Development Of New-onset Atrial Fibrillation Research Articles

Relationship between atrial fibrillation and P wave dispersion in inpatients with COVID-19

Objective: Various cardiac arrhythmias, primarily atrial fibrillation (AF), have been reported to occur in 7% to 22% of patients hospitalized due to coronavirus disease 2019 (COVID-19). It has been shown that P wave dispersion (PWD) predicts the development of AF in different clinical situations and is closely related to the inflammatory process. The aim of this study is to determine the relationship between PWD and the development of new-onset AF in hospitalized patients due to COVID-19.
 
 Methods: 51 COVID-19 patients who developed AF and 72 COVID-19 patients who did not develop AF were included in the study as the control group retrospectively. Electrocardiography (ECG) was performed in all patients and PWD was calculated. In addition, demographic data, imaging findings and laboratory test results of all COVID-19 patients were obtained from the institutional digital database and recorded. 
 
 Results: Patients who developed AF were older and had a higher frequency of hypertension and heart failure (p

The role of miR1 and miR133a in new-onset atrial fibrillation after acute myocardial infarction

BackgroundThe development of new-onset atrial fibrillation (NOAF) after acute myocardial infarction (AMI) is a clinical complication that requires a better understanding of the causative risk factors. This study aimed to explore the risk factors and the expression and function of miR-1 and miR-133a in new atrial fibrillation after AMI.MethodsWe collected clinical data from 172 patients with AMI treated with emergency percutaneous coronary intervention (PCI) between October 2021 and October 2022. Independent predictors of NOAF were determined using binary logistic univariate and multivariate regression analyses. The predictive value of NOAF was assessed using the area under the receiver operating characteristic (ROC) curve for related risk factors. In total, 172 venous blood samples were collected preoperatively and on the first day postoperatively; the expression levels of miR-1 and miR-133a were determined using the polymerase chain reaction. The clinical significance of miR-1 and miR-133a expression levels was determined by Spearman correlation analysis.ResultsThe Glasgow prognostic score, left atrial diameter, and infarct area were significant independent risk factors for NOAF after AMI. We observed that the expression levels of miR-1 and miR-133a were significantly higher in the NOAF group than in the non-NOAF group. On postoperative day 1, strong associations were found between miR-133a expression levels and the neutrophil ratio and between miR-1 expression levels and an increased left atrial diameter.ConclusionsOur findings indicate that the mechanism of NOAF after AMI may include an inflammatory response associated with an increased miR-1-related mechanism. Conversely, miR-133a could play a protective role in this clinical condition.

Cardiopulmonary bypass management and risk of new-onset atrial fibrillation after cardiac surgery.

Cardiopulmonary bypass (CPB) management may potentially play a role in the development of new-onset atrial fibrillation (AF) after cardiac surgery. The aim of this study was to explore this potential association. Patients who underwent coronary artery bypass grafting and/or valvular surgery during 2016-2020 were included in an observational single-centre study. Data collected from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry and a local CPB database were merged. Associations between individual CPB variables (CPB and aortic clamp times, arterial and central venous pressure, mixed venous oxygen saturation, blood flow index, bladder temperature and haematocrit) and new-onset AF were analysed using multivariable logistic regression models adjusted for patient characteristics, comorbidities and surgical procedure. Out of 1999 patients, 758 (37.9%) developed new-onset AF. Patients with new-onset postoperative AF were older, had a higher incidence of previous stroke, worse renal function and higher EuroSCORE II and CHA2DS2-VASc scores and more often underwent valve surgery. Longer CPB time [adjusted odds ratio 1.05 per 10 min (95% confidence interval 1.01-1.08); P = 0.008] and higher flow index [adjusted odds ratio 1.21 per 0.2 l/m2 (95% confidence interval 1.02-1.42); P = 0.026] were associated with an increased risk for new-onset AF, while the other variables were not. A sensitivity analysis only including patients with isolated coronary artery bypass grafting supported the primary analyses. CPB management following current guideline recommendations appears to have minor or no influence on the risk of developing new-onset AF after cardiac surgery.

