Increased Prevalence Of Atrial Fibrillation Research Articles

S-04-5: AUTOMATED DETECTION OF ATRIAL FIBRILLATION DURING ROUTINE OSCILLOMETRIC MEASUREMENT OF BLOOD PRESSURE: SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Efficient screening strategies are necessary for detecting atrial fibrillation (AF) aiming at stroke prevention. In 2013 the UK National Institute for Health and Care Excellence recommended opportunistic AF screening during routine office blood pressure (BP) measurement using an automated monitor with high diagnostic accuracy. This systematic review and meta-analysis evaluated the current evidence on the diagnostic accuracy of AF detection technologies implemented in automated devices for office, home, and ambulatory BP measurement. Design and method: A systematic PubMed search was conducted using the algorithm: “atrial fibrillation” AND (“blood pressure” OR “blood pressure monitor” OR “blood pressure device” OR “blood pressure measurement”) AND (detect∗ OR screen∗), until May 2022. Results: Initial search retrieved 423 articles of which 37 were relevant and 17 were included in meta-analysis. Three studies (n = 1465, weighted age 77.8 years, males 51%, AF prevalence 10.4%) evaluated the diagnostic accuracy of office BP monitors. Meta-analysis showed pooled sensitivity, specificity, and accuracy: 94% (95% CI 88–98%), 94% (89–98), and 94% (89–97), respectively. Eleven studies (n = 8343, weighted age 66.7 years, males 47%, AF prevalence 7%) evaluated the diagnostic accuracy of home BP monitors. Pooled sensitivity, specificity and accuracy were 98% (93–100%), 94% (90–97) and 95% (91–97), respectively. Three studies (n = 238, weighted age 68.0 years, males 62%, AF prevalence 12%) evaluated the diagnostic accuracy of ambulatory BP monitors. Pooled sensitivity, specificity and accuracy were 94% (81–100%), 82% (77–87) and 83% (78–88), respectively. Simultaneous (or shortly before/after BP measurement) 12- or single-lead electrocardiography (ECG) was used as reference method in studies evaluating office/home BP monitors. For ambulatory BP monitors, two studies used 24h-continuous ECG Holter monitoring and one study used pacemaker recordings (implanted for sick sinus syndrome). Analysis per individual was performed for the evaluation of office and home BP monitors (an individual was considered as AF positive if the majority of BP readings indicated AF, e.g., 2 of 3). For ambulatory BP monitors, analysis per reading was performed (vs. simultaneous ECG trace). With increasing AF prevalence across studies, meta-regression analysis showed higher positive predictive value and a trend towards lower negative predictive value. Conclusions: There is considerable evidence that AF detection during routine automated BP measurement in elderly people using office, home, or ambulatory BP monitors has high diagnostic accuracy. AF screening in the elderly during routine office and out-of-office BP measurement is feasible and can increase early detection of asymptomatic AF.

Development of a Care Pathway for Atrial Fibrillation Patients in the Emergency Department.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence is continuously increasing in the United States, leading to a progressive rise in the number of disease-related emergency department (ED) visits and hospitalizations. Although optimal long-term outpatient management for AF is well defined, the guidelines for optimal ED management of acute AF episodes is less clear. Studies have demonstrated that discharging patients with AF from the ED after acute stabilization is both safe and cost effective; however, the majority of these patients in the United States and in our institution are admitted to the hospital. To improve care of these patients, we established a multidisciplinary collaboration to develop an evidence-based systematic approach for the treatment and management of AF in the ED, that led to the creation of the University of California-Cardioversion, Anticoagulation, Rate Control, Expedited Follow-up/Education Atrial Fibrillation Pathway. Our pathway focuses on the acute stabilization of AF, adherence to best practices for anticoagulation, and reduction in unnecessary admissions through discharge from the ED with expedited outpatient follow-up whenever safe. A novel aspect of our pathway is that it is primarily driven by the ED physicians, while other published protocols primarily involve consulting cardiologists to guide management in the ED. Our protocol is very pertinent considering the current trend toward increased AF prevalence in the United States, coupled with a need for widespread implementation of strategies aimed at improving management of these patients while safely reducing hospital admissions and the economic burden of AF.

