History Of AbstractBackgroundAtrial Fibrillation Research Articles

Interventional rhythm control is associated with an improved long-term prognosis of patients with atrial fibrillation undergoing transcatheter edge-to-edge mitral valve repair

Abstract Background Atrial fibrillation (AF) is the most common concomitant disease in patients undergoing transcatheter edge-to-edge repair (TEER) for severe mitral regurgitation (MR) and detrimentally affects their long-term survival. While the prognostic improvement of catheter ablation (CA) of AF in the overall cohort of heart failure (HF) patients as well as that of surgical ablation of AF with concomitant MR surgery are well established, data on the outcomes of CA of AF in TEER patients are lacking. Methods In a multicenter retrospective observational cohort study, consecutive patients undergoing TEER were enrolled and long-term survival of patients receiving catheter ablation (CA) for AF was compared with that of patients on pharmacological AF treatment and with that of patients without a history of AF, using propensity score matching and multivariable Cox regression analyses. Results A total of 821 patients were identified who successfully underwent TEER procedure. Within this cohort, 608 (74.1%) had concomitant AF, of which 48 patients received CA. Patients with CA of AF showed significantly higher cumulative survival 5 years after the TEER procedure compared with propensity score-matched patients on pharmacological rhythm control of AF (64.6% [31/48] vs. 33.3% [64/192], p=0.01) or on rate control of AF (64.6% [31/48] vs. 25.0% [24/96], p=0.0015). Multivariable Cox regression analysis confirmed that CA of AF was independently associated with significantly better long-term outcome than pharmacological rhythm control and rate control of AF (hazard ratio [HR] 0.4, 95%-confidence interval [CI] 0.2-0.9, p=0.02 and HR 0.4, 95%-CI 0.2-0.7, p=0.004, respectively). CA even offsets the prognostic disadvantage of coexisting AF, as the cumulative survival 5 years after TEER intervention is not significantly different from propensity score-matched TEER patients without a history of AF (64.6% [31/48] vs. 38.9% [56/144], p=0.3). Conclusion Using established statistical methods of propensity score matching and multivariable Cox regression, we demonstrate a significantly improved long-term outcome of TEER patients undergoing CA of concomitant AF compared with pharmacological AF management. CA even offsets the prognostic disadvantage of coexisting AF, as the outcome is not significantly different from that of TEER patients without a history of AF. In light of the growing evidence of prognostic benefit and safety of CA of AF in the overall cohort of HF patients, our data, albeit not randomized, provide strong evidence for interventional rhythm control of AF as an essential part of a modern and holistic management of TEER patients. We alert to the importance of treating concomitant AF, as this is a very promising approach to improve the prognosis of this unique and continually growing HF population.Flow chart of the study designSurvival analyses of PSM cohorts

Atrial fibrillation diagnosed at different phases of myocardial infarction are all associated with excess risk

Abstract Background Atrial fibrillation (AF) in patients with myocardial infarction (MI) is associated with higher mortality and cardiovascular complications such as hospitalisation due to heart failure and ischaemic stroke. It is unknown whether the association with poor outcomes is general or specific for AF diagnosed before, at or during follow-up after an MI. Purpose The aim of this study was to investigate the occurrence of AF, and its clinical correlates at different stages in patients with acute MI. In addition, we also explored whether any association between AF and mortality, incident heart failure or stroke differed for AF diagnosed at these stages. Methods Patients attending cardiac rehabilitation after MI in Sweden 2006-2020 were identified in the Swedish registry for cardiac disease SWEDEHEART. The patients were divided into groups with sinus rhythm at hospitalisation and follow-up (reference group), AF at MI hospitalisation including prior and new-onset AF during MI hospitalisation, and late-onset AF diagnosed at cardiac rehabilitation follow-up visits during the first year post-MI. All patients were followed until 2020-12-31 and the groups were compared regarding overall mortality, hospitalisation due to heart failure, and stroke using log-rank test and Cox-regression adjusted for age in cubic splines and sex. Results Overall 104,325 patients (26% female) between 18-80 years old were investigated. 4731 patients presented with AF at admission for MI (4.5%) and 2,119 (2%) had a persistent AF at discharge. Out of these, 139 had new-onset AF at MI. STEMI was more common in patients with new onset AF compared to those with a history of AF before MI (40.3% vs 31.7%, p=0.013). During the one-year follow-up period after index MI 448 patients had a new-onset AF which was associated with older age, NSTEMI, reduced ejection fraction and more extensive coronary artery disease at the index MI. The association between AF diagnosed at the different phases of MI with outcomes are illustrated in figure 1. During a median follow-up of 7.0 years, patients with AF at MI had a higher mortality (33.3% vs 14.2%, p<0.001), more hospitalisations due to heart failure (25.6% vs 6.7%, p<0.001) and stroke (8.0% vs 3.9%, p<0.001) compared to patients with SR. Patients with new-onset AF at MI had a similar risk for these outcomes compared to patients with a history of AF at MI. Patients with late-onset AF during the one-year follow-up period after index MI also had higher mortality (28.3% vs 12.2%, p<0.001) and more hospitalisations for heart failure (21.9% vs 5.6%, p<0.001) but not stroke (4.2% vs 3.9%, ns) compared to patients that remained in SR. Conclusion In patients attending cardiac rehabilitation after MI, chronic AF, new-onset AF at MI and late-onset AF were associated with increased risk for mortality, heart failure hospitalisations and stroke. Hence, AF should be considered a severe risk factor in patients with MI irrespective of time of occurrence.AF at MI

