Lower Incidence Of Atrial Fibrillation Research Articles

Statin treatment in stroke patient with low‐density lipoprotein cholesterol levels below 70 mg/dL

Background and purposeThe effectiveness of hyperlipidemia treatment in strokes secondary prevention has been established. However, whether pretreatment with statins could confer protective effects when a patient's baseline low-density lipoprotein cholesterol (LDL-C) level is <70 mg/dL remains uncertain. Additionally, the ability of statin treatment to reduce poststroke complications, mortality, and recurrence in this patient group is unclear. Methods and resultsIn this retrospective observational study, we enrolled patients who had experienced an ischemic stroke with LDL-C levels <70 mg/dL. We analyzed the association of statin use with baseline characteristics, stroke severity, in-hospital complications, mortality rates, stroke recurrence rate, and mortality rate. Patients who used and patients who did not use statins were similar in terms of age and sex. Patients using statins had higher rates of diabetes mellitus, hypertension, prior stroke, and coronary artery disease but a lower incidence of atrial fibrillation. Stroke severity was less pronounced in those using statins. We also evaluated the relationship between in-hospital statin use and complications. We noted that in-hospital statin use was associated with lower rates of infection, hemorrhagic transformation, gastrointestinal hemorrhage, and mortality, as well as higher rates of positive functional outcomes. The 1-year recurrence rate was similar in both groups. ConclusionsStatin use is associated with milder strokes and improved poststroke outcomes, even in patients with well-controlled LDL levels. Neurologists may consider prescribing statins for patients with ischemic stroke who do not overt hyperlipidemia. Further research into potential underlying mechanisms is warranted.

Lower Atrial Fibrillation Risk With Sodium-Glucose Cotransporter 2 Inhibitors Than With Dipeptidyl Peptidase-4 Inhibitors in Individuals With Type 2 Diabetes: A Nationwide Cohort Study.

Accumulating evidence shows that sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce adverse cardiovascular outcomes. However, whether SGLT2i, compared with other antidiabetic drugs, reduce the new development of atrial fibrillation (AF) is unclear. In this study, we compared SGLT2i with dipeptidyl peptidase-4 inhibitors (DPP-4is) in terms of reduction in the risk of AF in individuals with type 2 diabetes. We included 42,786 propensity score-matched pairs of SGLT2i and DPP-4i users without previous AF diagnosis using the Korean National Health Insurance Service database between May 1, 2016, and December 31, 2018. During a median follow-up of 1.3 years, SGLT2i users had a lower incidence of AF than DPP-4i users (1.95 vs. 2.65 per 1,000 person-years; hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55-0.97; p=0.028]). In individuals without heart failure, SGLT2i users was associated with a decreased risk of AF incidence (HR, 0.70; 95% CI 0.52-0.94; p=0.019) compared to DPP-4i users. However, individuals with heart failure, SGLT2i users was not significantly associated with a change in risk (HR, 1.04; 95% CI, 0.44-2.44; p=0.936). In this nationwide cohort study of individuals with type 2 diabetes, treatment with SGLT2i was associated with a lower risk of AF compared with treatment with DPP-4i.

Real World Experience of Ibrutinib in an Ethnically Diverse Canadian Community Hospital

