Patients In Atrial Fibrillation Group Research Articles

Association between red blood cell distribution width and non-valvular atrial fibrillation in hemodialysis patients: a single-center Chinese population study

Background Red blood cell distribution width (RDW) has emerged as a prognostic marker of atrial fibrillation (AF) in various clinical settings. However, the relationship by which RDW was linked to AF in hemodialysis (HD) patients was not clear. We sought to reveal the relationship between RDW and AF occurrence in HD patients. Methods We enrolled 170 consecutive maintenance HD patients, including 86 AF patients and 84 non-AF patients. All participants’ medical history and detailed clinical workup were recorded before the first dialysis session of the week. Electrocardiography, laboratory and transthoracic echocardiography examination indices were compared between the AF group and non-AF group. Multivariable logistic regression analysis was performed to identify the independent predictors of AF occurrence in HD patients. Results There were all paroxysmal AF patients in AF group. Compared to the non-AF group, patients with AF group had a significantly older age (61.0 ± 1.48 vs. 49.71 ± 1.79, p < 0.001), lower BMI (24.3 ± 4.11 vs. 25.8 ± 3.87, p < 0.05), higher RDW (15.10 ± 0.96 vs. 14.26 ± 0.82, p < 0.001) and larger LAD (39.87 ± 3.66 vs. 37.68 ± 5.08, p < 0.05). Multivariable logistic regression analyses demonstrated that values of age (OR: 1.030, 95%CI: 1.004-1.057, per one- year increase), BMI (OR: 0.863, 95%CI: 0.782–0.952, per 1 kg/m2 increase), RDW (OR: 2.917, 95%CI: 1.805–4.715, per 1% increase) and LAD (OR: 1.097, 95%CI: 1.004–1.199, per 1 mm increase) were independently associated with AF occurrence (p < 0.05, respectively). The best cutoff value of RDW to predict AF occurrence was 14.65% with a sensitivity of 68.6% and a specificity of 72.6%. Conclusions The increased RDW was significantly associated with the paroxysmal AF occurrence in HD patients.

P3765Low vascular endothelial growth factor-C was a predictor for cardiovascular events in patients with atrial fibrillation and suspected or known coronary artery disease: a subanalysis of the ANOX study

Abstract Background Lymphatic system has been considered to play an important role in cardiovascular disease. We recently reported that vascular endothelial growth factor-C (VEGF-C), a central player in lymphangiogenesis, predicted all-cause mortality in patients with suspected or known coronary artery disease (CAD). However, relationship between VEGF-C and atrial fibrillation (AF) remains unclear. Methods The ANOX study is a multicenter, prospective cohort study of 2,418 patients with suspected CAD, to determine the predictive value of possible novel biomarkers related to angiogenesis or oxidative stress for major adverse cardiovascular events (MACE) among patients undergoing elective angiography. Blood samples were collected from the arterial catheter sheath at the beginning of coronary angiography. Serum levels of VEGF-C, as well as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin-I (cTnI), and high-sensitivity C-reactive protein (hsCRP), were measured. The outcome was a MACE defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. Results Of a total of 2,418 patients, 261 patients had AF at baseline. AF group were older, and had more chronic kidney disease, history of heart failure, and history of stroke, but less diabetes, dyslipidemia, and CAD. The median level of NT-proBNP, cTnI, and hsCRP were higher in AF group [AF vs non-AF: NT-proBNP, 1048 pg/ml vs 162 pg/ml (p&lt;0.0001); cTnI, 0.0003 ng/ml, vs 0.0 ng/ml (p&lt;0.0001); hsCRP, 1.43 ug/ml vs 0.88 ug/ml (p=0.0005)], whereas median level of VEGF-C was lower in AF group [3107 pg/ml vs 3590 pg/ml (p&lt;0.0001)]. AF was associated with lower VEGF-C and higher hsCRP after adjustment for potential confounders. During the 3-year follow-up, 29 (11.1%) patients in AF group and 136 (6.3%) patients in non-AF group developed MACE (p=0.007). Incidence of stroke was higher in AF group (17 (6.5%) vs 52 (2.4%); p&lt;0.0009), despite that the incidence of cardiovascular death and myocardial infarction were similar between the groups. We divided the entire cohort into two groups based on the lowest quartile of VEGF-C or highest quartile of other biomarkers, lowest quartile of VEGF-C (log rank p=0.0004), as well as highest quartile of cTnI (log rank p=0.0009), were significantly associated with MACE in AF group. After adjustment for established risk factors and these biomarkers, both lowest quartile of VEGF-C (HR, 2.73; 95% CI, 1.27–6.06) and highest quartile of cTnI (HR, 2.54; 95% CI, 1.08–6.09) were significantly associated with MACE in AF group. Conclusions AF was associated with lower level of VEGF-C, and low VEGF-C as well as high cTnI might serve as an independent predictor of MACE in patients with AF and suspected or known CAD.