The assessment of left atrial and left atrial appendage mechanics in patients with different stages of atrial fibrillation

Abstract Background Atrial fibrillation (AF) is associated with left atrial (LA) mechanical dysfunction, which predisposes to stasis of blood within the LA and thus increases the risk of stroke. However, limited is known about the mechanical functional alterations of left atrial appendage (LAA) in relation to stages of AF. Here, we sought to analyse LA and LAA mechanics during different stages of AF in detail. Methods A total of 92 patients with AF referring for radiofrequency ablation were consecutively enrolled. Patients were categorized according to rhythm and stages of AF:sustained AF(SAF) (n=31), paroxysmal AF with sinus rhythm(PAF-SR)(n=30) andAF rhythm(PAF-AF)(n=31)at the time of echocardiography. Twenty-seven patients without a history of AF were included as controls. Using speckle-tracking echocardiography, LA and LAA global peak positive longitudinal strain (GLS) and mechanical dispersion (MD) were measured in all patients. Mechanical dispersion was defined as the standard deviation of the time to peak of the regional strain corrected by R-R interval. Results Patients with PAF-AF and SAF displayed prominently impaired LA and LAA mechanics(all P < 0.01 vs. PAF-SR and no AF). In the presence of SR, only LAA mechanical function were lower in PAF patients than patients without AF(LAA GLS 20.5±5.7%(no AF) vs 15.9±5.4%(PAF-SR); LAA MD 6.9±3.8%(no AF) vs 9.4±3.9(PAF-SR),both P<0.01). AF stages were independent determinants of LA and LAA mechanics after adjusting for age and comobidities. Conclusions AF affected mechanical function of LA and LAA on their own, and more so if stage of AF has advanced to more persistent forms. In addition, LAA mechanical dysfunction occurred earlier than that of LA.fig 1fig 2

Fully automatic screening for atrial fibrillation using a photoplethysmography based wristband and a novel smart infrastructure

