Overall Incidence Of Atrial Fibrillation Research Articles

Risk of Atrial Fibrillation in Patients with Different Cancer Types in Taiwan.

Atrial fibrillation (AF) commonly occurs in approximately 2% of cancer patients, and the incidence of AF among cancer patients is greater than in the general population. This observational study presented the incidence risk of AF among cancer patients, including specific cancer types, using a population database. The Taiwan Cancer Registry was used to identify cancer patients between 2008 and 2017. The diagnosis of AF was based on the International Classification of Diseases codes (ICD-9-CM: 427.31 or ICD-10-CM: I48.0, I48.1, I48.2, and I48.91) in Taiwan national health insurance research datasets. The incidence of developing AF in the cancer population was calculated as the number of new-onset AF cases per person-year of follow-up during the study period. The overall incidence of AF among cancer patients was 50.99 per 100,000 person-years. Patients aged older than 65 years and males had higher AF incidence rates. Lung cancer males and esophageal cancer females showed the highest AF incidence risk (185.02 and 150.30 per 100,000 person-years, respectively). Our findings identified esophageal, lung, and gallbladder cancers as the top three cancers associated with a higher incidence of AF. Careful monitoring and management of patients with these cancers are crucial for early detection and intervention of AF.

Ultrasound‐guided point‐of‐care ablation for atrial fibrillation in intensive care

Cha et al1 reported short learning curve and low complication rate of radiofrequency catheter ablation for atrial fibrillation (AF) without using fluoroscopy based on a series of 30 cases. Their study confirms other reports of feasibility and safety to perform AF ablation using imaging guidance with intracaradiac echocardiography (ICE). ICE was previously reported to be vastly superior to fluoroscopy in defining cardiac anatomy, directing the position of the ablation catheter, identifying proper electrode-tissue contact, detecting electrode migration during ablation, recognizing pulmonary vein stenosis, detecting pericardial effusion, and visualizing microbubble and coagulum formation. This was further confirmed by a recent meta-analysis evaluating the use of imaging with real-time ICE during endocardial ablation showed improvements in efficiency compared with the use of traditional fluoroscopy, without compromising clinical effectiveness or safety2. Cha et al1 discussed the avoidance of radiation hazard as an important advantage. We believe that another important advantage of this innovative approach deserves better highlight. Utilization of ICE could become a game changer for point-of-care atrial ablation in critically ill population, particularly during current pandemic. The overall incidence of AF in patients in the intensive care unit is close to 6%, with the new onset of AF being a marker of poor short-term and long-term prognosis.3 The reported incidence of AF in patients with sepsis or after cardiac valve surgery is disproportionately high (33% and 60%, respectively). It is important to acknowledge that in general, the causes of AF in intensive care are multifactorial and often rapidly reversible through simple measures or the passing of time. However, some patients with persistent AF and hemodynamic instability require pharmacological therapy and/or cardioversion, both of which are associated with iatrogenic risks, variable success rate, and frequent recurrence of AF. Despite growing knowledge of structural and electrical atrial remodeling during critical illness,4 the use of catheter ablation in patients with AF who are in intensive care has not been adequately investigated. Which subgroups of intensive care patients could benefit in short or long term from early catheter ablation remains speculative. The barriers to investigating the potential role of catheter ablation for AF in patients who are critically ill include the long procedural time and the need to transfer patients who have hemodynamic and/or respiratory instability or who are highly infectious to the catheterization laboratory. The latter has profound importance during SARS-CoV-2 pandemic, as intrahospital transfer of highly contagious patients presents major risk for other noninfected hospital patients, multiple staff, and the visitors. Major technological advances improved ICE capabilities in quality of imaging and in ability to integrate with CARTOSOUND system. Recent introduction of commercially available, live, 3D ICE imaging with a wide-angle elevation displays the complete cardiac structures, including the pulmonary veins and intracardiac devices. Identified limitations of 3D ICE related to the spatial resolution5 should not present problems for visualizing ablation catheters. Transesophageal echocardiography was used for point-of-care guidance of atrial ablation in AF, but the procedure presents additional risks associated with aerosol generation in patients suffering from coronavirus or other virulent respiratory pathology. Modern ICE technology offers viable alternative to transesophageal echocardiography, minimizing aerosol-related risks while maintaining comparable spatial and temporal resolution adequate for guiding ablation. In summary, the investigation by Cha et al1 opens new and exciting opportunities for expansion of zero-fluoroscopy approach to catheter ablation in AF. Short learning curve and shorter procedural time expands opportunities for long overdue research on ICE-guided catheter atrial ablation in subgroups of critically ill patients, particularly when pharmacological intervention fails to control persistent AF with hemodynamic instability. The study further expands available solutions for patients who present major epidemiological risk by adding point-of-care ICE-guided atrial ablation as an option of modern clinical armamentarium. The author declares no conflict of interest.

