Number Of Atrial Fibrillation Patients Research Articles

Open resection for a large iatrogenic radial artery pseudoaneurysm. Case report.

Introduction and importanceWe present the case in which a large symptomatic pseudoaneurysm (PSA), 6 × 5 cm, with one year of evolution on the path of the right radial artery (RRA) appeared after its punction and cannulation for performing cardiac catheterism in an atrial fibrillation (AF) indefinite anticoagulated patient. Diagnosis and surgical planning were consolidated only by using color duplex ultrasound (CDU), contrasted images were not indicated.The open surgical management was performed during a short-time supraclavicular blockade of peripheral nerves without stopping nor bridging anticoagulant therapy. Complete excision of the deforming mass with no blood loss, decompression of the adjacent structures and direct closure of the arterial defect without compromising of its lumen and path were also achieved.Case presentationA 74-year-old, Hispanic male patient and former smoker underwent coronary catheterization for thoracic typical pain. One year after, he is admitted for move restrictive pain in distal right forearm and hand paresthesia related to a rapidly growing right radial artery PSA of 6 cm in diameter where the indefinite anticoagulation, indicated for chronic AF, confers a risk of major bleeding.After clinic and exclusive CDU assessing, the patient granted us written authorization for performing an open surgery.One year follow up showed an asymptomatic patient with no RRA residual lesions.Clinical discussionAlthough contrasted are the preferred diagnosis methods when arterial issues are suspected especially angiography since, when indicated, the endovascular treatment may be performed immediately after diagnosis. The CDU performed with a high-sensitivity transducer is the image of choice for an immediate differential diagnosis (Meola et al., 2021 [1]). In addition, it allowed us to see both, the particular PSA inside structure and the patency of ipsilateral ulnar artery, necessary details to propose the successful open surgical treatment finally conducted.ConclusionVascular and trauma surgeons should be trained to ensure the correct diagnosis based on preexisting medical conditions, clinical findings and those provided by CDU in order to offer an appropriate and definitive management to peripheral vascular iatrogenic lesions with potential bleeding risk, especially in anticoagulated patients. Since large limb deforming PSAs are recommended to be excided through open access, they should also be trained to perform it without additional risks nor sequelae.Since the number of AF patients is increasing worldwide, main aspects on anticoagulation therapy have to be taught to every surgical team.

The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF): study rationale, design, and patient characteristics

Atrial fibrillation (AF) is a major cause of ischemic stroke and the number of AF patients is increasing. Thus, up-to-date multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. The Finnish anticoagulation in atrial fibrillation (FinACAF) study has collected comprehensive data on all Finnish AF patients from 1st January 2004 to 31st December 2018. The aim of this paper is to describe the study rationale, the process of integrating data from the applied resources and to define the study cohort. Using national unique personal identification number, individual patient data is linked from nationwide health care registries (primary, secondary, and tertiary care), drug purchases, education, and socio-economic status as well as places of domicile, incomes, and taxes. Six regional laboratory databases (~ 282,000, 77% of the patients) are also included. The study cohort comprises of a total of 411,000 patients. Since the introduction of the national primary care register in 2012, 9% of all AF patients were identified outside hospital care registers. The prevalence of AF in Finland—4.1% of whole population—is for the first time now established. The FinACAF study allows a unique possibility to investigate the epidemiology and socio-medico-economic impact of AF as well as the cost effectiveness of different AF management strategies in a completely unselected, nationwide population. This article provides the rationale and design of the study together with a summary of the characteristics of the cohort.

Cryoballoon atrial fibrillation ablation experience in Japan.

