Frequency Of Atrial Fibrillation Research Articles

Baseline characteristics of outpatients with heart failure according to phenotype: preliminary analysis from SMYRNA-HF registry

Objectives: SMYRNA-HF study is a prospective multicenter registry study to determine the profiles of patients with heart failure (HF) in Turkey. This study aimed to present the baseline characteristics of preliminary cohort by comparing them according to different HF phenotypes. Methods: The first SMYRNA-HF cohort included outpatients with HF from 9 centers. Patients were classified into three HF phenotypes as HF with reduced ejection fraction (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF) as recommended by guidelines. Results: Overall, 298 patients were included in this preliminary analysis that 57% of the patients were classified as having HFrEF, 33.3% as having HFpEF, and 9.7% as having HFmrEF. Female gender was more common in HFpEF (p = 0.003). Age, frequency of diabetes mellitus, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker, use of beta-blocker, use of daily loop diuretic, heart rate, blood urea nitrogen levels, lipid profiles, hemoglobin, white blood cell, platelet levels were similar among three HF phenotypes. Body mass index (BMI) (p < 0.001), frequency of hypertension (HT) (p < 0.001), and atrial fibrillation (AF) (p = 0.015) were higher in HFpEF. Ischemic etiology (p < 0.001) was less frequent in HFpEF. Use of mineralocorticoid receptor antagonist was higher in HFrEF (p < 0.001). Conclusions: Our study presented the baseline characteristics of outpatients with HF in Turkey. There were significant differences among HF phenotypes in terms of gender, BMI, frequency of HT, AF, and ischemic etiology. Treatment implementations seem to follow the guidelines. Although the rates are low, new treatment approaches recommended in the most recent guidelines seem to enter clinical practice.

A descriptive report on short QT interval in Kherameh branch of the PERSIAN cohort study

Short QT-interval is a condition that bear the suspicion of short QT syndrome (SQTS). SQTS is known to increase risk of life-threatening arrythmias and sudden cardiac death (SCD). Due to the insufficient population-based studies and use of various QT cut-off values, it accounts for as an undiagnosed condition. In this study, we sought for prevalence of short QT interval in Kherameh cohort study, one of the southern branches of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Data of 4363 adult subjects were analyzed from phase 1 of the cohort during 2014–2017. The corrected QT (QTc) intervals were calculated and electrocardiograms (ECGs) with QTc of less than 370 ms (msec) were reanalyzed for bradycardia, early repolarization, atrial fibrillation (AF), arrhythmias, and other electrical conduction abnormalities. Seventy-two subjects (1.65%) had a QTc of less than 370 ms (mean QTc of 360.72 ± 11.72). A male predominance and a lower mean heart rate observed in SQTS susceptible group (M/F of 1/0.26 vs. 1/1.145, p-value < 0.0001; 58.389 ± 9.787 vs. 70.899 ± 11.775; p-value < 0.0001) compare to the subjects with normal QTc. At least, 2 subjects with high-probability SQTS and 3 with intermediate-probability SQTS identified. The frequency of AF, syncope, bradycardia, early repolarization, low voltage ECG, and infantile SCD in first- and second-degree relatives were 16.67, 4.17, 33.33, 11.11, 11.11, 11.11%, respectively. The prevalence of short QT interval in our cohort was in line with previous studies. The incidence of cardiac symptoms/events, familial SCDs and ECG derived specific findings were high amongst SQTS-susceptible index persons. However, these variables could not predict the symptomatic subjects, which emphasizes gene studies and family screening.

Abstract TP201: How Often Is Occult Atrial Fibrillation In Cryptogenic Stroke Causal Versus Incidental?

