Impact Of New-onset Atrial Fibrillation Research Articles

Prognostic impact of new-onset atrial fibrillation in myocardial infarction with and without improved ejection fraction.

Improvement in left ventricular ejection fraction (impEF) often presents in contemporary acute myocardial infarction (AMI) patients. New-onset atrial fibrillation (NOAF) during AMI is an important predictor of subsequential heart failure (HF), while its impact on the trajectory of post-MI left ventricular ejection fraction (LVEF) and prognostic implication in patients with and without impEF remains undetermined. We aimed to investigate the prognostic impacts of NOAF in AMI patients with and without impEF. Consecutive AMI patients without a prior history of AF between February 2014 and March 2018 with baseline LVEF≤40% and had ≥1 LVEF measurement after baseline were included. ImpEF was defined as a baseline LVEF≤40% and a re-evaluation showed both LVEF>40% and an absolute increase of LVEF≥10%. Persistently reduced EF (prEF) was defined as the second measurement of LVEF either ≤40% or an absolute increase of LVEF<10%. The primary endpoint was a major adverse cardiac event (MACE) that was composed of cardiovascular death and HF hospitalization. Cox regression analysis and competing risk analysis were performed to assess the association of post-MI NOAF with MACE. Among 293 patients (mean age: 66.6±11.3years, 79.2% of males), 145 (49.5%) had impEF and 67 (22.9%) developed NOAF. Higher heart rate (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.73-0.97; P=0.015), prior MI (OR: 0.25, 95% CI: 0.09-0.69; P=0.008), and STEMI (OR: 0.40, 95% CI: 0.21-0.77; P=0.006) were independent predictors of post-MI impEF. Within up to 5years of follow-up, there were 22 (15.2%) and 53 (35.8%) MACE in patients with impEF and prEF, respectively. NOAF was an independent predictor of MACE in patients with impEF (hazard ratio [HR]: 7.34, 95% CI: 2.49-21.59; P<0.001) but not in those with prEF (HR: 0.78, 95% CI: 0.39-1.55; P=0.483) after multivariable adjustment. Similar results were obtained when accounting for the competing risk of all-cause death (subdistribution HR and 95% CIs in impEF and prEF were 6.47 [2.32-18.09] and 0.79 [0.39-1.61], respectively). The NOAF was associated with an increased risk of cardiovascular outcomes in AMI patients with impEF.

Impact of new-onset atrial fibrillation on the incidence of tricuspid regurgitation: a call to attention.

Impact of new-onset atrial fibrillation on the incidence of tricuspid regurgitation: a call to attention.

Clinical Outcomes in Hospitalized Patients with Cancer and New versus Preexistent Atrial Fibrillation.

There is limited information on the prognostic impact of new onset versus preexistent atrial fibrillation (AF) in hospitalized patients with cancer. We sought to determine the clinical impact of new onset AF (NOAF) compared with preexistent AF in hospitalized patients with cancer. All patients with cancer hospitalized over the course of one year with clinically manifest new or preexistent AF were enrolled in the Memorial Sloan Kettering Cancer Center (MSKCC) AF registry. The relationship of NOAF to the primary composite outcome of all cause death, cardiovascular (CV) rehospitalization or cerebrovascular event (CVE), as well as secondary CV endpoints, were analyzed using proportional hazards regression. Where applicable, the competing risk of death was accounted for using methodology described by Fine and Gray. Among 606 patients included in the analysis, 313 (51.7%) had NOAF and 293 (48.3%) had preexistent AF. Patients with NOAF were younger and had less frequent prior history of CV disease compared with patients with preexistent AF. At follow up, patients with NOAF had a higher adjusted hazard for the primary composite outcome versus patients with prior AF (HR 1.64, 95% CI 1.27, 2.13, p=0.002), as well as the secondary CV composite outcome of clinical AF recurrence, CV death, CV rehospitalization or CVE (HR 2.17, 95% CI 1.57, 2.99, P<0.0001). In hospitalized patients with cancer and electrocardiographically manifest new versus preexistent AF, NOAF was associated with a higher risk for the primary composite outcome of all-cause death, CV rehospitalization or CVE.