Safety and feasibility of same-day discharge following catheter ablation of atrial fibrillation: what is known and what needs to be explored?

Catheter ablation of atrial fibrillation (AF) is the most effective rhythm control strategy and its role in the treatment of AF patients has been strengthened by recent guidelines. An increasing AF prevalence and the resulting demands on interventional electrophysiology call for improved resource allocation through both technical innovations and streamlined workflows and patient pathways. Same-day discharge is already established in the context of other electrophysiological interventions; however, its broad implementation in the practice of AF ablation is pending for several reasons, despite the fact that the body of evidence is growing and the majority of reports propagate early discharge to be feasible and safe under certain conditions. This review article is intended to provide an overview of the existing data, classify these into the specific study context, and to show limitations and open questions.

Ischemic stroke with Atrial Fibrillation, characteristics and time-trends over 12-year period 2006-2017 in the Dijon Stroke Registry

Because of the aging population, an increase in the prevalence of atrial fibrillation (AF) is currently observed, thus exposing to a rise in AF-related ischemic stroke (IS). The aim was to analyze the current prevalence of AF among IS patients (period 2014-17), their characteristics, and temporal trends from 2006 to 2017, in the population-based Dijon Stroke Registry. We used data from the Dijon Stroke Registry. IS patients were included between 2006 and 2017 ( n = 2,417). Vascular risk factors and past medical history were collected, including AF. “Previous AF” was defined if it was mentioned in the medical file before stroke, and “newly-diagnosed AF” if it was diagnosed during the diagnostic work-up of the acute stroke. We assumed Poisson distribution for the annual number of AF cases. During the period 2014-2017, over the 796 IS patients recorded in the Dijon Stroke Registry, 239 (30.0%) had AF, of whom 79 (9.9% of IS patients) had newly-diagnosed AF and 98 (12.3%) had previous AF treated with oral anticoagulants. IS patients with AF had more disabilities and a higher initial severity according to the NIHSS score compared to those without AF. AF patients had also more frequent hypercholesterolemia and heart failure. The age-adjusted prevalence of AF in IS patients increased between 2006 and 2017 (+ 9% per time period), with an important increase in men aged 65-74 (+ 81%) and women aged ≥ 85 (+ 24%) years old, and a significant decrease in women aged 65-74years old (-39%). The use of oral anticoagulant treatment in previous AF patients increased between 2006-2009 and 2014-2017 (29.3% to 61.3%, P < 0.0001). The increase in AF prevalence in IS patients could be related to a better diagnosis of this condition. Despite some improvements, an underuse of oral anticoagulation in patients with previously known AF was still observed, thus indicating a prevention target on which to act to reduce the future burden of stroke.

Impact of timing of atrial fibrillation, CHA2DS2-VASc score and cancer therapeutics on mortality in oncology patients

ObjectivesTo investigate timing and age distribution of atrial fibrillation (AF) in selected oncology patients, and the impact of AF timing, CHA2DS2-VASc score and cancer therapeutics on mortality.MethodsThis is a retrospective...

Epidemiology and treatment of atrial fibrillation in patients with type 2 diabetes in the UK, 2001\u20132016

