Predictors Of Atrial Fibrillation Development Research Articles

Dosiahnennia arytmolohii u prohnozuvanni zloiakisnykh arytmii pid chas khvorob sertsia za kraini desiatyrichchia (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. With severe heart diseases, ventricular arrhythmias and atrial fibrillation can occur. The aim of the study. To analyze the achievements of arrhythmology in the field of predicting malignant arrhythmias over the past decades cardiology and to present the own results. Materials and methods. Literature surway of 34 articles supplemented with own results directed towards prediction of cardiac arrhythmia including the malignant arrhythmias. Results. Conducted investigation identified the following signs predicting the arrhythmias development: left ventricular hypertrophy, blockage of the bundle of His left limb, severe hypertension, diabetes. Left ventricle and left atrial remodeling are predictors of atrial fibrillation development. In patients with coronary arteries disease, predictors of atrial fibrillation development are increased heart volume and size, as well as decreased left ventricle ejection fraction. In 5 monographs on cardiac arrhythmias, predictors of prognosis and algorithms for the development of malignant cardiac arrhythmias are presented in details. Together with professor O. Sychov it was elaborated original classification of supraventricular extrasystoles. Conclusion. Over the past decades, a number of prognostic criteria for malignant cardiac arrhythmias and sudden cardiac death were elaborated. These include: pronounced left ventricle hypertrophy, blockage of the left limb bundle of His, severe form of hypertension, progressive chronic heart failure, the occurrence of T. Killip II and more, ventricular extrasystole 3-5 grades according to B. Laun, ventricular tachycardia of the “pirouette” type, reduction of the left ventricle ejection fraction is less than 40.0 %, thickening of the left ventricle posterior wall and interventricular membrane 14 mm and more, sino-atrial and atrio-ventricular blockage, prolongation of the Q-T interval, use of anti-arrhytmic drugs of IA and IS classes, etc. As a rule, the more of these arrhythmias predictors are exposed, the more often sudden cardiac deaths develops. Hovewer, certain exceptions of this rule sometimes appear. Keywords: coronary heart disease combined with hypertension, diagnostic criteria, predictors of complications progression.

THE ROLE OF BLOOD PRESSURE LEVEL IN THE DEVELOPMENT OF ATRIAL FIBRILLATION AFTER CORONAVIRUS INFECTION

Objective: It is known, that arterial hypertension (AH) is the main cause of atrial fibrillation (AF). The aim of our study was to assess the parameters of systemic hemodynamics as a predictor of AF development after coronavirus infection (CI). Design and method: We examined 118 patients with AF, at the age of 62.5 + 0.09 years with AF, who, on average, 6.2 + 0.5 months had undergone CI. Of these, 14 people (8.4%) also had atrial flutter. 72 people (61 %) had AF before CI (1st group of patients). The remaining 46 patients (39 %) had no history of this arrhythmia (2nd group of patients). Office blood pressure was measured according to the generally accepted method. Results: In the 1st group, the indicators of systolic blood pressure (SBP) were significantly lower than in the 2nd group (131.4 + 1.72 and 139.5 + 2.99 mm Hg, p < 0, 05), indicators of diastolic blood pressure (DBP) (81.5 + 0.74 and 87.9 + 2.41 Hg, p < 0.05), and heart rate (HR) (83, 0 + 1.86 and 98.0 + 2.4 bpm, p < 0.05). This difference in the groups was more significant between patients with hypertension: SBP, respectively (134.7 + 1.5 and 143.9 + 3.8 mm Hg, p < 0.05), DBP (83.3 + 1.1 and 90.5 + 2.6 Hg, p < 0.05), and heart rate HR (83.0 + 1.86 and 98.0 + 2.4 bpm, p < 0.001). In addition, in group 1, AH was found significantly less frequently (in 59 out of 72 patients, 81.9%) than in patients in group 2 (in 42 out of 46 patients, 91.3%), p < 0.05. Conclusions: An increase in SBP, DBP HR and AH, are predictors of the development of AF in patients after CI.

Assessment of the frequency and possible risk factors for paroxysmal atrial fibrillation in the early postoperative period after transapical implantation of the MedLab-CT valve

