Onset AF Research Articles

Diagnostic yield of cardiac monitors in patients with suspected arrhythmias: systematic literature review and network meta-analysis

Abstract Objective To demonstrate the diagnostic yield (DY) across cardiac rhythm monitors stratified by monitoring duration for symptomatic patients with suspected cardiac arrhythmias (palpitations, dizziness, syncope, presyncope, lightheadedness). Methods PubMed, Embase, and Scopus were searched to identify published randomized and observational studies between January 1, 2000, and November 28th, 2021. DY data were extracted for comparative studies. The DY of cardiac monitors in these patients was reviewed for Any Arrhythmia, Clinically Relevant Arrhythmia, Explained Episodes (symptomatic and clinically relevant), New Onset Atrial Fibrillation, and Symptomatic Events. Clinically Relevant Arrhythmia was defined by the study and included atrial fibrillation, atrial flutter, atrial tachycardia, other SVT, VT, pause, and bradycardia. Patients who had a history of prior stroke or transient ischemic attack were excluded. Network meta-analysis (NMA) was used to pool estimates. Cardiac monitoring duration was categorized into the following 3 timeframes: 3 days or less (≤3 d), greater than 3 days to less than 30 days (>3 d), and 30 days or greater (≥ 30 d). Results Inclusion and exclusion criteria identified a pooled population of 1696 patients in 6 comparative studies, 2 Randomized Controlled Trials (RCTs) and 4 non-RCTs (Figure 1). NMA results for comparative studies show that monitoring durations of >3 d and ≥30 d provided significant better DY than ≤3 d (Table 1). The odds ratio for DY of >3 d as compared to ≤3 d was 5.75 (95% CI 2.05-19.38) in patients with Any Arrhythmias, 5.99 (95% CI 2.10 - 7.79) in patients with Clinically Relevant Arrhythmias, 10.22 (95% CI 0.61 - 4343.00) in patients with Explained Episodes, and 2.74 (95% CI 1.12 - 7.53) in patients with New Onset Atrial Fibrillation. As only a single study provided results on Symptomatic Events, NMA was not possible for this measure. The odds ratio for DY of >3 d as compared to ≥30 d was 0.02 (95% CI 0.00 - 0.15) in patients with Any Arrhythmias, 0.03 (95% CI 0.00 - 0.10) in patients with Clinically Relevant Arrhythmias, 0.04 (95% CI 0.01 - 0.13) in patients with Explained Episodes, and 0.17 (95% CI 0.03 - 0.66) in patients with diagnosis of New Onset Atrial Fibrillation. Conclusion NMA indicates that >3 d and ≥30 d provide significantly better DY than ≤3 d for identifying Any Arrhythmia, Clinically Relevant Arrhythmia, and New Onset AF. Despite favorable odds ratios for ≥30 d over >3 d, these values were associated with uncertainty due to the limited studies available for monitoring durations of ≥30 d. Overall, in patients experiencing symptoms of palpitations, dizziness, syncope, and without prior stroke or transient ischemic arrest, >3 d of monitoring improved DY compared with shorter monitoring durations.Figure 1.Prisma Flow DiagramTable 1.Diagnostic Yield Comparison.

Atrial fibrillation recurrence in oncocardiological patients treated with catheter ablation. A retrospective cohort study

Abstract Background The relationship between oncological events and cardiovascular pathologies is a subject still widely discussed. Certain chemotherapy drugs, including alkylating agents, anthracyclines, taxanes, and topoisomerase II inhibitors have proven to possess arrhythmic and cardiotoxic capabilities. There is enough evidence to suggest an association between oncological events and the appearance of newly onset AF, but there is little to no scientific literature about the management of these patients and the outcome of normal therapeutically procedures. Purpose This study assess if oncocardiological patients with AF should be considered a risk group when planning to undergo catheter ablation for the arrhythmia treatment. Methods The studied population was based on the data recollection from the electrophysiology department and consisted of patients with AF intervened by radiofrequency catheter ablation. All the procedures were conducted between January 1st 2019 and December 31st 2022. Among 138 participants enrolled for this study, 68 of them had either recent history of oncological events (maximum of 5 years cancer-free). The control group had no previous nor active history of cancer. The cohort with the desired exposure (cancer patients) was compared with a cancer-free group. Two primary outcomes were measured: procedure related complications, and first AF recurrence within the first 12 months. Complications were categorized according to two dichotomous variables: the existence of acute complications directly during the procedure or within the first 12 hours after the end of the procedure, and the occurrence of self-limited arrhythmic events during the blanking period. Results When compared as dichotomous variables (yes/no) with Fisher’s exact test, no statistical significance was observed between the studied cohort and control for complications and events during blanking. The proportion of patients free of sustained episodes of AF at 12 months was 52,9% in the oncologic group and 77,9% in the Control group (P = 0.003; RR of 3.14; 95% CI 1.5 - 6.6) for the oncologic group. When not adjusted by any other factor, association with Cancer was shown (HR 2.43; P =0.005; 95% CI 1.3 – 4.4) for recurrence of arrhythmic events. The regression model with Kaplan-Meier method shows the overall 12-month survival in two groups and the difference between the two survival curves was statistically significant (P=0.0016). Conclusion Oncocardiological patients have demonstrated a significantly higher incidence in post-ablational recurrence when compared with a similar cancer-free control group. Results found in acute and chronic procedural complications were similar in both cohorts.