Predictors of the development of cognitive impairment in patients undergoing pulmonary thromboendarterectomy

Aim: To study the clinical and functional features, as well as intra- and postoperative indicators of patients with chronic thromboembolic pulmonary hypertension (CTEPH) with the development of negative dynamics of cognitive status in the early postoperative period and to identify pathophysiological factors associated with this disorder.Material and Methods. The study included patients with CTEPH scheduled for pulmonary endarterectomy (PEA). The 1st group (38 people) consisted of patients with the development of negative dynamics of cognitive functions according to the MMSE scale in the early postoperative period, the 2nd group (91 people) – without negative dynamics of cognitive functions. Preoperative clinical, anamnestic data, intraoperative parameters, early postoperative complications and their relationship with the negative postoperative dynamics of cognitive status were analyzed.Results. The average age of patients in the general group was 54.1 (44.3–68.1) years. The 1st group was characterized by older age (p = 0.03), a prevalence of patients with diabetes mellitus (p = 0.02), arterial hypertension (p = 0.04), atherosclerosis of the brachiocephalic arteries ≤ 50% (p = 0.04) and higher level of Charlesson comorbidity index (p = 0.002) in comparison with the 2nd group. Intraoperative factors for the development of postoperative cognitive impairment were a longer circulatory arrest (CA) during PEA and a more pronounced decrease in cerebral oxygenation during CA. The 1st group of patients were characterized by a large number of complications, including pulmonary heart failure (p = 0.02), acute renal failure (p < 0.001) and atrial fibrillation (p < 0.001) in comparison with the 2nd group. The development of negative postoperative dynamics of cognitive status in CTEPH patients was associated with baseline reduced cognitive function – OR 2.3 (1.4–9.2 95% CI) (p = 0.01) and with the presence of three or more CA during PEA – OR 3.2 (1.1–12.7 95% CI) (p = 0.01).Conclusion. Independent factors for the development of negative postoperative dynamics of cognitive status in patients with CTEPH were baseline impairment of cognitive function (< 20 points according to the MMSE scale), three or more CA during PEA, and the development of new-onset atrial fibrillation in the early postoperative period.

Epidemiology, Risk Factors, and Outcome of Cardiac Dysrhythmias in a Noncardiac Intensive Care Unit.

Several extrinsic factors contribute to the development of cardiac dysrhythmias. In intensive care unit (ICU) settings and among critically ill patients who are exposed to a large number of risk factors, cardiac disturbances are more common. This study aimed to examine the epidemiology, risk factors, and outcome of cardiac dysrhythmias in a non-cardiac ICU. This is a retrospective, single-center, observational study conducted in a tertiary noncardiac ICU at Imam Khomeini Hospital in Ahvaz, Iran. Out of the 360 adult patients aged 18 years and older who were admitted to ICU for longer than 24 h, 340 cases who met the study inclusion criteria were recruited between March 2018 until October 2018. The most common nonsinus dysrhythmias were new-onset atrial fibrillation (NOAF) (12.9%) and ventricular tachycardia (21 patients-6.2%). According to our results, previous percutaneous coronary instrumentation, acute kidney injury, sepsis, and hyperkalemia act as risk factors in the development of cardiac dysrhythmias. Additionally, we found out that thyroid dysfunction and pneumonia can predict the development of NOAF in critically ill patients. The estimated mortality rate among patients with NOAF in this study was 15.7% (p < .05). Cardiac dysrhythmias are common in ICU patients and treating the risk factors can help to prevent their development and improve patient management and outcome.

Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis.

New-onset atrial fibrillation (NOAF) is one of the leading causes of morbidity and mortality, especially in older patients in the intensive care unit (ICU). Although many comorbidities are associated with NOAF, the effect of anemia on the onset of atrial fibrillation is still unknown. This study aimed to test the hypothesis that anemia is associated with an increased risk of developing NOAF in critically ill patients in intensive care. We performed a retrospective analysis of critically ill patients who underwent routine hemoglobin and electrocardiography monitoring in the ICU. Receiver operating characteristics analysis determined the hemoglobin (Hb) value that triggered NOAF formation. Bivariate correlation was used to determine the relationship between anemia and NOAF. The incidence of NOAF was 9.9% in the total population, and 12.8% in the patient group with anemia. Analysis of 1931 patients revealed a negative association between anemia and the development of NOAF in the ICU. The stimulatory Hb cut-off value for the formation of NOAF was determined as 9.64 g/dL. Anemia is associated with the development of NOAF in critically ill patients in intensive care.

