Previous History Of Atrial Fibrillation Research Articles

195: Women with atrial flutter differ from men

The management and prognosis of heart diseases (HD) or arrhythmias may depend on the patient gender. The purpose of the study was to look for the influence of gender on the indications and the long-term results of ablation of atrial flutter (AFl). 965 patients, 743 males, 222 females (23%), mean age 64 ± 12 years were consecutively referred for radiofrequency ablation of recurrent or poor-tolerated AFL Clinical history, other arrhythmias as atrial fibrillation (AF), data of echocardiography were collected. The patients were followed from 3 months up to 10 years. Women tended to be older than men (65.5±12 vs 64±11.5 years) (p< 0.08). Underlying HD was as frequent in women as in men (76%). HD nature differed: women had more congenital HD (10 vs 2%, p<0.0001), more valvular HD (17.5 vs 10% p<0.002) and less respiratory failure (4.5 vs 10%) (p<0.01), less ischemic HD (5 vs 20%)(p<0.0000) than men. Hypertensive HD, dilated cardiomyopathy or various HD's did not differ. Previous history of AF was more frequent in women (31.5%) than in men (26%) (p<0.012). AFl-related rhythmic cardiomyopathy tended to be less frequent in women than in men (4 vs 8%) (p<0.07). Presentation with 1/1 AFl was as frequent in women as in men (10% vs 7%). AFl ablation-related major complications as complete AV block, death or cardiac shock were more frequent in women than in men (4 vs 1%)(p<0.004). After 3±3 years, AFl recurrences tended to be less frequent in women than in men (8.5 vs 13%)(p<0.06). AF occurrence was more frequent in women than in men (24 vs 14%)(p<0.0002). Among these patients 66% of women and men had no history of AF before AFl ablation. Their risk of AF remains higher in women than in men (16% vs 8%)(p<0.007). There gender-related differences in the prevalence, clinical presentation, ablation-related complications and AF incidence. AFL is less common in women than in men, despite similar age and as frequent underlying HD. The risk of AFl ablation-related major complications is higher in women than in men. Women have more frequently history of AF and an independent higher risk than men of developing AF after ablation of atrial flutter.

209: Incidence of atrial fibrillation in patients with atrial flutter before and after ablation according to the nature of associated heart disease

Radiofrequency (RF) ablation is a treatment of choice of typical atrial flutter (AFl). However the risk of atrial fibrillation (AF) is high. Heart disease (HD) presence may modify this risk. The purpose of the study was to look for the role of associated HD on previous history of AF and later occurrence of AF after AFl ablation. 965 patients, mean age 64±12, were consecutively referred for ablation of recurrent or poor-tolerated AFL. Clinical history, occurrence of AF, data of echocardiography was collected. Patients were followed from 3 months up to 10 years. Antiarrhythmic drugs were stopped after ablation except in patients with history of AF before ablation. HD was present in 744 patients (77%): hypertensive disease (HTD) (n=186), ischemic HD (IHD) (n=163), valvular HD (VHD) (n=113), dilated cardiomyopathy (DCM) (n= 87), respiratory failure (resp) (n=84), congenital HD (cong) (n=26), miscellaneous HD (n=59). Prior AF was more frequent in patients without HD (67%) than in patients with HD (26%)(p<0.0000). Differences were significant with all subgroups of HD except for patients with DCM (55%). Last patients differed significantly from all other subgroups of HD. During follow-up (3±3years) 40 patients without HD (22%), 115 with HD (18%) developed AF (NS). There were no differences among all subgroups of HD. Among patients with later AF, 15 without HD (8%); 70 with HD (10%) had no prior AF (NS). Among subgroups with HD, patients with cong HD had a higher risk of AF (28.5%) than patients without HD (10%)(p< 0.003) or patients with DCM (7%) (p<0.01) or HTD (7.5%). Differences were not significant for other HD's. Surprisingly patients without HD had more frequently prior AF than patients with HD. However after AFl ablation AF risk was similar. Antiarrhythmic drugs maintained in patients with AF history could have decreased the risk of subsequent AF. Prior AF was more frequent in patients with DCM than in patients with other HD. After AFl ablation only patients with congenital HD seem to have a high risk of developing AF compared to patients with HD of other origin or patients without HD.

