New-onset Atrial Fibrillation In Patients Research Articles

Prediction of new-onset atrial fibrillation with the C2HEST score in patients admitted with community-acquired pneumonia.

Patients hospitalized for community-acquired pneumonia (CAP) may have a higher risk of new-onset atrial fibrillation (NOAF). The C2HEST score was developed to evaluate the NOAF risk in the general population. Data on the value of the C2HEST score in acute patients admitted with CAP are lacking. We want to establish the predictive value of C2HEST score for NOAF in patients with CAP. Patients with CAP enrolled in the SIXTUS cohort were enrolled. C2HEST score was calculated at baseline. In-hospital NOAF was recorded. Receiver-operating Characteristic (ROC) curve and multivariable Cox proportional hazard regression analysis were performed. We enrolled 473 patients (36% women, mean age 70.6 ± 16.5years), and 54 NOAF occurred. Patients with NOAF were elderly, more frequently affected by hypertension, heart failure, previous stroke/transient ischemic attack, peripheral artery disease and hyperthyroidism. NOAF patients had also higher CURB-65, PSI class and CHA2DS2-VASc score. The C-index of C2HEST score for NOAF was 0.747 (95% confidence interval [95%CI] 0.705-0.786), higher compared to CURB-65 (0.611, 95%CI 0.566-0.655, p = 0.0016), PSI (0.665, 95%CI 0.621-0.708, p = 0.0199) and CHA2DS2-VASc score (0.696, 95%CI 0.652-0.737, p = 0.0762). The best combination of sensitivity (67%) and specificity (70%) was observed with a C2HEST score ≥ 4. This result was confirmed by the multivariable Cox analysis (Hazard Ratio [HR] for C2HEST score ≥ 4 was 10.7, 95%CI 2.0-57.9; p = 0.006), independently from the severity of pneumonia. The C2HEST score was a useful predictive tool to identify patients at higher risk for NOAF during hospitalization for CAP. www. gov (NCT01773863).

New-onset atrial fibrillation detected by ambulatory ECG monitoring after transcatheter aortic valve implantation.

Little is known about the occurrence of subclinical new-onset atrial fibrillation (NOAF) after transcatheter aortic valve implantation (TAVI). We aimed to evaluate the incidence, predictors, and clinical impact of subclinical NOAF after TAVI. This was a multicentre study, including patients with aortic stenosis (AS) and no previous atrial fibrillation undergoing TAVI, with continuous ambulatory electrocardiogram (AECG) monitoring after TAVI. A total of 700 patients (79±8 years, 49% female, Society of Thoracic Surgeons score 2.9% [1.9-4.0]) undergoing transarterial TAVI were included (85% balloon-expandable valves). AECG was started 1 (0-1) day after TAVI (monitoring time: 14<span class="eij_ref" contenteditable="false" data-id="26797">12</span><span class="eij_ref" contenteditable="false" data-id="18749">13</span><span class="eij_ref" contenteditable="false" data-id="26798">14</span> days). NOAF was detected in 49 patients (7%), with a median duration of 185 (43-421) minutes (atrial fibrillation burden of 0.7% [0.3-2.8]). Anticoagulation was started in 25 NOAF patients (51%). No differences were found in baseline or procedural characteristics, except for a higher AS severity in the NOAF group (peak gradient: no NOAF: 71.9±23.5 mmHg vs NOAF: 85.2±23.8 mmHg; p=0.024; mean gradient: no NOAF: 44.4±14.7 mmHg vs NOAF: 53.8±16.8 mmHg; p=0.004). In the multivariable analysis, the baseline mean transaortic gradient was associated with a higher risk of NOAF after TAVI (odds ratio 1.04, 95% confidence interval: 1.01-1.06 for each mmHg; p=0.006). There were no differences between groups in all-cause mortality (no NOAF: 4.7% vs NOAF: 0%; p=0.122), stroke (no NOAF: 1.4% vs NOAF: 2.0%; p=0.723), or bleeding (no NOAF: 1.9% vs NOAF: 4.1%; p=0.288) from the 30-day to 1-year follow-up. NOAF detected with AECG occurred in 7% of TAVI recipients and was associated with a higher AS severity. NOAF detection determined the start of anticoagulation therapy in about half of the patients, and it was not associated with an increased risk of clinical events at 1-year follow-up.

