Prevalence Of Arrhythmias Research Articles

Prevalence of Arrhythmias in Patients With Coronary Microvascular Dysfunction.

Coronary microvascular dysfunction (CMD) is an important cause of angina with nonobstructive coronary arteries (ANOCA). It is unclear whether CMD is associated with arrhythmia. This study aimed to evaluate the prevalence of arrhythmias in patients with ANOCA and CMD compared to those in patients with ANOCA without CMD. In this observational study of the Coronary Microvascular Disease Registry (NCT05960474), patients with ANOCA who underwent invasive coronary functional assessment for CMD were included. The diagnosis of arrhythmia was based on 12-lead electrocardiography (ECG), or clinical diagnosis accompanied by ECG evidence within 1 year before CMD evaluation. The study included 262 patients; 66 (25.2%) were CMD-positive. Patients with CMD were older, and there was no difference in history of heart failure and baseline left ventricular ejection fraction compared to those without CMD. Premature atrial contractions (PACs) (25.8% vs. 5.6%; p < 0.001), supraventricular tachycardia (SVT) (24.2% vs. 6.6%; p < 0.001), premature ventricular complexes (PVCs) (43.9% vs. 10.7%; p < 0.001), nonsustained ventricular tachycardia (NSVT) (28.8% vs. 3.1%; p < 0.001), and accelerated idioventricular rhythm (9.1% vs. 2.6%; = 0.02) were more common in CMD-positive patients. In a multivariate analysis adjusting for baseline differences and other variables clinically associated with arrhythmia, CMD was associated with PACs (odds ratio [OR]: 4.7; 95% confidence interval [CI]: 1.8-11.9), SVT (OR: 3.5; 95% CI: 1.5-8.6), PVCs (OR: 5.9; 95% CI: 2.6-13.0), and NSVT (OR: 9.5; 95% CI: 3.2-27.7). Patients with ANOCA and CMD have a higher likelihood of arrhythmias, especially ventricular arrhythmias.

Environmental Factors, Occupational Hazards, and Seasonal Changes: Unveiling the Triggers of Atrial Fibrillation.

Atrial Fibrillation (AF) is the most common cardiac arrhythmia in the world, with a lifetime risk of 26% for men and 23% for women. Atrial fibrillation is a prevalent cardiac arrhythmia that is more common with increasing age. Globally, around 33.5 million people are estimated to have AF, which is anticipated to rise as the population ages. Although effective therapeutic methods exist, they are costly for the healthcare system. The search was conducted across multiple databases, including Medline, PubMed, and Google Scholar, as well as through manual searches of recognized publications and their bibliographies. Identifying modifiable risk factors for AF and implementing appropriate preventative measures may significantly improve public health and reduce healthcare costs. The development of AF has been reported to be associated with various causes, including electrical and structural changes in the atrial tissue. This article has reviewed how environmental factors, occupational hazards, and seasonal variability can affect AF. The incidence and prevalence of AF have been increasing, leading to a high lifetime risk for individuals. The available evidence indicates that seasonal variation, environmental factors, such as noise and air pollution, type of job, and altitude are all associated with an increased risk of developing AF. Although the exact mechanisms underlying these associations remain unclear, it is likely that a combination of factors, including changes in autonomic tone, inflammation, and oxidative stress, play a role. This review has highlighted the significance of assuming the role of environmental and occupational factors in the development of AF.

Prevalence of Mitral Annular Disjunction at Cardiac MRI: Results from a Multicenter Registry.

Purpose To determine the prevalence of mitral annular disjunction (MAD) in patients undergoing cardiac MRI for various clinical indications and to assess the association of MAD with arrhythmia, mitral valve prolapse (MVP), and myocardial alteration. Materials and Methods This study analyzed data from a retrospective observational registry of consecutive patients undergoing cardiac MRI for different clinical indications. Cardiac MRI examinations were performed from January 2019 to June 2019 at 13 Italian hospitals. Images underwent double reading by expert cardiac radiologists from the enrolling center and the core laboratory to assess the presence of MAD. Presence and maximum length of MAD and its association to MVP pattern, functional and structural myocardial alteration, and arrhythmia were evaluated using nonparametric and parametric tests. Logistic regression models were used to identify predictors of arrhythmia. Results Cardiac MRI studies from 2611 consecutive patients (1730, 66% male; median age, 53 years; IQR, 39-65 years) were evaluated. Prevalence of MAD was 5.44% (142 of 2611). MAD was an incidental finding in 74.6% (106 of 142) of patients. Patients with MAD had a higher prevalence of arrhythmias compared with patients without MAD (40% [57 of 142] vs 18% [444 of 2469]; P < .001). Patients with MAD and bileaflet MVP showed a longer MAD compared with patients with single-leaflet or absent MVP (median, 7 mm [IQR, 3-9.5 mm] vs 4 mm [IQR, 3-5 mm]; P < .001), a higher prevalence of systolic curling (75% [21 of 28] vs 30.7% [35 of 114]; P < .001), higher extracellular volume values (30% [IQR, 28%-32%] vs 27% [IQR, 25%-30%]; P = .04), and a higher prevalence of arrhythmia (64.2% [18 of 28] vs 34.2% [39 of 114]; P = .006). MAD length of at least 5 mm was an independent predictor of arrhythmia (odds ratio 3.96; 95% CI: 1.93, 8.15; P < .001). Conclusion MAD was a frequent incidental finding on cardiac MRI scans from a multicenter registry. MAD length of at least 5 mm and coexisting bileaflet MVP showed a higher risk of arrhythmia. Keywords: MR Imaging, Cardiac, Mitral Annular Disjunction Supplemental material is available for this article. ©RSNA, 2024.