Cardiac tamponade as a rare complication after giant coronary fistula percutaneous closure

We present the case of an unusual complication after percutaneous closure of a giant coronary artery fis-tula. A 76-year-old man with previous admissions due to right heart failure and previous history of atrial fibrillation under acenocumarol, was admitted to our hospital for new onset of symptoms, characterized by progressive dyspnoea and peripheral edema. Physical examination revealed signs of congestive heart failure and a continuous murmur loudest along the lower sternal border. X-Ray showed cardiomegaly due to right chambers dilatation. Transthoracic echocardiography showed right chambers pressure and volume overload, with right ventricular enlargement and dysfunction, tricuspid annulus dilatation and severe tricuspid regurgitation. Cardiac catheterization showed significant elevation of right atrial pressure, as well as significant step-up of oxygen saturation in this chamber. Coronary angiography revealed the presence of a large fistula between the circumflex coronary artery (CCA) and coronary sinus (CS), with severe dilation of the CCA (maximum diameter20 mm). An Amplatzer? PDA was implanted in a distal elbow of the fistula with initailly good results. Anticoagulant therapy was then reinitiated, and a few days later, the patient developed clinical worsening of heart failure and dyspnoea. Echocardiogram showed significant pericardial effusion. Pleuropericardial window was then made draining a500 cm3 of bloody pericardial effusion. The postoperative outcome was excellent, with symptomatic relief and no signs of heart failure.

Angioedema of the small bowel caused by angiotensin converting enzyme inhibitor

A 69-year-old male with a previous history of atrial fibrillation and hypertension was admitted to the emergency department because of acute onset of abdominal pain, accompanied by distension, nausea and diarrhea. Physical examination was unremarkable except for diffuse abdominal tenderness on palpation without rebound or guarding. Normoactive bowel sounds were noted. Routine blood analysis showed elevated C-reactive protein 12.8 mg/dl (normal values 0.1-1.0) and INR of 3.1 (normal values 0.9-1.2 – therapeutic values 2.0-3.0). Patient was treated for atrial fibrillation with anticoagulation therapy. Hypertension was treated with beta-blocker and angiotensin-converting enzyme inhibitor Lisinopril SandozR for 10 days.

Preoperative serum levels of interleukin-6 and interleukin-8 as predictors of the development of postoperative atrial fibrillation among patients undergoing coronary artery bypass grafting surgery

Objectives The aim of the study was to evaluate the ability of preoperative estimation of serum interleukins (IL-6 and IL-8) for predicting the possibility of development of postoperative atrial fibrillation (POAF) among patients who have undergone coronary artery bypass grafting (CABG) surgery. Patients and methods The study included 90 patients who underwent CABG, with a mean age of 63.8 ± 4.7 years. All patients underwent on-pump surgery with a mean aortic cross-clamping time of 65.9 ± 14.6 min and a mean cardiopulmonary bypass (CPB) time of 99.1 ± 19.7 min. Preoperative blood samples were collected for enzyme-linked immunosorbent assay estimation of serum IL-6 and IL-8 levels. Results After CABG surgery, 24 patients developed POAF (26.7%); five were female and 19 were male with a mean age of 64.1 ± 5.2 years. Four patients had a history of previous atrial fibrillation (AF), whereas 20 patients had no history of preoperative AF. Mean aortic clamping and CPB times were significantly longer in POAF patients compared with AF-free patients. Mean preoperative serum IL-6 and IL-8 levels were significantly higher in patients compared with controls, with significantly higher levels in POAF patients compared with AF-free patients. There was a positive significant correlation between the occurrence of POAF and history of preoperative AF, preoperative serum levels of IL-6 and IL-8, and aortic clamping and CPB times. Regression analysis defined elevated serum levels of IL-6 and IL-8, prolonged aortic clamping and CPB times, and history of preoperative AF as predictors of the occurrence of POAF among patients undergoing CABG in decreasing order of significance. Conclusion Inflammatory factors play a prominent role in the pathogenesis of POAF; high preoperative serum levels of IL-6 and IL-8 could aid in identification of patients liable to develop POAF, especially when associated with prolonged clamping time or preoperative history of AF.