Aim. To study the incidence and possible risk factors for atrial fibrillation (AF) in the early postoperative period after transapical implantation of the first Russian aortic valve (TAP-AVI).Methods. The study included 118 patients after successful TAP-AVI. Patients with open aortic valve replacement due to dislocation of the prosthesis were excluded, as well as subjects with permanent AF and who died in the early postoperative period. The mean age of the patients was 71.1±4.9 years, body mass index 31.1±5.9 kg/m2 , males - 39.8%, hypertension was present in 93.2%, diabetes mellitus (DM) - in 27.9%, paroxysmal AF - in 12.7%, coronary artery disease (CAD) was in 56.7%, 8.4% were smokers. The median follow-up time corresponded to the hospital stay - 9.5 days. To identify cardiac arrhythmias, regular daily ECG recording in 12 leads was initiated from the first day after TAP-AVI. In the presence of palpitations, 24-hour ECG monitoring was performed. Indicators such as age, male gender, DM, history of AF, interatrial block before surgery, CAD, and echocardiographic parameters were studied as possible predictors of AF development in the early postoperative period after TAP-AVI. There were no significant differences in the baseline parameters in patients with AF paroxysms and sinus rhythm.Results. In the early postoperative period, AF was encountered in 46 (39%) of patients. New-onset AF occurred in 38 (32.2%) patients. No cerebrovascular event occurred in patients with post-surgery AF. The only statistically significant risk factor for AF in the postoperative period was CAD (OR 5.756; 95% CI 1.009-8.132; p = 0.048).Conclusion. In the early postoperative period, the only significant predictor of AF was the presence of documented CAD.

Predictors of atrial fibrillation recurrence after surgical ablation of long-standing persistent AF with concomitant coronary artery bypass grafting

Abstract Background A long-standing persistent form of atrial fibrillation (AF) in anamnesis, requiring surgical ablation together with coronary artery bypass surgery (CABG), significantly increases the risk of reccurence in the postoperative period. Before operation should consider the predictors of AF for long-term preservation of rhythm after surgery. Purpose To evaluate the predictors of AF recurrence on 3rd day and at discharge in patients after CABG with concomitant surgical ablation of long-standing persistent AF. Methods A prospective randomized single-center analysis was performed on patients with long-standing persistent AF, undergoing CABG with concomitant left atrial ablation (LAA) or biatrial ablation (BA) between 2016 and 2019. 116 patients were randomized into two groups: 58 in LAA+CABG, 58 in BA+CABG. The median age of the patients was 65 (IQR, 61 to 67.75) years in gr. BA and 62 (IQR, 58 to 66) in gr. LAA (Mann-Whitney U-test, p=0.050), 83% of men were in gr. BA (Fisher test, p>0.999). Predictors of AF development on day 3 were identified using multivariable logistic regression from the following baseline characteristics: myocardial infarction in anamnesis, time of artificial circulation, time of application of radiofrequency energy, the size of the left and right atrium, funcrional class of cardiac angina and heart failure, gender, age, acute cerebrovascular accident (CVA), additional intervention on the heart (operations for aortic aneurysm, mitral, aortic and tricuspid valves replacement), concomitant cardiovascular, respiratory, digestive and urogenital diseases. Results Using a multivariate model of logistic regression, the following significant predictors of arrhythmias on the 3rd day in gr. BA were included: additional intervention on the heart valves (OR 63.13, p=0.001); an increase in the functional class (FC) of chronic heart failure (CHF) NYHA by 1 (OR 40.06, p=0.018); a history of CVA (OR 9.13, p=0.026). The following significant predictors of AF reccurence on the 3rd day in gr.LAA were identified: an increase in the long axis of the right atrium by 1 cm (OR 3.05, p=0.006); an increase of the FC of cardiac angina by 1 (OR 7.11, p=0.011); in women (OR 7.14, p=0.017). In BA significant predictors of AF reccurence at discharge were: an increase in the long axis of the left atrium by 1 cm (OR4.86, p=0.015); reccurence of AF on the 3rd day (OR 17.45, p=0.005); 1 year increase in age (OR 1.24, p=0.023); the presence of diabetes (OR 47.67, p=0.002). In gr. LAA the predictors at discharge were: reccurence of AF on 3rd day (OR 38.35, p=0.001); a history of CVA increases the chances of arrhythmia (OR 210.83, p=0.032). Conclusion Number of clinical and functional characteristics of a patient may be predictors of AF. We examined the predictors of reccurence of AF after surgical ablation of long-standing persistent AF with concomitant CABG. Taking them into account when choosing the optimal strategy of treatment is important. Funding Acknowledgement Type of funding sources: None.

Impact of haemodialysis in the development of atrial fibrillation: a retrospective cross-sectional study