Ventricular Septal Myectomy Decreases Long-Term Risk for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) and is an important cause of morbidity and embolic stroke. The impact of outflow obstruction and the influence of surgical septal myectomy on the development of new-onset AF has not been well described. Consecutive patients with HCM without previous AF were followed for 5.0 ± 3.6years for new-onset AF, including 717 with obstruction who did not undergo surgical myectomy (outflow gradients ≥30mm Hg at rest or after provocation), 555 with nonobstructive HCM (outflow gradients &lt;30mm Hg), and 503 who underwent surgical myectomy. Patients with obstructive HCM who did not undergo myectomy had a 1.5-fold increased risk for new-onset AF compared with nonobstructive HCM (26% vs 16% at 10years, hazard ratio = 0.69, p=0.02). Patients who underwent myectomy had more advanced heart failure (95% vs 18% New York Heart Association class III, p &lt;0.001) and had larger left atrium dimension (42±7 vs 41±7mm; p &lt;0.01) as compared with patients with obstructive HCM who did not undergo myectomy. However, after myectomy, the risk of new-onset AF was significantly lower than nonoperated obstructive (17% vs 26% at 10years, p=0.04) and no different from the risk of AF in patients with nonobstructive HC (hazard ratio 0.95, p=0.81).In conclusion, patients with HCM with outflow obstruction are at a higher risk for AF compared with patients with nonobstructive HCM. However, after surgical myectomy, the risk for new-onset AF is substantially reduced. In addition to the known benefits of myectomy to permanently relieve outflow tract obstruction and mitral regurgitation, reverse heart failure symptoms, and increase longevity, myectomy is now shown to decrease susceptibility to AF in HCM.

Is serum magnesium level associated with atrial fibrillation in the mixed medical/surgical intensive care unit setting?

Although low serum magnesium level is a a relatively common problem in mixed medical/surgical intensive care units (ICUs), its association with new-onset atrial fibrillation (NOAF) has been studied to a lesser extent. We aimed to investigate the effect of magnesium levels on the development of NOAF in critically ill patients admitted to the mixed medical/surgical ICU. A total of 110 eligible patients (45 female, 65 male) were included in this case-control study. The age and sex-matched control group (n = 110) included patients with no atrial fibrillation from admission to discharge or death. The incidence of NOAF was 2.4% (n = 110) between January 2013 and June 2020. At NOAF onset or the matched time point, median serum magnesium levels were lower in the NOAF group than in the control group (0.84 [0.73-0.93] vs. 0.86 [0.79-0.97] mmol/L; p = 0.025). At NOAF onset or the matched time point, 24.5% (n = 27) in the NOAF group and 12.7% (n = 14) in the control group had hypomagnesemia (p = 0.037). Based on Model 1, multivariable analysis demonstrated magnesium level at NOAF onset or the matched time point (OR: 0.07; 95%CI: 0.01-0.44; p = 0.004), acute kidney injury (OR: 1.88; 95%CI: 1.03-3.40; p = 0.039), and APACHE II (OR: 1.04; 95% CI: 1.01-1.09; p = 0.046) as factors independently associated with an increased risk of NOAF. Based on Model 2, multivariable analysis demonstrated hypomagnesemia at NOAF onset or the matched time point (OR: 2.52; 95% CI: 1.19-5.36; p = 0.016) and APACHE II (OR: 1.04; 95%CI: 1.01-1.09; p = 0.043) as factors independently associated with an increased risk of NOAF. In multivariate analysis for hospital mortality, NOAF was an independent risk factor for hospital mortality (OR: 3.22; 95% CI: 1.69-6.13, p<0.001). The development of NOAF in critically ill patients increases mortality. Critically ill patients with hypermagnesemia should be carefully evaluated for risk of NOAF.

Predictive value of uric acid/albumin ratio for the prediction of new-onset atrial fibrillation in patients with ST-Elevation myocardial infarction.

There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.

