Higher Risk Of Atrial Fibrillation Research Articles

PSYCHOSOCIAL STRESSORS AT WORK AND ATRIAL FIBRILLATION INCIDENCE: A 18-YEAR PROSPECTIVE STUDY

Objective: Psychosocial stressors at work are generally defined according to the job strain and the effort-reward imbalance at work (ERI) models. These work stressors were shown to increase coronary heart disease risk, with a higher risk among workers exposed to both stressors. The effect of combined exposure to both work stressors on atrial fibrillation (AF) incidence is not known. The aim of the present study was to examine the separate and combined effect of job strain and effort-reward imbalance at work on atrial fibrillation incidence. Design and method: The study design was a prospective cohort study. A total of 5,926 white-collar workers (3,021 women and 2,905 men) free of cardiovascular disease at baseline were followed for 18 years. Psychosocial stressors at work were measured according to the job strain and ERI models using validated instruments. AF events were identified in medical databases with universal coverage. Hazard ratios (HR) with 95% confidence intervals were estimated using Cox regression models, adjusting for socioeconomic characteristics, lifestyle-related factors and clinical factors. Results: During the follow-up, 186 AF events were identified. Workers exposed to job strain (HR = 1.8; 95% CI 1.1-2.9) or effort-reward imbalance at work (HR = 1.4; 95% CI 1.1-2.0) had a higher risk of AF, following adjustment for socioeconomic characteristics, lifestyle and clinical risk factors. Combined exposure to job strain and ERI was associated with a two-fold AF risk increase (HR = 2.0; 95% CI 1.3-3.1) in fully adjusted models. Conclusions: Workers exposed to job strain or effort-reward imbalance at work, separately and in combination, were at increased AF risk. Prevention strategies targeting psychosocial stressors at work should be considered to decrease the burden associated with AF.

0820 Integrated Polysomnographic and Sleep Symptom-Based Cluster Subtypes Associated with Incident Atrial Fibrillation

Abstract Introduction While sleep disorders are implicated in atrial fibrillation (AF), the interplay and overlap of these disorders in AF risk remains unclear and a risk stratification challenge. Sleep-based clusters associated with AF can account for this complexity and translate to actionable approaches to identify at-risk patients. We hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF. Methods Cleveland Clinic patients (age>18) who underwent PSG 11/27/2004-12/30/2015 were retrospectively examined. Clusters were identified using latent class analysis of 23 symptoms (e.g. related to sleep disordered breathing (SDB), sleepiness, REM intrusion, NREM parasomnias), Epworth Sleepiness Scale (ESS) score, and 24 measures of SDB and sleep architecture from PSG reports. Outcome was 5-year incident AF. Cox-proportional hazards models were adjusted for age, sex, race, body mass index, cardiovascular disease and risk factors, tobacco use, chronic obstructive pulmonary disease, anti-arrhythmic medication use, and positive airway pressure use. Results The sample included 43,433 patients: age 51.8±14.5, 51.9% (n=22,548) male, 74.4% (n=32,313) White, 7.3% (n=3,151) with baseline AF, and 4.3% (n=1,875) developed 5-year incident AF. Five clusters were identified and ranked by strength of AF association: 1) Hypoxemic (n=3,245): highest %time SaO2< 90% (T90), 2) Apneas+Arousals (n=4,592): most witnessed apneas, highest apnea hypopnea index (AHI), highest arousal index, least hypopneas, 3) Short sleep+NREM (n=6,126): shortest sleep time, longest REM latency, lowest %REM, 4) Hypopneas (n=2,661): most hypopneas, 5) Long sleep+REM (n=26,809): longest sleep time, shortest REM latency, highest %REM. Compared to ‘Long sleep+REM’, ‘Hypoxemic’ had 47% higher AF risk (HR=1.47,95%CI=1.27-1.69), and ‘Hypopneas’ did not differ (HR=1.05,95%CI=0.86-1.28). Conclusion Of five clusters identified, the ‘Hypoxemic’ subtype conferred the strongest AF risk with the highest degree of hypoxemia (highest T90, lowest minimum and mean SaO2), maximum end-tidal CO2, heart rate, and ESS score. Consistent with prior evidence of hypoxemia as an AF driver and cardiovascular risk of the sleepy phenotype, this constellation of symptoms and physiologic alterations illustrates risk in the clinical setting, providing potential value as a risk prediction tool. Future investigation should focus on external validation of these findings. Support (if any) Cleveland Clinic Neurological Institute Center for Outcomes Research & Evaluation Pilot Grant, Transformative Research Resource Development Award

