Manifestation Of Atrial Fibrillation Research Articles

The role of laboratory markers in predicting the effectiveness of catheter treatment for atrial fibrillation: a literature review

Atrial fibrillation (AF) is the most common cardiac arrhythmia among the adult population. There are many possible causes of AF: structural heart disease, inflammatory and autoimmune diseases, obesity, alcohol abuse, diabetes mellitus, obstructive sleep apnea and old age. The ectopic activity of pulmonary vein couplings lies in the pathogenesis of paroxysmal and persistent forms of AF. The role of AF itself in triggering the inflammatory process in the atrium myocardium has also been proven. Despite the large amount of existing data, the search for the causes of AF continues. Previously, AF was considered the outcome of prolonged hemodynamic stress, arterial hypertension and valvular heart disease. Recently, views on the pathogenesis of AF have changed, since patients with metabolic diseases, without hypertrophy and dilatation of the left ventricle, but with disturbances in the structure and function of the atria, most often the left atrium, are increasingly encountered. There is an active search for laboratory markers to identify groups of patients most susceptible to developing AF. Determining the cause of atrial fibrillation and pathogenesis in each patient is important for selecting therapy and determining treatment tactics. Currently, a search is underway for laboratory markers that may be associated with the manifestation of atrial fibrillation, with atriopathy, and the effectiveness/ineffectiveness of catheter treatment for atrial fibrillation. An analysis of clinical studies was carried out based on articles indexed in the Scopus, VAK, Russian Science Citation Index, PubMed, and Web of Science databases.

Predictive value of left and right atrial strain for the detection of atrial fibrillation in patients with cryptogenic stroke and implant of loop recorder

Abstract Funding Acknowledgements Type of funding sources: None. Background Structural and functional remodeling of left and right atrium (LA-RA) are predictors of the risk of hospitalization and mortality. These are chronic and complex processes, dependent on an adaptive response implemented by the atrial myocytes against stressors of an electrical, mechanical and metabolic nature. Atrial fibrillation (AF) is the most common condition associated with remodeling of both atria, of which it can be cause and effect at the same time: atrial enlargement, interstitial fibrosis and myocardial distension. Often the first manifestation of AF is cryptogenic stroke (CS) which is associated with a high rate of recurrence and adverse long-term follow-up outcomes, mainly due to its unknown etiology often leading to secondary prevention ineffective. Asymptomatic (AF) may play an important pathophysiological role to detect CS. Evidence has demonstrated the efficacy of AF ablation in restoring the structure of the LA and, consequently, in favoring the maintenance of sinus rhythm. However, little is known regarding the evaluation of RA remodeling and its variation over time in patients with FA. Aim of the study Evaluate the relationship between echocardiographic parameters of LA and RA function, and the occurrence of AF revealed by continuous ECG monitoring through insertable cardiac monitors (ICM) implant in a cohort of patients with CS Methods Single-center retrospective study. A total of 204 patients who suffered from cryptogenic stroke underwent ICM between May 2013 and July 2022. All detected AF episodes lasting more than 30 seconds were considered, according to Guidelines. All patients underwent to Transthoracic Echocardiography (TTE) to study on LA and RA function, including both standard and longitudinal strain-derived parameters. Transesophageal Echocardiography (TEE) was also performed to exclude embolic sources. Results During a median follow-up period of 15.3 months (interquartile range, 7.4 / 23.5), continuous ECG monitoring revealed AF in 96 patients (47.0%). Many echocardiographic parameters, such as LA maximum and minimal volume were significantly associated with the occurrence of AF, suggesting the worst atrial function in the AF group. Furthermore, multivariable regression analysis revealed that peak atrial contraction strain of both atria were independently associated with AF (p < 0.001,respectively). Conclusion In patients with cryptogenic CS, LA and RA strain analysis are strong and independent predictors of the occurrence of AF despite clinical and morpho-functional echocardiographic parameters.