Application Evaluation of Esmolol Hydrochloride-Assisted Interventional Therapy on New-Onset Atrial Fibrillation in Patients with Severe Sepsis: A Retrospective Study

Objective: This study aims to explore the application effect of adjuvant therapy with esmolol hydrochloride on new-onset atrial fibrillation (NOAF) in patients with severe sepsis. Methods: Retrospective analysis was conducted on 170 patients with NOAF and severe sepsis admitted to our hospital from January 2022 to January 2023. After excluding eight patients who did not meet the inclusion criteria, the remaining 162 patients were included in the study. Based on different treatment methods, the patients were divided into the control group (n = 83, routine treatment) and the observation group (n = 79, esmolol hydrochloride in combination with routine treatment). The cardiac function indexes such as left atrial diameter, left ventricular end-diastolic dimension, left ventricular end-systolic dimension and left ventricular ejection fraction; left atrial wall tension-related indexes, including atrial natriuretic peptide, B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide; inflammatory factors, including a C-reactive protein, high-sensitivity C-reactive protein, interleukin-6 and procalcitonin and the incidence of adverse reactions were compared between the two groups. Statistical methods were used to process and compare the above-mentioned data and index results. Results: No significant difference was observed in cardiac function indexes, left atrial wall tension-related indexes and inflammatory factors in both groups before treatment (p &gt; 0.05). After treatment, the observation group had lower cardiac function indexes, left atrial wall tension-related indexes and inflammatory factors than the control group (p &lt; 0.05), and the incidence of adverse reactions in the two groups was similar (p &lt; 0.05). Conclusion: The adjuvant therapy with esmolol hydrochloride has a certain clinical effect on patients with severe sepsis and NOAF, which improves the cardiac function of such patients and reduces their inflammation levels up to a point, showing a clinical application value.

Establishment and evaluation of a nomogram for in-hospital new-onset atrial fibrillation after percutaneous coronary intervention for acute myocardial infarction.

New-onset atrial fibrillation (NOAF) is prognostic in acute myocardial infarction (AMI). The timely identification of high-risk patients is essential for clinicians to improve patient prognosis. A total of 333 AMI patients were collected who underwent percutaneous coronary intervention (PCI) at Zhejiang Provincial People's Hospital between October 2019 and October 2020. Least absolute shrinkage and selection operator regression (Lasso) and multivariate logistic regression analysis were applied to pick out independent risk factors. Secondly, the variables identified were utilized to establish a predicted model and then internally validated by 10-fold cross-validation. The discrimination, calibration, and clinical usefulness of the prediction model were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow test decision curve analyses, and clinical impact curve. Overall, 47 patients (14.1%) developed NOAF. Four variables, including left atrial dimension, body mass index (BMI), CHA2DS2-VASc score, and prognostic nutritional index, were selected to construct a nomogram. Its area under the curve is 0.829, and internal validation by 10-fold cross-folding indicated a mean area under the curve is 0.818. The model demonstrated good calibration according to the Hosmer-Lemeshow test (P = 0.199) and the calibration curve. It showed satisfactory clinical practicability in the decision curve analyses and clinical impact curve. This study established a simple and efficient nomogram prediction model to assess the risk of NOAF in patients with AMI who underwent PCI. This model could assist clinicians in promptly identifying high-risk patients and making better clinical decisions based on risk stratification.

Clinical and Laboratory Data Up on Hospital Admission are Predictors of New-Onset Atrial Fibrillation in Patients Hospitalized Due to COVID-19 Pneumonia.

New-onset atrial fibrillation (NOAF) occurs in patients hospitalized due to COVID-19. It is still unknown whether clinical and laboratory data assessed upon hospital admission have predictive value for NOAF. To analyze, upon hospital admission, variables with predictive potential for the occurrence of NOAF in patients with COVID-19 pneumonia. Observational, retrospective, case-control study. Electronic medical reports of consecutive patients, 60 years of age or older, hospitalized due to COVID-19 pneumonia between March 1st and July 15th, 2020, were reviewed. Non-paired Student or chi-squared tests compared variables. A Cox proportional hazard model was employed to identify independent predictors of NOAF. P value < 0.05 was considered statistically significant. Among 667 patients hospitalized due to COVID-19, 201 (30.1%) fulfilled the inclusion criteria. NOAF was documented in 29 patients (14.4%), composing group 1. Group 2 was composed of 162 patients without NOAF. Ten patients were excluded due to the AF rhythm upon hospital admission. In groups 1 and 2, there were differences in overall in-hospital survival rate (24.1 % vs. 67.9%; p<0.001), length of stay in ICU (11.1 ± 10.5 days vs. 4.9 ± 7.5 days; p=0.004) and need for mechanical ventilation rate (82.9% vs. 32.7%; p<0.001). In the Cox model, age > 71 y/o (HR=6.8; p<0.001), total leukocyte count ≤ 7,720 cels.μL-¹ (HR=6.6; p<0.001), serum [Na+] ≤ 137 mEq.L-¹ (HR=5.0; p=0.001), SAPS3 score > 55 (HR=5.6; p=0.002), and disorientation (HR=2.5; p=0.04) on admission were independent predictors of NOAF. NOAF is a common arrhythmia in elderly hospitalized patients with COVID-19 pneumonia. Clinical and laboratory parameters evaluated on admission have a predictive value for the occurrence of NOAF during hospitalization.

