Frequency Of Atrial Fibrillation Research Articles

Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature.

Although the benefits of exercise training have been shown repeatedly in many studies, its relationship with the occurrence of atrial fibrillation (AF) in competitive athletes still remains controversial. In the present review, we sought to demonstrate a comprehensive report of the incidence, pathophysiology, and therapeutic approaches to AF in elite athletes. A 2 to 10 times higher frequency of AF has been shown in many studies in high-intensity endurance athletes compared to individuals who do not exercise. Moreover, a U-shaped relationship between male elite athletes and AF is demonstrated through this finding, while the type and the years of physical activity seem to relate to AF development. A strong correlation seems to exist among the type of exercise (endurance sports), age (>55 years), gender (males), and the time of exercise training, all contributing to an increased risk of AF. The pathophysiology of AF still remains unclear; however, several theories suggest that complex mechanisms are involved, such as bi-atrial dilatation, pulmonary vein stretching, cardiac inflammation, fibrosis, and increased vagal tone. Elite athletes with AF require a comprehensive clinical evaluation and risk factor optimization, similar to the approach taken for nonathletes. Although anticoagulation and rate or rhythm control are cornerstones of AF management, there are still no specific guidelines for elite athletes.

Diagnostic capability of long-term electrocardiographic telemonitoring for detection of heart rhythm disorders

prevalence of cardiac rhythm and conduction disorders is increasing and associated with the growing amount of people of older age groups. The extended use of traditional electrocardiography (ECG) recorders is currently limited due to duration of the investigation, possible skin irritation and withdrawal of consent by the patients. The aim: evaluation of the frequency of arrythmia incidents in adult patients of different ages by assessing the patch monitoring results, and the impact of the monitoring duration on the possibility of diagnosis. Materials and methods: study included 1123 patients aged from 18 to 99 (599 women and 524 men), data about whom was collected in 2021-2022. ECG was recorded by the «Mawi Heart patch» – a single-use dual-channel device for continuous ECG recording for up to2 7 days. Results: the average ECG monitoring time was 81,03±18,5 hours or 3,37±0,7 days. The majority of the participants (74,35%) received the continuous 3-day ECG monitoring. Most rhythm disorders were recorded in the first 24 hours, but over the next 2 days, atrial fibrillation (AF) was detected in 7,66%, more often in men (48 participants, p=0,048) and with some differences in age groups. Starting above 50 years of age, the frequency of AF diagnosing on the first monitoring days is decreased and it is significantly statistically lower (61,11%, p<0,05). Three-day ECG monitoring is associated with a higher chance of detecting AF (OR=2,03; 1,53-3,02, p=0,031) regardless of gender, while the 5-day monitoring wasn’t as effective. The prolonging of the monitoring time increased the number of diagnosed supraventricular tachycardia (SVT) cases by 5,53% in men and 8,35% in women. The 3 days of monitoring are associated with a higher chance of SVT detection (OR = 4,18; 3,32–4,95, p=0,009). There is a direct correlation between SVT detection and the older age groups (r=0,53, p<0,05). SVT detection is higher in patients of 71-80 years old (OR = 2,71; 2,35–3,75, p=0,0041), and of 81-99 years (OR = 2,92; 2,56–3,49, p=0,0039). Conclusion: The frequency of arrhythmia detection, in patients referred to long-term patch monitoring, is high both for AF and SVT. The sex and age patterns for the prevalence of the described arrhythmias were statistically confirmed. The use of long-term ECG patch monitoring increases the chance of arrhythmia detection, primarily for older patients.

Heart Rhythm Disturbances in Cardiac Surgery Patients with Coronary Artery Disease

