Relationship Of Atrial Fibrillation Research Articles

The relationship of atrial fibrillation with left atrial size in patients with essential hypertension

Atrial fibrillation (AF) is the most common sustained arrhythmia and it is a major public health problem worldwide. Hypertension is one of the major risk factors for the development of AF. This study is carried out to determine the prevalence and independent risk factors for atrial fibrillation (AF) in hypertensive patients and to evaluate the relationship of AF with left atrial size. This is a retrospective observational cross – sectional study that used a retrospective electronic chart review of all admitted patients to cardiology department at King Abdullah university hospital (KAUH) in Irbid, Jordan, with a diagnosis of hypertension along with various acute cardiac admissions, including AF during 1-year period (January 1st to December 31 of 2021). Risk factors for AF (age, sex, DM, coronary artery disease, valvular heart disease, Cor-pulmonale, obstructive sleep apnea, and congestive cardiac failure) were retrieved from electronic charts of the patients. A total of 958 patients were admitted to the coronary care unit (CCU) and intermediate care unit (IMCU) during a 1-year period. Among them, 276 had 2 or 3 admissions. The main reason of admission was acute coronary syndrome (n = 491), heart failure (n = 180), and AF (n = 144), indicating AF prevalence of 15%. However, there were 40 patients with combined causes. All patients in the study (n = 958) were diagnosed with hypertension, including patients with atrial fibrillation (n = 144). The mean age of patients was 61.4 (± 11.46) years, and approximately two thirds of them were males (65.4%). The binary logistic regression model demonstrated a significant statistical relationship of age, left atrial size, coronary artery disease, left ventricular ejection fraction, left ventricular dimensions in systole and diastole, and heart failure with the occurrence of AF after controlling for gender, smoking, and diabetes. Findings indicate that left atrial size plays a significant role in the development of AF in patients with hypertension. However, the prevalence of AF significantly increased with advancing age in both sexes because of increased left ventricular hypertrophy, which leads to increased left atrial size.

Relationship of atrial fibrillation with obesity and chronic heart failure

The article presents the current state of the problem of atrial fibrillation as the most widespread cardiac rhythm disorder, the occurrence of which significantly worsens the quality of life of patients and reduces their life expectancy. Undoubtedly, a significant number of patients with atrial fibrillation suffer from obesity and heart failure. The review article reviews the understanding of the fundamental pathogenetic mechanisms of atrial fibrillation and the associated changes in the cellular, molecular, electrophysiological, and structural architecture of the atria. Information on the topic from publications based on PubMed, Google Scholar, and eLIBRARY databases was used, with a depth of coverage of 5 years.

The relationship of atrial fibrillation and tricuspid annular dilation to late tricuspid regurgitation in patients with degenerative mitral repair

ObjectivesGuidelines do not address preoperative atrial fibrillation when considering adding tricuspid annuloplasty to mitral surgery. Our purpose was to determine the occurrence of late tricuspid regurgitation in patients with less than moderate tricuspid regurgitation undergoing surgery for degenerative mitral regurgitation and the importance of atrial fibrillation and tricuspid annular dilation. MethodsFrom 2004 to 2017, 1021 patients underwent surgery for degenerative mitral regurgitation; 869 (85%) had less than moderate tricuspid regurgitation, and 846 (97%) underwent repair. Preoperative atrial fibrillation was present in 199 patients and ablated in 194 patients (97%). Tricuspid annular diameter was measured in 657 of 869 patients (76%). ResultsFor patients who did not receive tricuspid annuloplasty, recurrent moderate or more late tricuspid regurgitation was 8% (45/576) in the no atrial fibrillation group and 25% (38/154) in the atrial fibrillation group (P < .001; odds ratio, 2.42). In 75.2% of patients (494/657), the tricuspid annulus was less than 4.0 cm; in 17% of patients (112), the tricuspid annulus was 4.0 to 4.4 mm (mean 41.1 mm); and in 7.8% of patients (51), the tricuspid annulus was 45 mm or more (47.8 mm). Only tricuspid diameter 45 mm or more was a risk for late tricuspid regurgitation (P = .002; odds ratio, 3.25). Progression to moderate or higher tricuspid regurgitation was associated with an increase in long-term mortality: unadjusted hazard ratio, 3.58 (2.04-6.29) (P < .001); adjusted hazard ratio, 2.37 (1.23-4.57) (P = .010). ConclusionsPreoperative atrial fibrillation is an important risk factor for late tricuspid regurgitation despite concomitant ablation surgery. Tricuspid annular dilation was not associated with late tricuspid regurgitation until the annulus was 45 mm or greater. Progression to moderate or greater tricuspid regurgitation was associated with an increase in late mortality.