Automated left atrial strain analysis for predicting new-onset atrial fibrillation in patients with ST-elevation myocardial infarction: A prospective echocardiography study

Automated left atrial strain analysis for predicting new-onset atrial fibrillation in patients with ST-elevation myocardial infarction: A prospective echocardiography study

Aromatase Inhibitor Therapy Increases the Risk of New-Onset Atrial Fibrillation in Patients With Breast Cancer

BackgroundPrevious studies suggest that aromatase inhibitors (AIs) increase the risk of adverse cardiovascular events and cardiac arrhythmias in patients with breast cancer, but it is unclear whether AIs also increase the risk of new-onset atrial fibrillation (AF). ObjectivesThe purpose of this study was to investigate whether the use of AIs was associated with an increased risk of new-onset AF in patients with breast cancer. MethodsWe performed a retrospective analysis involving 5,707 patients with breast cancer (mean age 63.9 ± 11.2 years and 99.9% women) who received adjunctive hormone therapy with an AI (AI group, n = 4,878) or tamoxifen (tamoxifen group, n = 829) in Hong Kong between January 1, 1999, and December 31, 2020. After propensity score matching, there were 1,658 and 829 patients with balanced characteristics in the AI group and tamoxifen group, respectively. ResultsAfter 8,863 patient-years of follow-up, patients who were prescribed AI had a trend toward more new-onset arrhythmias compared with those prescribed tamoxifen (0.62 vs 0.30 per 100 patient-years; crude HR: 2.05; P = 0.053). The difference in arrhythmic risk was mainly driven by a higher incidence rate of new-onset AF in the AI group (0.59 vs 0.27 per 100 patient-years; crude HR: 2.18; P = 0.046). The use of AIs was confirmed to be an independent risk factor for new-onset AF on multivariate analysis (adjusted HR: 2.75; P = 0.01). ConclusionsAmong breast cancer patients prescribed adjunctive hormonal therapy, AI was associated with an increased risk of new-onset AF. Regular surveillance for new-onset AF should be considered in breast cancer patients treated with an AI.

A Predictive Model of New-Onset Atrial Fibrillation After Percutaneous Coronary Intervention in Acute Myocardial Infarction Based on the Lymphocyte to C-Reactive Protein Ratio.

Lymphocyte to C-reactive protein ratio (LCR) is a recognized systemic inflammatory marker and novel prognostic indicator for several cancers. This study investigated the relationship between preoperative LCR and new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Patients with AMI (n=662) with no history of atrial fibrillation (AF) were enrolled and classified into NOAF and non-NOAF groups based on the occurrence of postoperative NOAF during hospitalization. Logistic regression models were used to analyze NOAF risk factors and to assess the association between preoperative LCR and NOAF incidence. We constructed a new nomogram from the selected NOAF risk factors, and tested its predictive performance, degree of calibration, and clinical utility using receiver operating characteristic and calibration curves, decision curve analysis, and clinical impact curves. Overall, 84 (12.7%) patients developed NOAF during hospitalization. The LCR was significantly lower in the NOAF group. Preoperative LCR accurately predicted NOAF after AMI and was correlated with increased NOAF risk. Age, body mass index, diabetes, serum albumin levels, uric acid levels, left atrium (LA) diameter, left ventricular ejection fraction, left circumflex artery stenosis > 50%, and Killip class II status were independent predictors of NOAF after AMI. In addition, a new nomogram combined with LCR was constructed to stratify the risk of NOAF in patients with AMI. The performance of the new nomogram was satisfactory, as shown by the receiver operating characteristic curve, calibration curve, decision curve analysis and clinical impact curve. Preoperative LCR was an independent predictor of NOAF in patients with AMI after PCI. The novel nomogram combined with LCR could rapidly and individually identify and treat patients at a high risk of NOAF.

Left atrial function and the risk of new-onset atrial fibrillation in cardiac amyloidosis