Abstract 14375: Does Race Provide Protection From New Onset Atrial Fibrillation After Typical Flutter Ablation in Male Veteran Patients?

Introduction: Patients undergoing typical atrial flutter (AFL) ablation remain at risk of developing atrial fibrillation (AF). However, it is unknown whether common risk factors associated with AF occurrence, particularly race, bear out in this population. Hypothesis: We sought to compare the occurrence of new AF in male veteran African-American (AA) and Caucasian (Cau) patients with AFL following successful cavo-tricuspid isthmus ablation. Methods: A retrospective review of patients undergoing AFL ablation between 2002 and 2019 was performed. Patients with prior history of AF were excluded. Records were reviewed and demographics, comorbidities and post-ablation outcomes including new AF and stroke were recorded. The overall incidence of AF and cases per 1000 person-years (CPTPY) were determined. Results: The study cohort comprised 217 patients (age: 66±9.3 years, AA: 97 [45%], Cau:108 [50%]; see Table) with a mean follow-up of 55±42 months after AFL ablation. New AF was detected in 30 (31%) AA and 45 (42%) Cau patients (p=0.21 by Log Rank test). Overall incidence of AF was 78 CPTPY (67 and 91 CPTPY cases in AA and Cau patients, respectively). Time to occurrence of AF was earlier in Cau than AA patients (p=<0.001). New stroke events occurred in 9 (4.4%) patients (4 AA, 5 Cau; p=0.86). Conclusions: Male AA and Cau patients have similar significant risks for developing AF and experiencing stroke after AFL ablation.

Incidence of atrial fibrillation in an opportunistic screening campaign in a general practitioner setting: a prospective population study

Abstract Introduction The detection of atrial fibrillation (AF) largely depends on the method used, thus the reported true rate of incident AF is controversial. The detection of symptomatic AF is straight forward in most cases, while it is unclear which strategies provide the best results for the detection of silent AF. Traditional methods like pulse palpation have a low accuracy and pulse guided ECG confirmation is not deemed cost-effective. Purpose The aim of the study was to detect the incidence symptomatic AF, using ECG, and opportunistic screening of silent AF, using an AF-detection capable automatic sphygmomanometer, in patients ≥65 years old in the general practitioner (GP) setting. Methods This was a population-based prospective cohort study of unselected general population referred for routine visits in 93 randomly selected GPs. Patients of both sexes of ≥65 years without previous diagnosis of AF were considered for the study. Each patient if symptomatic was directly referred to perform an ECG, otherwise if asymptomatic, underwent blood pressure monitoring with an AF-detection capable automatic sphygmomanometer followed by an ECG in case the device signaled AF. Results The final population comprised of 14987 individuals of ≥65 years old. The follow up extended to 16838 patient-years. The overall incidence of AF was 2.25% patient-years (95% CI 2.03–2.48). AF incidence was significantly higher in male (male/female ratio 1.29), overweight (BMI: 28.2 kg/m2 vs 27.0 kg/m2), older (79.1 vs 75.4 years old) individuals, with 44.9% belonging to the ≥80-year-old group. Other risk factors for incident AF were higher systolic BP measurements, history of stroke/TIA, congestive heart failure and chronic kidney disease. On multivariate analysis, age (annual increment), mitral valve disease, previous stroke and the number of annual visits (>10), were independent predictors of incidental AF. About 25% of cases were silent AF (0.56% patient-years, 95% CI 0.46–0.69) and were identified using the AF-detection capable automatic sphygmomanometer. Independent predictors of silent AF were age (per year increment), overweight (BMI >28 kg/m2) and the number of visits (>10) in the GPs' office. Conclusions We found a higher than previously reported incidence of AF possibly due to capturing silent AF. This simple protocol, using an AF-capable automatic sphygmomanometer, might be feasible and easily implemented on the routine GP care where high rates of coverage can be achieved. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Veneto Region Italy

Physical Activity and Risk of Atrial Fibrillation: A Nationwide Cohort Study in General Population