New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

The authors aimed to identify risk factors and outcomes associated with new-onset atrial fibrillation (NOAF) after transcatheter aortic valve replacement (TAVR). NOAF is a common complication after TAVR, although estimates of the precise occurrence are variable. This study sought to quantify the occurrence of NOAF after TAVR and to explore the outcomes and predictors associated with this complication. We searched Medline, EMBASE, and the Cochrane database from 2016 to 2020 for articles that reported NOAF after TAVR. We extracted data for studies published before 2016 from a previous systematic review. We pooled data using a random effects model. We identified 179 studies with 241,712 total participants (55,271 participants with pre-existing atrial fibrillation (AF) were excluded) that reported NOAF from 2008 to 2020. The pooled occurrence of NOAF after TAVR was 9.9% (95%CI: 8.1%-12%). NOAF after TAVR was associated with a longer index hospitalization (mean difference=2.66days; 95%CI: 1.05-4.27), a higher risk of stroke in the first 30days (risk ratio [RR]: 2.35; 95%CI: 2.12-2.61), 30-day mortality (RR: 1.76; 95%CI: 1.12-2.76), major or life-threatening bleeding (RR: 1.60; 95%CI: 1.39-1.84), and permanent pacemaker implantation (RR: 1.12; 95%CI: 1.05-1.18). Risk factors for the development of NOAF after TAVR included higher Society of Thoracic Surgeons score, transapical access, pulmonary hypertension, chronic kidney disease, peripheral vascular disease, and severe mitral regurgitation, suggesting that the risk for NOAF ishighest in more comorbid TAVR patients. NOAF is common after TAVR. Whether AF after TAVR is a causal factor or a marker of sicker patients remains unclear.

Risk factors of postoperative atrial fibrillation in patients undergoing beating heart coronary artery bypass

Aim: This study aims to establish new-onset atrial fibrillation (AF) risk factors and postoperative outcomes after off-pump coronary artery bypass graft (CABG) surgery. Material and Methods: Four hundred ninety patients who underwent off-pump CABG were enclosed in study. Patients divided into two groups in line with the development of new-onset AF as AF group (n=62) and non-AF group (n=428). Groups were compared in terms of preoperative clinical features and perioperative data, and multivariate analysis accomplished to identify independent clinical predictors of AF following off-pump CABG. Results: AF was presented in 62 (12.7%) of the patients, and those were significantly older and had significantly higher additive EuroSCORE scores than without AF. Also patients with postoperative AF had significantly prolonged intensive care unit and longer hospital stays at postoperative period. In the multivariant logistic regression analysis performed, advanced age, mean Euroscore, Mild to moderate mitral regurgitation, Prolonged air leak from thorax drain, mean ventilation time, severe pleural effusion, need for inotropic drug support were found to be risk factors for postoperative AF. Conclusion: Our study showed that age, high Euroscore, mild to moderate mitral regurgitation, prolonged ventilation time, severe pleural effusion and low cardiac output were risk factors of postoperative AF in patients underwent off-pump CABG. Also In patients who developed postoperative AF, prolonged intensive care unit and hospital stays were observed. Prospective randomized studies with larger patient series are recommended to support our study.

Relation between CRP-Albumin ratio and left atrial volume index for prediction of new onset atrial fibrillation in patients with STEMI treated with percutaneous coronary interventions

New onset atrial fibrillation (NOAF) in the case of acute myocardial infarction appears to be associated with inflammation. However, its influence alongside other risk factors is currently unknown. In this study, the effect of inflammation in predicting NOAF independent of left atrial volume index (LAVi) was investigated with a new marker, the C-reactive protein/Albumin ratio (CAR). We included 945 ST-elevation myocardial infarction (STEMI) patients who underwent pPCI. Two groups were defined according to the presence of NOAF and the groups were compared for demographic, clinical and angiographic findings. Predictors of the NOAF were assessed by multivariable regression analysis. Fifty-five (5.8%) patients had NOAF after the procedures. CAR was substantially higher in patients with NOAF (5.9 [4.9] vs 0.46 [1] p&lt;0.01). CAR was shown as an independent marker for NOAF (OR:1.19 95% CI: 1.11-1.27 p&lt;0.01) development in multivariable regression analysis. In receiver operating curve characteristics, the sensitivity and the specificity of the value CAR&gt;4.2 were 64% and 81% (AUC: 0.86) respectively. In subgroup analysis, OR of CAR in LAVi ≥26.7 ml/m² was 19.5 and 22.1 in LAVi&lt;26.7 ml/m² (p for interaction=0.02). A novel inflammatory marker, CAR has the potential to predict the development of NOAF regardless of LAVi in patients with STEMI treated by PPCI.

