Permanent Atrial Fibrillation Group Research Articles

Paroxysmal atrial fibrillation is associated with poor sleep quality: Tamagawa cross-sectional study on the relationship between lifestyle and atrial fibrillation (TAMAGAWA-AF study).

Quality of life (QOL) is reduced in patients with atrial fibrillation (AF). However, data regarding the association between sleep quality, one of the major components of QOL, and AF are insufficient. This cross-sectional study aimed to elucidate whether sleep quality is reduced in patients with AF. We recruited 2054 consecutive outpatients (64 ± 10 years, 1089 men) who had regularly presented to 26 clinics affiliated with the Tamagawa Medical Association, Tokyo, Japan. The patients were divided into paroxysmal AF (PaAF), persistent or permanent AF (PeAF), and non-AF groups. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The global PSQI score was calculated according to the answer to each question, and poor sleep quality was defined as a global PSQI score ≥6 points. Logistic regression analysis was used to obtain odds ratio for poor sleep quality in the PaAF and PeAF groups, relative to the non-AF group. The PaAF group showed significantly increased odds ratio for poor sleep quality (1.49, 95% confidence interval 1.02-2.17), after adjusting for multiple potential confounders. In contrast, no significant odds ratio for poor sleep quality was observed in the PeAF group (1.09, 95% confidence interval 0.70-1.71). Among the PSQI components, poor subjective sleep quality and sleep disturbances were the main determinants of poor sleep quality in the PaAF group. Sleep quality was found to be reduced in patients with PaAF, and this may be attributed to poor subjective sleep quality and sleep disturbances.

Inflammation Burden and Atrial Fibrillation Burden: A Bidirectional Relationship.

Atrial fibrillation (AF) burden is defined as the proportion of time the patient remains in AF over a given period of time; thus, it is theoretically highest in permanent AF and lowest in paroxysmal AF. Inflammation is associated with the initiation and maintenance of AF. However, the relationship between systemic immune-inflammation index (SII) and AF burden is unknown. In the present study, we investigated the relationship between SII and AF burden. The present study is a cross-sectional analysis of 453 patients (252 females and 201 males, aged 44 to 94 years) with AF (138 with paroxysmal AF and 315 with permanent AF) who visited the cardiology outpatient clinic between October 2022 and June 2023. SII was calculated as (neutrophils × platelets/lymphocytes). The predictive role of SII and other inflammatory markers in the likelihood of AF pattern was evaluated by logistic regression analyses, and p value < 0.05 was considered statistically significant. Age, diastolic blood pressure, heart rate, diabetes mellitus, neutrophil, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, SII, C-reactive protein, red blood cell distribution width, hemoglobin A1c, and left atrial diameter were significantly higher in the permanent AF group. According to the logistic regression analysis, age (p = 0.038), diabetes mellitus (p = 0.024), red blood cell distribution width (p = 0.023), C-reactive protein (p = 0.010), SII (p = 0.001), and left atrial diameter (p < 0.001) significantly contributed to the prediction of the likelihood of permanent AF. SII is independently associated with the AF burden. Prospective studies are needed to determine whether SII may be useful in identifying patients at high risk for AF progression.

Left atrial dysfunction during stress in patients with atrial fibrillation

Abstract Background Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS). Objective This study sought to assess LA function at rest and during stress across the spectrum of AF. Methods In a prospective, multicentric, observational study design, we studied a cohort of 2391 patients (age=67±12 years; 1459, 61% male): 2142 (89.6%) were in sinus rhythm (SR, Group 1), 165 (6.9%) had a history of paroxysmal AF (Group 2) and 84 (3.5%) were in permanent AF (Group 3). All patients were referred for CCS and underwent stress echocardiography (SE) with exercise (n=1092, 45.3%), dobutamine (n=320, 13.4%) or vasodilators (n= 989, 40.3%: dipyridamole n=963 and adenosine n=26). Left atrial volume index (LAVI) and LA reservoir strain (LASr) were assessed at rest and peak stress. Analysis with different vendors was performed offline on anonymized cine-loops by observers unaware of the study hypothesis. Results The progressive increase in LA dysfunction from Group 1 to 3 was accompanied by greater signs of pulmonary congestion and LV dysfunction (see Table 1). In particular, LASr progressively decreased from Group 1 to 3, both at rest and during stress, regardless of the stress employed (see Figure 1). Conclusions LA reservoir function can be easily assessed with deformation imaging at rest and during exercise or pharmacological stress echocardiography. LA dysfunction progressively increases from SR to paroxysmal to permanent AF and is associated with more important LV systolic dysfunction, LV filling pressure, and pulmonary congestion in CCS.Table 1.Echocardiographic parametersFigure 1.LAVI and LASr at rest and peak

