Frequency Of Atrial Fibrillation Research Articles

P375The impact of hypothyroidism on hospitalization frequency and cost-effectiveness among patients with atrial fibrillation

Abstract Background thyroid disorders are a well-known fact of high risk developing of atrial fibrillation (AF). While it is established that hyperthyroidism increases AF incidence, data of the effect of hypothyroidism on AF and heart failure is contradictory. Purpose to examine effect of untreated hypothyroidism on frequency of paroxysmal AF, state of the permanent AF and chronic heart failure (CHF) which is the main cause of high rate repeated hospitalizations. Methods This retrospective study was conducted among patients (pts) with AF, who were admitted to the hospital from June 2018 till June 2019. They were divided into 2 groups: 1-st group – pts with AF and hypothyroidism and 2-nd group – euthyroid pts (by using hormonal replacement therapy) with AF. All pts were surveyed about their age, gender, medical history, therapy, number and reasons for hospitalization for the past 12 months. Reference range of TSH was 0,4-4,0 mU/L. Results A total of 75 pts, 57,3% (n = 43) women, 41,3% (n = 31) men, mean age 70,5 years (SD 6,7) were enrolled in the research. 1-st group consist of 66,7% (n = 24) women, 33,3% (n = 12) men, mean age 70,3 years (SD 6,8), paroxysmal AF 38,9% (n = 14), permanent AF 61,1% (n = 22), first diagnosed hypothyroidism during hospitalization 61,1% (n = 22), mean TSH 9,3 mU/L (SD 3,7), 33,3 % (n = 12) were re-admitted 2 and more times, mean hospitalization duration 7,1 day (SD 1,1). 2-nd group consist of 51,3% (n = 20) women, 48,7% (n = 19) men, mean age 70,6 years (SD 10,6), paroxysmal AF 35,9% (n = 14), permanent AF 64,1% (n = 25), mean TSH 2,1 mU/L (SD 1,12), 17,9 % (n = 7) were hospitalized 2 times, mean hospitalization duration 5,9 day (SD 0,9). Reasons for hospitalization in the 1-st group were pharmacological cardioversion (n = 8) and decompensated CHF (n = 4), in the 2-nd group were pharmacological cardioversion (n = 2) and decompensated CHF (n = 5). Average cost of whole hospitalization in the 1-st group was 252$ (SD 8,1), in the 2-st group – 221 $ (SD 5,2). As an example, average cost for patient with CHF and AF per month in Ukraine is 45 $. Conclusion Tight control of thyroid function ensures optimal dose of hormonal replacement therapy and decrease number of repeated hospitalizations and average hospitalization duration in patients with AF and hypothyroidism. As a result, we receive improving of cost-effectiveness of hospitalization AF pts.

Implications of Atrial Fibrillation Among Patients With Atherosclerotic Cardiovascular Disease Undergoing Noncardiac Surgery

Atrial fibrillation (AF) is a common perioperative arrhythmia. However, its occurrence and implications remain poorly defined in the setting of noncardiac procedures. We sought to define the incidence, prevalence, and prognostic implications of AF among patients with atherosclerotic cardiovascular disease (ASCVD) undergoing noncardiac surgery. Using a previously validated approach that employed unique patient-linked variables in the New York State Inpatient Database from January 1, 2012, to December 31, 2014, the frequency of new-onset and pre-existing AF was determined in adults with ASCVD aged ≥18 years undergoing noncardiac surgery. The secondary outcomes were stroke within 1 month and all-cause mortality. Using multivariable logistic regression models, the factors and outcomes associated with new-onset AF after noncardiac surgery were assessed. Nine surgical subgroups of major noncardiac surgery served as exposure. A total of 184,775 patients were identified during the study period. Age ≥65, anemia, history of heart failure, valvular heart disease, and thoracic surgery were predictors of new-onset AF after noncardiac surgery. Among 3,806 patients (2.5%) developed new-onset AF and 31,603 (17.5%) patient had pre-existing AF. After multivariable-adjusted modeling, new-onset AF was associated with increased odds of stroke within 1 month (odds ratio: 1.31, 95% confidence interval: 1.12 to 1.53; p < 0.001)], mortality (odds ratio: 3.74; 95% confidence interval: 3.30 to 4.24; p < 0.001) and longer length of stay in the hospital (10 days; interquartile range: 6 to 16 days; p < 0.001). New-onset AF portends a poor prognosis in patients with ASCVD undergoing noncardiac surgeries. The risk profile of patients that develop new-onset AF differs across patient phenotypes and by surgical procedure.