Chronic Lymphocytic Leukemia (CLL) is an indolent lymphoproliferative disorder commonly managed in community centers. Ibrutinib revolutionized the management of patients with CLL (2). Ibrutinib was initially considered an easy to administer, well tolerated oral medication with excellent efficacy. It was the first clinically available Bruton's Tyrosine Kinase (BTK) inhibitor widely used to treat CLL (3). Recently there have been concerns about cardiovascular toxicities leading to the use of alternative BTK inhibitors (5). Where alternative BTK inhibitors are available these toxicity concerns have led to a decline in the use of ibrutinib to treat CLL. The population served is ethnically diverse consisting of 52% South East Asian with a significant population of African origin. We suspected that the concerns regarding Ibrutinib toxicity were not seen in our patient population prompting a retrospective review of our experience. Ibrutinib therapy A total of 106 CLL patients treated with Ibrutinib were identified from which data was extracted. The mean age was 63.4 years. Patients with CLL treated with Ibrutinib from 2014 to 2021 were identified using OPIS and Meditech and data was extracted manually. Table 1 60% of patient received their initial drug funding through compassionate access, 2% via private insurance and the remaining 38% through the provincial health system. The majority of patients who received funding through compassionate access were eventually transitioned to the provincial health system for drug funding. Toxicity and outcomes Table 2 81% of treated patients never required a dose adjustment of Ibrutinib. The majority of dose reductions were of a temporary nature. We were unable to obtain accurate response data in our retrospective review. 82 of the 106 patients continue on ibrutinib therapy. It is presumed that these patients continue to benefit from therapy without disease progression although response data details were poorly recorded in the medical record. Conclusions There is a lack of data of community real world experience with Ibrutinib particularly in the Canadian setting. Community centers generally are lacking in information technology required to do retrospective audits. Our data shows that ibrutinib therapy for CLL is a reasonable and effective option with good tolerability in a patient population with high cardiovascular risk. The data is limited by the retrospective data collection. The efficacy of therapy is likely comparable to that of the published literature. These data suggest that the tolerability of Ibrutinib therapy seems better than that of the published literature (1) with a low incidence of atrial fibrillation, dose adjustments and low drug discontinuation rate. Of note Richter's transformation was also uncommon in our patient population. This is particularly of interest as our study did capture patients in the early days of ibrutinib therapy when there were concerns that Richter's transformation was more common than seen today. Many of the patients who were treated with ibrutinib would not have received the drug today because of cardiovascular concerns (4). At that time, it was the only available oral targeted agent for the treatment of chronic lymphocytic leukemia. Other agents such as Venetoclax, Acalabrutinib, Zanubrutinib and novel combinations were unavailable at that time or were not funded. These lack of options likely contribute to the persistence of Ibrutinib therapy in our patients. These data suggest that ibrutinib can be used in a high cardiovascular risk population with good efficacy and tolerability. 1.Alloucjery, M., Tomowiak, C., Lombard, T., &amp; et al. (2021). Safety Profile of Ibrutinib: An Analysis of the WHO Pharmacovigilance Database. Front Pharmacology, 12:769315. 2.Byrd, J. C., Brown, J. R., O'Brien, S., &amp; et al. (2014). Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. NEJM, 371(3):213-223. 3.Byrd, J. C., Furman, R. R., &amp; Coutre, S. S. (2013). Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia. NEJM, 369(1):32-42. 4.Lovell, A. R., Jammal, N., &amp; Bose, P. (2022). Selecting the optimal BTK inhibitor therapy in CLL: rationale and practical considerations. Therapueltic Advances in Hematology, 13:1177/20406207221116577. 5.Salem, J. E., Manouchehri, A., &amp; Bretagne, M. (2019). Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia. J Am Coll Cardiol, 74:1667-1678.

Ranolazine is associated with a reduced incidence of atrial fibrillation in patients with chronic coronary syndrome: the results of a real-world analysis of an Italian population

Abstract Background Ranolazine (Ran) is an anti-anginal drug acting as a late sodium current inhibitor at a cell membrane level. This mechanism of action could be implicated in the control of arrhythmia development. Indeed, some evidence supports the efficacy of Ran as an anti-arrhythmic agent, with a synergistic effect with that of Class III agents, namely amiodarone and dronedarone. Aims Aim of this study was to evaluate if the use of Ran in patients with chronic coronary syndrome (CCS) in comparison with other treatments (No-Ran), was associated with a lower incidence of atrial fibrillation (AF) in a real-world clinical setting in Italy. Methods Patients included in the database of the National Health System were evaluated (N=6.1 million); the recorded information concerned hospitalizations with the related diseases, clinical events, visits and drug therapy. Patients hospitalized for any cause and discharged with a diagnosis of angina between 2011 and 2020 (ICD-9-CM codes: 413-414) were included in the study provided they had not experienced an AF episode in the 12 preceding months (characterization period). Study population was divided into the Ran (at least one drug prescription) and in the No-Ran cohorts. The mean follow up was 4.3 years for the Ran and 5.0 years for the No-Ran cohorts, respectively. Results The study population included N=171,015 patients (mean age: 72 years, men: 66%). Among them, N=148,808 (No-Ran cohort) were treated with other therapies while N=22,207 (Ran cohort) received Ran. After propensity score matching, Ran (N=6,384) and No-Ran (N=25,536) cohorts did not differ for age, Charlson comorbidity index, use of aspirin, beta-blockers, Ca-antagonists and nitrates. The incidence of a new episode of AF during the follow-up period was 5.3% and 9.6% in the Ran and in the No-Ran cohorts, respectively (p&amp;lt;0.001). The Cox-regression analysis showed that independently of age, male gender, heart and renal failure, COPD, use of beta-blockers, Ca-antagonists and nitrates, and of cardiovascular procedures, Ran therapy was associated with a 41% risk reduction to develop AF (HR=0.59, 95%CI: 0.53-0.67, p&amp;lt;0.001). Conclusions Our real-world study, performed in a whole subset of the Italian population, showed that Ran use in a long-term follow-up was associated with a lower incidence of AF in patients with CCS.

Changes in alcohol consumption habits and risk of atrial fibrillation: a nationwide population-based study.