Abstract 17542: Impact of New-Onset Atrial Fibrillation Detected by Cardiac Implantable Electronic Devices on Embolic Stroke Events

Background: The association between atrial fibrillation (AF) detected by implanted cardiac implantable electronic devices (CIEDs) and the incidence of embolic stroke has been reported. However, the cut-off value of new-onset AF duration detected by CIEDs for embolic stroke is still unknown. In previous studies regarding the cut-off value of AF duration, patients who had a history of AF or had received anticoagulant therapies were also included. Therefore, the solo effect of AF on the risk of embolic stroke cannot be reliably evaluated on these studies. The aim of this study is to identify the incidence of embolic stroke in Japanese patients with a CIED and examine the cut-off value of AF duration detected by CIEDs as a risk factor for embolic stroke. Methods: We retrospectively analyzed the database of our CIEDs clinic. Every 6 months, AF events were checked by CIEDs. Patients who had a history of AF or had received anticoagulant therapies before and after a CIED implantation were excluded. We examined the characteristics and incidence of embolic stroke and investigated the relationship between new-onset AF detected by CIEDs and the incidence of embolic stroke. Results: We enrolled 710 consecutive patients who were followed-up at our CIED clinic. We excluded 360 patients who had a history of AF or had received anticoagulant therapies. Finally, 350 patients (follow-up period, 75±58 months; age, 70±16 years) were included in this study. During the follow-up period, 24 patients (6.9%) had embolic stroke. Receiver-operating characteristic curve analysis confirmed that 30 seconds was the best cut-off value of AF duration detected by CIEDs for embolic stroke (AUC = 0.72). Multivariate analysis demonstrated that independent predictors for embolic stroke were left atrial diameter ≥40mm (p=0.019), new-onset AF ≥ 30 seconds (p = 0.0016). Conclusion: AF episodes lasting for ≥ 30 seconds was the risk factor of embolic stroke. We should evaluate AF burden carefully in this population.

Prognostic Impact of New-Onset Atrial Fibrillation After Single or Double Stent Left Main Bifurcation PCI.

Incidence and prognostic value of new-onset atrial fibrillation after single versus double stent strategy in bifurcation left main disease has not been yet investigated. We retrospectively analyzed the procedural and medical data of patients referred to our center for complex left main bifurcation disease, treated using crossover provisional stenting, T or T-and-Protrusion, Culotte, and Nano-inverted-T techniques between January 1, 2008, and May 1, 2018. Multivariate Cox-regression analysis was used to assess the role of different stent strategies, adjusted for confounders, on the risk of new-onset atrial fibrillation during the follow-up period. Five hundred two patients (316 males, mean age 70.3 ± 12.8 years, mean Syntax score 31.6 ± 6.3) were evaluated. At a mean follow-up of 37.1 ± 10.8 months (range: 22.1- 39.3 months); Target lesion failure rate was 10.1%. Stent thrombosis and cardiovascular mor- tality were observed in 1.2% and 3.6% in of cases, respectively. New-onset atrial fibrillation occurred in 23 out of 502 patients (4.6%). Patients with new-onset atrial fibrillation resulted more frequently female, older, obese, and diabetic and more frequently experienced target lesion failure and cardiovascular death. New-onset atrial fibrillation-free survival favored single versus double stent technique and among double stent techniques nano-inverted-T tech- niques compared to the others. Single stent strategy had a lower risk of new-onset atrial fibril- lation compared to double stent technique on multivariate analysis (Hazard Ratio (HR): 1.14, 95% CI: 1.10-1.19, P < .001 vs. HR: 1.28, 95% CI: 1.23-1.32, P < .0001). New-onset atrial fibrillation in distal left main bifurcation disease treated with per- cutaneous coronary intervention had a low incidence but resulted more frequently after double than after single stenting technique and was associated with worse outcomes.