Abstract Background Atrial Fibrillation (AF) is the leading cause of stroke, and its prevalence is expected to rise. While early detection is crucial in preventing thromboembolic events, its often asymptomatic and paroxysmal nature makes it challenging to capture using conventional electrocardiography (ECG). Photoplethysmography (PPG) enabled devices, such as smartwatches, allow continuous monitoring of the heart rhythm and accurate screening for AF. Purpose In this study, we aimed to build an IT-infrastructure for fully automated screening of AF in hospitalised patients at risk using a PPG-based wrist worn wearable device. Methods We conducted an investigator-initiated, prospective, clinical trial to evaluate the performance of a PPG-based wristband coupled to an automatic data process device hub in hospitalised patients. Participants with a CHA2DS2-VASc score of two or higher and no prior history of AF were eligible for the study. Consenting participants received a wristband with a built-in PPG sensor to be worn during the entire hospital stay. Data from the wristband was automatically transmitted, stored, analysed and visualised. When absolute arrhythmia (AA) was detected in the PPG signal, a subsequent seven-day Holter ECG was performed to confirm the diagnosis. Results A total of 346 patients were included in the analysis (age 72 ± 10 years; 175 females (50.6%); mean CHA2DS2-VASc score of 3.5 ± 1.3). No data was lost in the process. The mean monitoring time was 4.3 ± 4.4 days, 45.9% was evaluable. In twelve patients (3.5%, CI: 1.5% - 5.4%) absolute arrhythmia (AA) was detected in the PPG-signal. The mean screening time until first detection of AA was 14.7 ± 16.8 hours. The highest detection rate was observed within the first 24 hours of screening (p = 0.004) (Figure 1). The AA burden per hour was 1.9 times greater during the night (22:00 - 06:00) compared to the day (p = 0.003) (Figure 2). Of the 346 patients, 304 (87.9%) were compliant in wearing the wristband for the entire hospitalisation. In nine patients a Holter ECG was recorded, no AF was identified. Conclusions We successfully established an infrastructure for automated AF screening in hospitalised patients using wrist-worn PPG devices, enabling real-time visualisation of incoming data and facilitating therapeutic interventions with minimal delay. To our knowledge this is the first hospital to implement a fully automated AF screening infrastructure based on PPG devices. In a population at risk, AA was identified in 3.5% of all patients. The high compliance rate of the wearable device further supports its feasibility and utility in clinical practice.Figure 1:Time to first detection of AAFigure 2:Total AA burden per hour

The impact of atrial fibrillation on prognosis in aortic stenosis.

Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and often coexist. Various studies have focused on the prognostic value of AF in patients with AS, but rarely considered left ventricular (LV) diastolic function as a prognostic factor. To evaluate the prognostic impact of AF in patients with AS while correcting for LV diastolic function. Patients with first diagnosis of significant AS were selected and stratified according to history of AF. The endpoint was all-cause mortality. In total, 2849 patients with significant AS (mean age 72±12years, 54.8%men) were evaluated, and 686 (24.1%) had a history of AF. During a median follow-up of 60 (30-97) months, 1182 (41.5%) patients died. Ten-year mortality rate in patients with AF was 46.8% compared to 36.8% in patients with sinus rhythm (SR) (log-rank P<0.001). On univariable (HR: 1.42; 95% CI: 1.25-1.62; P<0.001) and multivariable Cox regression analysis (HR: 1.19; 95% CI: 1.02-1.38; P=0.026), AF was independently associated with mortality. However, when correcting for indexed left atrial volume, E/e' or both, AF was no longer independently associated with all-cause mortality. Patients with significant AS and AF have a reduced survival as compared to patients with SR. Nonetheless, when correcting for markers of LV diastolic function, AF was not independently associated with outcomes in patients with significant AS.

The impact of atrial fibrillation on prognosis in aortic stenosis

Abstract Background Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and increasing with age. Various studies have focused on the complex relationship between these entities that frequently coexist. AS might induce adverse cardiac remodelling, which is associated with poor prognosis in severe AS. Left atrial remodelling, especially left atrial enlargement, is also an important risk factor for AF. Purpose To evaluate the additive prognostic value of AF besides markers of left atrial and left ventricular remodelling in patients with AS, irrespective of severity of AS and left ventricular ejection fraction (LVEF). Methods Patients with moderate and severe AS were selected and history of AF was assessed. Subgroups were defined according to LVEF (reduced (&amp;lt;50%) vs. preserved (≥50%)) and severity of AS (moderate vs. severe). The endpoint was all-cause mortality. Unadjusted Kaplan-Meier survival curves were plotted. Four multivariable Cox regression models were constructed. Results In total, 2849 patients with moderate and severe AS (mean age 72±12 years, 54.7% men) were evaluated of whom 686 (24.1%) had a history of AF. Regarding the defined subgroups, 1091 (38.3%) patients had severe AS and 2207 (77.5%) patients had preserved LVEF. During a median follow-up time of 60 months (interquartile range 30 to 97), 1182 (41.5%) patients died. Ten-year mortality rate in patients with AF was 46.8% compared with 36.8% in patients with sinus rhythm (SR) (Figure 1) (p&amp;lt;0.001). In subgroup analysis, patients with AF and severe AS, moderate AS or preserved LVEF had worse survival than those who maintained SR (p=0.015, p&amp;lt;0.001 and p&amp;lt;0.001 respectively). On univariable (HR: 1.42; 95% CI: 1.25 to 1.62; p&amp;lt;0.001) and multivariable Cox regression analysis (HR: 1.19; 95% CI: 1.02 to 1.38; p=0.026) adjusting for age, body mass index, hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, kidney function, New York Heart Association class, aortic valve replacement as a time-dependent covariate, left ventricular mass index, left ventricular end-diastolic volume index, LVEF, mean aortic valve gradient, tricuspid annular plane systolic excursion, AF is independently associated with mortality (Table 1; model 1). However, when correcting for LAVI, E/e' or both, AF is no longer independently associated with all-cause mortality (Table 1; model 2–4). Conclusion Patients with moderate or severe AS and AF have a significantly higher 10-year mortality rate than patients with SR. This finding is irrespective of AS severity and also apparent in the subgroup with preserved LVEF. Nonetheless, when correcting for markers of diastolic dysfunction, AF is not independently associated with outcome in patients with moderate or severe AS. Funding Acknowledgement Type of funding sources: None.