Atrial fibrillation on the intensive care unit : The special prognostic importance of the first manifestation

Atrial fibrillation (AF) is the most common arrhythmia in the intensive care unit (ICU) and is associated with increased mortality. The AF is classified into five different forms, initially diagnosed AF, paroxysmal AF, persistent AF, long-standing persistent AF and permanent AF. Studies could confirm that the first manifestation of AF (new onset AF) is of particular importance in intensive care patients. The mortality and costs are much higher than for patients with chronic AF. This important clinical difference of the AF pattern should be taken into consideration in the treatment of intensive care patients. The treatment of comorbidities is essential in the treatment concept on the ICU. In patients with an increased risk of thromboembolic complications, therapeutic anticoagulation is indicated, although the greatly increased risk of bleeding during intensive care treatment should be considered in individual cases. In cases of hemodynamic instability electrical cardioversion should immediately be carried out. Otherwise, pharmacological cardioversion can also be carried out. Apart from a few exceptions, amiodarone is the antiarrhythmic drug of choice for rhythm control due to the contraindications for other drugs.

Tracking Atrial Fibrillation by 24-Hour Holter ECG in Ischemic Stroke of Unclear Origin, an Experience of the Cardiology Department of the University Hospital of Marrakesh

Background: Stroke is a worldwide growing health problem; a significant proportion of acute ischemic strokes occur as the first manifestation of atrial fibrillation. We sought to evaluate the performance of 24-hour rhythm monitoring in detecting paroxysmal atrial fibrillation. Methods: This was a cross-sectional study conducted at the University Hospital of Marrakech, in 174 selected patients with ischemic stroke without clear etiology at baseline subjected to ambulatory Holter monitoring. Results: The overall detection rate for atrial fibrillation was 4.1%, allowing the initiation of anticoagulant therapy in selected patients. Nevertheless, although some degree of success in detecting AF in a short period of monitoring was achieved, it is believed that the prevalence of AF is still underestimated by this screening modality. Conclusion: Tracking atrial fibrillation is a fundamental element in the secondary prevention of stroke; the development of new digital technologies now makes the possibility of long-term heart rhythm monitoring accessible. Numerous ECG recording solutions have been scientifically proven reliable, some are already recommended for the detection of cardiac arrhythmias. The choice of the screening method must be tailored to each individual case.

NICE atrial fibrillation guideline snubs wearable technology: a missed opportunity?

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a growing public health epidemic. In the UK, over 1.3 million people have a diagnosis of AF and an estimated 400,000 remain undiagnosed. AF-related strokes account for a quarter of all strokes and, as AF episodes are often asymptomatic, are still often the first manifestation of AF. Early diagnosis and initiation of oral anticoagulation, where appropriate, may prevent some of these thromboembolic strokes. Public Health England is committed to decrease the incidence of AF-related strokes and has sponsored initiatives aimed at improving AF detection by promoting the uptake of wearable technologies. However, the National Institute for Health and Care Excellence (NICE) has not recommended wearable technology in their recent AF diagnosis and management guidelines (NG196). Diagnostic accuracy of single-lead electrocardiography (ECG) generated by the latest iteration of wearable devices is excellent and, in many cases, superior to general practitioner interpretation of the 12-lead ECG. High-quality ECG from wearable devices that unequivocally shows AF can expedite AF detection. Otherwise, there is a real risk of delaying AF diagnosis with the potential of devastating consequences for patients and their families.

Vorhofflimmern – syndromaler Phänotyp bei HFpEF oder primäre Erkrankung?