The aim. To analyze arrhythmological complications in cardiac surgery patients with coronary artery disease (CAD). Materials and methods. This was a retrospective data analysis of 354 cardiac surgery patients with various forms of CAD who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The mean age of the patients was 61.9 ± 9.6 years. All the patients underwent laboratory examinations, electrocardiography, echocardiography, coronary angiography and cardiac surgery. The patients with uncomplicated forms of CAD (n = 194) underwent isolated surgical revascularization of the myocardium, in the case of complicated forms of CAD (n = 160), coronary bypass surgery was supplemented with valvular or ventricular correction. Results. Postoperative atrial fibrillation (AF) occurred in 40 (20.6%) patients with uncomplicated CAD and 43 patients with complicated CAD (26.8%), p = 0.1667. Among patients with complicated forms of CAD, 2 (1.25%) had paroxysms of ventricular tachycardia, which required the implantation of a cardioverter-defibrillator, also in this group of patients complete left bundle branch block occurred more often (p = 0.0020). The postoperative period in patients with impaired glucose metabolism was characterized by more frequent development of AF in patients with type 2 diabetes mellitus (33.3%, p = 0.0006), with impaired glucose tolerance (24.8%, p = 0.0156) compared to patients with normoglycemia (12.6%). Conclusions. There was no statistically significant difference in the frequency of postoperative AF in patients with various forms of CAD (p = 0.1667). In the occurrence of postoperative AF paroxysms, the negative influence of type 2 diabetes mellitus (p = 0.0006), impaired glucose tolerance (p = 0.0156), stage III-IV chronic kidney disease (p = 0.0015) and gouty arthritis (p = 0.0072) has been proven. The presence of postoperative AF was associated with acute encephalopathy (p = 0.0291) and panic attacks (p = 0.0043). The occurrence of postoperative AF increased the length of stay of cardiac surgery patients with CAD in the hospital from 8.2 ± 2.9 to 11.06 ± 6.8 days (p < 0.0001).

Atrial Imaging and Cardiac Rhythm in Cryptogenic Embolic Stroke: The ARIES Study.

Unknown cardioembolic sources are frequent causes of cryptogenic stroke. We analyzed the risk of atrial fibrillation (AF) or high burden of ectopic atrial activity (HBEA) in patients with cryptogenic stroke, assessing atrial function and 1-year outcomes. The ARIES (Atrial Imaging and Cardiac Rhythm in Cryptogenic Embolic Stroke) study is an observational study including patients with cryptogenic stroke. We analyzed the frequency of AF and HBEA (>3000 atrial ectopic beats/day or >2 bursts or atrial tachycardia between 3 beats and ≤30 seconds) in two 30-day Holter-ECGs, comparing advanced echocardiography signs of left atrial (LA) dysfunction according to rhythm: AF, HBEA, and normal sinus rhythm. We also evaluated 1-year stroke recurrence and mortality. The study included 109 patients; 35 (32.1%) patients had AF, 27 (24.8%) HBEA, and 47 (43.1%) normal sinus rhythm. Compared with those with normal sinus rhythm, patients with AF presented higher 2-dimensional and 3-dimensional LA indexed volumes (38.8±11.2 versus 27.3±11.8 mL/m2, and 50.6±17.2 versus 34.0±15.4 mL/m2, respectively, P<0.001), lower 3-dimensional LA ejection fraction (50±14.6 versus 62.7±11.8, P=0.001), LA reservoir strain (22.0±8.6 versus 30.4±10.5, P<0.001), and LA contraction strain (10.5±8.18 versus 17.1±7.5, P<0.001), remaining significant in multivariate analysis. Patients with HBEA showed higher LA indexed volumes and lower LA reservoir strain than patients with normal sinus rhythm only in univariate analysis. There were no differences in ischemic recurrence or mortality among the groups. Patients with cryptogenic stroke showed a high incidence of AF and HBEA. AF is strongly related to LA volume, LA function, and LA reservoir and contraction strain, whereas HBEA showed milder structural changes. Advanced LA echocardiography could help patient selection for long-term ECG monitoring in suspected cardiac sources.

Discordant Treatment Goals for PatientsWith Atrial Fibrillation and Clinical Trials Metrics.

Most clinical trials define successful atrial fibrillation (AF) treatment as no AF episodes longer than 30 seconds. Yet, there has been minimal study of how patients define successful treatment and whether their perspectives align with trial outcomes. Survey patients with AF to identify: 1) what aspect of AF is most important to address (frequency, duration, or severity of AF episodes); 2) what AF burden would be considered acceptable to consider treatment successful; and 3) to establish patient preferences for successful treatment thresholds for a validated patient-reported outcome (PRO) score. We surveyed patients receiving active care for AF at a single tertiary care center modeled after the Toronto AF Severity Scale (AFSS). The survey consisted of current and "successful treatment" AF frequency, burden, and symptom domains; and baseline socioeconomic information. Of 7,000 invitations, 852 individuals completed the survey (12% response) with a mean age of 65 ± 13 years, 36.5% were female, and they had a mean CHA2DS2-VAsc score of 2.9 ± 1.9. Overall, 114 (13%) selected a decrease in AF episode duration as their top treatment priority, 505 (59%) episode frequency, and 230 (27%) episode severity. Overall, 207 (24%) patients would only consider a treatment successful if they never had AF again, whereas 645 (76%) patients considered success to be fewer AF episodes. A total of 341 (40%) patients would only consider a treatment successful if AF episodes lasted less than a few minutes, whereas 509 (60%) patients would accept AF episodes lasting >30minutes. An AFSS symptom score≤5 was considered a good outcome by 80% of respondents. Patients prioritize decreased AF frequency over improvements in severity or duration, and an AFSS≤5 would be a reasonable outcome of AF treatment. Most patients would consider treatment successful if they had more than 1 AF episode lasting longer than 30 seconds. Future clinical trial design should consider patients' perspectives when designing outcomes.

