Development Of Atrial Fibrillation In Patients Research Articles

Sex Differences in the Expression of Cardiac Remodeling and Inflammatory Cytokines in Patients with Obstructive Sleep Apnea and Atrial Fibrillation

Although there is a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF) and numerous investigations have examined the mechanism of AF development in OSA patients, which includes cardiac remodeling, inflammation, and gap junction-related conduction disorder, there is limited information regarding the differences between the sexes. This study analyzes the impact of sex differences on the expression of cardiac remodeling, inflammatory cytokines, and gap junctions in patients with OSA and AF. A total of 154 individuals diagnosed with sleep-related breathing disorders (SRBDs) were enrolled in the study and underwent polysomnography and echocardiography. Significant OSA was defined as an apnea–hypopnea index (AHI) of ≥15 per hour. Exosomes were purified from the plasma of all SRBD patients and incubated in HL-1 cells to investigate their effects on inflammatory cytokines and GJA1 expression. The differences in cardiac remodeling and expression of these biomarkers in both sexes were analyzed. Of the 154 enrolled patients, 110 patients were male and 44 patients were female. The LA sizes and E/e’ ratios of male OSA patients with concomitant AF were greater than those of control participants and those without AF (all p < 0.05). Meanwhile, female OSA patients with AF had a lower left ventricular ejection fraction than those OSA patients without AF and control subjects (p < 0.05). Regarding the expression of inflammatory cytokines and GJA1, the mRNA expression levels of GJA1 were lower and those of IL-1β were higher in those male OSA patients with AF than in those male OSA patients without AF and control subjects (p < 0.05). By contrast, mRNA expression levels of HIF-1α were higher in those female OSA patients with and without AF than in control subjects (p < 0.05). In conclusion, our study revealed sex-specific differences in the risk factors and biomarkers associated with AF development in patients with OSA.

Predictive nomogram models for atrial fibrillation in COPD patients: A comprehensive analysis of risk factors and prognosis.

The aim of the present study was to identify the independent risk factors and prognostic indicators for atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD) and to develop predictive nomogram models. This retrospective study included a total of 286 patients with COPD who were admitted to the Second Affiliated Hospital of Guilin Medical College between January 2020 and May 2022. The average age of the patients was 77.11±8.67 years. Based on the presence or absence of AF, the patients were divided into two groups: The AF group (n=87) and the non-AF group (n=199). Logistic regression analysis was conducted to identify variables with significant differences between the two groups. Nomogram models were constructed to predict the occurrence of AF in COPD patients and to assess prognosis. Survival analysis was performed using the Kaplan-Meier method. The follow-up period for the present study extended until April 31, 2023. Survival time was defined as the duration from the date of the interview to the date the participant succumbed or the end of the follow-up period. In the present study, age, uric acid (UA) and left atrial diameter (LAD) were found to be independent risk factors for the development of AF in patients diagnosed with COPD. The stepwise logistic regression analysis revealed that age had an odds ratio (OR) of 1.072 [95% confidence interval (CI): 1.019-1.128; P=0.007], UA had an OR of 1.004 (95% CI: 1.001-1.008; P=0.010) and LAD had an OR of 1.195 (95% CI: 1.098-1.301; P<0.001). Univariate and multivariate Cox regression analysis revealed that LAD and UA were independent prognostic factors for long-term mortality in COPD patients with AF. LAD had a hazard ratio (HR) of 1.104 (95% CI: 1.046-1.165; P<0.001) and UA had an HR of 1.004 (95% CI: 1.000-1.008; P=0.042). Based on these findings, predictive nomogram models were developed for AF in COPD patients, which demonstrated good discrimination ability with an area under the curve of 0.886. The prognostic nomogram for COPD patients with AF also showed good predictive accuracy with a concordance index of 0.886 (95% CI: 0.842-0.930). These models can provide valuable information for risk assessment and prognosis evaluation in clinical practice. Age, UA and LAD are independent risk factors for AF in COPD patients. The developed nomogram models provide a reliable tool for predicting AF in COPD patients and for prognosis assessment.

Early Detection of Atrial Fibrillation in Chronic Obstructive Pulmonary Disease Patients.

