First Episode Of Atrial Fibrillation Research Articles

Evaluation of the management of a first crisis of atrial fibrillation in a group of Cameroon’s urban setting subjects

BackgroundAtrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. When atrial fibrillation is first diagnosed, it tends to be permanent and associated with significant morbidity and mortality. We aimed to study the management of a first episode of atrial fibrillation in a group of patients in Yaounde, Cameroon.MethodsWe conducted a retrospective study with data collected from the Cardiology department of Yaounde Central Hospital and the internal medicine department of Yaounde General Hospital over five years (January 2017 to December 2021), for a duration of 4 months, from February 2022 to May 2022. All patients older than 15 years with a first episode of atrial fibrillation were included, and all patients with incomplete medical records were excluded. The association between different variables was assessed using a χ² test and logistic regression method with a significance threshold of p < 0.05.ResultsOf the 141 patients recruited, the mean age was 68.5 ± 10.6 years. The sex ratio (M/F) was 0.7. The main associated factors and co-morbidities were hypertension in 70.2% (99) patients, heart failure in 36.9% (52) patients and a sedentary lifestyle in 33.3% (47) patients. The most common anticoagulant treatment was AntiVitamin K, used in 64.5% (91) of patients. Heart rate control was the most commonly used symptom control strategy in 85.1% (120) patients, mainly with beta-blockers in 52.5% (74). We found 1.4% (2) participants who were not treated with antithrombotics as recommended. Treatment of arrhythmia due to co-morbidities was not always recommended. The complication rate was 94.3% (133) patients. Control of the bleeding risk due to antithrombotic therapy and monitoring of anticoagulant therapy were not optimal. The heart rate control strategy had a higher success rate, and the sinus rhythm maintenance rate at one year was 61.7% (37) participants.ConclusionThe management of a first episode of atrial fibrillation at Yaoundé’s Central and General Hospitals is not always performed according to current recommendations and is far from optimal. However, nearly two out of three patients maintained sinus rhythm for one year.

The Incidence of Atrial Fibrillation After Percutaneous Patent Foramen Ovale Closure Detected by Implantable Loop Recorders

BackgroundPatent foramen ovale (PFO) is seen in 25% of the general population but in up to 50% of patients ≤60 years old with cryptogenic strokes. Trials have shown that PFO closure vs medical therapy reduces the risk of future strokes. PFO closure may cause atrial fibrillation (AF), with prior trials reporting an incidence of 2% to 11.9%. However, the true incidence of AF after PFO closure is unknown due to limitations in prior studies for long-term monitoring. MethodsThis is a retrospective observational study at a single center. Patients who underwent PFO closure and had an implantable loop recorder prior to PFO closure were included. The final review included 38 patients who had at least 2 months of implantable loop recorder data post-PFO closure. ResultsTen out of 38 (26%) patients developed AF post-PFO closure. The median time to the first episode of AF was 3.95 weeks, with 40% having their first AF episode after 3 months. Median duration of AF episodes was 1 hour. One hundred percent had spontaneous termination of AF. Of the AF patients, 70% were started on oral anticoagulant therapy. ConclusionsOur review shows a higher incidence of AF post-PFO closure as compared with most reported prior studies. We recommend larger prospective studies to explore the true incidence of AF post-PFO closure, its clinical impact, and subsequent stroke risk.

Abstract 14992: Impact of Coronary Artery Disease on Rate vs. Rhythm-Control of Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is a common arrhythmia that can impair quality of life and increase cardiovascular mortality. Previous studies have shown potentially better outcomes with rate-control agents in patients with coronary artery disease (CAD). Yet, optimal treatment of AF is not yet known. Methods: Leveraging data from the AFFIRM trial, we performed a post-hoc analysis examining outcome differences in patients on rate vs. rhythm-control agents, based on CAD status. The primary outcome was defined as death from any cause; secondary outcomes included ischemic stroke, major bleeding, and hospitalization after baseline. Univariate and multivariate modeling were used to determine risk factors associated with designated outcomes. Results: Of 4060 patients enrolled, 1551 patients had CAD at baseline. There were no differences in treatment randomization based on CAD status; however, more patients with CAD had worse heart function and comorbid CHF. More patients with CAD ultimately used some form of rate-control compared to those without. Overall, CAD patients were more likely to experience death (HR 2.08 [1.79-2.42], P&lt;0.001), specifically those on rhythm-control (HR 1.24 [1.01-1.52], P=0.04, Figure). CAD patients were also more likely to have ischemic stroke (HR 1.24 [1.00-1.53], P=0.05). When comparing CVD vs. non-CVD death, only CAD patients on rhythm-control exhibited a significantly higher rate of CVD death (HR 1.39 [1.03-1.89], P=0.03), while no differences in primary outcomes were noted for all other groups (P&gt;0.05, Figure). In multivariate modeling, the effect of treatment arm on risk of CVD death in CAD patients diminished upon accounting for age, smoking, rhythm at randomization, first episode of AF, CHF, and LVEF&lt;50% (HR 1.18 [0.93-1.50], P=0.17). Conclusions: AF patients with CAD on rhythm-control agents exhibited worse CVD outcomes, which may be more reflective of heart disease severity rather than treatment effects.