Abnormal blood pressure response to exercise and ventricular arrhythmias: a suspicious association in athletes.

Abnormal blood pressure response to exercise (ABPR) in athletes is considered a risk for incident hypertension, conferring a higher cardiovascular risk profile. We sought to describe the clinical cardiovascular features of athletes with ABPR and, moreover, the relationship of ABPR with occurrence of exercise-induced ventricular ectopic beats (VEBs). We enrolled 1460 elite athletes (56.1% male; mean age 25.8 ± 5.1 years old), engaged in skills, power, mixed and endurance sport, who underwent clinical examination, transthoracic echocardiogram (TTE) and exercise stress testing. ABPR was defined as >220/85 mmHg in males and >200/80 mmHg in females. ABPR was found in 8% (n = 117) of athletes, being older (P = 0.049) and presenting higher cardiovascular risk profile (obesity, P = 0.007; glucose intolerance, P = 0.043 and familiarity for cardiovascular disease, P = 0.026). Athletes with ABPR had higher prevalence of exercise-induced VEBs (19.6% vs. 11.9% in normotensive athletes, P = 0.015). Uncommon VEBs morphology was more frequent in athletes with ABPR (64.7% vs. 19% in the normotensive, P = 0.0002). Finally, in those with ABPR and VEBs, TTE revealed greater left ventricular end-diastolic diameter indexed (P = 0-006), LVEDVi (P = 0.017) and LVMi (P = 0.04) compared to those without VEBs. A not small group of elite athletes (8%) presented an exaggerated blood pressure response to exercise and exhibited higher cardiovascular risk profile compared to their normotensive counterparts. Moreover, athletes with ABPR showed higher prevalence of ventricular arrhythmias on effort and the combination of ABPR and ventricular arrhythmias was associated with more pronounced cardiac remodelling.

Cost Effectiveness of Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: A Systematic Review and Meta-analysis.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with substantial morbidity and mortality. Current international guidelines recommend antiarrhythmic drugs or catheter ablation (CA) as rhythm-control strategies for AF. This study aimed to comprehensively assess economic evaluations (EEs) of the treatment of AF by country income level. Seven electronic databases were systematically searched for EE literature until March 30, 2024, with no constraints on time or language. Two independent reviewers selected the studies, extracted the data, and assessed the quality of the data. Full EEs comparing CA with antiarrhythmic drugs for rhythm-control treatment were included; surgical or rate-control treatments were excluded. The quality of the included articles was assessed using the ECOBIAS checklist. Costs were converted to purchasing power parity US dollars for 2023. A random-effects meta-analysis was applied to pool incremental net benefit (INB) based on a heterogeneity test and its degree (I2 > 25% or Cochran's Q test < 0.1). We also explored heterogeneity and potential publication bias and conducted sensitivity and subgroup analyses. In total, 27 studies across nine countries were eligible, predominantly from high-income countries (n = 25), with a smaller subset from upper-middle-income countries (n = 2). Because of the heterogeneity among the studies, a random-effects model was selected over a fixed-effects model to pool INBs. Most studies (n = 21) favored CA as the cost-effective intervention, yielding an INB of $US23,796 (95% confidence interval [CI] 15,341-32,251) in high-income countries. However, heterogeneity was substantial (I2 = 99.67%). In upper-middle-income countries, the estimated INB was $US18,330 (95% CI - 11,900-48,526). The publication bias results showed no evidence of asymmetrical funnel plots. In this meta-analysis, CA emerged as a cost-effective rhythm-control treatment for AF when compared with antiarrhythmic drugs, particularly in high-income countries. However, economic evidence for upper-middle-income countries is lacking, and no primary evaluations were found for low-middle-income and low-income countries. Further EEs are necessary to expand the understanding of AF treatment globally.