Although exercise prevents cardiovascular disease and mortality, vigorous exercise and endurance athletics can cause atrial fibrillation (AF). However, no large cohort study has assessed the relationship between physical activity and AF in the general population. We assessed the effect of physical activity at different energy expenditures on the incidence of AF. We studied 501,690 individuals without pre-existing AF (mean age, 47.6 ± 14.3 years; 250,664 women [50.0%]) included in the Korean National Health Insurance Service database. The physical activity level was assessed using a standardized self-reported questionnaire at baseline. During a median follow-up of 4 years, 3,443 participants (1,432 women [41.6%]) developed AF. The overall incidence of AF at follow-up was 1.79 per 1,000 person-years. The subjects who met the recommended physical activity level (500–1,000 metabolic equivalent task [MET] minutes/week) had a 12% decreased AF risk (adjusted hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.80–0.97), but not the insufficiently (1–500 MET-minutes/week; HR: 0.94, 95% CI: 0.86–1.03) and highly active subjects (≥1,000 MET-minutes/week; HR: 0.93, 95% CI: 0.85–1.03). The recommended minimum key target range of physical activity level was associated with the maximum benefit for reduced AF risk in the general population. The dose-response relationship between physical activity level and AF risk showed a U-shaped pattern. Although exceeding the key target range attenuated this benefit, it did not increase the AF risk beyond that during inactivity.

Atrial fibrillation after transhiatal esophagectomy with transcervical endoscopic esophageal mobilization: one institution\u2019s experience

BackgroundThere have been numerous studies regarding atrial fibrillation (AF) associated with cardiac and pulmonary surgery; however, studies looking at esophagectomy and atrial fibrillation are sparse. The goal of this study was to review our institution’s atrial fibrillation rate following esophagectomy in order to better define the incidence and predisposing factors in this patient population.MethodsA retrospective chart review of all patients undergoing esophagectomy with transcervical endoscopic mobilization of the esophagus (TEEM) at the Medical College of Wisconsin and Affiliated Hospitals from July 2009 through December 2012.ResultsSeventy-one patients underwent TEEM esophagectomy during the study period. Of those, 23 (32.4%) patients developed new atrial fibrillation postoperatively. ICU (Intensive Care Unit) length of stay was 7.1 days for those that did not receive amiodarone, compared to 5.3 days for those that did receive amiodarone (p < 0.025). Those that went into AF spent on average 9.3 days in the ICU compared to 4.7 days for their counterparts that did not go into AF (p < 0.006). Total length of stay was not statistically different between populations [15.1 +/− 11.3 days compared to 13.5 +/− 9.4 days for those who did not go into AF (p < 0.281)]. Receiving preoperative amiodarone was found to reduce the overall incidence of AF. There was a trend towards decreased risk of going into AF in those who received preoperative amiodarone with an adjusted hazard ratio of 0.555 (p = 0.057).ConclusionSimilar to data reported in previous literature, postoperative atrial fibrillation was found to increase ICU length of stay as well as overall length of hospital stay. Preoperative amiodarone administration displayed a trend toward decreasing the rates of atrial fibrillation in patients undergoing TEEM.

Identifying specific risk factors for the development of atrial fibrillation on ibrutinib.

128 Background: Ibrutinib is a tyrosine kinase inhibitor that has proven benefit in B-cell malignancies. Previous studies have shown that the overall incidence of atrial fibrillation (AF) while on ibrutinib is 6-16%. We investigated specific risk factors for the development of AF while on ibrutinib in an open-label single center study. Methods: We conducted a retrospective study of patients treated with ibrutinib between July 2012 and August 2017. ECGs were manually reviewed to document AF. Patients with existing AF or valvular heart disease were excluded. Patients were followed for incident AF until the end of the medical record, death, or August 2017. The presence or absence of AF risk factors and duration of ibrutinib treatment were documented. Statistical analysis used chi-square tests for categorical variables and t-tests for continuous variables. Results: 161 patients were included in the analysis. Mean age was 65.5 years, 70.8% were men, and 60.9% had CLL (13.0% Waldenstrom macroglobulinemia, 10.6% mantle cell lymphoma, and 15.5% other). After a mean follow up of 686 days, the incidence of AF was 9.9%. Combined systolic or diastolic heart failure (HF) was statistically associated with incident AF (p = 0.00454). Ibrutinib treatment length (p =0.09698), age (p = 0.08181), obesity, (p = 0.30800), coronary artery disease (CAD, p = 0.16422), hypertension (HTN, p = 0.65447), diabetes mellitus (DM, p = 0.58836), and male sex (p = 0.30800) were not associated with incident AF (Table 1). Of those with heart failure, 29.4% developed incident AF. Conclusions: In this large retrospective open-label cohort study, the incidence of AF on ibrutinib was higher in patients with heart failure. Duration of ibrutinib treatment was not associated with incident AF. Ibrutinib should be used with caution in patients with heart failure and these patients should be closely monitored for incident AF. [Table: see text]

Can dexmedetomidine reduce atrial fibrillation after cardiac surgery? A systematic review and meta-analysis.

