In-hospital Atrial Fibrillation Research Articles

Stratification of arrhythmic risk in patients admitted for acute coronary syndrome: the role of the machine learning-derived PRAISE score

Abstract Funding Acknowledgements None. Background Patients with acute coronary syndrome (ACS) have a high arrhythmic burden, and either ventricular and supraventricular arrhythmias are very common during hospitalization[1]. Patients who develop arrhythmias show higher mortality and worse prognosis. The PRAISE (Prediction of Adverse Events Following an Acute Coronary Syndrome) score is a machine-learning based model for predicting 1-year all cause death, recurrent acute myocardial infarction and major bleedings in patients after ACS[2]. To date, its role to predict arrhythmic complications in ACS remains unknown. Purpose We hypothesized that patients with higher PRAISE score have a higher arrhythmic burden. Aim was to evaluate in a prospective protocol the PRAISE score capability for identifying patients with ACS at higher risk of arrhythmic complications during in-hospital stay. Methods A total of 365 consecutive patients admitted to our cardiac intensive care unit for ACS and undergoing percutaneous coronary intervention were enrolled. All patient was monitored by continuous electrocardiogram during hospitalization. The PRAISE score was obtained for each patient <24 hours from admission. Patients were divided into 2 groups based on the results of the PRAISE score for all-cause of death as patients without high PRAISE score (e.g. with low to intermediate risk, n=350) and patients with high PRAISE score (e.g. with high risk, n=15). The occurrence of atrial fibrillation (AF) and ventricular arrhythmias (VAs) up to discharge was recorded. AF was defined by detection of at least one episode of uncoordinated atrial electrical activation and irregular R-R intervals, in absence of distinct repeating P waves and with irregular atrial activations lasting at least 5 minutes. We considered as VAs all episodes of ventricular non-sustained tachycardia, sustained ventricular tachycardia and ventricular fibrillation. Results ROC curve analysis indicated a significant relationship between high PRAISE score and risk of both in-hospital AF (AUC 0.89, 95%CI 0.82-0.94, p=0.0001) and VAs (AUC 0.69, 95%CI 0.64-0.75, p=0.0001). A high PRAISE score had a specificity of 99% for AF and 92% for VAs. By Kaplan-Meier analysis, patients with high PRAISE score more frequently developed AF (30% vs 4% in those without high score; log rank p=0.00001) and VAs (77% vs 35%; log rank p=0.00001). Multivariate analysis showed that a high PRAISE score was an independent predictor of both AF (HR 4.08, 95%CI 1.14-14.58, p=0.030) and VAs (HR 2.36, 95%CI 1.08-5.14, p=0.030). Conclusions In patients hospitalized for ACS, the PRAISE score has a comprehensive capability to identify with high specificity those patients prone to develop arrhythmic events during hospitalization. This may be important in order to stratify patients with higher arrhythmic risk in whom individualized strategies may improve the clinical outcome.Baseline features of the populationKaplan-Meier anaysis

Atrial fibrillation incidence after coronary artery bypass graft surgery and percutaneous coronary intervention: the prospective AFAF cohort study

Objectives. Atrial fibrillation is a common arrhythmia in patients with ischemic heart disease. This study aimed to determine the cumulative incidence of new-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting surgery during 30 days of follow-up. Design. This was a prospective multi-center cohort study on atrial fibrillation incidence following percutaneous coronary intervention or coronary artery bypass grafting for stable angina or non-ST-elevation acute coronary syndrome. Heart rhythm was monitored for 30 days postoperatively by in-hospital telemetry and handheld thumb ECG recordings after discharge were performed. The primary endpoint was the cumulative incidence of atrial fibrillation 30 days after the index procedure. Results. In-hospital atrial fibrillation occurred in 60/123 (49%) coronary artery bypass graft and 0/123 percutaneous coronary intervention patients (p < .001). The cumulative incidence of atrial fibrillation after 30 days was 56% (69/123) of patients undergoing coronary artery bypass grafting and 2% (3/123) of patients undergoing percutaneous coronary intervention (p < .001). CABG was a strong predictor for atrial fibrillation compared to PCI (OR 80.2, 95% CI 18.1–354.9, p < .001). Thromboembolic stroke occurred in-hospital in one coronary artery bypass graft patient unrelated to atrial fibrillation, and at 30 days in two additional patients, one in each group. There was no mortality. Conclusion. New-onset atrial fibrillation during 30 days of follow-up was rare after percutaneous coronary intervention but common after coronary artery bypass grafting. A prolonged uninterrupted heart rhythm monitoring strategy identified additional patients in both groups with new-onset atrial fibrillation after discharge.