Rhythm versus rate control strategies regarding anticoagulant use in elderly non-valvular atrial fibrillation patients: Subanalysis of the ANAFIE (All Nippon AF In the Elderly) Registry

BackgroundData on real-world antiarrhythmic and anticoagulant therapy use in elderly atrial fibrillation (AF) patients are lacking; thus, we performed a subanalysis of data from the ANAFIE registry to clarify the current management of Japanese patients aged ≥75 years with non-valvular AF. MethodsThe ANAFIE registry was a multicenter, prospective, observational study. Patients were stratified into three groups: rhythm control group, rate control group, and no antiarrhythmic group. The CHADS2, CHA2DS2-VASc, and HAS-BLED scores were used to estimate embolic and bleeding risk. ResultsAmong 32,490 patients, the overall frequencies of AF by type were 42.0 % (paroxysmal), 30.1 % (persistent and long-standing persistent), and 27.9 % (permanent). Significant differences (p < 0.0001, each) in age were observed among the three groups; more patients aged 75–79 years received rhythm control (44.2 %) vs rate control (38.8 %). Patients aged ≥85 years received either rate control therapy or no antiarrhythmic agent (∼20 %, each). In the overall population, 36.9 % and 19.6 % of patients were receiving rate and rhythm control therapy, respectively; 43.4 % were not receiving antiarrhythmic therapy. The rate control group consisted mainly of patients with persistent (16.3 %) and permanent AF (38.6 %), and the rhythm control group, of patients with paroxysmal AF (79.0 %). Significantly lower embolic and bleeding risk scores and significantly higher embolic risk scores were observed in patients in the rhythm and rate control groups, respectively. In total, 92.1 % of elderly Japanese patients with AF were receiving anticoagulant therapy. The frequency of direct-acting oral anticoagulant (DOAC) use was similar (∼66 %) among the three groups. Significantly more patients in the rate control group (28.6 %) were being treated with warfarin than in the rhythm control group (21.6 %) (p < 0.0001). ConclusionsUse versus non-use and antiarrhythmic therapy varied significantly by age, stroke risk scores, type of AF, and DOAC use between subgroups.

P3622Demographic and clinical characteristics of atrial fibrillation patients suffering from an ACS without prior revascularization history

Abstract Background The incidence of atrial fibrillation in acute coronary syndromes (ACS) ranges from 3% to 25%. The purpose of the current study was to investigate the demographic and baseline clinical characteristics, cardiovascular risk factors and comorbid conditions between patients (pts) with concomitant atrial fibrillation (AF) to those without AF in patients suffering from ACS without previous coronary artery bypass graft (CABG) and/or percutaneous coronary intervention. Methods The MINOCA-TR study has a cross-sectional, multicenter, observational design and was conducted with 32 interventional cardiology centers in our country. Heart rhythm at emergency admission, demographical, clinical and angiographic data was recorded for each patient. Patients with stable coronary artery disease, unstable angina pectoris and with type 4/5 myocardial infarction were excluded from study population. Results A total of 1626 patients (male: 70.7%, mean age: 61.4±12.5 years) were classified according to the presence of AF. The rate of AF was 3.1% in study population. This group was older (73.4 vs. 61.0 years, p&lt;0.001) and AF was more common among females (43.1% vs. 28.7%, p=0.027). The frequency of AF was slightly higher (7.8%) in MINOCA group (p=ns). STEMI presentation was more common in patients without AF (31.3% vs. 46.9%, p=0.028). LVEF was significantly lower in ACS patients with AF (44.1% vs. 49.4%, p=0.039). The frequency of AF was significantly higher (3.7%) in MINOCA group. AF vs. non-AF ACS pts w/o prior revasc Parameter ACS with AF ACS without AF p value Age (years) 73.4 (±9.4) 61.0 (±12.4) &lt;0.001 Female (%) 43.1 28.7 0.027 cTnT levels (pg/dL) median (IQR) 15.2 (96) 15.3 (428) 0.421 STEMI (%) 31.3 46.9 0.028 LVEF (%) 44.1 (±12.2) 49.4 (±10.4) 0.039 MINOCA (%) 7.8 6.6 0.743 STEMI: ST-segment elevation MI; NSTEMI: Non-ST-segment elevation myocardial infarction; LVEF: left ventricular ejection fraction; MINOCA: Myocardial Infarction with Non-Obstructive Coronary Arteries. Conclusions The frequency of AF was relatively lower in patients suffering from an ACS without prior revascularization history. They were older than patients without AF and were common in females. Non-ST-segment elevation myocardial infarction was significantly higher in the AF. The presence of MINOCA was similar between 2 groups.