In Japan, cryoballoon ablation has been widely accepted and more than 70 000 patients have undergone pulmonary vein isolation using this novel technology since the introduction. This review focused on the current status of cryoballoon ablation in Japan and clarified the characteristics as compared to Europe and the United States. The number of atrial fibrillation patients undergoing cryoballon ablation has rapidly increased over the last 6 years. Most of the Japanese physicians consider the indication of cryoballoon ablation based on the anatomy of the pulmonary veins and left atrium evaluated on preprocedural computed tomography, and often perform adjunctive radiofrequency ablation after the pulmonary vein isolation. The reported overall efficacy and safety were similar to that in Europe and the United States; however, there are some distinctive complications of the cryoballoon procedure in Japan, such as air embolisms, gastric hypomotility and coronary artery spasms. Currently, the cryoballoon pulmonary vein isolation is widely accepted in Japan owing to the low incidence of lethal complications, shorter procedure time and acceptable single procedure atrial fibrillation freedom.

The Sensitivity of The Heart Rate Detection for Atrial Electrograms Signal

Atrial Fibrillation (AF) is the most familiar example of arrhythmia that will occur health problems such as stroke, heart failure and other complications. Globally, the number of AF patients will more than triple by 2050 worldwide. Current methods involve performing large-area ablation without knowing the exact location of key parts. The reliability of the technology can be used as a target for atrial fibrillation’s catheter ablation. The factors that leading to the onset of atrial fibrillation include the triggering factors that induce arrhythmia and the substrate that maintains the arrhythmia. The project’s aim is to create a method for identifying AF that can be used as screening tool in medical practice. The primary goals for the detection method’s design are to develop a MATLAB software program that can compare the complexity of a normal ECG signal and an AF ECG signal. Currently, this can be achieved by the ECG Signal’s R peaks and RR Interval. For AF detection, there are more R peaks and RR Intervals and it is irregular. In this research, the detection of AF is based on the heart rate (RR Intervals). For the ECG preprocessing, Pan-Tompkins Algorithm and Discrete Wavelet Transform is used to detect the sensitivity on the R peaks and RR Intervals. As a result, Discrete Wavelet Transform algorithm gives 100% sensitivity for the dataset obtained from MIT-BIH Atrial Fibrillation and MIT-BIH Arrhythmia Database.

All you want to know about the arrhythmia: A comprehensive, nationwide registry study of atrial fibrillation in Finland

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District Funding The Finnish Foundation for Cardiovascular Research OnBehalf FinACAF Introduction The number of atrial fibrillation (AF) patients is increasing, and thus, the socio-medico-economic impact of AF is exploding. Up-to-date, multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. Purpose The aim of the Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is to evaluate the incidence and prevalence of AF, risk of stroke, thromboembolic complications, myocardial infarction, major bleeding events, and mortality in AF patients using comprehensive nationwide registries regulated by law. Assessment of the socio-medico-economic aspects of AF and the effect of socio-economic factors on the AF treatment play a central role in this study. Methods The FinACAF study collects data from 411 000 patients covering all Finnish AF patients from 1st January 2004 to 31st December 2018. Using national unique personal identification number, individual patient data from ten nationwide population registries and six regional laboratory databases (∼282000, 77 % of the patients) are linked together. All the register data were obtained during Q1-Q2/2020. The main results will be expected during Q1-2/2021. Results Since the introduction of the national primary care register in 2012, 9% of all AF patients were identified outside hospital care registers. The total number of AF patients on 31st December 2018 was 227 114, which translates to an AF prevalence of 4.1% in Finland (population of 5 517 900). The Table represents the registries used in the FinACAF study. Conclusions The FinACAF study records all patient contacts with the health care institutions and organizations, as well as incomes and places of domicile. Thus, the database allows a unique possibility to investigate the epidemiology and socio-medico-economic impact of AF as well as the cost effectiveness of different AF management strategies in a completely unselected, nationwide population. This data will markedly help "leading with data" when the increasing number of AF patients are treated. The registries used in the FinACAF study Register Registry Information obtained Finnish Care Register for Health Care: Primary, Hospital and Social care registries National Institute for Health and Welfare Diagnosis (ICD-10), procedure codes and date; non-hospital institutionalizations National Prescription Register, National Reimbursement Register The Social Insurance Institution of Finland Drug purchases (date, ATC codes, amount), Reimbursement decisions for chronic diseases (date, ICD-10) National Causes of Death Register, The Register of Completed Education and Degrees Statistics Finland Deaths and causes of deaths (ICD-10), Education and socio-economic status National Cancer Registry (1st Jan 1950 to 31st Dec 2018) Finnish Cancer Registry National registry of all cancer cases (e.g. date, ICD-O-3, TNM) Population Register, Tax register Population Register Center, Tax Administration Places of domicile, Income and taxes Laboratory databases (1st Jan 2010 to 31st Dec 2018) Six largest regional laboratory databases INR and other relevant laboratory measurements