Abstract Background Chronic kidney disease (CKD) is a very common co-morbidity in patients with cardiovascular disease, particularly in those with atrial fibrillation (AF). There is an increasing number of patients on haemodialysis who have AF and its impact is not fully understood. Purpose To assess the prevalence of AF in patients on haemodialysis, trying to identify predictors of AF development. Methods Unicentric, retrospective study including all patients admitted to the Nephrology ward from October 2020 to December 2020 who had CKD. Cardiovascular risk factors, known cardiac disease, time on haemodialysis, type of vascular access and demographic data were analysed. The control group was comprised of hospitalized CKD patients who were not on renal replacement therapies. Results A total of 126 patients were included, 57 on dialysis. Mean age for the renal replacement therapy group was 71.07±15.68 years and for the control group was 72.59±14.74 years old (p=0.575). There was an increased proportion of patients with type 2 diabetes mellitus in the control group (39 vs 20, p=0.021). No statistically significant differences were found regarding hypertension, heart failure, coronary disease or sleep apnoea between groups. The prevalence of AF was similar in both the haemodialysis and the control group (26.3% vs 24.6%, p=0.829). Age, heart failure and coronary disease were significant risk factors for AF, irrespective of the studied group (p<0.05). There was also a significant correlation between time on dialysis and a greater likelihood of presenting AF (p<0.05). There was no correlation with type of vascular access. Using the Youden index, an age of 80.5 years was determined as the cut-off for an increased prevalence of AF, irrespective of the study group (sensitivity of 66.7%; Specificity of 78.8%). Using ROC curves, an area under the curve (AUC) of 0.74 was obtained for age and the likelihood of AF (figure 1). Regarding time on dialysis, a cut-off point of 4.5 years was obtained with an AUC of 0.67 (sensitivity of 73% and specificity of 68.7%) (figure 2). Conclusion AF is very common in patients with end-stage renal disease, with a prevalence estimated to be 4 times greater than the general population. Our results suggested that, while haemodialysis may not be a risk factor for AF by itself, a longer time on haemodialysis may contribute to its onset. Age was also a contributing factor. Further prospective studies with more homogeneous groups are needed to clarify its role as an independent risk factor for AF. Funding Acknowledgement Type of funding sources: None. Figure 1. Age as predictor of AFFigure 2. Time on dyalisis as predictor of AF

Atrial fibrillation in patients with SARS-CoV-2 infection

Introduction and objectivethe SARS-CoV-2 infection ranges from asymptomatic to critical forms and several prognostic factors have been described. Atrial fibrillation (AF) is common in acute situations where it is linked with more complications and mortality. We aimed to evaluate the prognostic information of AF in this population. Methodsretrospective analysis of a cohort of 517 patients consecutively admitted in a tertiary hospital due to SARS-CoV-2 infection. We divided the patients in two groups according the development of AF and compared the main features of both groups. An univariable and multivariable analysis of mortality were also performed. Resultsamong 517 patients with SARS-CoV-2 infection admitted in a tertiary center, 54 (10.4%) developed AF. These patients are older (81.6 vs 66.5 years old, p<0.001) and present more hypertension (74% vs 47%, p<0.001), cardiomyopathy (9% vs 1%, p=0.002), previous heart failure admission (9% vs 0.4%, p<0.001), previous episodes of AF (83% vs 1%, p<0.001) and bigger left atrium (47.8 vs 39.9mm, p<0.001). AF COVID-19 patients present more acute respiratory failure (72% vs 40%, p<0.001) and higher in-hospital mortality (50% vs 22%, p<0.001). Predictors of AF development are age and previous AF. AF is not an independent predictor of in-hospital mortality. Predictors are age, creatinine>1.5mg/dL at admission, LDH>250UI/L at admission and acute respiratory failure. ConclusionAtrial fibrillation appears in 10% of hospitalized patients with SARS-CoV-2 infection. These patients present more comorbidities and two-fold increase in hospital mortality. Atrial fibrillation is not an independent prognostic factor.

Assessment of the frequency and possible risk factors for paroxysmal atrial fibrillation in the early postoperative period after transapical implantation of the MedLab-CT valve

Aim.To study the incidence and possible risk factors for atrial fibrillation (AF) in the early postoperative period after transapical implantation of the first domestic aortic valve (TAVI) “MedLab-CT”.Material and methods.The study included 118 patients after successful TAVI. The study did not include patients with open aortic valve replacement due to dislocation of the prosthesis, with severe intraoperative complications leading to the death of the patient, and patients with permanent AF. The mean age of the patients was 71.1 ± 4.9 years, body mass index was 31.1 ± 5.9 kg/m2, men were 39.8%, hypertension was in 93.2%, diabetes mellitus (DM) was in 27.9%, paroxysmal AF was in 12.7%, coronary heart disease (CHD) was in 56.7%, smoking was noted in 8.4% cases. The median follow-up time corresponded to the hospital stay - 9.5 days. To identify cardiac arrhythmias, daily regular ECG recordings in 12 leads were assessed from the first day after TAVI. In the presence of palpitations, 24-hour ECG monitoring was performed. Indicators such as age, male gender, DM, history of AF, interatrial block before surgery, CHD, and echocardiographic parameters were studied as possible predictors of AF development in the early postoperative period after TAVI. There were no significant differences in the studied parameters in patients with AF paroxysms and sinus rhythm.Results.In the early postoperative period, AF episodess occurred in 46 (39%) patients. New-onset AF occurred in 38 (32.2%) patients. The only statistically significant risk factor for AF in the postoperative period in our series of observations was CHD (OR 5.756; 95% CI 1.009-8.132; p = 0.048).Conclusion.Patients with paroxysmal AF in the early postoperative period were not detected cerebrovascular events. In the early postoperative period, the only significant predictor of AF was the presence of proven CHD in patients.