Atrial fibrillation (AF) is an important medical problem, as it significantly affects patients' quality of life and prognosis. AF often complicates the course of chronic obstructive pulmonary disease (COPD), a widespread disease with heavy economic and social burdens. A growing body of evidence suggests multiple links between COPD and AF. This review considers the common pathogenetic mechanisms (chronic hypoxia, persistent inflammation, endothelial dysfunction, and myocardial remodeling) of these diseases and describes the main risk factors for the development of AF in patients with COPD. The most effective models based on clinical, laboratory, and functional indices are also described, which enable the identification of patients suffering from COPD with a high risk of AF development. Thus, AF in COPD patients is a frequent problem, and the search for new tools to identify patients at a high risk of AF among COPD patients remains an urgent medical problem.

Atrial fibrillation and obstructive sleep apnea syndrome: results of a retrospective study

Objective – to study the incidence and risk factors of atrial fibrillation (AF) in patients with obstructive sleep apnea syndrome (OSA), verified according to screening respiratory monitoring during sleep, performed during hospitalization in a therapeutic hospital. Design and methods. The study performed a retrospective analysis of 291 case histories of patients hospitalized in a therapeutic clinic in 2021-2022. All patients underwent overnight respiratory monitoring as part of the initial screening examination for sleep-disordered breathing. Results. Obstructive sleep apnea syndrome was identified in 216 patients, mild severity – in 27,8%, moderate severity – in 20,3%, severe severity – in 26,1% of patients. The incidence of atrial fibrillation in patients with diagnosed OSA was 28,7% and was significantly higher in patients with severe apnea compared to patients with mild apnea (p=0,043). According to the results of the analysis of the reasons underlying the development of AF in patients with verified apnea, arterial hypertension was identified in 96,8% of patients, chronic heart failure in 72,6%, coronary heart disease in 51,6%, thyrotoxicosis in 6,5%, sick sinus syndrome in 4,8% of patients, 19,4% of patients without structural heart damage. In severe apnea, the permanent form of AF was more common (p=0,008), and in mild OSA, paroxysmal AF was more common (p=0,024). It was found that the volumes of the left and right atria in patients with AF and severe OSA are greater than in patients with mild apnea. Conclusion. AF in OSA often occurs in patients without organic heart disease. The most common risk factors for AF in patients with OSA were arterial hypertension, found in 96,8% of subjects, as well as obesity (in 74,2%). The incidence of AF in patients with severe apnea is higher than in patients with mild apnea. The permanent form of AF is detected more often, and atrial volumes are larger in patients with severe OSA compared to patients with mild sleep-disordered breathing.

The relationship of atrial fibrillation with left atrial size in patients with essential hypertension

Atrial fibrillation (AF) is the most common sustained arrhythmia and it is a major public health problem worldwide. Hypertension is one of the major risk factors for the development of AF. This study is carried out to determine the prevalence and independent risk factors for atrial fibrillation (AF) in hypertensive patients and to evaluate the relationship of AF with left atrial size. This is a retrospective observational cross – sectional study that used a retrospective electronic chart review of all admitted patients to cardiology department at King Abdullah university hospital (KAUH) in Irbid, Jordan, with a diagnosis of hypertension along with various acute cardiac admissions, including AF during 1-year period (January 1st to December 31 of 2021). Risk factors for AF (age, sex, DM, coronary artery disease, valvular heart disease, Cor-pulmonale, obstructive sleep apnea, and congestive cardiac failure) were retrieved from electronic charts of the patients. A total of 958 patients were admitted to the coronary care unit (CCU) and intermediate care unit (IMCU) during a 1-year period. Among them, 276 had 2 or 3 admissions. The main reason of admission was acute coronary syndrome (n = 491), heart failure (n = 180), and AF (n = 144), indicating AF prevalence of 15%. However, there were 40 patients with combined causes. All patients in the study (n = 958) were diagnosed with hypertension, including patients with atrial fibrillation (n = 144). The mean age of patients was 61.4 (± 11.46) years, and approximately two thirds of them were males (65.4%). The binary logistic regression model demonstrated a significant statistical relationship of age, left atrial size, coronary artery disease, left ventricular ejection fraction, left ventricular dimensions in systole and diastole, and heart failure with the occurrence of AF after controlling for gender, smoking, and diabetes. Findings indicate that left atrial size plays a significant role in the development of AF in patients with hypertension. However, the prevalence of AF significantly increased with advancing age in both sexes because of increased left ventricular hypertrophy, which leads to increased left atrial size.