Antithrombotic Therapy in Cancer Patients with Cardiovascular Diseases: Daily Practice Recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO) and the Society for Thrombosis and Hemostasis Research (GTH e.V.).

Active cancer by itself but also chemotherapy is associated with an increased risk of cardiovascular disease (CVD) and especially coronary artery disease (CAD) and atrial fibrillation (AF). The frequency of CVD, CAD, and AF varies depending on comorbidities (particularly in older patients), cancer type, and stage, as well as the anticancer therapeutic being taken. Many reports exist for anticancer drugs being associated with CVD, CAD, and AF, but robust data are often lacking. Because of this, each patient needs an individual structured approach concerning thromboembolic and bleeding risk, drug-drug interactions, as well as patient preferences to evaluate the need for anticoagulation therapy and targeting optimal symptom control. Interruption of specific cancer therapy should be avoided to reduce the potential risk of cancer progression. Nevertheless, additional factors like thrombocytopenia and anticoagulation in the elderly and frail patient with cancer cause additional challenges which need to be addressed in daily clinical management. Therefore, the aim of these recommendations is to summarize the available scientific data on antithrombotic therapy (both antiplatelet and anticoagulant therapy) in cancer patients with CVD and in cases of missing data providing guidance for optimal careful decision-making in daily routine.

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

Abstract:&#x0D; Atrial fibrillation (AF) is a common arrhythmia associated with various cardiac conditions. This study investigates the frequency of AF in patients with accessory pathways, anomalous electrical connections that can lead to supraventricular tachycardia.&#x0D; Objective:&#x0D; The primary objectives are to determine the prevalence of AF in patients with accessory pathways, identify associated factors, and assess the impact on clinical outcomes. A comprehensive dataset of 400 patients undergoing supraventricular tachycardia ablation at Hayatabad Medical Complex from 2020 to 2022 was analyzed.&#x0D; Method:&#x0D; A retrospective study design was employed, utilizing patient records with documented accessory pathway(s) and complete clinical-electrophysiological data. Demographic information, clinical presentation, electrocardiographic and electrophysiological data, ablation procedures, and clinical outcomes were systematically collected. Analytical approaches included frequency calculation, comparative analysis, regression analysis, and outcome assessment.&#x0D; Result:&#x0D; Out of 400 patients, 3.5% presented with AF at the time of accessory pathway ablation. Age was identified as a significant predictor of AF occurrence, with a mean age of 63.2 years in AF cases compared to 55.8 years in non-AF cases. Recurrence of arrhythmias was observed in 57.1% of patients with AF, emphasizing the need for ongoing monitoring and management.&#x0D; Conclusion:&#x0D; This study contributes valuable insights into the relatively low prevalence of AF in patients with accessory pathways. While certain factors, including age, may be associated with AF, they do not serve as definitive predictors. Tailored management and adherence to guidelines are crucial for optimizing outcomes in this unique patient population. Future research may explore genetic factors and refine risk stratification models for a deeper understanding of AF in patients with accessory pathways.

Comorbid Patients with Abdominal Obesity and High Risk of Atrial Fibrillation: Correction of Modifiable Risk Factors as a Strategy of Primary Prevention (Prospective Study)

Aim. To assess whether correction of modifiable risk factors is efficient to prevent atrial fibrillation (AF) in comorbid patients with abdominal obesity and premature atrial contractions.Materials and Methods. We enrolled 889 comorbid patients with abdominal obesity and premature atrial contractions, aged from 58 to 72 years (average age 66.4 ± 0.7 years). The duration of follow-up was 3 years. All patients underwent correction of potentially modifiable risk factors of AF (normalisation of body weight, blood pressure, blood glucose and lipid levels, cessation of smoking, elimination of physical inactivity) until their target values were achieved. Endpoints included maintenance of sinus rhythm or registration of AF. After the follow-up, all patients could be divided into two groups: 578 (65.02%) patients with incomplete correction of risk factors, 95 (10.69%) patients who achieved target values, and 216 (24.29%) without risk factor correction.Results. Within the first two years of follow-up, the frequency of AF did not differ significantly and was 85.29%, 94.32%, and 93.47% respectively. In patients who achieved target values of potentially modifiable risk factors for &gt; 1 year, the ratio of actual to predicted development of AF during the 2nd and 3rd year of follow-up was 57.58% and 14.29%, respectively.Conclusion. In comorbid patients with abdominal obesity and premature atrial contractions, reduction of AF was observed exclusively in patients with successful correction of all potentially modifiable risk factors for ≥ 2 years.