Abstract Background Cardiac amyloidosis (CA) is an infiltrative disease characterized by the accumulation of misfolded proteins into the extracellular matrix of the myocardium. Ventricular but also atrial myopathy are described in CA, with higher risk of atrial fibrillation (AF) and cardioembolic events even during sinus rhythm. Purpose We aimed to investigate which parameters of left atrial (LA) structure and function could predict new-onset AF (NOAF) in patients with CA, aiding in improved follow-up. Methods We prospectively included patients diagnosed with CA, both light chain (AL) and variant transthyretin (ATTRv) with no history of AF, from 2 tertiary European centers. Cardiac involvement was assessed according to current European recommendations. Comprehensive echocardiographic studies were performed at baseline with measurement of both classical structure and function parameters parameters derived from speckle tracking echocardiography measured with a vendor-dependent analysis software and the primary outcome was NOAF. Results Of the 179 patients diagnosed with CA, 86 were excluded due to history of AF, unacceptable image quality and non-AL or non-ATTRv diagnoses. Finally, 93 patients with CA were included (mean age 54.3±9.8, 58% males), and 44 patients developed NOAF during a median follow up of 11 (32.5) months. Patients with NOAF had heavier hearts (LVMi 155.5±39.6 vs. 136.6±44.3 g/m2, p= 0.03), worse global LV function (LVEF 46.7±10.9 vs. 53.8±11.2 %, p= 0.003), more LV longitudinal impairment (GLS -10.0±4.7 vs. -13.4±3.7 %, p= 0.0002), larger atria (LAVi 44.6±14.3 vs. 35.4±13.6 mL/m2, p= 0.002) and worse LA function (LA emptying fraction 28.5±15.5 vs. 44.9±14.6 %, p&amp;lt; 0.001; LA peak longitudinal strain (PALS) 13.6±11.3 vs. 20.5±10.4 %, p= 0.003). In the multivariate analysis adjusting for confounding factors, including LA diameter, LAVi and other LA function parameters, lower PALS was independently associated with higher risk for NOAF (HR: 0.874, 95% CI: 0.784-0.974, p= 0.014). Using the receiver operating characteristics curve analysis, we identified the optimal cut-off of PALS for predicting NOAF as 14.3% (Sn 71%, Sp 73%, AUC 0.75). Furthermore, PALS ≤14.3% was an independent predictor for NOAF (HR: 5.259, 95% CI: 2.653–10.423, P&amp;lt; 0.001). The Kaplan–Meier curves showed that patients with PALS ≤14.3% had a higher risk for NOAF than those with PALS &amp;gt;14.3% (P&amp;lt;0.001 by log-rank test, Figure 1). Conclusions PALS is an independent predictor for NOAF in patients with CA.Figure 1.Kaplan-Meier curves for NOAF

Lower dose direct oral anticoagulation and warfarin in atrial fibrillation. Ischemic stroke, intracranial hemorrhage and mortality in a nationwide registry study

Abstract Background and aims Direct oral anticoagulants (DOACs) have replaced Vitamin-K antagonists as the primary choice of oral anticoagulation (OAC) in atrial fibrillation (AF). However, after several years of experience with DOACs, no studies have been made comparing the efficacy and safety of reduced dose DOACs and warfarin when the quality of warfarin treatment (time in the therapeutic range, TTR) information is available. Methods The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a nationwide study of AF patients combining data from several Finnish healthcare registers. We included all new-onset AF patients from 2011 to 2018 in Finland with purchases of either reduced dose DOAC or warfarin with eligible laboratory data. For patients on warfarin, we calculated TTR percentages and divided patients into TTR quartiles. Occurrence of ischemic stroke (IS), intracranial haemorrhage (ICH), or death during OAC use were recorded as outcomes during a maximum follow-up of 730 days. Crude and weighted rates of IS, ICH and mortality are provided. To minimize confounding by baseline characteristics and concomitant medications, an inverse probability of treatment weighted analysis was applied. Results A total of 52,022 new-onset AF patients with OAC therapy (46.1% male, mean age 75.7 years, 43 548 on warfarin) were followed for 56 382 patient-years (py). The rate of IS among patients was 1.63/100 py for dabigatran (n=2 672), 1.64/100 py for apixaban (n=3 936), 1.49 /100 py for rivaroxaban (n=1 866). For patients with warfarin, the rates of IS in TTR quartiles were 3.45, 1.79, 1.18 and 0.74/100 py from the lowest (mean TTR 32%) to the highest TTR quartile (mean TTR 90%). The weighted rates of IS were 1.34, 0.96 and 1.25/100 py for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 3.70, 1.87, 1.21 and 0.97/100 py. The rates of ICH were 0.68, 1.09 and 1.06/100 py for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 3.60, 0.99, 0.51 and 0.32/100 py. The weighted rates of ICH were 0.70, 0.70 and 0.90/100 py for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 3.80, 1.03, 0.54, 0.34 and 0.97/100 py. For mortality, raw incidences rates were 4.31, 11.40, and 8.11/100 py for for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 16.45, 5.33, 2.31, and 1.53/100 py. The weighted rates were 3.97, 7.97, and 6.78, for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 18.08, 5.86, 2.58, and 1.73/100 py. Figures portray cumulative IS incidence and mortality. Conclusion The incidence rates of all three outcomes were highest among patients on warfarin in the lowest TTR quartiles. For reduced dose DOAC patients, weighted IS rates were highest for those on dabigatran, ICH rates for those on rivaroxaban, and mortality rates for those on apixaban.Cumulative Incidence of Ischemic StrokeCumulative mortality