PurposeCardiac surgery patients always present with atrial fibrillation (AF) after admission to the intensive care unit, leading to high mortality and lengthy hospitalization. Dexmedetomidine (DEX) is a popular medication used for sedation in the intensive care unit; however, whether it can reduce AF needs to be analyzed.Materials and methodsThree primary databases, Medline, Embase (Ovid SP) and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched. All English language and randomized control designed clinical publications comparing DEX to control medicines for sedation after elective cardiac surgery were included. Two independent colleagues conducted the data extraction and quality assessments. The subgroup analysis was performed according to the medicine used, age, AF history, and whether previous beta-blocker premedication and cardiopulmonary bypass (CPB) were applied. The overall incidence of AF was analyzed.ResultsA total of 1,295 patients in nine studies met the selection criteria among 2,587 studies screened from the database. After quantitative synthesis, our results revealed that the DEX group was not associated with a decreased incidence of AF compared with the placebo (risk ratio [RR] 0.76, 95% CI 0.37, 1.55, P=0.44) and morphine groups (RR 0.86, 95% CI 0.56, 1.31, P=0.48). Subgroup analysis also indicated that the DEX vs propofol comparison exhibited no difference: 1) for patients of age >60 years (P=0.69) or ≤60 years (P=0.69); 2) under CPB surgery (P=0.45) or without CPB surgery (P=0.88); 3) with beta-blocker premedication (P=0.32) or without beta-blocker premedication (P=0.90); and 4) with AF history (RR 1.07, 95% CI 0.85, 1.36, P=0.57) or without AF history (P=0.30).ConclusionThis meta-analysis revealed that DEX could not reduce the incidence of AF compared to control medicines following cardiac surgery. DEX may have an increased influence on AF occurrence if patients had a history of AF. However, cautious interpretation should be made due to high clinical heterogeneity.

Relation of Atrial Fibrillation in Acute Myocardial Infarction to In-Hospital Complications and Early Hospital Readmission

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) and contributes to high rates of in-hospital adverse events. However, there are few contemporary studies examining rates of AF in the contemporary era of AMI or the impact of new-onset AF on key in-hospital and postdischarge outcomes. We examined trends in AF in 6,384 residents of Worcester, Massachusetts, who were hospitalized with confirmed AMI during 7 biennial periods between 1999 and 2011. Multivariate logistic regression analysis was used to examine associations between occurrence of AF and various in-hospital and postdischarge complications. The overall incidence of AF complicating AMI was 10.8%. Rates of new-onset AF increased from 1999 to 2003 (9.8% to 13.2%), and decreased thereafter. In multivariable adjusted models, patients developing new-onset AF after AMI were at a higher risk for in-hospital stroke (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.6 to 4.1), heart failure (OR 2.0, 95% CI 1.7 to 2.4), cardiogenic shock (OR 3.7, 95% CI 2.8 to 4.9), and death (OR 2.3, 95% CI 1.9 to 3.0) than patients without AF. Development of AF during hospitalization for AMI was associated with higher rates of readmission within 30 days after discharge (21.7% vs 16.0%), but no significant difference was noted in earlypostdischarge 30-day all-cause mortality rates (8.3% vs 5.1%). In conclusion, new-onset AF after AMI is strongly related to in-hospital complications of AMI and higher short-term readmission rates.

Abstract 15163: Recent Trends in Atrial Fibrillation and Short Term Outcomes Following Acute Myocardial Infarction : A Population Based Perspective