Atrial fibrillation and heart failure with preserved left ventricular (LV) ejection fraction (HFpEF) are of high importance in cardiology due to the increasing number of cases. Both diseases can mutually affect each other and important cardiovascular risk factors, e.g. arterial hypertension, diabetes mellitus, obesity and chronic renal insufficiency can be observed with increasing frequency. Currently proven treatment concepts for patients with heart failure and reduced ejection fraction (HFrEF) do not appear to have a comparable prognostic or symptomatic benefit for patients with HFpEF. In addition, there are indications that de novo manifestation of atrial fibrillation in HFpEF patients has been linked to reduced survival. Also, heart and kidney function are negatively affected by atrial fibrillation. Retrospective analyses of patients with HFpEF and atrial fibrillation who had been treated by pulmonary vein isolation could show that interventional treatment of the atrial fibrillation led to an improvement in the New York Heart Association (NYHA) stage and diastolic function. Currently running prospective randomized clinical trials, such as the AMPERE study including patients with HFpEF and atrial fibrillation undergoing pulmonary vein isolation, will hopefully provide reliable prospective randomized data and possibly show an improved symptom control and perhaps also prognostically relevant treatment for HFpEF patients with atrial fibrillation.

Ischemic stroke as the initial manifestation of atrial fibrillation; is it higher than expected?

Ischemic stroke as the initial manifestation of atrial fibrillation; is it higher than expected?

Abstract MP48: Racial And Urban-rural Disparities In The Frequency Of Ischemic Stroke As First Manifestation Of Atrial Fibrillation

Introduction: Atrial fibrillation (AF) may be asymptomatic and remain undiagnosed until the development of complications, which precludes primary prevention efforts. We aimed to quantify racial and rural-urban disparities in the frequency of incident AF presenting with ischemic stroke in a nationally representative sample of Medicare beneficiaries. Hypothesis: Black patients have higher frequency of stroke as the first presentation with AF than White patients. Methods: We used a 5% random sample of Medicare claims data to identify patients newly diagnosed with AF in 2016. The primary outcome was stroke as first AF manifestation, and was defined by inpatient diagnosis of ischemic stroke within 7 days prior to the first AF diagnosis. We computed age- and sex-adjusted proportion of AF diagnosis manifesting as stroke and used multivariable logistic regression to quantify the association of race and urban/rural residence with the outcome, adjusting for demographic and clinical characteristics. Results: Among 39,437 patients newly diagnosed with AF, 2,821 (7.2%) had ischemic stroke as the first AF manifestation. In urban areas, age- and sex-adjusted proportions of AF diagnosis manifesting as stroke were 7.2(95%CI: 6.8,7.4)% for White and 9.5(8.4,10.8)% for Black, compared to 5.9(5.4,6.4)% and 8.1(5.8,11.1)% in rural areas ( Figure ). After adjusting for age, sex, CHA 2 DS 2 -VASc score, Alzheimer's disease, Medicaid enrollment, and receipt of low-income subsidy, Black race (adjusted OR [95%CI]: 1.21 [1.05, 1.40], vs. White) and urban residence (1.16 [1.06, 1.28], vs. rural) were associated with increased risk of stroke as first AF manifestation. Conclusion: We observed uneven distributions in the frequency of stroke as first manifestation of AF between White and Black patients and between rural and urban residents. Further research is needed to evaluate the effectiveness of AF screening efforts in reducing inequities in health outcomes associated with AF.

Genetically determined atrial fibrillation and risk of stroke: a Mendelian randomization study