Introduction: Long-term cardiac monitoring studies have unveiled low-burden, occult atrial fibrillation (AF) in some patients with otherwise cryptogenic stroke (CS). But occult AF is also found in some normal individuals and patients with stroke of known cause (KS). Clinical management would be aided by estimates of how often occult AF in a patient with CS is causal versus incidental. Methods: Through systematic search, we identified all case-control and cohort studies applying identical long-term monitoring techniques to both CS and KS patients. We performed a random-effects meta-analyses across these studies to determine the best estimate of the differential frequency of occult AF in CS and KS among all patients, and across age subgroups. We then applied Bayes’ theorem (method of Alsheikh-Ali et al, Stroke 2009) to determine the probability that occult AF is causal or incidental. Results: The systematic search identified 3 case-control and cohort studies enrolling 575 patients (337 CS, 238 KS). Methods of long-term monitoring were implantable loop recorder in 191 (33.2%), extended mobile external cardiac monitor in 277 (48.2%), and patch/event/Holter monitoring in 107 (18.6%). In formal meta-analysis, the summary odds ratio for occult AF in CS vs KS in all patients was 1.72 (95%CI 0.91-3.25) (Figure). With application of Bayes theorem, the corresponding probabilities indicated that, when present, occult AF in CS patients is causal in 44.4% and incidental in 55.6%. Only one study reported age-specific subgroup data: these suggested occult AF in CS patients was causal in 93% of patients &lt;65y vs 5.6% of patients ≥65y, but estimates had limited precision. Conclusions: In patients with cryptogenic stroke, when occult AF is found, it is likely causal in about 44% of patients, who may benefit from anticoagulation, and likely incidental in about 56% of patients, who may not benefit from anticoagulation. Figure

Frequency of Atrial Fibrillation in Patients Presenting With Decompensated Heart Failure.

BackgroundAtrial fibrillation (AF) is a common concern in patients with heart disease, especially those with acute decompensated heart failure (ADHF). We conducted a cross-sectional study to determine the frequency of AF and associated risk factors among patients with ADHF at a tertiary care hospital in Peshawar, Pakistan.MethodsWe conducted a cross-sectional analytical study of hospitalized patients with ADHF treated in a tertiary care hospital in Peshawar, Pakistan, from June 5 to October 30, 2021. The study's primary outcome was the proportion of patients with ADHF who had AF, and our secondary outcome was examining the risk factors for AF. The College of Physicians and Surgeons Pakistan provided ethical approval of the study design. Data were analyzed using IBM SPSS Statistics for Windows version 24.0 (IBM Corp., Armonk, NY, USA). We applied the chi-square test to compare the proportion of AF concerning risk factors (i.e., comorbidities).ResultsOne hundred ninety-four patients with ADHF were included in the study; 54.6% were male and 45.4% female. Most (56.7%) were older than 60, and 38.1% were aged 40-60. The prevalence of AF was 38.1%. Diabetes, hypertension, previous stroke, myocardial infarction (MI), and chronic obstructive pulmonary disease (COPD) were the most common comorbidities. All patients with ADHF with AF also had MI and hypertension. Patients of known coronary artery disease (CAD) but without MI, previous percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) surgery were less associated with AF than other comorbidities.ConclusionsWe conducted this study to determine the incidence of AF among patients with ADHF. AF occurs in a significant amount of patients with ADHF, and the risk factors associated with AF in these patients include hypertension, history of MI, diabetes, and COPD. Healthcare professionals should screen patients with ADHF for AF, especially those with common risk factors.

Interleukin-6-Mediated-Ca2+ Handling Abnormalities Contributes to Atrial Fibrillation in Sterile Pericarditis Rats.

Pre-existing Ca2+ handling abnormalities constitute the arrhythmogenic substrate in patients developing postoperative atrial fibrillation (POAF), a common complication after cardiac surgery. Postoperative interleukin (IL)-6 levels are associated with atrial fibrosis in several animal models of POAF, contributing to atrial arrhythmias. Here, we hypothesize that IL-6-mediated-Ca2+ handling abnormalities contribute to atrial fibrillation (AF) in sterile pericarditis (SP) rats, an animal model of POAF. SP was induced in rats by dusting atria with sterile talcum powder. Anti-rat-IL-6 antibody (16.7 μg/kg) was administered intraperitoneally at 30 min after the recovery of anesthesia. In vivo electrophysiology, ex vivo optical mapping, western blots, and immunohistochemistry were performed to elucidate mechanisms of AF susceptibility. IL-6 neutralization ameliorated atrial inflammation and fibrosis, as well as AF susceptibility in vivo and the frequency of atrial ectopy and AF with a reentrant pattern in SP rats ex vivo. IL-6 neutralization reversed the prolongation and regional heterogeneity of Ca2+ transient duration, relieved alternans, reduced the incidence of discordant alternans, and prevented the reduction and regional heterogeneity of the recovery ratio of Ca2+ transient. In agreement, western blots showed that IL-6 neutralization reversed the reduction in the expression of ryanodine receptor 2 (RyR2) and phosphorylated phospholamban. Acute IL-6 administration to isolated rat hearts recapitulated partial Ca2+ handling phenotype in SP rats. In addition, intraperitoneal IL-6 administration to rats increased AF susceptibility, independent of fibrosis. Our results reveal that IL-6-mediated-Ca2+ handling abnormalities in SP rats, especially RyR2-dysfunction, independent of IL-6-induced-fibrosis, early contribute to the development of POAF by increasing propensity for arrhythmogenic alternans.