P5352The main characteristics and multimorbidity in patients with history of stroke, myocardial infarction and their combination (hospital registry data)

Abstract Aim To assess characteristics and patterns of cardiovascular (CV) and non-cardiovascular (non-CV) multimorbidity in patients with history of stroke (STR) without myocardial infarction (STRH), history of myocardial infarction (MI) without stroke (MIH), and their combination (STRH+MIH) on a basis of the hospital registry. Methods The hospital registry included 8954 patients with arterial hypertension (AH), ischemic heart disease, chronic heart failure (CHF), atrial fibrillation (AF) and their combinations hospitalized to the National Medical Research Center for Preventive Medicine (Moscow, Russia) from 01.04.13 to 31.03.17. 2020 (22.6%) patients had a MIH, 857 (9.6%) – a STRH and 318 (3.6%) had a combination of them. Results The age of patients with MIH was significantly less than in STRH and in the combined group (66.8±11.3 vs 70.8±10.9 and 71.6±9.9 years, p&lt;0.05). 70% of patients in STRH+MIH group had primary MI earlier than STR (on the average 3.8 years). The age of primary MI and STR was 61.3±11.4 and 65.8±11.7 years respectively (p&lt;0.001). 27% of all STRH and 14% of MIH cases were presented in MIH+STRH group. Men prevailed in MIH and MIH+STRH (70% and 64.5%) groups, women – in STRH (59%). In MIH group compared with STRH and STRH+ MIH groups was lower frequency of AH (90.2% vs 97.2%; 96.5%) and AF (21.2% vs 41.5%; 41.5%). CHF patients prevailed in STRH+MIH and MIH groups (70.4%; 57.1% vs 40.7%), p&lt;0.0001. The most number of CV diseases (CVDs) was in STRH+MIH group (3.09±0.8) and less in MIH (2.9±1.0) and STRH (1.96±0.9) groups. In STRH+MIH patients compared with STRH and MIH groups were also more often identified: diabetes (35.2%; 22.3%; 24.7%, p&lt;0.0001), digestive diseases (80.2% vs 73.4%; 75.6%, p&lt;0.0001 and p=0.025), kidney diseases (56.6% vs 44,7%; 29%, p&lt;0.0001 and p=0.0003), respiratory diseases (37.4% vs 23.9%; 31.9%, p=0.005; p=0,001), anemia (12.9% vs 7.9% and 6.9%, p=0.0002 and p=0.009). The number of obese patients did not differ significantly in all groups (33.0%; 30.7%; 28.1%, p&gt;0.05). The average number of comorbid non-CV diseases (non-CVDs) was: 1.96±0.5 in MIH group; 2.03±0.3 in patients with STRH and 2.55±0.3 in STRH+MIH group (p&lt;0.05, adjusted to age and sex). The total number of CVDs and non-CVDs was maximal (5,6) in STRH+MIH group, less in MIH (4.65) and STRH (3,99) groups. Conclusions Patients with history of stroke and myocardial infarction had maximal number both of CVDs and non-CVDs compared with groups of only myocardial infarction or stroke history, i.e. they had the higher CV risk and the most unfavorable profile in hospital registry. So, the multidisciplinary approach for the treatment and prevention in this multimorbid group is most indicated. 70% of patients in combined group had primary MI earlier than primary stroke (on the average 3.8 years). This fact confirmed the suggestion that MI is the earlier part of cardiovascular continuum than stroke.