Stress echocardiography: application of the ABCDE protocol in patients with permanent atrial fibrillation

Abstract Objectives A new standard of practice in stress echocardiography (SE) was founded with the development of the ABCDE protocol, which added functional information to conventional ischemia diagnosis. Each step showed to provide incremental prognostic information: step A, regional wall motion abnormalities; step B, B lines; step C, left ventricular contractile reserve; step D, Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery; and step E, electrocardiogram-based heart rate reserve. However, the utility of SE and ABCDE protocol in patients with atrial fibrillation (AF) has never been tested. Background A growing body of evidence suggests that AF patients have a significant residual risk of myocardial infarction despite anticoagulant treatment; furthermore, they have an increased risk of heart failure and all-cause death. However, ABCDE-SE has never been applied in this population. Methods Of the 3965 patients who completed clinically indicated ABCDE-SE and with available information on rhythm stored in the shared data bank and enrolled from 13 certified centers, 3891 were in sinus rhythm (SR, Group 1) and 50 in permanent AF (Group 2) at the time of the test. ABCDE-SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal). The employed stress was an exercise in 1626 (41%), vasodilator in 1864 (47%), and dobutamine in 475 (12%). Results Group 2 pts were older than Group 1 patients, more frequently hypertensives and diabetics, with lower ejection fraction, and with more signs of pulmonary congestion at rest. During stress, differences were magnified, and Group 2 patients showed more peak stress B-lines and higher values of peak WMSI compared with Group 1 (see Table). In addition, patients with AF had higher ABCDE scores (Group 1= 1.5 ±1.4 vs. Group 2= 2.6±1.6, p&amp;lt;0.0001). The distribution of the score in patients in SR and AF is shown in Figure. Conclusions Patients with AF are scarcely represented among patients undergoing SE. Patients with AF showed a higher prevalence of positivity in each step and a higher ABCDE score. More specifically, AF patients are more vulnerable than patients in SR to coronary microvascular dysfunction and chronotropic incompetence during stress.TableFigure

Abstract 16806: Transcatheter Edge-to-Edge Repair Lessens Atrial Fibrillation Burden by Ameliorating Left Atrial Strain in Moderate-to-Severe Mitral Regurgitation Patients

Introduction: trans-catheter edge-to-edge repair (TEER) represents a therapeutic possibility in patients with moderate-severe mitral regurgitation (MR) considered at high surgical risk. Only in recent years, it has been realized that left atrial (LA) function plays a prognostic role in these patients. Hypothesis: since atrial fibrillation (AF) depends in part on LA geometry, we considered that two-dimensional speckle-tracking-echocardiography analysis could predict AF burden. Aim: we therefore evaluated the AF occurrence long term after TEER. Methods: one hundred nine patients treated by TEER between February ‘15 and April ’22 underwent reservoir (R_s), conduct (D_s), and contractile (C_s) evaluations strains before and 1,6,12 months after TEER. Cardiac rhythm was monitored through 24 hours Holter-ECG or previously implanted cardiac devices, when available. Statistical analysis was performed with SPSS. Comparisons were carried out by ANOVA and MANOVA. Results: to the permanent AF group (n=35), no paroxysmal (N=15), nor persistent (N=8) case was added during follow-up after TEER. Among the sinus rhythm (N=51) group, one episode of atrial tachyarrhythmia was found at device interrogation and one patient developed paroxysmal AF (2/51; 3,9%). Significant improvements in total cohort were observed at 12 months follow-up for R_s (from 10,77±5,74% to 16,28±6,93%; p&lt;0,0001), D_s (from -6,72±4,44% to -9,73±4,48%; p=0,0003) and C_s (from -5,21±5,11% to 7,72±5,4%; p=0,0184) compared to baseline. AF burden in paroxysmal AF (baseline: 9,2±4,7 hours, follow-up: 5,8±4,2 hours; p&lt;0,001) was significantly reduced as well as ventricular rate (baseline 88±14 bpm; 12 months 76±13 bpm; p&lt;0,001) in permanent AF group. Conclusions: MR reduction following TEER dictates positive LA remodelling and significant improvement of LA strain. Overall, the impact on LA geometry contributed to lessen incidence and burden of AF.

Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation.

Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS) but sometimes occult at rest and elicited by stress. This study sought to assess LA volume and function at rest and during stress across the spectrum of AF. In a prospective, multicenter, observational study design, we enrolled 3042 patients [age = 64 ± 12; 63.8% male] with known or suspected CCS: 2749 were in sinus rhythm (SR, Group 1); 191 in SR with a history of paroxysmal AF (Group 2); and 102 were in permanent AF (Group 3). All patients underwent stress echocardiography (SE). We measured left atrial volume index (LAVI) in all patients and LA Strain reservoir phase (LASr) in a subset of 486 patients. LAVI increased from Group 1 to 3, both at rest (Group 1 = 27.6 ± 12.2, Group 2 = 31.6 ± 12.9, Group 3 = 43.3 ± 19.7 mL/m2, p < 0.001) and at peak stress (Group 1 = 26.2 ± 12.0, Group 2 = 31.2 ± 12.2, Group 3 = 43.9 ± 19.4 mL/m2, p < 0.001). LASr progressively decreased from Group 1 to 3, both at rest (Group 1 = 26.0 ± 8.5%, Group 2 = 23.2 ± 11.2%, Group 3 = 8.5 ± 6.5%, p < 0.001) and at peak stress (Group 1 = 26.9 ± 10.1, Group 2 = 23.8 ± 11.0 Group 3 = 10.7 ± 8.1%, p < 0.001). Stress B-lines (≥2) were more frequent in AF (Group 1 = 29.7% vs. Group 2 = 35.5% vs. Group 3 = 57.4%, p < 0.001). Inducible ischemia was less frequent in SR (Group 1 = 16.1% vs. Group 2 = 24.7% vs. Group 3 = 24.5%, p = 0.001). In CCS, rest and stress LA dilation and reservoir dysfunction are often present in paroxysmal and, more so, in permanent AF and are associated with more frequent inducible ischemia and pulmonary congestion during stress.

Prevalence of Cardio-Embolic Brain Complications in Permanent and Paroxysmal Atrial Fibrillation Patients.

Background: Atrial fibrillation (AF) is the most frequent of all cardiac arrhythmias, with an increasing prevalence in the last 20 years. Cardio-embolic brain complications (CEBC) related to AF often occur or recur, even following appropriate treatment. Method: We conducted a retrospective study and analyzed the presence of stroke, dementia, and Parkinson’s disease (PD) in both paroxysmal and permanent AF patients. The records of 1111 consecutive admitted patients with primary diagnosis of AF at the Municipal Emergency University Hospital, Timisoara, between 2015 and 2016 were examined. Statistical analysis was performed on the patients included in the study based on the inclusion and exclusion criteria. Results: A significant statistical difference was noted among the permanent AF group for stroke (48.75% vs. 26.74%, p < 0.001) and dementia (10.25% vs. 3.86%, p < 0.001) compared to paroxysmal AF patients. Permanent AF patients presented a higher risk of developing stroke, dementia, and PD compared to patients with paroxysmal AF. Meanwhile, male gender and an increase in age showed an increase in the odds of having cardio-embolic brain complications in patients with paroxysmal AF. Conclusion: Based on the results obtained, it can be concluded that the risk of cardio-cerebral embolic complications is greater in permanent AF patients compared to paroxysmal AF cases. Ischemic stroke and dementia are more frequent in the permanent AF group, but analyzing the data regarding the age of onset paroxysmal AF is critical due to the fact that it involves a younger population. Prompt diagnosis and treatment can help significantly in saving stroke patients.

Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort Study.