Introduction: Atrial Fibrillation (AF) is a common complication during hospitalization for acute myocardial infarction (AMI) and is associated with increased morbidity and mortality in patients with AMI.However, there is limited information on contemporary trends in the incidence of AF in patients admitted with AMI and its impact on clinically relevant in-hospital and post-discharge outcomes. Methods: We examined trends in AF complicating AMI using data from the Worcester Heart Attack Study. The study population consisted of 6384 residents of Worcester, Massachusetts hospitalized with AMI for 7 biennial years from 1999 to 2011. Data was abstracted through the review of hospital medical records. Multivariate logistic regression analysis was used to examine the association between occurrence of AF and various in-hospital complications. Results: Overall incidence of AF complicating AMI was 10.8 %. The rate increased in the first half of the study period from 1999 to 2003 and declined thereafter .In models adjusting for other factors associated with adverse outcomes following AMI, we noted that compared to patients who did not develop AF, those who developed AF following AMI were at a higher risk of developing stroke [OR 2.53, 95 % CI 1.56 to 4.13], heart failure [OR 1.56, 95 % CI 1.31 to 1.87], and cardiogenic shock [OR 3.72, 95 % CI 2.82 to 4.90]. All-cause mortality during hospitalization was higher in those who developed AF[ OR 2.34, 95 % CI 1.87 to 2.94 ]; as was 30 day post discharge mortality [OR 1.29, 95 % CI 0.90 to 1.86] and 30 day post discharge readmission rate [OR 1.37, 95 % CI 1.09 to 1.72]. Conclusion: Our findings show that despite advancements in the treatment of AMI and reduced in-hospital mortality over the last 2 decades, new-onset AF remains common and related to multiple in-hospital and post-discharge adverse outcomes. Increased in-hospital monitoring and short-term post-discharge surveillance appears warranted for patients who develop AF in the context of AMI.

Abstract 15578: Adiposity, Systolic Blood Pressure, Smoking and Atrial Fibrillation: Analyses of 2.3 Million US Adults Attending Cardiovascular Screening

Aims: Unlike other vascular conditions, and for reasons that are incompletely understood, the prevalence of atrial fibrillation (AF) is rising sharply. Analysis of a large healthy cohort which was screened for AF allows reliable assessment of its association with several classical vascular risk factors. Methods: Between 2009 and 2013, around 3 million US adults attended cardiovascular screening clinics and had an ECG to identify AF. Personal and family medical history, medication use, smoking and alcohol consumption were recorded via questionnaires, and height, weight and blood pressure were measured. Age and gender-specific incidence of AF and associations between body mass index (BMI), systolic blood pressure (SBP) and smoking were measured in 2,320,190 participants with no reported prior history of AF, stroke or CHD. Results: The median age was 65, and two-thirds were female. The overall incidence of AF was 0.36%, but it was over twice as common in males (0.59%) than in females (0.23%) and rose sharply with age, doubling in each decade in both men and women. A positive association was seen between adiposity and AF in men and women across all ages studied: approximately 50% increase per 5 unit rise in BMI. By contrast, AF was only weakly associated with SBP - 10% increase per 10mmHg rise in SBP among participants aged under 70 years, and flat or even inversely associated among those over 70 years. Smoking was not associated with AF in men or women at any age (Odds Ratio for current vs never smokers = 0.97 [95% CI 0.79-1.19]). Conclusion: A 10 unit increase in BMI (ie, going from an “ideal” weight to “obese”) doubled the risk of AF. However, blood pressure was less strongly associated with AF, and only in those under 70 years, suggesting some other mechanism behind the BMI - AF association. Current smoking was not associated with AF. Rising rates of obesity may be driving the observed increase in AF in the developed world.

Abstract 16715: Incidence of Atrial Fibrillation After Atrial Flutter Ablation: A Meta-analysis Study

Background: Atrial Flutter (AFL) is usually initiated with short bursts of Atrial Fibrillation (AF). The incidence rate of AF after AFL ablation is variable. We evaluated the occurrence of AF in patients who underwent successful AFL catheter ablation with documented prior AF versus no prior AF. Methods: A meta-analysis was performed by searching online databases from January 1996 to April 2015 for studies describing patients who underwent typical AFL catheter ablation with and without prior AF. Results: A total of 36 articles were included, describing 6567 patients with typical AFL (2753 with prior AF and 3814 with no prior AF) who underwent ablation with 95% average success rate (bidirectional block). The overall incidence of AF after ablation was 35.3% (41% prior to ablation) during mean weighted follow-up (f/u) duration of 29.4 months. AF incidence after AFL ablation was 23% in patients with no prior AF and 52% in those with prior AF (OR 3.96, 95% CI [3.174.95] ; p&lt;0.00001). Subgroup analysis based on duration of f/u showed a significant variation of this probability (p=0.0003) between the group with &lt; 2 years f/u, compared to &gt; 2 years f/u due to an increase of AF incidence rate in patients with no prior AF. In studies with &lt; 2 years f/u duration, AF weighted average incidence rate after AFL ablation was 53.6 % in patients with prior AF and 14.3% in those with no prior AF (OR 6.90, 95% CI [4.5410.48] ; p&lt;0.00001). In studies with &gt; 2 years f/u duration, post-ablation AF developed in 51.3% of those with prior AF and in 26.3% of those with no prior AF (OR 2.93, 95% CI [2.423.56] ; p&lt;0.00001). Figure 1 Conclusions: Patients with prior history of AF have a higher incidence of AF after AFL ablation when compared to patients with no prior history of AF. However, this significantly decreases with extended follow-up duration due to an increase of detected AF in patients with no prior history of AF. This finding is important for decisions regarding anticoagulation plan after successful AFL ablation.

Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation

BackgroundIn patients with an acute coronary syndrome (ACS), no conclusive agreement has been reached to date regarding the association between the different types of atrial fibrillation (AF) and the in-hospital mortality risk. We conducted a retrospective cohort study in patients with ACS to determine the prognostic implications of the different types of AF. MethodsWe analyzed 6705 consecutive patients with ACS admitted to a coronary care unit (CCU), including 3094 with ST segment elevation myocardial infarction (STEMI) and 3611 with non-ST-elevation acute coronary syndrome (NSTE-ACS). We identified the patients with pre-existing AF, new-onset AF at admission, and new-onset AF at the CCU. ResultsThe overall incidence of AF was documented in 360 (5.4%) of the patients (STEMI, 5%; NSTE-ACS, 5.6%), 140 (2.1%) of whom had pre-existing AF, and 220 (3.2%) of whom had new-onset AF (AF at admission, 1.3%; AF at the CCU, 1.9%). The patients with AF had high-risk clinical characteristics and developed major adverse events more frequently than did the patients without AF. The unadjusted in-hospital mortality risk was significantly higher in the patients with pre-existing AF (STEMI, 3.79-fold; NSTE-ACS, 3.4-fold) and AF at the CCU (STEMI, 2.02-fold; NSTE-ACS, 8.09-fold). After adjusting for the multivariate analysis, only the AF at the CCU in the NSTE-ACS group was associated with a 4.40-fold increase in the in-hospital mortality risk (odds ratio 4.40, CI 1.82–10.60, p=0.001). In the STEMI group, the presence of any type of AF was not associated with an increased risk of mortality. ConclusionAmong the different types of AF in patients with ACS, only the new-onset AF that developed during the CCU stay in patients with NSTE-ACS was associated with a 4.40-fold increase in the in-hospital mortality risk.

Response to the Letter to the Editor titled “Atrial fibrillation in patients with acute coronary syndromes”

We appreciate the expressed enthusiasm about our paper. We believe that our study contributes 3 main findings. First, the overall incidence of AF occurring in the hospital following non-ST-segment elevation acute coronary syndrome (NSTE ACS) was 6%, but 44% of that occurred after coronary artery bypass graft (CABG) surgery. Second, the majority of these atrial fibrillation (AF) patients did not receive oral anticoagulation at discharge, despite almost 60% having a CHADS2 score ≥2 and almost 90% having a CHA2DS2-VASc score ≥2.

Systematic review of atrial fibrillation and stroke in patients with hypertrophic cardiomyopathy

Background: Hypertrophic Cardiomyopathy (HCM) is a common inherited myocardial disease associated with atrial arrhythmia. Current guidelines for the management of Atrial Fibrillation (AF) do not give detailed advice on management in HCM patients because of a lack of robust clinical prediction tools that can estimate risk of developing AF and an absence of adequately powered studies. Objective: To summarise and critically review literature on AF and stroke in HCM patients and to perform a meta-analysis to determine clinical risk factors for AF and stroke. Data sources: PubMed and Web-of-Science and reference lists of related articles. Study selection: Published articles on clinical studies addressing the topic of HCM, AF and stroke in human subjects. Data extraction: 2 investigators independently extracted data from identified articles. Studies in English language investigating AF and stroke in HCM as primary or secondary endpoint were included. Reviews, case reports, abstracts were excluded. Data synthesis: A random effect meta-regression model was used to determine the pooled overall prevalence and incidence of AF and stroke. The I2 statistic was used to estimate the proportion of total variability in the data attributed to the heterogeneity between the studies. Results: In a total population of 5397 patients in 29 retrospective studies, the overall prevalence of AF was 21.61% (95% CI 19.30-23.92, I2=67.3%, p<0.01). The overall prevalence of thromboembolism in HCM patients with AF was 30.65% (95% CI 23.35-37.95, I2=85%, p<0.01). The overall incidence of AF was 2.99% (95% CI 2.48-3.50, I2=75.4% (p<0.01). The overall incidence of all thromboembolic complications in HCM patients with AF was 4.35% (95% CI 2.91-5.79, I2=62.4%, p<0.05). LA size and age were predictive for the development of AF and stroke in the majority of studies. Meta-analysis revealed an LA diameter of 38.03 mm (95% CI 34.62-41.44) in SR patients and 45.37 mm (95% CI 41.64-49.04) in AF patients. There were no randomized controlled trials of therapy; anticoagulation was associated with a lower incidence of stroke in a small number of studies, but data on the effects of pharmacological therapy and radiofrequency ablation were limited and contradictory. Conclusions: AF is common in HCM and associated with a high risk of thromboembolism. LA size and age are independently associated with AF, but the published literature is insufficient to create a robust tool for the prediction of AF or thromboembolic risk in patients in SR. There are no trials of therapy, but most data suggest that once patients have AF, they should be anticoagulated.