Increased atrial, ventricular, and total epicardial fat volumes in non-valvular atrial fibrillation: a CMR DIXON study

BackgroundAtrial fibrillation (AF) is the most prevalent persistent arrhythmia in the heart. Several clinical conditions are known to predispose AF development including obesity. Impressive data suggests that local epicardial fat depots play an important role in AF development. When determining total body fat, magnetic resonance imaging (MRI) is often regarded as the gold standard. It is also a viable option for identifying and measuring epicardial fat. We aimed to evaluate the relation between epicardial fat volume measured by cardiac MRI and the presence of non-valvular atrial fibrillation.Subjects and methodsThe study is an observational comparative case–control study conducted on 31 patients with AF and a comparative group of 31 individuals with matched age, sex, and other risk factors who had never experienced AF. Each participant was subjected to full history taking, a detailed history of AF, and cardiac MRI. CMR Dixon sequence was used and manually processed for epicardial fat volume quantification, then atrial, ventricular and total epicardial fat volumes were compared in the 2 groups.ResultsThere is a statistically significant difference between AF case group vs control group with higher atrial, ventricular, and total epicardial fat volume in AF case group (193.9 ± 68.0 ml, 248.2 ± 55.5 ml, 442.1 ± 94.6 ml) vs control (91.4 ± 34.0 ml, 134.5 ± 44.4 ml, 225.9 ± 69.7 ml), respectively.ConclusionOur study reveals a higher epicardial fat volume in AF patients compared to healthy controls, suggesting epicardial fat as a potential risk factor for non-valvular AF.

Effect of acupuncture on quality of life in atrial fibrillation: study protocol for a randomised controlled trial

IntroductionAtrial fibrillation (AF) is the prevalent cardiac arrhythmia and can significantly impair the quality of life (QoL). Although catheter ablation (CA) is an established treatment for AF,post-procedural complications or perceived...

Abstract 4137177: A pharmacovigilance investigation from the FAERS database on patients using pembrolizumab and its association with cardiac arrhythmias

Background: Arrhythmia is always a concern in oncological treatments. The advent of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, enhancing the immune system's ability to combat malignancies. They are being more frequently used, revealing a range of immune-related adverse events (irAEs). This study aims to investigate the incidence of cardiac arrhythmias in patients receiving Pembrolizumab. Methods: We conducted a retrospective analysis of the FDA Adverse Event Reporting System (FAERS) database, focusing on reports submitted between 2006 to 2024. Cases involving patients treated with ICs were identified, and information related to cardiac arrhythmias was extracted using the Medical Dictionary for Regulatory Activities (MedDRA). Patients ≥ 18 years of age treated with ICIs were included in this study. A disproportionality analysis was conducted to identify arrhythmia events associated with pembrolizumab by comparing it with other immune checkpoint inhibitors (nivolumab, ipilimumab, and atezolizumab) and the entire FAERS database using the reporting odds ratio (ROR) and information component (IC). Results: A comprehensive analysis of 61,236 reported cases of pembrolizumab use revealed a total of 3,901 cases with cardiac complications. Among these, 672 cases (17.22 %) of arrhythmias were reported, with 452 individuals (67.26%) requiring hospitalization and 172 cases (25.59%) resulting in fatalities. Atrial fibrillation emerged as the most prevalent arrhythmia (49.7%). The occurrence of ventricular tachycardia with an ROR of 1.67 (1.18–2.35) and an IC of 0.44 (0.01–1.46) and complete atrio-ventricular block with an ROR of 1.57 (1.19–2.08) and an IC of 0.40 (0.04–1.24) were statistically significant. The reported arrhythmias associated with pembrolizumab are tabulated in Table 1 . The majority of events were reported in males, as shown in Figure 1 . Conclusion: This research offers significant insights into the connection between ICIs and cardiac arrhythmias, utilizing real-world data from the FAERS database. Healthcare providers should monitor cardiac events in patients receiving ICIs and aim to achieve a balance between anticancer effectiveness and cardiovascular safety. Further investigation is necessary to better understand the underlying mechanisms of arrhythmia and enhance risk stratification strategies for this specific patient group.

Abstract 4113371: Impact of Protein-Energy Malnutrition on Atrial Fibrillation Outcomes: Insights from National Inpatient Sample (NIS) Study