IMPLANTABLE LOOP RECORDER IN BRUGADA SYNDROME: INSIGHTS FROM A SINGLE–CENTER EXPERIENCE

Abstract Brugada syndrome (BrS) is characterized by a “coved” ST segment elevation of ≥2 mm in the right precordial electrocardiographic (ECG) leads, either spontaneously or drug–induced. Risk stratification in individuals with BrS remains challenging. Currently, miniaturized and remotely monitored implantable loop recorders (ILRs) are available, providing physicians with a diagnostic tool that can help guide intervention or therapy decisions for these patients. The objective of this study was to investigate the characteristics and outcomes of patients diagnosed with BrS who underwent ICM insertion during routine clinical activity. This is a retrospective single center cohort study. We screened 147 consecutive patients who were diagnosed with BrS based on the presence of spontaneous or drug–induced type 1 ECG pattern between January 2009 and May 2023. Once this comprehensive diagnostic pathway was completed, we engaged in detailed counseling with patients to discuss the potential need for ICD implantation or ILR insertion, if deemed indicated. Compared to patients who did not receive a device, those who received an ILR had a higher prevalence of suspected arrhythmic syncope (43% vs. 22%, p=0.012) and tended to be younger (median age 38 years, IQR 30–52, vs. 43 years, IQR 35–55, p=0.044) and with a higher presence of SCN5A gene mutations (17% vs. 6%). On the other hand, compared to patients who received an ICD, those with an ICM underwent programmed ventricular stimulation less frequently (40% vs. 85%, p=0.010) and, as a result, had a lower frequency of positive result of this test (0% vs. 91%, p< 0.001). During a median follow–up period of 14.7 months (IQR, 4.7–44.8), no deaths occurred among the patients with ILR. Eight individuals (19%) were diagnosed with arrhythmic findings through continuous ILR monitoring. Among these findings, three patients experienced AF (including one case of new–onset AF), two patients exhibited symptomatic asystolic pauses lasting 16 seconds and 3.6 seconds respectively, two patients had non–sustained ventricular tachycardia, and one patient had episodes of paroxysmal supraventricular tachycardia. Except for a history of AF, no significant differences were observed between patients with arrhythmic findings and those without any events. In the ICD group, the median follow–up period was 32.2 months (IQR, 23.2–95.0). During this period, no deaths occurred and no appropriate or inappropriate ICD therapies were delivered.

Comparisons of APACHE II, CURB-65, Pneumonia severity index, and CHA2DS2-VAS score on new onset cardiovascular events, including atrial fibrillation, for critical illness with pneumonia

Abstract Background pneumonia patients afflicted with cardiac disease were frequented with higher rates of short-term mortality. Furthermore, the most common arrhythmia (25%) in critically ill patients is atrial fibrillation and its increased incidences in hospital mortality and extended length of hospital stays. The early detection of the occurrence of atrial fibrillation and other CV events is important among these severely pneumonia patients. Purpose The purpose of this article is to determine the appropriate risk assessments and to make a comparison of predictive performance among four common practice risk scores: APACHE II, CURB-65, pneumonia severity index and CHA2DS2-VASc. Methods This was a retrospective, observational study from consecutive critical pneumonia patients admitted to medical intensive care unit. Heart failure, acute coronary syndrome, atrial fibrillation, ventricular tachycardia or stroke are defined as a cardiovascular event. Those who had the missing data about APACHE II, CURB-65, PSI and CHA2DS2-VASc scores had already been excluded from this study. The baseline characteristics of patients between the disease groups (CV vs. non-CV; AF vs. non-AF) were compared by using the independent sample t-test for continuous variables and the chi-square test for categorical variables, respectively. The performance of discriminating in-hospital CV and AF events for the four risk scores was evaluated using the ROC curve analysis. The areas under the ROC curve (AUC) of the four risk scores were compared using the Delong’s non-parametric method. Results 252 (22.6%) of the 1,117 patients suffered from CV events during the hospitalization. Compared to patients averting CV events, those who experienced CV events during hospitalization were older, more likely to smoke, experiencing more altered mental states, of poor renal function, of higher prevalence of all comorbidities except liver disease, of a long duration of ICU and yielded higher values of the four risk scores. There were 99 patients who suffered from CV events other than an AF episode. After excluding the 99 patients, 153 (15%) of the remaining 1,018 patients had an AF event during hospitalization. The values of the four risk scores were also significantly greater in the AF group. The performance of discriminating CV events for the four risk scores was fair with the values of AUC ranging from 61.8% of APACHE II to 64.8% of CURB 65 (Fig 1). However, no significant difference of the AUC values between any two risk scores. In terms of discriminating AF episode (Fig 2) for the four risk scores, the performance was obviously poorer with the values of AUC less than 60%, except for the CURB 65. Conclusion CURB 65 is simple and effective tool for predicting new onset cardiovascular events, including atrial fibrillation, in ICU patients with pneumonia.new onset CV eventonw onset AF event