Long-term prognostic impact of new-onset atrial fibrillation in patients with preserved and mildly reduced ejection fraction following myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background/aim It is well known that atrial fibrillation (AF) significantly increases risk of short- and long-term mortality in patients with ST-elevation myocardial infarction (STEMI), especially in those with reduced left ventricular ejection fraction (EF), but its prognostic impact in patients with STEMI and preserved or mildly reduced EF is not well defined. The aim of this study was to analyse the prognostic impact of new-onset AF on long-term mortality in patients with preserved and mildly reduced EF after STEMI. Method we included 1874 consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI). New-onset AF was defined as electrocardiographic or monitoring evidence of a AF lasting at least 30 seconds in patients with no medical history of previous AF. Echocardiographic examination was performed before discharge, EF was calculated using bi-plane method. Preserved EF was defined as ≥50% and midly reduced EF was defined as EF 41-49%. Patients with cardiogenic shock at admission and patients with previous AF of any form (paroxysmal, persistent or permanent) were excluded. The follow-up period was 6 years. Results Among all analysed patients 491 (26.6%) patients were women and 1375 (73.4%) were men. The median age of all analysed patients was 58 (IQR 46, 69) years and median EF was 52% (IQR 45%, 57%). New-onset AF was registered in 78 (4.2%) patients. Among them 27 (34.6%) patients had AF at admission and 51 (65.4%) patients develop AF later at a median time 4 (IQR 1, 25) hours. Median duration of AF was 17 (IQR 6, 25) hours. All of the analyzed patients with new-onset AF were converted into sinus rhythm with medication (amiodarone) or they converted spontaneously upon myocardial revascularization. As compared with patients without AF, those with AF were older and presented more often with Killip class II and III; they had lower systolic blood pressure and creatinine clearance at admission; they had more often 3-vessel coronary artery disease (at initial angiogram), preprocedural flow TIMI=0 and postprocedural flow TIMI&amp;lt;3. EF values were similar among patients with and without AF 50% (IQR 44%, 55%) and 51% (IQR 45%, 55%) respectively, p=0.93. Six-year mortality was significantly higher in patients with new-onset AF as compared with patients without AF (14.1% vs 2.6%, respectively, p&amp;lt;0.001) as shown in Figure 1. In Cox regression model new-onset AF was an independent predictor of 6-year mortality–HR 4.53 (95% CI 2.29-8.94), p&amp;lt;0.001. Other independent predictors for 6-year mortality were older age, Killip class II and III at admission and baseline creatinine clearance &amp;lt;60ml/min/m2. Conclusion New-onset AF was a strong indepedent predictor for 6-year mortality in analyzed patients with preserved and mildly reduced EF after STEMI.

Prognostic Significance of New-Onset Atrial Fibrillation in Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction Following Acute Myocardial Infarction: Data from the NOAFCAMI-SH Registry.