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia. Protein-energy malnutrition (PEM) has been implicated in various cardiovascular conditions, but the studies on its impact on AF outcomes are limited. This study aims to investigate the relationship between PEM and AF outcomes, since malnutrition could be a modifiable risk factor. Methods: Utilizing data from NIS (2017–2020), patients of age more than 18 years with a primary diagnosis of AF and a secondary diagnosis of PEM were identified. Data analysis was performed using STATA, employing the Student's t-test and Fischer's exact test to compare continuous variables and proportions, respectively. Adjusted odds ratios were calculated through multivariate regression analysis. The primary outcome was mortality, with secondary outcomes being mean length of stay (LOS), total hospitalization cost, major adverse cardiovascular events (MACE) and various in-hospital complications. Trends in mortality, LOS, and total cost of hospitalization were also assessed. Results: A total of 17,652,695 patients with AF were identified, of whom 1,452,695 (8.22%) had PEM. Patients with PEM had increased mortality (10.8% vs 4.52%, p&lt;0.001), increased mean LOS (10.14 days vs 5.52 days, p&lt;0.001) and a higher hospitalization cost ($121,721 vs 69,348, p&lt;0.001). In AF patients with PEM compared to those without PEM, there were significantly increased rates of ACS (adjusted odds ratio, or aOR=1.21, 2.48 vs 1.85, p&lt;0.001), pulmonary edema (aOR=1.37, 0.61 vs 0.44, p&lt;0.001), CVA (aOR=1.45, 1.7 vs 1.04, p&lt;0.001) acute respiratory failure (aOR=1.78, 20.27 vs 11.75, p&lt;0.001), need of mechanical ventilation (aOR= 2.46, 9.36 vs 3.96, p&lt;0.001), ARDS (aOR= 2.8, 0.55 vs 0.21, p&lt;0.001), AKI (aOR=1.57, 35.45 vs 24.12, p&lt;0.001), and septic shock (aOR= 3.32, 10.3 vs 3.24, p&lt;0.001). There is an increased trend of mortality (10.77 in 2017 vs 11.87 in 2020, p&lt;0.001), LOS (10.49 in 2017 vs 10.8 in 2020, p=0.04) and total hospitalization cost ($121,233 in 2017 vs $140,869 in 2020, p&lt;0.001) in patients with AF and PEM. Conclusion: Our study highlights the association between PEM and adverse AF outcomes, revealing PEM as a significant predictor of increased mortality, morbidity, length of stay, and hospitalization costs. These results emphasize the necessity for targeted nutritional interventions in AF management. Further research and clinical strategies addressing nutritional deficits in AF populations are essential for improving outcomes.

Abstract 4117834: Utility of Abdominal Aortic Calcification Assessment for the Prediction of Major Adverse Cardiovascular Events in Liver Transplant Patients

Background: Cardiovascular disease is a leading cause of postoperative morbidity and mortality following liver transplantation (LT). Presence of abdominal aortic calcification (AAC) has been linked to cardiovascular events in the general population. We investigated whether AAC on pre-transplant computed tomography (CT) predicts major adverse cardiovascular events (MACE) post-LT. Methods: Consecutive LT patients between 2010-2018 from the Victorian Liver Transplant Unit (Australia) were included. Extent of AAC was quantified in a blinded fashion, with high AAC defined as a calcium score of ≥500. MACE was defined as any recorded episodes of acute coronary syndrome (ACS), ventricular arrhythmia, decompensated heart failure, or stroke. The primary outcome was post-LT MACE at 30 days and the secondary outcome was all-cause mortality at maximal follow-up. Results: Of 461 patients undergoing LT, 350 had suitable CTs for analysis, of which 90 (25.7%) had also undergone CT coronary angiography. High AAC was identified in 98 patients (28.0%). This finding demonstrated a moderate correlation with high coronary artery calcium score (CACS) ≥400 (r=0.52, p&lt;0.001). Fifty-eight MACE occurred in 42 patients (12.0%) within 30-days. High AAC was associated with increased risk of 30-day MACE (OR=2.68 (95%CI 1.39-5.17), p=0.004), and long-term mortality (HR=2.52 (95%CI 1.29-4.92), p=0.007) at a median follow-up of 4.0 years. In addition, high AAC predicted an increased risk of ACS (OR 3.80 (95%CI 1.18-12.27), p=0.025), heart failure (OR 3.07 (95%CI 1.21-7.80), p=0.020) and atrial fibrillation (OR 2.04 (95%CI 1.02-4.07), p=0.048), with a trend to increased prevalence of ventricular arrhythmia (OR 2.67 (95%CI 0.84-8.50), p=0.10). Following multivariate analysis, high AAC remained a strong independent predictor of MACE (OR=3.49, 95%CI 1.21-10.06, p=0.021). Addition of AAC to the revised cardiac risk index (RCRI) improved model fit for predicting MACE (net reclassification improvement of 52.7% (p&lt;0.001)). Conclusions: This study demonstrates for the first time that high AAC on routine abdominal CT scans is associated with a 3-fold increased risk of 30-day MACE post-LT, and improves cardiovascular risk prediction compared to traditional risk scores. Quantification of AAC may offer a simple method of improving cardiovascular risk assessment and implementation of preventative strategies in liver transplant patients, using pre-existing scans without additional cost or patient risk.

Abstract 4123563: High Prevalence of Unrecognized Actionable Cardiac Arrhythmias in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease

Background: Patients with chronic obstructive pulmonary disease (COPD) are at high risk for developing arrhythmias due to hypoxemia, right heart failure and use of beta-agonists inhalers. Symptoms related to arrhythmias can often be masked or confounded by symptoms related to COPD exacerbation and remain undiagnosed. Objective: To identify the incidence of actionable arrhythmias in patients with no prior cardiology follow-up and moderate–severe COPD with continuous monitoring. Methods: An automatic referral for electrophysiology (EP) consult was generated in patients with moderate-severe COPD if they answered yes to one of the following: palpitations, dizziness, abnormal ECG, near syncope. Upon consultation with EP specialist, implantation of loop reorder was discussed (ILR) with the patient. Patients were then monitored for 12 months via remote monitoring. Actionable arrhythmia was defined the arrhythmia that correlated with symptoms triggered by the patient, necessitated adjustment of medications (including initiation of anticoagulation), catheter ablation and implantation of implantable cardiac defibrillator (ICD) or permanent pacemaker (PPM). Results: Out of 62 patients referred 22 (35.5%) agreed to undergo ILR implantation. Of the 22 (50.0% female, 62 ± 9.5 years) patients implanted with an ILR, 15 (68.2%) had an actionable arrhythmia after a mean follow-up of 2.7± .3 months. These included 14 symptomatic events requiring medication adjustment (10 atrial tachycardias, 4 ventricular events), 7 cases of atrial fibrillation (requiring initiation of anticoagulation in all cases and catheter ablation in 1), 1 case of sinus node dysfunction requiring pacemaker implantation, and 1 episodes of sustained ventricular tachycardia requiring ICD implantation. Conclusion: Continuous monitoring had high yield in diagnosing significant arrhythmic events in patients with moderate-severe COPD. Awareness should be raised about the high arrhythmic risk of this population and the role of continuous monitoring should be sought in larger studies.

Abstract 4137188: Racial and Ethnic Disparities in Catheter Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia globally, with an escalating incidence in the United States. It is known that racial and ethnic disparities exist in the management of AF. Although current guidelines recommend catheter ablation (CA) as one of the most effective rhythm control strategies, recent data suggest that minority populations, including Black, Hispanic, and Asian individuals with AF, are less likely to undergo CA, and aggregate data are lacking in this area. Aims/Hypothesis: To determine differences in CA rates and the likelihood of undergoing CA for AF in racial/ethnic minority populations compared to Caucasians. We hypothesized that minorities are less likely to undergo CA for AF than their non-minority counterparts. Methods: A systematic search of PubMed, EMBASE, and Cochrane Library, based on an a priori registered protocol (PROSPERO Registration CRD42024496174), from January 1st, 2010, to January 2nd, 2024, was conducted to identify studies with ≥ 500 participants assessing CA use in AF in at least two racial/ethnic groups. Data were combined using a random-effects model meta-analysis. Results: A total of 431 non-duplicate records were identified. After independent screening based on inclusion/exclusion criteria, 19 studies comprising 12,598,109 patients were included. Among them, 9,577,652 (76.0%) were White, 789,954 (6.3%) were Black, 476,216 (3.8%) were Hispanic, 113,005 (0.9%) were Asian, while 1,641,282 (13.0%) were classified as other or were missing race/ethnicity data. The proportion of White subjects who underwent CA for AF was 4% (95% CI 3-5%). In contrast, the proportion of Black, Hispanic, and Asian individuals with AF who underwent CA was 2% (95% CI 1-3%), respectively, for each group. Pooled odds ratios (OR) of having CA for AF compared to Whites were 0.68 (95% CI 0.56 - 0.83), 0.72 (95% CI 0.63 - 0.82), 0.64 (95% CI 0.48 - 0.86) for Blacks, Hispanics, and Asians, respectively. Conclusions: The use of CA among the total AF population was low across all ethnic groups. Moreover, racial/ethnic minority groups were significantly less likely to undergo CA compared to White patients.

A comparison of comorbidities and their risk factors prevalence across rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis with focus on cardiovascular diseases: data from a single center real-world cohort

Management of comorbidities is essential to a patient-centered approach to the treatment of chronic inflammatory arthritis. The aim of this study was to compare the prevalence of comorbidities and their risk factors in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) in a single center outpatient cohort. This cross-sectional study included adult patients diagnosed with RA, PsA, and axSpA from a single rheumatology outpatient center. Comorbidities were documented by physicians, and patients were categorized into two age groups, younger (< 45 years) and older (≥ 45 years), with age- and gender-based comparisons. Disease activity, comorbidities, and cardiovascular (CV) risk factors were analyzed using chi-squared tests for categorical variables and independent samples t-tests for continuous variables, with p values < 0.05 considered statistically significant. Comorbidities were registered by physicians using GoTreatIt® Rheuma software. Among 508 RA, 267 PsA, and 285 axSpA patients, the four most common comorbidities were hypertension (36.4%, 25.1%, and 19.7%, respectively), dyslipidemia (19.5%, 15.4%, 14.7% respectively), obesity (16.9%, 22.5%, 14% respectively) and thyroid disease (21.5%, 13.9%, 11.2% respectively). Other comorbidities differed among the diseases and included osteoporosis, osteoarthritis, diabetes mellitus, arrhythmia, and asthma in RA, diabetes mellitus, depression and asthma in PsA, osteoporosis and serious infection in axSpA. RA patients, compared to axSpA had a higher prevalence of coronary artery disease (4.1% vs. 0.7%, p = 0.006), arrhythmia (6.9% vs. 2.5%, p = 0.008) and major adverse cardiac events (2.6% vs. 0.4%, p = 0.024) compared to axSpA. Osteoporosis was more frequent in RA (19.1%) and axSpA (8.4%) than in PsA (2.3%; p < 0.001) and was frequently diagnosed in patients aged < 45. Depression prevalence was surprisingly low (1.6%, 5.2%, and 1.8%, respectively). RA patients had the highest multimorbidity rate, with 26.6% reporting three or more comorbidities, compared to 16.8% in PsA and 10.6% in axSpA (p < 0.001). Health status was poorest in RA and worse in women compared to men for all diseases. RA, PsA, and axSpA share the same four most common comorbidities: hypertension, dyslipidemia, obesity, and thyroid disease but have different prevalence of other disorders and CV risk factors, indicating the need for an individual screening and prevention approach. The possible unrecognition of depression should be evaluated.

Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients.

Purpose: Sex differences in cardiac arrhythmias are well established. This study aimed to explore the prevalence of arrhythmias in transgender and nonbinary (TGNB) adults. Methods: This cross-sectional study utilized electronic medical records from a center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups: TGNB (transgender men, transgender women, nonbinary [NB]-assigned male at birth, NB-assigned female at birth), cisgender men, and cisgender women. The primary outcome was any arrhythmia using age- and race-adjusted regression models comparing transgender patients with cisgender men and cisgender women. Prevalence of arrhythmias was explored in transgender people with a gender-affirming hormone therapy (GAHT) prescription. Results: The sample included 49,862 adults, with 7121 (14%) TGNB persons. Median age was 28 years. Prevalence of arrhythmias was low (0.7-1.4% NB persons, 1.4-1.5% transgender persons). After adjustment, transgender women and transgender men had similar odds of any arrhythmia compared with cisgender men (transgender women: adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.63-1.24, p = 0.52; transgender men: aOR 1.17, 95% CI 0.82-1.62, p = 0.37), but higher odds of any arrhythmia compared with cisgender women (transgender women: aOR 1.65, 95% CI 1.13-2.34, p = 0.01; transgender men: aOR 2.15, 95% CI 1.48-3.04, p < 0.001). Prevalence of arrhythmias appeared similar among transgender adults regardless of GAHT use (transgender men: 1.5% vs 1.9%, transgender women: 1.2% vs 2.1%). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

Safety of catheter ablation for atrial fibrillation in patients with liver cirrhosis.

Atrial fibrillation is the most prevalent cardiac arrhythmia, and catheter ablation (CA) has emerged as a viable treatment option for selected patients. However, its safety profile in liver cirrhosis (LC) populations remains underexplored. This was an observational analysis of the National Inpatient Sample Database 2016-2020; we analyzed adult encounters undergoing CA for atrial fibrillation who had a concomitant diagnosis of LC. Using propensity scores, encounters were divided into two cohorts based on the presence or absence of LC and matched in a 1:1 fashion using LC as the dependent variable. In-hospital mortality and postprocedure total complications were compared using regression models. 93 830 procedures were identified for non-LC patients and 960 involving LC patients; after propensity score matching, each cohort included 910 hospitalizations. The mean age in the LC-matched cohort was 66.5 ± 9.1 years. In-hospital mortality did not differ between the groups (aOR = 1.01; 95% CI [0.06-16.1]; p = .99). However, the LC cohort exhibited higher odds of total complications (aOR = 1.98; 95% CI [1.42-2.75]; p < .001). Length of stay (LOS) was comparable, but total costs were higher in the LC cohort: LOS was 2 days (95% CI [1-3]) in the LC group versus 3 days (95% CI [1-4]) (p < .11) and LC: $202,000 (95% CI [$142 000-$261 000]) versus non-LC: $189 000, (95% CI [$153 000-$222 000]) (p < .0001). In this national analysis of patients undergoing CA for AF, those with LC had similar in-hospital mortality, postprocedure complications, and LOS compared to noncirrhotic patients. Furthermore, longitudinal studies are needed to assess the safety profile of CA in this subpopulation.

Atrial and ventricular arrhythmias in young, lifelong and retired elite endurance athletes