Diagnostic Yield of Extended Cardiac Patch Monitoring in Cryptogenic Stroke Patients (P11-5.032)

<h3>Objective:</h3> To evaluate the diagnostic yield of detecting atrial fibrillation (AF) and/or atrial flutter (AFL) with extended cardiac patch monitoring in our cryptogenic stroke population. <h3>Background:</h3> Cryptogenic stroke accounts for 15–40% of yearly strokes with increased incidence in younger patients. It is standard of care at our comprehensive stroke center located in the stroke belt to discharge cryptogenic stroke patients with a 14-day continuous cardiac monitoring patch (Zio) to evaluate for paroxysmal AF/AFL. <h3>Design/Methods:</h3> We propose to conduct a retrospective chart review from January 2019 to June 2022 (3.5 years) of all adult stroke patients with a discharge diagnosis of ischemic stroke using the Get With The Guidelines stroke database at our institute. We will be analyzing all cryptogenic stroke patients who were discharged with a Zio patch. The following data points will be collated; demographics, baseline stroke risk factors, left atrium volume, Zio patch results including wear time, analyzed time, AF burden, duration the first episode of AF detected, patient events, and other irregular arrhythmias. Our preliminary data from January 2021 to June 2022 (18 months), observed 270 cryptogenic stroke discharges. Out of which, 165 met the eligibility criteria and were discharged with a Zio patch. <h3>Results:</h3> AF/AFL was detected in 14 patients (8.5%). The mean duration before the first episode of paroxysmal AF (PAF) was 3.7 days and the median duration was 1.5 days. 43 percent of PAF occurred after 48 hours. <h3>Conclusions:</h3> The preliminary data demonstrated a relatively low yield of AF/AFL detection with Zio patch monitoring in our cryptogenic stroke population. We plan to complete the prespecified data collection period to achieve a larger sample size and further analyze independent risk factors for AF/AFL detection and patient compliance. <b>Disclosure:</b> Dr. Rice has nothing to disclose. Dr. Lucioni has nothing to disclose. Mr. Aiello has nothing to disclose. Dr. Ranasinghe has nothing to disclose.

RISK OF HEART FAILURE AFTER CATHETER ABLATION VS. MEDICAL THERAPY FOR ATRIAL FIBRILLATION IN OLDER ADULTS

Abstract Background Age increases the risk of atrial fibrillation (AF). Catheter ablation (CA) proved being safer and superior to anti-arrhythmic drugs (AADs) in maintaining sinus rhythm and preventing readmissions. However, data on the risk of developing heart failure (HF) following each treatment in older adults is limited. Methods A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD 9 and 10 codes, a cohort of patients without a history of HF, aged 65 to 75, with an Elixhauser Comorbidity Index (ECI) of &amp;gt;4 and new-onset AF (index event) was identified. The cohort was then divided into two groups based on treatment received following the index event and matched considering age, gender, ECI, and other cardiovascular diseases. Records from both groups were reviewed for the first episode of HF over 12 months following the initiation of treatment. Pearson’s chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value &amp;lt; 0.05 was deemed significant. Results 6,446 were included in each group. The mean age, gender and ECI were indifferent. 958 (15%) of patients treated with AADs and 987 (15.3%) of patients treated with CA had a first episode of HF over a year after the treatment which was not significantly different between groups (RR=1.03, CI95% = 0.95- 1.11, p=0.49). Conclusion The modality of treatment after the first episode of AF in older population doesn’t significantly affect the risk of HF over the first year.