Analysis of the Amplified P-Wave or Artificial Intelligence-Derived P-wave-Analysis Enable Identification of Patients with Atrial Fibrillation during Sinus Rhythm

Abstract Funding Acknowledgements Type of funding sources: None. Introduction / Aims This study sought to develop and validate diagnostic models to identify individuals with atrial fibrillation (AF) using amplified p-wave analysis or neural-network-trained p-wave-analysis during sinus rhythm (SR). Methods 1492 patients (491 healthy controls, 499 with paroxysmal AF and 502 with persistent AF) underwent digital 12-lead-ECG recording during sinus rhythm. The patient cohort was divided into training and validation set in a 3:2 ratio. P-wave indices including duration of standard p-wave (standard PWD; 10mm/mV, 25mm/sec, see ECG in the left panel), amplified digital p-wave (APWD, 60-100mm/mV, 175mm/sec; see ECG in the middle panel) and advanced inter-atrial block (aIAB) along with the parameters body surface area (BSA) and LA diameter (LAD) were used to develop diagnostic models using logistic regression. Each model was developed from the training set and further tested in both training and validation sets for its diagnostic performance in identifying individuals with AF. A neural-network was trained to identify the p-wave and its features (duration, morphology) to differentiate between individuals with known versus those without AF. Results Compared to standard PWD (Reference model, AUC=0.637 and 0.632, for training and validation set, respectively), APWD (Basic model) importantly improved the accuracy to identify individuals with AF (AUC=0.86 and 0.866). The ECG-based model combining APWD, aIAB and body surface area (BSA) further improved the diagnostic performance for AF (AUC=0.892 and 0.885). The integrated model, which further combined left atrial diameter (LAD) with parameters of the ECG-based model, achieved the highest diagnostic performance (AUC=0.916 and 0.902). Notably, the neural network-based p-wave-analysis identified AF patients with high accuracy during sinus rhythm (AUC: 0.85; sensitivity: 77%; specificity: 78%). Conclusions Both, the analysis of amplified p-wave and a neural-network-based automatic p-wave analysis during sinus rhythm allow identification of individuals with atrial fibrillation. The current diagnostic models provide a new basis for identifying individuals at high risk for AF, who would most benefit from AF screening.

Accuracy of real time heart rate monitoring using smartwatch in a stroke care unit

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ISCIII Smartwatch with heart rate (HR) tracker measures may allow for identification of people with high resting HR who have a higher risk of atrial fibrillation (AF), a potent independent risk factor for embolic strokes. In this research, we propose a new protocol for collecting real time data of patients with cryptogenic stroke including HR at rest along with monitoring electrocardiogram (ECG). First, we assess the concordance of HR measurement between telemetry (TLM) and two smartwatches in acute stroke patients, as well as the determinants of measurement error. Method We included patients over 50 years of age hospitalized in our Stroke Unit who were monitored by TLM and used the Garmin Vivosmart HR® (S1) and Fitbit Charge 5® (S2) devices. Mean HR was collected at 5, 10, 15, 20, and 25 minutes. We applied the Bland-Altman method in combination with Lin's Concordance Correlation Coefficient (CCC) to assess agreement between measurements. A coefficient CCC > 0.9 indicates acceptable agreement. Results The experimental setup was performed using 49 stroke patients (59% women, mean age 78 ± 9.86 years, and 69% with a history of AF). Poor agreement was observed between HR measurements by SI or S2 and TLM (CCC = 0.48 and 0.57 respectively), which was conditioned by the presence of AF during the measurement (CCC = -0.17 and -0.06). There was only good concordance in the absence of AF (CCC = 0.97 and 0.92). A higher percentage of error between measurements was significantly associated with a HR > 90 bpm, a history of AF, or presenting AF during the measurement (p<0.001). Conclusions Real-time monitoring of HR at rest in each smartwatch was not accurate in acute stroke patients who had presented AF during the intake, or when HR by TLM was greater than 90. This suggests certain limitations when considering the application of processed data from this wearable technology.