Heavy alcohol consumption is an established risk factor for atrial fibrillation (AF). However, the association between habitual changes in heavy habitual drinkers and incident AF remains unclear. The aim of this study was to evaluate whether absolute abstinence or reduced drinking decreases incident AF in heavy habitual drinkers. Atrial fibrillation-free participants with heavy alcohol consumption registered in the Korean National Health Insurance Service database between 2005 and 2008 were enrolled. Habitual changes in alcohol consumption between 2009 and 2012 were classified as sustained heavy drinking, reduced drinking, and absolute abstinence. The primary outcome measure was new-onset AF during the follow-up. To minimize the effect of confounding variables on outcome events, inverse probability of treatment weighting (IPTW) analysis was performed. Overall, 19 425 participants were evaluated. The absolute abstinence group showed a 63% lower incidence of AF (IPTW hazard ratio: 0.379, 95% confidence interval: 0.169-0.853) than did the sustained heavy drinking group. Subgroup analysis identified that abstinence significantly reduced incident AF in participants with normal body mass index and without hypertension, diabetes, dyslipidaemia, heart failure, stroke, chronic kidney disease, or coronary artery disease (all P-value <0.05). There was no statistical difference in incident AF in participants with reduced drinking compared with sustained heavy alcohol group. Absolute abstinence could reduce the incidence of AF in heavy alcohol drinkers. Comprehensive clinical measures and public health policies are warranted to motivate alcohol abstinence in heavy drinkers.

Associations of Life’s Essential 8 and fine particulate matter pollution with the incidence of atrial fibrillation

Both unhealthy lifestyle factors and ambient air pollution have been closely linked with the risk of atrial fibrillation (AF). We retrieved 250,898 participants without AF at baseline from UK Biobank. LE8 was determined by 8 metrics, and was characterized as low, moderate and high cardiovascular health (CVH). Exposure to PM2.5 was estimated at the geocoded residential address of each participant. During a median follow-up of 12.46 years, we identified 14,743 (5.9%) incident AF cases. Participants with moderate and high CVH showed a decreased risk of incident AF compared to those with low CVH. Of the LE8 metrics, ideal body mass index (BMI) and blood pressure (BP) were associated with a decrease of 11.57% and 11.46% AF cases. High PM2.5 exposure was associated with an 8% increased risk of AF as compared to low PM2.5 exposure. Compared with those who had low CVH and high PM2.5 exposure, participants with a high CVH and low PM2.5 exposure had the lower AF incidence. Our study found higher CVH is protective, while higher PM2.5 might be one risk factor of AF. Adherence to the LE8 guidelines may help reduce the incidence of AF, especially in those with lower PM2.5 exposure.

Associations of dietary patterns, ultra-processed food and nutrient intake with incident atrial fibrillation

ObjectiveTo examine the associations between specific dietary patterns and incident atrial fibrillation (AF).MethodsUsing data from the UK Biobank, dietary intakes were calculated from 24-hour diet recall questionnaires. Indices representing adherence...

Racial Differences in Atrial Fibrillation Management Between White Patients and Black Patients in Transthyretin Cardiac Amyloid

Black patients have higher rates of stroke than White patients. Paradoxically, atrial fibrillation (AF) affects twice as many White patients compared with Black patients. Transthyretin cardiac amyloidosis (ATTR-CA) is associated with both AF and strokes. We hypothesized that although Black patients with ATTR-CA have a lower incidence of AF, when diagnosed with AF, they have increased thromboembolic events. Patients with ATTR-CA (n=558) at 3 international centers were retrospectively identified. We compared baseline characteristics, presence of AF, outcomes of thromboembolism (stroke, transient ischemic attack, and peripheral embolism), major bleed, and mortality by race. Of all patients, 367 of 488 White patients (75%) were diagnosed with AF compared with 39 of 70 Black patients (56%) (p=0.001). Black patients with AF had a hazard ratio of 5.78 (95% confidence interval 2.30 to 14.50) for time to first thromboembolic event compared with White patients. There were no racial differences in major bleeding. Black patients with AF more often lacked anticoagulation (p=0.038) and had higher incidence of labile international normalized ratio (p <0.001). In conclusion, these data suggest that although Black patients with ATTR-CA have lower incidence of AF, they have increased thromboembolic events compared with White patients. These findings may be related to treatment discrepancies, time in therapeutic range for warfarin, and disparities in healthcare.