P211 BLEEDING AND THROMBOSIS: A MULTIDISCIPLINARY SLALOM

Abstract GG is a 75 kg and 75 years old smoker man with metabolic syndrome, potus, OSAS and LBBB. In 1/2022 the echo imaging showed EF 35%, high dissincrony and PVCs so a myocardial SPECT had been recommended but not carried out by the patient. In 6/2022 new exertional dyspnea, orthopnea and peripheral oedema lead the patient to the Emergency Department: the ECG indicated new onset AF 75 bpm, at laboratory tests creatinine 1.8 mg/dL and NTproBNP 6200 pg/ml and echocardiography confirmed hypokinetic cardiopathy with EF 35%, mild–moderate mitral and tricuspidal regurgitation with pulmonary hypertension and vascular congestion. Admitted for heart failure and new onset AF, diuretic and levosimendan ev, MRA, BB and LMWH started with benefit. At the end of inotropic therapy, ARNI, SGLT2 and inhaled cortisone began. Myocardial SPECT proved moderate fixed inferior wall hypoperfusion. Hospitalization was complicated by ecchymoses and hematomas of abdomen superficial soft tissues during LMWH and proximal saphenous vein and III middle left thigh thrombophlebitis, so apixaban 5mg BID and elastic stockings started with resolution. The onset of paresthesias, pain and left leg progressive hyposthenia led to diagnosis of a partial hematoma of the ilio–psoas muscle resulting in a complete left femoral nerve lesion and severe obturator nerve and left lumbosacral trunk suffering plus further right iliac and rectus abdominis muscles hematomas. Discontinued apixaban, after 72 hours the hematoma was surgically removed without complications and fast recovery thanks to FKT. 9 days later left leg DVT recurrence was observed: in absence of absolute contraindications to anticoagulant therapy and blood count stability, without evident new bleedings, heparin infusion was set with maintenance of the aPTT values at the lower therapeutic range limits. One week later radiological imaging demonstrated reduction of left retroperitoneal hematoma so dabigatran 150 mg BID was initiated. Control echo showed EF 42%, mild MR and TR. Regular the subsequent rehabilitation course: the patient was discharged with dabigatran 110 mg twice daily to limit long–term bleeding risk. The thrombotic/bleeding risks require a complex therapeutic modulation in a multidisciplinary teamwork.

Atrial fibrillation is associated with worse short and long-term outcomes in critically ill patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF), either chronic or new onset, is common in critically ill patients. Its epidemiology and relationship with clinical outcomes, and the role of post-discharge anticoagulation, is unknown. Methods Single-center retrospective, cohort study, evaluating all patients with AF admitted to a non-cardiac intensive care unit during a 54-month period. Their clinical outcomes at short-term (hospital discharge) and long-term (2-year follow-up) were evaluated. The hazard ratio (HR) with 95% CI for the 2-year all-cause mortality was computed for the whole population with AF compared with a matched one, without AF (1:2 ratio). Results We screened 1357 patients, mean age 75±15.2 years, length of intensive care unit stay 4.7±5.1 days, hospital mortality 26%. We identified 215 (15.8%) patients with AF (66% chronic AF). The 2-year all-cause mortality was similar in patients with chronic or new onset AF (58.5% vs 50.7%, p=0.388). Only 85 patients received anticoagulation following their hospital discharge, mostly with chronic AF (74.5% vs 25.5%, p<0.001). We found no benefit from anticoagulation on the 2-year mortality rate (adjusted HR 1.09, 95% CI 0.63-1.86, p=0.6). We successfully matched 145 patients with AF with 290 controls. Mortality was higher in patients with AF, either in-hospital mortality or during long-term follow-up (mortality 53.8% vs 36.9%, HR 1.76; 95% CI 1.31-2.37, p=0.001). Conclusions Patients with AF, both chronic and new onset, had significantly worse short- and long-term outcomes. No mortality benefit was found from anticoagulation after hospital discharge in patients with AF.

CLINICO-ETIOLOGICAL PROFILE OF ATRIAL FIBRILLATION IN A TERTIARY CARE HOSPITAL

Background And Objectives: Atrial Fibrillation is one of the frequently encountered arrhythmia in our population. This also has a significant effect on economic burden to the society by causing both morbidity and mortality. This study is intended to find out the varied presenting symptoms of AF and also possible underlying predisposing factors- cardiac and non-cardiac in Indian context. Methods: This is a cross-sectional study done over 1 year. All patients above the age of 18 with clinically proven new onset AF and hemodynamically stable were enrolled after obtaining their informed consent. Any arrhythmia other than AF or with hemodynamic instability was excluded. All the demographic characteristics, past history, presence of co morbid illness were noted. Basic blood panel with thyroid profile were obtained. Trans thoracic echo with M-mode and colour doppler was done for every patient. The collected data were analysed with IBM.SPSS statistics software 21.0 Version. For descriptive data, frequency and percentage analysis were used. Results: In our study 63% of patients were females. Most common age group was 41-60 years. Rheumatic heart disease was the most common cause of AF in our study, Systemic hypertension was the second most common cause for AF.CAD was seen in 17 cases, diabetes in 22 cases and COPD in 13 cases Breathlessness was the most common complaint followed by palpitation. Cardiac failure was seen in 37 % of cases while ejection fraction was decreased in 29 patients. Uncontrolled heart rate or tachycardia was seen in 49 % of patients. Coming to ECHO findings, increased LVIDd was seen in 30 patients. Regional wall motion abnormality was seen in 15 % of patients in our study group. Increased left atrial size – the most common ECHO finding seen in atrial fibrillation was present in 61 patients while increased right atrial size was seen in 26 patients. Conclusion: Rheumatic heart disease was the most common aetiology followed by dilated cardiomyopathy in our patients. Breathlessness was the most common presentation, complete echocardiographic evaluation is valid in these patients for etiological evaluation and follow up.