Small Incision Fasciotomy in a Patient with Compartment Syndrome and Peripheral Arterial Occlusive Disease

An 82-year-old-man with a previous history of atrial fibrillation was admitted with acute limb ischemia. Emergent embolectomy was performed, but after the operation, the patient suffered from recurrent ischemic pain. Peripheral angiography revealed thrombosis of the distal popliteal artery due to pre-existing peripheral arterial occlusive disease. Bypass surgery of the popliteal artery and posterior tibial artery was then performed. Although peripheral blood flow was restored after the operation, he suffered from compartment syndrome the next day. The patient was treated with an emergent bed-side fasciotomy using a small incision, achieving full recovery of blood flow to the distal artery. The wound closed secondarily without surgical closure. In a patient with peripheral arterial occlusive disease, fasciotomy should be performed at a lower compartment pressure due to a lack of peripheral perfusion pressure. Emergent small incision fasciotomy was effective in this patient with an acute compartment syndrome and an ischemic limb.

Elevated Pre-Operative Serum Peptides for Collagen I and III Synthesis Result in Post-Surgical Atrial Fibrillation

This study sought to determine if serum markers for collagen I and III synthesis, the carboxyl terminal peptide from pro-collagen I (PICP) and the amino terminal peptide from pro-collagen III (PIIINP), correlate with left atrial (LA) fibrosis and post-operative atrial fibrillation (AF). AF after cardiac surgery is associated with adverse outcomes. We recently demonstrated that LA fibrosis is associated with post-operative AF in patients with no previous history of AF. Fifty-four patients having cardiac surgery without a history of AF consented to left and right atrial biopsies and a pre-operative peripheral blood draw. Picrosirius red staining quantified the percentage of fibrosis, and reverse transcriptase polymerase chain reaction assessed atrial tissue messenger ribonucleic acid transcripts involved in the fibrosis pathway. PICP and PIIINP levels were measured using an enzyme immunosorbent assay. Eighteen patients developed AF, whereas 36 remained in normal sinus rhythm. LA fibrosis was higher in patients who developed AF versus normal sinus rhythm (6.13 ± 2.9% vs. 2.03 ± 1.9%, p = 0.03). LA messenger ribonucleic acid transcripts for collagen I, III, transforming growth factor, and angiotensin were 1.5- to 2.0-fold higher in AF patients. Serum PICP and PIIINP levels were highest in AF versus normal sinus rhythm (PICP: 451.7 ± 200 ng/ml vs. 293.3 ± 114 ng/ml, p = 0.006; PIIINP: 379 ± 286 pg/ml vs. 191.6 ± 162 pg/ml, p = 0.01). Furthermore, there was a linear correlation between LA fibrosis and serum PICP levels (R(2) = 0.2; p = 0.01), and of the markers, only PICP was independently associated with AF. This demonstrates that serum PICP and PIIINP levels correlate with the presence of LA fibrosis and may act as predictors for post-operative AF even in the absence of previous history of AF.

Atrial Fibrillation and Mortality in Patients with Acute Myocardial Infarction: A Systematic Overview and Meta-analysis

Atrial fibrillation (AF) confers an increased risk of mortality in patients hospitalized for acute myocardial infarction (AMI). However, it is unclear whether new-onset and preexisting AF portend a different risk. We extracted data from studies that evaluated in-hospital mortality in patients with AMI and included information on cardiac rhythm. Overall, the risk of mortality was higher in patients with AF than in those in sinus rhythm (OR 2.00, 95% CI: 1.93-2.08; P < 0.0001). Compared with patients who remained in sinus rhythm, the risk of death was increased in patients with new AF certain (sinus rhythm on admission, new AF during hospitalization, and history of no evidence of prior AF; OR 3.38, 95% CI: 2.98-3.83; P < 0.0001), new AF uncertain (sinus rhythm on admission, AF during hospitalization, but no clear information about previous history of AF; OR 1.90, 95% CI:1.83-1.98; P < 0.0001), and permanent AF (AF before and during hospitalization; OR 2.01, 95% CI:1.70-2.38;P < 0.0001). In a meta-regression analysis, the risk of death was 87% higher in patients with new AF certain than in those with permanent AF (P = 0.013) or AF uncertain (P = 0.003), and not dissimilar in patients with new AF uncertain and permanent AF (P = 0.706).