Predicting new-onset heart failure hospitalization of patients with atrial fibrillation: development and external validations of a risk score

Abstract Background Atrial fibrillation (AF) is a well-known risk factor for heart failure (HF), and HF development as a complication of AF is associated with a decline in the quality of life and poor prognosis. However, unlike thrombotic events, incidence of HF in patients with AF has not changed for decades, and a preventive strategy has yet to be developed. Purpose We sought to develop a risk model for new-onset HF admission in patients with AF and without a history of HF. Additionally, we attempted to externally validate the developed risk model. Methods We utilized two multicenter, prospective, observational registries of AF and analyzed the patients without a history of AF. One of which is defined as a derivation cohort, which included 2,857 patients, and the other is defined as a validation cohort, which included 2,516 patients. We developed a risk model by selecting variables with regularized regression and weighing coefficients by Cox regression analysis with the derivation cohort. The external validity was tested in the validation cohort. Results During the follow-up period, 148 patients (5.2%) in the derivation cohort and 104 patients (4.1%) in the validation cohort developed HF during the median follow-up period of 1,396 (interquartile range [IQR]: 1,078–1,820) days and 1,168 (IQR: 844–1,309) days, respectively. In the derivation cohort, four predictors (age, hemoglobin, serum creatinine, and log-transformed brain natriuretic peptide) were identified as potential risk factors for HF development. The developed risk model showed good discrimination and calibration in both the derivation (area under the curve [AUC], 0.77 [95% confidence interval (CI) 0.73–0.81]; Hosmer-Lemeshow test, P=0.257) and validation cohorts (AUC: 0.76 [95% CI 0.72–0.81]; Hosmer-Lemeshow test, P=0.475). Considering death not due to HF as a competing risk, the cumulative incidence curves for HF admission stratified by the risk score were generated, which showed higher HF hospitalization rate for the higher risk score categories. Conclusion The newly developed risk model with four readily available clinical characteristics and biomarkers performed well in the prediction of new-onset HF admission of patients with AF in both derivation and validation cohort. Funding Acknowledgement Type of funding sources: None.

Plasma amyloid-beta levels and risk of new-onset atrial fibrillation in the general population