Therapeutic advances in atrial fibrillation based on animal models.

Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia among humans, with its incidence increasing significantly with age. Despite the high frequency of AF in clinical practice, its etiology and management remain elusive. To develop effective treatment strategies, it is imperative to comprehend the underlying mechanisms of AF; therefore, the establishment of animal models of AF is vital to explore its pathogenesis. While spontaneous AF is rare in most animal species, several large animal models, particularly those of pigs, dogs, and horses, have proven as invaluable in recent years in advancing our knowledge of AF pathogenesis and developing novel therapeutic options. This review aims to provide a comprehensive discussion of various animal models of AF, with an emphasis on the unique features of each model and its utility in AF research and treatment. The data summarized in this review provide valuable insights into the mechanisms of AF and can be used to evaluate the efficacy and safety of novel therapeutic interventions.

Atrial Fibrillation following CABG Surgery. Our Experience with 100 Patients

Introduction: Atrial fibrillation (AF) is the most common complication of cardiac surgery, occurring in 10-40% of patients. Postoperative AF (POAF) refers to new-onset AF in a patient without a history of AF that occurs within the first four weeks after cardiac surgery. While POAF can be transient and without consequences, it may lead to severe complications, increasing mortality and morbidity in the postoperative period. Risk factors can be patient-related, intraoperative, and postoperative.&#x0D; This study aimed to estimate the frequency of AF in patients after CABG combined with valvular replacement or not. Identification of patients vulnerable to arrhythmia will allow targeting of those most likely to benefit from prophylactic therapy. &#x0D; Material and Methods: The presented study is a prospective study of 100 patients undergoing elective CABG from February to April 2022 with a mean age of 66 ± 13 years, 30% women, undergoing CABG at the University Hospital Centre “Mother Teresa” Tirana, that developed POAF.&#x0D; Results: Postoperative atrial fibrillation occurred in sixteen patients (16%) at a median of 3.7 days after cardiac surgery (2nd – 7th day). 94% (15) of POAF occurred in CABG only, and 6% (1) in the combined intervention (AVR et CABG).&#x0D; Conclusion: AF is the most common complication after CABG. The occurrence is not dependent on the type of intervention (only CABG or combined with valve replacement), the number of vessels that underwent bypass grafting, or the type of vessel. Electrolytic imbalance should be assessed during the postoperative course of patients who undergo CABG.&#x0D;

Incidence of Atrial Fibrillation or Arrhythmias After Patent Foramen Ovale Closure

BackgroundPatients with a patent foramen ovale (PFO) who undergo percutaneous PFO closure are at a greater risk of developing atrial fibrillation (AF) compared with patients whose PFOs are managed medically. Postclosure AF appears to be well tolerated if treated but may increase the risk for stroke. Postclosure AF is reported to occur in 3.7% to 7.4% of patients; however, incidence across devices remains uncertain. This study aims to evaluate the frequency of postclosure AF, atrial flutter, and arrhythmias in 6 PFO closure devices. MethodsFour hundred forty-five patients underwent percutaneous PFO closure with appropriate follow-up between 2001 and 2021. The procedure was performed using Abbott Amplatzer PFO, Amplatzer ASD, Amplatzer Cribriform, NMT CardioSEAL, Gore Helex, or Gore Cardioform devices. Incidence of AF, atrial flutter, and arrhythmias were assessed by electrocardiogram within 6 months from closure. Multivariate logistic regression evaluated potential predictors of postclosure AF or atrial flutter. ResultsPostclosure AF or atrial flutter occurred in 30 patients (6.7%) within 6 months, and its incidence was significantly different across devices. Gore Cardioform had the greatest frequency of postclosure AF or atrial flutter events (16.8%) compared with other devices. The Gore Cardioform device, larger device sizes, and male sex were associated with greater risk of postclosure AF or atrial flutter. ConclusionsPostclosure AF or atrial flutter was more likely to occur in the Gore Cardioform device, in males, and in patients who underwent PFO closure with larger devices. Although it is more effective for complete closure, the Gore Cardioform device was shown to be an independent predictor of postclosure AF or atrial flutter.