The Effect of a High Dose of Atorvastatin on the Occurrence of Atrial Fibrillation After Coronary Artery Bypass Grafting

Recent studies have suggested that statins reduce the incidence of atrial fibrillation (AF) after cardiac operations. Statin therapy at intensive doses, however, has yet to be thoroughly investigated. We retrospectively studied 1,839 consecutive patients (1,177 men [73.2%]) who underwent isolated coronary artery bypass grafting and had no history of previous AF, pacemaker implantation, or antiarrhythmic medication. Data recorded included the atorvastatin dose during hospitalization, demographic, echocardiographic, and angiographic data, medical history, drug treatment, and procedural characteristics. Continuous telemonitoring during the first 72 postoperative hours assessed for AF, which was defined as episodes lasting more than 5 minutes. The dose-related effect of atorvastatin on postoperative AF was investigated by logistic analysis in 1,607 patients: 75 (4.7%) did not receive atorvastatin vs 1,047 (65.1%) and 485 (30.2%) who received 40 mg/d or 80 mg/d, respectively, for at least 3 days before the operation. The study population was a mean age of 60.6 ± 9.5 years. Multivariate logistic regression demonstrated that a lack of atorvastatin pretreatment along with older age, enlarged left atrium, and male sex, and not taking β-blockers, tended to be associated with an increased risk of postoperative AF. There was no significant difference between the effect of a higher (80 mg/d) and a lower dose (40 mg/d) in reducing postoperative AF. Atorvastatin pretreatment significantly reduced the occurrence of AF after bypass grafting; nonetheless, the difference between the beneficial effects of intensive and routine atorvastatin treatments on postoperative AF was not significant.

Abstract 3530: Low yield of Transthoracic and Transesophageal Echocardiography in the Management of Patients with Acute Ischemic Strokes

Background Echocardiography has become ubiquitous in the diagnostic armamentarium of ischemic strokes. There is however insufficient evidence to recommend transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in every patient with ischemic stroke. We sought to determine diagnostic yield of TTE and TEE in determining cardiac etiology for ischemic strokes. Methods This is a retrospective chart review of patients with diagnosis of ischemic stroke admitted to the Foothills Medical Center, Calgary from Jan 2009 to June 2010. These patients had TTE and/or a TEE as part of inpatient diagnostic evaluation. Patients with previous history of atrial fibrillation and anticoagulation were excluded. Clinical findings,baseline cardiac exam and ECG were noted. High yield findings on TTE and TEE were defined using American Heart association guidelines( mitral stenosis,LV/LA thrombus/aneurysym,apical akinesia/septal aneurysym,severe LV dysfunction,ASD,vegetation).Topographical distribution of infarcts on follow-up brain imaging and vascular imaging findings within 7 days after the event were documented. These imaging findings were categorized in following groups: normal, infarcts with presumed cardioembolic source (single cortical, multiple cortical, bilateral infarcts with normal vascular imaging), lacune (single subcortical) and infarcts due to large artery atherosclerosis (single or multiple infarcts in the territory of an abnormal large artery). Results 397 patients with TTE and 67 with TTE/TEE as a workup for ischemic stroke were included in the study. High yield TTE findings were seen in 34/397(8.6%) patients. High yield TEE findings were found in 5/65 (7.7%) patients. Thirteen of 34 (38%) patients with high yield TTE findings had abnormal ECG or baseline cardiac exam at presentation in comparison to 10/423(2%) patients with no high yield findings (p=0.02). There was a suggestion that imaging patterns with presumed cardioembolic source showed association with high yield TTE findings [19/39 (50%) patients in comparison to 144/423(19%)] patients with no high yield findings.(p=0.07 OR 1.84 95% CI 0.95-3.84). Among the various topographical patterns, single cortical infarct with normal vascular imaging was significantly associated with high yield TTE findings. (p&lt;0.03, OR 2.20 95% CI 1.04 - 4.64). Conclusion The diagnostic yield of TTE and TEE in determining cardio-embolic sources is relatively low. Baseline abnormal ECG and clinical exam along with specific patterns of imaging may help to determine cardioembolic etiology. A more rational approach to use of cardiac imaging is required in settings with limited resources.