Early Clinical Outcomes and Advantages of a Novel-Size Adjustable Second-Generation Cryoballoon: A Proof-of-Concept Study.

(1) Background/Objective Balloon-guided catheter ablation (CA) has emerged as an alternative option for atrial fibrillation (AF) management. The recent introduction of a novel-size adjustable second-generation cryoballoon (CB) system offers innovations, but clinical outcomes remain unexplored. This study aims to assess the acute performance of the POLARx FIT™ CB system in AFCA. (2) Methods: Consecutive patients undergoing AF ablation with the POLARx FIT™ CB system in our center were included. The primary outcome was the rate of 31 mm balloon-size utilization, with secondary outcomes including acute pulmonary vein isolation (PVI) rate, periprocedural complications, and in-hospital AF recurrences. (3) Results: Twenty-four patients with a mean age of 59.5 years, predominantly male (87.5%), and exhibiting paroxysmal AF (91.7%) were enrolled. Procedural characteristics demonstrated a high acute success rate (100% PV isolation) with a favorable safety profile. Notably, the 31 mm CB configuration was utilized in 51% of applications, showcasing its adaptability in challenging anatomies. No major complications occurred, with two patients experiencing in-hospital self-limiting AF recurrences. (4) Conclusions: This study represents the first comprehensive assessment of the POLARx FIT™ CB system in AF ablation. While acknowledging the study's limitations, this novel CB emerges as a promising tool, warranting further exploration in larger studies with extended follow-up periods.

Predictors of Atrial Fibrillation Developing in Hospital Stage After Coronary Artery Bypass Surgery

Aim To identify independent predictors associated with in-hospital atrial fibrillation (AF) following coronary artery bypass grafting (CABG).Material and methods The study included 80 patients (88.75 % men) who had elective CABG surgery at the Sklifosovsky Research Institute of Emergency Medicine. Based on the development of AF during the hospital stage of treatment (up to 10 days after CABG surgery), patients were divided into two groups. The group with AF consisted of 19 patients, and the group without AF consisted of 61 patients. All patients underwent electrocardiography (ECG), transthoracic echocardiography (EchoCG) with calculation of the left ventricular (LV) geometry type, and assessment of operational indexes. During surgery, biopsy of a part of the right atrial (RA) appendage was taken from 61 patients to verify the severity of myocardial fibrosis on a four-score scale where 0 is no interstitial fibrosis, 1 is slight fibrosis, 2 is moderate fibrosis, and 3 is severe fibrosis.Results All included patients had a low risk of developing postoperative complications according to the EuroSCORE II scale. According to EchoCG data, patients with AF had significantly higher ratios of left ventricular myocardial mass to body surface area (LVMM / BSA) (p = 0.0006) and of left atrial volume to body surface area (LA volume / BSA), p = 0.008). The distribution of patients by type of LV geometry was as follows: in the group with AF, 52.63 % (n=10) of patients were diagnosed with concentric LV hypertrophy (LVH) whereas in the group without AF, the majority of patients (83.60 %, n=51) had normal LV geometry and concentric LV remodeling (LVR) (p&lt;0.0001). According to the results of histological study, patients of the AF group more frequently had moderate and severe interstitial fibrosis in the AF appendage (p = 0.003). After multivariate regression and ROC analysis, the predictive value remained for concentric LVH (p=0.002), LVMM / BSA ratio ≥97 g / m2 (p=0.006), LA volume / BSA ratio ≥ 34.4 ml / m2 (p=0.04), and for RA appendage interstitial fibrosis score ≥2 (p=0.004). Based on the identified predictors, a regression model was developed to predict the development of AF at the hospital stage after CABG (p&lt;0.0001). The sensitivity and specificity of the model were 86.67 % and 78.26 %, respectively.Conclusion In patients at low perioperative risk, the LVMM / BSA ratio ≥97 g / m2, the LA volume ratio / BSA ≥34.4 ml / m2, a RA appendage interstitial fibrosis score ≥2, and the presence of LVH were independent predictors of the development of AF at the hospital stage after CABG operation.Conclusion In patients at low perioperative risk, a LVMM / BSA ratio ≥97 g / m2, a LA volume / BSA ratio ≥34.4 ml / m2, a RA appendage interstitial fibrosis score ≥2, and the presence of LVH were independent predictors of the development of AF at the hospital stage after CABG.