Novel Predictor of the AF Development in Patients with OSAS: Importance of Visceral Adipose Index.

Obstructive sleep apnea syndrome (OSAS) is a sleep disorder whose frequency is increasing daily due to modern lifestyle. Patients with atrial fibrillation (AF), which has the same predisposing factors, frequently visit the outpatient clinic with complaints of palpitation. Existing symptoms are often associated with the course of OSAS, and the development of AF, a disease with high morbidity and mortality, cannot be detected. In our study, we investigated the relationship between the visceral adiposity index (VAI) and AF development in these patients. We retrospectively analyzed 207 patients with OSAS who visited the cardiology outpatient clinic. The data of 44 patients with AF and 163 patients without AF were compared. Demographic characteristics and clinical risk factors were similar between the groups (p>0.05). VAI, apnea-hypopnea index, and inflammatory markers were higher in the AF group, and these risk factors were significant in the multivariate analysis (p<0.05). Our study is important in terms of showing VAI as one of the most important predictors of AF, which has an impact on mortality and morbidity in patients with OSAS, whose frequency is increasing daily. Further prospective studies are required to confirm our observations and determine their clinical applicability.

Evaluation of risk factors for long-term atrial fibrillation development in patients undergoing typical atrial flutter ablation: a multi-center pilot study

Abstract Background/Introduction Atrial flutter (AFL) and atrial fibrillation (AF) are the most commonly detected supraventricular arrhythmia and share similar pathophysiological mechanisms (1). After the successful ablation of AFL, AF frequently occurs in such patients in the long-term follow up (2). As emphasized in some studies, some mechanisms seem to predispose to the development of AF in AFL patients and approximately 20% of such kind of patients have accompanying AFL (3). Purpose We aim to analyze independent risk factors that predict the development of AF in patients who underwent typical AFL ablation. Methods Our study was designed as multi-center, cross-sectional and retrospective. A total of 442 patients who underwent typical AFL ablation at 3 different centers between January 1, 2018 and January 1, 2022 were included retrospectively. The patients after the ablation procedure were divided into those who developed AF and those who did not. The patients were followed up for an average of 12 (4-20) months. In the post-procedure period, atrial arrhythmias were investigated with 24-hour Holter and ECG at 1st month, 6th month, 12th month and at 6-month intervals thereafter. Results AF developed in 206 (46.6%) patients in the long-term follow-up. Age, hypertension (HT), obstructive sleep apnea syndrome (OSAS), previous cerebrovascular accident (CVA), left atrium antero-posterior diameter, severe mitral regurgitation, hemoglobin, blood glucose and HbA1c values were found to be significant in univariable analysis. According to multivariable analysis, HT (p=0.014; HR: 1.483 (1.084 – 2.030)), OSAS (p=0.008; HR: 1.520 (1.117 – 2.068)) and previous CVA (p=0.038; HR: 1.749) (1,031 – 2,968)) were independently associated with the development of AF in AFL patients who underwent ablation procedure. Conclusion In the present study, we found that HT, OSAS and previous CVA were independently correlated with the development of AF in the long-term follow-up of patients who underwent typical AFL ablation. We consider that AFL patients with such risk factors should be followed-up closely following cavo-tricuspid isthmus ablation for the development of AF. Univariable and Multivariable Analyzes Kaplan - Meier Curves

Atrial fibrillation in patients with dilated cardiomyopathy: prevalence, risk factors and prognostic significance