EP News: Allied Professionals

Using the Rochester Epidemiology Project (REP) registry, Siontis et al (Ann Intern Med 2022;175:1065, PMID 35878404) sought to assess whether there was a difference in outcomes in patients presenting with their first episode of atrial fibrillation (incident AF) during or within 30 days of noncardiac surgery (defined as any procedure occurring under general anesthesia) vs those with incident AF not within 30 days of an operative procedure (nonoperative AF). The REP is a medical records linked registry of nearly all patients residing within Olmsted County, MN, from which investigators can search for data using diagnostic and procedure codes. All patients with AF or atrial flutter diagnosis were validated by nurse abstractors as having AF or atrial flutter on electrocardiography, telemetry, device interrogation, or other monitoring. All patients with incident AF during the study period were included except for patients with incident AF after cardiothoracic surgery. Comorbidities, anticoagulant prescriptions, later procedures such as cardioversion and ablation, and outcomes were also captured. The primary outcome was occurrence of ischemic stroke or transient ischemic attack (TIA), and secondary outcomes included recurrent AF episodes, all-cause death, and cardiovascular-related death.

Incidence and exploratory analysis of cancer development after new on-set atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Inflammation may play an important role in the development of atrial fibrillation (AF). Some studies have suggested that cancer through inflammatory mediators may promote the development of AF (1-2). Our hypothesis was that patients with a first episode of AF might be at increased risk of developing cancer. We set out to study the incidence of cancer in the 2 years following a first episode of AF and to investigate the differences between patients (pts) who develop malignancies and those who do not. Methods Clinical and analytical data were collected from pts presenting with an episode of AF, diagnosed electrocardiographically, to the Emergency Department of our hospital in Spain between 2010-2015 (n=2013). After selecting pts with a first episode and excluding pts with a history of AF or cancer and those with an identified precipitating factor, a sample of 712 pts was obtained (mean age 74.3±14.7; 61.9% female). The minimum follow-up was 2 years, registering cancer occurrence and type, total mortality, emergency department attendance and hospitalization for cardiovascular causes, AF recurrences as well as bleeding and embolic events. We compared data from those who developed cancer during the 2 years after AF debut with those who did not, as well as with the incidence and types of cancer in the general population in Spain (SP) in 2012 (3). Results Of the 712 patients, 35 patients (4.91%) were diagnosed with cancer during the 2-year follow-up (annual incidence: 2.45% (sample) vs 0.46% (SP); p&amp;lt;0.01). The annual incidence in our &amp;lt;65 years old sample was 0.28% vs 0.18% in SP; p&amp;lt;0.05. In the &amp;gt;65 years old group, annual incidence was 2.17% (sample) vs 0.28% (SP); p&amp;lt;0.01. There were also differences between cancer types, with non-solid neoplasms being more frequent in our sample (34.28%), followed by colorectal and breast (14.28% both) (Figure 1). In multivariate analysis comparing patients with and without cancer in our sample, occurrence of cancer was only associated with non-typical symptoms (absence of palpitations) : 33.38% vs 14.28%; p&amp;lt;0.05, and lower creatinine levels in patients developing cancer. Multiple correspondence analysis (MCA) also found no variables associated with cancer development (Figure 2). The mortality rate was higher in the group that developed cancer (54.28% vs 36.02%, p&amp;lt;0.05), with no significant differences in the remaining events. Conclusions There is a relatively high incidence of cancer in patients with a first episode of AF (annual incidence of 2.45% after AF debut is 6.1 times the risk in the general population), in particular in the group of age &amp;gt; 65 years old. No relevant clinical or analytical variable was able to predict the patient who will develop cancer. Further studies and exploration of new variables are needed to better assess the association between AF and cancer occurrence.

Artificial intelligence-electrocardiography to detect atrial fibrillation: trend of probability before and after the first episode.

Artificial intelligence (AI) enabled electrocardiography (ECG) can detect latent atrial fibrillation (AF) in patients with sinus rhythm (SR). However, the change of AI-ECG probability before and after the first AF episode is not well characterized. We sought to characterize the temporal trend of AI-ECG AF probability around the first episode of AF. We retrospectively studied adults who had at least one ECG in SR prior to an ECG that documented AF. An AI network calculated the AF probability from ECGs during SR (positive defined >8.7%, based on optimal sensitivity and specificity). The AI-ECG probability was reported prior to and after the first episode of AF and stratified by age and CHA2DS2-VASc score. Mixed effect models were used to assess the rate of change between time points. A total of 59 212 patients with 544 330 ECGs prior to AF and 413 486 ECGs after AF were included. The mean time between the first positive AI-ECG and first AF was 5.4 ± 5.7 years. The mean AI-ECG probability was 19.8% 2-5 years prior to AF, 23.6% 1-2 years prior to AF, 34.0% 0-3 months prior to AF, 40.9% 0-3 months after AF, 35.2% 1-2 years after AF, and 42.2% 2-5 years after AF (P < 0.001). The rate of increase prior to AF was higher for age >50 years CHA2DS2-VASc score ≥4. The AI-ECG probability progressively increases with time prior to the first AF episode, transiently decreases 1-2 years following AF and continues to increase thereafter.