1049 PREVALENCE OF ATRIAL FIBRILLATION AND FEASIBILITY OF PULMONARY VEIN ISOLATION AFTER PATENT FORAMEN OVALE CLOSURE

Abstract Background Data about prevalence and the risk of atrial fibrillation, stroke, and need for pulmonary vein isolation (PVI) after device closure of a patent foramen ovale (PFO) are still lacking. We aim to investigate the prevalence and the risk of atrial fibrillation after PFO closure and the feasibility of PVI in a PFO closure cohort compared to contemporary PVI without PFO closure. Methods retrospective observational study of consecutive patients undergoing PFO closure enrolled from February 2013 to September 2020. Patients were divided into 3 groups: i) patients without AF before and after the procedure (n=132), ii) patients with paroxysmal AF prior to the procedure (n=21), iii) patients with documented AF after the procedure (n=13). All patients with AF occurrence were treated with adequate anticoagulation therapy according to the current ESC Guidelines. We compared the procedural data of these patients to a matched contemporary cohort without previous PFO closure undergoing PVI in our center. AF and stroke prevalence and PVI feasibility after PFO closure were assessed at follow up. Results one-hundred and sixty-six consecutive PFO closure patients were enrolled; the mean age was 54 ± 13 years. Median follow-up was 3.5 + 2.5 years. During the study period, 21 patients had AF before or after the PFO closure (group 2) and 13 (7.8%) new onset AF (group 3). Stroke after the PFO closure occurred in 8 patients (4.8%), of which 4 in the group with new onset AF (30% of the group 3). Among the 34 patients with AF, 10 patients (6%) underwent a PVI. Compared to a contemporary matched PVI cohort, total procedural times and fluoroscopy times were significantly higher in the patients with previous PFO closure (108±15 vs 75±29, p=0.002 and 3±1.5 vs 8±7, p<0.001). Similar rate of AF relapses (p=0.198) was observed between the two groups, with a trend for higher rate of complication (pericardial effusion) for the cohort with previous PFO closure (p=0.06). Conclusion This study shows that a more accurate screening and treatment of AF is needed in patients with cryptogenic stroke despite the presence of a PFO, possibly a bystander. In our study, 30% of patients with new onset AF after PFO closure, experienced a further stroke after the procedure. In case of AF, the indication for PVI should be considered prior to the PFO closure since it turns out to be more difficult in terms of procedural and fluoroscopy times and risks of complications after PFO closure.

8 DIFFERENCES BETWEEN PATIENTS HOSPITALIZED FOR PAROXYSMAL ATRIAL FIBRILLATION AND HEART FAILURE WITH PRESERVED, MIDLY-REDUCED, AND SEVERELY-REDUCED EJECTION FRACTION

Abstract Introduction Paroxysmal atrial fibrillation (PAF), is a very common cardiac arrhythmya in patients with heart failure (HF). In the last five years we observed many patients with AF. Aim of this observation was to evaluate differences on clinical outcomes of a paroxysmal AF episode on patients with preserved (HFpEF), mildly reduced (HFmrEF), or severely-reduced (HFrEF) ejection fraction. Methods 439 patients consecutively hospitalized in our Cardiology Unit from January 2017 to January 2022 for paroxysmal AF were retrospectively evaluated. Of them, 201 presented without heart failure, 59 with a previously known HFpEF, 49 patients with HFmrEF, and 130 patients with HFrEF. For each patient, demographic and clinical characteristics, comorbidities, instrumental data and clinical outcomes (percentage of cardioverted arrhythmia, length of hospitalization) were collected. To examinate the correlations between characteristics of patients and clinical outcomes, chi-square or Pearson test were performed. Results patients with AF and HF were significantly older rather than AF patients without HF. No significantly differences we found between the three HF groups. The three groups of AF patients with HF presented more comorbidities rather than AF patients without HF. The duration of hospitalization were significantly longer for AF patients with HF rather than AF no-HF patient, without differences between the three goups . Percentage of cardioverted AF were significantly higher in no-HF patients rather than in HFrEF, but not in HFpEF and HFmrEF patients . In no-HF and in HF groups, age and length of hospitalizations were significantly correlated, but no differences we found between the groups. In the three HF groups, number of comorbidity were inversely correlated with percentage of cardioversion, but not in no-HF group. Age was significantly correlated with failure in attemps of cardioversion, without differences between HF and no-HF patients. Conclusions our hospitalized patients for a newly onset AF and HF presented worse clinical outcomes rather AF patients without HF. This worsening clinical outcome, seem at least in part due to differences on age and comorbidities between the three groups, whereas cardiac systolic function seems not been significantly related with worse clinical outcomes.

Similar clinical outcomes with transcatheter aortic valve implantation and surgical aortic valve replacement in octogenarians with aortic stenosis.

