinical and echocardiographic characteristic are described in table1. The initial value of the ST2S biomarker was higher in AF cases with respect to controls (p<0.001). The patients with paroxysmal AF had higher levels of ST2S.0 (12113.4 pg/mL) respect to control cases but with no significant difference (p=0.234). Comparing the values of ST2S in persistent AF patients (15634.8 pg/mL) with controls the value was higher with a significant difference. ST2S baseline values were compared according to the rhythm and patients in AF had significantly higher levels with respect to those in sinus rhythm (SR). ST2S baseline values were also compared according to heart rate (HR) and those in tachycardia had higher levels respect to those who didn't(Table2). When analyzing ST2S levels in the complete cohort of patients with AF according to recurrence, there were no significant differences (Figure1). In multivariant analysis only AF rhythm and LA index volume were significant predictors of recurrence at 3 months follow-up and AF rhythm and age were predictors at 6 months follow-up. Conclusions ST2S baseline values were higher in persistent AF with respect to paroxysmal AF and only persistent AF patients had higher levels compared with controls. Initial ST2S biomarker levels did not have a predictive value in the global cohort of AF but do correlate with the type of AF and AF rhythm. With these results we consider that even though there is an association with AF and ST2S biomarker levels, when analyzing independently to the type of procedure ST2S values were not predictive of recurrence at mid-term follow-up.

Features of the Course of Atrial Fibrillation in Patients with the History of COVID-19: Impact on the Possibility and Tactics of Restoring Sinus Rhythm

Introduction. Atrial fibrillation (AF) is a potentially life-threatening complication of infection. In general, AF has a high prevalence in elderly population with cardiovascular risk factors and comorbidities. Thus, the presence of AF correlates with adverse outcomes in patients with previous coronavirus disease (COVID-19) which deserves increased attention and should be appropriately treated to prevent adverse outcomes.
 The aim. To analyze the prevalence and clinical course of AF in hospitalized patients after COVID-19 to determine approaches to restoring sinus rhythm.
 Materials and methods. The study included 179 patients with various types of heart rhythm and conduction disorders who suffered from COVID-19 and were hospitalized to the Department of Clinical Arrhythmology and Electrophysiology of the National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the NAMS of Ukraine” from 09/20/2020 to 12/21/2021. 116 patients were hospitalized with AF who suffered from coronavirus infection between 1 and 12 months ago (5.1 ± 0.2 months on average). Other heart rhythm and conduction disorders were the cause of hospitalization for 63 patients (35.2%). The first group was formed by 36 people (31%) in whom AF occurred after coronavirus infection. The second group included 25 patients in whom the form of AF changed, namely: there was a transition from paroxysmal form of AF to persistent AF, or persistent AF to a permanent form of AF. The third group included 55 patients in whom the form of AF did not change. However, in the third group, two subgroups were formed: 3A consisting of 35 patients, in whom, although the form of AF did not change, the frequency or duration of paroxysms increased, and 3B, which included 20 patients without significant changes in the course of AF. As a control group, 49 patients with AF without a history of coronavirus infection were examined.
 Results. In most patients (65%), the reason for hospitalization was AF. The first recorded paroxysms of this arrhythmia were recorded in 31% of patients 2 months after the coronavirus infection. In this group, more than half of the cases (58.4%) were patients with persistent AF, and 8.3% of those hospitalized failed to restore sinus rhythm. In those who had AF before COVID-19, 75% of its course worsened: the frequency or duration of paroxysms increased. The persistent form of AF was dominant and occurred after a previous infection in 58% of cases. In patients who had AF before COVID-19, its course worsened (in 76% of the examined persons) after the infection. Patients with a history of coronavirus infection had more frequent use of drug therapy, which is probably due to the delayed time of hospitalization to the clinic from the onset of the paroxysm.
 Conclusion. AF is the most common arrhythmia and has a worse course in hospitalized patients after coronavirus infection.