The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients

Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and duration of atrial fibrillation. One hundred and ninety-six patients with coronary heart disease (152 men, age 62.7 ± 10.1 years) underwent surgical revascularization. Extracorporeal circulation was used in 64 patients and minimal extracorporeal circulation was used in 75 patients. Fifty-seven patients underwent surgery without extracorporeal circulation. During the first three postoperative days, subjects were monitored for the duration and incidence of atrial fibrillation, laboratory markers of inflammation (C-reactive protein, leucocytes) and serum potassium. Demographic data and associated cardiovascular diseases in the groups were not statistically different. The overall incidence of atrial fibrillation was 56% (110 patients). The highest incidence of atrial fibrillation was found in the extracorporeal circulation subgroup, with a significantly lower incidence using minimal extracorporeal circulation, and in patients operated on without extracorporeal circulation (75 vs 47 vs 46%, P <0.001). The longest duration of atrial fibrillation was found in patients operated on with extracorporeal circulation compared with minimal extracorporeal circulation, and without extracorporeal circulation (9.7 ± 11.6 vs 4.9 ± 8.3 vs 3.1 ± 5.2, P ≤0.001). The incidence of postoperative atrial fibrillation significantly correlated with elevation of inflammatory markers (C-reactive protein, leucocytes) compared with patients who were free of atrial fibrillation (P ≤0.001, P ≤0.05). The values of serum potassium were not significantly different. The relationship between postoperative atrial fibrillation and echocardiographic parameters was not confirmed. The use of extracorporeal circulation leads to a higher incidence of postoperative atrial fibrillation compared with the use of minimal extracorporeal circulation or with surgery without extracorporeal circulation, probably due to enhanced systemic inflammatory response.

Age is a strong risk factor for atrial fibrillation after pulmonary lobectomy

Background Atrial fibrillation (AF) after pulmonary lobectomy can be associated with increased morbidity and mortality as well as increased costs. Methods The records of 360 patients who underwent lobectomy between 2004 and 2008 at a single institution were reviewed. Univariate and multivariate analyses were performed to identify whether any recorded parameters served as prognostic variables in the development of AF. Results The overall incidence of AF was 18% (65 of 360). Univariate/multivariate analyses showed that age and preoperative history of AF/antiarrhythmic medications were strongly predictive for the development of AF ( P ≤ .001). Conclusions Age and pre-existing cardiac disease/arrhythmias are strong risk factors for AF after pulmonary lobectomy by both univariate and multivariate analyses. This study suggests that the elderly are at increased risk for AF. Therefore, this population should be monitored closely or targeted for prophylactic therapy.

Atrial fibrillation and changes in serum and urinary electrolyte levels after coronary artery bypass grafting surgery

Our study was designed to assess the incidence of atrial fibrillation, changes in serum electrolyte concentrations and urinary electrolyte excretion following coronary artery bypass grafting surgery. A total of 165 patients who underwent elective coronary artery bypass grafting surgery at the Department of Cardiac Surgery (Heart Center) during the period of 2004-2005 were enrolled. Serum K(+), Na(+), Mg(2+), Ca(2+), Cl(-), and P(-) concentrations were measured before cardiopulmonary bypass (CPB), on the arrival to an intensive care unit, and 15-18 hours after the surgery. Urinary excretion of K(+), Na(+), Mg(2+), Ca(2+), Cl(-), and P(-) was estimated 24 hours before the surgery, during the surgery, and 24 hours after the surgery. Cardiac rhythm was monitored throughout the study. All patients randomly were divided into the group 1 (n=55), which received magnesium sulphate infusion, and group 2 (n=110), which did not receive magnesium sulphate. The overall incidence of atrial fibrillation was 27.4%. The patients in the group 1 had significantly higher levels of serum magnesium before CPB and serum chloride after the surgery. Urinary magnesium and calcium excretion was significantly higher in the group 1 during and after the surgery. Before the surgery and 24 hours after the surgery, phosphate excretion was significantly higher in the group 1. The incidence of atrial fibrillation after myocardial revascularization surgery remains high (27.4%). Serum electrolyte concentrations after myocardial revascularization varied within normal ranges. Magnesium sulphate infusion did not decrease the rate of postoperative atrial fibrillation during the early postoperative period in normomagnesemic patients.