The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction: A CARISMA substudy

The incidence and risk associated with new-onset atrial fibrillation (AF) occurring after discharge in patients with acute myocardial infarction (MI) remains unknown. This study sought to describe the incidence and clinical risk associated with postdischarge new-onset AF in post-MI patients with left ventricular systolic dysfunction. The population included 271 post-MI patients with left ventricular ejection fraction ≤ 40% and no history of previous AF from the Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction (CARISMA) study. All patients were implanted with an implantable cardiac monitor and followed up every 3 months for 2 years. Major cardiovascular events were defined as reinfarction, stroke, hospitalization for heart failure, or death. The risk of new-onset AF is highest during the first 2 months after the acute MI (16% event rate) and decreases until month 12 post-MI, after which the risk for new-onset AF is stable. The risk of major cardiovascular events was increased in patients with AF events ≥ 30 seconds (hazard ratio [95% CI] = 2.73 [1.35 to 5.50], P = .005), but not in patients with AF events lasting <30 seconds (hazard ratio [95% CI] = 1.17 [0.35 to 3.92], P = .80). More than 90% of all recorded AF events were asymptomatic. Using an implantable cardiac monitor, the incidence of new-onset AF was found to be 4-fold higher than earlier reported. In the study population, in which treatment with beta-blockers was optimized, the vast majority of AF events were asymptomatic, emphasizing the importance of using continuous monitoring for studies concerning AF in heart failure patients. A duration of 30 seconds or more identified clinically important AF episodes documented by an implantable cardiac monitor.

Diagnostic capabilities of devices for cardiac resynchronization therapy

Atrial fibrillation and chronic heart failure often coexist. Asymptomatic atrial fibrillation is common in patients with known atrial fibrillation but also in patients with no history of previous atrial fibrillation. The enhanced diagnostic capabilities of modern implantable devices for cardiac resynchronization therapy allow collecting of data on the clinical status of the patient in addition to information on device performance and cardiac rhythm. We present a paradigmatic case of newly diagnosed atrial fibrillation with hemodynamic consequences detected by the diagnostics of a biventricular implantable cardioverter-defibrillator. We discuss the clinical utility of device-based monitoring and the potential advantages of wireless remote-control systems of implantable devices in the management of heart failure patients.

Relationship between mortality of patients with atrial fibrillation and mortality of general population in Serbia

Large population-based observational trials have shown atrial fibrillation (AF) to be an independent risk factor for increased mortality. To examine all-cause mortality and cardiovascular mortality of patients with AF compared to corresponding mortality in general population of Serbia. This longitudinal observational study included patients with nonvalvular AF as the main indication for in-hospital and/or outpatient treatment at the Clinical Centre of Serbia, Belgrade, during the period 1992-2007, if the latest date of the first diagnosed AF was early January 2003, so that the total follow-up could last at least 5 years (minimum 1 year prospectively), or until death. Patients with acute causes of AF, advanced left ventricular systolic dysfunction (LVEF < or = 25%), preexcitation, known malignancy or any advanced chronic disease and patients with poorly documented history of previous AF were not included. To compare mortality of study population with mortality of general population, we used standardized mortality ratio (SMR) and chi-square test, p < 0.05. Out of 1100 patients (389 females, 35.4%), aged 52.7 +/- 12.2 years, with total follow-up 9.94 +/- 6.05 years (prospective 5.75 +/- 4.28, retrospective 4.21 +/- 5.51), 40% had no underlying disease; others most frequently had arterial hypertension. AF was paroxysmal in 665 (60.5%), persistent in 225 (20.5%) and permanent in 210 patients (19.1%). Newly diagnosed AF was documented in 1058 patients (96.2%). Until the end of the study, 85 patients died (7.7%). Cardiovascular death was noted in 62 patients (72.9%), most frequently in form of sudden death (27/85, 31.7%), death from congestive heart failure (18/85, 21.2%) and stroke (14/85, 16.5%). Most patients (67/85, 78.8%) had AF at the time of death. SMR for all-cause mortality was 2.43 (p < 0.0001) and for cardiovascular mortality 3.03 (p < 0.0001). All-cause mortality and cardiovascular mortality of AF patients are higher than corresponding mortality in general population of Serbia, despite active treatment.

Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics

Little is known about the incidence of paroxysmal atrial tachycardias (PAT) in patients with heart failure (HF). The availability of cardiac resynchronization therapy (CRT) devices with extended diagnostics for AT enables continuous monitoring of PAT episodes. The aim of the study was to assess the incidence over time of PAT in HF patients treated with CRT. Consecutive patients in NYHA functional class III or IV despite optimal drug therapy, QRS duration > or = 130 ms, left ventricular ejection fraction < or = 35%, and left ventricular end-diastolic dimension > or = 55 mm were eligible for enrolment. Patients with permanent or persistent atrial fibrillation (AF) were not included in the study. The first follow-up examination was performed 2 weeks after implantation, to optimize atrial sensing and CRT. Subsequent follow-up examinations were carried out 15 and 28 weeks after implantation, to collect the telemetric data. A total of 173 patients (67 +/- 11 years, M 116) were enrolled. Complete arrhythmia monitoring data were available from 120 patients over a mean follow-up of 183 +/- 23 days. Atrial tachycardia episodes were detected through telemetry in 25 of 120 patients (21%) during at least one follow-up examination. Atrial tachycardia episodes were recorded in 29 and 17% (P = NS) of patients with and without previous history of AF, respectively. More than 20% of the overall HF patient population treated with CRT suffer PAT episodes. Paroxysmal atrial tachycardia may interfere with response to CRT. Therefore, telemetric data may be relevant to drive the appropriate therapy in each patient.