Abstract Background Atrial fibrillation (AF) is a major health burden worldwide, with significant sex differences in epidemiology and risk factors. Amyloid-β40 (Aβ40) and Amyloid-β42 (Aβ42), the hallmark of cerebral amyloid angiopathy, have recently been linked to prevalence and prognosis of several cardiovascular outcomes including stroke and coronary heart disease. However, whether these biomarkers are associated with incident AF remains largely unknown. Purpose To investigate the associations between plasma concentrations of Aβ40 and Aβ42 with new-onset AF. Methods 4,134 participants without a history of AF at baseline (from 2002 to 2005) with qualified plasma samples in the Rotterdam Study were included in this study. AF was diagnosed by electrocardiograms, general practitioners' and hospital records. Cox proportional hazards regression models with natural cubic splines were used to assess the linear/nonlinear association between biomarkers and risk of new-onset AF. All models were adjusted for traditional cardiovascular risk factors. Results Mean age was 71.3±7.2 years and 2,383 (57.6%) were women. Median follow-up time was 9.2 years. In the fully adjusted model, higher levels of Aβ40 [hazard ratio, 95% confidence interval: 1.16 (1.05–1.28)] and Aβ42 [1.19 (1.09–1.31)], as well as Amyloid-β42 to β40 ratio (Aβ42/40) [1.09 (1.02–1.17)] were significantly associated with incident AF. The observed association between Aβ40 and AF attenuated after mutual adjustment for Aβ42 [1.05 (0.92–1.19)]. In addition, a J-shaped association was found between Aβ40 and AF with the lowest AF risk at Aβ40 values of 212.5 pg/ml. Conclusions Both Aβ40 and Aβ42 were independently significantly associated with new-onset AF in the general population independent of cardiovascular risk factors. Findings also suggest a stronger association between AF onset and Aβ42 and AF onset, compared to Aβ40. A nonlinear association was found between Aβ40 and AF, reflecting a substantially increased AF risk among participants with severely increased Aβ40 values. Funding Acknowledgement Type of funding sources: None.

High prevalence of deleterious variants in cardiomyopathy genes in patients with early onset atrial fibrillation

Abstract Background Atrial Fibrillation (AF) is a common cardiac arrhythmia associated with increased morbidity and mortality. AF has a significant heritable component and genome-wide association studies have associated numerous loci in the human genome with AF. The arrhythmia is relatively rare in younger individuals, but studies have shown that individuals with early-onset AF may harbour a considerable burden of pathogenic genetic variants. In recent years, the concept of atrial cardiomyopathy has emerged as a mechanism involved in AF pathogenesis. Genes well-known to be related to ventricular structure, including cardiomyopathies have now also been associated with AF. Purpose Using targeted genetic sequencing, this study aimed to elucidate the role of deleterious genetic variants in cardiomyopathy genes in early-onset AF, and provide new insights into AF pathogenesis. Methods We performed targeted genetic sequencing of 445 Danish individuals with onset of AF before age 40 years and no other cardiovascular co-morbidities, and of 387 controls with no history of AF. Based on guidelines for genetic testing for clinical use, we focused on 30 genes with well-established associations with dilated cardiomyopathy, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. We examined the prevalence of loss-of-function variants (defined as variants leading to premature stop-codon, frameshift or splice-site variants), as these are most likely to be disease-causing. We filtered for rare variants using a minor allele frequency &amp;lt;0.1%. The difference in prevalence in the two groups was analyzed using a logistic regression model. Results We found that 38 of the 445 early-onset AF patients carried loss-of-function variants in well-established cardiomyopathy genes. The prevalence of rare, loss-of-function variants was enriched in cases compared with controls (8.5%. vs. 1.0%, P=8.27x10–7). The variants were identified in eight different genes, with most rare variants found in the TTN gene (Table 1). In sensitivity analyses excluding TTN variants, we found that 12 individuals (∼2.7%) with AF harbored deleterious loss-of-function variants (P=0.0396). Conclusions Individuals with early onset of AF have a considerable burden of rare, deleterious variants in established cardiomyopathy genes. These new insights could help inform future recommendations for genetic testing and follow-up to detect early cardiomyopathy manifestations to prevent adverse outcomes in patients with early onset of AF. These findings support the presence of atrial cardiomyopathy. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Hallas-Møller emerging investigator grant, The Novo Nordisk Foundation (NNF: NNF17OC0031204)The John and Birthe Meyer Foundation

Ischemic stroke in patients with congenital heart disease and atrial fibrillation