The impact of the frailty syndrome on the functioning of patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation is one of the most common supraventricular arrhythmias, which are related to the patient's health condition in progressive treatment. The aim of the study was to evaluate the relationship between the frailty syndrome and the functioning of patients with atrial fibrillation. Material and methods 98 patients (64 women and 34 men) over 65 years of age suffering from atrial fibrillation were included in the study. In the study 2 questionaries have been used: The Frailty Indicator (TFI) and The Functioning in the Chronic Illness Scale (FCIS). The frailty syndrome was recognized at values of 5 or more. Results Frailty syndrome was recognized in 96,94% of cases. The total value of the frailty syndrome correlates negatively and significantly with all components of functioning in a chronic illness. A similar correlation is also found in the physical domain and the components of functioning in chronic illness. The social domain correlates statistically negatively with the patient's impact on the illness. Exact results are presented in the table below. Conclusions Atrial fibrillation has an indirect impact on the lives of patients. The attitude of patients has an indirect influence on the course of atrial fibrillation, and patients are pessimistic about the future. Frailty syndrome worsens the functioning of patients in atrial fibrillation.The correlation between FCIS and TFI

Clinical factors that influence the onset of atrial fibrillation or worsen its course after infection with Covid - 19

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): In. of cardiology Introduction It is known that atrial fibrillation (AF) is not only one of the most common arrhythmias, but also a frequent rhythm disturbance in patients who have undergone SARS-CoV-2 infection. This arrhythmia often develops in the post-covid period. Purpose to determine clinical factors associated with the onset or worsening of the course of atrial fibrillation in patients with coronavirus disease (COVID-19). Materials and methods The study included 187 patients aged 62.5±0.9 years (47% men, 53% women). The vast majority of patients (89%) had arterial hypertension (II stage – 80%, III stage – 9%). Chronic forms of coronary heart disease were diagnosed in 53% of patients. The first three groups formed 116 patients who had AF and underwent coronavirus infection (CI). The first group (G1) consisted of 36 patients who did not have AF before CI. The second group (G2) was represented by 25 patients in whom the transition of the paroxysmal form of AF into persistent, or persistent AF into its permanent form occurred. The third group (G3) consisted of 55 patients in whom the form of AF did not change, but in 35 of them the frequency or duration of AF paroxysms increased (subgroup 3a), and in 20 people the frequency or duration of AF paroxysms did not change (subgroup 3b). Two control groups were also formed: K1 - 49 patients with AF who did not have a history of HF, and K2 - 22 patients with extrasystole who experienced HF, but who did not develop AF. The results. G1 patients were older than those in K2 (63.6±0.64 years vs. 50.7±1.1 years, respectively; p<0.001). At the same time, G2 patients at the time of inclusion in the study were older than those in G3 (66.5±1.04 years vs. 62.9±1.12 years, respectively; p<0.05). Women more often occurred in G1 than in K1 (51.7% vs. 30.6%, respectively; p<0.001), as well as in the combined group of G2-G3 compared to K1 (53.7% vs. 30.6% ,respectively; p<0.001). Concomitant hypertension was associated with an increase in the frequency and duration of AF paroxysms after COVID-19. Thus, group 2, compared to group 3, was characterized by more frequent detection of both stage II hypertension (72% vs. 65.5%; p<0.05) and its stage III (12% vs. 3.6%, p<0 ,05). Similarly, patients with chronic forms of CAD were more frequent in group 2, in contrast to group 3 (72.0% vs. 50%, p<0.001). In addition, the frequency of detection of patients with chronic forms of coronary heart disease was higher in subgroup 3a, compared to subgroup 3b (54.3% vs. 45.0%; p<0.005). Conclusion Older age, female sex, hypertension, and coronary heart disease were clinical factors associated with the occurrence of AF or worsening of previously diagnosed AF in patients with COVID-19.