Time-in-therapeutic-range defined warfarin and standard dose direct oral anticoagulants in atrial fibrillation: Ischemic stroke, intracranial hemorrhage and death in a nationwide registry study

Abstract Background and aims Direct oral anticoagulants (DOACs) have almost replaced warfarin in stroke prevention of patients with atrial fibrillation (AF). However, little is known whether DOACs are more efficacious or safer than warfarin having information on time-in-therapeutic-range (TTR) in the warfarin-treated patients. Methods The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a nationwide study of AF patients combining data from several Finnish health care registers. We analyzed all new-onset AF patients from 2011 to 2018 with available laboratory data. The rates of ischemic stroke (IS), intracranial hemorrhage (ICH) and mortality during oral anticoagulation (OAC) use were analyzed until maximum follow-up of 730 days. Confounding factors by baseline characteristics as well as medications were taken into account by an inverse probability of treatment weighted analysis. For warfarin users, TTR was calculated and patient quartiles by TTR were assigned. The rates of IS, ICH and mortality in TTR quartiles for warfarin users were compared to standard dose dabigatran (150 mg bd.), apixaban (5mg bd.) and rivaroxaban (20mg od.). Results Altogether, 73 469 new-onset AF patients with OAC therapy (50.4 % male, mean age 73.0 years, 43 548 on warfarin, with mean TTR 66% and median TTR 72%) were followed for 76 546 patient years (py). The rate of IS among patients with standard dose DOACs was 0.73/100 py for dabigatran (n=4 545)[HJK1] , 1.05/100 py for apixaban (n=12 426) and 0.83/100 py for rivaroxaban (n=12 950). In the TTR quartiles of patients on warfarin, rates of IS were 3.5, 1.8, 1.2 and 0.74/100 py from the lowest (mean TTR 32%) to the highest quartile (mean TTR 90%), respectively. The weighted rates of IS were 1.3, 1.1 and 0.87/100 py for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 3.2, 1.7, 1.2 and 0.7/100 py. The respective rates of ICH were 0.47, 0.62 and 0.67/100 py for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 3.6, 0.99, 0.51 and 0.32/100 py. The weighted rates of ICH were 0.70, 0.65 and 0.73/100 py for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 3.4, 0.96, 0.51 and 0.30/100 py. For mortality, the raw incidence rates were 1.2, 2.8 and 2.1/100 py for for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 16.5, 5.3, 2.3, and 1.5/100 py. The weighted rates were 1.6, 2.9, and 2.6, for dabigatran, apixaban and rivaroxaban, and for warfarin from the lowest to the highest quartile: 14.6, 4.8, 2.0, and 1.3/100 py. The Figures provide cumulative incidence of IS and total mortality (crude rates) of the analyzed OAC groups. Conclusions The rates of IS, ICH and mortality were highest among patients on warfarin in the two lowest TTR quartiles, whereas the differences between high TTR groups and standard dose DOACs were only modest.Cumulative incidence of ischemic strokeCumulative mortality rate

New-Onset Atrial Fibrillation in the Critically Ill COVID-19 Patients Hospitalized in the Intensive Care Unit.

New-onset atrial fibrillation (NOAF) is the most frequently encountered cardiac arrhythmia observed in patients with COVID-19 infection, particularly in Intensive Care Unit (ICU) patients. The purpose of the present review is to delve into the occurrence of NOAF in COVID-19 and thoroughly review recent, pertinent data. However, the causality behind this connection has yet to be thoroughly explored. The proposed mechanisms that could contribute to the development of AF in these patients include myocardial damage resulting from direct virus-induced cardiac injury, potentially leading to perimyocarditis; a cytokine crisis and heightened inflammatory response; hypoxemia due to acute respiratory distress; disturbances in acid-base and electrolyte levels; as well as the frequent use of adrenergic drugs in critically ill patients. Additionally, secondary bacterial sepsis and septic shock have been suggested as primary causes of NOAF in ICU patients. This notion gains strength from the observation of a similar prevalence of NOAF in septic non-COVID ICU patients with ARDS. It is plausible that both myocardial involvement from SARS-CoV-2 and secondary sepsis play pivotal roles in the onset of arrhythmia in ICU patients. Nonetheless, there exists a significant variation in the prevalence of NOAF among studies focused on severe COVID-19 cases with ARDS. This discrepancy could be attributed to the inclusion of mixed populations with varying degrees of illness severity, encompassing not only patients in general wards but also those admitted to the ICU, whether intubated or not. Furthermore, the occurrence of NOAF is linked to increased morbidity and mortality. However, it remains to be determined whether NOAF independently influences outcomes in critically ill COVID-19 ICU patients or if it merely reflects the disease's severity. Lastly, the management of NOAF in these patients has not been extensively studied. Nevertheless, the current guidelines for NOAF in non-COVID ICU patients appear to be effective, while accounting for the specific drugs used in COVID-19 treatment that may prolong the QT interval (although drugs like lopinavir/ritonavir, hydrochlorothiazide, and azithromycin have been discontinued) or induce bradycardia (e.g., remdesivir).