Abstract Background Atrial fibrillation (AF) is one of the most common arrhythmias in patients with congenital heart disease (CHD). The risk of developing AF is more than 20 times higher in patients with CHD compared with non-CHD controls. However, while it is known that young non-CHD patients with AF have a low risk for ischemic stroke (IS), little is known about the risk for IS young CHD patients with AF. Purpose To investigate the risk of developing IS in younger patients with CHD and AF compared to non-CHD control patients with AF. Method Using data from the National Swedish Patient Register and Cause of Death register, all CHD and born in Sweden between 1970 and 2017 with history of AF were identified. The Swedish total population register was used to identify age and sex matched controls. Among the matched controls, non-CHD patients AF were identified and used as reference group. CHD and non-CHD patients were followed from onset of AF until index IS, death or end of study (31st December 2017). Cox proportional hazard regression model with hazard ratio (HR) and 95% confidence interval (CI) was used to estimate the risk of IS in CHD patients with AF compared with non-CHD controls with AF. Results A total of 951 CHD with AF and 606 non-CHD controls with AF were identified. With ages ranging from 0 to 47 years, the median age was 25.6 and 30.7 years for CHD and non-CHD respectively. In patients with CHD and AF, 2.9% of patients (n=28) developed IS during follow up (mean follow up 34 years, SD ± 11.2), compared 0.5% (n=3) in non-CHD controls with AF (mean follow up 37 years, SD ± 9.5 years). The unadjusted HR for IS in CHD patients with AF compared with non-CHD controls with AF was 4.61 (95% CI1.39–15.25). When adjusted for age, sex, hypertension and heart failure, the risk of IS was more than five times higher (HR 5.16, 95% CI 1.52–17.46) in CHD patients compared with non-CHD patients. The adjusted HR for developing IS in non-complex CHD with AF compared with matched controls was 4.56 (95% CI 1.00–20.79). For patients born 1970–1989 the HR of IS was 7.35 (95% CI 1.70–31.75). Conclusion In this nationwide, register-based cohort study, the absolute number of IS among younger CHD patients with AF was relatively low. However, the risk for developing IS was more than 5 times higher compared to non-CHD patients with AF; highlighting the need of stroke score models in younger population, particularly to CHD patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish state under an agreement between the Swedish government and city Councils

Effect of alirocumab on incidence of atrial fibrillation after acute coronary syndromes: insights from ODYSSEY OUTCOMES

Abstract Background Atrial fibrillation (AF) is a marker of risk in patients presenting with acute coronary syndromes (ACS). The potential effect of inhibiting proprotein convertase subtilisin/kexin type 9 (PCSK9) on the incidence of AF is unknown. Methods The ODYSSEY OUTCOMES trial compared randomized treatment with the PCSK9 inhibitor alirocumab or placebo in patients with recent ACS and residual dyslipidaemia despite optimal statin therapy. The current analysis determined: 1) whether alirocumab treatment influenced incident AF; 2) whether a history of AF influenced the risk of major adverse cardiovascular events (MACE); and 3) whether there was interaction between AF at baseline and randomized treatment on MACE. AF was determined from the medical history and investigator reports of adverse events. Results Of 18,924 participants, 662 (3.5%) had a history of AF at randomization and 18,262 (96.5%) had no history of AF. Of the latter category, 499 (2.7%) had incident AF. Older age, randomization in South America or Eastern Europe, history of heart failure or myocardial infarction, and higher body mass index were factors associated with incident AF. Treatment with alirocumab or placebo did not influence incident AF (2.2% vs 2.6%, respectively; hazard ratio 0.90, 95% confidence interval 0.75–1.08; Figure). Patients with a history of AF had a greater burden of comorbidities, including cerebrovascular disease, peripheral artery disease, hypertension and heart failure; they also had higher rates of MACE (Table). There was no significant interaction between AF and randomized treatment on risk of MACE (P interaction=0.78) Conclusions Although treatment with alirocumab did not significantly modify the risk of incident AF after ACS in this analysis, future studies with more sensitive and systematic methods of ascertainment may be warranted. History of AF is a strong predictor of risk of recurrent MACE after ACS. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Sanofi, Regeneron Pharmaceuticals, Inc

Differential impact of adiposity on risk of atrial fibrillation in men and women in UK Biobank