Abstract 12343: A Real-World Disproportionality Analysis of Atrial Fibrillation Adverse Events for Glucagon Like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors

Introduction: Diabetes mellitus (DM) is a known risk factor for atrial fibrillation (AF). Anti-diabetic agents such as metformin and sodium glucose co-transporter-2 inhibitors have been proven to have a protective role against AF. Recent data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RA) do not increase the risk of AF whereas evidence regarding dipeptidyl peptidase-4 inhibitors (DPP-4i) is limited. We sought to examine the association between AF and GLP-1 RA, DPP-4i using the Food and Drug Administration’s Adverse Event Reporting System (FAERS) database. Hypothesis: We hypothesized that GLP-1 RA and DPP-4i may have a protective role against AF. Methods: We interrogated the FAERS database for reports of AF in patients on linagliptin, sitagliptin, saxagliptin, and alogliptin in the DPP-4i group and exenatide, liraglutide, dulaglutide, albiglutide, and semaglutide in the GLP-1 RA group. Number of AF events reported for each drug were collected and compared with all the other drugs in the FAERS database. Disproportionality analysis was performed using the reporting odds ratio (ROR). Results: We identified a total of 159,901 and 44,071 adverse event reports in the GLP-1 RA and DPP-4i groups, respectively. The reporting of AF was significantly lower for GLP-1 RA compared to all other drugs in FAERS (ROR 0.56; 95% CI 0.49-0.63). The reporting of AF was significantly higher in DPP-4i (ROR 2.02; 95% CI 1.76-2.33). Saxagliptin demonstrated the highest reporting of AF (ROR 2.67; 95% CI 2.00-3.57) followed by linagliptin (ROR 1.87; 95% CI 1.41-2.47) in DPP-4i group. Conclusions: The reporting frequency of AF was significantly lower in GLP-1 RA group. This complements the existing evidence and alludes to the protective role of GLP-1 RA against AF. In contrast, the reporting frequency of AF was significantly higher in DPP-4i group, especially with saxagliptin and linagliptin. Validation with larger prospective clinical data is needed to confirm these findings.

Atrial fibrillation as a preoperative risk factor predicts long-term mortality in elderly patients without heart failure and undergoing hip fracture surgery

Patients with atrial fibrillation (AF) constitute a significant portion of hip fracture patients, and both diseases tend to present more frequently in older age. Our goal was to evaluate the long-term mortality of patients with AF who were free from heart failure undergoing hip fracture surgery. This observational, retrospective study was done in a single research and training hospital setting. Hospital electronic health record data, National Health Registry data, and National Death Registry System data for 233 consecutive patients who were above 65 years of age and were planned to undergo surgery for hip fracture were retrieved and analyzed. An experienced cardiologist evaluated the patients prior to surgery. Each member of the research cohort was categorized into one of the two groups based on their survival status (survivor and non-survivor groups). Of the 233 cases, 89 (38.2%) who were included in the investigation died during the follow-up period. The median long-term follow-up period was 34 (12-42) months. The frequency of AF was significantly higher in the non-survivor group. In multivariable Cox regression analysis, AF (HR: 2.195, 95%CI 1.365-3.415, p<0.001), advanced age, and blood urea level were determined as independent predictors for all-cause long-term mortality. AF is an independent predictor for long-term death in hip fracture cases above 65 years of age who were free from heart failure.