Atrial fibrillation, not atrial cardiopathy, is associated with stroke: A single center retrospective study

BackgroundAtrial fibrillation (AF) increases the risk of thromboembolism. Atrial cardiopathy, defined as structural left atrial enlargement (LAE), has been proposed to be a unifying risk factor for stroke, with or without atrial fibrillation (AF). We sought to understand the relative importance of LAE and AF as risk factors for stroke. MethodsWe performed a retrospective analysis of all patients who underwent echocardiography within the Henry Ford Health System between March and September 2016. Patients were categorized based on the degree of LAE (none, mild, moderate and severe). The diagnosis of prior stroke or AF was ascertained by the presence of these conditions in the electronic medical record (www.EPIC.com). ResultsTotal of 8679 cases, 54% were female, 41% were African-American, and mean age was 65 ± 17 years. Fifteen percent had mild, 12% had moderate and 18% had severe LAE; the frequency of AF was 22%; and prior stroke was 18%. In multivariate analysis, the odds of AF increased progressively with severity of LAE (adjusted OR for mild 1.81, moderate 2.13 and severe 4.38, all P < .001) and AF was confirmed as a risk factor for prior stroke (aOR 1.34, CI 1.15–1.56, p < .001). By contrast, there was no association between LAE and stroke (aOR 0.98 CI 0.86–1.12, p = .74), regardless of the severity of LAE, and regardless of whether AF was present or not. ConclusionStructural LAE, found in almost half of this population, has a significant association with AF. While AF was confirmed to have a significant association with prior stroke, we found no association between stroke and LAE. AF, not LAE, appears to be the true atrial factor associated with stroke.

New-onset Atrial Fibrillation in Patients Presenting with Acute Myocardial Infarction.

BackgroundAtrial fibrillation (AF) can be seen secondary to the complications after acute myocardial infarction (AMI), but it has a poor prognosis when occurs independently. These patients are prone to an increased risk of all in-hospital major cardiac complications and also at an increased risk of mortality. Therefore, it is important to quantify the burden of this aggravating complication in an otherwise lethal manifestation of acute coronary syndrome. The aim of this study was to find the frequency of AF in patients presenting with AMI and the factors associated with it.MethodsWe conducted this observational study on 216 patients who presented with AMI at the largest cardiac center of Karachi, Pakistan from July 2014 to January 2015 with AMI without a past history of AF. Patients underwent routine clinical assessment and laboratory investigations. Atrial fibrillation, detected on electrocardiographic assessment at the time of admission or during hospital stay without a prior history of persistent atrial flutter or paroxysmal atrial fibrillation, was classified as new-onset atrial fibrillation (AF).ResultsWe selected a total of 216 patients, 117 (54.2%) male and mean age of 50.76 ± 6.00 years. Diabetes was found in 140 (64.8%), 164 (75.9%) were hypertensive, and 61 (28.2%) patients were smokers. ST-segment elevation myocardial infarction (STEMI) was diagnosed in 97 (44.9%) patients. The new onset of atrial fibrillation was found in 27 (12.5%) of the patients with AMI. Univariate analysis revealed a statistically significant association of new-onset AF with hypertension.ConclusionThe new onset of atrial fibrillation was found in 12.5% of the patients presented with acute myocardial infarction. It is a significant complication in term of its frequency in AMI and it is more common in hypertensive patients.

Diagnostic Performance of a Smart Device With Photoplethysmography Technology for Atrial Fibrillation Detection: Pilot Study (Pre-mAFA II Registry).

BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The asymptomatic nature and paroxysmal frequency of AF lead to suboptimal early detection. A novel technology, photoplethysmography (PPG), has been developed for AF screening. However, there has been limited validation of mobile phone and smart band apps with PPG compared to 12-lead electrocardiograms (ECG).ObjectiveWe investigated the feasibility and accuracy of a mobile phone and smart band for AF detection using pulse data measured by PPG.MethodsA total of 112 consecutive inpatients were recruited from the Chinese PLA General Hospital from March 15 to April 1, 2018. Participants were simultaneously tested with mobile phones (HUAWEI Mate 9, HUAWEI Honor 7X), smart bands (HUAWEI Band 2), and 12-lead ECG for 3 minutes.ResultsIn all, 108 patients (56 with normal sinus rhythm, 52 with persistent AF) were enrolled in the final analysis after excluding four patients with unclear cardiac rhythms. The corresponding sensitivity and specificity of the smart band PPG were 95.36% (95% CI 92.00%-97.40%) and 99.70% (95% CI 98.08%-99.98%), respectively. The positive predictive value of the smart band PPG was 99.63% (95% CI 97.61%-99.98%), the negative predictive value was 96.24% (95% CI 93.50%-97.90%), and the accuracy was 97.72% (95% CI 96.11%-98.70%). Moreover, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mobile phones with PPG for AF detection were over 94%. There was no significant difference after further statistical analysis of the results from the different smart devices compared with the gold-standard ECG (P>.99).ConclusionsThe algorithm based on mobile phones and smart bands with PPG demonstrated good performance in detecting AF and may represent a convenient tool for AF detection in at-risk individuals, allowing widespread screening of AF in the population.Trial RegistrationChinese Clinical Trial Registry ChiCTR-OOC-17014138; http://www.chictr.org.cn/showproj.aspx?proj=24191 (Archived by WebCite at http://www.webcitation/76WXknvE6)