Association of atrial fibrillation with coronary bed lesions (according to the coronary angiography register)

Aim. To identify the relationship of atrial fibrillation (AF) with features of lesions of the main coronary arteries or primary branches in patients with coronary artery disease (CAD). Material and methods . From the local database of coronary angiography, 6978 patients with hemodynamically significant (50% of the lumen and more) coronary lesions were selected. The main group consisted of 205 patients with AF. To create an age-matched comparison group, 810 patients without AF were selected from the remaining 6773 patients using a method based on equalizing the frequency distributions. Results. Patients with AF accounted for 2,9% of all patients with hemodynamically significant coronary stenosis. In patients with AF, obesity (56,6% vs 44,5%, p=0,002) and severe (III-IV) classes of chronic heart failure (CHF) according to NYHA classification (51,8% vs 22,8%, p<0,001) was more often detected. These patients had a higher mass index of the left ventricular (LV) (170,9±41,2 g/m 2 vs 150,0±34,7 g/m 2 , p<0,001), higher size index of the right ventricle (RV) (13,8±2,1 mm/m 2 vs 13,1±1,3 mm/m2, p<0,001); hemodynamically significant mitral (MR) (49,7% vs 15,9%, p<0,001) and aortic regurgitation (AR) (6,7% vs 1,5%, p<0,001) was also more often detected. Patients with AF more often had lesions of the right coronary artery (RCA) (90,2% vs 82,1%, p=0,005) and calcification of the coronary arteries (24,3% vs 14,8%, p=0,001), less often — the left type of coronary circulation (6,6% against 12,0%, p=0,029). According to the results of multivariate analysis, the presence of significant MR increased the risk of AF by 3,5 times, AR increased by 3,1 times. With CHF worsening to III-IV NYHA classes, the risk of AF increased by 2,1 times, with the presence of RCA — by 80%, obesity of 2 or 3 degrees — by 40%. An increase in the RV size indices for each mm/m2 increased the risk of AF by 14%; in the LV myocardium mass for each g/m 2 — by 0,5%. Conclusion. Angiographic predictor of AF in patients with CAD is the RCA lesion.

Relationship of atrial fibrillation with hip fractures caused by falls in the elderly

Objective To explore the relationship between atrial fibrillation and hip fractures caused by falls in the elderly. Methods All patients aged 65 years or older who underwent surgical treatment for hip fractures caused by falls in our department from January 2015 to December 2017 were enrolled.The relationships of atrial fibrillation as well as chronic medical history with hip fractures were retrospectively analyzed.The control group was matched 1 to 1 by age, sex, and admission time.Chi-square test and Logistic regression analysis were used to calculate the odds ratio(ORvalue)of fractures in patients with atrial fibrillation. Results There was no significant difference in the history of smoking, drinking, diabetes, coronary heart disease, heart failure, chronic kidney disease, chronic obstructive pulmonary disease(COPD), and Parkinson's disease between the two groups.A total of 37 patients had a history of atrial fibrillation in the fracture group, compared to 18 patients with atrial fibrillation in the control group.The incidence of atrial fibrillation in the fracture group and the control group were 9.6% and 4.7%, respectively, with crude OR=2.18, 95%CI(1.32-4.15), P=0.008 and adjusted OR=2.27, 95%CI(1.37-5.20), P=0.02.Compared with the control group, the incidence of stroke(χ2=14.06, P<0.05), osteoporosis(χ2=200.64, P<0.01)and cognitive impairment(χ2=8.23, P<0.01)increased in the fracture group.When classified by age and sex in the fracture group, the incidence of atrial fibrillation had no significant difference between different gender and age subgroups. Conclusions Atrial fibrillation is an independent risk factor for hip fractures caused by falls in the elderly.There is no significant difference in the incidence of atrial fibrillation in hip fracture patients between the different ages(65-74 years, 75-84 years, ≥of 85 years)and genders.In addition, stroke, osteoporosis, and cognitive impairment increase the risk of hip fractures caused by falls in elderly patients. Key words: Accidental falls; Hip fractures; Atrial fibrillation

Association of short- and long-term exposure to air pollution with atrial fibrillation.