Relationship between disease severity and atrial fibrillation in chronic obstructive pulmonary disease.

The aim of this study was to elucidate the relationship between atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) classification based on clinical severity determined in current guidelines. AF is the most common chronic arrhythmia that requires treatment. COPD is one of the risk factors for AF, but this relationship was only explored through respiratory function test results. Patients who received inpatient treatment for COPD between November 2019 and January 2017 were screened. Patients with coronary artery disease, heart failure, valvular heart disease, diabetes, chronic kidney disease, hypertension, thyroid dysfunction, and sleep apnea syndrome were excluded. According to the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, patients with COPD were divided into groups A, B, C, and D, and the relationship between AF and these groups was investigated. There was no difference between the two groups (depending on the presence of AF) in terms of sex and body mass index. There was a significant difference between the two groups in terms of age, left ventricular ejection fraction (LVEF), left atrium, right atrium, right ventricle, and systolic pulmonary artery pressure. When patients with COPD were classified according to clinical and symptomatic severity, the frequency of AF increased as the clinical severity increased. Regardless of the forced expiratory volume - first second (FEV1) value in the respiratory test, the incidence of AF is higher in patients with COPD with a clinically more severe picture.

Geriatric assessment in elderly patients receiving oral anticoagulants: results of the nursing study

Abstract Background It is well known that thrombosis and bleeding risk increases with age, in the same time prevalence of geriatric syndromes increases too. It can influence negatively on efficacy and safety of anticoagulant therapy. However, impact of geriatric syndromes is often underestimated in clinical practice. Purpose To evaluate prevalence of geriatric syndromes in elderly patients receiving oral anticoagulants (OAC). Methods This study enrolled 510 patients (19% male) aged 75–100 (mean 82±4) years hospitalized to our clinic consecutively from June to November in 2019. Nurses examined all patients according to specially designed nursing assessment algorithm that included Mini-Cog test, Morse Fall and Norton scales, Barthel Activities of daily living Index, Short Physical Performance Battery (SPPB) tests, Mini Nutritional Assessment (MNA) scale, Geriatric Depression Scale (GDS-15), and some other questionnaires. Before hospitalization, 61 patients (12%) received OAC due to atrial fibrillation (AF) (83,6%), venous thromboembolism (VTE) (9,8%) and AF+VTE (6,6%). In all patients, AF frequency was 21% (n=107), but OAC were prescribed in 51% (n=55) only. Patients receiving OAC (group 1; n=61) did not differ from those without OAC (group 2; n=449) by age, sex, frequency of hypertension, previous myocardial infarction and revascularization, stable angina, and some other chronic diseases. Results Patients in group 1 had lower score on Norton scale (17,2±2,3 vs 18,1±1,8; p=0,001), Barthel Index (87,9±19,1 vs 94,4±10,7; p&amp;lt;0,001), SPPB (4,5±3,1 vs 6,0±3,3; p=0,001), walk speed (0,50±0,44 vs 0,60±0,30 m/s; p=0,014) and higher score on Morse Fall scale (47,8±20,7 vs 39,8±20,6; p=0,005) compared to patients in group 2. They had higher frequency of frailty (SPPB tests ≤7 score) (82% vs 66%; p=0,011), functional dependence (Barthel Index ≤60 score) (71% vs 44%; p&amp;lt;0,001) and pressure ulcers high risk (Norton scale ≤13 score) (6,6% vs 1,6%; p=0,012). They also had higher frequency of fall in the past year (57% vs 41%; p=0,017), high fall risk (Morse Fall scale ≥51 score) (38% vs 28%; p=0,073) and subcutaneous hematomas (25% vs 12%; p=0,009). Univariate regression analysis with age and sex adjustment showed that patients receiving OAC had higher risk of functional dependence (OR 3,05; 95% CI 1,69–5,49; p&amp;lt;0,001), frailty (OR 2,31; 95% CI 1,16–4,62; p=0,018) and pressure ulcers high risk (OR 4,24; 95% CI 1,19–15,16; p=0,026). OAC therapy was also associated with falls in the past year (OR 1,94; 95% CI 1,13–3,35; p=0,016) Conclusion Patients receiving OAC had a higher incidence of some geriatric syndromes, such as frailty, functional dependence, falls, pressure ulcers high risk, and lower functional status compared to patients without OAC. Nursing assessment of geriatric patients provides physician with additional data that allows to identify factors potentially affecting the efficacy and safety of OAC therapy. Funding Acknowledgement Type of funding sources: None.