Tolerability of Acalabrutinib after Prior Ibrutinib Treatment in Patients with CLL: Experience of a Tertiary Cancer Care Center

Introduction: Treatment of chronic lymphocytic leukemia (CLL) has been revolutionized by the introduction of Bruton Tyrosine Kinase inhibitors (BTKi). Ibrutinib (IBR) and acalabrutinib (ACA) are two BTKi approved for the treatment of CLL patients (pts) with both frontline and relapsed disease. Based on its kinome inhibitory properties, IBR has more off-target kinase interactions compared to the second-generation BTKi ACA, including inhibition of ITK, HER2, HER4, and TEC, likely leading to increased off-target toxicity (Estupiñán, 2021 and McMullen, 2014). Results from the first randomized phase III trial comparing ACA to IBR in pts with previously treated CLL found a lower incidence of atrial fibrillation (Afib) with ACA (Byrd, 2021). However, there is lack of information on tolerability of ACA in pts treated outside clinical trials who had received prior IBR treatment. Our study aimed, therefore, to evaluate the real-world tolerability of ACA after IBR therapy in pts with CLL with specific attention to cardiovascular effects. Methods: All pts with CLL treated at our institution between 11/2019 and 5/2021 with ACA after prior IBR therapy were included in this study. Pts with less than 6 months of follow up were excluded unless they died prior to that period. Pts with confirmed Richter's Transformation were also excluded. All data were retrospectively obtained through institutional electronic health records, including demographics, clinical and genetic prognostic factors, toxicities, survival outcomes, duration of ACA therapy and reasons for IBR and ACA discontinuation. All grading of adverse events was completed utilizing the Common Terminology Criteria for Adverse Events (CTCAE), International Society on Thrombosis and Hemostasis (ISTH), or European Organization for Research and Treatment of Cancer (EORTC) definitions, as appropriate. All adverse events considered possibly related to BTKi are reported. A waiver of informed consent was granted for this retrospective study. Results: 52 pts treated with ACA and history of prior IBR treatment were identified (Table 1). The median age was 68 years (range, 40-92 years) and 25% were > 75 years old. ACA was administered for a median of 12.4 months (range, 0.4-43.3 months) with 19 pts (37%) requiring a dose reduction at some point during ACA treatment. The most commonly reported adverse effects during IBR treatment included arthralgia/myalgia (31%), Afib (17%), rash (15%), GI upset (12%), and hypertension (HTN, 10%). The reason for IBR treatment discontinuation was adverse effects in 47 pts (90%), progression in 4 pts (8%) and pts preference in 1 (2%). The most commonly reported adverse effects during ACA treatment included GI upset/GERD (25%), headache (17%), arthralgia/myalgia (12%), Afib (10%) and cytopenias (10%). At the time of data collection, 17 (33%) patients had discontinued ACA treatment. The reason for ACA treatment discontinuation was adverse effects in 14 pts (27%), progression in 2 pts (4%) and pt preference in 1 (2%). Specific attention was given to cardiovascular effects since a significant proportion of pts had a past medical history of cardiac comorbidities prior to ACA treatment, including history of HTN in 33 pts (63%) and Afib in 12 pts (23%). New onset Afib developed in 1 pt (2%) and recurrent Afib was observed in 4 pts (8%) during ACA therapy. The 4 pts with recurrent Afib had history of Afib while on IBR therapy. Median time to Afib events with ACA was 4.4 months (range, 0.5-13.3 months). New or worsening HTN developed in only 1 pt while on ACA therapy. Time to HTN episode was 0.2 months. There were few instances of major bleeding with either IBR (2%) or ACA (6%). Two pts (4%) developed an invasive infection while on IBR, no evidence of invasive infection has been reported in the pts receiving ACA. At the time of data collection, 3 patients have died, causes of death included sepsis, respiratory failure and multiorgan failure that were not deemed treatment-related. Conclusion: This real-world experience shows overall good tolerability of ACA after prior IBR therapy in pts with CLL. We observed a lower incidence of Afib (17% vs. 10%) and HTN (10% vs. 2%) during ACA treatment compared to IBR, even if cardiovascular co-morbidities were common among our pts. With a median follow up of 12.4 months (range, 0.4-43.3 months) since the start of ACA therapy, only 27% of pts discontinued treatment because of toxicity. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Associations of Serum and Dialysate Potassium Concentrations With Incident Atrial Fibrillation in a Cohort Study of Older US Persons Initiating Hemodialysis for Kidney Failure