Magnetic resonance phase contrast velocity mapping for flow quantification in irregular heart rhythms using radial k-space ultrashort echo time imaging

BackgroundPhase contrast velocity mapping sequences utilising ultrashort echo time (UTE) radial k-space sequences have been used to reduce intravoxel dephasing at high velocities. We evaluated the accuracy of the UTE flow sequence for mitral regurgitation (MR) quantification, including patients with atrial fibrillation. MethodsForty patients underwent cardiac MRI for indirect MR quantification by assessment of aortic flow using a UTE phase contrast sequence (TE 0.65 ms) combined with left ventricular stroke volume. Retrospective ECG-gating was used in sinus rhythm (30 patients), prospective ECG-triggering in atrial fibrillation (10). MR was also quantified by a standard phase contrast sequence (TE 2.85 ms, standard flow method) and by comparing stroke volumes (volumetric method). ResultsUTE flow-derived MR measurement showed modest agreement in sinus rhythm (95% limits of agreement: ±38.2 ml; ±29.8%) and atrial fibrillation (±33.7 ml; ±30.3%) compared to standard flow assessment. There was little systematic bias in sinus rhythm (mean offset −4.4 ml /−3.5% compared to standard flow assessment), but a slight bias towards greater regurgitation in atrial fibrillation (+15.2 ml /+14.0%). There were wider limits of agreement between the UTE flow method and volumetric method than between the regular flow method and the volumetric method in sinus rhythm (±48.4 ml; ±36.4%; mean offset: −12.2 ml /−9.0%) and similar limits of agreement in atrial fibrillation (±29.6 ml; 25.8%; +12.0 ml /+10.3%). ConclusionsUTE flow imaging is inferior to conventional flow techniques for MR assessment in patients with sinus rhythm as well as atrial fibrillation. However, the number of atrial fibrillation patients in this initial study is small.

PCV89 ASSESSMENT OF CARE OPPORTUNITY GAPS FOR ATRIAL FIBRILLATION IN NHS ENGLAND

Implement the Anticoagulation Value Optimisation Tool to calculate the opportunity gaps for detection of non-valvular atrial fibrillation (AF) and anticoagulation of AF patients, and determine the level of improvement needed to meet the NHS Long Term Plan (LTP) detection target of 85%. The online tool was developed to inform Clinical Commissioning Groups (CCGs) in England about gaps in care and improve stroke prevention while optimising budget and resources and is currently populated with Quality and Outcomes Framework 2018/19 data. The care gaps addressed are the number of expected cases of AF versus the number of patients registered as having AF (detection gap) and the number of AF patients at high risk of stroke not anticoagulated (protection gap). Additional Pareto curve analysis in Excel allowed assessment of how many more cases of AF would need to be detected and treated to close these gaps by 85%. Across all 191 CCGs in England, the detection gap was 230,922 cases of AF (range 11 to 9,210 cases undetected per CCG). To achieve 85% detection, 122 of 191 CCGs would have to increase the number of AF cases identified by at least 813; eight CCGs would need to improve by more than double that number. The overall protection gap was 142,930 (range 76 to 3,960 patients per CCG not started on anticoagulants). To achieve 85% improvement, 130 of 191 CCGs would need to increase the number of anticoagulated patients by at least 474, and 15 would have to increase the number by more than twice that value. Current detection and protection gaps indicate the continued need to improve the management of AF in England and address variation. Action will be needed to achieve a sustainable diagnosis and anticoagulation service.

