Secondary Atrial Fibrillation Research Articles

Predicting stroke risk after sepsis hospitalization with new-onset atrial fibrillation.

New-onset atrial fibrillation (AF) during sepsis is common, but models designed to stratify stroke risk excluded patients with secondary AF. We assessed the predictive validity of CHA2DS2VASc scores among patients with new-onset AF during sepsisand developed a novel stroke prediction model incorporating presepsis and intrasepsis characteristics. We included patients ≥40 years old who survived hospitalizations with sepsis and new-onset AF across 21 Kaiser Permanente Northern California hospitals from January 1, 2011 to September 30, 2017. We calculated the area under the receiver operating curve (AUC) for CHA2DS2VASc scores to predict stroke or transient ischemic attack (TIA) within 1 year after a hospitalization with new-onset AF during sepsis using Fine-Gray models with death as competing risk. We similarly derived and validated a novel model using presepsis and intrasepsis characteristics associated with 1-year stroke/TIA risk. Among 82,748 adults hospitalized with sepsis, 3992 with new-onset AF (median age: 80 years, median CHA2DS2VASc of 4) survived to discharge, among whom 70 (2.1%) experienced stroke or TIA outcomeand 1393 (41.0%) died within 1 year of sepsis. The CHA2DS2VASc score was not predictive of stroke risk after sepsis (AUC: 0.50, 95% confidence interval [CI]: 0.48-0.52). A newly derived model among 2555 (64%) patients in the derivation set and 1437 (36%) in the validation set included 13 variables and produced an AUC of 0.61 (0.49-0.73) in derivation and 0.54 (0.43-0.65) in validation. Current models do not accurately stratify risk of stroke following new-onset AF secondary to sepsis. New tools are required to guide anticoagulation decisions following new-onset AF in sepsis.

Abstract P502: Lifestyle Modification for Secondary Prevention of Atrial Fibrillation: A Pilot Study

Background: Addressing modifiable cardiovascular risk factors through lifestyle interventions may be effective for secondary atrial fibrillation (AF) prevention. Aims: To assess feasibility, acceptability, and preliminary effectiveness of an exercise and nutrition-based cardiac rehabilitation-like program for patients with symptomatic AF. Methods: We enrolled overweight (body mass index [BMI] ≥ 28 kg/m 2 ) adults aged ≥ 30 years with symptomatic AF in a 12-week cardiac lifestyle group program, which included 6 virtual and 6 in-person visits. All visits included discussion and education about nutrition, exercise, and behavior modification. In-person visits included supervised aerobic exercise and strength training. Patients were evaluated to assess health history, diet, and baseline cardiac risk factors. Outcomes at baseline and 12 weeks included feasibility of participation, change in weight and BMI, acceptability, and changes in survey-based AF burden and symptoms, and AF-related quality of life (QOL). Results: From 84 invitees, 11 (13.1%) were enrolled (mean age 64; baseline BMI 38 kg/m 2 ; 45% female); 9 (82%) completed the program. Patients attended an average of 9.7 (81%) visits (Range: 6-11). Mean weight loss was 9.1 pounds (Range: 0-16) and mean BMI decrease was 1.4 kg/m 2 (Range: 0-2.6). Nine of 11 patients completed baseline and follow-up surveys (Table) . Patients found the program helpful overall: all reported making diet and exercise changes during the program; 8 (89%) were confident in continuing dietary changes and 7 (77%) were confident in continuing exercise changes after the program. Patients reported decreased AF burden and symptoms, and increased QOL at the conclusion of the program (Table) . Conclusions: Participation in a cardiac rehab-like program was feasible and acceptable for overweight patients with symptomatic AF. Results suggest preliminary effectiveness of the program for reducing AF burden and symptoms and increasing quality of life.

Lifestyle modification and risk factor control in the prevention and treatment of atrial fibrillation

Atrial fibrillation (AF) is the most prevalent arrhythmia and is related with significant morbidity, mortality and costs. In spite of relevant advances in the prevention of embolic events and rhythm control, little has been done to reduce its prevalence, progression and impact, since it increases with ageing as well as with common risk factors such as alcohol intake, tobacco use and stress as well as with arterial hypertension, diabetes mellitus, heart failure, sleep apnea, kidney failure, chronic pulmonary obstructive disease, ischemic heart disease and stroke, among other important comorbidities. Fortunately, new evidence suggests that lifestyle modifications and adequate risk factors and comorbidities control could be effective in primary and secondary AF prevention, especially in its paroxysmal presentations. This is why a multidisciplinary approach integrating lifestyle modifications, risk factors and comorbidities control, is necessary in conjunction with rhythm or rate control and anticoagulation. Unfortunately, that holistic approach strategy is not considered, is scarcely studied or is subtilized in general clinical practice. The present statement's objectives are to: 1) review the relationship between habits, risk factors and illnesses with AF, 2) review the individual and common physiopathology mechanisms of each one of those conditions that may lead to AF, 3) review the effect of control of habits, risk factors and co-morbidities on the control and impact of AF, and 4) supply guidelines and recommendations to start multidisciplinary and integrative AF treatment.