Patients with Type 2 diabetes mellitus (T2DM) have an increased risk of atrial fibrillation (AF). The current study aimed to investigate the prevalence and treatment of AF in patients with T2DM, assess the impact of direct oral anticoagulants (DOACs) introduction on oral anticoagulant (OACs) prescribing rates, and factors associated with OAC initiations in patients with T2DM and AF. The Health Improvement Network (THIN) database (2001–2016), was used to examine the annual prevalence and treatment of AF in T2DM. The impact of DOACs introduction on OAC prescribing rates were investigated using interrupted time series analysis (ITS). Factors associated with OAC initiations were also identified using multivariate logistic regression. The prevalence of AF increased from 2.7 [95% confidence intervals (CI) 2.5–2.8] in 2001 to 5.0 (4.9–5.1) in 2016 per 100 persons. OACs prescribing within 30-days of AF diagnosis increased from 21.5% in 2001 to 56.8% in 2016. ITS analysis showed that OAC prescribing increased after DOAC introduction (P < 0.001), however, no immediate change was observed (P = 0.29). T2DM patients with AF, aged 60–79, male gender and BMI ≥ 25 were more likely to receive OAC, adjusted OR 1.3 (1.2–1.5) for aged 60–79, 1.3 (1.2–1.4) for male gender and 2.0 (1.9–2.2) for BMI ≥ 25, respectively. This study highlighted an increase in prevalence of AF in patients with T2DM during the study period. Further studies are warranted to investigate factors contributing to the underuse of OAC in patients with T2DM and AF.

Genetic risk and atrial fibrillation in patients with heart failure.

AimsTo study the association between an atrial fibrillation (AF) genetic risk score with prevalent AF and all‐cause mortality in patients with heart failure.Methods and resultsAn AF genetic risk score was calculated in 3759 European ancestry individuals (1783 with sinus rhythm, 1976 with AF) from the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT‐CHF) by summing 97 single nucleotide polymorphism (SNP) alleles (ranging from 0–2) weighted by the natural logarithm of the relative SNP risk from the latest AF genome‐wide association study. Further, we assessed AF risk variance explained by additive SNP variation, and performance of clinical or genetic risk factors, and the combination in classifying AF prevalence. AF was classified as AF or atrial flutter (AFL) at baseline electrocardiogram and/or a history of AF or AFL. The genetic risk score was associated with AF after multivariable adjustment. Odds ratio for AF prevalence per 1‐unit increase genetic risk score was 2.12 (95% confidence interval 1.84–2.45, P = 2.15 × 10−24) in the total cohort, 2.08 (1.72–2.50, P = 1.30 × 10−14) in heart failure with reduced ejection fraction (HFrEF) and 2.02 (1.37–2.99, P = 4.37 × 10−4) in heart failure with preserved ejection fraction (HFpEF). AF‐associated loci explained 22.9% of overall AF SNP heritability. Addition of the genetic risk score to clinical risk factors increased the C‐index by 2.2% to 0.721.ConclusionsThe AF genetic risk score was associated with increased AF prevalence in HFrEF and HFpEF. Genetic variation accounted for 22.9% of overall AF SNP heritability. Addition of genetic risk to clinical risk improved model performance in classifying AF prevalence.

Temporal trends in prevalence and outcomes of atrial fibrillation in patients undergoing percutaneous coronary intervention.

BackgroundAtrial fibrillation (AF) is the most common arrhythmia in patients undergoing percutaneous coronary intervention (PCI).HypothesisLarge administrative data may provide further insight into temporal trends in the prevalence and burden of AF in patients who underwent PCI.MethodsUsing the National Inpatient Sample database in the U.S., AF patients ≥18 years who underwent PCI between 2005 and 2014 and were identified by the International Classification of Diseases, ninth revision, Clinical Modification, were examined. In‐hospital mortality, morbidity, resource use, and medical costs were evaluated in crude and propensity‐matched analyses.ResultsAmong an estimated 6 272 232 hospitalizations, of patients undergoing PCI, AF prevalence was 9.9% and steadily increased from 8.6% to 12.0% between 2005 and 2014 (P < .001); there was also a greater proportion of comorbidities. There was a marked increase in AF prevalence among those aged ≥65 years and those undergoing elective PCIs. AF was independently associated with higher in‐hospital mortality and higher rates of transient ischaemic attack/stroke, bleeding complications, and non‐home discharge. Excessive in‐hospital mortality, stroke rate, gastrointestinal bleeding, blood transfusion, length of stay, and costs among AF hospitalizations were consistently observed throughout the study period.ConclusionAF becomes more prevalent in patients undergoing PCI, possibly due to a higher comorbidity, particularly in elderly patients with non‐acute indications. Less favorable trends in mortality, bleeding, and stroke among AF patients who underwent PCI were consistent over time. Continuous efforts are needed to improve outcomes and manage strategies for AF patients undergoing PCI.