Plasma TSH and cardiovascular disease in the general population: A Mendelian randomization study of 105,224 individuals

Background and aimsThe association between thyroid stimulating hormone (TSH) and cardiovascular disease has mainly been determined using clinical categories of disease. We tested the hypothesis that TSH on a continuous scale is associated with risk of atrial fibrillation (AF), myocardial infarction (MI), stroke, heart failure (HF), aortic valve stenosis (AVS), and major adverse cardiovascular events (MACE) and whether these associations are likely to be causal. MethodsWe first tested whether plasma TSH on a continuous scale was observationally associated with incident cardiovascular events in a prospective cohort study of 105,224 individuals from the Copenhagen General Population Study followed for a median 7 years. Next, we tested whether a genetic risk score weighted on TSH was associated with cardiovascular endpoints. Finally, using Mendelian randomization, we tested whether the observed associations were likely to be causal. ResultsUsing restricted cubic splines, lower concentrations of TSH relative to the population median (=1.53 mIU/L) were associated with higher risk of AF, MI, stroke, HF, AVS, and MACE. Comparing individuals with TSH ≤5th percentile (≤0.54 mIU/L) versus >50th percentile (>1.53 mIU/L), hazard ratios (HRs) ranged from 1.12 (1.00–1.26) for stroke to 1.27 (1.11–1.46) for HF. Genetic risk estimates per standard deviation decrease in TSH were 1.28 (1.08–1.52) for AF, 1.35 (1.06–1.71) for MI, 1.06 (0.89–1.26) for stroke, 1.19 (0.94–1.52) for HF, 1.53 (1.03–2.26) for AVS, and 1.09 (0.97–1.23) for MACE. ConclusionsIn 105,224 individuals from the general population low plasma TSH was observationally and genetically associated with increased risk of AF, MI, and AVS suggesting that these observations may reflect causal pathways.

Correlation between the triglyceride-glucose index and the onset of atrial fibrillation in patients with non-alcoholic fatty liver disease

BackgroundNon-alcoholic fatty liver disease (NAFLD) is associated with atrial fibrillation (AF). Insulin resistance (IR) is the main cause of the high prevalence of AF in NAFLD patients. The triglyceride-glucose index (TyG) is a novel IR-related indicator implicated in the incidence and severity of NAFLD. However, the role of TyG in determining the risk for AF in patients with NAFLD remains unclear.MethodsA retrospective study was conducted on 912 patients diagnosed with NAFLD via ultrasonography. These patients were divided into two groups: (1) NAFLD+ AF and (2) NAFLD+ non-AF. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to assess the correlation between the TyG index and the high risk for AF. A receiver operating characteristic (ROC) curve was constructed to evaluate the predictive value for the TyG index for AF. Restricted cubic splines (RCS) were used to test the linear correlation between TyG and the risk for AF.ResultsA total of 204 patients with AF and 708 patients without AF were included in this study. The LASSO logistic regression analysis showed that TyG was an independent risk factor for AF (odds ratio [OR] = 4.84, 95% confidence interval [CI] 2.98–7.88, P < 0.001). The RCS showed that the risk for AF increased linearly with TyG over the entire TyG range; this risk was also evident when the patients were analyzed based on sex (P for nonlinear > 0.05). In addition, the correlation between TyG and AF was a consistent finding in subgroup analysis. Furthermore, ROC curve analysis showed that TyG levels combined with traditional risk factors improved the predictive value for atrial fibrillation.ConclusionThe TyG index is useful in assessing the risk for atrial fibrillation in patients with NAFLD. Patients with NAFLD and increased TyG indices have higher risks for atrial fibrillation. Therefore, TyG indices should be assessed when managing patients with NAFLD.