[The role of atherosclerotic coronary arteries lesions in development of new-onset atrial fibrillation after coronary artery bypass surgery].

Aim To study the relationship between the type of circulation, severity and localization of atherosclerotic damage of coronary arteries, results of laboratory and instrumental tests, and historical data in patients with multivascular coronary lesions and atrial fibrillation (AF) that developed after coronary bypass surgery.Material and methods This was a novel, retrospective study of data of patients after elective coronary bypass surgery at the Cardiac Surgery Department #1 of the N.V. Sklifosofsky Research Institute of Emergency Care from December, 2018 through December, 2020. The study included 100 patients. The main group consisted of 20 patients whose early postoperative period (first 7 days after surgery) was complicated with postoperative atrial fibrillation (POAF) (mean age, 65.15±9.7 years). The comparison group included 80 patients without the POAF complication during the early postoperative period (mean age, 62.0±9.16 years). Prior to the coronary bypass surgery, all patients underwent clinical, laboratory, and instrumental examination. Based on data of selective coronary angiography, localization, severity of coronary atherosclerotic damage (according to angiographic classification), number of affected arteries, and the type of circulation were taken into account.Results Intergroup differences in the incidence and localization of myocardial infarctions in history, severity of arterial hypertension in history, class of chronic heart failure (according to the New York Heart Association, NYHA, classification), and heart rate were absent. 100 % of patients had left atrial (LA) dilatation not correlated with the development of AF in the early postoperative period. According to data of coronary angiography, there was no statistically significant association between the type of circulation and the development of POAF. The right type of myocardial blood supply prevailed in patients of both groups. There was no correlation between the severity and localization of coronary atherosclerotic lesions and the development of AF in the early postoperative period.Conclusion The development of AF following coronary bypass surgery was not associated with features of coronary atherosclerotic lesions, which may indicate active development of inter- and intra-systemic anastomoses in patients with long-term history of chronic coronary atherosclerosis.

Abstract 9755: Impact of Outflow Obstruction and Septal Myectomy on Long Term Risk of New Onset Atrial Fibrillation in Hypertrophic Cardiomyopathy

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), with patients having a 4 to 6 fold greater likelihood of developing AF as compared to the general population, and is an important cause of morbidity, impaired quality of life and embolic stroke in HCM. The impact of outflow obstruction and the influence of surgical septal myectomy on the development of new-onset AF has not been well described. Aim: To characterize the risk of new-onset AF in nonobstructive and obstructive HCM and compare to AF risk in patients after myectomy. Methods: 1767 consecutive HCM patients without prior AF history, seen at the Tufts HCM Institute between 2004 and 2019, including 712 with obstruction (outflow gradients ≥ 30mmHg at rest or following provocation) who did not undergo invasive septal reduction therapy (SRT), 552 with nonobstructive HCM (outflow gradients &lt; 30mmHg), and 503 who underwent surgical myectomy were followed for an average of 4.3 ±4.2 years for new-onset symptomatic AF. Isolated post-operative episodes of AF, i.e., occurring within the first 3 months after myectomy, were excluded from analysis. Results: Patients with obstructive HCM who did not undergo SRT had a 1.5-fold increased risk for new-onset AF as compared to nonobstructive HCM (rate onset of 2.8%/year vs.1.7%/year, p=0.04), with freedom from AF at 10-years of 72% in obstructive patients. Patients undergoing myectomy were older (52 ± 15 vs. 50 ± 15 years; p&lt;0.01), had larger LA dimension (42 ± 7 vs 40 ± 6mm; p&lt;0.01), and higher HCM-AF risk scores (22 ± 3.5 vs. 19 ± 3.8; p&lt;0.01) as compared to nonobstructive HCM. However, despite a higher predicted risk for new-onset AF at time of myectomy (2.7%/year vs. 1.5%/year), after myectomy the risk of new onset AF was no different from patients with nonobstructive HCM (hazard ratio 0.9; rate of onset of 1.8%/year vs. 1.7%/year; p=.73), with freedom from AF at 10-years of 83% post-myectomy. Conclusions: Patients with obstructive HCM have a higher risk of AF as compared to nonobstructive HCM. After myectomy risk of new-onset AF is substantially reduced, such that risk is no different from patients with nonobstructive HCM. These data demonstrate efficacy of myectomy in decreasing long term risk of AF in obstructive HCM.