Atrial fibrillation (AF) disproportionally affects persons on maintenance hemodialysis (HD). Associations of serum and dialysate potassium concentrations [K+] with AF incidence are poorly understood. We conducted a cohort study using Medicare claims merged with clinical data from a dialysis provider to determine whether serum-[K+] and/or dialysate-[K+] independently associated with AF incidence. Persons insured by fee-for-service Medicare aged≥67 years at dialysis initiation and free from diagnosed AF prior to day 120 of dialysis were eligible. Serum-[K+] and dialysate-[K+] were assessed in 30-day intervals and patients were followed-up with for AF incidence in subsequent 30-day intervals. During 2006 to 2011, 15,190 persons (mean age= 76.3 years) initiating HD had no prior AF diagnosis. Mean serum-[K+] was 4.5 mEq/l; dialysate-[K+] was 3 mEq/l in 34% and 2 mEq/l in 52% of patients. Followed-up over 21,907 person-years, 2869 persons had incident AF (incidence/100 person-years, 13.1 [95% confidence interval [CI], 12.6-13.6]). The multivariable-adjusted association of serum-[K+] with incident AF was J-shaped as follows: relative to a serum-[K+] of 4.5 mEq/l, lower serum-[K+] associated with increased AF risk, whereas confidence bands for higher serum-[K+] indicated no association. Dialysis against a dialysate-[K+] of 3 mEq/l versus 2 mEq/l independently associated with a 14% (95% CI, 5%-24%) lower incidence of AF. No effect modification between serum-[K+] and dialysate-[K+] was detected (P= 0.34). Lower serum-[K+] was independently associated with incident AF whereas elevated serum-[K+] was not. The findings support adoption of dialysate solutions with a dialysate-[K+] of 3 mEq/l, regardless of patients' serum-[K+], and elimination of lower dialysate-[K+] solutions from practice. Clinical trials randomizing patients to different dialysate-[K+] are warranted to establish causality.

Abstract 9459: Bariatric Surgery Improves Mortality in Patients With Heart Failure

Introduction: Bariatric surgery has been associated with decreased adverse cardiovascular outcomes. There is a paucity of data regarding long-term outcomes in patients with heart failure who underwent bariatric surgery. Hypothesis: Bariatric surgery is associated with better long-term outcomes in patients with heart failure and BMI≥40. Methods: Using ICD-10 codes, we identified patients with heart failure and BMI≥40 from 2016 to 2021 by using the TriNetx diamond network which includes data from ambulatory and primary care electronic medical records, medical claims from claims clearinghouses, and patient medication data from pharmacy claims around the USA. The patient population was divided in 2 groups, those who underwent a bariatric surgery procedure versus those who did not. Subgroup analysis of patients with systolic and diastolic heart failure was also performed. Propensity score matching was used to equilibrate for approximately 90 variables. The outcomes were measured from 3 months up to 5 years after the index event. Results: A total of 2,896 patients were included in each cohort, 63% were females. Patients with heart failure and BMI ≥ 40 kg/m2 that underwent bariatric surgery had approximately 67% lower likelihood of mortality (OR 0.336, P&lt;0.0001), 50% lower incidence of atrial fibrillation (OR 0.504, P&lt;0.0001), 45% less ventricular tachycardia (OR0.556, P0.0014), 43% less AMI (OR 0.578, P 0.0148), and 30% less cerebral ischemia (OR 0.708, P0.043). On subgroup analysis, similar outcomes were seen in patients with systolic heart failure except for cerebral ischemia which did not have a significant association. In patients with diastolic heart failure, only mortality and atrial fibrillation had lower incidences after bariatric surgery. Conclusions: Bariatric surgery is associated with decreased mortality and cardiovascular outcomes in patients with heart failure and BMI≥40. Prospective and/or randomized studies are required to prove these results.

Abstract 12142: Cardiovascular Associations of Chimeric Antigen Receptor T-cell Therapy: A Retrospective Cohort Study From National Inpatient Sample 2016-2019

Introduction: After FDA approval in 2017, chimeric antigen receptor (CAR) T-cell therapy gained high popularity in various hematological malignancies. Hypothesis: There are no sex-based differences in in-hospital mortality and length of stay after CAR T-cell therapy. Methods and Results: From 2018 to 2019, using national inpatient sample, among a total of 14,189,303 hospitalizations (unweighted sample) 704 (0.01%) CAR T-cell therapy were performed, 306 in 2018 and 408 in 2019. Among the CAR T-cell therapy performed, 58.4% (n = 417) were males, 2.9% (n=21) had pulmonary edema, 0.6% (n=6) had acute decompensated heart failure, 3.08% (n=22) had supraventricular tachycardia, 3.36% (n=24) had ventricular tachycardia, 1.94% (n=14) had pericardial effusion (including chronic pericarditis or tamponade), 0.14% (n=1) had acute pericarditis, 0.14% (n=1) had non ST-segment elevation myocardial infarction, 3.64% (n=26) required pressors, 8.68% (n=64) had atrial fibrillation, 3.64% (n=26) had disseminated intravascular coagulation, 4.76% (n=34) required mechanical ventilation. 3.92% (n=28) died in the hospital and mean length of stay (LOS) was 20.5 days. The mean age for CAR T-cell therapy was 54 ± 18 years. Among CAR T cell therapy population, compared to males, females were similar in age (mean age: 54.6 vs. 54 years; p=0.606), had lower incidence of atrial fibrillation (4.38% vs 11.75%, p&lt;0.001) but similar in-hospital mortality (3% vs 4.6%, p=0.334) and similar LOS (21 days vs 20 days, p=0.740). Conclusions: CAR T cell therapy is associated with few cardiovascular conditions. We did not find sex-based differences in in-hospital mortality or LOS in CAR T cell therapy.