Atrial fibrillation in adult congenital heart disease and the general population

Atrial fibrillation (AF) in adult patients with congenital heart disease (ACHD) may appear early, depending on individual characteristics. The goals of this study were to investigate the epidemiological spectrum of AF in the entire cohort of ACHD and compare it with that in the general population. A retrospective study was performed in the nationwide cohort 2000-2014 with AF onset during 2003-2014. In the cohort of ACHD, 2350 patients had AF; the incidence increased with age, plateauing around age 70. In patients aged 25-29, 45-49, 65-69, 75-79, and ≥80 years, the annual incidence was 1.3, 7.9, 20.6, 23.7, and 21.4/1000 per year, respectively. In the general population without CHD, 347,979 patients had AF; the annual incidence was <1/1000 per year in those aged <55 years but increased steadily with age (3.6, 8.6, and 14.2/1000 per year in aged 65-69, 75-79, and ≥80 years, respectively). Compared with individuals without ACHD, ACHD patients aged <50 years and those aged both 50-54 and 55-59 years exhibited a 20-fold and 10-fold higher incidence of AF, respectively. Patients with complex congenital heart disease and Ebstein's anomaly had the highest risk of AF (cumulative risk >10% by age 50 and >20% by age 60), followed by those with tetralogy of Fallot, tricuspid atresia, endocardial cushion defect, and secundum atrial septal defect (cumulative risk >5% by age 50 and >10% by age60). Compared with individuals without ACHD, AF in patients with ACHD likely appeared 30 years earlier, with a 10- to 20-fold higher incidence plateauing around age 70. Yet, incidence in individuals without ACHD continued to increase. AF burden in patients with ACHD is not expected to increase in a never-ending way.

PO-01-226 RACIAL DIFFERENCES AND SIMILARITIES IN ATRIAL FIBRILLATION EPIDEMIOLOGY, RISK FACTORS, AND MORTALITY IN COMMUNITY-BASED COHORTS: RESULTS FROM THE KOREAN NHIS-HEALS AND UK BIOBANK STUDIES

Atrial fibrillation (AF) is associated with mortality, morbidity, and medical costs. Despite the increasing public health importance of AF, race-specific disease distributions and associations between clinical risk factors and AF have received limited attention. This study aimed to compare established associations between risk factors and AF in white Europeans from the UK Biobank and Asian subjects from the Korean NHIS-HEALS (National Health Insurance Service-Health Screening) study. This study included 402,229 and 484,406 patients without a diagnosis of nonvalvular AF from the Korean NHIS-HEALS cohort and UK Biobank, respectively. The incidence of AF, its associations with mortality, common risk factors, biomarkers, prevalent cardiovascular disease, and their attributable risk by race were examined. The median follow-up time was 11.8 years (interquartile range [IQR] 11.1–12.6) in the UK Biobank and 7.6 years (IQR 7.0–8.2) in the Korean NHIS-HEALS. Fewer AF cases were observed in Korean NHIS-HEALS (N=9182; 2.3%) than in the UK Biobank (N=25312; 5.2%). Cardiovascular risk factors, comorbidities, and glucose levels were associated with an increased risk of new-onset AF in both cohorts, with significant interactions by country for associations with body mass index (BMI), economic status, smoking history, history of heart failure, and cholesterol level. BMI was more strongly related to new-onset AF in UK Biobank [hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.29–1.33] compared to Korean NHIS-HEALS (HR, 1.11; 95% CI, 1.09–1.14), with a relative risk ratio of 1.18 (95% CI, 1.15–1.21). Total cholesterol was inversely associated with incident AF in both cohorts (HR, 0.86; 95% CI, 0.85–0.87 versus 0.91; 95% CI, 0.89–0.93 in Korean NHIS-HEALS), relative risk ratio 0.95 (95% CI, 0.92–0.97). Attributable risk proportion of most classical risk factors were similar in both the studies. In this first large-scale comparison of Caucasian and Asian populations, the cumulative risk of developing AF was higher in the UK than in Korea over most of their lifespan. Higher BMI, smoking, history of heart failure, and lower total cholesterol levels were associated with a higher risk of AF in the UK than in Asians.