Transcatheter aortic valve implantation (TAVI) is the preferred treatment option for severe aortic stenosis in the elderly and in patients with comorbidities. We sought to compare outcomes after TAVI and surgical aortic valve replacement (SAVR) in octogenarians. In this retrospective cohort study conducted at our tertiary center, clinical data were gathered before and after TAVI and SAVR procedures performed from January 2013 to May 2019; follow-up completed in March 2021. The primary outcome was 1-year mortality. Patients were stratified according to Society of Thoracic Surgeons (STS) score and procedure type. Propensity score-based matching was also performed. Of 542 patients who matched the inclusion criteria, 273 underwent TAVI and 269 SAVR. TAVI patients were older (85.8 ± 3.0 vs. 82.2 ± 2.2 years; P < 0.001) and had a higher mean STS score (5.0 ± 4.0 vs. 2.8 ± 1.3; P < 0.001) and EuroSCORE II (5.3 ± 4.1 vs. 2.8 ± 6.0; P < 0.001). Rates of postoperative permanent pacemaker insertion (15.0% vs. 9.3%; P = 0.040) and paravalvular leak (9.9% vs. 0.8%; P < 0.001) were higher and acute kidney injury lower (8.8% vs. 32.7%; P < 0.001) after TAVI, with no difference between treatment groups for major bleeding (11.0% vs. 6.7%; P = 0.130) or 30-day mortality (5.5% vs. 3.7%; P = 0.315). A statistically significant difference was found between TAVI and SAVR in low- and intermediate-risk groups when it came to occurrence of paravalvular leak, acute kidney injury, and new onset AF (all P < 0.001). This analysis of an octogenarian "real-life" population undergoing TAVI or SAVR (with a biological valve) showed similar outcomes regarding clinical endpoints in low- and medium-risk (STS score) groups.

Prevalence of atrial fibrillation and feasibility of pulmonary vein isolation after patent foramen ovale closure

Abstract Background Data about prevalence and the risk of atrial fibrillation, stroke, and need for pulmonary vein isolation (PVI) after device closure of a patent foramen ovale (PFO) are still lacking. We aim to investigate the prevalence and the risk of atrial fibrillation after PFO closure and the feasibility of PVI in a PFO closure cohort compared to contemporary PVI without PFO closure. Methods Retrospective observational study of consecutive patients undergoing PFO closure enrolled from February 2013 to September 2020. Patients were divided into 3 groups: i) patients without AF before and after the procedure (n=132), ii) patients with paroxysmal AF prior to the procedure (n=21), iii) patients with documented AF after the procedure (n=13). All patients with AF occurrence were treated with adequate anticoagulation therapy according to the current ESC Guidelines. We compared the procedural data of these patients to a matched contemporary cohort without previous PFO closure undergoing PVI in our center. AF and stroke prevalence and PVI feasibility after PFO closure were assessed at follow up. Results One-hundred and sixty-six consecutive PFO closure patients were enrolled; the mean age was 54±13 years. Median follow-up was 3.5±2.5 years. During the study period, 21 patients had AF before or after the PFO closure (group 2) and 13 (7.8%) new onset AF (group 3). Stroke after the PFO closure occurred in 8 patients (4.8%), of which 4 in the group with new onset AF (30% of the group 3). Among the 34 patients with AF, 10 patients (6%) underwent a PVI. Compared to a contemporary matched PVI cohort, total procedural times and fluoroscopy times were significantly higher in the patients with previous PFO closure (108±15 vs 75±29, p=0.002 and 3±1.5 vs 8±7, p&amp;lt;0.001). Similar rate of AF relapses (p=0.198) was observed between the two groups, with a trend for higher rate of complication (pericardial effusion) for the cohort with previous PFO closure (p=0.06). Conclusion This study shows that a more accurate screening and treatment of AF is needed in patients with cryptogenic stroke despite the presence of a PFO, possibly a bystander. In our study, 30% of patients with new onset AF after PFO closure, experienced a further stroke after the procedure. In case of AF, the indication for PVI should be considered prior to the PFO closure since it turns out to be more difficult in terms of procedural and fluoroscopy times and risks of complications after PFO closure. Funding Acknowledgement Type of funding sources: Public Institution(s).

Early and late new-onset of atrial fibrillation in acute coronary syndromes: Their differences in mortality and cardiac event.

BackgroundIn a stressful situation like acute coronary syndrome (ACS), the occurrence of the first episode of atrial fibrillation is more frequent. The impact of the timing occurrence of AF new‐onset (nAF) in the setting of ACS is still debatable.MethodsMulticenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry, including 29 851 patients admitted for ACS between 1/10/2010 and 4/09/2019. The group with early nAF ‐ nAF in the first 48 h of hospitalization; and late nAF ‐ patients with nAF after the first 48 h of in‐hospital admission.ResultsNew‐onset AF was identified in 1067 patients, nonetheless, just 38.1% had late nAF. The group with late nAF presented more cardiovascular comorbidities and worse left ventricular ejection fraction. Late nAF patients received more anti‐arrhythmic therapy, and early nAF had a higher beta‐block prescription. Early nAF had higher rates of in‐hospital complications, on the other hand, late nAF group exhibited more mortality and readmission at one year follow‐up. Multiple logistic regression revealed that symptoms onset to the first medical contact time, admission hemoglobin <12 g/dl, right bundle branch block at admission, and diuretic therapy during the hospitalization for ACS were predictors of late nAF in ACS.ConclusionsThe ACS population could be divided by the timing of nAF occurrence into the two groups with different characteristics, therapeutic approaches, and outcomes. Late nAF patients had a worse prognosis at 1 year follow‐up, however, the early nAF group had more major adverse cardiac events during the hospitalization for ACS.