Early and late new-onset of atrial fibrillation in acute coronary syndromes: Their differences in mortality and cardiac event.

BackgroundIn a stressful situation like acute coronary syndrome (ACS), the occurrence of the first episode of atrial fibrillation is more frequent. The impact of the timing occurrence of AF new‐onset (nAF) in the setting of ACS is still debatable.MethodsMulticenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry, including 29 851 patients admitted for ACS between 1/10/2010 and 4/09/2019. The group with early nAF ‐ nAF in the first 48 h of hospitalization; and late nAF ‐ patients with nAF after the first 48 h of in‐hospital admission.ResultsNew‐onset AF was identified in 1067 patients, nonetheless, just 38.1% had late nAF. The group with late nAF presented more cardiovascular comorbidities and worse left ventricular ejection fraction. Late nAF patients received more anti‐arrhythmic therapy, and early nAF had a higher beta‐block prescription. Early nAF had higher rates of in‐hospital complications, on the other hand, late nAF group exhibited more mortality and readmission at one year follow‐up. Multiple logistic regression revealed that symptoms onset to the first medical contact time, admission hemoglobin <12 g/dl, right bundle branch block at admission, and diuretic therapy during the hospitalization for ACS were predictors of late nAF in ACS.ConclusionsThe ACS population could be divided by the timing of nAF occurrence into the two groups with different characteristics, therapeutic approaches, and outcomes. Late nAF patients had a worse prognosis at 1 year follow‐up, however, the early nAF group had more major adverse cardiac events during the hospitalization for ACS.

Left Atrial Deformation Imaging and Atrial Fibrillation in Patients with Rheumatic Mitral Stenosis

Atrial fibrillation (AF) is a frequent complication of rheumatic mitral stenosis (MS) and is associated with worse outcomes. Prediction of new-onset AF by assessing left atrial (LA) mechanics with speckle-tracking echocardiography might be useful for risk stratification and guiding therapeutic strategies. Therefore, the aim of this study was to assess the association of LA reservoir strain (LASr) and strain rate (LASRr) with AF at follow-up in patients with rheumatic MS. Left atrial reservoir strain and LASRr measured by speckle-tracking echocardiography were assessed in 125 patients (mean age, 50±15years; 80.8% female) with rheumatic MS and without a history of AF. Patients were followed up for the occurrence of a first episode of AF after the index echocardiogram. During a median follow-up of 32 (9.5-70) months, 41 patients (32.8%) developed new-onset AF. Patients who developed AF had significantly more impaired LASr (13.4%±5.2% vs 18.9%±8.2%; P<.001) and LASRr (0.72±0.26s-1 vs 0.98±0.36s-1;P<.001) compared with patients who remained in sinus rhythm. On multivariable Cox regression analysis, LASr < 21% and LASRr < 0.8s-1 were independently associated with the development of AF at follow-up (hazard ratio=7.03, 95% CI, 2.08-23.77, P=.002; and hazard ratio=3.42, 95% CI, 1.59-7.34, P=.002, respectively). LASr and LASRr are impaired in patients with rheumatic MS, and the degree of impairment is associated with new-onset AF at follow-up.

Impact of excessive supraventricular ectopic activity detected in the acute phase of stroke or TIA on AF detection and death within 24 months – results of the prospective MonDAFIS study