Atrial fibrillation in patients with SARS-CoV-2 infection

Introduction and objectivethe SARS-CoV-2 infection ranges from asymptomatic to critical forms and several prognostic factors have been described. Atrial fibrillation (AF) is common in acute situations where it is linked with more complications and mortality. We aimed to evaluate the prognostic information of AF in this population. Methodsretrospective analysis of a cohort of 517 patients consecutively admitted in a tertiary hospital due to SARS-CoV-2 infection. We divided the patients in two groups according the development of AF and compared the main features of both groups. An univariable and multivariable analysis of mortality were also performed. Resultsamong 517 patients with SARS-CoV-2 infection admitted in a tertiary center, 54 (10.4%) developed AF. These patients are older (81.6 vs 66.5 years old, p<0.001) and present more hypertension (74% vs 47%, p<0.001), cardiomyopathy (9% vs 1%, p=0.002), previous heart failure admission (9% vs 0.4%, p<0.001), previous episodes of AF (83% vs 1%, p<0.001) and bigger left atrium (47.8 vs 39.9mm, p<0.001). AF COVID-19 patients present more acute respiratory failure (72% vs 40%, p<0.001) and higher in-hospital mortality (50% vs 22%, p<0.001). Predictors of AF development are age and previous AF. AF is not an independent predictor of in-hospital mortality. Predictors are age, creatinine>1.5mg/dL at admission, LDH>250UI/L at admission and acute respiratory failure. ConclusionAtrial fibrillation appears in 10% of hospitalized patients with SARS-CoV-2 infection. These patients present more comorbidities and two-fold increase in hospital mortality. Atrial fibrillation is not an independent prognostic factor.

Predictors of atrial fibrillation occurrence in patients with hypertrophic cardiomyopathy

Abstract Introduction Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of dysrhythmias, especially atrial fibrillation (AF). Purpose The aim of this study was to evaluate the incidence of AF in HCM patients (P) and to determine predictors of AF. Methods Retrospective analysis of HCM P at a single tertiary center. Baseline clinical, echocardiographic and cardiovascular magnetic resonance (CMR) characteristics were collected. On follow up AF was identified by electrocardiogram and/or 24 hours Holter monitoring. Results 61P (59% male) were included, with a mean age of 58±2 years. 27.9% had angina (all of them CCS 2), 34.4% were in NYHA II and 14.8% in NYHA III, 8.2% had syncope and 39.3% had palpitations. A family history of sudden cardiac death (SCD) or cardiomyopathy was present in 40.4% of the cases. The mean HCM risk SCD score was 3.35±0.28%. On echocardiography left atrium (LA) diameter was 44.86±0.87mm, LA volume (LAvol) was 89.97±5.39mL (indexed LAvol 46.05±2.55mL/m2), interventricular septum (IVS) was 16.83±0.663mm, left ventricle (LV) mass was 290.94±13.897g and maximum wall thickness (MWT) was 20.59±0.596mm. 77% P had LA enlargement. 88.5%P had late gadolinium enhancement (LGE) in CMR with a median number of 5±7 segments involved. AF developed in 23P (37.7%), with a mean age of 58±3 years. Predictors of AF development were NYHA III (p=0.007), risk score (p=0.007), LA diameter (p=0.007), LAvol (p=0.005) and indexed LAvol (p=0.002), MWT (p=0.0015), LGE in more than 5 segments (p=0.029) and LGE in the inferior basal and inferior median IVS (p=0.033 and p=0.042). The only independent predictor was LAvol (p=0.0012), with an area under the curve of 0.755 and a cut off of 85.9mL being the best predictor (p=0.004). Combining LAvol &amp;gt;85.9mL with LGE involving &amp;gt;5 segments and LAvol &amp;gt;85.9mL with LGE in inferior basal IVS (IBIVS) a statistically significant difference between groups was achieved (p=0.009 in the combined predictor LAvol + LGE &amp;gt;5 segments and p=0.002 in the combined predictor LAvol + LGE in IBIVS) (figure 1 and figure 2). In a multivariable analysis including these 2 combined predictors and LAvol alone the only independent predictor was the combination of LAvol + IBIVS involvement. Conclusion AF is frequent in patients with HCM and develops in younger ages than in general population. NYHA III, risk score, LA diameter, LAvol, MWT, LGE &amp;gt;5 segments and LGE in IBIVS and in IMIVS were predictors of AF, with LAvol being the independent predictor. The combination of LAvol with LGE &amp;gt;5 segments and LAvol with LGE in IBIVS presented stronger predictor value comparing with these characteristics alone. Funding Acknowledgement Type of funding source: None

P2464Reduction in left atrial reservoir strain is an independent predictor of atrial fibrillation in patients with arterial hypertension and preclinical diastolic disfunction