Abstract Background Atrial fibrillation (AF) and obesity are common conditions with important health implications. Greater adiposity has been associated with higher risk of AF. However, body fat distribution differs between sexes, and the independent effects of different adiposity measures on AF risk remain unclear. Purpose To establish the independent effects of general and central adiposity on risk of incident AF in men and women. Methods UK Biobank is a prospective study involving 502,536 adults (aged 40–69). Participants underwent an extensive baseline interview and physical assessment (including bio-impedance measurements). Incident AF cases were identified by linkage to national hospital statistics and death registry data. Cox regression models adjusted for age, sex, ethnicity, deprivation, smoking and alcohol, were used to estimate effects of general adiposity (body mass index [BMI] and body fat mass), central adiposity (waist circumference [WC]), and lean mass, on risk of incident AF (per sex-specific standard deviation [SD]). Results Among 477,918 participants (mean age 56.4 years, SD 8.1; 45% men) with no history of AF, mean BMI was similar in women (27.0kg/m2, SD 5.0) and men (27.8kg/m2, SD 4.1). Conversely, mean WC was lower in women (84.5cm, SD 12.3) than men (96.8cm, SD 11.0), while mean body fat mass was higher in women (26.9kg, SD 9.8) than men (22.2kg, SD 8.0). A total of 14,362 incident AF events were identified (5,254 in women, 9,108 in men) over 8.1 years median follow-up. AF was positively associated with adiposity. A 1-SD higher BMI, equivalent to 4.6kg/m2, and a 1-SD higher WC, equivalent to 11.7cm, were each associated with &amp;gt;30% higher risks of AF (hazard ratio [HR] BMI 1.32 [95% CI 1.30–1.34]; WC 1.37 [1.35–1.39]), and showed no sex differences. Lean mass was also strongly associated with AF (1.41 [1.39–1.43]), and similar between sexes. In contrast, a 1-SD higher body fat mass, equivalent to 9.0kg, was associated with a 34% higher risk of AF overall (1.34 [1.32–1.36]), but had a stronger effect in women (1.41 [1.38–1.45]) than men (1.30 [1.28–1.33]), p-interaction 1x10–6; albeit effects were comparable per kg). After adjustment for body fat mass and lean mass, WC remained positively associated with AF overall (1.19 [1.15–1.23]) and in both sexes (1.14 [1.09–1.20] in women, 1.21 [1.17–1.26] in men). However, following adjustment for lean mass and WC, body fat mass remained positively associated with AF (1.09 [1.06–1.12]) overall, and in women (1.19 [1.14–1.26]) but was almost completely attenuated in men (1.04 [1.01–1.08]), p-interaction 0.004 (Figure). Associations were not materially changed by further adjustment for height, or by excluding those with prior vascular disease. Conclusions Central adiposity is strongly and independently associated with AF in both sexes. Conversely, general adiposity is independently associated with risk of AF in women but not men. Suggesting the impact fat distribution on AF risk differs by sex. Fat mass, waist circumference &amp; AF risk Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Non-invasive mid-term ECG monitoring for the detection of atrial fibrillation in an outpatient population

Abstract Background Atrial fibrillation (AF) is a common arrhythmia with significant morbidity due to an increased risk of ischemic stroke. Outpatient electrocardiogram (ECG) monitoring is an integral part of the diagnosis of AF. Conventional 24 hour Holter monitoring can be cumbersome and often fails to diagnose patients with paroxysmal AF. Spyder ECG is a non-invasive ECG monitoring device that allows wireless transmission of ECG information for analysis. It is small and comfortable, allowing for easy application for the screening and detection of AF over a mid-term duration. Purpose This study aims to evaluate the incidence of AF in patients with no prior AF and CHADsVASC score of at least 1 with the use of the Spyder ECG mid-term ECG monitoring device. Methods Patients aged 21 to 85 years old with no prior history of AF and CHADsVASC score of at least 1 were recruited from outpatient clinics of 3 large tertiary hospitals in Singapore from December 2016 to April 2019. Patients wore the Spyder ECG device for up to 2 weeks, during which continuous ECG information was uploaded onto a central cloud database and analysed. Results There were 363 patients recruited. The mean age was 61±10.0 years and 65.1% were male. There were 80.3% Chinese, 11.6% Malay, 7.5% Indian and 20.6% of other races. 68.3% of the patients were non-smokers and 74.0% of them were non-alcohol drinkers. The mean BMI of 25.5±4.7 kg/m2. The patient population had significant co-morbidities. 76.3% of the patients had hypertension, 69.4% of them had hyperlipidemia and 40.5% of them had diabetes mellitus. 10.0% of them had congestive cardiac failure and 56.7% had ischaemic heart disease. 11.3% of patients had a previous stroke and 20.4% had a prior myocardial infarction. 7.8% of the patients had asthma, 5.8% of them had thyroid disease and 9.9% of them had chronic kidney disease. They were monitored for a mean of 5.4±2.9 days each. There were 15 (4.1%) patients in whom AF was detected. The patients with AF wore the device for a mean of 5.7±2.0 SD days. The mean burden of AF was 9.0% of monitored time. 46.7% of the patients with AF had detection of AF on the first day, 26.7% on the second day, 13.3% on the third day and 13.3% on the seventh day. The mean duration of the first episode of AF was 251±325 minutes. 7 out of 15 (46.7%) of patients had first episodes of AF lasting less than 10 minutes. Conclusion Continuous mid-term ECG monitoring was able to detect AF in 15 (4.1%) of a population of 363 patients with no prior AF and CHADsVASC score of at least one, monitored for a mean of 5.4 days. Most episodes (53.3%) of AF were detected after the first day of ECG monitoring. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Duke-NUS Medical School Singapore