Abstract Background/Introduction Detection of atrial fibrillation (AF) and subsequent initiation of oral anticoagulation remain key goals in the care of stroke patients. The European Society of Cardiology guideline recommend continuous ECG monitoring for at least 72 hours in stroke patients without previously known AF. Excessive supraventricular ectopic activity (ESVEA) has been identified as a marker for patients at risk for AF in the general population. Robust data on the clinical relevance of ESVEA detected in the acute phase of ischemic stroke or transient ischemic attack (TIA) are lacking. Purpose To assess the impact of ESVEA (defined as presence of supraventricular beats ≥480/day or at least one atrial run of ≥10 and &amp;lt;30 seconds during continuous ECG monitoring for 72 hours) in patients with acute ischemic stroke/TIA without (previously) known AF on recurrent stroke, all-cause death and detection of a first episode of AF within 24 months. Methods The investigator-initiated, prospective, open, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke study randomized 3,465 acute stroke patients without known AF 1:1 to usual diagnostic procedures for AF detection or additive Holter-ECG recording for up to seven days in-hospital (NCT02869386). ECG core-lab analysis included the number of atrial ectopic beats per day, the number of atrial runs as well as the duration of the longest atrial run per 24 hours. Patients were followed-up for two years. Secondary study objectives include the comparison of recurrent stroke, myocardial infarction, major bleeding and all-cause death in ESVEA patients, patients with newly diagnosed AF vs. non-ESVEA patients with sinus rhythm at baseline. Data were analyzed using Fisher's exact test. Results In 1,714 patients randomized to the intervention group, 1,693 (98.8%) had analyzable ECG recordings of a median duration of 121 hours (IQR 73–166). 1,435 (84.8%) patients had continuous ECG monitoring for the first 72 hours. At this time, ESVEA was detected in 363 (25.3%) of 1,435 patients, while a first episode of AF was detected in 48 (3.3%). At 24 months, AF was newly detected in 57 (15.7%) ESVEA patients vs. 53 (6.2%) non-ESVEA patients (p&amp;lt;0.001) with available follow-up. At 24 months, 68 (24.5%) ESVEA patients vs. 77 (9.0%) non-ESVEA patients were on oral anticoagulation (p&amp;lt;0.001). The composite of recurrent stroke, myocardial infarction, major bleeding and death at 24 months did not differ significantly between ESVEA patients vs. non-ESVEA patients (14.3% vs. 11.6%; p=0.389). However, all-cause death was higher in ESVEA patients (6.6% vs. 3.1% in non-ESVEA patients; p=0.01). Conclusions ESVEA detected after acute ischemic stroke/TIA identifies patients at high-risk for AF and may be used to guide prolonged ECG monitoring. The higher risk of death in ESVEA patients vs. non-ESVEA patients within 24 months after stroke/TIA deserves further investigation. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bayer Vital GmbH, Bayer HealthCare Pharmaceuticals, Germany.

Prognosis of new-onset of atrial fibrillation in acute coronary syndrome: Portuguese experience

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Acute coronary syndrome (ACS) and atrial fibrillation (AF) are common diseases in developed countries and in some cases, the first episode of AF can occur during the ACS. A stressful event like an ACS can be a trigger for AF, being important to realize its impact and prognosis in the short and long term. Objective Evaluate the impact and prognosis of new-onset AF in ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without new-onset AF, and B – patients that presented new onset of AF. Were excluded patients without a previous cardiovascular history or clinical data during the admission and the follow-up period. Logistic regression was performed to assess if new-onset AF in ACS was a predictor of major adverse cardiac events and mortality. Kaplan-Meier test was performed to establish the survival rates and re-admission for one year of follow up. Results 9687 patients suffered ACS and had follow-up at 1 year, 9264 in group A (95.6%) and 423 in group B (4.4%). Both groups were similar regarding dyslipidemia, diabetes mellitus, previous coronary artery disease, multivessel disease after the cardiac catheterization. Group A had more smokers (28.2 vs 17.8%, p &amp;lt; 0.001) and left ventricular ejection fraction (LVEF) &amp;gt;50% (69.2 vs 45.1%, p &amp;lt; 0.001). On the other hand, group B was elderly (67 ± 14 vs 75 ± 12, p &amp;lt; 0.001), female (26.9 vs 34.0%, p &amp;lt; 0.001), arterial hypertension (70.5 vs 77.5%, p = 0.005), was more admitted directly to the cat lab (12.5 vs 17.7%, p = 0.002), ST-segment elevation myocardial infarction (40.2 vs 49.9%, p &amp;lt; 0.001), Killip-Kimball classification &amp;gt; I (12.8 vs 34.8%, p &amp;lt; 0.001) and hybrid revascularization (0.7 vs 2.4%, p = 0.002). Logistic regression revealed that new-onset of AF in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 1.75, p &amp;lt; 0.001, confidence interval (CI) 1.47-2.09), cardiogenic shock (OR 3.08, p &amp;lt; 0.001, CI 2.37-4.01), sustained ventricular tachycardia (OR 2.29, p &amp;lt; 0.001, CI 1.61-3.25) and intrahospital mortality (OR 1.99, p &amp;lt; 0.001, CI 1.51-2.63). Nevertheless, new-onset of AF was not associated with re-infarction (p = 0.361), mechanical complications (p = 0.319), atrioventricular block (p = 0.574), stroke (p = 0.131) and cardiac arrest (p = 0.060) during the hospitalization for ACS. Mortality rates at one year of follow-up showed significant differences, p &amp;lt; 0.001, between the two groups (Figure 1). Similar results were found concerning re-admission for all causes, p = 0.021 (Figure 2), on the other causes, re-admission for cardiovascular causes do not reveal to be significant, p = 0.515. Conclusions New-onset of AF in ACS was a predictor of congestive heart failure, cardiogenic shock, sustained ventricular tachycardia and intrahospital mortality. AF was associated with higher mortality rates and re-admission for all causes at one year follow up.