Heartbeat: sex differences in patient-reported outcomes with atrial fibrillation

Patient-reported outcome measures (PROMs) now are recognised as an essential element in clinical cardiovascular research studies. In addition, we are increasing aware of significant sex differences, not only in risk...

Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players.

BackgroundHabitual high‐intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength‐type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population‐based controls. The secondary aim was to characterize other conduction system parameters.Methods and ResultsThis cross‐sectional study compared former NFL athletes (n=460, age 56±12 years, black 47%) with population‐based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study‐2 (n=925, age 54±9 years, black 53%). AF was present in 28 individuals (n=23 [5%] in the NFL group; n=5 [0.5%] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95% CI: 2.1–15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80% had a CHA 2 DS 2‐VASc score ≥1. Former NFL players also had an 8‐fold higher prevalence of paced cardiac rhythms (2.0% versus 0.25%, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first‐degree atrioventricular block (18% versus 9%, P<0.001).ConclusionsFormer NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population‐based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80% should have been considered for anticoagulation based on their stroke risk.

Abstract 281: Contemporary Epidemiology of Atrial Fibrillation Among Medicare Beneficiaries, 2004-2013

Background: Atrial fibrillation (AF) is the most common dysrhythmia in clinical practice, and is a significant contributor to morbidity and mortality. Prior reports have projected a large increase in AF burden over time. A contemporary assessment of epidemiology is needed to assess if an emphasis of prevention strategies over the last decade has been effective in alleviating this risk. Methods: We used a 5% national sample of all Medicare beneficiaries in the US from 2002 through 2013 to construct a longitudinal cohort of 2.3 million fee-for-service Medicare beneficiaries administratively followed for ≥2 years using claims data. Trends in incident and prevalent AF were assessed for 2004 through 2013. Using ICD-9 codes, encounters with AF were identified from inpatient, outpatient, and physician claims. AF during the first 2 years of entry into the cohort was defined as pre-existing AF. Incident AF was defined as having either 1 inpatient claim with a diagnosis of AF or 2 outpatient or physician claims with AF. Calendar-year prevalence comprised pre-existing and incident AF for the respective years as well as those with incident AF in preceding years. Age-adjusted time trends were assessed using Poisson regression. Results: Between 2002 and 2013, 219,570 patients had incident AF. At incidence, mean age was 79 years, 55% were women, and 92% and 5% were white and black, respectively. Age-adjusted AF incidence decreased by 0.4/1000 per year between 2004 (20/1000) and 2013 (17/1000). While incidence declined for white men and women (P&lt;.05), it has remained unchanged for black men and women (Figure). Proportion of incident events in the outpatient setting increased from 26% to 40%. One-year mortality was 9%, and remained unchanged throughout the study period. Over this period, the overall prevalence of AF decreased by 0.9/1000 per year (p&lt;.05), however, there was a relative increase in AF prevalence among black men. Conclusions: Between years 2004 and 2013, the overall incidence and prevalence of AF among a 5% sample of Medicare beneficiaries stabilized. There were, however, differences across racial groups, with a slight decline in incidence among white men and women, which was not observed in black men and women.

The association of QRS duration with atrial fibrillation in a heart failure with preserved ejection fraction population: a pilot study.