PurposeThe prognostic impact of new-onset atrial fibrillation (NOAF) among different heart failure (HF) subtypes including HF with preserved (HFpEF, ejection fraction [EF] ≥50%), mid-range (HFmrEF, EF 40%~49%), and reduced (HFrEF, EF <40%) EF following acute myocardial infarction (AMI) remains unclear. We aimed to investigate the incidence and prognostic implication of post-MI NOAF across HF subtypes.Patients and MethodsWe included 1413 patients with post-MI HF (743 with HFpEF, 342 with HFmrEF and 328 with HFrEF) between February 2014 and March 2018. NOAF was considered as patients without a preexisting AF who developed AF during the AMI hospitalization. The primary endpoint was all-cause mortality.ResultsOf 1413 patients (mean age 66.8 ± 12.6 years, 72.9% men) analyzed, 200 (14.2%) developed post-MI NOAF. Patients with HFrEF were more likely to experience NOAF compared to those with HFmrEF or HFrEF (18.9%, 13.7% and 12.2% in HFrEF, HFmrEF and HFpEF, respectively; p for trend = 0.006). During a median follow-up of 28.5 months, 192 patients died (70 with HFrEF, 35 with HFmrEF and 87 with HFpEF) and 195 patients experienced HF rehospitalization (79 with HFrEF, 37 with HFmrEF and 79 with HFpEF). After multivariable adjustment, NOAF was independently associated with all-cause mortality (hazard ratio [HR]: 1.79, 95% confidence interval [CI]: 1.03–3.12) only in the HFrEF group compared to sinus rhythm (SR), whereas an increased risk of HF rehospitalization was found in all HF subtypes, particularly in HFmrEF (HR: 5.08, 95% CI: 2.29–11.25) and HFpEF (HR: 2.83 95% CI: 1.64–4.90).ConclusionIn patients with post-MI HF, NOAF carried a worse prognosis for all-cause death in the HFrEF group and for HF rehospitalization in all HF subtypes.

Abstract 12634: Impact of New-Onset Atrial Fibrillation (NOAF) versus Pre-Existing Atrial Fibrillation on Outcomes After Transcatheter Aortic Valve Replacement/Implantation (TAVR/TAVI)

Background: Aortic stenosis patients who undergo Transcatheter Aortic Valve Replacement/Transcatheter Aortic Valve Implantation (TAVR/TAVI) experience a high incidence of pre-existing atrial fibrillation and new-onset atrial fibrillation (NOAF) post-operatively. We aim to update current evidence concerning the incidence of 30-day mortality, stroke, acute kidney injury, length of stay, and early/late bleeding in TAVR/TAVI with NOAF or pre-existing atrial fibrillation (preAF). Methods: We searched Pubmed, Google Scholar, JSTOR, Cochrane Library and Web of Science for studies published between January 2012 and December 2020 that reported the association between NOAF/preAF and clinical complications after TAVR/TAVI. Relevant studies were included in our systematic review and meta-analysis. Our primary clinical outcomes included 30-day mortality, stroke, early bleeding, and late bleeding. The secondary clinical outcomes included acute kidney injury and extended length of stay. Results: We included 15 studies based on 158,220 TAVI/TAVR adult patients (&gt;18 years of age) with NOAF or preAF. Compared to patients in sinus rhythm, TAVR/TAVI patients who developed NOAF had higher risk of 30-day mortality, acute kidney injury, early bleeding events, extended length of stay and stroke (OR: 3.18 [95% CI 1.58, 6.40]) (OR: 3.83 [95% CI 1.18, 12.42]) (OR: 1.70 [95% CI 1.05, 2.74]) (OR: 13.96 [95% CI, 6.41, 30.40]) (OR: 2.51 [95% CI 1.59, 3.97], respectively). Compared to patients in sinus rhythm, TAVR/TAVI patients with pre-AF had higher risk of acute kidney injury and early bleeding episodes (OR: 2.43 [95% CI 1.10, 5.35]) (OR: 17.41 [95% CI 6.49, 46.68], respectively). Pre-AF was not associated with an increase in 30-day mortality, late bleeding, stroke, and length of stay after TAVR/TAVI. Conclusions: The findings of our meta-analysis showed that atrial fibrillation (AF) was associated with higher risk of all primary and secondary outcomes. Specifically, NOAF but not pre-AF was associated with higher risk of 30-day mortality, stroke, and extended length of stay in TAVR/TAVI patients.

Gender Differences in the Impact of New-Onset Atrial Fibrillation on Long-Term Risk of Ischemic Stroke after Acute Myocardial Infarction.