Abstract 12823: As Anticoagulation Use Increases, Embolic Events Downtrend in Atrial Fibrillation Hospitalizations

Background: Direct oral anticoagulants and Left atrial appendage closure (LAAC) were approved for use in 2010 and 2015, respectively. Data on temporal changes in stroke prevention strategies and rates of embolic complications in atrial fibrillation (AF) in the 2010s decade are limited. Aims: Describe trends in long-term anticoagulation (AC), LAAC use, and in-hospital AF associated ischemic stroke (IS), transient ischemic attacks (TIA), and systemic embolic events (SEE) between 2010 and 2019. Methods: The national inpatient database was used to identify patients with AF from 2010 to 2019. Data were divided into 2 eras: 2010-2014 and 2015-2019. Results: A total of 40,787,136 inpatients with AF were identified: prevalence increased from 18,594,372 in 2010 to 2014 (46%; mean [SD] age 75.5 [12.0] years; 50.3% male) to 22,192,764 in 2015 to 2019 (54%; mean [SD] age 75.1 [11.8] years; 52.5% male). There was a marked increase in long-term AC use (27.2% to 40.2%; P=0.001) and rates of percutaneous LAAC procedures (0.01% to 0.6%; P &lt;0.001) from 2015 to 2019. IS rates among patients with AF increased from 2010 to 2014 (3.5% to 3.8%; P=0.04), with no significant temporal change from 2015 to 2019 (P=0.84). TIA rates declined from 2010 to 2014 (1.2% to 1.0%; P=0.017) and continued a downtrend from 2015 to 2019 (0.9% to 0.7%; P=0.002). There was no temporal change in SEE or the composite outcome of all embolic events from 2010 to 2014, followed by a decline from 2015 to 2019 in SEE (0.5% to 0.4%; P 0.012) and all embolic events (5.1% to 4.8%; P 0.026) ( Figure 1 ). Mean rates of major bleeding events increased from 5.7% in 2010-2014 to 9.1% in 2015-2019 (P &lt;0.001). Conclusion: In an inpatient AF population, the composite outcome of all embolic events and specifically SEE downtrend from 2015 to 2019, likely due to increased AC use. Further data assessing the risk-benefit ratio of available therapies for stroke prevention in inpatients with AF - AC and LAAC - are needed to optimize personalized strategies.

Ischaemic Supraventricular Tachycardia: A Rare Case Report

The incidence of supraventricular arrhythmias other than Atrial Fibrillation (AF) and atrial flutter in postmyocardial Infarction (MI) patients is usually rare. The incidence of in-hospital AF after MI ranges from 5%-18%. Paroxysmal Supraventricular Tachycardia (PSVT) occurs in less than 10% of patients after an acute MI. Herein, the authors presented a case of a 47-year-old male presented to the Casualty Department with chief complaints of palpitations for the past six hours. The Electrocardiogram (ECG) revealed Supraventricular Tachycardia (SVT), and immediate pharmacological cardioversion was performed. Coronary Angiogram (CAG) was conducted, which revealed double vessel disease with critical lesions in the proximal Right Coronary Artery (RCA) and mid Left Circumflex (LCX). Percutaneous coronary intervention was performed for both lesions. The patient was discharged in a stable condition. Prompt and immediate diagnosis of arrhythmias is crucial, especially in patients with MI, to reduce mortality and morbidity.

Atrial Fibrillation and Cardiovascular Risk Assessment among COVID-19 Patients Using Different Scores.

Since the advent of severe acute respiratory syndrome-coronavirus-2 in December 2019, millions of people have been infected and succumbed to death because of this deadly virus. Cardiovascular complications such as thromboembolism and arrhythmia are predominant causes of morbidity and mortality. Different scores previously used for atrial fibrillation (AF) identification or prediction of its complications were investigated by physicians to understand whether those scores can predict in-hospital mortality or AF among patients infected with the severe acute respiratory syndromecoronavirus-2 virus. Using such scores gives hope for early prediction of atrial arrhythmia and in-hospital mortality among coronavirus disease 2019-infected patients. We have discussed the mechanisms of AF and cardiovascular damage in coronavirus disease 2019 patients, different methods of AF prediction, and compared different scores for prediction of in-hospital mortality after this viral infection.