Heart failure is a significant cause of morbidity and mortality, yet patient risk stratification may be difficult. Prevention or treatment of atrial fibrillation (AF) may be an important strategy in these patients that could positively affect their outcome. It has been demonstrated that in patients with systolic dysfunction, prolonged QRS duration (QRSd), an easily measured electrocardiographic parameter, is associated with AF. Prolonged QRSd is associated with an increase in prevalence of AF in patients with heart failure with preserved ejection fraction(HFPEF). Between February 2006 and February 2009, 718 patients were discharged with a diagnosis of HF from the Dartmouth-Hitchcock Medical Center. Of these, 206 had EF ≥50% by echocardiography performed within 72 hours of admission. After exclusions, 82 patients remained, of which 25 had AF and 57 had sinus rhythm. Characteristics of the AF and sinus-rhythm patients were compared in this pilot study. After adjustment for age, prior diagnosis of HF, and left atrial area, there was a nonsignificant trend (odds ratio: 2.2, 95% CI of 0.3-17.2) for a QRSd >120 ms to be associated with AF. Similar to results in patients with systolic dysfunction, patients with preserved EF may have an association between a prolonged QRSd and AF.

Periodic limb movements of sleep are associated with an increased prevalence of atrial fibrillation in patients with mild sleep-disordered breathing

BackgroundGrowing evidence indicates that periodic limb movements of sleep (PLMS) may be related to increased risk of developing cardiovascular disease. However, the association of PLMS with atrial fibrillation (AF) is unclear, especially in patients with sleep-disordered breathing (SDB). This study sought to investigate whether PLMS were associated with increased AF prevalence, independent of established risk factors. MethodsWe performed a cross-sectional study of patients who underwent attended polysomnography at Mayo Clinic from 2011 to 2014. The association of PLMS with AF prevalence was estimated by using logistic regression models. Results15,414 patients were studied, 76.3% of individuals with SDB defined by apnea-hypopnea index (AHI) ≥5/h, and 15.3% with a diagnosis of AF. In univariate logistic modelling, individuals with periodic limb movement index (PLMI) ≥30/h had higher odds of AF (odds ratio [OR] 1.96, 95% confidence interval [CI]1.79–2.16, p<0.001) when compared to patients with PLMI <15/h. After multivariate adjustment (for age, race, sex, history of smoking, hypertension, diabetes, coronary artery disease, heart failure, cerebrovascular disease, renal disease, iron deficiency anemia, chronic obstructive pulmonary disease, AHI, arousal index), in mild SDB patients, a PLMI ≥30/h or periodic limb movement arousal index (PLMAI) ≥5/h had significantly higher odds of AF than those with PLMI <15/h (OR 1.21, 95% CI 1.00–1.47, p=0.048) or PLMAI <1/h (OR 1.27, 95% CI 1.03–1.56, p=0.024). ConclusionsFrequent PLMS are independently associated with AF prevalence in patients with mild SDB. Further studies are needed to better understand the relationship with incident AF.

Novel non-invasive algorithm to identify the origins of re-entry and ectopic foci in the atria from 64-lead ECGs: A computational study.

Atrial tachy-arrhytmias, such as atrial fibrillation (AF), are characterised by irregular electrical activity in the atria, generally associated with erratic excitation underlain by re-entrant scroll waves, fibrillatory conduction of multiple wavelets or rapid focal activity. Epidemiological studies have shown an increase in AF prevalence in the developed world associated with an ageing society, highlighting the need for effective treatment options. Catheter ablation therapy, commonly used in the treatment of AF, requires spatial information on atrial electrical excitation. The standard 12-lead electrocardiogram (ECG) provides a method for non-invasive identification of the presence of arrhythmia, due to irregularity in the ECG signal associated with atrial activation compared to sinus rhythm, but has limitations in providing specific spatial information. There is therefore a pressing need to develop novel methods to identify and locate the origin of arrhythmic excitation. Invasive methods provide direct information on atrial activity, but may induce clinical complications. Non-invasive methods avoid such complications, but their development presents a greater challenge due to the non-direct nature of monitoring. Algorithms based on the ECG signals in multiple leads (e.g. a 64-lead vest) may provide a viable approach. In this study, we used a biophysically detailed model of the human atria and torso to investigate the correlation between the morphology of the ECG signals from a 64-lead vest and the location of the origin of rapid atrial excitation arising from rapid focal activity and/or re-entrant scroll waves. A focus-location algorithm was then constructed from this correlation. The algorithm had success rates of 93% and 76% for correctly identifying the origin of focal and re-entrant excitation with a spatial resolution of 40 mm, respectively. The general approach allows its application to any multi-lead ECG system. This represents a significant extension to our previously developed algorithms to predict the AF origins in association with focal activities.