Background: Atrial fibrillation (AF) has been identified as a major risk factor for mortality after acute coronary syndrome (ACS). However, the long-term risk of ischemic stroke associated with new-onset atrial fibrillation (NOAF) in ACS remains controversial, and its gender-specific association is unknown. Methods: We analyzed the data of 10,137 ACS survivors included in a multicenter, prospective registry for Korean patients with acute myocardial infarction (AMI) between January 2004 and August 2014. Subjects were categorized into three groups (non-AF vs. NOAF vs. previous AF) based on medical history and electrocardiographic evidence of AF, either at admission or during hospitalization. Results: Among the total study population (72.3% men), 370 patients (3.6%) had NOAF and 130 (1.3%) had previous AF. During a median follow-up of 61 months (interquartile range, 38.8 to 89.3 months), 245 (2.4%) patients (218 (2.3%) non-AF vs. 15 (4.1%) NOAF vs. 12 (9.2%) previous AF, p < 0.001) experienced ischemic stroke. After adjustment for confounding variables, both NOAF (adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09–3.24, p = 0.024) and previous AF (adjusted HR 4.00, 95% CI 2.03–7.87, p < 0.001), along with older age, diabetes, current smoker, and previous stroke were independent risk factors of ischemic stroke. In the gender-stratified analysis, men with previous AF but not NOAF had a significantly higher risk of ischemic stroke (adjusted HR 4.14, 95% CI 1.79–9.55, p = 0.001) than those without AF. In women, NOAF (adjusted HR 2.54, 95% CI 1.21–5.35, p = 0.014) as well as previous AF (adjusted HR 3.72, 95% CI 1.16–11.96, p = 0.028) was a strong predictor of ischemic stroke, and the predictive value was comparable to that of previous AF among patients with a CHA2DS2-VASc score ≥ 2. Conclusions: Both NOAF and previous AF were associated with ischemic stroke after AMI, but the impact of NOAF as a risk factor of ischemic stroke was significant only in women.

Rhythm outcomes after aortic valve surgery: Treatment and evolution of new-onset atrial fibrillation.

BackgroundThe impact of new‐onset atrial fibrillation (AF) after aortic valve (AV) surgery on mid‐ and long‐term outcomes is under debate. Here, we sought to follow up heart rhythms after AV surgery, and to evaluate the mid‐term prognosis and effectiveness of treatment for patients with new‐onset AF.MethodsThis single‐center cohort study included 978 consecutive patients (median age, 59 years; male, 68.5%) who underwent surgical AV procedures between 2017 and 2018. All patients with postoperative new‐onset AF were treated with Class III antiarrhythmic drugs with or without electrical cardioversion (rhythm control). Status of survival, stroke, and rhythm outcomes were collected and compared between patients with and without new‐onset AF.ResultsNew‐onset AF was detected in 256 (26.2%) patients. For them, postoperative survival was comparable with those without new‐onset AF (1‐year: 96.1% vs. 99.3%; adjusted P = .30), but rate of stroke was significantly higher (1‐year: 4.0% vs. 2.2%; adjusted P = .020). With rhythm control management, the 3‐month and 1‐year rates of paroxysmal or persistent AF between patients with and without new‐onset AF were 5.1% versus 1.3% and 7.5% versus 2.1%, respectively (both P < .001). Multivariate models showed that advanced age, impaired ejection fraction, new‐onset AF and discontinuation of beta‐blockers were predictors of AF at 1 year.ConclusionsIn most cases, new‐onset AF after AV surgery could be effectively converted and suppressed by rhythm control therapy. Nevertheless, new‐onset AF predisposed patients to higher risks of stroke and AF within 1 year, for whom prophylactic procedures and continuous beta‐blockers could be beneficial.

Incidence and Prognostic Impact of New-Onset Atrial Fibrillation in Patients with Severe Covid-19: A Retrospective Cohort Study.