Abstract Background Based on observational evidence, atrial fibrillation is a well-established risk factor of stroke to be considered for antithrombotic treatment in presence of additional clinical conditions derived from multivariate risk models. Although biologically plausible, it however still is unknown whether this association is causal and confined to the embolic stroke subtype. Purpose Our objective was to explore whether genetically determined manifestation of atrial fibrillation was associated with stroke and its etiologic subtypes by conducting a 2-sample Mendelian randomization (MR) study on publicly available summary statistics from GWAS consortia. Methods Genetic instruments for atrial fibrillation were obtained from the AFGen Consortium comprising 17,931 cases and 115,142 controls. Their associations with stroke and stroke subtypes were evaluated in the MEGASTROKE genome-wide association study data set (67 162 cases; 454 450 controls) applying inverse variance–weighted meta-analysis, weighted-median analysis, Mendelian randomization–Egger regression, and multivariable Mendelian randomization. The dataset of Nielsen et al. comprising a total of 60,620 cases with atrial fibrillation and 970,216 controls of European ancestry from six contributing studies was used as an independent validation sample. Genetic instruments for atrial fibrillation were further tested for association with etiologically related traits by using publicly available genome-wide association study data. Results Genetic predisposition to atrial fibrillation was associated with higher risk of any stroke (beta coefficient [b] ± standard error [se] = 0.22±0.04; P=0.0001), any ischemic stroke (b ± se = 0.24±0.05; P=0.0003), and cardioembolic stroke (b ± se = 0.76±0.10; P<0.0001), but not with small-vessel stroke or large artery stroke, see figure. Analyses in the validation sample showed similar associations (any stroke: b ± se = 0.19±0.04; P<0.0001; any ischemic stroke: b ± se = 0.21±0.04; P<0.0001; cardioembolic stroke: b ± se = 0.82±0.13; P<0.0001). Genetically determined atrial fibrillation was further weakly associated with chronic kidney disease (b ± se = 0.10±0.04; P=0.0261), but not with coronary artery disease and myocardial infarction or any other available phenotype. Conclusions Genetic predisposition to atrial fibrillation is associated with higher risk of any stroke, mainly driven by the ischemic and cardioembolic subtypes. In contrast, large artery and small-vessel strokes did not exhibit a causal relationship with atrial fibrillation. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Medical University of Vienna, Austria

EFFECTIVENESS OF TREATMENT WITH MEBICAR IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION

Violation of the heart rhythm is widespread at present. Anxiety-depressive symptoms and a tendency to chronic stress leads to the depletion of the body, which contributes to arrhythmia. The aim of the study is to assess the severity of clinical and hemodynamic indices by using anxiolytic drug mebicar. Materials and methods. Assessment of psycho-emotional status was studied using the psychosocial scale of stress by L. Reader, PSS-10 PHQ-15 and questionnaire identification of social factors that can affect health. Determination of cortisol level in serum was carried out by immunoassay (ELISA) on the ER-500 Microplate Reader. The concentration of N-terminal fragment of the brain natriuretic peptide precursor (NTproBNP) in serum was determined by ELISA using a Biosan PST-60HL shaker. Results. The results of the survey showed a direct dependence of the manifestation of atrial fibrillation (AF) on the level of psychoemotional stress. We found that in group 1b (standard treatment+mebicar) there were complaints of increased excitability (p<0.001), (p-reliability difference of indices before and after treatment), fatigue (p<0.001), deterioration of memory (p<0.01), appetite loss (p<0.05), sleep disturbance (p<0.001), signs of severe sweating (p<0.001), indicating the appearance of astheno-vegetative syndrome. The reduction of manifestations of high stress (p<0.01) in patients of group 1b (standard treatment+mebicar) was noted. A similar pattern was detected in the severity of anxiety in men (p<0.01). Conclusions. Application in the complex therapy of patients with stable coronary heart disease (SIHD) in conjunction with AF anxiolytics of the benzodiazepine series (mebicar) has allowed stopping anxiety-depressive disorders. Analyzing the level of cortisol, we observed its increase depending on the degree of anxiety and depression; NT-proBNT metrics are respectively.