THE IMPACT OF ADIPOKINES IN THE ONSET OF ATRIAL FIBRILLATION

Objective: Several adipose tissue bioactive factors (adipokines) have been linked to cardiovascular (CV) diseases. Apelin and omentin-1 have cardioprotective effects whereas visfatin and chemerin have negative effects on CV function. The aim of this study was to calculate apelin, omentin-1, visfatin and chemerin plasma levels in patients with a first episode of atrial fibrillation (AF) investigating any potential association of these factors with the presence of the arrhythmia. Design and method: Overall, 60 patients without a previous history of AF were studied. Of them, 30 had a first documented episode of AF on ECG or 24-hour Holter monitoring during the last month and 30 did not. Apelin, omentin-1, visfatin and chemerin plasma levels were measured by the Elisa method. Results: Compared to non-AF patients, visfatin and chemerin levels were higher in patients with a first episode of AF while apelin and omentin-1 levels were lower. However, statistically significant differences were observed only for apelin and visfatin. No statistically significant differences in demographic characteristics and CV risk factors were noted between the two groups (Table). Conclusions: Visfatin as a non-cardioprotective adipokine was increased in patients having AF for the first time while apelin as a cardioprotective adipokine was decreased indicating a potential correlation of these hormones with the presence of the arrhythmia.

Atrial fibrillation as a frequent reason for calls by Emergency Medical Teams

Introduction. Atrial fibrillation is the most common supraventricular arrhythmia which is also a frequent cause of calls by Emergency Medical Services Teams.The purpose of the work was presentation of the conduct of the Medical Rescue Teams in about patients with atrial fibrillation. Research methodology. The study included an 86-year-old woman who was called by the Medical Rescue Team due to increasing weakness accompanied by chest pain and dyspnoea. At the patient after a thorough medical history and physical examination, the first episode of atrial fibrillation was found. An individual case study method was used. The study was conducted on the basis of a medical rescue cardthose. Conclusions.There is no one size fits all regimen for the management of patients with atrial fibrillation. There are algorithms that facilitate the implementation of appropriate treatment. The rescue operation must always be tailored to the individualthe patient's health status and modified as necessary. Thanks to this procedure, paramedics minimize the chances of making a mistake and improve the patient's health.

The role of timing in treatment of atrial fibrillation: An AFFIRM substudy

In contrast to historical trials, the Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST-AFNET 4) suggests the superiority of early rhythm control over rate control in patients with recent-onset atrial fibrillation (AF). The relative contribution of timing vs improvement in AF therapeutics over time is unclear. This study aimed to isolate the assessment of early intervention for AF from temporal changes in AF treatments through a secondary analysis of subjects from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. We compared rate and rhythm control treatments in AFFIRM subjects stratified by time from their diagnosis of AF. Time-to-event analysis was performed to compare all-cause mortality, cardiovascular hospitalizations, stroke, and number of hospitalization days. Of the 4060 AFFIRM subjects, 2526 subjects (62.2%) had their first episode of AF within 6 months of study enrollment. Participants with "new" AF had a decreased risk of all-cause mortality (P = .001) than did those with prior AF diagnoses. Individuals previously diagnosed with AF were similar in age and demographic characteristics, but had more medical comorbidities, including myocardial infarction (P = .006), diabetes mellitus (P = .002), smoking (P = .003), and hepatic or renal comorbidities (P = .008). There were no differences in mortality, cardiovascular hospitalizations, or stroke between rate and rhythm control strategies in either AF subgroup. AFFIRM subjects diagnosed with AF within 6 months of study enrollment showed no difference in survival, cardiovascular hospitalization, or ischemic stroke between rate and rhythm control strategies. Superiority of rhythm control strategies reported by newer AF trials may be more attributable to the refinement of AF therapies and less related to the timing of intervention.