Clinical Overview of Obesity and Diabetes Mellitus as Risk Factors for Atrial Fibrillation and Sudden Cardiac Death.

The epidemics of obesity and diabetes mellitus are associated with an increased incidence of both atrial fibrillation (AF), the most common sustained arrhythmia in adults, and sudden cardiac death (SCD). Obesity and DM are known to have adverse effects on cardiac structure and function. The pathologic mechanisms are thought to involve cardiac tissue remodeling, metabolic dysregulation, inflammation, and oxidative stress. Clinical data suggest that left atrial size, epicardial fat pad thickness, and other modifiable risk factors such as hypertension, glycemic control, and obstructive sleep apnea may mediate the association with AF. Data from human atrial tissue biopsies demonstrate alterations in atrial lipid content and evidence of mitochondrial dysfunction. With respect to ventricular arrhythmias, abnormalities such as long QT syndrome, frequent premature ventricular contractions, and left ventricular hypertrophy with diastolic dysfunction are commonly observed in obese and diabetic humans. The increased risk of SCD in this population may also be related to excessive cardiac lipid deposition and insulin resistance. While nutritional interventions have had limited success, perhaps due to poor long-term compliance, weight loss and improved cardiorespiratory fitness may reduce the frequency and severity of AF.

New atrial fibrillation diagnosed by 30-day rhythm monitoring

Recent studies of patients with pacemakers and implantable cardioverter/defibrillators have shown that subclinical atrial fibrillation (AF) is common and is associated with thromboembolic risk. We sought to evaluate the frequency, characteristics, and impact of new AF diagnosed by ambulatory 30-day rhythm monitoring. The 30-day rhythm monitoring data from January 2010 to August 2015 at our institution were reviewed. Medical record review was performed on patients that had a new or preexisting diagnosis of AF. Of 2,326 patients without a previous diagnosis of AF, 78 had a new diagnosis of AF (3.4%) during 30-day monitoring. Patients with a new diagnosis of AF (mean age of 68.5 years, 56% female) had a mean CHA2DS2-VASc score of 3.2 (±1.8). The median time to diagnosis was 6 days, and 86% were diagnosed within 14 days. In 31 patients (40%), AF was exclusively detected automatically by the monitor. Of 46 patients that had manually activated the monitor, 34 also had automatically detected AF. Each patient had a median of 7 episodes, with the median duration of the longest episode being approximately 2 hours. Following the diagnosis of AF, 37 (47%) were started on anticoagulation and 9 (12%) were prescribed aspirin. A total of 3.4% of patients who underwent 30-day rhythm monitoring for any indication were found to have a new diagnosis of AF (402 per 1000 patient-years). Most of these episodes were detected automatically, corresponding to device-detected subclinical AF. The most common intervention following diagnosis of AF was initiation of oral anticoagulation.

Magnetic Resonance Imaging White Matter Hyperintensity as a Predictor of Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source