PO-05-193 PREVALENCE OF ARRHYTHMIAS AND CARDIAC CONDUCTION DISEASE IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICE

Left ventricular assist devices (LVADs) have been shown to increase the functional status and survival of patients with end -stage heart failure. There is limited data regarding the prevalence of arrhythmias and conduction disease in patients implanted with LVADs. Our objective was to determine the prevalence of arrhythmias and conduction disease in hospitalized patients with LVADs using the National Inpatient Sample (NIS) from 2016-2019. A retrospective study was done using the Nationwide Inpatient Sample from 2016-2019. 17,125 hospitalisations with LVADs were identified using ICD-10 codes. Multivariate logistic regression analysis was used to adjust for confounders and analyze the variables for the adjusted odds ratio. Among 17,125 hospitalizations, the average age was 55 years and 62% were male. Atrial fibrillation (AF) was the most prevalent (43%) atrial arrhythmia, followed by atrial flutter (AFL) (14%), and supraventricular tachycardia (SVT) (13%). Ventricular tachycardia (VT) was the most common ventricular arrhythmia (47%), and less than one percent of the cohort had reported episodes of ventricular fibrillation/flutter (< 1%). In terms of conduction disease, 10% had either first-degree (1AVB), <1% had second-degree AV block (2AVB), 10% had right (RBBB), and 3% had left bundle branch block (LBBB). When adjusted to patient demographics, comorbidities, and hospital characteristics, patients with LVADs had a higher risk of AF (aOR= 2.00, p<0.0001), AFL (aOR=3.5, p<0.0001), SVT (aOR=4.63, p<0.0001), VT (aOR=17.7, p<0.0001), and complete heart block (CHB) (aOR=2.6, p<0.0001). Patients with LVADs are more likely to develop atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, RBBB, and CHB. Atrial fibrillation was our cohort's most common arrhythmia, consistent with prior observational studies' trends.

Clinical and radiological predictive factors of silent AF in ESUS stroke

A quarter of cerebral infarctions remain without etiology (ESUS: embolic stroke of unknown source) with a risk of recurrence under anti-platelet therapy greater than 4% per year. In this population, the challenge is the detection of subclinical atrial fibrillation (AF), the incidence of which could reach 25%. The efficacy of the probabilistic anticoagulation strategy has not been demonstrated in this population making it necessary to identify ESUS patients at high risk of subclinical AF. The aim of this study is to determine clinical and radiological predictive factors of silent AF in ESUS stroke. Monocentric descriptive and analytical historical cohort study conducted at the Neurology Department between January 2016 and December 2020. Three hundred Esus patients were included. In our study 42/300 (14%) patients had at least one episode of AF (> 30 s). In univariate analysis, the variables significantly associated with slower AF in ESUS-type stroke were age greater than or equal to 60 years (P = 0.004, OR = 3.76), female gender (P = 0.045, OR = 1.94), coronary artery disease (P = 0.008, OR = 3.43), previous stroke (P = 0.007, OR = 2.67), stroke of different territory or age (P = 0.031, OR = 2.65), stroke on awakening (P < 10−3, OR = 5.95), higher NIHSS score on admission (P = 0.023, OR = 1.08), lower NIHSS score on discharge (P = 0.031, OR = 0.89), older cerebellar stroke (P < 10−3, OR = 14.16). In multivariate analysis, higher NIHSS score at admission (P = 0.023, OR = 1.08), and lower NIHSS score (P = 0.031, OR = 0.89) at discharge appeared as independent predictors of the occurrence of a subclinical AF episode. In this cohort of ESUS patients, several factors appeared to be predictive of subclinical AF. The subgroup of ESUS patients with these factors appeared to benefit from probabilistic anticoagulation in preventing recurrent cerebral infarction. A therapeutic trial should confirm this hypothesis.

Electrocardiographic and echographic predictive factors of silent AF in ESUS stroke