Aim. To study the epidemiological profile and long-term prognostic significance of atrial fibrillation (AF) as a risk factor for adverse clinical outcomes in patients with dilated cardiomyopathy (DCM).Material and methods. The study included 270 patients with DCM (206/76,3% men, age 47 [37; 56] years, left ventricular (LV) ejection fraction 29 [21; 35]%). The observation period was 6 years (Me 76 [57; 119] months). To assess the effect of AF on DCM prognosis, Kaplan-Meier curves and Cox regression of clinical outcomes, including cardiovascular death, heart transplantation, and ventricular assist device implantation, were analyzed.Results. Of 270 patients with DCM, paroxysmal AF was detected in 10 (3,7%) patients (initial, 5/1,85%; during the first follow-up year, 5/1,85%). After 5 years, another 65 (24,1%) individuals had AF (paroxysmal, persistent or permanent). Ventricular tachyarrhythmias were registered in 163 (60,4%) patients. Compared with patients maintaining sinus rhythm, patients with AF were older (51,4±10 vs 43,6±13 years, p=0,001) and had lower exercise tolerance (6-minute walk test: 379±45 vs 445±43 meters; p=0,0002) and a higher heart failure functional class (NYHA class III-IV: 38/50,7% vs 52/26,7%; χ2=13,6; p=0 ,0003). In patients with AF, initially more pronounced manifestations of right ventricular contractile dysfunction (TAPSE: 13,1±3,4 vs 15,5±4,6 mm; p=0,0001) and LV diastolic dysfunction (E/A: 2,9±1,5 vs 2,1±1,3; p=0,006; E/e' 15,6±6,9 vs 11,8±7,2; p=0,019), more dilated left atrium (left atrial volume index: 63,3±19 vs 50±18,7 ml/m2; p=0,006). During the 6-year median follow-up, AF was observed in 75 patients (0,46 new cases/100 patients/year). As a result of Cox regression analysis, AF as a time-dependent factor was identified as an independent predictor of cardiovascular death (hazard ratio 3,99; 95% confidence interval, 1,67-8,59; p=0,0001).Conclusion. AF, as one of the most common sustained atrial tachyarrhythmias in the population, demonstrated a lower prevalence (27,8%) in the DCM cohort compared to ventricular tachyarrhythmias (60,4%), but a high prognostic significance of the negative impact on the risk of fatal outcomes. The development of AF in patients with DCM is associated with a 4-fold increase in cardiovascular death risk over a 6-year period.

Epicardial Adipose Tissue and Development of Atrial Fibrillation (AFIB) and Heart Failure With Preserved Ejection Fraction (HFpEF).

Epicardial adipose tissue (EAT) has been associated with the development of many cardiovascular abnormalities, of which the development of atrial fibrillation (AFIB) in this group of patients is not an uncommon finding. Several mechanisms have been proposed to explain the role of EAT in the development of AFIB. It involves cardiac remodeling owing to the underlying fatty infiltration and the subsequent inflammation and fibrosis. This leads to the formation of ectopic foci that can lead to AFIB. Some studies propose that structural and valvular heart disease and increased hemodynamic stress further augment the development of AFIB in patients with underlying EAT. The degree of development of AFIB is also related to EAT thickness and volume. Therefore, EAT quantification can be used as an imaging technique to predict cardiovascular outcomes in these patients. Obesity also plays an important role in the development of AFIB both as an independent factor and by leading to adipose tissue deposition on the epicardial tissue. Understanding the pathophysiology of EAT is important as it can lead to the development of therapies that can target obesity as a risk factor for preventingAFIB. Some promising therapies have already been investigated for decreasing the risk of AFIB in patients with EAT. Dietary changes and weight loss have been shown to reduce the deposition of fat on epicardial tissue. Antidiabetic drugs and statin therapy have also shown promising results. Bariatric surgery has been shown to decrease EAT volume on echocardiography in obese patients.

Sepsis-induced coagulopathy is associated with new episodes of atrial fibrillation in patients admitted to critical care in sinus rhythm.

Sepsis is a life-threatening disease commonly complicated by activation of coagulation and immune pathways. Sepsis-induced coagulopathy (SIC) is associated with micro- and macrothrombosis, but its relation to other cardiovascular complications remains less clear. In this study we explored associations between SIC and the occurrence of atrial fibrillation (AF) in patients admitted to the Intensive Care Unit (ICU) in sinus rhythm. We also aimed to identify predictive factors for the development of AF in patients with and without SIC. Data were extracted from the publicly available AmsterdamUMCdb database. Patients with sepsis and documented sinus rhythm on admission to ICU were included. Patients were stratified into those who fulfilled the criteria for SIC and those who did not. Following univariate analysis, logistic regression models were developed to describe the association between routinely documented demographics and blood results and the development of at least one episode of AF. Machine learning methods (gradient boosting machines and random forest) were applied to define the predictive importance of factors contributing to the development of AF. Age was the strongest predictor for the development of AF in patients with and without SIC. Routine coagulation tests activated Partial Thromboplastin Time (aPTT) and International Normalized Ratio (INR) and C-reactive protein (CRP) as a marker of inflammation were also associated with AF occurrence in SIC-positive and SIC-negative patients. Cardiorespiratory parameters (oxygen requirements and heart rate) showed predictive potential. Higher INR, elevated CRP, increased heart rate and more severe respiratory failure are risk factors for occurrence of AF in critical illness, suggesting an association between cardiac, respiratory and immune and coagulation pathways. However, age was the most dominant factor to predict the first episodes of AF in patients admitted in sinus rhythm with and without SIC.