Evaluating atrial fibrillation artificial intelligence for the ED: statistical and clinical implications

ObjectiveAn artificial intelligence (AI) algorithm has been developed to detect the electrocardiographic signature of atrial fibrillation (AF) present on an electrocardiogram (ECG) obtained during normal sinus rhythm. We evaluated the ability of this algorithm to predict incident AF in an emergency department (ED) cohort of patients presenting with palpitations without concurrent AF. MethodsThis retrospective study included patients 18 years and older who presented with palpitations to one of 15 ED sites and had a 12‑lead ECG performed. Patients with prior AF or newly diagnosed AF during the ED visit were excluded. Of the remaining patients, those with a follow up ECG or Holter monitor in the subsequent year were included. We evaluated the performance of the AI-ECG output to predict incident AF within one year of the index ECG by estimating an area under the receiver operating characteristics curve (AUC). Sensitivity, specificity, and positive and negative predictive values were determined at the optimum threshold (maximizing sensitivity and specificity), and thresholds by output decile for the sample. ResultsA total of 1403 patients were included. Forty-three (3.1%) patients were diagnosed with new AF during the following year. The AI-ECG algorithm predicted AF with an AUC of 0.74 (95% CI 0.68–0.80), and an optimum threshold with sensitivity 79.1% (95% Confidence Interval (CI) 66.9%–91.2%), and specificity 66.1% (95% CI 63.6%–68.6%). ConclusionsWe found this AI-ECG AF algorithm to maintain statistical significance in predicting incident AF, with clinical utility for screening purposes limited in this ED population with a low incidence of AF.

Abstract P212: Circulating And Tissue Omega-3 Fatty Acid Biomarkers And Incident Atrial Fibrillation: An Individual Participant-level Pooled Analysis Of Prospective Studies

Background: Evidence for the role of omega-3 fatty acids in the prevention of atrial fibrillation (AF) remain inconsistent, with some recent RCTs even suggesting possible harm. Whether long-term dietary intake of these fatty acids, as assessed using objective biomarkers, is related to AF is not known. Aims: To prospectively evaluate circulating and tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), and the sum of EPA and DHA (also known as the omega-3 index), with respect to incident AF. Methods: We used data from a global consortium of 13 prospective cohort studies with measurements of EPA, DPA, or DHA in adults (age≥18) identified through March 2021. Participating studies conducted de novo participant-level analyses using a prespecified analytical plan with harmonized definitions for exposures, outcomes, covariates, and subgroups. Associations were pooled using inverse-variance weighted meta-analysis. Results: Among 45,910 participants, a total of 6,229 incident cases of AF were ascertained, with median follow-up ranging from 0.9 to 29.1 years. In the multivariable analysis, per interquintile range (difference between the 90 th and 10 th percentiles for each fatty acid), DPA, DHA, and EPA+DHA ( Figure 1 ) were associated with 11%, 13%, and 9% lower incidence of AF, respectively ( P &lt;0.01 for each). EPA levels were not associated with incident AF. Heterogeneity as measured using I 2 ranged from 0% for DPA to 56.7% for EPA+DHA. Associations were broadly consistent irrespective of baseline cardiovascular risk, global region, age, sex, or lipid fraction. Conclusion: Biomarkers of omega-3 fatty acids including DPA, DHA, and EPA+DHA demonstrated an inverse association with incident AF. In the absence of RCTs examining long-term dietary omega-3 intake and AF risk, our results do not suggest that higher levels of these fatty acids are associated with harm.

Effect of the ALDH2 Variant on the Prevalence of Atrial Fibrillation in Habitual Drinkers.

Alcohol-a risk factor for atrial fibrillation (AF)-is metabolized by aldehyde dehydrogenase 2 (ALDH2). Dysfunctional alleles of ALDH2 (ALDH2-deficient variants) are prevalent among East Asians. Because the prevalence of AF is estimated to be high in ALDH2-deficient variant carriers, we investigated the correlation between AF and ALDH2-deficient variant carriers, including the association with habitual alcohol consumption. A total of 656 consecutive patients were included in this investigation. ALDH2 genotypes were divided into ALDH2 homozygous wild-type (∗1/∗1), ALDH2 heterozygous-deficient allele (∗1/∗2), and ALDH2 homozygous-deficient allele (∗2/∗2). Multivariate analyses were applied to determine the correlation between ALDH2 genotype and AF. ALDH2∗1/∗2 and ALDH2∗2/∗2 carriers who were ALDH2-deficient variant carriers comprised 199 (30.3%) and 27 (4.1%) patients, respectively. Among these patients, the proportions of habitual alcohol consumption were 26.1% and 0%, respectively. Multivariate analysis revealed that ALDH2∗1/∗2 itself was not a risk factor for AF (odds ratio [OR]: 1.28; P=0.21). However, habitual alcohol consumption in ALDH2∗1/∗2 carriers was an independent risk factor of AF (OR:4.13; P=0.001). Contrary to expectations, ALDH2∗2/∗2 itself had a lower incidence of AF among other risk factors (OR: 0.37; P=0.03). Although the ALDH2∗1/∗2 itself was not associated with AF, ALDH2∗1/∗2 carriers with habitual alcoholconsumption could experience AF because of slow alcohol metabolism. In contrast, ALDH2∗2/∗2 itself had a lower incidence of AF. This might be related to the absence to habitual alcohol consumption in ALDH2∗2/∗2 carriers because ofthe negligible activity of ALDH2. Thus, abstaining from alcohol consumption might prevent the development of AF in patients who are ALDH2∗1/∗2 carriers.