Quality of Oral Anticoagulation with Vitamin K Antagonists and Direct Oral Anticoagulants in ‘real-World’ Patients: Lessons from a Five Years Audit Study

Background: Even with the introduction of direct oral anticoagulants (DOACs), anticoagulation clinics (ACs) stand with a key role in monitoring. Indeed, routine evaluation by health care professionals is recommended as it is with vitamin K antagonists (VKA) with adjustments in practices of anticoagulation management services. Quality of oral anticoagulation (QOA) is associated to better clinical outcomes in those patients with indications for such therapy. It is well established that patients receiving VKA therapy, maintenance of an international normalized ratio (INR) in the therapeutic range is essential for treatment efficacy and safety. It has been reported that ACs should aim for a time in therapeutic range (TTR) between 70-80% to optimize benefit and minimize the risk of adverse events. So far, QOA for DOACs is not fully established. Aim: Since few clinical data are available considering the new era of ACs, this study aims to describe actual trends and QOA of an AC at a large academic medical hospital. Methodology: We retrospectively analyzed 23275 appointments of 5 consecutive years (May 2018 to May 2023), corresponding to 930 patients that are regularly followed up at an outpatient AC of a central hospital under anticoagulation for at least 8 weeks. TTR (≥70%) determined by Rosendaal method was used for patients under AVK and for those individuals in DOACs, QOA was considered the presence of therapeutic plasma levels of the drugs after the European Heart Rhythm Association 2021 in, at least, one determination. Patients were divided according to target INR in 3 groups: Group 1 with target INR 2-3, including 809 patients mean age 65±18 years (mean±SD), majority (36.6%) with atrial fibrillation (AF); Group 2 with target INR 2.5-3.5, including 92 patients with mean age 70±11 years, majority (85.9%) with mechanical heart valves; Group 3 with target INR 3-4, including 29 patients with mean age 63±15 years, majority (55.5%) with antiphospholipid syndrome. Seventy patients were under DOACs (apixaban in 74.3%), with mean age of 71±17 years, majority (62.9%) with non-valvular AF, were included in Group 1 and all individuals were under direct inhibitors of factor Xa. Descriptive statistics (mean, standard deviation, minimum, maximum, chi-square), inferential statistics (t-test, A-Nova and effect sizes) tests were performed. Results: The 930 patient population, 52.2% female, mean age of 65±18 years and 87% in Group 1, showed a mortality of 17%. The mean recall interval between appointments was superior to 90 days in 94% of the population. The individuals who died in comparison with the survivors showed higher frequency of AF (54.1%) [ χ 2= 47.099; p&amp;lt;.001; φ=.225], were from Group 1 (93%) [ χ 2= 6.641; p=.036; φ=.085], male (59.2%) [ χ 2= 10.103; p=.001; φ=-.104] and older [76±12 vs .63±18 years (p&amp;lt;.001), respectively]. No differences were noticed in mortality between AVK and DOACs [ χ 2= 1.828; p=.401; φ=-.044], even DOAC patients being older than AVK patients (71±17 vs 65±17; p=.005), respectively. QOA associated with mortality being the individuals who died with higher frequency of no QOA (21.9% vs 13.9%) [ χ 2= 8.126; p=.004; φ=-.101] respectively. The individuals on AVK from Group 1 corresponding to 86% of total population showed a mean TTR of 76%, patients from Group 2 had a TTR of 72% and patients in Group 3 had TTR of 55%. From the individuals under DOACs, only 30% had at least one determination of plasma levels of the drug and all but one showed therapeutic levels. Comparatively with our previous studies related to the periods of 2006-2012 and 2012-2018, we noticed a significant decrease in patient population / appointments size (2087/ 61988) (1587/ 37931),(p &amp;lt;.001) with an increase of TTR in Group 1 (1927/1430 patients) (83% /72%) and Group 2 (120/125 patients) (74% / 69%) but a TTR decrease in Group 3 (40 / 32 patients) (54% / 60%) (p &amp;lt;.001). respectively. Mortality in the 2012- 2018 period was 18%. Conclusions and Discussion: The trends of decreasing the number of anticoagulated patients at our AC with an overall good quality of monitoring but with a low percentage of individuals under DOACs suggests that the majority of anticoagulated population is on these drugs without routine follow up in opposition to the recent recommendations. Our study underlines the importance of the quality of anticoagulation monitoring on mortality that was no different from the previous years before SARS-CoV- 2 pandemic nor between AVK and DOACs.

Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Catheter ablation for persistent atrial fibrillation (AF) has shown limited success. To determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI). This prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022. Patients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio. The primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months. A total of 170 patients (mean [SD] age, 62.0 [12.3] years; 136 men [80.0%]) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 [70.6%] vs 40 [47.1%]). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 [95% CI, 0.33-0.85]). The waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm. ClinicalTrials.gov Identifier: NCT05333952.

Prognostic impact of thyroid dysfunction in patients with incident heart failure: a nationwide study

Abstract Background Thyroid hormones directly affect the cardiovascular system. Thyroid dysfunction can cause a variety of haemodynamic alterations and has been associated with an increased risk of atrial fibrillation (AF), heart failure (HF), and all-cause mortality. However, a paucity remains regarding knowledge on the prognostic impact of thyroid dysfunction in patients with HF. Purpose To examine the impact of the whole spectrum of thyroid dysfunction in patients with HF on the associated risk of AF, HF admissions, and all-cause mortality. Methods This Danish cohort study included patients with a first-time HF diagnosis from 2000–2021. According to blood samples within 6 months prior to the HF diagnosis, the study population was categorized based on thyroid function in 1) overt hypothyroidism, 2) subclinical hypothyroidism, 3) euthyroidism, 4) subclinical hyperthyroidism, and 5) overt hyperthyroidism. With up to one year of follow-up from the date of HF diagnosis, we used Aalen-Johansen estimator to examine the cumulative incidence frequency (CIF) of AF and HF admissions and Kaplan-Meier estimates to assess all-cause mortality. Multivariable Cox proportional hazard analysis was performed to investigate differences in outcomes among groups. Results Of the 7,380 individuals included in this study (56.6% female, median age 76.5 years [p25-p75: 67.9-84.1]), 102 (1.4%) had overt hypothyroidism, 1,706 (23.1%) had subclinical hypothyroidism, 4,374 (59.3%) were euthyroid, 691 (9.4%) had subclinical hyperthyroidism, and 507 (6.9%) had overt hyperthyroidism. Compared with euthyroid patients, the adjusted one-year hazard ratio (HR) for AF was 0.77 (95% CI, 0.49-1.20) for overt hypothyroidism, 1.01 (95% CI, 0.90-1.13) for subclinical hypothyroidism, 1.18 (95% CI, 1.01-1.38) for subclinical hyperthyroidism, and 1.19 (95% CI, 1.01-1.39) for overt hyperthyroidism (Figure). The adjusted one-year HR for HF hospitalizations was 1.51 (95% CI, 1.06-2.14) in patients with overt hypothyroidism, 1.07 (95% CI, 0.96-1.20) in patients with subclinical hypothyroidism, 0.99 (95% CI, 0.84-1.16) in patients with subclinical hyperthyroidism, and 1.26 (95% CI, 1.06-1.50) in patients with overt hyperthyroidism. The adjusted one-year HR for mortality was 1.81 (95% CI, 1.25-2.63) in patients with overt hypothyroidism, 1.25 (95% CI, 1.10-1.42) in patients with subclinical hypothyroidism, 1.15 (95% CI, 0.96-1.37) in patients with subclinical hyperthyroidism, and 1.46 (95% CI, 1.20-1.78) in patients with overt hyperthyroidism. Conclusion In patients with HF, overt and subclinical hyperthyroidism was associated with an increased rate of AF. Both hypo and hyperthyroid states were associated with increased risk of HF admission and mortality. Increased awareness regarding thyroid status in patients with HF is warranted.

Abstract 19176: Atrial Fibrillation Prevalence With Mavacamten for Obstructive Hypertrophic Cardiomyopathy