Automated deep learning quantification of epicardial adiposity on cardiac CT predicts atrial fibrillation risk immediately following cardiac surgery and long-term

Abstract Introduction Epicardial adipose tissue (EAT) is a visceral fat deposit within the pericardial sac which surrounds the heart myocardium and coronary arteries. The automated quantification of EAT volume is possible from routine CCTA scans via a deep-learning approach. The use of automated EAT quantification for the assessment of atrial fibrillation (AF) risk in the post-operative period, and longer-term, has not been previously investigated. Purpose To apply a deep-learning approach for automated segmentation of EAT from routine CCTA scans to assess the immediate post-operative and long-term risk of AF conveyed by EAT. Methods A deep-learning automated EAT segmentation tool using a 3D Residual-U-Net neural network architecture for 3D volumetric segmentation of CCTA data was created and trained on over 2800 consecutive CCTA performed as part of clinical care in patients with stable chest pain from 2015 onwards within the European arm of the Oxford Risk Factors And Non Invasive Imaging (ORFAN) Study. External validation in 817patients demonstrated excellent correlation between machine and human expert (CCC = 0.972). The prognostic value of deep-learning derived EAT volume was assessed in the AdipoRedOx Study (n=253; UK patients undergoing cardiac surgery) against both immediate in-hospital outcomes and longer-term outcomes from UK-wide NHS data, with adjustment for AF risk factors. Results There were 97 cases of new-onset AF in the immediate post-operative period (38.3%). EAT volume was found to be an independent predictor of post-operative AF regardless of body mass index. Utilising the median EAT volume as the cut point, the adjusted hazard ratio (HR [95% CI]) for risk of new-onset post-operative AF in-hospital was 1.56 [1.09–3.85], p&amp;lt;0.01 (Figure 1A). In receiver-operator characteristic analysis EAT volume added significant incremental prognostic power for the discrimination of in-hospital post-operative AF over a traditional risk factor model ΔAUC=0.101, p&amp;lt;0.01 (Figure 1B). Over a median follow-up period of 89 months there were 48 unique cases (19%) of confirmed AF found in nation-wide NHS hospital episode statistics data for the AdipoRedOx cohort. EAT volume was found to be a significant independent predictor of long-term AF. Utilising the median EAT volume as the cut point, the adjusted HR for risk of new-onset long-term AF following cardiac surgery was 1.25 [1.08–3.17], p&amp;lt;0.01 (Figure 1C). Conclusions Automatically segmented EAT volume measured using a deep learning network predicts risk of both short-term new onset AF following cardiac surgery, and long-term risk of AF in the 7 years following the surgery independently of BMI and AF risk factors. This suggests that EAT is a potent mediator of AF risk in the post cardiac surgery setting. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): British Heart Foundation - TG/19/2/34831EU Commission - 965286

Efficacy and Safety of Triiodothyronine Treatment in Cardiac Surgery or Cardiovascular Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Low levels of the active thyroid hormone triiodothyronine (T3) in cardiac patients are associated with worse outcomes. The aim of this analysis was to assess if T3 treatment is beneficial and safe in patients undergoing cardiac surgery or those with cardiovascular diseases in whom there is observed or expected reduction in serum T3 levels. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed as per the PRISMA guidelines. Pubmed, EMBASE, and Web of Science databases were searched for RCTs published between January 1, 1960 and March 30, 2022 that evaluated the effects of T3 therapy in patients undergoing cardiac surgery or with cardiovascular diseases. The primary outcomes were measures of cardiac function. Weighted mean difference (MD) or relative risk was calculated using a random effects model. PROSPERO registration number CRD42020211966. Results: Of the 3181 full-text articles screened, 34 studies with 2547 participants (number ranging between 13 and 223, mean ages between 0.5 and 73 years, mean percentage of women between 7% and 64%) were included. In 12 RCTs with 1093 adults undergoing cardiac surgery T3 therapy was associated with improvement in cardiac index (MD [95% confidence interval], 0.24 [0.08 to 0.40] L/min/m2, I2 = 74%). The quality of evidence was high to moderate. In 3 RCTs with 188 children undergoing cardiac surgery, 3 RCTs with 131 adult cardiac donors, 3 RCTs with 83 adult patients with heart failure, and 2 RCTs with 89 adults with acute myocardial infarction, T3 therapy did not improve cardiac index or left ventricular function; the quality of evidence ranged from high (pediatric cardiac surgery) to low (other groups). No detrimental effect of T3 therapy was observed on heart rate, risk of in-hospital atrial fibrillation, or mortality. Conclusions: Short-term T3 therapy is safe and trials in adults undergoing cardiac surgical procedures to evaluate longer term clinical endpoints are required. Current data do not support the routine use of T3 therapy in children undergoing cardiac surgery or in cardiac donors. Adequately designed trials are required to determine if T3 therapy improves cardiac function and clinical outcomes in patients with heart failure or acute myocardial infarction.