ERYTHROCYTES AGGREGABILITY AND INTRACARDIAC HEMODYNAMICS IN PATIENTS WITH ATRIAL FIBRILLATION

According to the World Health Organization the morbidity of atrial fibrillations is 1-2% of the general population, which is extremely high number due to the severity of the disease. The frequency of morbidity will increase by about 2.5 times (1). Namely, the unfavorable epidemiological picture of atrial fibrillation makes the project relevant. There are numerous studies, although intracardiac hemodynamics and hemorheologycal parameters and their role in the course of atrial fibrillation have not been studied; We have studied the hemorheological profile in patients with atrial fibrillation. Changes of rheological parameters and hemodynamics were assessed against the background of rhythm disturbances. We examined 50 patients (women-22, men - 28, the average age of 65±10) and 20 healthy volunteers. We have studied the Index of the Erythrocytes aggregability, which is the area of aggregated erythrocytes divided by the full area of the erythrocytes. These new innovative methods “Georgian Technique” is created by Georgian scientists and they are famous in the world as direct, numeral and exact [G. Mchedlishvili, 2004; N. Maeda, 2010; M. Mantskava M., 2011]. Also, all patients the studies: ECG, ECHOcardioscopy was performed. After statistical processing of the material, it was found that erythrocytes aggregability is highly impaired in patients with permanent and persistent forms of atrial fibrillation. Mean value of EAI is 41.7 ± 10.4 compared to the control group, where the average EAI value is within 25.6 ± 1.2. The Index of erythrocytes aggregability (EAI) are significantly increased in inverse proportion to the decrease of the left ventricular ejection fraction. A negative correlation was revealed between the Index of erythrocytes aggregation and the left ventricular ejection fraction (R=0.4); According to the obtained data, changes of rheological parameters deepen in the wake of disruption of intracardiac hemodynamics; This confirms the notion that a small blood vessel is the "target" in the case of atrial fibrillation. From hemodynamic mechanisms rheology plays an important role. They are determinants of hemodynamic processes in the body (2).

Incidence and time course of atrial fibrillation following patent foramen ovale closure.

Determine the true incidence and time course of atrial fibrillation (AF) after patent foramen ovale closure (PFOc) using implantable loop recorders (ILR) placed during cryptogenic stroke evaluation. Published trials report a 2%-6.6% incidence of postimplant atrial fibrillation (PIAF) after PFOc, which is probably a gross underestimation, as only patients presenting in AF were captured. Episodes of paroxysmal and silent AF would have been missed. Of 761 patients who underwent PFOc at a single center between January 2016 and December 2020, 35 patients had an ILR implanted before PFOc, without documentation of AF, and had ≥1 month of monitoring post-PFOc. The incidence, onset, and conclusion of AF episodes were determined from a review of patient records. The mean duration of ILR monitoring was 54.6 ± 39.4 weeks after PFOc. AF occurred in 13/35 (37%) patients. PFOc patients who developed PIAF were older than those who did not (62 ± 11 vs. 52 ± 14 years, p = 0.03). In 12/13, the initial PIAF event occurred within 4 weeks of PFOc, with the greatest frequency around 2 weeks and conclusion by 12 weeks in all. No recurrent strokes occurred during ILR monitoring. The actual incidence of PIAF was far greater than previously reported and was significantly associated with older age at PFOc. The timing of PIAF onset and termination were consistent with a postimplant inflammatory mechanism. The higher actual PIAF incidence underscores its low stroke potential in this population. A larger prospective trial is required to validate these preliminary results.

Factors aggravating the course of atrial fibrillation in comorbid hypertension and type 2 diabetes mellitus