Introduction: Mavacamten is a first-in-class, small molecule, selective cardiac myosin inhibitor for treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM). Partial reversal of hypertrophic remodelng, diastolic dysfunction, and sarcomeric calcium sensitivity have been reported. While atrial fibrillation (AF) prevalence is observed in ~10% of pre-approval study subjects, the effects of mavacamten on AF have not been reported. Hypothesis: AF prevalence remains elevated after mavacamten therapy for HCM Methods: Chart review was performed for standard of care clinical encounters, 12-lead ECG, and echocardiography (TTE) for patients treated mavacamten at a single HCM referral center. Results: Among 12 patients prescribed mavacamten, 92% had no prior AF symptoms nor diagnosis. After 6 months of mavacamten therapy, 25% had AF with 17% new-onset. TTE demonstrated resolution of LVOT gradients in 100% of AF patients at 6 months. Case 1: 60-year-old male with OSA and LVOT gradients of 31 mmHg at rest and 41 mm Hg with Valsalva was started on mavacamten for exertional fatigue and dyspnea. After 3 months, he developed new-onset, paroxysmal AF treated by TEE-guided cardioversion, amiodarone and apixiban. Case 2: 66-year-old female with LVOT gradients of 38 mmHg at rest and 74 mm Hg with Valsalva initiated mavacamten for exertional dyspnea. After mavacamten initiation, exertional symptoms improved but frequent episodes of symptomatic AF persisted despite sotalol 120mg. Case 3: 58-year-old female with LVOT gradient of 97 mm Hg at rest and no change with Valsalva and dyspnea on exertion. After unexplained syncopal events, an implantable cardiac monitor recorded AF. After 1 month of mavacamten, she experienced increased frequency of AF. Conclusions: In a single center experience with mavacamten, AF prevalence of 25% with 17% new onset AF developed despite improvement in symptoms and hypertrophic remodeling parameters. As a novel cardiac myosin inhibitor that attenuates hypertrophic remodeling, diastolic dysfunction, and calcium sensitivity that are anticipated to reduce AF susceptibility, more observation of arrhythmia incidence and burden in larger cohorts will inform arrhythmia outcomes and mechanisms in HCM.

Abstract 11315: Sex-Based Differences Following Catheter Ablation of Atrial Fibrillation: Patient Reported Outcomes and Quality of Life

Introduction: Catheter ablation for atrial fibrillation (AF) has been established as an effective intervention to improve quality of life (QoL). Data are scarce on sex-based differences in ablation outcomes. Objective: To examine clinical outcomes and QoL following AF ablation in females vs males from a large patient-reported outcomes (PRO) database. Methods: All patients undergoing AF ablation (2013-2021) at our center were assessed for outcomes using automated PRO surveys. The primary endpoint was AF recurrence based on PRO and electrocardiographic documentation. The atrial fibrillation symptom severity scale (AFSSS) was utilized to quantify QoL response. Baseline and 1-year patient surveys were used to estimate AFSSS as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous with 9 frequencies/durations in between). Results: A total of 7,166 patients were included (29.8% female). Compared to men, women were older (67 vs 64.2 years) and more likely to have paroxysmal AF (55% vs 45%). The rate of any post-procedural complications was low (&lt;3%) and comparable between men and women. At 3 years, the cumulative incidence of AF recurrence was higher in women compared to men (32% vs 27%; p-value&lt;0.05); Figure. In adjusted multivariable analysis, women had a 19.9% increased risk of AF recurrence compared to men during follow-up. Similar results were observed irrespective of AF type (paroxysmal vs persistent). QoL was significantly improved at 1 year in both groups; with a comparable reduction of mean AFSSS from 13.9 to 6.1 (56.3% decrease) in women and 10.88 to 4.29 (60.5% decrease) in men. Similarly, AF burden was significantly and comparably reduced in both men and women. Conclusions: Following catheter ablation for AF, women were found to be at increased risk for AF recurrence during follow-up. Nonetheless, both men and women had significant and comparable improvement in QoL and AF burden.

Association between atrial fibrillation reoccurrence and new-onset ischemic stroke among patients with nonvalvular atrial fibrillation

Objective: Explore the association between atrial fibrillation (AF) reoccurrence and new-onset ischemic stroke (IS) in patients with nonvalvular AF, and explore whether there is a high-risk period of IS after recurrent episodes of AF. Methods: A nested case-control study design was used. A total of 565 nonvalvular AF patients with new-onset IS after a follow-up of at least 2 years in the China-AF cohort were enrolled as the case group, and 1 693 nonvalvular AF patients without new-onset IS were matched as the control group at a ratio of 1∶3. Frequency and types of recurrent AF in the previous 1 or 2 years were compared between two groups, and the adjusted associations of AF reoccurrence with new onset IS were explored using conditional logistic regression analysis. The proportion of recurrent AF was compared between the case period and control period, and conditional logistic regression analysis was performed to calculate adjusted associations of case-period AF with IS. Results: The nested case-control study design results showed that the proportion of at least one record of recurrent AF in the previous 1 year was higher in the case group than in the control group (72.0% vs. 60.8%, P<0.05), and the recurrent AF was positively correlated with new-onset IS (adjusted OR=1.80, P<0.001). Similar results were also observed in the previous 2 years period. The case-crossover study design analysis showed that among 565 patients with new-onset IS, recurrent AF in the case period was positively correlated with IS (adjusted OR=1.61, P=0.003). Conclusion: Recurrent AF is associated with IS, and there may be a high-risk period of IS after recurrent episodes of AF.