Prognostic value of plasma neutrophil gelatinase-associated lipocalin for cardiovascular events in patients with chronic heart failure and atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. We aimed to assess the prognostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL), a marker of renal tubular damage, in patients with heart failure with or without atrial fibrillation (AF). Methods The study involved 113 (83.2% men) patients with mean age 60.0 [54.0-67.0] years with II-IV functional class (recommendations of the New York Heart Association) is due to ischemic heart disease. Serum levels of NGAL were quantified by ELISA. Echocardiography was performed according to the American Society of Echocardiography/European Association of Echocardiography recommendations. Receiver operating characteristic (ROC) curve analysis was used to determine the best NGAL cut-off to predict events. Cox proportional hazards models were used to investigate the prospective association between NGAL and events during follow-up. Outcome was cumulative incidence of the primary endpoint (cardiovascular death, myocardial infarction, stroke, HF hospitalization) at 36 months. Results Median plasma NGAL in patients with and without AF was 34 (25-46) ng/ml and 26 (18-44) ng/ml, p&amp;lt;0.01, respectively. The ROC curve showed an optimal admission NGAL level cut-off &amp;gt;25.5 ng/mL, with 70% sensitivity and 89% specificity. The area under the ROC curve (AUC) was (0.814; p&amp;lt;0.01). In patients with CHF and atrial fibrillation multivariable analysis shows, that NGAL independently associated with outcomes (HR 2.35, 95% CI 1.2-4.61; p&amp;lt;0.01). Conclusions Admission plasma NGAL &amp;gt;25.5 ng/ml appears a sensible tool for in-hospital AF prediction as well as an marker for adverse cardiovascular outcome during long-term follow-up period.

Developing a Risk Prediction Model for Early Atrial Fibrillation Recurrence After Maze Procedure.

The efficiency of maze is a safe procedure in AF patients who underwent concomitant mitral valve surgery was more than 60%. The aim of this study was to define predictors of early AF recurrence after concomitant maze procedure with valvular surgery. In this retrospective study, 234 patients with AF underwent concomitant valvular replacement and maze procedure. Patients were classified into 2 groups of sinus and atrial fibrillation (AF). Baseline characteristics of patients were then compared between 2 groups. Totally, 234 patients were enrolled, 148 of which maintained sinus rhythm during hospitalization. Left atrial diameter and type of valvular surgery were similar in both groups. Age, number of replaced valves, concomitant coronary artery bypass grafting, and history of preoperative persistent AF and beta-blocker therapy were independent predictors of in-hospital AF recurrence. We used these variables to build a model to anticipate early AF recurrence. Being older, multivalvular surgery, and persistent preoperative AF were the predictors of higher risk of early recurrent AF, whereas concomitant coronary artery bypass grafting and using beta-blocker had a protective effect. This model based on preoperative and operative characteristics can help us to better evaluate if the patient benefits from maze procedure coincide with valvular surgery.

Utilization and in‐hospital complications of catheter ablation for atrial fibrillation in patients with obesity and morbid obesity

BackgroundReal‐world data on atrial fibrillation (AF) ablation outcomes in obese populations have remained scarce, especially the relationship between obesity and in‐hospital AF ablation outcome.HypothesisObesity is associated with higher complication rates and higher admission trend for AF ablation.MethodsWe drew data from the US National Inpatient Sample to identify patients who underwent AF ablation between 2005 and 2018. Sociodemographic and patients' characteristics data were collected, and the trend, incidence of catheter ablation complications and mortality were analyzed, and further stratified by obesity classification.ResultsA total of 153 429 patients who were hospitalized for AF ablation were estimated. Among these, 11 876 obese patients (95% confidence interval [CI]: 11 422–12 330) and 10 635 morbid obese patients (95% CI: 10 200–11 069) were observed. There was a substantial uptrend admission, up to fivefold, for AF ablation in all obese patients from 2005 to 2018 (p < .001). Morbidly obese patients were statistically younger, while coexisting comorbidities were substantially higher than both obese and nonobese patients (p < .01) Both obesity and morbid obesity were significantly associated with an increased risk of total bleeding, and vascular complications (p < .05). Only morbid obesity was significantly associated with an increased risk of ablation‐related complications, total infection, and pulmonary complications (p < .01). No difference in‐hospital mortality was observed among obese, morbidly obese, and nonobese patients.ConclusionOur study observed an uptrend in the admission of obese patients undergoing AF ablation from 2005 through 2018. Obesity was associated with higher ablation‐related complications, particularly those who were morbidly obese.