Arrhythmia patterns during and after hospitalization for COVID-19 infection detected via patch-based mobile cardiac telemetry

BackgroundCoronavirus infection is the cause of the current world-wide pandemic. Cardiovascular complications occur in 20–30% of patients with COVID-19 infection including myocardial injury and arrhythmias. Current understanding of specific arrhythmia type and frequency is limited. ObjectiveWe aimed to analyze arrhythmia type and frequency in patients with COVID infection, identifying arrhythmia patterns over time during hospitalization and post discharge utilizing a patch based mobile cardiac telemetry system. MethodsA prospective cohort study during the COVID-19 pandemic was performed. We included in our study patients hospitalized with COVID-19 infection who had a patch-based mobile telemetry device placed for cardiac monitoring. ResultsQuantitative reports for 59 patients were available for analysis. Arrhythmias were detected in 72.9% of patients and at a consistent frequency throughout the monitoring period in 52.9%–89.5% of patients daily. The majority of arrhythmias were SVT (59.3% of patients) and AF (22.0%). New onset AF was noted in 15.0% of all patients and was significantly associated with older age (OR 1.4 for 5 yrs. difference; 95% CI 1.03–2.13). Of 9 patients who were discharged with continued patch monitoring, 7 (78%) had arrhythmic events during their outpatient monitoring period. ConclusionIn COVID-19 patients arrhythmias were observed throughout hospitalization with a consistent daily frequency. Patients continued to exhibit cardiac arrhythmias after hospital discharge of a type and frequency similar to that seen during hospitalization. These findings suggest that the risk of arrhythmia associated with COVID infection remains elevated throughout the hospital course as well as following hospital discharge.

780 Appearing and disappearing right-heart thrombus: a case reporto in COVID-19 patient

Abstract Aims Venous thromboembolism represents frequent complication of patients with severe COVID-19 disease. Several reports about atypical thrombosis are described, rarely it has been described a right venticular thrombus during the course of infection. We report a case of right endoventricular thrombosis in a patient with SARS-Cov-2 pneumonia. Methods and results A 58-year-old man was admitted to our ward for severe respiratory failure in interstitial pneumonia. The nasopharyngeal swab for COVID-19 resulted positive. Steroids and prophylaxis with LMWH were started, associated to CPAP to maintain good gas exchange. During hospitalization a venous ECD was performed with evidence of left popliteal thrombosis despite the therapy. d-Dimer was 4463 ng/ml. A new onset AF was documented at the telemetry, without troponin elevation. A cardiac ultrasound was performed showing a right endoventricular lesion of 1.8 cm adhering to the free wall of the right ventricle. A CT-pulmonary angiogram (CTPA) resulted negative for pulmonary embolism and confirmed suspected right ventricular thrombus. Treatment with fondaparinux 7.5 mg was started. After 10 days, cardiac ultrasound shown complete resolution of thrombosis, and CT confirmed the disappearing of the mass. Dabigatran 150 mg twice/day was started. Patient clinically improved and he was discharged after 20 days of hospitalization. Conclusions SARS-CoV-2 infection may cause inflammation with cytokine storm and hypercoagulability leading to venous thromboembolism. Atypical thrombus formation was reported, including right-ventricle free wall. Early caridac ultrasound was critical to make diagnosis and starting prompt treatment, therefore routine cardiac ultrasound is mandatory in severe COVID-19 patients.

ECG markers of atrial abnormalities are not associated with new onset atrial fibrillation in patients with acute ST-segment elevation myocardial infarction

Abstract Introduction New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF is linked to atrial structural abnormalities or has different underlying mechanisms is not fully clarified. Purpose We aimed to assess the association of P wave indices as ECG markers of atrial structural abnormalities with new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI). Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF. The closest available ECGs prior to STEMI (median 448, interquartile rate 25–75% 112–1390 days before STEMI) were extracted from the regional electronic ECG databases and automatically processed using Glasgow algorithm. Patients with sinus rhythm ECGs were included in the current analysis (n=1481, mean age 68±12 years, 33% females). P-wave duration, PR interval, P-wave frontal axis and P terminal force in lead V1 (PTF-V1) were assessed. PTF-V1 &amp;gt;40 mm*ms was considered abnormal. Results Paroxysmal AF prior to STEMI was known in 77 patients (5.2%). Among patients without pre-existing AF (n=1404), new-onset AF during hospital admission was identified in 102 patients (6.9%). Patients with new-onset AF were older than those without AF history (74±9 vs 67±12 years, p&amp;lt;0.001), but did not differ in regard to other clinical characteristics. In univariate logistic regression analysis P wave duration as continuous variable, P wave duration &amp;gt;120 ms and PR interval were significantly associated with new onset AF (Table 1). However, after adjustment for age both, P wave duration &amp;gt;120 ms (odds ratio (OR) 1.20, 95% CI 0.77–1.89, p=0.418) and PR interval (OR 1.01, 95% CI 1.00–1.01, p=0.068), failed to demonstrate the significant association with new onset AF while age (OR 1.06, 95% CI 1.04–1.08, p&amp;lt;0.001) remained an independent risk factor for AF development. Conclusion In patients with acute STEMI new onset AF developed during hospital admission is common and strongly associated with age. P wave indices failed to demonstrate the significant association with new onset AF thus indicating that atrial structural abnormalities are unlikely the underlying cause of AF development in acute STEMI. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Scholarship grant from Swedish Institute. Table 1

Arrhythmia patterns in patients with COVID-19 infection during and post hospitalization detected via a patch-based mobile cardiac telemetry system