Abstract 17461: Efficacy of Long-Term Monitoring on Detecting Critical Cardiac Arrhythmias

Introduction: The ambulatory continuous ECG monitors can provide a comprehensive cardiac assessment in outpatient settings. Extended cardiac monitoring is often needed by physicians to assess the efficacy of treatment, evaluate symptoms, and to stratify patients at risk. In this study, we compare the impact of outpatient cardiac monitoring between 1-14 days and 15-30 days. Method: A retrospective analysis was done on ECG data collected from 2,679 patients using Zywie ECG monitors (Zywie, Inc., Georgia). These patients were monitored for 14-30 days. We evaluated three arrhythmias in this study: i) Atrial fibrillation (AF) of duration &gt;15s ii) Ventricular tachycardia (VT) consisting of more than 3 heartbeats iii) Pause of duration &gt;3s. We analyzed the first occurrence of arrhythmia episodes in every patient during their monitoring period. We identified at least one episode of AF in 486 patients, VT in 106 patients, and pause in 78 patients. Results: The incidence of the first episode of AF, VT, and pause was observed after 14 days of monitoring in 15.8%, 28.3%, and 23.1% patients, respectively (Figure 1). Furthermore, among the VT episodes, 85.3% episodes had a duration between 1-10s and 14.7% with a duration &gt;10s. Similarly, 76% of identified pauses had a duration between 3-4s, 12% between 4-5s, and 12% with a duration &gt;5s. Conclusion: The results demonstrate the incremental diagnostic yield of critical arrhythmic events when the monitoring is extended beyond 14 days. This study suggests that long-term outpatient monitoring can provide better diagnosis, especially for patients at a higher risk of developing critical arrhythmias.

Abstract 13015: First-degree Atrioventricular Block is Associated With Incident Atrial Fibrillation in the Japanese General Population Aged ≥ 40 Years

Introduction: First-degree atrioventricular block (fAVB) is a common cardiac conduction disorder diagnosed by prolongation of the PR interval ≥220 msec. Although it is generally considered benign, some previous studies demonstrated that fAVB was associated with incident atrial fibrillation (AF). However, evidence is scarce regarding the association between fAVB and incident AF in older populations. Hypothesis: We hypothesized that fAVB was significantly associated with incident AF in older populations. Methods: Eligible participants were residents in Kanazawa City who aged ≥ 40 years and underwent 12-lead ECG at the national Japanese health checkups in 2013. Participants with AF detected at the baseline exam and with no follow-up examinations between 2014 and 2018. fAVB was defined as PR interval ≥ 220 msec based on the Minnesota code (6-3). Incident AF was defined as the first episode of AF detected by 12-lead ECG at the annual health checkups. The cumulative incidence of AF was estimated by the Kaplan Meier curve analysis, and statistical significance was evaluated by the log-rank test. Unadjusted and adjusted hazard ratios (HRs) were computed by the Cox proportional hazard model. HRs were adjusted using three models in which conventional risk factors for AF were included (Table). Results: 37,730 participants (mean age, 72.3 ± 9.6 years; Male, 37%) were included. Baseline fAVB was observed in 667 (1.8%) participants. During the median follow-up period of 5 years (interquartile range, 4.0 - 5.0 years), 691 cases of incident AF were observed. Kaplan Meier curve showed that a 5-year cumulative incidence of AF was significantly higher in fAVB (+) group compared with fAVB (-) group (6.8% vs 2.1%, p &lt; 0.01). In the fully adjusted model, fAVB was significantly associated with incident AF (HR, 1.75; 95% confidence interval, 1.25 - 2.45; p-value &lt; 0.01) (Table). Conclusion: fAVB was independently associated with incident AF in this predominantly elderly Japanese population.

Opportunities to reduce the risk of stroke in AF: the REVIEW AF study

Abstract Background Stroke is one of the most devastating complications of atrial fibrillation (AF) and is associated with poor patient outcomes. Recent registry data has demonstrated improved use of stroke prevention therapy with the advent of direct-acting oral anticoagulants, but little data exists in the Australian health care setting. Purpose To examine the use of oral anticoagulant therapy in a cohort of individuals presenting to the emergency department (ED) due to AF. Methods A total of 437 consecutive individuals who presented to the ED with a primary diagnosis of AF to three tertiary hospitals in our city in South Australia between March 2013 and March 2014 were included. Data were collected retrospectively from electronic medical record review. CHA2DS2-VASc and HAS-BLED scores were calculated and any documented contraindications to the use of oral anticoagulation (OAC) taken in to consideration. Results Mean age was 69±15 years and 49.9% were male. A total of 244 (55.8%) individuals had a prior diagnosis of AF at index presentation. 179 (73.4%) of these individuals recorded a CHA2DS2-VASc score of ≥2. A total of 124 of these individuals were appropriately anticoagulated (69.3%) whilst 37 individuals were not treated with OAC and did not have a documented contraindication (20.7%). Anticoagulation status was unknown in 18 individuals due to a lack of documentation (10.0%). A CHA2DS2-VASc score of 0 was recorded in 25 individuals with a prior diagnosis of AF at index presentation with 3 individuals (12%) inappropriately overtreated with OAC. The remaining 193 individuals (44.2%) presented with a first episode of AF. In 129 (66.8%) of these individuals a CHA2DS2-VASc score of ≥2 was recorded and only 10 individuals had a documented contraindication to the use of OAC. In 119 (61.7%) individuals there were no documented contraindications to the use of OAC. In 74 (62.2%) of these presentations OAC was not commenced, whilst in 45 (37.8%) individuals OAC was prescribed. Conclusions Significant opportunity exists to improve the use of stroke prevention therapy in AF. Despite repeated opportunities to commence this therapy within the hospital setting, it remains frequently underutilised in individuals at high risk of stroke. Funding Acknowledgement Type of funding source: None