Corona virus disease 2019 (COVID-19) contributes to cardiovascular complications including arrhythmias due to high inflammatory surge. Nevertheless, the common types of arrhythmia amongst severe COVID-19 is not well described. New onset atrial fibrillation(NOAF) is frequentlyseen in critically ill patients and therefore we aim to assess the incidence of NOAF in severe COVID -19and its association with prognosis. This is a retrospective multicentre study including 109 consecutive patients admitted to intensive care units (ICU) with confirmed COVID-19 pneumonia and definitive outcome (death or discharge). The study period was between 11th March and 5th May 2020. Median age of our population was 59 years (IQR 53-65) and 83% were men. Nearly three-fourth of the population had two or more comorbidities. 14.6% developed NOAF during ICU stay with increased risk amongst older age and with underlying chronic heart failure and chronic kidney disease. NOAF developed earlier during the course of severe COVID-19 infection amongst non-survivors than those survived the illness andstrongly associated with increased in-hospital death (OR 5.4; 95% CI 1.7-17; p=0.004). In our cohort with severe COVID-19, the incidence of new onset atrial fibrillation is comparatively lower than patients treated in ICU with severe sepsis in general. Presence of NOAF has shown to be a poor prognostic marker in this disease entity.

Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry

Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization. Methods This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics. Results A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p&amp;lt;0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p&amp;lt;0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p&amp;lt;0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008). Conclusion NOAF complicating AMI is strongly associated with an increased long-term risk of heart. Cumulative incidence of outcome Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai

Incidence, Risk Factors and Subsequent Prognostic Impact of New-Onset Atrial Fibrillation in Infective Endocarditis.

Few studies with a large sample size have been performed to evaluate the incidence, risk factors and prognostic value of new-onset atrial fibrillation (AF) in patients with infective endocarditis (IE).Methods and Results:A total of 1,063 IE patients were included and 83 developed new AF. Compared with no-AF, the incidence of in-hospital death (6.0% vs. 22.9%, P<0.001) was higher in patients with new-onset AF. New-onset AF was independently associated with increased risk of in-hospital (adjusted odds ratio [OR]=3.92, P=0.001) and 1-year death (adjusted hazard ratio=2.91, P=0.001), while prior AF was not an independent factor. Kaplan-Meier curve analysis demonstrated new-onset AF mainly affected short-term death (180 days). Age (OR=1.04, P<0.001), rheumatic heart disease (OR=1.88, P=0.022), NYHA Class III or IV (OR=2.09, P=0.003), and left atrial diameter (LAD; OR=1.05, P=0.006) were independent risk factors for development of new AF. New-onset AF, not prior AF, was a prognostic factor in IE patients, which was mainly associated with increased risk of short-term death. Patients with concomitant rheumatic heart disease, poor cardiac function, and larger LAD had higher risk of developing new AF.

Prognostic impact of new-onset atrial fibrillation associated with worsening heart failure in aging patients with severely decompensated acute heart failure

BackgroundsThe prevalence of atrial fibrillation (AF) has been increasing in aging societies. The prognostic impact of AF associated with worsening heart failure (HF) remains obscure. Methods and resultsWe analyzed 1170 acute heart failure (AHF) patients who required intensive care. Patients were assigned to two groups according to the prevalence of AF: no episode of AF (n = 940) and pre-existing AF (Group-1, n = 230). Patients with no episode of AF (n = 940) were further divided into two groups according to presence of new-onset of AF after admission (Group-2a, n = 258) or not (Group-2b, n = 682). Kaplan-Meier curve analysis showed that prognosis, including all-cause mortality and HF-events within 1000 days, was significantly poorer in the Group-1 compared to the Group-2b. However, a multivariate Cox regression model showed that the Group-1 was not an independent predictor of 1000-day mortality and HF-events. Furthermore, Kaplan-Meier curve analysis showed that prognosis, including all-cause mortality and HF-events within 1000 days, was significantly poorer in the Group-2a than in the Group-2b. A multivariate Cox regression model revealed that the Group-2a was an independent predictor of 1000-day mortality (HR: 1.403, 95% CI: 1.018–1.934) and HF-events (HR: 1.352, 95% CI: 1.071–1.708). A multivariate logistic regression model showed that only age (≥75 years old) was independently associated with new-onset of AF after admission (odds ratio: 1.556, 95% CI: 1.130–2.143). ConclusionsNew-onset AF associated with worsening HF increases with age and is independently-associated with adverse outcome in patients with AHF.