Catheter Ablation of Paroxysmal and Persistent Atrial Fibrillation in Patients with Secondary Atrial Septal Defect. Evaluation of the Results and Impact on the Quality of Life

Introduction. The presence of atrial fibrillation (AF) in patients with secondary atrial septal defect (ASD) has significant impact on their quality of life (QoL) and reduces life expectancy. Current guidelines recommend catheter ablation (CA) for patients with AF in case of medical treatment failure, however, its use in patients with AF and ASD is still poorly studied.
 The aim. To study the efficacy and safety of CA and its impact on the QoL in patients with AF and secondary ASD.
 Materials and methods. In 2003-2023, 1408 patients with secondary ASD were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Of these, 54 patients who had AF and underwent the CA procedure were included in group 1 of our study. There were 36 (66.7%) men and 18 (33.3%) women aged 24-76 years (mean age 61.4 ± 9.8 years). Four (9.3%) patients had persistent AF and 50 (90.7%) patients had paroxysmal AF. Fifty-six patients with paroxysmal or persistent AF and with the comparable age, duration of symptoms and associated pathology but without ASD were examined as group 2. The type and results of surgical interventions were analyzed according to surgical reports. The results of the treatment and QoL were assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire during the follow-up period 1, 2 and 3 months after the procedure.
 Results. Pulmonary vein isolation was performed in all 54 (100%) patients of the group 1, as well as cavotricuspid isthmus ablation in 26 (48.2%) cases, cavotricuspid isthmus ablation and left atrial linear ablation in 2 (3.6%) cases. Type, length and complication of the procedure were comparable to those in the group 2. Fourty-four (81.5%) patients with ASD were free from AF 3 months after procedure, and their results did not differ from those obtained in the group 2 (p > 0.05). Average QoL indicators according to AFEQT significantly improved in both groups of patients who underwent CA. The differences in post-treatment QoL between patients of both groups were insignificant (p > 0.05).
 Conclusions. CA was found to be safe and beneficial in patients with AF and secondary ASD. The rate of procedural complications and cure rate in patients with AF and secondary ASD (81.5%) were compatible to those in patients without ASD (80.5%). AF has negative effect on the main indicators of the patient’s life. In patients with secondary AF with ASD who underwent CA, a significant improvement in AF symptoms and QoL according to the AFEQT questionnaire (total score 56.1 ± 2.7 before the procedure vs. 78.7 ± 4.0 at follow-up) was noted.

Antiarrhythmic Potential of Epicardial Botulinum Toxin Injection for Suppression of Postoperative Atrial Fibrillation.

Following heart surgery, postoperative atrial fibrillation (AF) is the most prevalent kind of secondary AF and the most frequent adverse event. Postoperative AF is related to a number of unfavorable cardiac outcomes, such as heart failure, stroke, and death. However, the pharmacological treatment for postoperative AF is only relatively efficient and is frequently linked to detrimental complications, including symptomatic bradycardia with atrioventricular block due to rate control drugs and elevated hemorrhage hazard attributable to the administration of anticoagulants. Ablation procedures also result in the irreversible damage of cardiac anatomic structures, which may have long-term negative implications on heart performance. As a result, there is an unmet demand for treatments that can minimize the incidence of postoperative AF in an effective and safe manner. Botulinum toxin is an established neurotoxin that has progressively gained use in every medical science domain. It hinders the propagation of impulses across nerve fibers without causing immediate damage to the cardiac tissue. The transient feature of botulinum toxin action and the eventual restoration of the autonomic nervous system transmission are undeniably advantageous and may render botulinum toxin a potential and feasible treatment approach for postoperative AF.

Primary Versus Secondary Atrial Fibrillation: Differences in Clinical Characteristics and Outcomes

Primary Versus Secondary Atrial Fibrillation: Differences in Clinical Characteristics and Outcomes