BackgroundCoronavirus infection (COVID-19) is the cause of the current world-wide pandemic. Cardiovascular complications occur in 20–30% of patients with COVID-19 infection including myocardial injury and arrhythmias. Current understanding of specific arrhythmia type and frequency is limited. In response to COVID-19 pandemic and overwhelmed hospital critical care and telemetry recourses, patch-based cardiac monitoring system received emergency Food and Drug Administration (FDA) approval for inpatient monitoring. A patch-based cardiac telemetry system has been shown to be useful for patient management during the COVID-19 pandemic and provides detailed analysis of cardiac rhythms.PurposeTo analyze arrhythmia type and frequency in patients with COVID-19 infection, identifying arrhythmia patterns over time during hospitalization and after discharge.MethodsA prospective cohort study during the COVID-19 pandemic was performed. We included patients hospitalized with COVID-19 infection who had a patch-based mobile telemetry device placed for cardiac monitoring. A quantitative analysis including type, frequency and duration of detected arrhythmias was performed at the end of the monitoring period.ResultsA total of 103 patients hospitalized with COVID-19 diagnosis underwent monitoring. Quantitative reports for 59 patients were available for analysis, among those 59% were males, median age 65 (IQR 56–76) yrs. Mean wear time was 6.8±5.0 days. Arrhythmias were detected in 72.9% of patients. Majority of arrhythmias were SVT (59.3% of patients) and AF (22.0%). Episodes of AF duration >30 min were detected in 12 patients. New onset AF was noted in 15.0% of patients and was significantly associated with age (OR 1.4 for 5 yrs difference; 95% CI 1.01–2.05). Brady arrhythmias (2nd degree, 3rd degree AV bock, pause≥3 seconds) were seen in 18.7% of patients. Arrhythmias were consistently detected throughout the monitoring period in 52.9%-89.5% of patients daily (Figure 1). In 9 patients who were discharged with continued patch monitoring, 3 patients (33.3%) had arrhythmic events during their outpatient monitoring period.ConclusionA majority of patients hospitalized with COVID-19 infection had arrhythmias detected by patch cardiac monitor. Arrhythmias were observed throughout hospitalization with a consistent daily frequency. Patients continued to exhibit cardiac arrhythmias after hospital discharge of a type similar to that seen during hospitalization. New onset AF often occurred and was associated with older age. Inpatient application of a patch cardiac telemetry with continued monitoring as outpatient is feasible and effective in detecting occult arrhythmias in patients with COVID-19 infection.Funding AcknowledgementType of funding sources: None. Daily frequency of arrhythmias detected

B-PO05-136 ANTI-CANCER THERAPY INDUCED ATRIAL FIBRILLATION - A PHARMACOVIGILANCE ANALYSIS

Certain anti cancer therapies have been associated with new onset AF. The FDA Adverse Event Reporting System (FAERS) is a publicly available database of adverse events (AE) of various drugs. To identify anti-cancer drugs associated with AF using FAERS. FAERS database was searched for all drugs reporting AF as an adverse event. Top 30 anti-cancer drugs reporting AF cases were shortlisted and analyzed. Top three anticancer drugs for each assessment of AF are given in the table. Lenalidomide had the largest number of AF cases reported for any anti-cancer drug (2363; 3.2% of all AF cases reported to FAERS), Ibrutinib (2138 cases; 2.9% of all AF reported to FAERS) had the largest proportion of AF of all reported cardiovascular AE for the drug (41.5%) and the second largest proportion of AF of all reported AE for the drug (5.3%). Among all deaths reported for a drug, Ibrutinib had the highest proportion of patients who had AF. The proportion of AF patients who died were lower for ibrutinib compared to other anti-cancer drugs. The comparative mortality ratio for death with AF is the lowest for Ibrutinib. The largest proportion of AF of all reported AE for any anti-cancer drug was for Nivolumab (5.7%). 24% of AF patients reported for the drug died. Prospective studies are needed to better understand the true incidence of new onset AF associated with chemotherapeutic drugs.

The impact of post-operative atrial fibrillation on outcomes in coronary artery bypass graft and combined procedures.

BACKGROUNDPost-operative atrial fibrillation (POAF) is a common yet understudied clinical issue after coronary artery bypass graft (CABG) leading to higher mortality rates and stroke. This systematic review and meta-analysis evaluated the rates of adverse outcomes between patients with and without POAF in patients treated with CABG or combined procedures.METHODSThe search period was from the beginning of PubMed and Embase to May 18th, 2020 with no language restrictions. The inclusion criteria were: (1) studies comparing new onset atrial fibrillation before or after revascularization vs. no new onset AF before or after revascularization. The outcomes assessed included all-cause mortality, cardiac death, cerebral vascular accident (CVA), myocardial infarction (MI), repeated revascularization, major adverse cardiac event (MACE), and major adverse cardiac and cerebrovascular events (MACCEs). RESULTSOf the 7,279 entries screened, 11 studies comprising of 57,384 patients were included. Compared to non-POAF, POAF was significantly associated with higher risk of all-cause mortality (Risk Ratio (RR) = 1.58; 95% Confidence Interval (CI): 1.42−1.76, P < 0.00001) with accompanying high level of heterogeneity ( I2 = 62%). ConclusionsPatients with POAF after CABG or combined procedures are at an increased risk of all-cause mortality or CVAs. Therefore, POAF after such procedures should be closely monitored and treated judiciously to minimize risk of further complications. While there are studies on POAF versus no POAF on outcomes, the heterogeneity suggests that further studies are needed.