Incidence, Predictors, Management, and Clinical Significance of New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Implantation

There is limited information on the incidence, management, and prognostic impact of new-onset atrial fibrillation (NOAF) following transcatheter aortic valve implantation (TAVI) for severe aortic valve stenosis. In the prospective ASAN-TAVI registry, we evaluated a total of 347 consecutive patients who underwent TAVI from March 2010 to August 2017. The primary end point was a composite of stroke or systemic embolism at 12 months. The study subjects were categorized into 3 groups; pre-existing AF (50 patients), NOAF (31 patients), and non-AF (266 patients) group. NOAF developed in 10.4% of patients without pre-existing AF after TAVI and most cases were paroxysmal type (93.6%). Pharmacologic and electrical cardioversion were tried in 13 (41.9%) and 6 (19.4%) patients and success rates were 61.5% and 33.3%, respectively. NOAF-associated case rate for primary end point was 22.6%. Transfemoral access and cardiac tamponade were independent predictors of NOAF. Patients with NOAF, as compared with those with pre-existing AF and those without AF, had an increased 1-year rate of primary end point (24.0% vs 9.9% vs 7.2%, respectively; p <0.001). By multivariable analysis, NOAF was an independent predictor of 1-year rate of primary end point (adjusted hazard ratio: 3.31; 95% CI: 1.34 to 8.20; p = 0.010). In conclusion, patients with severe aortic valve stenosis who underwent TAVI, NOAF occurred in 10% and 1 of 4 NOAF patients experienced stroke or systemic embolization. The presence of NOAF was associated with a substantially higher risk of stroke or systemic embolization.

New-Onset Atrial Fibrillation in St-Segment Elevation Myocardial Infarction: Predictors and Impact on Therapy And Mortality.

BackgrundNew-onset atrial fibrillation complicating acute myocardial infarction represents an important challenge, with prognostic significance.ObjectiveTo study the incidence, impact on therapy and mortality, and to identify predictors of development of new-onset atrial fibrillation during hospital stay for ST-segment elevation myocardial infarction.MethodsWe studied all patients with ST-elevation myocardial infarction included consecutively, between 2010 and 2017, in a Portuguese national registry and compared two groups: 1 - no atrial fibrillation and 2 - new-onset atrial fibrillation. We adjusted a logistic regression model data analysis to assess the impact of new-onset atrial fibrillation on in-hospital mortality and to identify independent predictors of its development. A p value < 0.05 was considered significant.ResultsWe studied 6325 patients, and new-onset atrial fibrillation was found in 365 (5.8%). Reperfusion was successfully accomplished in both groups with no difference regarding type of reperfusion. In group 2, therapy with beta-blockers and angiotensin-conversion enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) was less frequent, 20.6% received anticoagulation at discharge and 16.1% were on triple therapy. New-onset atrial fibrillation was associated with more in-hospital complications and mortality. However, it was not found as an independent predictor of in-hospital mortality. We identified age, prior stroke, inferior myocardial infarction and complete atrioventricular block as independent predictors of new-onset atrial fibrillation.ConclusionNew-onset atrial fibrillation remains a frequent complication of myocardial infarction and is associated with higher rate of complications and in-hospital mortality. Age, prior stroke, inferior myocardial infarction and complete atrioventricular block were independent predictors of new onset atrial fibrillation. Only 36.7% of the patients received anticoagulation at discharge.

New-onset atrial fibrillation after PCI and CABG for left main disease: insights from the EXCEL trial and additional studies.