Atrial fibrillation is a common cardiac arrhythmia and an important risk factor for stroke and cardiovascular morbidity. However, there is limited evidence regarding the association of air pollution with atrial fibrillation. This study aimed to compare the short-term and long-term effects of air pollution on atrial fibrillation. A nationwide cohort from the Korean general population. Different analytical approaches were used for short-term and long-term effects. For the analysis of short-term effects, the daily incidence of emergency admissions for atrial fibrillation was identified. The relationship of atrial fibrillation with air pollutants, including PM2.5 (particulate matter ≤ 2.5 μm in aerodynamic diameter), PM10, carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone, was analysed using a time-series analysis. The long-term effects of air pollution were analysed for subjects aged ≥30 years who resided in Seoul between 2007 and 2015 and had no history of atrial fibrillation. During the study period, 1137 emergency visits were identified in Seoul as being associated with atrial fibrillation. A 10-μg/m3 increase in ambient PM2.5 was shown to significantly increase emergency admissions by 4.5% at lag day 3 (p = 0.038). No other pollutants showed a significant relationship with emergency atrial fibrillation admission. Among 124,010 residents in Seoul, 1903 developed atrial fibrillation at a median follow-up of 9.5 years (1.95 per 1000 person-years). Long-term exposure to air pollution had no significant impact on atrial fibrillation occurrence (p = 0.830 for PM2.5). This study suggests that short-term exposure to PM2.5 triggers atrial fibrillation. However, we found no evidence linking atrial fibrillation with long-term exposure to air pollution.

Evaluation of the HAS-BLED, ATRIA, and ORBIT Bleeding Risk Scores in Patients with Atrial Fibrillation Taking Warfarin

ObjectivesVarious bleeding risk prediction schemes, such as the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized Ratio, Elderly, Drugs/alcohol (HAS-BLED), Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA), and Outcomes Registry for Better Informed Treatment (ORBIT) scores, have been proposed in patients with atrial fibrillation. We compared the relative predictive values of these bleeding risk scores for clinically relevant bleeding and the relationship of ATRIA and ORBIT scores to the quality of anticoagulation control on warfarin, as reflected by time in therapeutic range. MethodsWe conducted a post hoc ancillary analysis of clinically relevant bleeding and major bleeding events among 2293 patients receiving warfarin therapy in the AMADEUS trial. ResultsOnly HAS-BLED was significantly predictive for clinically relevant bleeding, and all 3 risk scores were predictive for major bleeding. The predictive performance of HAS-BLED was modest, as reflected by c-indexes of 0.59 (P < .001) and 0.65 (P < .002) for clinically relevant bleeding and major bleeding, respectively. The HAS-BLED score performed better than the ATRIA (P = .002) or ORBIT (P = .001) score in predicting any clinically relevant bleeding. Only the HAS-BLED score was significantly associated with the risk for both bleeding outcomes on Cox regression analysis (any clinically relevant bleeding: hazard ratio, 1.85; 95% confidence interval, 1.43-2.40, P < .001; major bleeding: hazard ratio, 2.40; 95% confidence interval, 1.28-4.52; P = .007). There were strong inverse correlations of ATRIA and ORBIT scores to time in therapeutic range as a continuous variable (low risk ATRIA, r = −0.96; P = .003; ORBIT, r = −0.96; P = .003). Improvement in the predictive performance for both ATRIA and ORBIT scores for any clinically relevant bleeding was achieved by adding time in therapeutic range to both scores, with significant differences in c-indexes (P = .001 and P = .002, respectively), net reclassification improvement, and integrated discriminant improvement (both P < .001). ConclusionsAll 3 bleeding risk prediction scores demonstrated modest predictive ability for bleeding outcomes, although the HAS-BLED score performed better than the ATRIA or ORBIT score. Significant improvements in both ATRIA and ORBIT score prediction performances were achieved by adding time in therapeutic range to both scores.

Abstract 15126: Cardiorespiratory Fitness and Atrial Fibrillation: A Population-based Follow-up Study

Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide and has a complex association with exercise capacity. The relationship of atrial fibrillation with cardiorespiratory fitness (CRF) has not been previously investigated. Methods: Cardiorespiratory fitness, as assessed by maximal oxygen uptake (VO2max), was measured at baseline in 1,950 middle-aged men (mean 52.6 ± 5.1 years) from the Kuopio Ischaemic Heart Disease Study (KIHD). Results: During an average follow-up of 19.5 years, there were 305 incident AF cases (annual AF rate of 65.1/1000 person-years, 95% CI: 58.2 to 72.8). Overall a non-linear association was observed between CRF and incident atrial fibrillation. Rate of incident AF varied from 11.5 (95% CI: 9.4-14.0) for the first quartile of CRF, to 9.1 (95% CI: 7.4-11.2) for second quartile, 5.7 (95% CI: 4.4-7.4) for third quartile and 6.3 (95% CI: 5.0-8.0) for the fourth quartile respectively, Figure 1. Usual levels of CRF were non-linearly associated with AF risk, Figure 2. Age-adjusted HR comparing top versus bottom fourth of usual CRF levels was 0.67(95% CI: 0.48-0.95), which attenuated to 0.98 (95% CI: 0.66-1.43) upon further adjustment for several risk factors. These findings were comparable across age, body mass index, history of smoking, diabetes and cardiovascular disease status at baseline. Conclusions: Improved fitness as indicated by higher levels of CRF is protective of atrial fibrillation within an optimal range, beyond which the risk of atrial fibrillation rises again. Our findings are congruent with emerging data on the complex relationship between physical fitness and incident AF.