Atrial fibrillation after cardiac surgery: Risk factors and their temporal relationship in prophylactic drug strategy decision

Objective Postoperative atrial fibrillation (AF) is a vexing problem in cardiac surgery. Our aim was to identify risk factors between surgical procedures, all having cardiopulmonary bypass (CPB) in common, and how AF contributes to early and late mortality. Methods Patients were reviewed during a 10-year period, comprising coronary artery bypass grafting (CABG, n = 7056), aortic valve replacement (AVR, n = 690) and their combination (COMB, n = 688). The study assessed 43 variables of which pre-/intraoperative data were evaluated for uni/multivariate analysis in relation to AF and type of surgery. Data were reviewed versus hospital and 1-year mortality; the latter being obtained from the Swedish population registry. Results The surgery subgroups exhibited obvious differences. The overall incidence of AF was 25.6%, ranging from 22.7% for CABG to 44.0% for COMB procedures. Numerous interaction patterns were seen among the analyzed parameters. In multivariate fashion, age was encountered in all groups, whereas coronary disease superimposed risk factors with reference to myocardial conditions at CPB weaning. Postoperative AF increased the length of hospitalization, whereas it did not affect hospital mortality. In CABG patients only, AF gave rise to increased 1-year mortality ( p < 0.001). Conclusions In addition to the accepted risk factors of AF, primarily age, we emphasize the importance of considering details at CPB weaning, a correlation that was coronary specific. The weaning period hides valuable information that can be useful for more specific AF-prophylactic strategies. The AF-related increase in late mortality after CABG but not after valve procedures is intriguing, and draws attention to possible AF recurrence during patient follow-up and management.

Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients

Objective The purpose of this study was to identify risk factors associated with the onset of atrial fibrillation after thoracic surgery to allow more targeted interventions in patients with the highest risk. Methods A comprehensive prospective database was used to identify patients undergoing major thoracic surgery from January 1, 1998, through December 31, 2002. Data collection was performed at point of contact: at preoperative evaluation, the time of the operation, discharge, and postoperative visits. All patients undergoing resection of a lung, the esophagus, the chest wall, or a mediastinal mass were included in this study. Univariate and multivariate analyses of factors associated with the development of atrial fibrillation were analyzed. Results There were 2588 patients who met the inclusion criteria. The overall incidence of atrial fibrillation was 12.3% (n = 319). Categories of disease were primary lung cancer, pulmonary metastasis, esophageal cancer, intrathoracic metastasis, benign lung disease, other mediastinal tumors, mesothelioma, chest wall tumors, benign esophagus, and “other.” Patients with atrial fibrillation had increased mean lengths of hospital stay, mortality rates, and mean hospital charges. Univariate analysis evaluated age, sex, disease category, comorbidities, preoperative therapy, and procedure, and significant variables were entered into the multivariate analysis. Significant variables (relative risk; 95% confidence interval) in the multivariate analysis were male sex (1.72; 1.29-2.28), age 50 to 59 years (1.70; 1.01-2.88), age 60 to 69 years (4.49; 2.79-7.22), age 70 years or greater (5.30; 3.28-8.59), history of congestive heart failure (2.51; 1.06-6.24), history of arrhythmias (1.92; 1.22-3.02), history of peripheral vascular disease (1.65; 0.93-2.92), resection of mediastinal tumor or thymectomy (2.36; 0.95-5.88), lobectomy (3.89; 2.19-6.91), bilobectomy (7.16; 3.02-16.96), pneumonectomy (8.91; 4.59-17.28), esophagectomy (2.95; 1.55-5.62), and intraoperative transfusions (1.39; 0.98-1.98). Conclusions The significant variables identified by means of multivariate analysis were associated with the occurrence of atrial fibrillation. Preventive therapies in selected populations might reduce the incidence of atrial fibrillation.