Effect of prior beta-blocker use on in-hospital atrial fibrillation development in patients with ST-elevation myocardial infarction

ABSTRACT Background and Aim There are conflicting results about the early administration of beta-blockers (bb) on in-hospital mortality and arrhythmias. Here, we wanted to investigate the effects of chronic bb use on in-hospital Atrial Fibrillation (AF) development in ST-Elevation Myocardial Infarction (STEMI) patients. Materials and Methods A total of 814 consecutive patients with STEMI were included in the study. They were divided into two groups according to whether they are using bb on admission or not. They were followed for AF development in-hospital and predictors of AF were determined by multivariable logistic regression analysis. Results Of the 814 patients, 103 (12.67%) patients were already using bb, while 711 (87.3%) were not. There were no significant differences in the frequency of AF development [3 (%2.9) vs 30 (%4.2), p = .788] between the groups. Multivariable logistic regression analysis showed that left atrial (LA) diameter is the only independent predictor of in-hospital AF development. Conclusions Our study showed that chronic bb use does not have an effect on in-hospital AF development in STEMI patients. Nevertheless, LA diameter was found to be an independent predictor of AF.

Temporal trends and in-hospital complications of catheter ablation for atrial fibrillation among patients with moderate and advanced chronic kidney diseases: 2005-2018.

Real-world data on atrial fibrillation (AF) ablation among moderate and advanced chronic kidney disease (CKD) patients have so far remained scarce, especially in-hospital AF ablation outcomes. We drew data from the US National Inpatient Sample to identify hospitalized patients who underwent AF ablation between 2005 and 2018, and further stratified by CKD classification. We assessed the trend of AF ablation, as well as its complications. A total of 152 630 patients who were primarily hospitalized for AF and underwent ablation were estimated. Among these, CKD patients were found in a total of 1509 participants, with 978, 206, and 325 under CKD3, CKD4, and CKD5/ESKD, respectively. There was a significant increment in admission rates for AF ablation in the CKD population across all CKD classifications (p < .001). All CKD patients were statistically older, with higher coexisting comorbidities, while hypertension was found substantially lower than non-CKD patients (p ≤ .001). Importantly, CKD, especially CKD3 and CKD5/ESKD, was significantly associated with an increased risk of total complications, and total bleeding, Neurological complications were found statistically lower in CKD patients (p = .029), and no mortality rates were significantly different (p = .287). Our study observed an increase in admission trends for AF ablation among moderate and advanced CKD patients from 2005 to 2018. CKD was strongly associated with higher procedure-related complications and bleeding, but neurological safety profiles and mortalities rates were nonsignificantly different.

Abstract 9142: Predictors of New-Onset Atrial Fibrillation in the Setting of Acute Coronary Syndromes: A Nationwide Multi-Center Study

Introduction: New-onset atrial fibrillation (AF) following acute myocardial infarction (AMI) is associated with adverse outcomes, though studies exploring the interaction between AF and the full spectrum of acute coronary syndromes (ACS) are scarce. We aim to identify predictors of new-onset AF in the setting of ACS by analyzing data from the prospective CONCORDANCE multi-center registry. Methods: Patients admitted to 41 Australian hospitals from 2009-2018 with ACS and had an angiogram were included. New-onset AF was defined as AF detected on index ECG and/or in-hospital AF. Independent predictors of new-onset AF were identified using multivariable logistic regression models. Results: Of 9070 consecutive patients admitted with ACS, 648 (7.1%) patients developed new-onset AF. These patients had higher rates of major adverse in-hospital events and all-cause mortality compared to patients without new-onset AF. Age (adjusted odds ratio [aOR] 1.04, 95% confidence interval [CI] 1.03-1.05), male sex (aOR 1.62, 95%CI 1.29-2.04), higher admission heart rate (aOR 1.02, 95%CI 1.01-1.02), cardiac arrest on admission (aOR 1.98, 95%CI 1.23-3.20), Killip classes 2 (aOR 1.38, 95%CI 1.10-1.73) and 3/4 (aOR 1.72, 95%CI 1.24-2.40) versus 1 were independent predictors of new-onset AF, whereas hypertension (aOR 0.81, 95%CI 0.67-0.99), higher minimum hemoglobin (aOR 0.98, 95%CI 0.97-0.98), pre-admission statins (aOR 0.71, 95%CI 0.56-0.89) and undergoing PCI (aOR 0.64, 95%CI 0.53-0.77) were associated with decreased risk of new-onset AF. When angiographic disease burden was included, double and triple-vessel disease were independent predictors of new-onset AF. However, sequential addition of CABG to the model nullified this association; (CABG (aOR 3.94, 95%CI 2.83-5.49), disease burden non-significant). In the CABG subgroup, peripheral arterial disease (aOR 1.98, 95%CI 1.20-3.27) was an independent predictor of new-onset AF (all p&lt;0.05). Conclusions: This present study identified patients at risk of new-onset AF in the setting of ACS. Such patients could be targeted for increased surveillance for AF and related adverse outcomes during the post-infarct period. In addition, future studies should explore strategies to prevent new-onset AF after ACS.