To provide an up-to-date review of recent trials examining the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) and the impact of postprocedural NOAF compared to nonsurgical atrial fibrillation. A recent analysis from the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that NOAF is much more frequent following surgical compared with percutaneous revascularization for LMCAD, and is strongly associated with an increased 3-year risk of mortality and stroke. In a recent Danish registry-based, propensity score-matched analysis, postsurgical NOAF conferred a lower risk of adverse outcomes compared with nonsurgical nonvalvular atrial fibrillation. These new studies confirm that although postsurgical NOAF after left main revascularization may be of less clinical significance than nonvalvular atrial fibrillation, its occurrence still is strongly associated with subsequent stroke and mortality. Future efforts are warranted to prevent postsurgical NOAF and determine strategies for its optimal management should it occur.

New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial

BackgroundThere is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). ObjectivesThis study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes. MethodsIn the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. ResultsAmong 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p < 0.0001). Older age, greater body mass index, and reduced left ventricular ejection fraction were independent predictors of NOAF in patients undergoing CABG. Patients with versus without NOAF had a significantly longer duration of hospitalization, were more likely to be discharged on anticoagulant therapy, and had an increased 30-day rate of Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs. 5.5%; p < 0.0001). By multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (6.6% vs. 2.4%; adjusted hazard ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; p = 0.001), death (11.4% vs. 4.3%; adjusted HR: 3.02; 95% CI: 1.60 to 5.70; p = 0.0006), and the primary composite endpoint of death, MI, or stroke (22.6% vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; p = 0.0004). ConclusionsIn patients with LMCAD undergoing revascularization in the EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)

TCT-80 Incidence, Predictors, and Outcomes of New-Onset Atrial Fibrillation and Flutter After PCI or CABG for Left Main Disease: Analysis From the EXCEL Trial

There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation or flutter (NOAF) following PCI or CABG for left main coronary artery disease (LMCAD). In the EXCEL trial, 1905 pts with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with

The impact of new-onset atrial fibrillation on short- and long-term outcomes after esophagectomy for esophageal cancer.

183 Background: AF is common after thoracic and esophageal surgical procedures. The full spectrum of risk factors, associations, and implications are unclear. Objective:The aim of this study was to assess the impact of new-onset atrial fibrillation (AF) after esophagectomy on short- and long-term outcome. Methods: A retrospective analysis was performed on patients with esophageal cancer who underwent esophagectomy with thoracotomy and laparotomy, with R0 or R1 resection between January 1997 and December 2012. For the 402 patients included in this study, we analyzed the stage of disease, neoadjuvant therapies, surgical approaches, surgical complications, postoperative medical complications, and overall and relapse-free survivals using medical records. Results: The median age was 62 (range 34-82). Most patients were male (90.0%) and had squamous cell carcinoma (90.3%). Pathological staging of the esophageal cancers according to UICC 7th TNM classification system was categorized as follows: 17 (4.2%), 96 (23.9%), 16 (4.0%), 43 (10.7%), 57 (14.2%), 78 (19.4%), 39 (9.7%), 37 (9.2%), and 19 (4.7%) patients were designated as stage 0, ⅠA, ⅠB, ⅡA, ⅡB, ⅢA, ⅢB, ⅢC and Ⅳ respectively. Of the 402 patients studied, 42 (10.6%) had AF, 87 (21.6%) had pneumonia, 80 (20.0%) had anastomotic leakage, and 69 (17.2%) had recurrent laryngeal nerve paralysis. At a median follow-up of 133 months, the median survival was 49 months, and 5-year survival was 48% in the AF group, compared with 138 months and 60% in the non-AF group (p = 0.212). AF was significantly associated with recurrent laryngeal nerve paralysis (p = 0.001), but not with pneumonia or anastomotic leakage. Conclusions: New-onset AF is common, mostly associated with recurrent laryngeal nerve paralysis, but not with pneumonia or anastomotic leakage. AF has no impact on oncologic outcomes.