Atrial Fibrillation is Associated with Increased Incidence of Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device: Systematic Review and Meta-Analysis

Background Gastrointestinal bleeding (GIB) can be a devastating complication after left ventricular assist device (LVAD) implantation. Atrial fibrillation (AF) is a common arrhythmia in LVAD patients. Little is known about the association between AF and GIB in LVAD population. Method We performed a comprehensive literature search through March 2019 using MEDLINE, EMBASE, Scopus and the Cochrane Library. Included studies were prospective or retrospective cohort studies that compared the risk of developing GIB in LVAD patients with and without AF. We calculated pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic using the random-effects model. Results Five studies were considered for the analysis including 1,258 LVAD patients; 512 with AF (40.7%) and 746 without AF (59.3%). After a median follow-up period of 9 months to 2 years, 349 (27.7%) patients developed GIB; 167 (32.6%) patients in AF group and 182 (24.4%) patients in non-AF group. There was a significant association between AF and increased incidence of GIB during LVAD support (OR = 1.50; 95%CI = 1.16-1.93, p = 0.002) (I2 =0%). Conclusion Our meta-analysis suggests that nearly half of LVAD population have concomitant AF. Presence of AF is associated with an increased risk of GIB during LVAD support. This should be taken into consideration when choosing anticoagulation strategy for LVAD patients with AF.

Risk factors of atrial fibrillation in critical ill patients

To observe the clinical features of atrial fibrillation (AF) patients, and to explore the correlation between the routine detection index and the new-onset AF and to find out risk factors for new AF in critically ill patients. A prospective observational study was conducted. The patients with AF admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from March 2016 to June 2017 were enrolled. The patients were divided into new-onset AF group and past-existed AF group according to their past history of AF (including persistent AF, paroxysmal AF or permanent AF). In addition, patients in ICU without history of AF and new-onset AF were selected as the control group (no AF group). The general epidemiological characteristics of patients in three groups, and the blood biochemical, coagulation and other related indicators at the time of AF occurred (new-onset AF group) or 48 hours after ICU admission (AF group and no AF group) were analyzed; the difference of laboratory indexes between patients in new-onset AF group with AF within 48 hours before occurred and patients in no AF group within 48 hours after admission to ICU was compared. The relationship between each index and new-onset AF were analyzed. Pearson or Spearman rank correlation was used for analysis. Risk factors of new-onset AF were analyzed by Logistic regression analysis. 1 673 patients were admitted to ICU, including 179 cases of AF (10.70%), and 106 males and 73 females, with an average age of (71.73±23.22) years. There was 75 new-onset AF (morbidity 4.48%), and had a 28-day mortality of 45.33% (34/75). There were differences in age, previous heart disease and heart failure (HF) among new-onset AF group (n = 75), past-existed AF group (n = 104) and no AF group (n = 75). Compared with other two groups, renal insufficiency rates, troponin, serum sodium, calcium and procalcitonin levels were higher, mechanical ventilation time and the length of ICU stay were significantly prolonged, ICU and hospitalization costs were higher in new-onset AF group. Compared with no AF group, new-onset AF patients with the higher percentage of septic shock, the accumulation of vascular contraction drugs within 24 hours after AF usage were higher, and used more anti-arrhythmic drugs, has higher brain natriuretic peptide (pro-BNP), serum creatinine, blood lactic acid levels, and lower albumin, oxygenation index, and serum potassium levels, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score and 28-day mortality were higher. Correlation analysis showed that age, APACHE II score, septic shock, HF, cardiovascular disease, renal insufficiency were positively correlated with new-onset AF (r values were 0.393, 0.270, 0.386, 0.251, 0.194, 0.170; P values were 0.000, 0.001, 0.000, 0.002, 0.017, 0.037, respectively). The age [odds ratio (OR) = 0.962, P = 0.046], basic oxygenation index (OR = 1.005, P = 0.028) and serum potassium levels (OR = 1.638, P = 0.022) were the risk factors for new-onset AF. Critical patients with a high incidence of AF, new-onset AF significantly prolong the length of ICU stay; age, APACHE II score, septic shock, cardiovascular disease, and renal insufficiency are related to new-onset AF; age, basic oxygenation index and serum potassium levels are risk factors for new-onset AF.