Dexmedetomidine versus propofol in reducing atrial fibrillation after cardiac surgery

ABSTRACT Objectives Atrial fibrillation is a common complication associated with cardiac surgery after cardiopulmonary bypass with a deleterious effect on morbidity and mortality. The current study aimed to compare between dexmedetomidine and propofol in reducing atrial fibrillation after cardiac surgery. Design A randomized prospective cohort study. Setting Conducted in Alexandria main university hospital. Participants 98 patients of either sex ASA II physical status aged 40–60 years. Interventions All patients were subjected to either propofol or dexmedetomidine infusion after cardiac surgery according to the assigned group. Measurements and Main Results The patients were divided into two groups where first group received dexmedetomidine infusion as postoperative sedation and the second group received propofol infusion. Both groups were assessed for incidence of atrial fibrillation, hypotension and length of intensive care stay. Incidence with atrial fibrillation was 0.9% in dexmedetomidine group vs. 13% in propofol group (P = 0.001) and intensive care stay was prolonged in propofol group 4.6 ± 1.2 day vs. 2.7 ± 1 for dexmedetomidine group (P = 0.002). There was no statistically significant difference between both groups regarding blood pressure or heart rate. Conclusion The use of dexmedetomidine for sedation after cardiac surgery was associated with a lower incidence of atrial fibrillation and hence decreased the duration of intensive care stay.

Abstract 12093: Tafamidis Use and New Onset Atrial Fibrillation in Patients With Cardiac Amyloidosis

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia seen in patients with cardiac amyloidosis (CA). Tafamidis, a transthyretin stabilizer, has been associated with reductions in all-cause mortality and other promising outcomes in patients with CA. However, its effect on incidence of AF still remains unknown. Hypothesis: Tafamidis therapy in patients with CA is associated with lower incidence of AF. Methods: A group of 200 patients with transthyretin CA following at our institution between 2003 and 2019 were retrospectively reviewed. Baseline characteristics, onset of AF (determined by ECG, device interrogation, or ambulatory monitoring) and tafamidis use data were collected. Patients with diagnosis of AF at baseline were excluded. Patients were matched based on age, sex, BMI, DM, HTN, ischemic heart disease, and stage of amyloid disease. Time to event analysis was performed to assess the incidence of new-onset AF in patients who had received tafamidis versus those who had not. Results: In total, 36 patients met inclusion criteria. Of these 36 patients diagnosed with incident AF, 10 received tafamidis therapy prior to AF diagnosis and 26 did not. Median time to Tafamidis initiation after diagnosis of cardiac amyloidosis was 243 [64, 776] days [IQR]. Average follow-up time was 21.8 ± 24.4 months. There were no significant differences between baseline characteristics, however there were more African Americans (27% vs. 0%) and Val122Ile mutations (23% vs. 10%) in the control group. Overall, tafamidis initiation was associated with lower incidence of new-onset AF compared to those who had not received the therapy (p=0.026). Persistent AF was the most common type of AF, no matter being on tafamidis or not. Conclusions: Tafamidis therapy in patients with CA might be associated with lower incidence of AF. The mechanism however is not clear and further studies are needed to re-examine this finding and elucidate the potential mechanism.

Monitoring and Managing BTK Inhibitor Treatment-Related Adverse Events in Clinical Practice.