Incidence of atrial fibrillation and its effects on long-term follow-up outcomes in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.

The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coronary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI. A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization. The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF (+) group, the all-cause and in-hospital mortality rates were found to be significantly higher. New-onset AF development in patients with STEMI was detected as an independent predictor of in-hospital mortality. In the era of primary percutaneous transluminal coronary angioplasty, new-onset AF rates were found to be lower than the literature data. In addition, new-onset AF was found to be a predictor of in-hospital mortality, and deaths occurred mostly in the early period. Therefore, close follow-up of these patients in the early period and re-evaluation in terms of AF burden when the patient becomes stable are important.

B-AB18-04 SGK1 DEFICIENCY IS PROTECTIVE IN A MODEL OF SEPSIS-RELATED ATRIAL FIBRILLATION

Sepsis is associated with new onset atrial fibrillation (AF), and AF in septic patients is associated with worse outcomes. Serum glucocorticoid kinase 1 (SGK1), a serine/threonine kinase in the PI-3 kinase pathway, is involved in cardiac inflammation. Prior work has suggested a potential therapeutic role for SGK1 inhibition in cardiac arrhythmias, which we investigated in a model of bacterial sepsis-induced AF. We sought to determine if 1) CLP, a well established model of polymicrobial sepsis leads to an increased risk of AF, and 2) whether SGK1 inhibition is protective in this model. Cecal ligation and puncture was performed in male wild type C57/Bl6 (WT) and mice with cardiac specific knockdown of SGK1 (SGK1 DN). Approximately 7 (range 7-9) days after sepsis induction, the mice underwent terminal in vivo electrophysiology studies to determine AF inducibility and basic atrial/ventricular tissue parameters. Additional mice were used to perform optical mapping to determine EP properties and flow cytometry to determine cellular composition. CLP-induced sepsis in WT mice led to high AF inducibility (5 out of 7 mice), as well as AF frequency and burden during EP study. As compared with naïve controls, the AF phenotype was associated with significantly slowed right atrial conduction velocity (0.54±0.03 versus 0.62±0.08 m/s) along with a similar trend in the left atrium, as measured by optical mapping. Flow cytometry revealed that sepsis increased fibroblasts, macrophages, and neutrophils in the atrial wall when compared to control mice without CLP. When CLP was performed in WT and SGK1 DN littermates, SGK1 DN mice had significantly (p<0.05 by chi-squared) lower AF inducibility (3 out of 8) than the WT mice (7 out of 8). In addition, there was a significant decrease in AF frequency and a trend towards a decrease in total AF burden during the entirety of the EP study. Bacterial sepsis in mice remodels the atrial cell composition and increases AF inducibility. Genetic SGK1 inhibition protected septic mice against AF. These data motivate further investigation into how inflammatory remodeling of atria contributes to sepsis-induced AF, and the potential of SGK1 inhibitors for treatment of this entity.

Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation.

Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV–) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.HIV+ men were younger than HIV– men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV– men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to –1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to –1.81; P = .66).We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.

Super and Nonresponders to Catheter Ablation for Atrial Fibrillation: A Quality-of-Life Assessment Using Patient Reported Outcomes.

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Chronic HDAC6 Activation Induces Atrial Fibrillation Through Atrial Electrical and Structural Remodeling in Transgenic Mice.