The STOP-BANG questionnaire shows an insufficient specificity for detecting obstructive sleep apnea in patients with atrial fibrillation.

Obstructive sleep apnea (OSA) is a sleep disorder associated with significant cardiovascular comorbidities, including cardiac arrhythmia. The STOP-BANG questionnaire is an eight-item self-report questionnaire designed to screen patients for OSA and was validated in preoperative surgical patients. The STOP items are snoring, daytime tiredness, observed apneas and high blood pressure. The BANG items are body mass index >35kg/m2 , age >50years, neck circumference >40cm and male gender. We aimed to determine the screening properties of the STOP-BANG questionnaire in patients with arrhythmia. Non-selected consecutive patients were recruited from arrhythmia clinics. Patients with previously diagnosed and/or treated OSA were excluded. The STOP-BANG questionnaire was self-administered. Patients underwent two consecutive nights of home sleep recording. OSA was defined as an apnea-hypopnea index score of ≥5/hr of sleep. The screening properties of the STOP-BANG questionnaire were analysed compared with the objective diagnosis of OSA by ambulatory testing. Ninety-five patients were included in the final analysis. Eighty-five percent were found to have OSA. The STOP-BANG score of ≥3 was 89% sensitive and 36% specific for diagnosis of OSA. The STOP-BANG questionnaire had fair performance, as indicated by an area under the curve of 0.74 (p=.004). In conclusion, the STOP-BANG questionnaire is sensitive; however, it has a low specificity with a high false positive rate. Given that a large number of atrial fibrillation patients need testing for OSA, we recommend the use of a level II sleep study regardless of the results of the screening questionnaire. This approach accurately identifies OSA and may limit the cost of unnecessary level-I sleep studies.

The changing circumstance of atrial fibrillation - progress towards precision medicine.

The prevalence of atrial fibrillation (AF) in the general population is between 1% and 2% in the developed world and is higher in men than in women. The arrhythmia occurs much more commonly in the elderly, and the estimated lifetime risk of developing AF is one in four for men and women aged 40 years and above. Projected data from multiple population-based studies in the USA and Europe predict a two- to threefold increase in the number of AF patients by 2060. The high lifetime risk of AF and increased longevity underscore the important public health burden posed by this arrhythmia worldwide. AF has multiple aetiologies and a broad variety of presentations. The primary pathologies underlying or promoting the occurrence of AF vary more than for any other cardiac arrhythmia, ranging from autonomic imbalance to organic heart disease and metabolic disorders, such as diabetes mellitus, metabolic syndrome, hyperthyroidism and kidney disease, and lifestyle factors such as smoking, alcohol consumption and participation in endurance sports. Biomarkers are increasingly being investigated and, together with clinical and genetic factors, will eventually lead to a clinically valuable detailed classification of AF which will also incorporate pathophysiological determinants and mechanisms of the arrhythmia. In turn, this will allow the development and application of precision medicine to this troublesome arrhythmia.

Stroke with atrial fibrillation or atrial flutter: a descriptive population-based study from the Brest stroke registry.