Abstract P2194: Investigating The Role Of Angiotensin II In The Pathogenesis Of Atrial Fibrillation In Covid-19 Patients Through Blocking The Renin-Angiotensin-Aldosterone System

Background: COVID-19 was found to be associated with a greater risk of developing atrial fibrillation (AF). It is thought that COVID-19 enters cells using its surface spike protein, which binds to the ACE-2 receptor and downregulates it. One of the functions of ACE-2 is converting the pro-inflammatory, anti-fibrinolytic angiotensin II (Ang II) to angiotensin I (Ang I). Therefore, when ACE-2 is downregulated, more Ang II is available to trigger its downstream detrimental effects. Thus, we hypothesized that blocking the effects of Ang II using ACE inhibitors (ACEis) or ARBs would confer a protective effect against the risk of AF. Objective: The purpose of this project was to conduct a retrospective cohort study to determine whether treatment with an ACEi/ARB would prevent the development of AF in patients hospitalized for COVID-19. This would help us better understand the pathogenesis of AF in COVID-19 patients. It would also help us decide whether prophylactic treatment with ACEi/ARB would help reduce the risk. Methods: We reviewed the records of all patients admitted for at least seven days for COVID-19 between January 2021 and June 2021. Of 5430 charts, 188 met the inclusion criteria. Results: Approximately 4.8% of patients hospitalized for COVID-19 developed AF. About 6.74% of patients that were not on an ACEi/ARB at any point during their hospitalization developed AF, whereas none of the patients on an ACEi/ARB developed AF, making the relative risk (RR) 0.1871 (95% CI 0.0108 to 3.2377, p-value 0.2492), and the number needed to treat 14.8. Interestingly, in the patients with a previous diagnosis of AF, there was also no statistically significant difference in the need to escalate rate or rhythm control strategy between patients on an ACEi/ARB compared to those who were not (6.67% vs 14.29%, respectively), with a RR of 0.4667 (95% CI: 0.0546 - 4.0629, p-value 0.4900). Conclusion: Our data to date show that the use of an ACEi/ARB is not associated with a statistically significant decrease in the risk of AF in patients hospitalized with COVID-19, which suggests that there may be another cellular mechanism by which COVID-19 causes AF. Therefore, prophylactically treating patients with an ACEi/ARB or holding them on admission may have no influence on the risk of AF.

Cardiac Magnetic Resonance Imaging-Derived Left Atrial Characteristics in Relation to Atrial Fibrillation Detection in Patients With an Implantable Cardioverter-Defibrillator.

Background Among patients with an implantable cardioverter-defibrillator, a high prevalence of atrial fibrillation (AF) is present. Identification of AF predictors in this patient group is of clinical importance to initiate appropriate preventive therapeutic measures to reduce the risk of AF-related complications. This study assesses whether cardiac magnetic resonance imaging-derived atrial characteristics are associated with AF development in patients with a dual-chamber implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator, as detected by the cardiac implantable electronic device. Methods and Results This single-center retrospective study included 233 patients without documented AF history at the moment of device implantation (dual-chamber implantable cardioverter-defibrillator [63.5%] or cardiac resynchronization therapy defibrillator [36.5%]). All patients underwent cardiac magnetic resonance imaging before device implantation. Cardiac magnetic resonance-derived features of left atrial (LA) remodeling were evaluated in all patients. Detection of AF episodes was based on cardiac implantable electronic device interrogation. During a median follow-up of 6.1 years, a newly diagnosed AF episode was detected in 88 of the 233 (37.8%) patients with an ICD. In these patients, increased LA volumes and impaired LA function (LA emptying fraction and LA strain) were found as compared with patients without AF during follow-up. However, a significant association was only found in patients with dilated cardiomyopathy and not in patients with ischemic cardiomyopathy. Conclusions LA remodeling characteristics were associated with development of AF in patients with dilated cardiomyopathy but not patients with ischemic cardiomyopathy, suggesting different mechanisms of AF development in ischemic cardiomyopathy and dilated cardiomyopathy. Assessment of LA remodeling before device implantation might identify high-risk patients for AF.