Bruton tyrosine kinase (BTK) inhibitors represent an important therapeutic advancement for B cell malignancies. Ibrutinib, the first-in-class BTK inhibitor, is approved by the US FDA to treat patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), and mantle cell lymphoma (MCL; after ≥1 prior therapy); and by the European Medicines Agency (EMA) for adult patients with relapsed/refractory (R/R) MCL and patients with CLL. Ibrutinib treatment can be limited by adverse events (AEs) including atrial fibrillation, arthralgias, rash, diarrhea, and bleeding events, leading to drug discontinuation in 4%–26% of patients. Acalabrutinib, a second-generation BTK inhibitor, is approved by the FDA to treat adult patients with CLL/SLL or MCL (relapsed after 1 prior therapy); and by the EMA to treat adult patients with CLL or R/R MCL. The most common AE associated with acalabrutinib is headache of limited duration, which occurs in 22%–51% of patients, and is mainly grade 1–2 in severity, with only 1% of patients experiencing grade ≥3 headache. Furthermore, acalabrutinib is associated with a low incidence of atrial fibrillation. Zanubrutinib, a selective next-generation covalent BTK inhibitor, is approved by the FDA to treat adult patients with MCL who have received ≥1 prior therapy, and is under investigation for the treatment of patients with CLL. In the phase 3 SEQUOIA trial in patients with CLL, the most common grade ≥3 AEs were neutropenia/neutrophil count decreased and infections. This review provides an overview of BTK inhibitor-related AEs in patients with CLL, and strategies for their management.

Meta-Analysis of Randomized Clinical Trials Comparing the Impact of Implantable Loop Recorder Versus Usual Care After Ischemic Stroke for Detection of Atrial Fibrillation and Stroke Risk

Implantable loop recorder (ILR) is recommended to detect subclinical atrial fibrillation (AF) after cryptogenic stroke; however, the clinical outcomes of this practice is unclear. We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate 12-month AF detection, change in oral anticoagulation (OAC), and recurrent stroke in ILR versus usual care after ischemic stroke. We searched Medline, Embase, Web of Science, Cochrane Library for randomized controlled trials comparing ILR with usual care after any ischemic stroke. Primary outcomes were cumulative AF detection and recurrent stroke (ischemic or hemorrhagic) or transient ischemic attack over 12 months. Secondary outcome was OAC initiation. Meta-analysis was performed with Mantel-Haenszel pooled odds ratios (ORs) and random effects models. Of 200 identified articles, 3 trials were included (1,233 participants). Cryptogenic stroke and underlying AF included cryptogenic stroke only, stroke of known cause and underlying-AF included small or large vessel stroke only, and post embolic rhythm detection with implantable vs external monitoring included all ischemic strokes. The 12-month AF detection was 13% in the ILR group and 2.4% in controls. ILR was more likely to detect AF compared with usual care (OR 5.8, 95% confidence interval 3.2 to 10.2). Stroke or transient ischemic attack occurred in 7% with ILR and 9% with usual care (OR 0.8, 95% confidence interval 0.5 to 1.2). In patients with detected AF, 97% and 100% were started on OAC in cryptogenic stroke and underlying AF and post embolic rhythm detection with implantable vs external monitoring, respectively, compared with 68% in stroke of known cause and underlying-AF. In conclusion, ILR was superior to usual care in AF detection, but the relative low incidence of AF and the nondifferential risk of stroke between the ILR and usual care arms may suggest that most patients do not benefit from ILR implantation. Further studies are warranted to understand if patient selection can be improved to increase the diagnostic yield of ILR.

The atrial fibrillation paradox -connecting hypertension to atrial disease and stroke

A “double paradox” exists in the understanding of racial differences in the association between traditional cardiovascular (CV) risk factors, the incidence and prevalence atrial fibrillation (AF), and the increased incidence of ischemic stroke. Simply stated, Black persons have an increased number of CV risk factors yet less AF. Despite lower incidence of AF, Black individuals have higher rates of stroke and systemic embolism. This important public health challenge is notable, given that, despite a significant decline in overall stroke mortality rates since the 1950s, age-adjusted stroke death rates have remained higher in Black versus White individuals through 2008.[2] The purpose of this review is to examine the risk of ischemic stroke in Black persons and provide a summary of options to improve the recognition of individual risk and reinforce preventive care. Consider the following concepts: • Black individuals have more traditional CV risk factors and higher rates of ischemic stroke, than their non-Hispanic White counterparts, yet a lower incidence and prevalence of AF. • The difference in the incidence of AF does not fully explain the differences in stroke risk • The explanation for these differences is likely complex and leads to the following questions. ○ Should researchers and clinicians reassess the way atrial disease and embolic risk are defined in specific populations? ○ Do traditional risk factors for AF account for increased stroke risk in select patient populations which also needs to be re-evaluated in the context of stroke reduction. As with prior work[1,17,18,19,21] which has addressed the “AF Paradox” this review supports the concept of atrial disease - including atrial fibrillation - as a continuum. There also appears to be a risk of stroke associated with this continuum in the absence of a diagnosis of AF.[1,18,21] These factors alone do not account for the differences in overall stroke rates in Black persons. In addition to a revision on the views of atrial disease, there should be a renewed emphasis early and aggressive blood pressure control – as well as other risk factor management – in Black individuals to affect the differences in stroke rates. The objective of this review is to re-examine the specific role of hypertension in atrial disease and perceptions on stroke risk, AF and possible differences between Black and White individuals.