Stroke is a major public health problem, the leading cause of acquired disability in adults and the third leading cause of death worldwide. Ischaemic stroke accounts for 80% of all strokes. Approximately 20% of DVAs are associated with atrial fibrillation (AF). However, 25% remain of undetermined origin (ESUS) with a risk of recurrence under anti-platelet therapy greater than 4% per year. In this population, the challenge is the detection of subclinical atrial fibrillation (AF), the incidence of which could reach 25%. The effectiveness of the probabilistic anticoagulation strategy has not been demonstrated in this population, making it necessary to identify ESUS patients at high risk of subclinical AF. The aim of this study is to determine the incidence and the electrocardiographic and echographic predictive factors of silent AF in ESUS stroke. Monocentric descriptive and analytical historical cohort study conducted at the Neurology Department between January 2016 and December 2020. Three hundred Esus patients were included. In our study, 42/300 (14%) patients had at least one episode of AF (> 30 s). In univariate analysis, the variables significantly associated with sluggish AF in ESUS-type stroke were age greater than or equal to 60 years (P = 0.004, OR = 3.76), female gender (P = 0.045, OR = 1.94), P-wave markers (abnormal axis, prolonged duration), P-wave dispersion (P < 10−3), a high number of supraventricular extrasystoles (P < 10−3, OR = 1.007), OG dilatation (P < 10−3, OR = 1.61) and diastolic dysfunction (P < 10−3, OR = 30.25). In multivariate analysis, p-wave dispersion (P < 10−3, OR = 57.77), number of SVSEs > 500/24 h (P < 10−3, OR = 185.83), and left atrial area > 20 cm2 (P < 10−3, OR = 74.7) appeared to be independent predictors of the occurrence of a subclinical AF episode. In this cohort of ESUS patients, several factors appeared to be predictive of subclinical AF. This result is consistent with the finding of several studies that the subgroup of ESUS patients with these factors appeared to benefit from probabilistic anticoagulation in preventing cerebral infarct recurrence.

Left atrial appendage occlusion combined with cryoballoon or radiofrequency ablation: One-year follow-up comparison.

A one-stop procedure involving catheter ablation and left atrial appendage occlusion (LAAO) is an option for high-risk atrial fibrillation patients. Few studies have reported the efficacy and safety of cryoballoon ablation (CBA) combined with LAAO, and no studies have compared the combination of LAAO with CBA or radiofrequency ablation (RFA). A total of 112 patients were enrolled in the present study; 45 patients received CBA combined with LAAO (group 1), and 67 patients received RFA combined with LAAO (group 2). Patient follow-up was performed for 1 year to detect peri-device leaks (PDLs) and safety outcomes (defined as a composite of peri-procedural and follow-up adverse events). The number of PDLs at the median 59 days follow-up was comparable between the two groups (33.3% in group 1 vs. 37.3% in group 2, p = 0.693). Safety outcomes were also comparable between the two groups (6.7% in group 1 vs. 7.5% in group 2, p = 1.000). Multivariable regression showed that PDLs risk and safety outcomes were all similar between the two groups. Subgroup analysis of PDLs indicated no significant differences. Follow-up safety outcomes were related to anticoagulant medication, and patients without PDLs were more likely to discontinue antithrombotic therapy. The total procedure and ablation times were all significantly shorter for group 1. When compared with left atrial appendage occlusion combined with radiofrequency, left atrial appendage occlusion combined with cryoballoon ablation has the same risk of peri-device leaks and safety outcomes, but the procedure time was significantly reduced.

Hypertension in peri- and postmenopausal women — pathophysiological mechanisms and approaches to treatment

This review presents epidemiological data on the effect of sex hormones and reproductive status on the level of blood pressure (BP) and the incidence of es­sential hypertension (EHT) in women. The role of estrogen deprivation and hyper­androgenism in the development of EHT in peri- and postmenopause is discussed. The main mechanisms of EHT in periand postmenopausal women: sympathetic and renin-angiotensin-aldosterone system hyperactivity, salt-sensitivity, high prevalence of abdominal obesity, metabolic syndrome, left ventricular hypertrophy, left atrial dilatation and high risk of atrial fibrillation, stroke and heart failure with preserved left ventricle ejection fraction. Data on the efficacy and tolerability of the main classes of antihypertensive drugs in women is presented. We discussed the mechanisms of selective I1-imidazoline receptor agonists and the results of cohort studies of moxonidine monotherapy and its combination with other antihypertensive drugs and hormonal menopausal therapy in peri- and post­menopausal women. Moxonidine reduces high blood pressure in peri- and postmenopausal women and has a beneficial effect on metabolic syndrome components, but is also effective in patients with hypertensive crises, especially with sympathetic hyperactivity.