PECULIARITIES OF THE COURSE OF ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER A CORONAVIRUS INFECTION

Objective: Arterial hypertension is one of the most common comorbid pathologies in patients with atrial fibrillation (AF). The aim of our study was to evaluate blood pressure indicators as a predictor of the development of AF after experiencing a coronavirus infection (CI). Design and method: 187 patients (pts) aged 62,5±0,9 years (47% men, 53% women) were included in the study. The vast majority of pts (89%) had arterial hypertension (stage2 – 80%, stage3 – 9%). The first three groups formed 116 pts who had AF and underwent CI. The first group (G1) consisted of 36 pts who did not have AF before CI. The second group (G2) was represented by 25 pts 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 pts in whom the form of AF did not change. Two control groups were formed: K1 - 49 pts with AF who did not have a history of CI, and K2 - 22 pts with extrasystole who experienced CI, but who did not develop AF. Results: Arterial hypertension affected the possibility of developing and worsening the course of AF after CI in G2 pts compared with K1 pts (88,0% vs. 80,0%, p&lt; 0,05), G1 compared with K2 patients. Concomitant hypertension was associated with an increase in the frequency and duration of AF paroxysms after COVID-19. Thus, G2, compared to G3, was characterized by more frequent detection of both 2nd degree hypertension (72% versus 65,5%; p&lt;0,05) and 3rd degree hypertension (12% versus 3,6%, p&lt;0.05). Conclusions: Arterial hypertension are predictors of the development of AF in patients after CI. The presence of AH significantly worsens the course of AF after CI, increasing the frequency of paroxysms of this arrhythmia and their duration.

SST2 association with atrial fibrillation development in patients with acute myocardial infarction with ST elevation

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is considered a significant myocardial infarction complication. Recent investigations found that soluble suppression of tumorigenicity 2 (sST2) is an important player in ST-segment elevation myocardial infarction (STEMI) development. However, sST2 role in the prognosis for atrial fibrillations in STEMI patients remains not fully clear. Purpose The study aimed to investigate the sST2 role in the prognosis of atrial fibrillations development in STEMI patients. Methods 193 STEMI patients were enrolled into the study. 101 males, 92 females, with average age of 61.23±7.45 years. The follow-up period was 6 month. Plasma sST2 levels were measured at admission by ELISA. Results Plasma sST2 concentrations in patients with developed AF were 47.56 IQR [29.87; 61.33] ng / mL, which was significantly higher than in those patients without developed AF 39.67 IQR [22.16; 49.77] ng / mL, p &amp;lt; 0.01.Logistic regression analysis indicated that increased sST2 as a significant predictor for AF development (OR = 1.121, 95% CI: 1.055–1.971, p &amp;lt; 0.01). It remained significant even after adjustment for age and sex (OR = 1.023, 95% CI: 1.009–1.865, p &amp;lt; 0.01). ROC analysis showed that sST2 cut-off level for AF development was 49.12 ng/ml with a sensitivity of 77.8% and specificity of 73.5%, AUC 0.811; 95 % CI 0.633-0.873; p &amp;lt;0.001 Conclusion The elevated sST2 plasma level is associated with an increased risk of atrial fibrillation in STEMI patients. Our findings suggest new approaches for better management of high-risk STEMI patients.

Observation of Post-Operative Support among LAVI and AF after MVR in Patients with Mitral Valve Disease

Introduction: Mitral valve disease is a common heart condition that may require mitral valve replacement (MVR) surgery. One of the potential complications after MVR is the development of atrial fibrillation (AF). Left atrial volume index (LAVI) is a measure of left atrial size that has been linked to the development of AF in patients with mitral valve disease. The present study aimed to observe the post-operative support needed by patients after MVR surgery, particularly those with elevated LAVI and the incidence of post-operative AF. Methods: This prospective observational study was conducted at the Department of Cardiac Surgery, National institute of cardiovascular diseases (NICVD), Sher-e-Bangla Nagar, Dhaka, Bangladesh. The study duration was 1 year, from Mar, 2018 to Feb, 2019. During this period, a total of 60 patients who underwent Mitral Valve Replacement (MVR) for mitral valve diseases at the study hospital were included in the study following the inclusion and exclusion criteria through a purposive sampling method. The 60 patients were divided in two equal groups, Group A, consisting of 30 Patients who had Left Atrial Volume Index of ≥ 39 ml/m2 after operation, while group B had been comprised of 30 patients who had Left Atrial Volume Index of &lt; 39 ml/m2 after operation. Result: Around 23.33% of participants in both groups were aged 21-30, while 40% of Group A and 36.66% of Group B were aged 31-40. In terms of BMI, 53.33% of Group A and 46.66% of Group B had a normal BMI, while 40% and 43.33% were overweight, and 6.66% and 10% were obese, respectively. Specifically, 23.33% of participants in Group A developed post-operative AF, while only 6.66% of participants in Group B developed it. The p-value for this comparison was 0.015. The results demonstrate that Group B had significantly smaller LA diameter, LA volume, LAVI, LVIDS, and LV ejection fraction compared to Group A at all three measurements post-operation (p&lt;0.05). However, there was no significant ...