Identifying Patients With Atrial Fibrillation in Administrative Data

BackgroundIdentifying patients with atrial fibrillation (AF) using administrative data is important for epidemiologic and outcomes research. Although administrative data cover large populations, it is necessary to assess their validity in identifying AF patients. MethodsWe used Ontario family physician electronic medical records from the Electronic Medical Record Administrative data Linked Database (EMRALD) as a reference standard to assess the accuracy of administrative data algorithms in identifying patients with AF. From a random sample of 7500 adult patients, patients with AF as recorded in family physician records were identified. ResultsThe optimal algorithm consisted of any of: hospitalization or an emergency room code for AF or prescription for an AF-specific antiarrhythmic agent or billing code for cardioversion, or prescription for an anticoagulant that was accompanied by a physician billing code. for arrhythmia. The algorithm sensitivity was 80.7% (95% confidence interval [CI], 75.1-86.3), specificity 99.1% (95% CI, 98.9-99.3), positive predictive value 71.1% (95% CI, 65.1-77.1), and negative predictive value 99.5% (95% CI, 99.3-99.7). This algorithm, applied to the Ontario population, resulted in a calculated increase in AF prevalence from 1.68% to 2.36% over the years 2000-2014. Anticoagulation rates for AF patients increased from 53% in 2011 to 60% in 2014. Among AF patients receiving anticoagulants, novel oral anticoagulant utilization increased from < 5% in 2011 to > 50% in 2014. ConclusionsIdentifying patients with AF can be done using administrative data, and the algorithm can be used to assess trends in disease burden over time and patterns of care in large populations.

Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial.

Exercise training is an effective treatment for important atrial fibrillation (AF) comorbidities. However, a high level of endurance exercise is associated with an increased AF prevalence. We assessed the effects of aerobic interval training (AIT) on time in AF, AF symptoms, cardiovascular health, and quality of life in AF patients. Fifty-one patients with nonpermanent AF were randomized to AIT (n=26) consisting of four 4-minute intervals at 85% to 95% of peak heart rate 3 times a week for 12 weeks or to a control group (n=25) continuing their regular exercise habits. An implanted loop recorder measured time in AF continuously from 4 weeks before to 4 weeks after the intervention period. Cardiac function, peak oxygen uptake (o2peak), lipid status, quality of life, and AF symptoms were evaluated before and after the 12-week intervention period. Mean time in AF increased from 10.4% to 14.6% in the control group and was reduced from 8.1% to 4.8% in the exercise group (P=0.001 between groups). AF symptom frequency (P=0.006) and AF symptom severity (P=0.009) were reduced after AIT. AIT improved o2peak, left atrial and ventricular ejection fraction, quality-of-life measures of general health and vitality, and lipid values compared with the control group. There was a trend toward fewer cardioversions and hospital admissions after AIT. AIT for 12 weeks reduces the time in AF in patients with nonpermanent AF. This is followed by a significant improvement in AF symptoms, o2peak, left atrial and ventricular function, lipid levels, and QoL. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01325675.