Abstract Left atrial (LA) dimensions, wall composition and function strongly depend on left ventricular (LV) diastolic function and impaired in patients with preclinical diastolic disfunction (PDD), which increases the likelihood of atrial fibrillation (AF) occurrence. LA longitudinal strain (LALS) is a sensitive parameter of subclinical myocardial changes and its reduction might be predictive for AF. Methods 168 patients (90 female) 68±9 years with arterial hypertension in sinus rhythm with preserved systolic function (LVEF&gt;50%) and PDD and without renal or valvular disease and 45 age and sex matched healthy controls were followed up for 2 years. PDD was diagnosed at stress echocardiography (SE) if E/e' ≥13, transmittal E wave deceleration time reduction &gt;50ms, systolic pulmonary artery pressure (sPAP) &gt;30 mmHg, and patients remained asymptomatic. LALS was measured by speckle tracking echocardiography as average value of two basal segments in 4 chamber view along with LA end-systolic volume index (LAVi), LA EF, LV mass index (LVMi), and LVLS. 72 hours Holter monitoring was performed every 6 months. Results Patients with PDD had larger LAVi, less LALS, higher LVLS and bigger LVMi compared with controls (LAVi 30.5±4.9 ml/m2 vs 23.1±4.8 ml/m2, p&lt;0.001; LALS 34.7±6.9% vs 45±4.3%, p&lt;0.001; LVLS –17.4±2.4% vs –20.8±2.1%, p&lt;0.002; LVMi 81.8±12.3 g/m2 vs 68±9.2 g/m2, p&lt;0.001). AF was registered in 42 (25%) patients with PDD. LAVi, LVLS and LVMi did not significantly differ in PDD patients with or without incidents of AF however LALS was significantly less in patients with AF (26.8±7.5% vs 37.2±8.1%, p&lt;0.01). Multivariate analysis defined LALS as an independent predictor of AF development (OR=2.4; 95% CI=2.41–5.96; p&lt;0.01) with the cut-off value of 28.9%. Conclusion LA peak reservoir LS is an independent predictor of AF development in patients with PDD.

Atrial fibrillation (AF) in patients with CLL treated with ibrutinib: Assessing prediction models and clinical outcomes.

7522 Background: Ibrutinib therapy is associated with an increased risk (~15%) of AF. An accurate risk assessment model for the development of AF in pts starting ibrutinib is not established, and outcomes after AF are not well described. Methods: An IRB approved retrospective review of CLL pts treated with ibrutinib at Mayo Clinic between Oct 2012 and Nov 2018 was conducted. Results: 299 pts were identified with a total of 565 years of ibrutinib exposure (Table). After a median follow-up of 24 months (range 0–70 months), 51 pts developed treatment-emergent AF (13 [25%] CTCAE 3 or higher). Our study assessed 3 clinical prediction models, the Framingham (Schanbel:Lancet 2009), Italian (Visentin:Blood 2018;132:3118), and Shanafelt (Shanafelt:Leuk Lymp; 2017) risk scores. Based on a lower Akaike information criteria, the Italian score was best able to predict risk of treatment emergent AF (2-year risk of AF with score 0 6%; 1-2 8%; 3-4 26%; 5+ 47%). Thirty (61%) pts were treated with medical therapy for AF (27 rate control; 2 rhythm control; 1 both). 16 (31%) pts underwent interventional therapy (3 AV node ablation; 11 cardioversion; and 2 pacemaker). Twelve (23%) pts temporarily held ibrutinib and resumed their original dose, 22 (43%) pts continued reduced dose ibrutinib and 11 (22%) continued their initial ibrutinib dose. Six (12%) pts permanently discontinued ibrutinib. Of 51 pts with treatment-emergent AF, 41 (80%) had a CHA2DS2-VASc score of ≥2 (41% received anticoagulation alone; 12% received antiplatelet therapy alone; 10% received both). No pt developed a thrombotic stroke after treatment-emergent AF. Two major bleeds, (1 GI and 1 intracranial) occurred, one in a pt on concomitant antiplatelet and anticoagulation therapy, and one in a pt receiving neither. The development of AF was associated with shorter event-free survival (HR 2.5, 95%CI 1.5-4.2, p&lt;.001) and shorter overall survival (HR 3.5, 95%CI 2.0-6.3, p&lt;.001). Conclusions: The Italian score was the best predictor of AF development in this cohort of ibrutinib treated pts. Although the vast majority of pts who develop AF after ibrutinib are able to continue therapy, the occurrence of AF appears to be associated with shorter EFS and OS. [Table: see text]