Background: Post-operative (POP) atrial fibrillation (AF) is frequent in patients who undergo cardiac surgery. However, its prognostic impact in the long term remains unclear. Methods: We followed 1386 patients who underwent cardiac surgery for an average of 10 ± 3 years. According to clinical history of AF before and after surgery, four subgroups were identified: (1) patients with no history of AF and without episodes of AF during the first 30 days after surgery (control or Group 1, n = 726), (2) patients with no history of AF before surgery in whom new-onset POP AF was detected during the first 30 days after surgery (new-onset POP AF or Group 2, n = 452), (3) patients with a history of paroxysmal/persistent AF before cardiac surgery (Group 3, n = 125, including 87 POP AF patients and 38 who did not develop POP AF), and (4) patients with permanent AF at the time of cardiac surgery (Group 4, n = 83). All-cause mortality was the primary outcome of the study. We tested the associations of potential determinants with all-cause mortality using univariable and multivariable statistical analyses. Results: Overall, 473 patients (34%) died during follow-up. After adjustment for multiple confounders, new-onset POP AF (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 0.90–1.89; p = 0.1609), history of paroxysmal/persistent AF before cardiac surgery (HR = 1.33, 95% CI: 0.71–2.49; p = 0.3736), and permanent AF (Group 4) (HR = 1.55, 95% CI 0.82–2.95; p = 0.1803) were not associated with a significantly increased risk of mortality when compared with Group 1 (patients with no history of AF and without episodes of AF during the first 30 days after surgery). In new-onset POP AF patients, oral anticoagulation was not associated with mortality (HR = 1.13, 95% CI: 0.83–1.54; p = 0.4299). Conclusions: In this cohort of patients who underwent different types of heart surgery, POP AF was not associated with an increased risk of mortality. In this setting, the role of long-term anticoagulation remains unclear.

Consequences of functional mitral regurgitation and atrial fibrillation in patients with left ventricular assist devices

Functional mitral regurgitation (MR) (FMR) and atrial fibrillation (AF) are common in patients undergoing left ventricular assist device (LVAD) implantation. However, the impact of FMR and AF on clinical outcomes is uncertain. This study aimed to investigate the characteristics and prognostic significance of FMR and AF in patients with LVADs. We retrospectively reviewed all patients who underwent LVAD implantation at our center between January 2010 and December 2017. We defined significant FMR as the ratio of MR color jet area to left atrial area of >20% and persistent or permanent AF (PeAF) as persistent or permanent AF at LVAD implantation. A total of 380 patients were included in this analysis. Patients were divided into 6 groups: patients with no PeAF and no significant FMR (Group 1), patients with no PeAF but with significant FMR (Group 2), patients with PeAF but no significant FMR (Group 3), patients with PeAF and significant FMR (Group 4), patients with concomitant mitral valve surgery (MVS) at LVAD implantation and without PeAF (Group 5), and patients with concomitant MVS and with PeAF (Group 6). A total of 56 patients (15%) died within 2 years. Kaplan-Meier curve analysis demonstrated a 2-year survival of 81% in Group 1, 89% in Group 2, 87% in Group 3, 47% in Group 4, 87% in Group 5, and 79 % in Group 6 (log-rank test, p < 0.001). The multivariable Cox proportional-hazards model showed that classification in Group 4 was an independent predictor of mortality (hazard ratio, 4.31; 95% CI: 2.19-8.46; p < 0.001). The coexistence of significant FMR and PeAF may represent a poor prognostic marker in patients undergoing LVAD implantation.

Heart rate variability in patients with atrial fibrillation and hypertension.

Atrial fibrillation (AF) and hypertension are independently associated with impaired autonomic function determined using heart rate variability (HRV). As these conditions frequently co-exist, we sought to determine whether AF would worsen HRV in hypertensive patients. We studied HRV in AF (and hypertension) (n=61) and hypertension control group (n=33). The AF (and hypertension) group was subdivided into permanent AF (n=30) and paroxysmal AF (n=31) and re-studied. Time-domain, frequency-domain and nonlinear measures of HRV were determined. Permanent AF group (n=30) was followed up after 8weeks following optimisation of their heart rate and blood pressure (BP). Time-domain and nonlinear indices of HRV were higher in AF (and hypertension) group compared to hypertensive controls (P≤.01). Time-domain and nonlinear indices of HRV were higher in permanent AF group compared to paroxysmal AF (P≤.001). Permanent AF was an independent predictor of HRV on multivariable analysis (P=.006). Optimisation of heart rate and BP had no significant impact on HRV in permanent AF. AF, independent of hypertension, is characterised with marked HRV and is possibly related to vagal tone. HRV is higher in permanent AF compared to paroxysmal AF suggesting evident autonomic influence in the pathophysiology of permanent AF. Modulation of autonomic influence on cardiovascular system should be explored in future studies.