Comparison of the Efficacy of Atorvastatin and Rosuvastatin in Preventing Atrial Fibrillation after Coronary Artery Bypass Grafting: A Double-Blind Randomized Comparative Trial.

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF. The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared. Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.

Impact of obesity on catheter ablation of atrial fibrillation: Patient characteristics, procedural complications, outcomes, and quality of life.

Obesity is a well-known risk factor for atrial fibrillation (AF). We aim to evaluate the effect of baseline obesity on procedural complications, AF recurrence, and symptoms following catheter ablation (CA). All consecutive patients undergoing AF ablation (2013-2021) at our center were enrolled in a prospective registry. The study included all consecutive patients with available data on body mass index (BMI). Primary endpoint was AF recurrence based on electrocardiographic documentation. Patients were categorized into five groups according to their baseline BMI. Patients survey at baseline and at follow-up were used to calculate AF symptom severity score (AFSS) as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous and 9 frequencies/durations in between). Patients were scheduled for follow-up visits with 12-lead electrocardiogram at 3, 6, and 12 months after ablation, and every 6 months thereafter. A total of 5841 patients were included (17% normal weight, 34% overweight, 27% Class I, 13% Class II, and 9% Class III obesity). Major procedural complications were low (1.5%) among all BMI subgroups. At 3 years AF recurrence was the highest in Class III obesity patients (48%) followed by Class II (43%), whereas Class I, normal, and overweight had similar results with lower recurrence (35%). In multivariable analyses, Class III obesity (BMI ≥ 40) was independently associated with increased risk for AF recurrence (hazard ratio,1.30; confidence interval, 1.06-1.60; p = .01), whereas other groups had similar risk in comparison to normal weight. Baseline AFSS was lowest in normal weight, and highest in Obesity-III, median (interquartile range) 10 (5-16) versus 15 (10-21). In all groups, CA resulted in a significantimprovement in their AFSS with a similar magnitude among the groups. At follow-up, AF burden was minimal and did not differ significantly between the groups. AF ablation is safe with a low complication rate across all BMI groups. Morbid obesity (BMI ≥ 40) was significantly associated with reduced AF ablation success. However, ablation resulted in improvement in QoL including reduction of the AFSS, and AF burden regardless of BMI.

Loss of the Atrial Fibrillation-Related Gene, Zfhx3, Results in Atrial Dilation and Arrhythmias.

ZFHX3 (zinc finger homeobox 3), a gene that encodes a large transcription factor, is at the second-most significantly associated locus with atrial fibrillation (AF), but its function in the heart is unknown. This study aims to identify causative genetic variation related to AF at the ZFHX3 locus and examine the impact of Zfhx3 loss on cardiac function in mice. CRISPR-Cas9 genome editing, chromatin immunoprecipitation, and luciferase assays in pluripotent stem cell-derived cardiomyocytes were used to identify causative genetic variation related to AF at the ZFHX3 locus. Cardiac function was assessed by echocardiography, magnetic resonance imaging, electrophysiology studies, calcium imaging, and RNA sequencing in mice with heterozygous and homozygous cardiomyocyte-restricted Zfhx3 loss (Zfhx3 Het and knockout, respectively). Human cardiac single-nucleus ATAC (assay for transposase-accessible chromatin)-sequencing data was analyzed to determine which genes in atrial cardiomyocytes are directly regulated by ZFHX3. We found single-nucleotide polymorphism (SNP) rs12931021 modulates an enhancer regulating ZFHX3 expression, and the AF risk allele is associated with decreased ZFHX3 transcription. We observed a gene-dose response in AF susceptibility with Zfhx3 knockout mice having higher incidence, frequency, and burden of AF than Zfhx3 Het and wild-type mice, with alterations in conduction velocity, atrial action potential duration, calcium handling and the development of atrial enlargement and thrombus, and dilated cardiomyopathy. Zfhx3 loss results in atrial-specific differential effects on genes and signaling pathways involved in cardiac pathophysiology and AF. Our findings implicate ZFHX3 as the causative gene at the 16q22 locus for AF, and cardiac abnormalities caused by loss of cardiac Zfhx3 are due to atrial-specific dysregulation of pathways involved in AF susceptibility. Together, these data reveal a novel and important role for Zfhx3 in the control of cardiac genes and signaling pathways essential for normal atrial function.