High sensitive C-reactive protein and interleukin 6 in atrial fibrillation with rheumatic mitral stenosis from Indian cohort

IntroductionPresence of chronic low grade inflammation has often been implicated in the etiology of atrial fibrillation (AF). Whether pre-existing inflammatory state promotes AF or initiation of AF activates inflammation is a dilemma among clinicians. This study investigates the role of high sensitive C reactive protein (hs-CRP) and interleukin 6 (IL-6) in AF with rheumatic mitral stenosis (Rh-MS) as markers of chronic inflammation. MethodsThis case control cohort included sixty five (n=65) Rh-MS patients having other valve lesions as trivial to mild. Out of them twenty nine (n=29; group C) had baseline AF and rest were normal sinus rhythm (NSR). A 24h holter recording was done in NSR patients to diagnose paroxysmal AF/tachyarrhythmia forming group B (n=12) and not having any tachyarrhythmia were designated as NSR; group A (n=24). Resultshs-CRP and IL6 showed statistically significant increase in group C (permanent AF) compared to group A (95% CI: 4.2–0.9, p=0.007; 95% CI: 1.2–0.89; p=0.05 respectively), while it was non significant between group A and group B (p>0.05). A weak positive correlation was observed with hs-CRP and left atrial volume index (LAVi) (r=0.45, p=0.06) in AF group as compared to NSR group. 68.2% of patients in AF group (27/41) had moderate to severe spontaneous echo contrast (SEC) as compared to 37.5% (10/24) in NSR group. ConclusionIncreased hs-CRP and IL-6 levels in the paroxysmal and permanent AF group may favour the hypothesis that low grade chronic inflammation could be the cause of atrial fibrillation than a consequence.

PP.36.22

Objective: New-onset atrial fibrillation (AF) is a common complication of acute coronary syndrome (ACS). The aim of the study was to evaluate the incidence of AF in patients with ACS and to evaluate if arterial hypertension is a risk factor for new-onset AF in patients with ACS. Design and method: We included 600 patients with ACS, 290 with STEMI and 310 with NSTEMI. At entry, all patients were in sinus rhythm. The AF group included patients with ACS and new onset AF and control group included patients with ACS without AF during the hospital course. Results: Mean age of patients was 63.6 ± 10.6 years, between them 425 were men and 275 women, mean BMI was 26.8 ± 2.6 kg/m2. The incidence of new-onset AF was 8% in the patients with ACS during hospital course. In AF group there were 48 patients and in control group were 552 patients. We analyzed risk factors for coronary artery disease (CAD) and incidence of AF and found that the patients in AF group were older 69.9 ± 9.4 years versus 63.1 ± 11.4 in control group and with higher BMI (28.0 ± 2.6 kg/m2 in AF group versus 26.7 ± 2.6 kg/m2 in control group), p < 0.01. In AF group there were 26 patients (54.2%) with hypertension versus 268 (48.6%) in the control group, p > 0.05. There was also not difference in gender distribution, frequency of smokers, diabetes mellitus and family history for CAD between the groups, p > 0.05. Multivariable logistic regression analyses showed that from risk factors for CAD older age, OR (95% CI) is 2.37 (1.23–4.58), p = 0.01 and increased BMI, OR (95% CI) is 1.17 (1.04–1.33), p = 0.012 were independent predictors of new onset AF in the patients with ACS. Conclusions: The incidence of new-onset AF was 8% in the patients with ACS during hospital course, but hypertension was not significant risk factor for new onset AF. The independent predictors of new-onset AF from risk factors for CAD in the patients with ACS were older age and increased BMI.

The association between apelin-12 levels and paroxysmal supraventricular tachycardia.

Our aim was to investigate the apelin-12 levels in patients with atrioventricular tachyarrhythmias and compare with those in patients with lone atrial fibrillation. Forty four patients with supraventricular tachycardia as atrial fibrillation, 44 patients with paroxysmal supraventricular tachycardia (P-SVT) as atrioventricular tachyarrhythmias, including atrioventricular nodal reentrant tachycardia or atrioventricular reentrant tachycardia, and 30 age- and sex-matched healthy individuals were included in the study. The apelin-12 levels were significantly lower in both atrial fibrillation and P-SVT groups than control group. In post-hoc analysis, there was no significant difference in apelin-12 levels between atrial fibrillation and P-SVT groups (P = 0.9). Patients in atrial fibrillation group and patients in P-SVT group had significantly lower apelin-12 levels than control group, separately (P < 0.001 and P < 0.001, respectively). The sensitivity and specificity values of the apelin-12 levels for predicting SVT, including both atrial fibrillation and atrioventricular reentrant tachycardia or atrioventricular nodal reentrant tachycardia were 64.77 and 90%, respectively (cut-off value was 0.87). The area under the receiver operator characteristic curve was 0.834 for the apelin-12 levels (P = 0.0001). Apelin-12 levels are lower in patients with atrial fibrillation and P-SVT than control groups. Lower apelin levels in patients with atrial fibrillation and P-SVT would be expected to result in a decrease in the conduction velocity.