Background and PurposeThis study aimed to investigate factors associated with stroke recurrence and new-onset atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS). MethodsBetween January 2005 and March 2012, a total of 1514 consecutive patients were admitted to our hospital with a diagnosis of acute ischemic stroke within 7 days after onset. Of these, 236 patients met the diagnostic criteria for ESUS. A retrospective analysis was performed of the following characteristics of these ESUS patients: medical history, comorbidities, and magnetic resonance imaging (MRI) findings including the deep and subcortical white matter hyperintensity (DSWMH) grade, drugs used for preventing recurrence, and clinical information such as NIH Stroke Scale scores on admission and outcomes evaluated by modified Rankin scale. The rate of recurrence after discharge and the frequency of new-onset AF were also determined. ResultsThere were 236 ESUS patients (141 men, mean age 70.2 ± 12.1 years). During the follow-up period, ranging from 7 days to 12.9 years (median 54.3 months), 32 (13.6%) and 44 (18.6%) of these patients had a recurrent ischemic stroke and new-onset AF, respectively. The most prevalent subtype of recurrent ischemic stroke was ESUS itself; this type of stroke occurred in 19 (59.3%) patients. AF was observed at stroke recurrence, but only 2 patients were diagnosed with cardioembolism. Multivariate analysis with a Cox proportional hazard model demonstrated that DSWMH grade greater than or equal to 3 was significantly associated with both recurrent ischemic stroke (hazard ratio 3.66, 95% confidence interval 1.69-7.92, P = .001) and new-onset AF (2.00, 1.03-3.90, .04). ConclusionsMRI classification of white matter hyperintensity could be effectively used as a predictor for recurrent ischemic stroke and new-onset AF in patients with ESUS.

Model-Based Assessment of f-Wave Signal Quality in Patients With Atrial Fibrillation.

The detection and analysis of atrial fibrillation (AF) in the ECG is greatly influenced by signal quality. The present study proposes and evaluates a model-based f-wave signal quality index (SQI), denoted, for use in the QRST-cancelled ECG signal. is computed using a harmonic f-wave model, allowing for variation in frequency and amplitude. The properties of are evaluated on both f-waves and P-waves using 378 12-lead ECGs, 1875single-lead ECGs, and simulated signals. decreases monotonically when noise is added to f-wave signals, even for noise which overlaps spectrally with f-waves. Moreover, is shown to be closely associated with the accuracy of AF frequency estimation, where implies accurate estimation. When is used as a measure of f-wave presence, AF detection performance improves: the sensitivity increases from 97.0% to98.1% and the specificity increases from 97.4% to97.8% when compared to the reference detector. The proposed SQI represents a novel approach to assessing f-wave signal quality, as well as to determining whether f-waves are present. The use of improves the detection of AF and benefits the analysis of noisy ECGs.

ISCHEMIC STROKE

Objectives: To determine the frequency and contributing factors of atrialfibrillation in patients with first ischemic stroke. Methodology: This study included 150 patientswith first acute ischemic stroke. All the patients had electrocardiography to detect the presenceof atrial fibrillation. The patients were also labeled for risk factors like hypertension, congestiveheart failure, smoking, and hyperthyroidism, etc. Setting: Mayo Hospital Lahore. Duration ofStudy: 1st January 2013 to 30th June 2013. Type: Descriptive Cross Sectional. Results: Atrialfibrillation was present among 22 (14.6%) patients. Among patients with atrial fibrillation,smoking, congestive heart failure and hypertension were the most frequent risk factors whichwere present in 11 (50%), 6 (27%), and 5 (22.7%) patients, respectively. Conclusion: Frequencyof atrial fibrillation among patients with first ischemic stroke was high. Smoking, congestiveheart failure and history of coronary artery bypass grafting are frequent risk factors.

Spatiotemporal Stability of Peak Bipolar Electrogram Entropy Regions in Sustained Human and Animal Atrial Fibrillation: Implications for Atrial Fibrillation Mechanism and Mapping

Background: High entropy has been associated with the spiral wave pivot and areas of wave break, but few data exist on the spatiotemporal stability of atrial fibrillation (AF) bipolar electrogram entropy (En). We determined the spatiotemporal stability of approximate, sample, and Shannon entropy (ApEn/SampEn/ShEn), and compared them with dominant frequency (DF) in human (H), sheep (S) and computer-simulated AF.