Abstract 11042: New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Background: New-onset atrial fibrillation (NOAF) is a common complication after transcatheter aortic valve replacement (TAVR), though estimates of the precise incidence are variable. We sought to quantify the incidence of NOAF after TAVR, explore the associated outcomes and identify predictors for this complication. Methods: Using a broad strategy, we searched Medline, EMBASE and the Cochrane database from 2015-2020 for articles that reported any outcomes of TAVR. We extracted data for studies published prior to 2015 from a previous systematic review (22 studies in total). Reviewers performed screening and data extraction in duplicate. We pooled data using a random effects model with Mantel-Haenszel weighting. Results: We identified 183 studies with 296,986 total participants that reported NOAF from 2008 to 2020. The pooled incidence of NOAF after TAVR was 9.9% (95%CI 8.1-12%). NOAF after TAVR was associated with longer index hospitalization (MD 2.66 days, 95% CI 1.05-4.27), higher risk of stroke (RR 1.65, 95% CI 1.09-2.5) and 30-day mortality (RR 1.76, 95%CI 1.12-2.76). NOAF after TAVR was also associated with increased risk of major or life-threatening bleeding (RR 1.60, 95%CI 1.39-1.84) and new permanent pacemaker implantation (RR 1.12, 95%CI 1.05-1.18). Risk factors for the development of NOAF after TAVR included trans-apical access, pulmonary hypertension, chronic kidney disease, peripheral vascular disease, and severe mitral regurgitation. Conclusions: NOAF is common after TAVR and associated with a longer hospital stay, a higher risk of stroke, major bleeding, mortality and permanent pacemaker implantation. Whether this risk is modifiable requires further study.

Pharmacological and non-pharmacological treatments and outcomes for new-onset atrial fibrillation in ICU patients: the CAFE scoping review and database analyses.