In-hospital complications in acute ST-elevation myocardial infarction depending on renal function.

To analyze in-hospital complications in patients with acute ST-elevation myocardial infarction (STEMI) depending on renal function. Observational study in patients with STEMI. The study included 169patients undergoing primary percutaneous coronary intervention. In all patients glomerular filtration rate (GRF) was calculated using the Modification of Diet in Renal Disease Study (MDRD) equation. Of these patients, 84had aGFR ≥ 90 ml/min/1.73 m2 (Group1) and 85 < 90 ml/min/1.73 m2 (Group2). Other parameters in both groups were comparable. Study groups were followed to compare Killip class > 2acute heart failure, in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation, new onset atrial fibrillation, and high grade atrioventricular block. All patients were treated according to European Society of Cardiology (ESC) guidelines for the management of acute myocardial infarction in patients presenting with ST elevation. Mean GFR in Group1 was 107.6 [Formula: see text] and in Group2 75.3 [Formula: see text] 11.2 (p < 0.0001). The incidence of atrial fibrillation was higher in Group2: in Group1 and Group2 the atrial fibrillation rate was 1.12% (one of 84) vs 8.24% (seven of 85) (p = 0.031), respectively. Group1 revealed significantly lower rates of acute heart failure (Killip class > 2): in Group1 and Group2 0% (0of 84patients) vs 5.88% (five of 85patients) (p = 0.024), respectively. The authors found no significant differences for other complications: in Group1 and Group2 ventricular tachycardia or ventricular fibrillation was 4.76% (four of 84patients) vs 5.89% (five of 85patients) (p = 0.75), high grade atrioventricular block was 2.38% (two of 84patients) vs 4.71% (four of 85patients) (p = 0.41), and the in-hospital pneumonia rate was 2.38% (two of 84patients) vs 4.71% (four of 85patients) (p = 0.41), respectively. Patients with lower GFR were more likely to suffer from in-hospital acute heart failure (Killip class > 2) and atrial fibrillation in STEMI despite primary percutaneous coronary intervention. Renal function did not affect in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation rates. The evaluation of kidney function through GFR in STEMI patients may make in-hospital complications more predictable.

Secundum atrial septal defects transcatheter closure versus surgery in adulthood: a 2000-2020 systematic review and meta-analysis of intrahospital outcomes.

Technologically, advances in both transcatheter and surgical techniques have been continuing in the past 20 years, but an updated comprehensive comparison in device-based versus surgery in adults in terms of incidence of in-hospital mortality, perioperative stroke, and atrial fibrillation onset is still lacking. We investigate the performance of transcatheter device-based closure compared to surgical techniques by a systematic review and meta-analysis of the last 20 years literature data. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature search was performed based on Cochrane Library, Embase, PubMed, and Google Scholar to locate articles published between January 2000 and October 2020, regarding the comparison between short-term outcome and post-procedural complications of atrial septal defect patients receiving transcatheter or surgical closure. The primary outcome was the comparison of in-hospital mortality from all causes between patients treated with transcatheter closure or cardiac. Secondary outcomes were the onset of post-procedural atrial fibrillation or perioperative stroke. A total of 2360 patients were included of which 1393 [mean age 47.6 years, 952 females (68.3%)] and 967 [mean age 40.3 years, 693 females (71.6%)] received a transcatheter device-based and surgery closure, respectively. In-hospital mortality [OR 0.16 (95% CI (0.66-0.44)), p = 0.0003, I2 = 0%], perioperative stroke [OR 0.51 (95% CI (0.31-0.84)), p = 0.003, I2 = 79%], and post-procedural atrial fibrillation [OR 0.14 (95% CI (0.03-0.61)), p = 0.009, I2 = 0%] significantly favoured transcatheter device-based closure. Transcatheter atrial septal defect closure resulted safer in terms of in-hospital mortality, perioperative stroke, and post-procedural atrial fibrillation compared to traditional surgery.