Učestalost atrijalne fibrilacije u bolesnika sa koronarnom bolešću

The incidence of atrial fibrillation in patients with coronary artery disease Dušan Miljković Health Center Varvarin Introduction: Atrial fibrillation(AF) is the most common and widespread long-term cardiac arrhythmia in adults.The aim was to examine the frequency of AF in ambulatory patients with coronarography confirmed coronary disease. Methods: The trial included 264 patients (57.5±9.4 years) with coronary artery disease, 204(77,3%) men and 60(22.7%) women. All clinical examinations were performed, continuous ECG control, laboratory, echocardio-graphic diagnostics and coronarography. Results: The incidence of AF in patients with coronary artery disease is 9.85%, paroxismal AF 4.17%, persistent and permanent AF 5.68%. There was no significant difference in the incidence of singl-vessel disease (p>0.05), two-vessel disease (p>0,05), three-vessel disease (p>0.05) and LM disease (p>0.05) among patients with coronary artery disea-se and without AF. Patients with persistent AF and coronary disease have significantly higher incidence of LCX (p<0.05) and RCA (p<0.01) than those without AF. There was no significant difference in the incidence of proximal segments of LCX (p>0.05) and RCA (p>0.05) between patients with and without AF with coronary artery disease. Conclusion: Three-vessel coronary disease, low ejection fraction left ventricle and secondary ischemic heart dise-ase followed by cardiac insufficiency are major factors contributing to the development of AF in stable coronary disease.

When Silence Isn't Golden: The Case of "Silent" Atrial Fibrillation.

Silent atrial fibrillation (AF) is common. In some patients, it is the only manifestation of AF, while in others, the AF may be symptomatic or both symptomatic and asymptomatic. Regardless, however, to date, the significance, detection, and management considerations for silent AF have been incompletely elucidated. This current study aimed to review, for both the current clinician and investigator, considerations and attitudes and the ongoing studies, respectively, with respect to silent AF. The methods used were a literature review and personal trial and clinical experience; the frequency of silent AF, concerns regarding silent AF, methods to detect silent AF, and prospective trials focused on the detection and management of silent AF were considered. The results of the literature search indicated that recently conducted relevant trials, such as PREDATE AF, ASSERT-II, and REVEAL AF, have shown that silent AF is frequent in patients with risk markers for AF and stroke in whom no prior AF history is present, and in whom no pacemaker or implantable cardioverter-defibrillator implantations have been previously performed. Furthermore, the GLORIA-AF Registry has reported the observance of more permanent AF and more prior strokes in asymptomatic patients. Ongoing trials such as ARTESiA and NOAH-AFNET 6 are expected to clarify the benefits and risks of oral anticoagulation in patients with silent AF. At present, when silent AF is detected in patients with stroke risk markers, most practitioners initiate an anticoagulation regimen.

Paroxysmal atrial fibrillation recurrences and quality of life in symptomatic patients: A crossover study of flecainide and pilsicainide

BackgroundThe therapeutic goals of atrial fibrillation (AF) patients are to reduce symptoms and prevent severe complications associated with AF. This study compared the efficacy of flecainide versus pilsicainide in reducing the frequency of AF and improving quality of life (QOL) in symptomatic paroxysmal AF patients without structural heart disease. MethodsThe Atrial Fibrillation and Quality Of Life (AF-QOL) study was a prospective, multicenter, randomized, open-label crossover study that compared flecainide and pilsicainide as antiarrhythmic drug therapy. Patients were randomized to receive 3 months of treatment with flecainide twice daily or pilsicainide 3 times daily. Each treatment consisted of a dose-finding phase (weeks 1–4) and an efficacy phase (weeks 5–12). Forty-three patients completed the trial. The main outcome was the number of days with documented AF episodes using a patient-operated electrocardiogram. QOL questionnaires (SF-36 and AF-specific QOL scores) were also completed. ResultsThe median (range) AF frequencies (days/8 weeks) were 2 (0–50) in the flecainide treatment group and 1 (0–54) in the pilsicainide treatment group (no significant between-group difference). No significant difference in the first recurrence of AF during the efficacy phase was noted between flecainide and pilsicainide treatments. The frequency and severity scores of AF-related symptoms improved from baseline to the end of the treatment periods. No significant differences in SF-36 or AF-related QOL scores were noted between the treatment groups. ConclusionsThis study found no difference in AF frequency or QOL between symptomatic paroxysmal AF patients who received flecainide or pilsicainide.