Atrial fibrillation (AF) is quite a common problem, and its frequency increases with age. The course of this rhythm disturbance in comorbid conditions of hypertension and diabetes mellitus (DM) may depend on many pathophysiological factors. Therefore, the study on factors of AF development and aggravation in these comorbidities remains relevant. Aim. The work aimed at determining the factors of development and aggravation of AF in patients with hypertension and type 2 DM. Materials and methods. 214 patients with AF, hypertension and type 2 DM were examined. They were distributed into groups: 1) isolated AF – 7.5 %; 2) AF and hypertension – 51.9 %; 3) AF, hypertension and DM – 25.2 %; 4) isolated hypertension – 5.1 %; 5) hypertension and DM – 10.3 %. The paroxysmal form of AF was revealed in 34.3 %, persistent – in 46.4 % and constant – in 19.3 %. Results. It was revealed that persons with taller stature experienced arrhythmia symptoms more frequently (P = 0.01). Sex, Quetelet index, height, duration of hypertension, SBP, glucose, glycated Hb, urea, fibrinogen, triglycerides, interventricular septum and left ventricular posterior wall thickness, LV ejection fraction, concentric type of remodeling influenced the development of next AF episode in conditions of comorbid hypertension and DM. Quetelet index (P = 0.03), duration of AH (P = 0.03), and glycated Hb level (P = 0.002) were the most significant factors for frequent AF recurrences. A history of at least one AF episode increased the risk of developing a subsequent one by 5.56 times (Р = 0.01). An increase in LA was significantly influenced by AF. Hypertension also contributed to cardiac remodeling, namely, its hypertrophy, while the presence of DM only enhanced this effect. The increase in LА over 4.43 cm (P = 0.0001) and RV over 2.59 cm (P = 0.02) significantly increased the risk of АF conversion to the permanent form. Conclusions. A special attention should be paid to such parameters as Quetelet index, duration of AH, elevated BP, daily SBP variability, glycated Hb level and fasting glycemia, echocardiography indexes (EF, size of LA and RV) to prevent the occurrence of AF and its chronicity in patients with hypertension and DM.

TCT-131 Incidence and Time Course of Atrial Fibrillation Following PFO Closure in Patients With Implantable Loop Recorder Device

TCT-131 Incidence and Time Course of Atrial Fibrillation Following PFO Closure in Patients With Implantable Loop Recorder Device

Clinical and Pathogenetic Assessment of Relationships Between the Dynamics of Body Weight Changes and Atrial Fibrillation in Patients with Primary Obesity

Aims.To evaluate the impact of body weight dynamics on the clinical course of atrial fibrillation in obese patients.Materials and methods. The study included 101 primary obese patients with paroxysmal or persistent atrial fibrillation. Study design: a retrospective, single-center, comparative study. Retrospectively аccording to the he body weight dynamics, patients were divided into 3 groups: those who increased their body weight by >3 % (Group 1, n=40), maintained their initial body weight by ±2.9 % (Group 2, n=29), and reduced their initial body weight by >3 % (Group 3, n=32). Follow-up examinations by a doctor were carried out at least once every 6 months for minimum 36 months. Change in AF type was determined by disease patterns and 7-day Holter monitoring results. The groups were comparable in gender (p=0,9267), age (p=0,3841), height (p=0,8900), and disease form (Paroxysmal atrial fibrillation /Persistent atrial fibrillation) (p=0,8826), the severity of symptoms on the European Heart Rhythm Association score of atrial fibrillations (p=0,8687) and systolic blood pressure at the beginning of the study (p=0,4500).Results. At the final control examination, the body weight of patients in Group 1 increased by an average of 11,4 [9,3; 13,1] kg (р <0,001*), while weight loss in Group 3 averaged -6,2 [-8,4; -5,3] kg (p <0,001*). The decrease in body weight of Group 2 patients was insignificant (p=0,5377) and amounted to -0,1 [-2,0; 1,3] kg. The progression of the disease from paroxysmal to persistent form was observed among 15 (37 %) patients in Group 1, 9 (31 %) patients — in Group 2, 2 (6 %) patients — in Group 3 (p=0,0079*). The regression of arrhythmia from persistent to paroxysmal form was not registered in group 1 (0 %), in group 2, the reverse development of the disease was noted in 1 patient (3 %) and in group 3 — in 6 patients (19 %) (p=0,0053*). There were no free from AF patients in Group 1 at the final follow-up, while 2 (7 %) patients were free from AF in Group 2 and 7 (22 %) — in Group 3 (р=0,0047*). In patients undergoing ablation, procedural success was determined after a 3-month blind period. The need for interventional procedures to restore the sinus rhythm and their multiplicity when comparing the groups did not differ significantly. However, in a pairwise comparison, the difference between groups 1 and 3 of participants was statistically significant (p=0,0079* and p=0,0374*, respectively). Conclusion. This study demonstrates the relationships between the dynamics of body weight and the clinical course of atrial fibrillation. The progression of obesity leads to the progression of the disease. Weight-loss management reverses the type and natural progression of AF, improves the prognosis and the course of disease, regardless of other significant risk factors, increases the anti-arrhythmic therapy effect and the effect of interventional treatment.