New-onset atrial fibrillation occurs in around 10% of adults treated in an intensive care unit. New-onset atrial fibrillation may lead to cardiovascular instability and thromboembolism, and has been independently associated with increased length of hospital stay and mortality. The long-term consequences are unclear. Current practice guidance is based on patients outside the intensive care unit; however, new-onset atrial fibrillation that develops while in an intensive care unit differs in its causes and the risks and clinical effectiveness of treatments. The lack of evidence on new-onset atrial fibrillation treatment or long-term outcomes in intensive care units means that practice varies. Identifying optimal treatment strategies and defining long-term outcomes are critical to improving care. In patients treated in an intensive care unit, the objectives were to (1) evaluate existing evidence for the clinical effectiveness and safety of pharmacological and non-pharmacological new-onset atrial fibrillation treatments, (2) compare the use and clinical effectiveness of pharmacological and non-pharmacological new-onset atrial fibrillation treatments, and (3) determine outcomes associated with new-onset atrial fibrillation. We undertook a scoping review that included studies of interventions for treatment or prevention of new-onset atrial fibrillation involving adults in general intensive care units. To investigate the long-term outcomes associated with new-onset atrial fibrillation, we carried out a retrospective cohort study using English national intensive care audit data linked to national hospital episode and outcome data. To analyse the clinical effectiveness of different new-onset atrial fibrillation treatments, we undertook a retrospective cohort study of two large intensive care unit databases in the USA and the UK. Existing evidence was generally of low quality, with limited data suggesting that beta-blockers might be more effective than amiodarone for converting new-onset atrial fibrillation to sinus rhythm and for reducing mortality. Using linked audit data, we showed that patients developing new-onset atrial fibrillation have more comorbidities than those who do not. After controlling for these differences, patients with new-onset atrial fibrillation had substantially higher mortality in hospital and during the first 90 days after discharge (adjusted odds ratio 2.32, 95% confidence interval 2.16 to 2.48; adjusted hazard ratio 1.46, 95% confidence interval 1.26 to 1.70, respectively), and higher rates of subsequent hospitalisation with atrial fibrillation, stroke and heart failure (adjusted cause-specific hazard ratio 5.86, 95% confidence interval 5.33 to 6.44; adjusted cause-specific hazard ratio 1.47, 95% confidence interval 1.12 to 1.93; and adjusted cause-specific hazard ratio 1.28, 95% confidence interval 1.14 to 1.44, respectively), than patients who did not have new-onset atrial fibrillation. From intensive care unit data, we found that new-onset atrial fibrillation occurred in 952 out of 8367 (11.4%) UK and 1065 out of 18,559 (5.7%) US intensive care unit patients in our study. The median time to onset of new-onset atrial fibrillation in patients who received treatment was 40 hours, with a median duration of 14.4 hours. The clinical characteristics of patients developing new-onset atrial fibrillation were similar in both databases. New-onset atrial fibrillation was associated with significant average reductions in systolic blood pressure of 5 mmHg, despite significant increases in vasoactive medication (vasoactive-inotropic score increase of 2.3; p < 0.001). After adjustment, intravenous beta-blockers were not more effective than amiodarone in achieving rate control (adjusted hazard ratio 1.14, 95% confidence interval 0.91 to 1.44) or rhythm control (adjusted hazard ratio 0.86, 95% confidence interval 0.67 to 1.11). Digoxin therapy was associated with a lower probability of achieving rate control (adjusted hazard ratio 0.52, 95% confidence interval 0.32 to 0.86) and calcium channel blocker therapy was associated with a lower probability of achieving rhythm control (adjusted hazard ratio 0.56, 95% confidence interval 0.39 to 0.79) than amiodarone. Findings were consistent across both the combined and the individual database analyses. Existing evidence for new-onset atrial fibrillation management in intensive care unit patients is limited. New-onset atrial fibrillation in these patients is common and is associated with significant short- and long-term complications. Beta-blockers and amiodarone appear to be similarly effective in achieving cardiovascular control, but digoxin and calcium channel blockers appear to be inferior. Our findings suggest that a randomised controlled trial of amiodarone and beta-blockers for management of new-onset atrial fibrillation in critically ill patients should be undertaken. Studies should also be undertaken to provide evidence for or against anticoagulation for patients who develop new-onset atrial fibrillation in intensive care units. Finally, given that readmission with heart failure and thromboembolism increases following an episode of new-onset atrial fibrillation while in an intensive care unit, a prospective cohort study to demonstrate the incidence of atrial fibrillation and/or left ventricular dysfunction at hospital discharge and at 3 months following the development of new-onset atrial fibrillation should be undertaken. Current Controlled Trials ISRCTN13252515. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 71. See the NIHR Journals Library website for further project information.

Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis

ObjectiveThe ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset...

Epicardial adipose tissue may predict new-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction.

In this study, we aimed to determine the relationship between EAT thickness in patients with STEMI who underwent primary percutaneous coronary intervention (pPCI) and the development of new-onset atrial fibrillation during hospital follow-up. Four hundred and thirteen consecutive patients [284 men (69%) and 129 women (31%)] with a mean age of 59 ± 11 years diagnosed with STEMI were included in this study. Atrial fibrillation developed in 52 (12.5%) patients during in-hospital follow-up and the remaining 361 patients were determined as the control group. There was no difference between the two groups in terms of age and sex. EAT thickness was measured using transthoracic echocardiography. Multiple regression analysis was performed to determine the independent predictors of atrial fibrillation. EAT thickness was higher in the group with atrial fibrillation than in the control group (P < 0.001). The SYNTAX risk score was higher in the atrial fibrillation group (P < 0.001). A positive correlation was observed between EAT thickness and SYNTAX score (r = 0.523, P < 0.001). In the logistic regression analysis, EAT was detected to be an independent predictor for the development of atrial fibrillation (odds ratio: 4.135, 95% confidence interval 1.245-8.176, P < 0.001). EAT thickness is an important marker of atrial fibrillation development in STEMI patients in the post-pPCI period. We think that EAT thickness can be used as a cardioembolic risk factor in STEMI patients.