P992Socio-demographic inequalities in the uptake of screening for atrial fibrillation within the STROKESTOP II study: support for decentralised screening

Abstract Funding Acknowledgements Roche Diagnostics, The Swedish Heart and Lung Foundation, Carl Bennett AB Background To prevent stroke as a first clinical manifestation of atrial fibrillation (AF), screening for AF has been suggested. In the STROKESTOP I (SSI) study, participation was significantly influenced by socio-demographic and geographic factors. Purpose The main aim was to improve participation in the STROKESTOP II (SSII) study, especially aiming at socioeconomically weaker groups. Methods As in the SSI study, in the SSII study all 75/76-year-olds were randomised 1:1 to either a screening arm or a control arm. The individuals in the screening arm were invited to an AF-screening-program. Two screening sites were added in the SSII study, located closer to low-income neighbourhoods with very low participation rates in the SSI study. Information on each invitee’s residential parish was used for a geo-mapping analysis of the geographical disparities in participation. Individual data for the participants and non-participants were obtained with respect to the following socioeconomic variables: educational level, disposable income, immigrant and marital status. Geographic and socio-demographic disparities in the uptake of the SS2 study were analysed and the results compared between the STROKESTOP trials. Results Overall, higher participation was observed in those with higher education, high income as well as among non-immigrants and married individuals. Participation between the SSI and SSII improved significantly in the two areas where additional screening sites were introduced. These improvements were generally significant, in each population group according to the socio-demographic characteristics. Conclusion Decentralisation of the screening sites in an AF-screening-program had significant impact on the screening uptake. Addition of local screening sites in areas with a very low uptake may have a beneficial impact on the uptake across the full spectrum of socio-demographic groups Abstract Figure. Participation map

P3703Frequency of undiagnosed atrial fibrillation in patients presenting with acute ischemic cerebrovascular stroke

Abstract Introduction Acute ischemic cerebrovascular stroke (CVS) can be the first clinical manifestation of atrial fibrillation (AF), that is why large-scale screening programs for AF are currently implemented especially in individuals more than or equal 65 years old. Yet, to date, cost-effectiveness data have relied on assumptions of stroke rates observed in patients with established AF, while the true incidence rates of undiagnosed AF presenting as a stroke remain unknown. Purpose To estimate the incidence of patients with no history of AF who are presented with acute ischemic CVS and are found to be in AF at the time of presentation or developed atrial fibrillation during the hospital stay. Methods A retrospective analysis of all patients admitted with acute CVS to a tertiary care stroke specialized center in the period from 01/01/2014 till 31/12/2017. Ischemic CVS is confirmed by either multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) of the brain. AF is documented by electrocardiography (ECG) that is made at admission or during hospital stay. Patients with history of AF on rate or rhythm-control therapy were excluded from the study. Results Of the 3299 patients admitted by acute ischemic CVS, 707 (21.43%) patients had history of AF and they were on medical rate or rhythm control therapy and thus were excluded from the study. Of the remaining 2592 patients eligible for the study, 1666 (64.27%) were males with a mean age of 56.06 years (±16.01). Regarding ECG, 2313 (89.24%) patients were in sinus rhythm and other non-AF rhythms and 211 (8.14%) presented with AF rhythm and 68 (2.62%) developed AF during their hospital stay with a cumulative incidence of (10.76%). Table 1. Baseline patient characteristics and ECG data (n=2592) Risk factors n=2592 Hypertension 1849 (71.33%) Diabetes Mellitus 925 (35.69%) Smoking 1445 (55.75%) ECG data Non-AF 2313 (89.24%) AF on admission 211 (8.14%) AF in hospital 68 (2.62%) Total AF 279 (10.76%) Undiagnosed AF in acute ischemic CVS Conclusion The incidence of undiagnosed atrial fibrillation in patients presented with acute cerebrovascular stroke is significantly high. Implementation of good screening programs can significantly reduce the risk of disabilities and morbidities.

The ambiguity of physical activity, exercise and atrial fibrillation.