Atrial fibrillation (AF) is a relatively common complication of hypertension. Chronic hypertension induces cardiac HDAC6 catalytic activity. However, whether HDAC6 activation contributes to hypertension-induced AF is still uncertain. We examined whether chronic cardiac HDAC6 activation-induced atrial remodeling, leading to AF induction.The HDAC6 constitutively active transgenic (TG) (HDAC6 active TG) mouse overexpressing the active HDAC6 protein, specifically in cardiomyocytes, was created to examine the effects of chronic HDAC6 activation on atrial electrical and structural remodeling and AF induction in HDAC6 active TG and non-transgenic (NTG) mice. Left atrial burst pacing (S1S1 = 30 msec) for 15-30 sec significantly increased the frequency of sustained AF in HDAC6 active-TG mice compared with NTG mice. Left steady-state atrial pacing (S1S1 = 80 msec) decreased the atrial conduction velocity in isolated HDAC6 active TG compared with NTG mouse atria. The atrial size was similar between HDAC6 active TG and NTG mice. In contrast, atrial interstitial fibrosis increased in HDAC6 active TG compared with that of NTG mouse atria. While protein expression levels of both CX40 and CX43 were similar between HDAC6 active TG and NTG mouse atria, a heterogeneous distribution of CX40 and CX43 occurred in HDAC6 active-TG mouse atria but not in NTG mouse atria. Gene expression of interleukin 6 increased in HDAC6 active TG compared with NTG mouse atria.Chronic cardiac HDAC6 activation induced atrial electrical and structural remodeling, and sustained AF. Hypertension-induced cardiac HDAC6 catalytic activity may play important roles in the development of AF.

Frequency of cardiac arrhythmias in older adults: Findings from the Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study

BackgroundProlonged monitoring of cardiac rhythm has been used to screen for subclinical atrial fibrillation (AF); little is known about other arrhythmias in the general population, especially in the elderly, who are at higher risk of arrhythmias. MethodsWe evaluated the frequency of arrhythmias in the tri-ethnic (white, Black, Hispanic), community-based Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study using a patch-based recorder for up to 14 days in 527 participants free of AF, congestive heart failure (CHF) or history of stroke. Differences according to gender, age, ethnicity and presence of hypertension, diabetes and pertinent ECG and echocardiographic variables were examined. ResultsMean age was 77.2 ± 6.8 years (37.2% men, 62.8% women). AF was present in 10 participants (1.9%), only 2 of them symptomatic. Supraventricular tachycardia (SVT) and ventricular tachycardia (VT) episodes were observed in 84.4% and 25.0% but only 13.5% and 10.6% of participants reported symptoms, respectively. Severe bradycardia (<40 bpm) was present in 12.5%. Sinus pauses and high-degree atrioventricular blocks were infrequent (2.1% and 1.5%, respectively). Most arrhythmias were more frequent in participants > 75 years; ventricular arrhythmias and severe bradycardia were more common in men. Whites had significantly more episodes of AF than Hispanics, SVT than Blacks and VT ≥ 10 beats than Hispanics and Blacks. Hypertensives had more episodes of severe bradycardia. LV hypertrophy or LVEF <55% were associated with more frequent ventricular and supraventricular arrhythmias. ConclusionsProlonged cardiac rhythm monitoring revealed moderate frequency of AF, but higher than expected frequencies of AF-predisposing arrhythmias. Ventricular arrhythmias were relatively frequent, whereas severe bradyarrhythmias were infrequent.

Atrial Fibrillation Following Patent Foramen Ovale Closure: Systematic Review and Meta-Analysis of Observational Studies and Clinical Trials.

Multiple studies evaluated whether patent foramen ovale (PFO) closure reduces the risk of ischemic stroke. One commonly reported complication of PFO closure is the development of atrial fibrillation (AF), which is itself a powerful stroke risk factor that requires specific management. This study aims to evaluate the frequency of AF in patients post-percutaneous closure of PFO and the clinical factors that predict AF detection. Studies were identified by systematically searching EMBASE and MEDLINE databases on July 11, 2019. Meta-analysis of proportions was performed, assuming a random-effects model. A total of 6 randomized controlled trials and 26 observational studies were included, comprising 3737 and 9126 patients, respectively. After PFO closure, the rate of AF development was 3.7 patients per 100 patient-years of follow-up (95% CI, 2.6–4.9). The risk of AF development is concentrated in the first 45 days post-procedure (27.2 patients per 100 patient-years [95% CI, 20.1–34.81], compared with 1.3 patients per 100 patient-years [95% CI, 0.3–2.7]) after 45 days. Meta-regression by age suggested that studies with older patients reported higher rate of AF (P=0.001).In medically treated patients, the rate of AF development was 0.1 per 100 patient-years of follow-up (95% CI, 0.0–0.4). Closure of PFO is associated with increased risk of AF compared with medical management (odds ratio, 5.3 [95% CI, 2.5–11.41]; P<0.001). AF is more common in PFO patients who had percutaneous closure compared with those who were medically treated. The risk of AF was higher in the first 45 days post-closure and in studies that included patients with increased age.