Cardiomyopathy and multiple arterial thrombosis in a patient with severe tachyform atrial fibrillation after COVID-19

We present a case of cardiomyopathy with a reduced left ventricular ejection fraction of up to 18%, multivessel arterial thrombosis in a patient who had undergone severe COVID-19 3.5 months earlier. The cardiopathy was initially considered as an outcome of SARSCoV2-induced myocarditis, but MRI with delayed gadolinium contrast revealed no fibrosis or evidence of active myocarditis. A detailed collection of the medical history showed that the duration of tachyform atrial fibrillation exceeded the 4 months indicated in the medical records. Oligosymptomatic manifestation of arrhythmia occurred 8 months earlier, the patient did not consult a physician due to epidemic conditions. Coronary angiography revealed subtotal stenosis of the anterior descending artery. Most probably, the cardiopathy was arrhythmogenic and ischemic. After achieving normosystole and coronary stenting, the left ventricular ejection fraction was 25-27%. At the first hospitalization 4 months ago, left atrial auricular thrombus was detected. After COVID-19 the patient received inadequately low dose of apixaban 5 mg per day. Three weeks after COVID-19, the patient was diagnosed with infarction of the right kidney, wall thrombosis in the abdominal aorta, thrombosis of the superficial femoral, deep femoral, popliteal, anterior tibial arteries on the left, right popliteal artery; thrombotic complications could have developed both in situ and as a result of cardioembolism. Administration of dabigatran 300 mg per day and aspirin helped to dissolve the thrombus in the left atrial auricle, improve the course of intermittent claudication, and avoid recurrent thrombotic complications. COVID-19 could contribute to the progression of atherosclerosis, more malignant course of atrial fibrillation, development of thrombosis, but coronavirus infection is not the only cause of severe disease in a patient. СOVID-19 can not only be the cause of direct lesions of the heart and vessels, but also have an indirect negative effect - to delay the detection of cardiac pathology and be the cause of its hypodiagnosis under the mask of “postcovid”.

Atrial Fibrillation in Hypertrophic Cardiomyopathy

The current information about features of atrial fibrillation in patients with hypertrophic cardiomyopathy is presented in this review. The data about prevalence, pathogenesis and its various complications in these patients are disclosed. The article contains updated clinical recommendations of authoritative medical societies on the discussing problem. There is detailed discussion of risk factors of atrial fibrillation onset in setting of hypertrophic cardiomyopathy with demonstration of results of different studies concerning to investigation of relationship between risk factors and probability of the arrhythmia development. There is description of detection methods, clinical manifestations, and the course of atrial fibrillation in patients with hypertrophic cardiomyopathy. The contemporary literature data are presented regarding to the management of patients with atrial fibrillation with use of anticoagulants, antiarrhythmic drugs, indications for performing of radiofrequency ablation and results of studies concerning long-term efficacy of such procedure are demonstrated. The discussion on the management of the patients in cases of sinus rhythm restoration or maintenance failure is described.

Atrial fibrillation in COVID-19 convalescent patient

We present a clinical case of spontaneous recovery of sinus rhythm in a patient with persistent atrial fibrillation who underwent COVID-19 infection. Global and Russian data on the effect of COVID-19 infection on the development and course of atrial fibrillation are discussed.