CLINICAL ANALYSIS OF ASSOCIATION OF CYSTATIN C AND ATRIAL FIBRILLATION

Some studies have disclosed atrial fibrillation (AF) is associated with inflammation. Cystatin C is not only inflammatory markers but also an independent predictor of cardiovascular events. Aim. We sought to investigate the relationship between serum levels of cystatin C and the occurrence and development of AF. Material and methods . 134 paroxysmal and persistent AF (AF1 group) and 121 permanent AF (AF2 group) patients in AF group and 154 healthy people in control group were prospectively measured for cystatin C, other inflammatory markers, biochemical indicators, left atrial diameter (LAD), left ventricular diameter (LVD) and left ventricular ejection fraction (LVEF). Results. (1) Compared with control and AF1 groups, AF2 group had higher values of cystatin C, high sensitivity C reactive protein (hsCRP), LAD and LVD whereas lower values of LVEF (P&lt;0.05). (2) After adjust for age, gender and body mass index (BMI), correlation analysis showed that serum level of cystatin C was closely related to hsCRP, LAD, systolic blood pressure (SBP) and creatinine, the correlation coefficient were respectively 0.658, 0.502, 0.475 and 0.530 (P&lt;0.01), but negatively associated with LVEF (P=0.011) in AF group. (3) Multivariate regression analysis showed the hsCRP, cystatin C, LAD and LVEF entered finally into the regression equation (cystatin C, OR: 3.41, 95%CI: 1.09–11.08, P=0.009). Conclusion . The serum levels of cystatin C has significant correlation with AF, which indicates cystatin C may play an important role in the process of AF development.

CLINICAL ANALYSIS OF ASSOCIATION OF CYSTATIN C AND ATRIAL FIBRILLATION

Some studies have disclosed atrial fibrillation (AF) is associated with inflammation. Cystatin C is not only inflammatory markers but also an independent predictor of cardiovascular events. Aim. We sought to investigate the relationship between serum levels of cystatin C and the occurrence and development of AF. Material and methods. 235 paroxysmal and persistent AF (AF1 group) and 254 permanent AF (AF2 group) patients in AF group and 221 healthy people in control group were prospectively measured for cystatin C, other inflammatory markers, biochemical indicators, left atrial diameter (LAD), left ventricular diameter (LVD) and left ventricular ejection fraction (LVEF). Results. (1) Compared with control and AF1 groups, AF2 group had higher values of cystatin C, high sensitivity C reactive protein (hsCRP), LAD and LVD whereas lower values of LVEF (P&lt;0.05). (2) After adjust for age, gender and body mass index (BMI), correlation analysis showed that serum level of cystatin C was closely related to hsCRP, LAD, systolic blood pressure (SBP) and creatinine, the correlation coefficient were respectively 0,614, 0,520, 0,463 and 0,538 (all P&lt;0,01), but negatively associated with LVEF (r= –0,356, P=0,012) in AF group. (3) Multivariate regression analysis showed the hsCRP, cystatin C, LAD and LVEF entered finally into the regression equation (cystatin C, OR: 3.25, 95%CI: 1.05–10.17, P=0,008). Conclusion. The serum levels of cystatin C has significant correlation with AF, which indicates cystatin C may play an important role in the process of AF development.

Predictors of post Coronary Artery Bypass Grafting Atrial Fibrillation

Objective To investigate the incidence and relative risk factors of post coronary artery bypass grafting (post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312 (33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40mm), a history of AF, pro-longed p-wave duration (≥120ms) and increased number of grafts (≥3). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.

Atrial Fibrillation after Percutaneous Coronary Intervention: Predictive Importance of Clinical, Angiographic Features and P-Wave Dispersion

Atrial fibrillation (AF) may occur during or after percutaneous coronary interventions (PCI). The purpose of the study was to determine the clinical, angiographic and electrophysiological predictors of AF after PCI. 225 patients undergoing PCI (mean age of 65 ± 11 years) who had sinus rhythm (SR) before balloon inflation were taken to study. Of these 22 developed AF in catheterization laboratory after balloon inflation or in 24 h following PCI (AF group), 203 did not (SR group). The patients in AF group were older (67 ± 9 vs. 63 ± 8 years, p < 0.05) and their ventricular ejection fraction was lower than SR group (56 ± 5 vs. 45 ± 7%, p < 0.05). The P-wave dispersion was significantly higher in AF group than SR group (53 ± 8 vs. 29 ± 10 ms, p < 0.001). For the patients with ST elevation myocardial infarction, the time from the onset of symptoms to balloon inflation was 3.7 ± 1.7 h in SR group. It was longer in AF group (4.1 ± 1.8 h, p < 0.05). TIMI perfusion grades 2 and 3 were achieved in 23 of 27 patients in SR group, and 5 of 8 patients in AF group. Multivessel disease was documented in 93 of the patients in SR group, and 12 in AF group. Clinical reperfusion was thought to be established in 20 in SR group, and 4 in AF group. In conclusion, our results show the importance of clinical factors, angiographic results and P-wave analysis in prediction of AF following PCI.