Association between hepatic steatosis and serum liver enzyme levels with atrial fibrillation in the general population: The Study of Health in Pomerania (SHIP)

BackgroundHepatic steatosis (HS) affects up to 35% of adults in the general population. Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and has a substantial impact on healthcare costs. We analyzed cross-sectional associations of HS and serum liver enzyme levels with prevalent AF in a general population sample. MethodsWe analyzed data from 3090 women and men, aged 20–81 years, from the population-based Study of Health in Pomerania. HS was determined by ultrasonography. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltranspeptidase (GGT) were measured photometrically. AF was determined by automatic electrocardiographic analysis software. ResultsThe prevalences of HS and AF were 30.3% and 1.49%, respectively. ALT, AST and GGT showed a positive linear association with the risk of prevalent AF, after multivariable adjustment. The adjusted odds ratios for AF per 1-standard deviation increment in log-transformed serum liver enzyme levels were 1.65 (95% confidence interval [CI]: 1.16 to 2.35; p = 0.006) for ALT, 1.47 (95%CI: 1.07 to 2.02; p = 0.017) for AST and 2.17 (95%CI: 1.64 to 2.87; p < 0.001) for GGT. In contrast, ultrasonographic HS was not associated with AF. ConclusionsOur findings indicate that moderately elevated serum liver enzymes, but not sonographic liver hyperechogenicity, were associated with increased AF prevalence in the general adult population. The hepatic release of increased levels of serum liver enzymes might be accompanied by higher levels of pro-inflammatory, pro-coagulant and pro-fibronogenic mediators that might lead to structural and electrical remodeling of the atrium resulting in the development and persistence of AF.

Age-Related Electrophysiological Changes of the Atrial Myocardium in Patients with Paroxysmal Atrial Fibrillation

The process of aging and its effect on the histological appearance of the conduction system of the heart have been scantly described. It is not easy to attribute a certain condition to the aging process because it is often impossible to separate physiological aging from the development of pathological changes due to a concomitant disease. Nevertheless, the fact is that atrial fibrillation (AF) is a common arrhythmia in the elderly, and its incidence rise sharply with age. The increase in prevalence of AF in older persons has been reported to be associated with degeneration of the atrial muscle in pathological studies. Evidence in the human atrial muscle of age-related electrical uncoupling of the side-to-side connections between bundles, related to the proliferation of extensive collagenous tissue septa in intracellular spaces was clearly demonstrated. This translates into electrophysiological changes, hence prolonged and fractionated atrial electrograms are recorded from these areas during sinus rhythm by endocardial mapping of the atrium. These abnormal atrial electrograms are characteristics of paroxysmal AF and were found in a significantly greater proportion in older patients than in younger ones with AF. Advancing age is associated with atrial remodeling characterized by anatomical and structural changes, reductions in atrial voltage with discrete areas of fractionated and prolonged atrial endocardial electrograms, widespread conduction slowing as well as anatomically determined functional conduction delay and block. These electrophysiological changes within the atrial myocardium may be responsible substrate for the increased propensity to develop AF with increasing age.

Metabolic syndrome, atrial fibrillation, and stroke: Tackling an emerging epidemic

The prevalence of atrial fibrillation (AF) and AF-related stroke is set to increase dramatically in coming decades, with developing regions such as Latin America experiencing the greatest impact. These trends are primarily driven by aging populations and by the increasing prevalence of the metabolic syndrome. The metabolic syndrome describes an association between diabetes, hypertension, obesity, and dyslipidemia and an increased risk of cardiovascular disease. It is in large part the result of unbalanced diet and sedentary lifestyle. These essentially modifiable risk factors are becoming more prevalent with the widespread adoption of so-called Western lifestyles. This review examines the physiology underlying the link between the metabolic syndrome and AF. Next, it highlights the importance of addressing lifestyle-related risk factors to mitigate the trend toward increasing AF prevalence. It then goes on to discuss the importance of stroke prevention therapy in patients with established AF, focusing on the relative merits of various available options for anticoagulation. Given the recent availability of comprehensive data on the 4 currently available non-vitamin K antagonist oral anticoagulant drugs, this review concludes by discussing the relative merits of specific agents in individual patient groups.

Circulation Editors’ Picks

<i>Circulation</i> Editors’ Picks