The relationship between hyperuricemia and atrial fibrillation in patients with heart failure

Objective Uric acid is the end product of purine metabolism. Overproduction and insufficient excretion cause an increase in serum uric acid(SUA) levels. In some studies, it has been shown that hyperuricemia is an independent predictor of cardiovascular mortality and poor prognosis of heart failure(HF). It has been found that the level of SUA may also be a biomarker to be used in demonstrating inflammation and oxidative stress. Recent studies have shown that inflammation and oxidative stress play a role in the pathogenesis of both HF and atrial fibrillation(AF). In this study, we aimed to investigate whether the level of SUA is associated with the development of AF in patients with HF. Methods A total of 1342 patients with HF who applied to outpatient clinic between 2018 and 2022 were scanned. Patients with one of the exclusion criteria were not included in the study. As a result, 538 HF patients were included. These patients were divided into 2 groups as new-diagnosed AF patients and patients without AF. Results SUA level was 9.29±2.93 mg/dL in patients with AF and 7.67±2.5 mg/dL in patients who did not develop AF, which was statistically significant(p&lt;0.001) Also furosemide use was 92.5% and 72.6% in patients with and without AF, respectively(p&lt;0.001). Other results of the study are described in the main text. In our multivariate analysis, SUA level and furosemide use were found to be associated with the development of AF[1.21 (1.09-1.35) p &lt;0.001 for SUA; 5.33 (1.87-15.18)(p=0.002) for furosemide]. Conclusion Hyperuricemia may increase the development of AF in patients with HF. According to this, correction of hyperuricemia can contribute positively to mortality and morbidity in HF patients.

Фибрилляция предсердий и инфаркт миокарда: клинико-патогенетические взаимосвязи и влияние на прогноз

Aim. To summarize the contemporary literature data on the clinical and pathogenic correlations between atrial fibrillation (AF) and myocardial infarction (MI). Key points. AF is one of the most common and clinically significant arrhythmias. In patients with MI, this type of arrhythmia is recorded for the first time in 6 % to 21 % of cases. The review discusses the incidence of AF in patients with various forms of coronary heart disease, mechanisms of arrhythmogenesis, and the ways to predict poor outcomes in a group of patients with AF who had a history of MI. Conclusion. The mechanisms of AF development in patients with MI need better understanding. AF impact on the short-term and long-term prognosis for patients with MI should be studied better, and modern tools for the classification of poor outcome risks should be developed. Keywords: atrial fibrillation, myocardial infarction, predictive significance.

PS-C02-4: QRS DURATION AS A PREDICTOR OF FUTURE ATRIAL FIBRILLATION IN END-STAGE RENAL DISEASE PATIENTS WITH PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION

Objective: We investigated the echocardiographic and electrocardiographic predictors for future development of AF in patients with ESRD and preserved LV EF who had never diagnosed AF. Design and method: Atrial fibrillation (AF) is a common cause which leads to adverse cardiovascular outcome in patients with end-stage renal disease (ESRD). AF is common arrhythmia in patients with reduced left ventricular (LV) ejection fraction (EF). It is unclear the predictor of new AF in patients with preserved LV EF. We enrolled 226 patients with ESRD who has performed transthoracic echocardiography. We excluded the 1) 16 patients who has been received a diagnosis of AF, and 2) 19 patients with LV EF &lt; 50%, and 191 patients (121 males, mean 62 ± 14 years years). Results: During a mean follow-up period of 885 ± 720 days, AF occurred in 20 (10.5%) patients. The patients with AF development was older (69 ± 12 vs. 61 ± 14 years, p = 0.023). There were no differences in history of hypertension, diabetes, stroke and coronary artery disease between two groups. In univariate Cox regression analysis, left atrial volume index (LAVI), right ventricular systolic pressure, age and QRS duration were associated with future AF events. After multivariate Cox regression analysis, age (HR: 1.015, 95% CI: 1.008–1.105, p value: 0.022) and QRS duration (HR: 1.025, 95% CI: 1.001–1.049, p value: 0.043) significantly predicted the future development of AF. Conclusions: QRS duration is well known predictor of cardiovascular outcome in patients with reduced LV EF. In this study, we demonstrated QRS duration predicted new AF events in ESRD patients with preserved LV EF.

Excessive supraventricular ectopic activity and future onset of atrial fibrillation in patients with cryptogenic stroke

ObjectivesAlthough evidence has shown the association of excessive supraventricular ectopic activity (ESVEA) with future development of atrial fibrillation (AF), this relationship is not yet fully understood. This study examines whether ESVEA can predict the future onset of AF, in patients presenting with cryptogenic stroke. Materials and MethodsA retrospective cohort of 124 non-AF, consecutive patients, hospitalized for cryptogenic stroke between 2014 and 2015, was retrieved. 24-h inpatient monitoring with Holter was employed to reveal ESVEA, defined as the presence of more than 20 premature atrial complexes per hour (PACs/h) on average, or a more than 5 s duration of the longest supraventricular run (LSVR). After a median follow-up period of 5.2 years, the patients were examined for AF. ResultsFrom initial 124 patients, 12 died and one was lost during follow-up. For the total of 111 patients finally included, the median age was 56 years and 25.2% were females. The overall baseline median CHA2DS2-VASc score was 3. AF was found in 13 (11.71%) patients. Patients who were finally diagnosed with AF had a significantly higher number of PACs/h and a longer median LSVR duration at baseline (16.67 vs. 0.21, p < 0.001 and 3 vs. 0 s, p < 0.001, respectively). The presence of ESVEA was also significantly more frequent among AF patients (46.15%, 95%CI: 17.78%–74.22%) compared to non-AF ones (6.1%, 95%CI: 1.3%–10.7%, p < 0.001). ConclusionsExcessive atrial ectopy, detected with 24 h inpatient Holter monitoring, is a significant indicator of future development of AF in patients presenting originally with a cryptogenic stroke.

Continuous positive airway pressure reduces the incidence of atrial fibrillation in patients with obstructive sleep apnea: A Meta-Analysis and Systematic Review.

INTRODUCTIONObstructive sleep apnea (OSA) and atrial fibrillation (AF) are disorders that have increased in the United States during recent years. Earlier investigations have shown that underlying undiagnosed and unmanaged OSA plays a significant role in high rates and also as a trigger for newly diagnosed AF. Since the introduction of continuous positive airway pressure (CPAP) as a main therapy for OSA, more studies have evaluated the effect of CPAP on the development or recurrence of AF in OSA patients. However, sample sizes in a limited number of studies have been too small to conclude whether CPAP therapy has a significant effect on the development of AF in patients with OSA. The authors report results of their systematic review and meta-analysis summarizing what is currently known about the efficacy of CPAP for mitigating AF in patients with OSA.METHODThe authors systematically reviewed the published reports on CPAP use and the incidence of AF from PubMed, Google Scholar, EMBASE, Web of Science, meeting abstracts, and Cochrane databases published between January 2015 and November 2021. Study data were extracted by two reviewers and a random-effects meta-analysis was performed using RevMan version 5.4.RESULTSA total of 17 studies that met inclusion criteria were identified Studies included a total of 6,523 patients, 3,248 (49.8%) who used CPAP and 3,275 (50.2%) who did not use CPAP. In a random effects model, patients treated with CPAP showed a decrease in the incidence of AF (OR, 0.51; 95% CI; 0.27; 0.97, p = 0.04). High heterogeneity among the included studies was also observed (I2 = 97%).CONCLUSIONOur results add to the increasing evidence that CPAP therapy may reduce the incidence of development of AF in patients with OSA. Prospective future studies and clinical trials are needed to refine our understanding of the relationship between OSA and AF and how CPAP may reduce cardiovascular disease development.