Фибрилляция предсердий у диализных пациентов (опыт одного центра)

The aim of the research is to determine frequency of atrial fi brillation; factors that lead to the formation of atrial fi brillation and the development of cardiovascular complications in dialysis patients. Material and methods. Analysis of current clinical practice in one out-patient hemodialysis center. Results. The incidence of atrial fi brillation in dialysis patients is 10.5 %. Most patients (72.4 %) had a paroxysmal form of atrial fi brillation. Th ere is clinical and laboratory characteristics of patients with atrial fi brillation. Atrial fi brillation occurred in 58.6 % of dialysis patients in average in 45 [15.4; 70.5] months after the beginning of regular hemodialysis, the rest got it in pre-dialysis period. Th e main factor associated with the development of atrial fi brillation on dialysis is the duration of dialysis therapy. Dialysis patients with atrial fi brillation are characterized by more pronounced systemic infl ammation and a higher incidence of hyperparathyroidism compared with patients without atrial fi brillation. Cardiovascular complications developed in 41.4 % dialysis patients with atrial fibrillation. Anuria is a factor associated with the development of myocardial infarction and stroke. Conclusion. Atrial fibrillation is found in every tenth dialysis patient. An increase in atrial fi brillation was noted along with an increase in hemodialysis duration. To optimize dialysis treatment of patients with atrial fibrillation further research is needed

TRPV4 blockade suppresses atrial fibrillation in sterile pericarditis rats.

Atrial fibrillation (AF) commonly occurs after surgery and is associated with atrial remodeling. TRPV4 is functionally expressed in the heart, and its activation affects cardiac structure and functions. We hypothesized that TRPV4 blockade alleviates atrial remodeling and reduces AF induction in sterile pericarditis (SP) rats. TRPV4 antagonist GSK2193874 or vehicle was orally administered 1 day before pericardiotomy. AF susceptibility and atrial function were assessed using in vivo electrophysiology, ex vivo optical mapping, patch clamp, and molecular biology on day 3 after surgery. TRPV4 expression increased in the atria of SP rats and patients with AF. GSK2193874 significantly reduced AF vulnerability in vivo and the frequency of atrial ectopy and AF with a reentrant pattern ex vivo. Mechanistically, GSK2193874 reversed the abnormal action potential duration (APD) prolongation in atrial myocytes through the regulation of voltage-gated K+ currents (IK); reduced the activation of atrial fibroblasts by inhibiting P38, AKT, and STAT3 pathways; and alleviated the infiltration of immune cells. Our results reveal that TRPV4 blockade prevented abnormal changes in atrial myocyte electrophysiology and ameliorated atrial fibrosis and inflammation in SP rats; therefore, it might be a promising strategy to treat AF, particularly postoperative AF.

Abstract 15617: Atrial Fibrillation Prevalence, Anticoagulation Practices, and Long-term Outcomes for Patients Discharged With Atrial Fibrillation After Tavr: Results From the Partner 2a and S3i Trials