Although commonly associated with cardiovascular disease or other medical conditions, atrial fibrillation may also occur in individuals without any known underlying conditions. This manifestation of atrial fibrillation has been linked to extensive and long-term exercise, as prolonged endurance exercise has shown to increase prevalence and risk of atrial fibrillation. In contrast, more modest physical activity is associated with a decreased risk of atrial fibrillation, and current research indicates a J-shaped association between atrial fibrillation and the broad range of physical activity and exercise. This has led to the hypothesis that the mechanisms underlying an increased risk of atrial fibrillation with intensive exercise are different from those underlying a reduced risk with moderate physical activity, possibly linked to distinctive characteristics of the population under study. High volumes of exercise over many years performed by lean, healthy endurance trained athletes may lead to cardiac (patho)physiological alterations involving the autonomic nervous system and remodelling of the heart. The mechanisms underlying a reduced risk of atrial fibrillation with light and moderate physical activity may involve a distinctive pathway, as physical activity can potentially reduce the risk of atrial fibrillation through favourable effects on cardiovascular risk factors.

When Silence Isn't Golden: The Case of "Silent" Atrial Fibrillation.

Silent atrial fibrillation (AF) is common. In some patients, it is the only manifestation of AF, while in others, the AF may be symptomatic or both symptomatic and asymptomatic. Regardless, however, to date, the significance, detection, and management considerations for silent AF have been incompletely elucidated. This current study aimed to review, for both the current clinician and investigator, considerations and attitudes and the ongoing studies, respectively, with respect to silent AF. The methods used were a literature review and personal trial and clinical experience; the frequency of silent AF, concerns regarding silent AF, methods to detect silent AF, and prospective trials focused on the detection and management of silent AF were considered. The results of the literature search indicated that recently conducted relevant trials, such as PREDATE AF, ASSERT-II, and REVEAL AF, have shown that silent AF is frequent in patients with risk markers for AF and stroke in whom no prior AF history is present, and in whom no pacemaker or implantable cardioverter-defibrillator implantations have been previously performed. Furthermore, the GLORIA-AF Registry has reported the observance of more permanent AF and more prior strokes in asymptomatic patients. Ongoing trials such as ARTESiA and NOAH-AFNET 6 are expected to clarify the benefits and risks of oral anticoagulation in patients with silent AF. At present, when silent AF is detected in patients with stroke risk markers, most practitioners initiate an anticoagulation regimen.

Stroke as the First Manifestation of Atrial Fibrillation.

Atrial fibrillation may remain undiagnosed until an ischemic stroke occurs. In this retrospective cohort study we assessed the prevalence of ischemic stroke or transient ischemic attack as the first manifestation of atrial fibrillation in 3,623 patients treated for their first ever stroke or transient ischemic attack during 2003–2012. Two groups were formed: patients with a history of atrial fibrillation and patients with new atrial fibrillation diagnosed during hospitalization for stroke or transient ischemic attack. A control group of 781 patients with intracranial hemorrhage was compiled similarly to explore causality between new atrial fibrillation and stroke. The median age of the patients was 78.3 [13.0] years and 2,009 (55.5%) were women. New atrial fibrillation was diagnosed in 753 (20.8%) patients with stroke or transient ischemic attack, compared to 15 (1.9%) with intracranial hemorrhage. Younger age and no history of coronary artery disease or other vascular diseases, heart failure, or hypertension were the independent predictors of new atrial fibrillation detected concomitantly with an ischemic event. Thus, ischemic stroke was the first clinical manifestation of atrial fibrillation in 37% of younger (<75 years) patients with no history of cardiovascular diseases. In conclusion, atrial fibrillation is too often diagnosed only after an ischemic stroke has occurred, especially in middle-aged healthy individuals. New atrial fibrillation seems to be predominantly the cause of the ischemic stroke and not triggered by the acute cerebrovascular event.