Frequency of de novo atrial fibrillation in patients presenting with acute ischemic cerebrovascular stroke

BackgroundAtrial fibrillation (AF) affects millions of people worldwide and can remain undiagnosed for years. It is a major cause of cerebrovascular stroke (CVS); hence, early detection is extremely important in order to decrease the risk of CVS. We conducted a retrospective observational study looking into the prevalence of silent AF in 3299 patients admitted from January 2014 to December 2017 in a tertiary care stroke specialized center. Ischemic CVS was confirmed either by using multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) of the brain. AF was diagnosed by electrocardiography (ECG) at the time of admission or during the hospital stay. Patients with a history of AF were excluded from the study.ResultsOf the 3299 patients admitted by acute ischemic CVS, 707 (21.43%) had a history of AF and thus were excluded from the study. Of the remaining 2592 patients eligible for the study, 1666 (64.27%) were males with a mean age of 56.06 years (± 16.01). A total of 2313 (89.24%) patients remained in sinus rhythm throughout the hospital stay, 211 (8.14%) patients were in AF on admission, and 68 (2.62 %) patients developed AF during their hospital stay. The total number of newly diagnosed patients with AF was 279 (10.76%).ConclusionThe prevalence of de novo atrial fibrillation in patients presented with acute cerebrovascular stroke is high. The implementation of good screening programs can significantly reduce the risk of disabilities and morbidities.

Prognostic factors of atrial fibrillation following elective coronary artery bypass grafting: the impact of quantified intraoperative myocardial ischemia

BackgroundAtrial fibrillation (AF) occurs in 28-33% of the patients undergoing coronary artery revascularization (CABG). This study focuses on both pre- and peri-operative factors that may affect the occurrence of AF. The aim is to identify those patients at higher risk to develop AF after CABG.Patients and methodsTwo patient cohorts undergoing CABG were retrospectively studied. The first group (group A) consisted of 157 patients presenting AF after elective CABG. The second group (group B) consisted of 191 patients without AF postoperatively.ResultsPreoperative factors presenting significant correlation with the incidence of post-operative AF included: 1) age > 65 years (p = 0.029), 2) history of AF (p = 0.022), 3) chronic obstructive pulmonary disease (p = 0.008), 4) left ventricular dysfunction with ejection fraction < 40% (p = 0.015) and 5) proximal lesion of the right coronary artery (p = 0.023). The intraoperative factors that appeared to have significant correlation with the occurrence of postoperative AF were: 1) CPB-time > 120 minutes (p = 0.011), 2) myocardial ischemia index < 0.27 ml.m2/Kg.min (p = 0.011), 3) total positive fluid-balance during ICU-stay (p < 0.001), 4) FiO2/PO2 > 0, 4 after extubation and during the ICU-stay (p = 0.021), 5) inotropic support with doses 15-30 μg/Kg/min (p = 0.016), 6) long ICU-stay recovery for any reason (p < 0.001) and perioperative myocardial infarction (p < 0.001).ConclusionsOur results suggest that the incidence of post-CABG atrial fibrillation can be predicted by specific preoperative and intraoperative measures. The intraoperative myocardial ischemia can be sufficiently quantified by the myocardial ischemia index. For those patients at risk we would suggest an early postoperative precautionary anti-arrhythmic treatment.