Atrial Remodelling : Role in Atrial Fibrillation Ablation.

There have been considerable advances in understanding the relationship of atrial fibrillation (AF) and atrial remodelling suggesting that remodelling states have a significant impact on treatment results. Therefore, we reviewed the literature about the role of atrial remodelling in AF treatment, focussing on AF ablation. Atrial fibrillatory activity, dominant frequencies (DF), complex fractionated atrial electrograms (CFAE) as well as function, volume, and fibrosis of the - especially left - atrium are most important characteristics for electrical, contractile, and structural remodelling predicting success of AF treatment. In particular, the results of AF ablation, either using catheter-based or surgical techniques, predominantly depend on the degree of structural remodelling, namely dilatation and fibrosis of the left atrium. The available data suggest that recognizing parameters of remodelling as predictors for AF treatment facilitates differentiation between patients who may or may not benefit from the procedure and individualization of AF treatment by adapting lesion sets, by ablating additional targets, by reducing left atrial size, or by applying extended pharmacological treatment.

Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated?

Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated?

Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated?

Atrial fibrillation (AF) is considered as a risk factor for stroke after coronary artery bypass grafting operations. A retrospective search in our hospital's medical record database was done to identify patients with postoperative strokes who underwent coronary artery bypass grafting operations from January 1, 1993, until December 31, 2004. All cases were individually reviewed, and the temporal relationship between neurologic event and postoperative episodes of AF was determined. During the study period it was our consistent policy to use only Coumadin anticoagulation limited to patients who had persistent AF or were to be discharged in AF. Of the 2,964 coronary artery bypass grafting operations, 576 patients (19.4%) had AF and 32 patients (1.1%) suffered stroke. Seventeen stroke patients maintained normal sinus rhythm during their hospital stay. Of the remaining 15 patients, 9 presented with neurologic deficit before the first episode of AF, with 5 having intraoperative and 4 having postoperative stroke. Of the 6 patients with AF before neurologic event, three strokes occurred within 1 week after spontaneous conversion to normal sinus rhythm. One patient with preoperative and also with intraoperative AF who underwent emergency coronary artery bypass grafting woke up with stroke. In the remaining two cases, the AF or atrial flutter episodes lasted less than 6 hours each before the neurologic event. More aggressive anticoagulation as suggested in the published guidelines could not have prevented strokes in any of these 6 patients. This retrospective analysis does not support the use of aggressive anticoagulation, particularly full intravenous heparinization as a bridging therapy to decrease the already low incidence of postoperative strokes after routine coronary artery bypass grafting surgery.

The Interrelationship Between Atrial Fibrillation and Atrial Flutter

For a long time, it has been known that atrial fibrillation and atrial flutter have a close clinical interrelationship. Recent electrophysiological studies, especially mapping studies, have significantly advanced our understanding of this interrelationship. Regarding the relationship of atrial fibrillation with atrial flutter: Atrial fibrillation of variable duration precedes the onset of atrial flutter in almost all instances. During the atrial fibrillation, the functional components needed to complete the atrial flutter reentrant circuit, principally a line of block between the venae cavae, are formed. If this line of block does not form, classical atrial flutter does not develop. If this line of block shortens or disappears, classical atrial flutter disappears. In fact, it is fair to say that the major determinant of whether atrial fibrillation persists or classical atrial flutter develops is whether a line of block forms between the venae cavae. Regarding the relationship of atrial flutter with atrial fibrillation: Studies in experimental models and now in patients have demonstrated that a driver (a rapidly firing focus or a reentrant circuit of very short cycle length) can cause atrial fibrillation by producing fibrillatory conduction to the rest of the atria. When the driver is a stable reentrant circuit of very short cycle length, it is, in effect, a very fast form of atrial flutter. There probably is a spectrum of reentrant circuits of short cycle length, i.e., “atrial flutter,” that depend, in part, on where the reentrant circuit is located. When the cycle length of the reentrant circuit is so short that it will only activate small portions of the atria in a 1:1 manner, the rest of the atria will be activated rapidly but irregularly, i.e., via fibrillatory conduction, resulting in atrial fibrillation. In short, there are probably several mechanisms of atrial fibrillation, one of which is due to a very rapid atrial flutter circuit causing fibrillatory conduction. In sum, atrial fibrillation and atrial flutter have an important interrelationship.