Automated left atrial strain analysis for predicting new-onset atrial fibrillation in severe hypoxemic COVID-19 pneumonia: A prospective study

IntroductionAtrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain analysis, assessing LA contractility have been associated with the development of new-onset atrial fibrillation (NOAF) in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict NOAF in patients with severe hypoxemic COVID-19 pneumonia.MethodWe conducted a prospective single center study at Amiens Hospital University (NCT04354558). The population study was composed of adult patients with a severe or critical Covid-19 pneumonia in sinus rhythm at inclusion. Transthoracic echocardiography was performed within 48 hours of admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of NOAF during the intensive care unit (ICU) stay.ResultsFrom March 2020 to February 2021, 79 patients were included. Sixteen patients (18%) developed NOAF in ICU. LAScd and LASr were significantly reduced in the NOAF group compared to the other group (8.1[6.3-10.9] vs. 17.2[5.0-10.2]%; P < 0.001 and 20.2 [12.3-27.3] % vs. 30.5 [23.8-36.2] %; P = 0.002 respectively). After adjustment, only LAScd remained independently predictive of NOAF (OR:2.43; 95%CI:1.18-3.37). A LAScd cut-off value of 11.1% had a sensitivity of 76% and a specificity of 75% to identify patients with NOAF. The 30-day cumulative risk of NOAF was 42 ± 9% with LAScd < 11% and 8 ± 4% with LAScd > 11% (log rank test P value < 0.0001) (Fig. 1).ConclusionIn patients with severe hypoxemic COVID-19 pneumonia, LAScd ≤ 11% at admission is a strong risk factor of NOAF development during critical care.

P Wave Duration/P Wave Voltage Ratio Plays a Promising Role in the Prediction of Atrial Fibrillation: A New Player in the Game.

Background Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. Identification of patients at risk for developing AF and the opportunity for early targeted intervention might have a significant impact on morbidity and mortality. Prolonged P wave duration and decreased P wave voltage have been shown to be independent predictors of AF. The present study aimed to investigate the role of P wave duration/P wave voltage in predicting new-onset AF. Methods We screened a total of 640 consecutive patients who admitted to cardiology outpatient clinic with a complaint of palpitation between 2012 and 2014. 24-h Holter monitoring, echocardiography, and electrocardiography (ECG) recordings were reviewed to identify new-onset AF. Patients were assigned into two groups based on presence (n = 150) and absence (n = 490) of new-onset AF. Previous ECGs with sinus rhythm were analyzed. P wave duration was measured in inferior leads, and P wave voltage was measured in lead one. P wave duration/P wave voltage was also calculated for each patient. Results One hundred fifty subjects (23.4%) had new-onset AF among 640 patients. P wave duration (123.27 ± 12.87 vs. 119.33 ± 17.39 ms, p=0.024) and P wave duration/P wave voltage (1284.70 ± 508.03 vs. 924.14 ± 462.06 ms/mV, p < 0.001) were higher, and P wave voltage (0.12 ± 0.04 vs. 0.13 ± 0.04 mV, p < 0.001) was significantly lower in the new-onset AF group compared with non-AFs. P wave duration/P wave voltage, with a cut off of 854.5 ms/mV, had 83.3% sensitivity and 62.0% specificity in a receiver operating characteristic curve (AUC 0.728, 95% CI 0.687–0.769; p < 0.001). Their negative and positive predictive values were 78.7% and 68.6%, respectively. In a univariate regression analysis, age, smoking, C-reactive protein, brain natriuretic peptide, left atrial diameter, left atrial volume index, P wave duration, P wave voltage, and P wave duration/P wave voltage were significantly associated with the development of new-onset AF. Moreover, smoking (OR 4.008, 95% CI 1.707–9.409; p=0.001), left atrial volume index (OR 7.108, 95% CI 4.400–11.483; p < 0.001), and P wave duration/P wave voltage (OR 1.002, 95% CI 1.000–1.003; p=0.044) were found to be significant independent predictors of new-onset AF in a multivariate analysis, after adjusting for other risk parameters. Conclusion The P wave duration/P wave voltage ratio is a practical, easy-to-use, cheap, and reliable electrocardiographic parameter, which can play a promising role for both in predicting and elucidating a mechanism of new-onset AF.