Left versus right atrial difference in dominant frequency, K + channel transcripts, and fibrosis in patients developing atrial fibrillation after cardiac surgery

The development of atrial fibrillation (AF) after cardiac surgery is associated with adverse outcomes; however, the mechanism(s) that trigger and maintain AF in these patients are unknown. The purpose of this study was to test our hypothesis that postoperative AF is maintained by high-frequency sources in the left atrium (LA) resulting from ion channel and structural features that differ from the right atrium (RA). Forty-four patients with no previous history of AF who underwent cardiac surgery consented to LA and RA biopsies. Histologic sections evaluated fatty infiltration, fibrosis, and iron deposition; quantitative reverse transcription-polymerase chain reaction (RT-PCR) assessed ion channel expression. In a subset of 27 patients, LA and RA unipolar recording leads were also placed. In patients who developed AF, the dominant frequency (DF) for each lead was calculated using fast Fourier transform. DFs during AF were LA 6.26 +/- 0.8 Hz, RA 4.56 +/- 0.7 Hz (P <.01). RT-PCR revealed LA-to-RA differences in mRNA abundance for Kir2.3 (1.8:1) and Kir3.4 (2.3:1). While LA fibrosis was greater in patients developing AF compared with those remaining in normal sinus rhythm (10.8% +/- 11% vs. 3.8% +/- 3.5%; P = .03), the amount of LA fibrosis inversely correlated with the LA DF. This is the first demonstration of LA-to-RA frequency differences during postoperative AF, which are associated with LA-to-RA differences in mRNA levels for potassium channel proteins and LA fibrosis. These results strongly suggest that sources of AF after cardiac surgery are located in the LA and are stabilized by LA fibrosis.

The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery

Background and ObjectivesThe incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery.Subjects and MethodsPatients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded.ResultsBetween January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage.ConclusionPostoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates.

Frequency, Duration, and Predictors of Newly-Diagnosed Atrial Fibrillation Following Dual-Chamber Pacemaker Implantation in Patients Without a Previous History of Atrial Fibrillation

The Silent Atrial Fibrillation Detection With Stored EGMs (SAFE) registry is the first prospective study to characterize the incidence, duration, and predictors of atrial high-rate episodes (AHREs) in patients without previous clinically diagnosed atrial fibrillation after dual-chamber pacemaker implantation. Patients underwent in-clinic device interrogation at 2 weeks and then 3, 6, and 12 months after implantation. An AHRE was defined as an atrial tachyarrhythmia with an atrial rate > or =180 beats/min lasting > or =5 minutes. During the first month after pacemaker implantation, AHREs were identified in 68 patients (4.6%). Thirty-four of these patients (50%) did not have AHREs beyond the first month after implantation; these patients were older than those who continued to have AHREs (79 +/- 9 vs 74 +/- 12 years, p = 0.05). Within the first 6 months after pacemaker implantation, 150 patients (10%) experienced a total of 455 AHREs, of which only 28 (6%) prompted clinical visits. The 6-month freedom from an AHRE was 82%. Overall, 75% of patients with AHREs had multiple episodes; most AHREs lasted 5 to 60 minutes. In conclusion, 6 months after dual-chamber pacemaker implantation, 10% of patients experienced > or =1 AHRE, usually lasting 5 to 60 minutes. Some patients had AHREs only within the first 30 days after implantation, suggesting the possibility of transient atrial proarrhythmia related to lead insertion.