BackgroundIn the 1990s, epidemiological studies estimated the prevalence of stroke caused by atrial fibrillation (AF) at about 15 %. Given the aging population, there is a rise in the number of AF patients. AF prevention guidelines based on clinical practice and the literature have been published and updated since 2001. Implementation seems to have an impact on the prescription of vitamin K antagonist (VKA). During the last 20 years, few population-based studies have focused on the prevalence of atrial arrhythmia (AA) in patients with stroke. The objective of the present prospective study, using data from 2008, was to evaluate the prevalence of AA (atrial fibrillation/flutter) in patients with stroke and the impact of implementing AF guidelines.MethodsThe prevalence of AA was studied in patients diagnosed with stroke from January 1 to December 31, 2008 in the population-based Stroke Registry of Brest, France (total population, 363,760 according to the 2008 census, with 295,553 aged 15 years or older). Guidelines implementation was assessed in terms of antithrombotic therapy (VKA, antiplatelet agent, none), and the CHADS2 (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, and prior Stroke or transient ischemic attack).Results851 cases of stroke were identified. The prevalence of AA was 31.7 % (n = 264), and increased with age from < 20 % in patients aged 45 to 54 years to nearly 50 % in patients ≥ 85 years. In patients with AA, 231 strokes were ischemic, 28 hemorrhagic and 5 undetermined. At time of stroke, AA was known in 207 patients (78.4 %). 54 of the 152 patients with CHADS2 score ≥ 2 (35.5 %) were treated with VKA; this proportion decreased with age: 50 % between 50 and 74 years, 43.8 % between 75 and 84 years, and 25 % at 85 years and older.ConclusionThe prevalence of AA in the population-based Brest Stroke Registry in 2008 was higher than that reported by studies conducted 20 years ago. Despite publication of AF prevention guidelines, VKA prescription and use in elderly patients were significantly low.

Clinical characteristics of atrial fibrillation patients with low body weight: from the Fushimi AF registry

Purpose: Atrial fibrillation (AF) is a common arrhythmic disorder among the elderly, and is increasing significantly as the population ages (reportedly 0.6% of total population in Japan). Thromboembolism is a devastating complication of AF. Recently, new oral anticoagulants have become available for the prevention of thromboembolism, but bleeding complications were more often observed in patients with low body weight. Japanese elderly patients are generally small and lean, and data regarding those with low body weight (<50 kg) are very limited. Methods: The Fushimi AF registry, a community-based prospective survey was designed to enroll all of the AF patients living in Fushimi-ku, Kyoto, Japan. Fushimi-ku is densely populated with a total population of 283,000, and is assumed to represent a typical urban community in Japan. On the basis of the general prevalence of AF in the Japanese, we estimated the total number of AF patients as 1,700. A total of 76 institutions, a large proportion of which were private clinics, participated in the study. At present, we have enrolled 3,378 patients (1.2% of total population) from March 2011 to November 2012. We compared the clinical backgrounds of AF patients between those with low body weight <50 kg (LBW) and those without it (non-LBW). Results: Patients with LBW accounted for 28.1% of all the patients, and 48.3% of patients ≥80 years of ages. LBW group was more often female (LBW 77.5% vs. non-LBW 26.1%), and was older (LBW 80.0±9.9 vs. non-LBW 72.1±10.3 years). Both the mean CHADS2 score and CHA2DS2-VASc score were higher in LBW group (2.39±1.35 vs. 2.04±1.33; P<0.01 and 4.22±1.60 vs. 3.19±1.66; P<0.01, respectively): heart failure and previous stroke were more in LBW (40.1% vs. 25.3%; P<0.01 and 26.0% vs. 20.2%; P<0.01, respectively), whereas hypertension and diabetes mellitus were less (56.5% vs. 64.8%; P<0.01 and 15.3% vs. 28.4%; P<0.01, respectively). Although it did not reach a significant difference, vascular diseases (prior myocardial infarction and peripheral artery disease) were more in LBW (12.0% vs. 10.0%; P=0.10). LBW group experienced more episodes of major bleeding (2.84% vs. 1.71%; P<0.01), and received lower warfarin prescription (41.8% vs. 51.2%; P<0.01). Conclusion: The Fushimi AF registry represents the clinical profile of real-world Japanese AF patients. Many of the Japanese AF patients have low body weight. They are generally old and have high risk profiles for thromboembolism as well as bleeding. Indication and dose selection of anticoagulation should be carefully determined.