The Involvement of Epicardial Adiposity and Inflammation in Postoperatory Atrial Fibrilation - Immunohistochemical Qualitative and Quantitative Assessment

Postoperatory atrial fibrillation (AF) is a common complication after cardiac surgery. Among others cardiac structural changes, epicardial adiposity (EA) and inflammation could be associated with increased cardiovascular risk, including AF. Because there are not enough studies on the association between epicardial fat and inflammation in AF, this paper assesses the association between structural changes in human right atrial appendages (RAA) in patients with and without AF with focus on EA and inflammation. RAA specimens from 20 coronary patients (ages 60 � 10 years) were divided in 2 groups including patients with and without postoperatory AF. Histological, immunohistochemical (IMH) and morphometrical methods were used for assessing EA, myocardial fatty infiltration, epicardial inflammatory foci, cardiomyocytes size and vacuolation and extent of interstitial fibrosis. Atrial changes were found in most patients from both groups, having higher proportions in postoperatory AF patients. EA extent and myocardial fatty infiltration were twofold to threefold higher in patients with postoperatory AF and associated epicardial mononuclear inflammation. RAA structural changes can indicate the susceptibility to develop postoperatory AF. Currently, EA and inflammation have recently emerged as new independent AF risk factors. So, we proposed to study RAA structural changes, including EA, epicardial inflammatory foci in relation with postoperatory AF frequency.

Frequency Gradient Within Coronary Sinus Predicts the Long-Term Outcome of Persistent Atrial Fibrillation Catheter Ablation.

BackgroundThe coronary sinus (CS), as a junction of the atria, contributes to atrial fibrillation (AF) by developing unstable reentry, and isolating the atria by ablation at the CS could terminate AF. The present study evaluated whether AF activities at the CS in a subset of patients contributed to AF maintenance and predicted clinical outcome of ablation.Methods and ResultsWe studied 122 consecutive patients who had a first‐time radiofrequency ablation for persistent AF. Bipolar electrograms were obtained from multiple regions of the left atrium by a Lasso mapping catheter before ablation. Pulmonary vein isolation terminated AF in 12 patients (9.8%). Sequential stepwise ablation was conducted in pulmonary vein isolation nontermination patients and succeeded in 22 patients (18%). In the stepwise termination group, AF frequency in the proximal CS (CSp) was significantly higher (10.2±2.1 Hz versus 8.3±1.8 Hz, P<0.001), and the ratio of distal CS (CSd) to proximal CS (CSd/CSp ratio, 56.6%±10.11% versus 70.7%±9.8%, P<0.001) was significantly lower than that in the nontermination group. The stepwise logistic regression analysis indicated that the CSd/CSp ratio was an independent predictor with an odds ratio of 1.131 (95%CI 1.053‐1.214; P=0.001). With a cutoff of 67%, the patients with lower CSd/CSp ratios had significantly better index and long‐term outcomes than those with higher ratios during a follow‐up of 46±18 months.ConclusionsRapid repetitive activities in the musculature of the proximal CS may contribute to maintenance of AF after pulmonary vein isolation alone in persistent AF. A cutoff at 67%, of the CSd/CSp frequency ratio might be an indicator to stratify the subset of patients who might benefit from CS ablation.

Recent Trends in Oral Anticoagulant Use and Post-Discharge Complications Among Atrial Fibrillation Patients with Acute Myocardial Infarction.

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI).The CHA2DS2VAScand CHADS2risk scoresare used to identifypatients with AF at risk for strokeand to guide oral anticoagulants (OAC) use, including patients with AMI. However, the epidemiology of AF, further stratifiedaccording to patients' risk of stroke, has not been wellcharacterized among those hospitalized for AMI. We examined trends in the frequency of AF, rates of discharge OAC use, and post-discharge outcomes among 6,627 residents of the Worcester, Massachusetts area who survived hospitalization for AMI at 11 medical centers between 1997 and 2011. A total of 1,050AMI patients had AF (16%) andthe majority (91%)had a CHA2DS2VAScscore >2.AF rates were highest among patients in the highest stroke risk group.In comparison to patients without AF, patients with AMI and AF in the highest stroke risk category had higher rates of post-discharge complications, including higher 30-day re-hospitalization [27 % vs. 17 %], 30-day post-discharge death [10 % vs. 5%], and 1-year post-discharge death [46 % vs. 18 %] (p < 0.001 for all). Notably, fewerthan half of guideline-eligible AF patientsreceived an OACprescription at discharge. Usage rates for other evidence-based therapiessuch as statins and beta-blockers,lagged in comparison to AMI patients free from AF. Our findings highlight the need to enhance efforts towards stroke prevention among AMI survivors with AF.