Cryoballoon pulmonary vein isolation as first line treatment for typical atrial flutter (CRAFT): study protocol for a randomised controlled trial

PurposeTreatment of typical atrial flutter (AFL) with cavo-tricuspid isthmus (CTI) ablation is associated with a high occurrence rate of new onset atrial fibrillation (AF) during follow-up. There are data to support the addition of pulmonary vein isolation (PVI) to CTI ablation in patients with both AF and AFL, but the role of cryoballoon PVI only, with no CTI ablation, in AFL patients with no prior documentation of AF has not been studied.MethodsCRAFT is an international, prospective, randomised, open with blinded assessment, multicentre superiority study comparing radiofrequency CTI ablation and cryoballoon PVI in patients with typical AFL. Participants with typical AFL are randomised in a 1:1 ratio to either treatment arm, with patients randomised to PVI not receiving CTI ablation. Post-procedural cardiac monitoring is performed using an implantable loop recorder. The primary endpoint is time to first recurrence of sustained symptomatic atrial arrhythmia. Key secondary endpoints include (1) total arrhythmia burden at 12 months, (2) time to first episode of AF lasting ≥ 2 min, (3) time to recurrence of AFL or AT and (4) procedural and fluoroscopy times. The primary safety endpoint is the composite of death, stroke/transient ischaemic attack, cardiac tamponade requiring drainage, atrio-oesophageal fistula, requirement for a permanent pacemaker, serious vascular complications requiring intervention or delaying discharge and persistent phrenic nerve palsy lasting > 24 h.ConclusionThis study compares the outcomes of 2 different approaches to typical AFL—the conventional ‘substrate’-based strategy of radiofrequency CTI ablation versus a novel ‘trigger’-based strategy of cryoballoon PVI.Trial registration(ClinicalTrials.gov ID: NCT03401099)

Risk of Atrial Fibrillation after Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter: Is Combined Ablation of Atrial Fibrillation Worthwhile?

ResumoFundamento A ablação da fibrilação atrial (FA) e do flutter atrial dependente de istmo cavo-tricuspídeo (FLA-ICT) pode ser realizada simultaneamente quando as duas arritmias tenham sido registradas antes do procedimento. Entretanto, a melhor abordagem não é clara quando pacientes com FLA-ICT são encaminhados para ablação sem o registro prévio de FA.Objetivos Avaliar a prevalência e identificar os preditores de ocorrência do primeiro episódio de FA após ablação de FLA-ICT em pacientes sem o registro prévio de FA.Métodos Coorte retrospectiva de pacientes submetidos exclusivamente a ablação por cateter para FLA-ICT, sem registro prévio de FA. As características clínicas foram comparadas entre os grupos em que houve ocorrência de FA pós-ablação de FLA-ICT vs. sem ocorrência de FA. O nível de significância estatística adotado foi de 5%. Na análise de preditores, o desfecho primário avaliado foi ocorrência de FA após ablação de FLA-ICT.Resultados De um total de 227 pacientes submetidos a ablação de FLA-ICT (110 com registro de FA e 33 sem seguimento adequado), 84 pacientes foram incluídos, dos quais 45 (53,6%) apresentaram FA pós-ablação. Não houve variáveis preditoras de ocorrência de FA. Os escores HATCH e CHA2DS2-VASC foram semelhantes nos dois grupos. As taxas de recorrência de FLA-ICT e complicações após a ablação foram de 11,5% e 1,2%, respectivamente.Conclusões A ablação de FLA-ICT é eficaz e segura, mas 50% dos pacientes desenvolvem FA após ablação. Entretanto, ainda é incerto o papel da ablação combinada (FLA-ICT e FA) visando prevenção da ocorrência de FA. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)