A greater burden of atrial fibrillation is associated with worse endothelial dysfunction in hypertension.

Atrial fibrillation (AF) and hypertension often co-exist and both are associated with endothelial dysfunction. We hypothesised that AF would further worsen endothelium-dependent flow-mediated dilatation (FMD) in hypertension patients compared to those without AF. In a cross-sectional comparison, we measured brachial artery diameter at rest and during reactive hyperaemia following 5 min of arterial occlusion in two patient groups: AF (and hypertension) (n = 61) and hypertension control groups (n = 33). The AF (and hypertension) subgroups: permanent AF (n = 30) and paroxysmal AF (n = 31) were also assessed. The permanent AF patients received heart rate and blood pressure (BP) control optimisation and were then followed up after eight weeks for repeat FMD testing. There was no significant difference in FMD between AF (and hypertension) group and hypertension control group (4.6%, 95% CI [2.6-5.9%] vs 2.6%, 95% CI [1.9-5.3%]; p = 0.25). There was a significant difference in FMD between permanent AF and paroxysmal AF groups (3.1%, 95% CI [2.3-4.8%] vs 5.9%, 95% CI [4.0-8.1%]; p = 0.02). Endothelium-dependent FMD response showed a non-significant improvement trend following eight weeks of heart rate and BP optimisation (3.1%, 95% CI [2.3-4.8%] (baseline) vs 5.2%, 95% CI [3.9-6.5%] (follow up), p = 0.09). Presence of AF generally does not incrementally worsen endothelial dysfunction in hypertension patients, although the duration and frequency of AF (paroxysmal AF to permanent AF) does lead to worsening endothelial function. Eight weeks of BP optimisation did not significantly improve endothelial dysfunction as measured by FMD.

P1878Long-term effect of atrial fibrillation on the evolution of mitral and tricuspid valve regurgitation

Abstract Background While severe mitral regurgitation is a well-established risk factor for atrial fibrillation (AF), it is less known whether atrial fibrillation induces mitral/tricuspid valve regurgitation (MR/TR). The present study aims to identify the long-term effects of permanent or non-permanent AF on atrial remodelling and on the progression of MR/TR. Methods The severity of MR/TR was assessed at baseline and after a period of 65±10 months in 37 patients with permanent AF, in 80 patients with non-permanent AF (of whom 43 were treated with ablation) and in 53 control patients with persistent sinus rhythm. MR/TR was qualitatively assessed by the multi-integrative approach, and quantitatively by measurement of the colour jet area. Results At baseline, AF patients had larger MR jet areas than control patients. At follow up, progression of MR, expressed as delta MR jet area, was 0.05±1.3 cm2 in the control group, 0.73±2.1 cm2 in the non-permanent AF group and 1.95±3.6 cm2 in the permanent AF group (p=0.001). Severe MR at follow up was observed in 0%, 2.5%, 8%, respectively. After adjustment for baseline clinical and echocardiographic parameters, permanent AF remained independently associated with the progression of MR. There was a significant positive correlation between a progression of MR and an increase in left atrial volume index (r=0.31, p&lt;0.001). Although rhythm control in non-permanent AF patients was better with AF ablation than with medical treatment only, the MR evolution was similar (delta MR jet area: 0.85±2.05 cm2 vs 0.61±2.12 cm2, p=0.6). Comparable findings, albeit less pronounced, were observed for the association between of AF and TR progression. MR jet area Conclusions The presence of longstanding AF is associated with a significant progression of MR/TR mainly due to atrial remodelling. Our data showed a beneficial effect of sustained rhythm control, either medically or by ablation, on MR/TR progression.