State of myocardium, stiffness of vascular wall and severity of emotional disorders in patients with myocardial infarction with atrial fibrillation

The widespread prevalence of myocardial infarction and the frequency of complications in the form of atrial fibrillation, makes it relevant to study its pathogenesis and effect on hemodynamics, significantly aggravating the patient’s condition, leading to a deterioration in hemodynamic parameters and the appearance of recurrent myocardial ischemia. At present, a large amount of data has been accumulated on the causes, electrophysiological mechanisms, and hemodynamic consequences of the development of atrial fibrillation during myocardial infarction. This circumstance necessitates both further study of the features of the development and course of atrial fibrillation, and the search for new approaches in organizing and optimizing the treatment of this complication. It is necessary to study in detail the structure of anxiety-depressive disorders, the state of the elastotonic properties of the vascular wall, endothelial function and heart remodeling in patients with myocardial infarction with various forms of atrial fibrillation.

Change in Atrial Fibrillation Burden over Time in Patients with Nonpermanent Atrial Fibrillation

Introduction The natural course of atrial fibrillation (AF) is not well defined. We aimed to investigate the change in AF burden over time and its associated risk factors among AF patients. Methods Fifty-four participants with recently documented paroxysmal or persistent AF were enrolled. Main exclusion criteria were permanent AF or previous catheter ablation for AF. AF burden was calculated as time in AF divided by total recording time using yearly continuous 7-day Holter-ECG recordings. A relative change ≥10% or an absolute change >0.5% in AF burden between two yearly Holter-ECG recordings was considered significant. Results Mean age was 67 years, 72% were men. The proportion of patients with no recorded AF increased from 53.7% at baseline to 78.6% (p=0.1) after 4 years of follow-up. In 7-day Holter-ECG recordings performed after baseline, 23.7% of participants had a decrease and 23.7% an increase in AF burden. In separate mixed effect models, AF burden over time was associated with prior stroke (β 42.59, 95% CI (23.40; 61.77); p < 0.0001), BNP (β 0.05, CI (0.02; 0.09); p=0.005) end-diastolic (β 0.49, CI (0.23; 0.74); p=0.0003) as well as end-systolic (β 0.25, CI (0.05; 0.46); p=0.02) left atrial volume, left atrial ejection fraction (β −0.43, CI (−0.76;−0.10); p=0.01), E-wave (β 36.67, CI (12.96; 60.38); p=0.003), and deceleration time (β −0.1, CI (−0.16; −0.05); p=0.002). In a multivariable model, a history of prior stroke (β 29.87, CI (2.61; 57.13); p=0.03) and BNP levels (β 0.05, CI (0.01; 0.08); p=0.007) remained significantly associated with AF burden. Conclusions Few patients with paroxysmal or persistent AF have AF episodes on yearly 7-day Holter-ECG recordings, and AF progression is rare. AF burden was independently associated with a history of prior stroke and BNP levels.

Epidemiology and clinical characteristics of atrial fibrillation in patients with inherited heart diseases.

The prevalence and clinical course of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is well described, though less so for other inherited cardiomyopathies (familial dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular noncompaction); and inherited arrhythmia syndromes (long QT syndrome, Brugada syndrome or catecholaminergic polymorphic ventricular tachycardia [CPVT]). We examined the frequency, clinical characteristics and AF-related management and outcomes amongst this patient population. We retrospectively studied consecutive probands with inherited cardiomyopathy (n = 962) and inherited arrhythmia syndromes (n = 195) evaluated between 2002 and 2018. AF was observed in 5% to 31% of patients, with the highest frequency in HCM. Age of AF onset was 45.8 ± 21.9 years in the inherited arrhythmia syndromes compared with 53.3 ± 15.3 years in the inherited cardiomyopathies, with four CPVT patients developing AF at a median age of 20 years. Overall, 11% of patients with AF had a transient ischemic attack or stroke of which a total of 80% were anticoagulated; with 48% of events occurring at a CHA2 DS2 -VASc < 2. Amongst sarcomere-positive HCM, AF was independently associated with age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.08; P = .0014), left atrial area (OR, 1.11; 95% CI, 1.05-1.17; P = .0005) and MYH7 variants (OR, 2.55; 95% CI, 1.16-5.61; P = .020). Up to one-third of inherited heart disease patients will develop AF. While common general population risk factors are key in patients with HCM, the genotype is independently associated with AF. Amongst inherited arrhythmia syndromes, AF is less common, though often occurs below the age of 50 years.