Different aspects of early and late development of atrial fibrillation during hospitalization in cryptogenic stroke

The detection of underlying atrial fibrillation (AF) has become increasingly possible by insertable cardiac monitoring (ICM). During hospitalization for cryptogenic stroke, factors related to the early and late development of AF have not been studied. CHALLENGE ESUS/CS is a multicenter registry of cryptogenic stroke patients undergoing transesophageal echocardiography. Twelve-lead electrocardiogram, continuous cardiac monitoring, and 24-h Holter electrocardiogram were all used for the detection of AF. Early and late detection of AF was determined with an allocation ratio of 1:1 among patients with AF. A total of 677 patients (68.7 ± 12.8 years; 455 men) were enrolled, and 64 patients developed AF during hospitalization. Four days after admission was identified as the approximate median day to classify early and late phases to detect AF: ≤ 4 days, 37 patients; > 4 days, 27 patients. Multiple logistic regression analysis showed that spontaneous echo contrast (SEC) (OR 5.91; 95% CI 2.19–15.97; p < 0.001) was associated with AF ≤ 4 days, whereas a large infarction > 3 cm in diameter (OR 3.28; 95% CI 1.35–7.97; p = 0.009) was associated with AF > 4 days. SEC and large infarctions were important predictors of in-hospital AF detection, particularly in the early and late stages, respectively; thus, they could serve as indications for recommending ICM.

Ten year experience with the concomitant Maze IV procedure for atrial fibrillation

Objective The Maze IV (M-IV) procedure is regarded as the golden standard in treatment for surgical ablation of atrial fibrillation (AF); however, long-term follow-up results are scarce. We present our institutional 10-year experience. Methods We collected data of 117 consecutive patients who have undergone a concomitant M-IV procedure between April 2006 and April 2016. Primary endpoints are freedom of atrial arrhythmias and freedom of atrial arrhythmias off antiarrhythmic drugs (AAD). Results Forty-seven patients (40.2%) had paroxysmal AF. Two-thirds of the procedures included mitral valve surgery. The average follow-up time per patient was 3.8 years (SD 2.8). Freedom of AF at 1 year was 79%, at 5 years freedom of AF was 69% and freedom of AF off AAD was 56%. Predictors of AF recurrence in multivariate analysis were age, preoperative pacemakers, redo cardiac surgery and in-hospital AF. Preoperative PVI ablation was found to be a protective factor. Conclusions The long-term outcomes of the M-IV procedure are good and remain stable over the years. Results could be improved if follow-up were to be intensified and recurrences dealt with aggressively. Key question: How many patients are free from AF in a 10-year period after concomitant M-IV surgical ablation? Key findings: In the long term around 70% of patients are free of AF with an increasing need for anti-arrhythmic drugs. Take home message: Early to midterm freedom from AF after concomitant M-IV procedure is high and remains stable after 3 years.

Diabetes and atrial fibrillation in hospitalized patients in the United States.

BackgroundData on the burden of atrial fibrillation (AF) associated with diabetes among hospitalized patients are scarce. We assessed the AF‐related hospitalizations trends in patients with diabetes, and compared AF outcomes in patients with diabetes to those without diabetes.HypothesisAF‐related health outcomes differ between patient with diabetes and without diabetes.MethodsUsing the National Inpatient Sample (NIS) 2004–2014, we studied trends in AF hospitalization rate among diabetic patients, and compared in‐hospital case fatality rate, length of stay (LOS), cost and utilization of rhythm control therapies, and 30‐day readmission rate between patients with and without diabetes. Logistic or Cox regression models were used to assess the differences in AF outcomes by diabetes status.ResultsOver the study period, there were 4 325 522 AF‐related hospitalizations, of which 1 075 770 (24.9%) had a diagnosis of diabetes. There was a temporal increase in AF hospitalization rate among diabetic patients (10.4 to 14.4 per 1000 hospitalizations among patients with diabetes; +4.4% yearly change, p‐trend < .0001). Among AF patients, those with diabetes had a lower in‐hospital mortality (adjusted odds ratio [aOR]: 0.68; 95% CI: 0.65–0.72) and LOS (aOR: 0.95; 95% CI: 0.94–0.96), but no difference in costs (aOR: 0.95; 95% CI: 0.94–0.96) and a higher 30‐day rate of readmissions compared with no diabetes (aHR 1.05; 95% CI: 1.01–1.08), compared to individuals without diabetes.ConclusionAF and diabetes coexist among hospitalized patients, with rising trends over the last decade. Diabetes is associated with lower rates in‐hospital adverse AF outcomes, but a higher 30‐day readmission risk.