Assessment of Left Atrial Function in Patients with Paroxysmal, Persistent, and Permanent Atrial Fibrillation using Two-Dimensional Strain.

Atrial fibrillation (AF) has a progressive nature, leading to structural, functional, and electrical changes in the left atrium (LA). Enhanced response to treatment in patients with AF can be achieved through improved knowledge of atrial structure and a better understanding of its function. The aim of this study was to assess LA strain and its determinants in patients with paroxysmal (PAF), persistent (PsAF), and permanent AF (PmAF). Fifty-eight patients with registered non-valvular AF were divided into 3 groups depending on the type of AF. The participants underwent transthoracic echocardiography to assess the anatomy and function of heart chambers. Left atrial longitudinal strain (LALS) was measured in four-chamber projections using two-dimensional speckle tracking echocardiography. Patients with PAF had higher LALS (15.7±12.0) when compared to those with PsAF (4.3±7.9) and PmAF (5.8±7.8, all P=0.003). Multiple linear regression showed that the independent predictors of LALS were diastolic blood pressure (β=0.95, R2=0.88) in the PAF group; left atrial area (β=-0.56) and creatinine (β=-0.63, R2=0.58) in the PsAF group; AF duration (β=0.89) in the PmAF group (R2=0.72). LA strain has different determinants depending on AF type. LA size, renal function, and AF duration determine LALS in long-lasting AF. LA strain is a simple and accurate technique to estimate LA dysfunction in patients with long-lasting AF.

Long-term effect of atrial fibrillation on the evolution of mitral and tricuspid valve regurgitation

Objective: The present study aims to identify the long-term effects of atrial fibrillation (AF) on atrial remodelling and on the progression of mitral/tricuspid valve regurgitation (MR/TR).Methods: The severity of MR/TR was assessed by the colour jet area and by multi-integrative approach at baseline and after a period of 65 ± 10 months in 37 patients with permanent AF, in 80 patients with non-permanent AF (of whom 43 were treated with ablation) and in 53 control patients with sinus rhythm.Results: At baseline, AF patients had larger MR jet areas than control patients. At follow up, progression of MR, expressed as delta MR jet area, was 0.05 ± 1.3 cm2 in the control group, 0.73 ± 2.1 cm2 in the non-permanent AF group and 1.95 ± 3.6 cm2 in the permanent AF group (p = .001). Severe MR at follow up was observed in 0%, 2.5%, 8%, respectively. There was a significant positive correlation between progression of MR and increase of left atrium volume (r = 0.31, p < .001). After adjustment for baseline clinical and echocardiographic parameters, permanent AF remained independently associated with the progression of MR. Although rhythm control was better with AF ablation than with medical treatment only, the MR evolution was similar. Comparable findings, albeit less pronounced, were observed for the association between of AF and TR progression.Conclusions: The presence of longstanding AF is associated with a significant progression of MR/TR mainly due to atrial remodelling. Our data showed a beneficial effect of sustained rhythm control, either medically or by ablation, on MR/TR progression.

The Relevance of Serum Cystatin C Level of Different Classification of Atrial Fibrillation

Objective: To investigate the relationship between serum level of cystatin C (Cys-C) and AF (atrial fibrillation) and its clinical classification. Method: From January 2017 to April 2019, 168 cases of Xiaogan Central Hospital were chosen as the object of this study. The subjects were divided into 86 patients with AF and 82 patients in the control group. The AF group was divided into paroxysmal AF group (29 cases), persistent AF group (27 cases) and permanent AF group (29 cases) according to the European atrial fibrillation management guidelines and the North America Society of Pacing and Electrophysiology (NASPE) arrhythmia group organized the categorization of AF. Results: Compared with the control group, the level of the serum Cys-C was significantly higher in the AF group, the difference was statistically significant (P < 0.05). There was significant difference in Cys-C level in patients with different types of AF (P < 0.05). The levels of neutrophil percentage, low density lipoprotein cholesterol (LDL-C), left ventricular diameter, left atrial diameter, C-reactive protein (CRP) and homocysteine in the AF group were significantly higher than those in the control group (P < 0.05). The difference of neutrophil percentage, LDL-C, left ventricular ejection fraction, left atrial diameter, CRP and homocysteine levels in patients with different types of atrial fibrillation was statistically significant (P < 0.05). Logistic analysis showed that the serum Cys-C level, CRP, homocysteine, left ventricular diameter, left atrial diameter could be used as an independent predictor of atrial fibrillation when other factors were corrected. Conclusion: Serum Cys-C level in atrial fibrillation group is significantly higher than the control group, there are differences between different atrial fibrillation clinical classification, its level increased with duration of atrial fibrillation. Serum Cys-C level and inflammatory markers CRP, WBC and neutrophilic granulocyte percentage were positively correlated, indicating that serum cystatin C is associated with chronic inflammation, involved in the occurrence of atrial fibrillation, maintain and recurrence. Logistic analysis showed that the serum cystatin C level could be used as an independent predictor of atrial fibrillation when other factors were corrected.