Burden of asymptomatic episodes of atrial fibrillation in a heart failure cohort

Heart failure is associated with an increased risk of developing atrialfibrillation (AF). The prevalence of AF in heart failure patients is 20-50%compared to a prevalence of ???1% in the general population. Prevalencestudies rely on detecting AF by standard ECG which fails to detectasymptomatic episodes of AF that often occur during AF development.In patients with heart failure AF is associated with increased risk ofstroke, all cause mortality and hospitalisation, hence the importance ofidentifying these at risk patients.We examined the occurrence of AF in 162 heart failure patients with cardiacresynchronization therapy (CRT) devices. AF episodes were definedas a period of mode-switching on the CRT devices with atrial rate >200for over 30s. Patient records were reviewed to establish which patientswere known to have chronic or paroxysmal AF.Of the 162 patients, 43 had chronic AF (26.5%), 18 paroxysmal AF(11.1%), and 101 (62.3%) had no previous history of AF and were insinus rhythm at their last clinic appointment. Of the 101 patients notknown to have AF, 27 had significant episodes of AF (26.7%, Fig. 1A)with mean AF burden of 1.6??0.9% and longest duration of 5.6??2.3hours (Fig 1B). The mean AF burden (30.6??8.8%, p<0.01) and longestduration (635??355 hours, p<0.05) were significantly larger in patientswith known paroxysmal AF as were the rates of anticoagulation rates(83.3% vs. 13.5% respectively, p<0.01).A significant number of patients with heart failure suffer from asymptomaticundiagnosed episodes AF and are often not anticoagulated. Comparedto patients with known AF patients with undiagnosed AF have lessAF burden. Further studies are warranted to assess the true burden ofatrial fibrillation and the need for formal anticoagulation in these ???atrisk??? heart failure patients.

Antiarrhythmic Effect of Statin Therapy and Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials

To improve the evaluation of the possible antiarrhythmic effect of statins, we performed a meta-analysis of randomized trials with statins on the end point of incidence or recurrence of atrial fibrillation (AF).The use of statins had been suggested to protect against AF in some clinical observational and experimental studies but has remained inadequately explored.A systematic review of controlled trials with statins was performed. Eligible studies had to have been randomized controlled parallel-design human trials with use of statins that collected data on incidence or recurrence of AF.Six studies with 3,557 patients in sinus rhythm were included in the analysis. Three studies investigated the use of statins in patients with a history of paroxysmal AF (n = 1) or persistent AF undergoing electrical cardioversion (n = 2), and 3 investigated the use of statins in primary prevention of AF in patients undergoing cardiac surgery or after acute coronary syndrome. Incidence or recurrence of AF occurred in 386 patients. Overall, the use of statins was significantly associated with a decreased risk of AF compared with control (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18 to 0.85, p = 0.02). Benefit of statin therapy seemed more marked in secondary prevention of AF (OR 0.33, 95% CI 0.10 to 1.03, p = 0.06) than for new-onset or postoperative AF (OR 0.60, 95% CI 0.27 to 1.37, p = 0.23).Use of statins was significantly associated with a decreased risk of incidence or recurrence of AF in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery or after acute coronary syndrome.

The Difference of Left Atrial Volume Index: Can It Predict the Occurrence of Atrial Fibrillation after Radiofrequency Ablation of Atrial Flutter?

important. We investigated variables predicting this evolution in ablated patients without a previous atrial fibrillation history. Materials and Methods：Thirty-six patients (Male=28) who were diagnosed as atrial flutter without previous atrial fibrillation history were enrolled in this study. Group 1 (n=11) was defined as those who developed atrial fibrillation after atrial flutter ablation during 1 year follow-up. Group 2 (n=25) was defined as those who has not occurred atrial fibrillation during same follow-up term. Echocardiogram was performed to all patients. We measured left atrial size, left ventricle end diastolic and systolic dimension, ejection fraction and left atrial volume index before and after ablation of atrial flutter. The differences of each variables were compared and analyzed between two groups. 1) Results：The preablation left ventricular ejection fraction (preLVEF) and postablation left ventricular ejection fraction (postLVEF) are 54±14%, 56±13% in group 1 and 47±16%, 52±13% in group 2. The differences between each two groups are statistically insignificant (2.2±1.5 in group 1 vs 5.4±9.8 in group 2, p=0.53). The preablation left atrial size (preLA) and postablation left atrial size (postLA) are 40±4 mm, 41±4 mm in group1 and 44±8 mm, 41±4 mm in group 2. The atrial sizes of both groups were increased but, the differences of left atrial size between two groups before and after flutter ablation were statistically insignificant (0.6±0.9