Background: Atrial fibrillation (AF) is associated with worse outcomes, including increased mortality, in patients undergoing transcatheter and surgical aortic valve replacement (TAVR/SAVR). Objective: To assess: (i) the short- and long-term prevalence of AF in intermediate surgical risk patients undergoing TAVR and SAVR; (ii) determine rates of anticoagulation (AC) prescription in patients with AF; and (iii) evaluate differences in outcomes. Methods: A total of 2663 patients from the PARTNER 2A and S3i trials were categorized into 3 groups by their baseline and discharge rhythm (sinus rhythm [SR] vs. AF): SR/SR, SR/AF, and AF/AF. Patients were followed for up to two years. Results: Table 1 presents the frequency of AF, AC prescription, and outcomes at 30-days, 1-year, and 2-year follow-up. SR/AF TAVR and SAVR patients continued to manifest relatively high rates of AF at each follow-up point. SR/AF patients were prescribed AC less often than AF/AF patients. For TAVR patients, the development of and discharge in AF was associated with increased bleeding (OR 1.59, 95% CI 1.11-2.26, p=0.01, SR/AF vs. AF/AF) and mortality (OR 1.77, 95% CI 1.04-3.00, p=0.03, SR/AF vs. AF/AF), but not stroke. There were no significant differences in outcomes in the SAVR patients. Conclusion: TAVR/SAVR patients who developed and were discharged in AF (SR/AF) were often in AF at 30 days, 1 year, and 2 year follow-up. While anticoagulation rates were lower in the SR/AF vs. the AF/AF group, bleeding and mortality, but not stroke, rates were higher for TAVR SR/AF vs. AF/AF patients. Further analyses of the associations between AF development, anticoagulation use, and outcomes in TAVR and SAVR patients are warranted.

Plasma exchange in patients with myocarditis: comparison study

Abstract Background Cardiac auto-antibodies (AABs) are detected frequently in patients with inflammatory dilated cardiomyopathy (iDCM) of arrhythmias due to myocarditis. Elimination of AABs with apheresis improves left ventricular function as well as the immunosuppressive drugs (ISDs) do. There is no data on the combined use of ISDs and apheresis. Aims To investigate the clinical efficiency of plasma exchange (PE) in patients with myocarditis in comparison with patients without PE. Methods There were 38 patients with iDCM under stable oral medication with maximal tolerated dose of β-blockers/angiotensin-converting enzyme inhibitor/aldosterone antagonists at least 3 month before study inclusion; and 48 patients with arrhythmias due to myocarditis resistant to antiarrhythmic drugs (AADs). Patients underwent evaluation including heart CT scan, MRI, endomyocardial biopsy, myocardial perfusion scan, and coronary angiography to diagnose myocarditis. All the patients had a high level of AABs against cardiac antigens. PE group were consisted of 19 patients with iDCM (left ventricular ejection fraction (LVEF) 35±7%) and 22 patients with arrhythmias (premature atrial (PACs) or ventricular (PVCs) contractions more than 3000/day or atrial fibrillation (AF)). All the patients in PE group underwent a single volume PE filled with 0.9% sodium chloride. Another 19 iDCM patients and 26 arrhythmic patients were controls without PE. Echocardiographic parameters, a 6-minute walk test (6MWT) distance, Holter monitoring and AABs level were assessed at baseline, 6 and 12 month follow-up. Some patients were treated by ISDs before PE. PE group patients got methylprednisolone (MP) significantly rare than controls after PE. The mean doses of MP were significantly lower than in controls too. Results AABs level significantly decreased just after PE and during the follow-up only in PE group. iDCM patients also had significant improvement in LVEF 35±7% vs. 45±11% at a year follow up, and 6MWT distance in comparison with LVEF 33±7% vs. 37±11% at a year follow up in controls. There were 58% PE group patients with absolute LVEF improvement &amp;gt;10% classified as responders in comparison with 32% responders in controls. There were 86% PE group patients with arrhythmias in and 58% patients in control group who were classified as responders as they achieved a decrease of PAVs and PVCs or AF frequency &amp;gt;75% relative to baseline. AADs were eliminated in 46% PE group patients and in 23% control group patients with arrhythmias. We also tried to predict good response for PE in both iDCM and arrhythmic patients. iDCM responders were characterized by LVEF≤37% at baseline. Arrhythmic group responders were characterized by higher level of AABs to cardiac conduction cells antigens at baseline. Conclusions PE improves both cardiac function and daily activities in patients with iDCM and arrhythmias due to myocarditis. PE is safe and high effective, and helps avoid using high doses of ISDs Funding Acknowledgement Type of funding source: None