Abstract Background Whilst endurance athletes are known to have an overall higher prevalence of atrial fibrillation (AF), the prevalence of other non-sustained and sustained atrial arrhythmias (AAs) and ventricular arrhythmias (VAs) remains poorly defined. Purpose We aimed to define the prevalence of non-sustained and sustained AAs (including AF) and VAs in a healthy cohort of young, lifelong and retired elite endurance athletes. We also sought to assess associations between arrhythmias, fitness and measures of cardiac structure. Methods Holter monitors in healthy endurance athletes (n=288) from an international cohort of elite endurance athletes (the Pro@Heart consortium) were analysed for the presence of sustained and non-sustained AAs and VAs. Athletes were sub-divided into young elite athletes (n=176) and former elite athletes (n=112) of which 60 were lifelong (≥2.5 hours/week) and 52 retired (&amp;lt;2.5 hours/week) athletes (determined by current high-intensity exercise activity). Each athlete underwent cardio-pulmonary exercise testing, echocardiography and contrast-enhanced cardiac MRI. Participants with known structural or electrical cardiac disease were excluded. Independent T-test / One-Way ANOVA (parametric data) or Mann-Whitney U / Kruskal-Wallis Tests (non-parametric data) assessed for differences between the groups. Results Young athletes (n=176, 70.5% male) were significantly fitter with a greater degree of cardiac remodelling as compared with lifelong (n=60, 63.3% male) and retired (n=52, 82.7% male) athletes (Figure 1). The prevalence of non-sustained AAs (young: 4.0% vs lifelong: 66.7% vs retired: 61.5%, p&amp;lt;0.001), sustained AAs (young: 0.6% vs lifelong: 8.3% vs retired: 15.4%, p&amp;lt;0.001) and non-sustained VAs (young: 1.7% vs lifelong: 18.3% vs retired: 23.1%, p&amp;lt;0.001) was higher in lifelong and retired athletes compared with young athletes (Figure 2). Non-sustained VAs were predominately monomorphic (85%), short and moderate rate (median duration 2.8 seconds and heart rate 154 beats per minute). No athletes developed sustained VAs and/or sudden cardiac arrest. Young athletes had less VAs that were multifocal in origin compared with lifelong and retired athletes (young: 29.5%, lifelong: 37.3%, retired: 53.5%, p=0.027). There was no difference in prevalence of any arrhythmia between lifelong and retired athletes. There were no significant correlations between arrhythmias and fitness or cardiac imaging parameters. Conclusion Healthy athletes have a significant prevalence of non-sustained atrial and ventricular arrhythmias and sustained atrial arrhythmias that is more prevalent in older athletes. In older athletes, the prevalence of arrhythmias is similar regardless of whether athletes are actively engaged in training or retired suggesting that pro-arrhythmic remodelling in athletes is sustained, not immediately reversible and may be minimally responsive to detraining.Arrhythmias and cardiac imagingArrhythmias amongst athlete groups

Concomitant left atrial appendage occlusion and transcatheter aortic valve replacement among patients with atrial fibrillation: an updated systematic review and meta-analysis

Abstract Background Atrial fibrillation (AF) is a prevalent arrhythmia in patients undergoing transcatheter aortic valve replacement (TAVR). Left atrial appendage occlusion (LAAO) has emerged as a viable strategy to prevent stroke in selected patients with AF. While both devices can be implanted simultaneously during a single procedure, the safety and efficacy of this approach remain uncertain. Purpose This study aims to evaluate the efficacy and safety of concomitant LAAO in patients with AF and aortic valve disease undergoing TAVR. Methods We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies that compared concomitant TAVR and LAAO with isolated TAVR. The study's primary outcomes were all-cause mortality, stroke or transient ischemic attack (TIA), and major bleeding. We established a minimum follow-up time of six months. Results Three studies met our eligibility criteria, including one randomized controlled trial and two observational studies. The meta-analysis included 570 patients, 249 (44%) who underwent LAAO and TAVR, with a mean follow-up of 16.3 months. In the overall population, there was no significant difference between the groups in all-cause mortality (relative risk [RR] 0.95; 95% confidence interval [CI] 0.67-1.35; p = 0.78; figure 1A), major bleeding (RR 1.15; 95% CI 0.75-1.77; p = 0.51; 1B), and stroke or TIA (RR 0.70; 95% CI 0.33-1.45; p = 0.33; figure 1C). Conclusion In conclusion, concomitant LAAO and TAVR did not demonstrate discernible clinical differences compared to isolated TAVR in patients with AF and aortic valve disease. We recommend that this therapeutic approach be individualized until more robust data become available.

Low conduction velocity is a key factor for localisation of reentrant drivers for atrial fibrillation

Abstract Background Atrial Fibrillation (AF) is a prevalent cardiac arrhythmia globally, associated with heightened risks of stroke, dementia, and heart failure. Catheter ablation, the sole curative therapy for AF, yields suboptimal success rates for persistent AF cases. Understanding the mechanisms and dynamics of AF remains challenging, hindering treatment advancements. Novel ablation strategies aimed at targeting substrates harbouring AF reentrant drivers (RD), such as low-voltage ablation and rotor-based ablation, have yet to demonstrate superiority over the gold standard ablation strategy – pulmonary vein isolation. Purpose The purpose of the study is to integrate in-silico 3D left atrial (LA) simulations and explainable artificial intelligence (AI) to pinpoint key factors for RD localisation in persistent AF, aiming to improve the mechanistic understanding of AF and help develop a more effective ablation strategy. Methods 3D LA models were derived from magnetic resonance images of 41 patients and combined with atrial cell electrophysiology models. Persistent AF was initiated in each patient-specific LA model with fast pacing, and five functional features (action potential duration (APD), conduction velocity (CV), wavelength, APD spatial gradient, CV spatial gradient, and wavelength spatial gradient) and three structural features (fibrotic density, fibrotic entropy, and image intensity ratio) were evaluated. A random forest AI model was trained to classify phase singularities corresponding to the RDs (PS-RD) in five distinct tissue classes (total LA tissue, healthy tissue, fibrotic border zone, dense fibrotic tissue, and PS-RD tissue) based on the functional and structural features. Shapley additive explanations (SHAP) analysis was then used to find the most influential feature in the AI model’s decision process. Results Simulations of the patient-specific LA models revealed that RDs were typically localised in regions with the lowest atrial CV, which often coincided with patches of dense fibrotic tissue. In a five-fold cross-validation, the random forest AI model achieved high accuracy in classifying PS-RD regions: a mean ROC AUC of 0.99 ± 0.010, a mean F1 score of 0.86 ± 0.034, a mean recall of 0.95 ± 0.058, and a mean precision score of 0.79 ± 0.085. The further SHAP analysis revealed that low CV was the key determinant in classifying the PS-RD regions. Conclusion Our study combined AF computational modelling and explainable AI to identify the key factors in RD localisation. Both the computational and AI models concluded that low CV was the most important determinant in localising RDs. These findings provide mechanistic evidence for the efficacy of ablation strategies that target low CV atrial areas for persistent AF patients.