Assessment of atrial electromechanical delay and P wave dispersion in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is associated with atrial fibrillation (AF) and reduced forced expiratory volume (FEV1) is an independent predictor for new onset AF. The aims of this study were (1) to analyze the atrial electromechanical delay (AEMD) and P wave dispersion which are two predictors of AF development in patients with COPD and without any cardiovascular disease, and (2) to assess the relationship of those with pulmonary functions as quantified by FEV1 measurements. The study included 41 patients with COPD (33 male; mean age: 51 years) and 32 healthy controls. P wave dispersion was calculated as the difference between the maximum and minimum P wave duration in a 12-lead surface electrocardiography (ECG) recording. AEMD, defined as the time interval from the P wave onset on the ECG to the initiation of the late diastolic (Am) wave using a tissue Doppler examination, was measured from the lateral mitral annulus (LAEMD), septal annulus (SAEMD), and tricuspid lateral annulus (TAEMD). P wave dispersion was significantly longer in the COPD group than those in the controls (76±19 ms vs. 45±10 ms; p<0.001). All of the AEMD measurements demonstrated significant prolongation in patients with COPD (LAEMD: 74±9 ms vs. 64±11 ms; SAEMD: 66±10 ms vs. 57±12 ms; and TAEMD: 65±9 ms vs. 46±7 ms; p<0.001 for all). The only correlation with FEV1 was observed in the TAEMD values of the COPD group (rs: -401; p<0.009). Both P wave dispersion and AEMD parameters were significantly longer in COPD patients without any established structural or functional cardiac abnormalities, indicating an increased tendency for AF development, beginning from the initial stages of the disease.

Predictive value of crp/albumin ratio for in-hospital atrial fibrillation development in st segment elevation myocardial infarction

Aim: Atrial fibrillation(AF) development in ST elevation myocardial infarction (STEMI) patients is associated with increased cardiovascular mortality and morbidity. The CRP to Albumin ratio(CAR) is a new described parameter and it has been suggested that this parameter may also be correlated with cardiovascular diseases. In this study, we investigated the association between AF development and the CAR in STEMI patients undergoing percutaneous coronary intervention. Material and Methods: This study was conducted in patients presenting to our department with a diagnosis of STEMI retrospectively and undergoing percutaneous coronary intervention. A total of 110 patients were included in the study. The patients were divided into two groups according to AF development and the predictors for AF development were investigated. Results: The mean age of the patients was 62±5.1 years and 72% of them were males. While CAR, TIMI, CRP, albumin, neutrophil to lymphocyte to ratio, lesion localization, myocardial blush grade and syntax score were associated with the AF development in the univariate analysis, the CAR was determined to be an independent predictor of AF development in the multivariate regression analysis. Conclusions: We have demonstrated that the CAR was an independent predictor for prediction of AF development and we think that this parameter may be useful in clinical practice.

Left atrial electromechanical conduction time predicts atrial fibrillation in patients with mitral stenosis: a 5-year follow-up speckle-tracking echocardiography study.

Prolonged left atrial electromechanical conduction time is related with atrial electrical remodeling, and is predictive of the development of atrial fibrillation. The aim of our study was to examine whether left atrial electromechanical conduction time (EMT) and left atrial strain as measured by speckle tracking echocardiography (STE) are predictors for the development of atrial fibrillation (AF) in patients with mitral stenosis (MS) at 5-year follow-up. A total of 81 patients (61% females; mean age 38.1 ± 12.1years) with mild or moderate MS of rheumatic origin according to ACC/AHA guidelines who were in sinus rhythm, and were asymptomatic or have NYHA class 1 symptom were included in the study. AF was searched by 12-lead electrocardiograms or 24-h Holter recordings during follow-up period. Atrial electromechanical conduction time (EMT), peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) were measured by STE. EMTs was defined as the interval between the onset of P-wave to the peak late diastolic longitudinal strain in the basal lateral and septal wall. During the follow-up period of 5 years (mean follow-up duration, 48.2 ± 13.3months), 30 patients (37%) developed AF on standard 12-lead ECG or at their 24-h Holter recording. At follow-up, patients who developed AF were older than patients without AF (42.4 ± 11.3 vs. 35.6 ± 11.9, p = 0.014). Mitral valve area (MVA) (1.39 ± 0.14 vs. 1.48 ± 0.18, p = 0.03), PALS (13.4 ± 4.6 vs. 19 ± 5.2, p < 0.001) and PACS (6 ± 2.7 vs. 8.4 ± 3.8, p = 0.004), were lower in patients who developed AF than in patients who did not develop. However, EMTs-Septal (208.2 ± 28.4 vs. 180.2 ± 38, p = 0.001), and EMTs-Lateral (247.1 ± 27.6 vs. 213.3 ± 43.5, p < 0.001) were longer in patients with AF than in patients without. In multivariate Cox regression analysis, PALS and left atrial EMTs-Lateral were independent predictors for development of AF at follow-up. In patients with mitral stenosis, left atrial strain and electromechanical conduction time in the lateral wall during the long term follow-up period are predictive for the development of atrial fibrillation. Speckle tracking echocardiography is a basic and easily-implemented method based on left atrial parameters which may be helpful for early detection of atrial fibrillation in patients with mitral stenosis.

Does Deficiency of Vitamin D Increase New Onset Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery?