Peculiarities of the clinical course of frederick's syndrome on the background of comorbid pathology in the absence of adequate therapy

Atrial fibrillation in old people is one of the most common causes of cardiac decompensation. It can also lead to sudden cardiac death and thromboembolism of vital organs. Comorbidities such as diffuse cardiosclerosis, myocarditis or cardiomyopathy, congenital or acquired defects of the valvular apparatus of the heart, pathology of the endocrine system, chronic obstructive diseases of the bronchopulmonary apparatus, malignant course of arterial hypertension or its refractoriness to therapy, uncontrolled intake of antiarrhythmic drugs, can complicate the course of atrial fibrillation the addition of a transverse atrioventricular block, which is called Frederick’s syndrome. This article presents a case of clinical observation of an uncontrolled course of atrial fibrillation with the subsequent development and progression of severe circulatory failure against the background of the addition of complete atrioventricular block. Such an important factor as adherence to medical recommendations can compensate for various pathological conditions for a long time without causing significant harm to health, which was neglected by the patient from the clinical case under consideration. The launched course of arterial hypertension probably launched a cascade of morphological changes in the structures of the heart, which subsequently led to the formation of atrial fibrillation, the development of heart failure, and the addition of complete atrioventricular block. The appearance of rhythm in the heart rate, which is characteristic of this conduction disturbance, is often perceived as an erroneous restoration of the rhythm in case of pre-existing atrial fibrillation; this can complicate the timely diagnosis of pathology, especially in the absence of syncope conditions characteristic of complete atrioventricular blockade. The risks of thromboembolic complications and sudden cardiac death are as high as those associated with isolated atrial fibrillation. During the examination of the patient, the absolute indications for transplantation of an artificial pacemaker were determined. Subsequently, an increase in the minute volume of blood and cardiac output, as expected, led to an improvement in the clinical course of the disease and well-being, however, the pre-existing hemodynamic disorder of a long-term nature in this patient led to irreversible decompensation of cardiac activity, which adversely affects the long-term prognosis for life.

Relationship between red blood cell distribution width and left atrial appendage thrombogenic milieu in old patients with non-valvular atrial fibrillation

Objective: To estimate the correlation between red cell distribution width (RDW) level and left atrial appendage thrombogenic milieu (LAATM) in elderly patients with non-valvular atrial fibrillation (NVAF). Methods: This was a retrospective case-control study. A total of 782 NVAF patients (age>60 years old) who finished transesophageal echocardiography (TEE) from January 2010 to December 2016 at Chaoyang Hospital was retrospectively screened, and diveded into LAATM group (n=65) and non LAATM group (n=717). RDW level was compared between the two groups. Potential association between RDW and LAATM was analyzed using multivariate logistic regression analysis. The accuracy of RDW for detecting LAATM was evaluated through receiver operating curve (ROC) analysis. Results: There were significant differences in age, history of heart failure, course of atrial fibrillation (AF), type of AF, NT-proBNP level, RDW level, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction (LVEF), left atrial diameter, CHADS(2) score and CHA(2)DS(2)-VASc score between the two groups (P<0.05). RDW level in LAATM group was significant higher than non LAATM group (13.4% (12.6%, 14.1%) vs. 12.1% (11.2%,13.0%), P<0.001). Multivariate logistic regression showed that RDW level associated with LAATM (OR=4.07, 95%CI 2.09-7.91, P<0.001). In ROC analysis, area under the curve was 0.81 (95%CI 0.74-0.88, P<0.001). When RDW level was 13.1%, LAATM could be diagnosed (sensitivity was 73.1% and specificity was 80.5%). Conclusions: RDW value is associated with the presence of LAATM in elderly NVAF patients. The RDW level has a certain reference value for predicting LAATM.