Atrial fibrillation in the young: clinical characteristics, predictors of new onset and outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) onset in the young (≤45 years) is uncommon and not well studied. Purpose Identifying the determinants of AF in this population in order to help direct timely diagnosis, appropriate follow up and management. Methods We retrospectively evaluated all patients aged ≤45, admitted to the internal and cardiology wards between January 2009 and December 2019 at a large tertiary center. Clinical, electrocardiographic and echocardiographic data were collected and compared among patients with and without AF at baseline. A subgroup of patients with no AF at baseline and a subsequent hospital visit were followed for development of new onset AF (NOAF). Results A total of 16,432 patients (55.5% male, 33 ±8.3 years old) were analyzed. At baseline, patients with AF (n = 366) tended to be older, more often male, and had a higher proportion of comorbidities and ECG conduction disorders, compared with the patients without AF (n = 16,066). Male sex, increased age, obesity, heart failure (HF) and the presence of left or right bundle branch block (LBBB and RBBB, respectively) were all strongly and independently associated with young-onset AF. A total of 10,691 patients were followed for a median of 41.5 (16.6-78.6) months, during which 85 patients developed NOAF (equivalent to 0.5%/year). Increased age, hypertension, HF, RBBB and LBBB were independent predictors of NOAF. CHARGE-AF score outperformed CHA2DS2-VASc score in NOAF prediction [AUC of ROC 0.75 (0.7-0.8) vs. 0.56 (0.48-0.65)]. Conclusions The annual risk of NOAF among young adults admitted to the hospital is noteworthy. NOAF may be predicted by clinical risk factors and the CHARGE-AF score. Characteristic No AF (N = 16066) AF (N = 366) Total (N = 16432) P value Age- yr. 33.06 ± 8.3 36.8 ± 7.3 33.1 ±8.3 &amp;lt;0.0001 Male gender 8914 (55.5) 240 (65.6) 9154 (55.7) &amp;lt;0.0001 BMI- kg/m2 25.5 ± 5.75 27.48 ± 6.36 25.2 ± 5.8 &amp;lt;0.0001 HTN 2679 (16.7) 73 (19.9) 2752 (16.7) 0.098 CHF 124 (0.8) 13 (3.6) 137 (0.8) &amp;lt;0.0001 PR interval &amp;gt; 200ms 117 (1.3) 15 (9.1) 132 (1.5) &amp;lt;0.0001 QRS interval &amp;gt; 120ms 220 (2.4) 25 (8.4) 245 (2.6) &amp;lt;0.001 LBBB 29 (0.2) 6 (1.6) 35 (0.2) &amp;lt;0.0001 LVEF &amp;lt; 40 323 (10.1) 35 (16.9) 358 (10.5) 0.002 CHA2DS2-VASc 0.75 ±0.75 0.73 ±0.84 0.74 ±0.76 0.647 CHARGE AF 6.3 ±1.1 6.8 ±0.9 6.32 ±1.06 &amp;lt;0.001

Incident atrial fibrillation and its risk prediction in patients developing COVID-19: A machine learning based algorithm approach

BackgroundThe elderly multi-morbid patient is at high risk of adverse outcomes with COVID-19 complications, and in the general population, the development of incident AF is associated with worse outcomes in such patients. There is therefore the need to identify those patients with COVID-19 who are at highest risk of developing incident AF. We therefore investigated incident AF risks in a large prospective population of elderly patients with/without incident COVID-19 cases and baseline cardiovascular/non-cardiovascular multi-morbidities. We used two approaches: main effect modeling and secondly, a machine-learning (ML) approach, accounting for the complex dynamic relationships among comorbidity variables. MethodsWe studied a prospective elderly US cohort of 280,592 patients from medical databases in an 8-month investigation of with/without newly incident COVID19 cases. Incident AF outcomes were examined in relationship to diverse multi-morbid conditions, COVID-19 status and demographic variables, with ML accounting for the dynamic nature of changing multimorbidity risk factors. ResultsMulti-morbidity contributed to the onset of confirmed COVID-19 cases with cognitive impairment (OR 1.69; 95%CI 1.52–1.88), anemia (OR 1.41; 95%CI 1.32–1.50), diabetes mellitus (OR 1.35; 95%CI 1.27–1.44) and vascular disease (OR 1.30; 95%CI 1.21–1.39) having the highest associations. A main effect model (C-index value 0.718) showed that COVID-19 had the highest association with incident AF cases (OR 3.12; 95%CI 2.61–3.710, followed by congestive heart failure (1.72; 95%CI 1.50–1.96), then coronary artery disease (OR 1.43; 95%CI 1.27–1.60) and valvular disease (1.42; 95%CI 1.26–1.60). The ML algorithm demonstrated improved discriminatory validity incrementally over the statistical main effect model (training: C-index 0.729, 95%CI 0.718–0.740; validation: C-index 0.704, 95%CI 0.687–0.72). Calibration of the ML based formulation was satisfactory and better than the main-effect model. Decision curve analysis demonstrated that the clinical utility for the ML based formulation was better than the ‘treat all’ strategy and the main effect model. ConclusionCOVID-19 status has major implications for incident AF in a cohort with diverse cardiovascular/non-cardiovascular multi-morbidities. Our ML approach accounting for dynamic multimorbidity changes had good prediction for new onset AF amongst incident COVID19 cases.