Deficiency of vitamin D is known to be effective in the development of hypertension, coronary artery disease, myocardial infarction, and stroke. Deficiency of vitamin D was also shown to be associated with new onset atrial fibrillation (AF) by activating the renin-angiotensin system. This study investigated whether or not levels of vitamin D are effective in the development of AF after coronary artery bypass grafting (CABG) surgery. A total of 283 patients undergoing CABG were included in this study. Clinical information, history of medication use, serum 25 hydroxy(OH) vitamin D, and calcium levels of all patients were evaluated preoperatively. AF developed postoperatively in 72 (25%) of patients. Serum 25(OH) vitamin D levels of patients in whom AF developed after CABG were significantly lower than patients in whom AF did not occur (15.6 ± 7.4 versus 19.1 ± 9.1; P = .004). Independent variables which were predictors of AF development in multivariate logistic regression analysis were ejection fraction (odds ratio [OR]: 0.93; 95% confidence interval [CI] 0.89-0.97; P = .003), left atrial dimensions (OR: 1.47; 95% CI 1.26-1.71; P &lt; .001), and serum 25(OH) vitamin D levels (OR: 0.95; 95% CI 0.91-0.99; P = .035). This study has shown that deficiency of vitamin D is associated with new onset AF post-CABG surgery.

Predictors and long-term clinical outcomes of newly developed atrial fibrillation in patients with cardiac implantable electronic devices.

To evaluate predictors and long-term prognosis of atrial fibrillation (AF) following cardiac implantable electronic device (CIED) implantation in patients without history of AF. From May 1994 to April 2014, 1825 patients with CIED were enrolled in a retrospective, single-center registry. A total of 880 patients from the registry without prior documented AF history were included in the final analysis and were placed into either non-detected AF (NDAF) group or CIED-detected AF group according to development of AF over a follow-up period of 7 years. AF development was defined as any paroxysmal atrial tachyarrhythmia (atrial rate ≥ 180 beats/min) lasting at least 5 minutes according to CIED records. Overall, 122 (13.8%) of the 880 patients experienced new development of AF during follow-up period. According to multivariate analysis, the independent predictors for development of AF were prior heart failure (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.50-3.85; P < 0.001), prior sinus node dysfunction (HR, 2.33; 95% CI, 1.62-3.55; P < 0.001), and left atrium volume index of 38.5 mL/m or more (HR, 2.01; 95% CI, 1.23-3.30; P = 0.005). In CDAF group, the risk of heart failure readmission (adjusted HR, 3.79; 95% CI, 1.99-7.22; P < 0.001) and stroke readmission (adjusted HR, 5.33; 95% CI, 1.58-17.97; P = 0.007) was higher than in nondetected AF group. In patients with CIED, prior history of heart failure, sinus node dysfunction, and LA volume index ≥38.5 mL/m were independent predictors of new AF cases. Newly developed AF was significantly associated with increased risk of HF and stroke readmission, according to long-term follow up.

CHOICE OF MANAGEMENT METHOD OF MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH LOW LEFT VENTRICULAR EJECTION FRACTION (&lt;35 %): A RANDOMIZED PROSPECTIVE STUDY

Purpose. Make a comparative assessment of supportive methods of myocardial revascularization in ischemic heart disease patients with low left ventricular ejection fraction (<35 %) conducted under CPB with cardioplegic cardiac arrest and on a beating heart combined with intraoperative use of IABP or levosimendan. Materials and methods. The study included 90 patients with coronary artery disease and left ventricular ejection fraction <35 %, which was performed CABG under normothermic CPB. Patients were randomized into 4 groups: IABP+CP (CPB with cardioplegia and IABP) (n=30), IABP+CPB (beating heart on a parallel CBP and IABP) (n=14), LS+CP (CBP with cardioplegia and levosimendan) (n=30), LS+CBP (beating heart on a parallel CBP and IABP) (n=16). The primary endpoint wastroponinI.Hemodynamic parameters, the markers of myocardial damage and heart failure, postoperative complications, length of ICU stay, length of hospital stay was evaluated. Results. In LS+CP and LS+CBP groups was revealed reduction in blood pressure (p=0.002 and p=0.013 respectively) and increase in heart rate (p=0.0008 and p=0.0002 respectively) before CBP in comparison with IABP. The average area under the curve (AUC) of troponin I concentration in LS+CP group was less than in IABP+CP group: 11.75 (6.28–13.29) ng/ml vs 24.43 (12.52–27.88) ng/ml, p=0.013. In LS+CP group was revealed decrease in length of ICU stay (2 (2–3) days) compared with IABP+CP group (4 (3–4) days, p=0.0002) and IABP+CBP group (4 (3–6) days, p=0.0008). Preoperative BNP concentration ≥203 pg/mL was a predictor of necessity for inotropic support with sensitivity 60 % (95 % CI 47.1–72.0) and specificity 93.75 % (95 % CI 69.8–99.8) (AUC 0.728; p=0.0001). Preoperative NTproBNP concentration ≥8.24 fmol/L was a predictor of necessity for inotropic support in the postoperative period with sensitivity 77.78 % (95 % CI 64.4–88.0) and specificity 66.67 % (95 % CI 38.4–88.2) (AUC 0.745; p=0.0012). In singlefactor regression analysis the independent effect on necessity for inotropic support in the early postoperative period exert the concentration of preoperative BNP (OR=1.01; 95 % CI 1.001–1.014; p=0.033). Belonging to LS+CP group reduces the risk of ICU stay for more than 3 days on 72 % (OR=0.28; 95 % CI 0.09–0.82; p=0.021). In multivariate regression analysis, a risk factor for 30-day mortality was the concentration of troponin I on the second postoperative day (OR=1.15; 95 % CI 1.03–1.27; p=0.010) and the preoperative concentration NTproBNP was a risk factor for the 1 year mortality (OR=1.02; 95 % CI 1.001–1.032; p=0.006). 6 hours CPK level after CBP was a predictor of atrial fibrillation development in the early postoperative period (OR=1.003; 95 % CI 1.001–1.005; p=0.003) and prolonged hospital stay for more than 14 days (OR=0.996; 95 % CI: 0.994–0.999; p=0.007) Conclusion. CABG on a beating heart under CPB in ischemic heart disease patients with low left ventricular ejection fraction (regardless of the hemodynamic support method) does not lead to significant decrease in serum concentration of Troponin I in the postoperative period. Intraoperative levosimendan infusion together with cardioplegic cardiac arrest improves early postoperative period, which is expressed in significant reduction in ICU stay. Thus, the most preferred method to support myocardial revascularization in ischemic heart disease patients with low left ventricular ejection fraction is combination of a standard methodology for CABG with cardioplegic myocardial protection accompanied by intraoperative infusion of levosimendan. Key words: cardiopulmonary bypass; coronary artery bypass surgery; beating heart; IABP; levosimendan.