Changes in endothelial progenitor cell function in elderly patients with permanent atrial fibrillation and their clinical significance

Objective To investigate changes in the number and function of endothelial progenitor cells (EPCs) in elderly patients with permanent atrial fibrillation(AF). Methods This prospective study included 35 elderly patients in each the permanent atrial fibrillation group and the control group.The numbers of circulating CD34+/KDR+cells in the two groups were determined by flow cytometry.After two sets of peripheral blood samples were taken, mononuclear cells were isolated through density gradient centrifugation and cultured in vitro.EPC colonies were identified by the methylthiazolyldipheny-tetrazolium(MTT)assay and adhesion assay.The proliferation, adhesion and vasculogenesis of EPC colonies were determined by Matrigel culture.Enzyme-linked immunosorbent assay and nitric acid reductase assay were used to measure the secretion of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in EPCs. Results The numbers of CD34+/KDR+ cells were lower in the AF group than in the control group (20.0±12.7)/104vs.(77.9±58.9)/104(P<0.05). The number of EPC colonies in the atrial fibrillation group was significantly lower than that in the control group (1.8±0.6)CFU vs.(3.5±0.8)CFU(P<0.01). The proliferation, adhesion and vasculogenesis of EPC colonies in the AF group decreased, compared with the control group (each P<0.01 or 0.05). Paracrine secretion of VEGF in the AF group (27.4±9.9)ng/L was lower than that in the control group (41.9±7.3)ng/L (P<0.01) and paracrine production of NO in the AF group also decreased (P<0.05). Conclusions EPCs In elderly patients with permanent atrial fibrillation show decreased numbers and reduced proliferation, adhesion and vasculogenesis.Paracrine VEGF and NO secretion is down as well. Key words: Stem cell; Endothelial cells; Atrial fibrillation; Nitric oxygen

Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis.

The relationship and clinical implications of atrial fibrillation (AF) in acute pulmonary embolism (PE) are poorly investigated. We aimed to analyze clinical characteristics and prognosis in PE patients with paroxysmal AF episode. Methods. From the 391 patients with PE 31 subjects with paroxysmal AF were selected. This group was compared with patients with PE and sinus rhythm (SR) and 32 patients with PE and permanent AF. Results. Paroxysmal AF patients were the oldest. Concomitant DVT varies between groups: paroxysmal AF 32.3%, SR 49.5%, and permanent AF 28.1% (p = 0.02). The stroke history frequency was 4.6% SR, 12.9% paroxysmal AF, and 21.9% permanent AF (p < 0.001). Paroxysmal AF comparing to permanent AF and SR individuals had higher estimated SPAP (56 versus 48 versus 47 mmHg, p = 0.01) and shorter ACT (58 versus 65 versus 70 ms, p = 0.04). Patients with AF were more often classified into high-risk group according to revised Geneva score and sPESI than SR patients. In-hospital mortality was lower in SR (5%) and paroxysmal AF (6.5%) compared to permanent AF group (25%) (p < 0.001). Conclusions. Patients with PE-associated paroxysmal AF constitute a separate population. More severe impairment of the parameters reflecting RV afterload may indicate relation between PE severity and paroxysmal AF episode. Paroxysmal AF has no impact on short-term mortality.

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.