Impact of rhythm control strategy on outcomes in patients with first diagnosed atrial fibrillation in an 11-year real-world registry

Abstract Background Atrial fibrillation (AF) is a highly prevalent arrhythmia with a high burden of disease. This sub-study of the Heidelberg Registry of Atrial Fibrillation (HERA-FIB) sought to evaluate clinical characteristics, treatment strategies and outcomes in patients with first diagnosed AF (FDAF). Methods Patients with AF presenting to the emergency department (ED) of an University Hospital between June 2009 and March 2020 were consecutively enrolled. Follow-up was performed for all-cause mortality, stroke, major bleeding and myocardial infarction (MI). Outcomes were were related to patients with FDAF or pre-existing AF, as well as assigned treatement strategy (rhythm vs. rate control). The trial was registered at ClinicalTrials.gov Identifier: NCT05995561. Results Overall 2,758 (27%) of all patients presented with FDAF. Compared to FDAF, patients with pre-existing AF showed higher all-cause mortality HR 1.41 (95%CI 1.28-1.55, p&amp;lt;0.0001) and major bleeding events 1.29 (95% CI 1.06-1.56, p=0.0098). Non-implementation of rhythm control in FDAF was seen in 2,079 cases (75.4%) and was associated with an excess of all-cause mortality HR 1.66 (95%CI 1.30-1.99, p&amp;lt;0.0001) and incident MI HR 1.79 (95% CI 1.03-3.09, p=0.0385). A non-implementation of rhythm control remained an independent predictor for all-cause mortality and MI even after adjustment for significant univariate variables aHR: 1.34 (95%CI: 1.04-1.72, p=0.0234) and aHR: 1.79 (95%CI: 1.03-3.09, p=0.0385). Conclusion Real-world data from FDAF patients presenting in the setting of an ED showed a potential benefit regarding mortality and MI for rhythm control strategy. Further research is needed to validate this hypothesis.

Implantable loop recorders in children and adolescents with Brugada syndrome: the YoungBruLoop study

Abstract Background Young (&amp;lt;18 years of age) patients with Brugada syndrome (BrS) are often underrepresented in BrS studies and their management, especially related to syncopal episodes, remains unclear. Purpose To describe the arrhythmia prevalence and clinical implication derived from continuous rhythm monitoring by implantable loop recorder (ILR) among patients younger than 18 years of age, and to assess the etiology behind syncope of undetermined origin. Methods A total of 147 BrS patients with ILR were enrolled in 12 international centers and divided into pediatric (age &amp;lt;12 years; n=77, 52%) and adolescents (age 13 to 18 years; n=70, 48%). Results Mean age was 11.3 years (36.1% females, 21.1% spontaneous type I ECG). Forty-six patients (31.2%) underwent ILR implant due to syncope. Over a median follow-up of 3.6 years, an arrhythmic event was recorded in 22.4% of patients and in the vast majority of cases it was of non-ventricular origin (44% atrial, 47% bradyarrhythmias). Predictors of arrhythmias at univariate Cox Regression analysis were spontaneous type I ECG (HR 2.1 - 95%C.I. 1.1-4.1), history of syncope (HR 3.1 - 95%CI 1.5-6.3) and age &amp;gt;12 years (HR 2.0 - 95%C.I. 1.0-3.3). Ventricular arrhythmias occurred in 4 patients, all with spontaneous BrS, and were related to fever in half of cases. In patients with recurrent syncope, the prevalence of truly arrhythmic syncope was 17.8%, and it was due to brady-, atrial- and ventricular arrhythmias in 40%, 20% and 40% of cases, respectively. Conclusions Continuous rhythm monitoring with ILRs in BrS pediatric patients detects a broad range of heart rhythm disturbances including life-threatening arrhythmias. Ventricular arrhythmias occur predominantly in patients with spontaneous type I ECG and in half of cases are fever-related. Despite the young age, brady- and atrial arrhythmias are overall frequent and represent the cause of arrhythmic syncope in 60% of patients. Young BrS patients with syncope of undetermined origin may benefit from ILR implant.