Abstract 12822: Prediction of New-Onset Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy Using RNA-Sequencing of Plasma Small Non-Coding RNAs

Background: It is known that about 20% of patients with hypertrophic cardiomyopathy (HCM) develop atrial fibrillation (AF), which can lead to stroke and worsening of heart failure. The current clinical model to predict new-onset AF in patients with HCM (HCM-AF score) offers only modest accuracy. RNA-sequencing (RNA-Seq) can determine concentrations of thousands of small non-coding RNAs (sncRNAs) in plasma. Hypothesis/Aims: To test the hypothesis that RNA-Seq of plasma sncRNAs predicts new-onset AF in HCM. Methods: In this prospective, multi-center cohort study, we conducted RNA-Seq of 3,740 plasma sncRNAs at enrollment on 283 patients with HCM without a prior history of AF. The outcome was new-onset AF. We developed a sncRNA-Seq-based LASSO classification model (sncRNA-Seq-based model) to predict new-onset AF using data from one institution (training set, n=193). We tested the predictive ability of the model in independent samples from the other institutions (test set, n=90). We also developed a clinical model with LASSO using all components of HCM-AF score - i.e., left atrial diameter, age, age at HCM diagnosis, and New York Heart Association functional class ≥2. We then compared the area under the receiver-operating characteristic curve (AUC) between the sncRNA-Seq-based model and the clinical model in the test set. Results: During a median follow-up of 2.8 [1.9-5.1] years, 25 patients (13%) in the training set and 7 (8%) in the test set developed new-onset AF. Using the sncRNA-Seq-based model developed in the training set, the AUC to predict new-onset AF in the test set was 0.82 (95% confidence interval [CI] 0.71-0.94, Figure ). This model outperformed the clinical model (AUC 0.59; 95% CI 0.38-0.81; Delong’s test P=0.02). Conclusion: This study serves as the first to demonstrate the ability of plasma sncRNA-Seq to predict new-onset AF in patients with HCM. The prediction model may help physicians identify patients with HCM who are at high risk of developing new-onset AF.

Abstract 12536: Occurrence of New-Onset Atrial Fibrillation in Patients After Left Atrial Appendage Closure

Introduction: Left atrial appendage closure (LAAC) has evolved as a non-pharmacological alternative for stroke prevention in patients with Atrial fibrillation (AF). The occurrence of post-operative AF is well described after cardiac and percutaneous procedures. But, there is limited understanding of the possibility of new-onset AF as a result of LAAC. Aims: To investigate the incidence of, and factors associated with, AF after LAAC. Methods: We conducted a retrospective analysis of 121 patients with i) paroxysmal AF, 2) had undergone LAAC, and 3) had an implantable electronic devices (CIEDs): pacemaker, defibrillator or implantable loop recorder. Patients with persistent AF and those presenting in AF on the day of LAAC were excluded. Data were collected on baseline characteristics, Colchicine use, antiarrhythmic drugs and prior history of AF ablation. Remote transmissions and device interrogations were analyzed to ascertain new-onset AF during the 6 months follow up period after LAAC. Univariate and multivariable analyses were performed to analyze factors associated with the occurrence of AF after LAAC. Results: Of the total 121 patients, 39 (32.2%) developed AF during the 6 month follow up period after LAAC. On univariate analysis, a lower CHA2DS2-Vasc score was associated with a lower incidence of AF post LAAC (OR 0.74, 95% CI 0.55-0.98, p = 0.04). On multivariable analysis, including variables of age, gender, CHA2DS2-Vasc score, use of Colchicine and history of AF Ablation, we observed a statistical trend towards the protective effect of prior AF ablation on occurrence of AF after LAAC (adjusted OR 0.32, 95% CI 0.10-1.05, p =0.06). There was also a statistical trend towards the protective effect of Colchicine on occurrence of AF after LAAC (adjusted OR 0.15, 95% CI 0.02-1.29, p =0.08). Conclusions: In our study of paroxysmal AF patients undergoing LAAC, who presented in sinus rhythm on the day of the procedure, the incidence of CIED detected post-procedural AF was 32.2%. We observed statistical trends towards protective effects of prior AF Ablation and use of Colchicine during the peri-LAAC period on occurrence of AF after LAAC.