Abstract 12077: Stroke as the First Manifestation of Atrial Fibrillation

Introduction: Atrial fibrillation (AF) may remain undiagnosed until an ischemic stroke occurs. In this retrospective cohort study we assessed the prevalence of ischemic stroke or transient ischemic attack (TIA) as the first manifestation of AF in a cohort of patients with AF-associated stroke or TIA. Methods: Altogether 3,623 patients treated for their first ever ischemic stroke or TIA during 2003-2012 were identified from the electronic patient records of four clinical centers. Two groups were formed: patients with a history of AF and patients with new AF diagnosed during hospitalization for stroke or TIA. A control group of 781 patients with intracranial hemorrhage was compiled similarly to explore the direction of causality between new AF and stroke. Results: The median age of the patients was 78.3 [13.0] years and 2,009 (55.5%) were women. New AF was diagnosed in 753 (20.8%) patients with stroke or TIA, compared to 15 (1.9%) with intracranial hemorrhage. Younger age (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00-1.02; p=0.014) and no history of coronary artery disease (OR: 1.45; 95% CI: 1.16-1.82; p=0.001) or other vascular diseases (OR: 1.75, 95% CI: 1.09-2.79. p=0.020), heart failure (OR: 2.62; 95% CI: 1.94-3.54, p&lt;0.001), or hypertension (OR: 1.22; 95% CI:1.01-1.47; p=0.041) were the independent predictors of new AF detected concomitantly with an ischemic event. Thus, ischemic stroke was the first clinical manifestation of AF in 37% of younger (&lt;75 years) patients with no history of cardiovascular diseases (Figure). Conclusions: In conclusion, AF is too often diagnosed only after an ischemic stroke has occurred, especially in middle-aged healthy individuals. New AF seems to be predominantly the cause of the ischemic stroke and not triggered by the acute cerebrovascular event.

Paroxysmal atrial fibrillation: dynamics of the main antioxidant enzymes--superoxide dismutase and catalase.

Researchers have a particularly strong interest in the mechanisms implicated in the clinical manifestation of atrial fibrillation. To examine dynamically the activity of the antioxidant enzymes, superoxide dismutase and catalase in patients with paroxysmal atrial fibrillation (duration < 48 hours). The studied parameters were examined in the erythrocytes of 51 patients (59.84 +/- 1.60, 26 men) immediately after their hospitalization, at 24 hours and 28 days after restoration of sinus rhythm. 52 controls (59.50 +/- 1.46, 26 men) were also included, none of which had a history of arrhythmia. Propafenone was used to manage the rhythm abnormality. The enzyme activity was determined by a spectrophotometric method. The average duration of atrial fibrillation episodes until the time of hospitalization was 8.14 hours (from 2 to 24 hours). During patient hospitalization the activity of superoxide dismutase and catalase was considerably higher compared to that of the controls (8.46 +/- 0.26 vs 5.81 +/- 0.14 U/mg Hb; 7.36 +/- 0.25 vs 4.76 +/- 0.12 E240/min/mg Hb; P < 0.001). This difference was maintained 24 hours after the rhythm regularization (7.19 +/- 0.25 vs 5.81 +/- 0.14 U/mg Hb, p < 0.001; 5.30 +/- 0.21 vs 4.76 +/- 0.12 E240/min/mg Hb, p < 0.05). Twenty-eight days after the restoration of sinus rhythm, the activity of catalase remained increased (5.11 +/- 0.08 vs 4.76 +/- 0.12 E240/min/mg Hb, p < 0.05). The paroxysmal atrial fibrillation in our study was characterized with significantly increased activity of superoxide dismutase and catalase even in the early hours of clinical manifestation of the disorder, which then slowly decreased with the restoration of sinus rhythm. Therefore, we can conclude that changes in oxidative status are closely related to the disease and are probably a part of the intimate mechanisms related to its initiation and clinical course.

Upper limb embolism as the first manifestation of atrial fibrillation

Upper limb embolism as the first manifestation of atrial fibrillation

ADVERSE PROGNOSIS OF ASYMPTOMATIC ATRIAL FIBRILLATION DETECTED INCIDENTALLY: A CASE FOR SCREENING

Stroke is not uncommonly the first clinical manifestation of atrial fibrillation (AF). Although ACC guidelines do not mention screening, ESC 2012 guidelines now recommend opportunistic screening for AF in patients ≥ 65, but the prognosis of incidentally detected asymptomatic AF that might be