Electrocardiographic Predictors of Atrial Fibrillation

Atrial fibrillation (AF) is the most common pathological arrhythmia, and its complications lead to significant morbidity and mortality. However, patients with AF can often go undetected, especially if they are asymptomatic or have a low burden of paroxysms. Identification of those at high risk of AF development may help refine screening and management strategies. PubMed and Embase databases were systematically searched for studies looking at electrocardiographic predictors of AF from inception to August 2021. A total of 115 studies were reported which examined a combination of atrial and ventricular parameters that could be electrocardiographic predictors of AF. Atrial predictors include conduction parameters, such as the PR interval, p-wave index and dispersion, and partial interatrial or advanced interatrial block, or morphological parameters, such as p-wave axis, amplitude and terminal force. Ventricular predictors include abnormalities in QRS amplitude, morphology or duration, QT interval duration, r-wave progression and ST segment, i.e., t-wave abnormalities. There has been significant interest in electrocardiographic prediction of AF, especially in populations at high risk of atrial AF, such as those with an embolic stroke of undetermined source. This review highlights the breadth of possible predictive parameters, and possible pathological bases for the predictive role of each parameter are proposed.

Association between sick sinus syndrome and atrial fibrillation: A systematic review and meta-analysis

AimsSick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and show a bidirectional relationship. This systematic review and meta-analysis aimed to decipher the precise relationship between SSS and AF, further exploring and comparing different therapy strategies on the occurrence or progression of AF in patients with SSS. Methods and resultsA systematic literature search was conducted until November 2022. A total of 35 articles with 37,550 patients were included. Patients with SSS were associated with new-onset AF compared to those without SSS. Catheter ablation was associated with a lower risk of AF recurrence, AF progression, all-cause mortality, stroke and hospitalization of heart failure compared to pacemaker therapy. Regarding the different pacing strategies for SSS, VVI/VVIR has higher risk of new-onset AF than DDD/DDDR. No significant difference was found between AAI/AAIR and DDD/DDDR, as well as between DDD/DDDR and minimal ventricular pacing (MVP) for AF recurrence. AAI/AAIR was associated with higher risk of all-cause mortality when compared to DDD/DDDR, but lower risk of cardiac death when compared to DDD/DDDR. Right atrial septum pacing was associated with a similar risk of new-onset AF or AF recurrence compared to right atrial appendage pacing. ConclusionSSS is associated with a higher risk of AF. For patients with both SSS and AF, catheter ablation should be considered. This meta-analysis re-emphasizes that high percentage of ventricular pacing should be avoided in patients with SSS in order to decrease AF burden and mortality.

The Use of Artificial Intelligence to Predict the Development of Atrial Fibrillation.

Atrial fibrillation (AF) is a major public health problem associated with preventable morbidity. Artificial intelligence (AI) is emerging as potential tool to prioritize individuals at increased risk for AF for preventive interventions. This review summarizes recent advances in the use of AI models to estimate AF risk. Several AI-enabled models have been recently developed which can discriminate AF risk with reasonable accuracy. AI models utilizing the electrocardiogram waveform appear to extract predictive information which is additive beyond traditional clinical risk factors. By identifying individuals at higher risk for AF, AI-based models may improve the efficiency of preventive efforts (e.g., screening, risk factor modification) intended to reduce risk of AF and associated morbidity.

Analysis of the Prevalence of Atrial Fibrillation and the Risk Factors in Hypertensive Population

Abstract Background To investigate the prevalence of atrial fibrillation in the hypertensive population and analyze its related factors to provide relevant scientific basis for the formulation of primary prevention of cardiovascular disease. Methods From March 2018 to August 2018, 14,268 residents were screened for physical examination and hypertension in Wuyuan district, Jiangxi Province, and collected information on demographic characteristics, life behavior patterns, personal disease history, and other information of survey subjects through questionnaire surveys. The central atrial fibrillation was determined by a 12-lead ECG examination and self-reported atrial fibrillation history. Logistic regression analysis model was used to analyze related factors of atrial fibrillation. Results Finally, 11,524 hypertensive patients were enrolled, aged (64.1 ± 9.8) years old, of which 5,542 were male. There were 388 patients with atrial fibrillation, aged (69.4 ± 9.6) years old, of which 180 were males. The prevalence of atrial fibrillation among hypertensive populations in Wuyuan district, Jiangxi Province was 3.37%, of which 3.00% were males and 3.75% were females. The prevalence of atrial fibrillation among hypertensive patients &amp;lt;45 years old is 1.70%, the prevalence rate of 45–65 years old is 1.89%, the prevalence rate of 65–75 years old is 4.18%, and the prevalence rate of ≥75 years old is 7.60%. The rate showed an upward trend with age (trend χ2 = 112.83, P &amp;lt; 0.001). The results of multivariate regression analysis showed that age, gender, length of sleep, low-density lipoprotein, blood pressure, and total bilirubin were independent risk factors for atrial fibrillation. Conclusions Age, gender, length of sleep, low-density lipoprotein, blood pressure level, and total bilirubin are related factors for the prevalence of atrial fibrillation in people with hypertension. Regular biochemical indicator monitoring should be conducted for key populations at high risk of atrial fibrillation. And actively carry out health education and intervention for high-risk groups of atrial fibrillation.