Prediction of atrial fibrillation development and progression: Current perspectives.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression (from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.

Blood transfusion and the risk of atrial fibrillation after cardiac surgery.

Red blood cell transfusion (Tx) induces a proinflammatory state. Inflammatory mediators are associated with an increased risk of postoperative atrial fibrillation (AF). Therefore, in this study we determined the association between AF and Tx after isolated coronary artery bypass graft surgery (CABG). Between January 2008 and December 2010, a total of 879 patients underwent CABG. Of these, 815 (92.7%) had complete data extracted from our institution's Society of Thoracic Surgeons (STS) database. Predictors of AF development among four levels of Tx versus nontransfused patients were examined. Multivariable logistic regression and propensity score matching models were used. The mean age was 65.8 years (±10.3), 77.4% were male, and 54.4% had an STS predicted risk score (mortality/morbidity) of ≥10%. A total of 564 (69.2%) had at least one unit of Tx. Adjusting for age, sex, time on pump, congestive heart failure, stroke, creatinine level (<1.5 mg per deciliter vs. ≥1.5), STS morbidity/mortality score, perioperative myocardial infarction (MI), cross-clamp time, medications, and hemoglobin level, the odds ratio (OR) of AF increased with increasing Tx (OR, 1.36; 95% confidence interval [CI], 1.11 to 1.68; p = 0.003). The odds of AF increased 61% with each increasing level of Tx (OR, 1.61; 95% CI, 1.15 to 2.26; p = 0.006, by propensity analysis). Perioperative Tx may be associated with excess AF following CABG. This risk increases with increasing number of Tx.

Serum cholesterol levels and postoperative atrial fibrillation

BackgroundPost-operative atrial fibrillation is an important complication after coronary bypass surgery. As inflammation and oxidative stress were makedly encountered in the etiology, high cholesterol was also defined to provoke atrial fibrillation. In this present study, the relationship between postoperative atrial fibrillation and preoperative serum lipid levels were evaluated.MethodsA total of 100 patients, who were operated at the department of Cardiovascular Surgery of our hospital were included to the study analysis. Patients, who had preoperative atrial fibrillation, thyroid dysfunction, or left atrial dilatation (above 4.5 cm) were excluded from the study. Patients were divided into two groups with postoperative atrial fibrillation development (Group I n = 36), and without atrial fibrillation development (Group II n = 64). Preoperative routine blood analyses, ECG, echocardiography were evaluated. Patients were followed for atrial fibrillation development for one month starting from the intensive care unit at the postoperative period. Serum lipid profiles and thyroid function were measured. For homogenization of inflammatory factors and oxidative stress, treatments other than statins, betablockers, calcium channel blockers, aspirin, ACE inhibitors, and ARB were stopped for 10 days. Atrial fibrillation for at least ≥5 minutes in the intensive care unit was accepted as postoperative atrial fibrillation.ResultsDemographic data were similiar between groups (p > 0.05). There was no difference in TC levels between groups, whereas LDL-C levels were statistically lower in patients developing post-operative atrial fibrillation (106.67 ± 28.36 vs 118.75 ± 27.75; P < 0.05).ConclusionThe more lowered is the LDL-C in the preoperative period, the more reduced risk of postoperative atrial fibrillation development. High levels of LDL-C in the preoperative period could be predictor of atrial fibrillation development in the post operative period.