Clinical characteristics of super-elderly patients with atrial fibrillation: from the Fushimi AF registry

Purpose: Atrial fibrillation (AF) increases as the population ages, but data regarding super-elderly patients (≥85 years of age) are quite limited. The purpose of this study is to investigate clinical characteristics of super-elderly patients with AF. Methods: The Fushimi AF registry, a community-based prospective survey was designed to enroll all of the AF patients in Fushimi-ku, Kyoto, Japan. Fushimi-ku is densely populated with a total population of 283,000, and is assumed to represent a typical urban community in Japan. On the basis of the general prevalence of AF in the Japanese (0.6%), we estimated the total number of AF patients as 1,700. A total of 76 institutions, a large proportion of which were private clinics, participated in the study. At present, we have enrolled 3,378 patients (1.2% of total population) from March 2011 to December 2012. We divided the entire cohort into two groups, super-elderly group (≥85 years of age; n=547, 16.2% of total) and others (n=2,831), and compared the clinical backgrounds between them. Results: Super-elderly patients were more often female (67.1% vs. 35.9%), and more lightweight (body weight 48.6 kg vs 60.5 kg, body mass index 21.0 vs 23.2). The mean CHADS2 score and CHA2DS2-VASc score were higher in the super-elderly group (2.83 vs. 1.95; P<0.01, and 4.62 vs 3.20; P<0.01). Heart failure and previous stroke were more in super-elderly patients (41.3% vs. 24.9%; P<0.01, and 28.7% vs. 17.8%; P<0.01, respectively), whereas dyslipidemia and diabetes mellitus were less (29.1% vs. 45.0%; P<0.01, and 17.0% vs. 24.4%; P<0.01, respectively). There were no significant difference in the prevalence of hypertension, coronary artery disease and peripheral artery disease between groups. Chronic kidney disease was more in super-elderly patients (39.6% vs. 23.6%; P<0.01). Super-elderly patients experienced more episodes of major bleeding (3.66% vs. 1.59%; P<0.01), and received lower warfarin prescription (36.8% vs. 50.2%; P<0.01). Conclusions The Fushimi AF Registry provides a unique snapshot of current realworld AF management in an urban community in Japan. Super-elderly patients with AF have higher risk profiles for thromboembolism, whereas they experience more episodes of major bleeding. Indication and dose selection of anticoagulation of super-elderly patients should be carefully determined.

Prevention of stroke in patients with nonvalvular atrial fibrillation.

To review the risk and pathogenesis of stroke associated with nonvalvular atrial fibrillation (AF) and the efficacies and risks of stroke prevention strategies. About 16% of ischemic strokes are associated with AF; AF is an independent risk factor for stroke. Review of the literature, focusing on 13 randomized trials of antithrombotic therapy. The overall risk of stroke in AF patients averages about 5%/y, but with wide variation depending on the presence of coexistent thromboembolic risk factors. AF patients with low (about 1% per year), moderate (about 3% per year), and high (about 6% per year) stroke risks have been identified, but the generalizability of risk stratification schemes to clinical practice has not been fully assessed. AF patients with prior stroke or transient ischemic attack, even if remote, are at highest risk (about 12% per year). Adjusted-dose warfarin (target International Normalized Ratio [INR] 2-3) is highly efficacious for preventing stroke in AF patients (about 70% risk reduction) and is safe for selected patients, if carefully monitored. Aspirin has a modest effect on reducing stroke (about 20% risk reduction). The numbers of AF patients that would need to be treated with warfarin instead of aspirin for 1 year to prevent one ischemic stroke are about 200, 70, and 20 for those with low, moderate and high risk, respectively. Many patients with nonvalvular AF have substantial rates of ischemic stroke. Stratification of stroke risk identifies AF patients who benefit most and least from lifelong anticoagulation. Warfarin is recommended for high-risk AF patients who can safely receive it. Aspirin may be indicated for those with a low stroke risk and for those who cannot receive warfarin. For AF patients considered to have a moderate risk of stroke, individual bleeding risk during anticoagulation and patient preference should particularly influence the choice of antithrombotic prophylaxis.