Association of accelerometer-derived circadian abnormalities and genetic risk with incidence of atrial fibrillation

Evidence suggests potential links between circadian rhythm and atrial fibrillation (AF). However, whether circadian disruption can predict the onset of AF in the general population remains largely unknown. We aim to investigate the association of accelerometer-measured circadian rest-activity rhythm (CRAR, the most prominent circadian rhythm in humans) with the risk of AF, and examine joint associations and potential interactions of CRAR and genetic susceptibility with AF incidence. We include 62,927 white British participants of UK Biobank without AF at baseline. CRAR characteristics, including amplitude (strength), acrophase (timing of peak activity), pseudo-F (robustness), and mesor (height), are derived by applying an extended cosine model. Genetic risk is assessed with polygenic risk scores. The outcome is the incidence of AF. During a median follow-up of 6.16 years, 1920 participants developed AF. Low amplitude [hazard ratio (HR): 1.41, 95% confidence interval (CI): 1.25–1.58], delayed acrophase (HR: 1.24, 95% CI: 1.10–1.39), and low mesor (HR: 1.36, 95% CI: 1.21–1.52), but not low pseudo-F, are significantly associated with a higher risk of AF. No significant interactions between CRAR characteristics and genetic risk are observed. Joint association analyses reveal that participants with unfavourable CRAR characteristics and high genetic risk yield the highest risk of incident AF. These associations are robust after controlling for multiple testing and in a series of sensitivity analyses. Accelerometer-measured CRAR abnormalities, characterized by decreased strength and height, and later timing of peak activity of circadian rhythm, are associated with a higher risk of AF in the general population.

Loss of a child and the risk of atrial fibrillation: a Danish population-based prospective cohort study

BackgroundSeveral studies suggest that bereavement is associated with increased risks of ischaemic heart disease, heart failure, stroke and cardiovascular mortality. Knowledge regarding the link between bereavement and the risk of...

Establishment and Verification of a Nomogram for Predicting the Probability of New-Onset Atrial Fibrillation After Dual-Chamber Pacemaker Implantation.

This study aims to establish and validate a nomogram as a predictive model in patients with new-onset atrial fibrillation (AF) after dual-chamber cardiac implantable electronic device (pacemaker) implantation. A total of 1120 Chinese patients with new-onset AF after pacemaker implantation were included in this retrospective study. Patients had AF of at least 180/minute lasting 5 minutes or longer, detected by atrial lead and recorded at least 3 months after implantation. Patients with previous atrial tachyarrhythmias before device implantation were excluded. A total of 276 patients were ultimately enrolled, with 51 patients in the AF group and 225 patients in the non-AF group. Least absolute shrinkage and selection operator (LASSO) method was used to determine the best predictors. Through multivariate logistic regression analysis, a nomogram was drawn as a predictive model. Concordance index, calibration plot, and decision curve analyses were applied to evaluate model discrimination, calibration, and clinical applicability. Internal verification was performed using a bootstrap method. The LASSO method regression analysis found that variables including peripheral arterial disease, atrial pacing-ventricular pacing of at least 50%, atrial sense-ventricular sense of at least 50%, increased left atrium diameter, and age were important predictors of developing AF. In multivariate logistic regression, peripheral arterial disease, atrial pacing-ventricular pacing of at least 50%, and age were found to be independent predictors of new-onset AF. This nomogram may help physicians identify patients at high risk of new-onset AF after pacemaker implantation at an early stage in a Chinese population.