Coronary Angiography–Derived Index of Microcirculatory Resistance Associated With New-Onset Atrial Fibrillation in Patients With STEMI

BackgroundCoronary angiography–derived index of microcirculatory resistance (caIMR) can effectively assess coronary microvascular dysfunction in patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to explore the role of caIMR in the occurrence of new-onset atrial fibrillation (NOAF) in patients with STEMI. MethodsThis was a single-centre retrospective clinical observational study. Patients diagnosed with STEMI from September 2019 to December 2022 were included. caIMR was calculated using computational flow and pressure simulations. During admission, suspicious heart rhythm was recorded by electrocardiographic (ECG) monitoring, and NOAF was confirmed by an immediate 12-lead ECG. ResultsA total of 739 patients were enrolled, including 57 (7.7) with NOAF. caIMR was significantly correlated with microvascular obstruction (R = 0.604; P < 0.001) and infarct size (R = 0.514; P < 0.001). After adjusting for potential confounding factors, the results showed that caIMR (odds ratio 1.058, 95% confidence interval 1.035-1.083; P < 0.001) was an independent risk factor for NOAF in patients with STEMI. Receiver operating characteristic analysis showed that the area under the curve of caIMR for predicting NOAF was 0.716. Compared with the caIMR < 27.35 U group, the caIMR ≥ 27.35 U group had higher high-sensitivity troponin T and N-terminal pro–B-type natriuretic peptide levels. When caIMR was added to the model, the reclassification and discriminant abilities improved significantly. ConclusionsHigher caIMR was an independent risk factor for NOAF in patients with STEMI. The caIMR had high specificity and sensitivity for predicting NOAF in patients with STEMI. The integration of caIMR into clinical risk factors showed significantly increased predictability for NOAF in patients with STEMI.

Incorporating uric acid into the CHA2DS2-VASc score improves the prediction of new-onset atrial fibrillation in patients with acute myocardial infarction

BackgroundNew-onset atrial fibrillation (NOAF) is a common cardiac arrhythmia observed in patients with acute myocardial infarction (AMI) and is associated with worse outcomes. While uric acid has been proposed as a potential biomarker for predicting atrial fibrillation, its association with NOAF in patients with AMI and its incremental discriminative ability when added to the CHA2DS2-VASc score are not well established.MethodsWe conducted a retrospective analysis of 1000 consecutive patients with AMI without a history of atrial fibrillation between January 2018 and December 2020. Continuous electrocardiographic monitoring was performed during the patients’ hospital stay to detect NOAF. We assessed the predictive ability of the different scoring models using receiver operating characteristic (ROC) curves. In addition, we employed the area under the curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) analyses to assess the incremental discriminative ability of uric acid when added to the CHA2DS2-VASc score.ResultsNinety-three patients (9.3%) developed NOAF during hospitalisation. In multivariate regression analyses, the adjusted odds ratio (OR) for NOAF was 1.439 per one standard deviation increase in uric acid level (95% confidence intervals (CI):1.182–1.753, p < 0.001). The ROC curve analysis revealed that the AUC for uric acid was 0.667 (95% CI:0.601–0.719), while the AUC for the CHA2DS2-VASc score was 0.678 (95% CI:0.623–0.734). After integrating the uric acid variable into the CHA2DS2-VASc score, the combined score yielded an improved AUC of 0.737 (95% CI:0.709–0.764, p = 0.009). Furthermore, there was a significant improvement in both IDI and NRI, indicating an incremental improvement in discriminative ability (IDI = 0.041, p < 0.001; NRI = 0.627, p < 0.001).ConclusionOur study suggests that uric acid level is an independent risk factor for the development of NOAF after AMI. Furthermore, the incorporation of uric acid into the CHA2DS2-VASc score significantly improves the discriminative ability of the score in identifying patients at high risk for NOAF.

Effects of using primary percutaneous coronary interventions on the incidence of new-onset atrial fibrillation following an acute myocardial infarction.

Acute ST-segment elevation myocardial infarction (STEMI) and new-onset atrial fibrillation (AF) are associated with increased risk of mortality. This study aimed to determine the proportion of patients who go on to develop new-onset a AF after undergoing a primary or delayed percutaneous coronary intervention (PCI) for an acute STEMI and to explore possible risk factors. One hundred and fifty-fourpatients who underwent PCI after STEMI were included in the study. Patient characteristics, baseline blood tests and cardiac parameters, type of PCI, and incidence of new-onset AF within 3 months of PCI were recorded and analyzed. Fifteendeveloped new-onset AF following the PCI, and 139 patients maintained a sinus rhythm. Univariate analysis showed significant differences between the two patient groups in terms of age, nature of the PCI (primary vs. delayed), left atrial diameter, and left ventricular diastolic dysfunction (p < .05). Age (odds ratio [OR] = 1.065, 95% confidence interval [CI]: 1.007-1.127, p < .05) and left atrial diameter (OR = 1.165, 95% CI: 1.008-1.347, p < .05), were independent predictors of new-onset AF after PCI. Primary PCI (OR = 0.232, 95% CI: 0.066-0.814, p < .05) was an independent protective factor. Age and left atrial diameter were independent risk factors of new-onset AF in patients undergoing a PCI following an acute myocardial infarction, while primary PCI was a protective factor. This discovery can help reduce mortality rate, improve long-term prognosis, and provide a theoretical basis for the prevention of new-onset AF.