0501 : Left atrial remodeling after percutaneous left atrial appendage closure

The importance of the left atrial appendage (LAA) on left atrial (LA) hemodynamics is unknown. We sought to evaluate the effect of LAA percutaneous closure (LAAPC) on left atrial remodeling in patients with paroxymal atrial fibrillation (AF) and permanent AF. All patients refered for LAAPC with Amplatzer Cardiac Plug (ACP) and Watchman device were enrolled. Cardiac computed tomography (CT) for LA volume measurement and transthoracic echocardiography (TTE) for diastolic function assessment were performed at baseline and 3 months after LAAPC. An average of 3 consecutives measurements were performed for TTE parameters in all patients. Sixty-three patients (mean age 73±9 years) were included. 38% (n=24) was in sinus rythm at baseline and 55% (n=35) in permanent AF. Patients in SR at baseline and permanent AF at 3 months were exclued (n=4, 7%). The mean CHA2DS2-VASc score was 4,3±1,3. The procedure was successful in all patients.There was no significant difference in the functionnal status (p=0,74) and BNP (155,6 ± 107 baseline vs 155±150,6 pg/ml at 3 months ; p=0,85). Left atrial volume excluding the LAA (14±55ml baseline vs 144±50 cm3 at 3 months; p=0,30) showed no significant change after 3 months in the overall population, neither in the SR (99,7 ± 19,1 baseline vs 103,8±21 cm3 at 3 months ; p=0,32) or the permanent AF groups (173,2±54 baseline vs 171,7±48,6 cm3 at 3 months ; p=0,59).MV peak E-wave (84,2 ± 22,7 ; 86,7±26 cm/s, p=0,62) and A-wave velocities (65,4±14,4 ; 68,5 ± 22,2 cm/s, p=0,66) did not differ between baseline and three months. E/E’ ratio was higher in the overall population and there was a trend to higher E/E’ ratio in the SR group. There's no evidence for early LA remodeling after LAAPC. LV pressure loading might be slighlty more elevated after LAA closure suggesting the potential reservoir role of the LAA. Further studies are warranted to confirm these prelimary results. The author hereby declares no conflict of interest

0290: Left atrial remodeling after percutaneous left atrial appendage closure

The importance of the left atrial appendage (LAA) on left atrial (LA) hemodynamics is unknown. We sought to evaluate the effect of LAA percutaneous closure (LAAPC) on left atrial remodeling in patients with paraxysmal atrial fibrillation (AF) and permanent AF. All patients refered for LAAPC with Amplatzer Cardiac Plug (ACP) and Watchman device were enrolled. Cardiac computed tomography (CT) for LA volume measurement and transthoracic echocardiography (TTE) for diastolic function assessment were performed at baseline and 3 months after LAAPC. An average of 3 consecutives measurements were performed for TEE parameters in all patients. Sixty-three patients (mean age 73±9 years) were included. 38% (n=24) in sinus rythm (SR) at baseline and 55% (n=35) in permanent AF. Patients in SR at baseline and permanent AF at 3 months were excluded (n=4,7%).The mean CHA2DS2-VASc score was 4,3±1,3. There was non significant difference in the functionnal status and BNP level (155,6±107 vs ±150,7pg/mL; p=0,85) between baseline and 3 months follow-up. Left atrial volume excluding the LAA (145 ±55cm 3 baseline vs 144±50cm 3 at 3 months; p=0,30) showed no significant change after 3 months in overall population, neither in the SR (99,7±19,1 vs 103,8±21cm 3 ; p=0,32) or the permanent AF groups (173,2±54 vs 171,7±48,6cm 3 ; p=0,59). MV peak E-wave (84,2±22,7 vs 86,7±26cm/s; p=0,62) and A-wave velocities (65,4±14,4; 68,5±22,2cm/s; p=0,66) dit not differ between baseline and follow-up but E/E’ ratio was increased in the overall population after LAAPC (7,9±2,1 vs 9,1±3,6cm/s; p=0,038) and there was trend to higher E/E’ ratio in the SR group (7,7±1,6 vs 9±3,3cm/s, p=0,46). There’s no evidence for early LA remodeling after LAAPC, but diastolic function might be negatively influenced by LAAPC suggesting the potential role of LAA in atrial function. Further studies are warranted to confirm the prelimary results.