AF and in-hospital mortality in COVID-19 patients

There are conflicting data on whether new-onset atrial fibrillation (AF) is independently associated with poor outcomes in COVID-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing AF, and new-onset AF. The primary aim of this study was to assess patient outcomes in COVID-19 patients with sinus rhythm, pre-existing AF, and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with COVID-19 infection. This was a single-center retrospective study of patients with a confirmed diagnosis of COVID-19 admitted between March and September 2020. Patient demographic data, medical history, and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF. The study population comprised of 1241 patients. A total of 94 (7.6%) patients had pre-existing AF and 42 (3.4%) patients developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (odds ratio [OR] 3.58, 95% confidence interval [CI] 1.78-7.06, P < .005) and after (OR 2.80, 95% CI 1.01-7.77, P < .005) propensity score matching compared with the no-AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared with patients with no AF (postmatching OR: 1.13, 95% CI 0.57-2.21, P = .732). New-onset AF, but not pre-existing AF, was independently associated with elevated mortality in patients hospitalised with COVID-19. This observation highlights the need for careful monitoring of COVID-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in COVID-19 patients.

ECG abnormality and predictor of new-onset atrial fibrillation in hypertension and diabetes mellitus population: An observational analytic study from cardiovascular outpatient clinic at a National Cardiovascular Center in Indonesia.

Population-based studies have also found that diabetes mellitus (DM) and hypertension (HT) are independent risk factors for atrial fibrillation (AF). However, less is known about new-onset atrial fibrillation (NOAF) risk factors and its correlation with DM and HT. The aim of this study was to determine the prevalence and pattern of ECG abnormalities, and the predictor of NOAF in patients with HT and DM. This cross-sectional study was conducted at a tertiary hospital from May until December 2021. All medical record data from outpatients who had both diagnoses HT and DM were included in this study. Data from patients with unstable hemodynamics and lack of complete medical record data were excluded. Then, patient history, medical records, ECG, and laboratory information were reviewed. There were 162 patients included in this study. Arrhythmia was found in 14.2% of the population, with new-onset AF (NOAF) as the most common finding with 8.6% incidence, followed by PVC (3.1%) and PAC (2.5%). Bivariate analysis showed that valvular heart disease, random blood glucose, LVEF, and infection status were associated with a higher incidence of NOA. Model from multivariate logistic regression showed that valvular heart disease and random blood glucose level were independently correlated with NOAF (p = .009). It can be concluded that random blood glucose level at a certain point and valvular heart disease can be used as a risk predictor of NOAF in the hypertension population with concomitant DM.

Propensity-score matched analysis of patent foramen ovale closure in real-world study cohort with cryptogenic ischemic stroke

IntroductionPatent foramen ovale (PFO) occurs in 25% of the general population and in 40% of cryptogenic ischemic stroke patients. Recent trials support PFO closure in selected patients with cryptogenic stroke. We examined the outcomes of transcatheter PFO closure in a real-world study cohort with cryptogenic stroke. MethodsConsecutive ischemic stroke patients who were classified as cryptogenic on the TOAST aetiology and diagnosed with a PFO were included. All patients underwent either transcatheter PFO closure or medical therapy. A 2:1 propensity score matching by sex and Risk-of-Paradoxical-Embolism (RoPE) score was performed. Multivariable regression models adjusted for sex and RoPE score. ResultsOur cohort comprised 232 patients with mean age 44.3 years (SD 10.8) and median follow-up 1486.5 days. 33.2% were female. PFO closure (n=84) and medical therapy (n=148) groups were well-matched with <10% mean-difference in sex and RoPE score. Two patients in the treated group (2.4%) and seven in the control group (4.7%) had a recurrent ischemic stroke event. Multivariable Cox regression demonstrated a hazard-ratio of 0.26 (95%CI 0.03-2.13, P=0.21) for PFO closure compared to control. The incidence of atrial fibrillation (AF) detected post-PFO closure was similar between the treated and control (1.19% vs 1.35%, multivariable logistic regression odds-ratio 0.90, 95%CI 0.04-9.81, P=0.94). There were no major periprocedural complications documented. The difference in restricted mean survival-time free from stroke at two years between treated and control was 26.2 days (95%CI 5.52-46.85, P=0.013). ConclusionsIn this Asian cohort, we report a low incidence of ischemic stroke recurrence and new-onset AF in patients who underwent PFO closure. When compared to the medical therapy group, there was no significant difference in the incidence of stroke recurrence and new-onset AF. Further studies involving larger real-world cohorts are warranted to identify patients who are more likely to benefit from PFO closure.