Prognostic value of mitral regurgitation in patients with heart failure undergoing cardiac resynchronization therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac resynchronization therapy (CRT) is a well-established treatment for specific groups of heart failure (HF) patients. CRT improves outcomes in ischemic and non-ischemic HF patients, depending on different predictors. Mitral regurgitation (MR) is a common echocardiographic finding with uncertain reported impact on prognosis. Purpose We sought to investigate clinical outcomes in HF patient undergoing CRT according to MR severity, for both ischemic and non-ischemic HF etiology. A transthoracic echocardiogram was performed before and 1-year after device-based therapy to all patients (in doubtful cases, a cardiac magnetic resonance imaging was also performed to evaluate the mitral regurgitant volume). Methods Single-center retrospective study of consecutive patients submitted to CRT implantation. Patients were stratified attending to MR at baseline and after CRT, as having significant (moderate and severe MR) or non-significant MR. The primary endpoint was a composite of major adverse cardiac events (MACE), including HF hospitalization or all-cause mortality. Sustained ventricular arrhythmic events were the secondary endpoint. Results 117 HF patients (mean age 71.1 ± 10.6 years, males 67.5%) were enrolled, 31.6% had an ischemic HF etiology and 23.9% were included in the baseline significant MR (SMR) group. Regarding baseline characteristics, 40.2% had atrial fibrillation (AF), 23.9% obstructive pulmonary disease (COPD) and 9% peripheral artery disease (PAD). Patients in SMR group had more dyslipidemia (p = 0.026) and lower left ventricular ejection fraction (median 25% vs 32%, p = 0.001). At 1-year of follow-up, 11.1% had significant MR, most (61.5%) with the same MR baseline degree and presented with higher NYHA class (p = 0.032). During the follow-up, 15.4% reached the primary endpoint while 8.5% the secondary endpoint. Ischemic etiology (p = 0.204, p = 0.191) and the severity of baseline MR (p = 0.106, p = 0.213) did not predict any of the endpoints. On the contrary, male gender (p = 0.033), alcohol consumption (p = 0.003), PAD (p = 0.004) and COPD (p = 0.005) were independent predictors for MACE endpoint at a multivariable analysis. For the secondary endpoint, PAD (p = 0.020) and AF (p = 0.001) were both significant predictors. Significant MR after CRT implantation was an independent strong predictor only for MACE outcome (HR 4.37, p = 0.014). Conclusions Baseline significant MR was not associated with clinical outcomes after CRT implantation. However, MR at follow-up was a strong determinant of higher mortality and HF hospitalizations in more symptomatic patients, regardless of HF etiology.

Validation of the Use of Discharge Diagnostic Codes for the Verification of Secondary Atrial Fibrillation in Administrative Databases

Background“Secondary” atrial fibrillation (AF) denotes AF that is precipitated by short-term triggers and that may be reversible. Using administrative data to study secondary AF is of interest, but the ability of these data to verify secondary AF has not been studied. MethodsWe conducted a cross-sectional analysis of 1000 randomly selected hospitalizations of patients discharged alive between January 1, 2016 and March 31, 2020, with AF coded as the most responsible diagnosis (type 1), post-admit comorbidity (type 2), or secondary diagnosis (type 3). We compared diagnosis types to AF category (secondary or not) as determined by a physician blinded to the discharge diagnosis type. We calculated the positive predictive value (PPV) of the designation of secondary AF in comparison to physician determination. ResultsA total of 421 hospitalizations had AF documented as a type 2 diagnosis; this had a PPV of 94.8% for physician determination of secondary AF. After excluding hospitalizations with preexisting AF, and those for which AF type could not be determined by the physician, the PPV of a type 2 diagnosis (n = 391) for secondary AF was 99.7%. Type 3 diagnoses of AF (n = 222) mostly captured hospitalizations with preexisting AF (87.8% of type 3 diagnoses). ConclusionsA type 2 diagnosis can be used to verify secondary AF in people who were first diagnosed with AF while hospitalized for other causes. This verification facilitates cohort studies and clinical trial recruitment of people with this AF subtype, although it should not be used to determine the prevalence or incidence of secondary AF.

Effects of the ABC pathway on clinical outcomes in a secondary prevention population of Chinese patients with atrial fibrillation: A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry.

The atrial fibrillation better care (ABC) pathway is a simple, comprehensive framework that facilitates provision of integrated care for atrial fibrillation (AF) patients. We evaluated management of AF patients in a secondary prevention cohort using the ABC pathway and examined the impact of ABC adherence on clinical outcomes. The Chinese Patients with Atrial Fibrillation registry is a prospective registry conducted in 44 sites across China between October 2014 and December 2018. The primary outcome was the composite of all-cause mortality/any thromboembolism (TE), all-cause death, any TE and major bleeding at 1 year. Of the 6420 patients, 1588 (24.7%) had a prior stroke or transient ischemic attack and were identified as the secondary prevention cohort. After excluding 793 patients due to insufficient data, 358 (22.5%) were ABC compliant and 437 (27.5%) ABC noncompliant. ABC adherence was associated with a significantly lower risk of the composite outcome of all-cause death/TE, odds ratio (OR) 0.28 (95% confidence interval [CI]: 0.11-0.71) and all-cause death, OR 0.29 (95% CI: 0.09-0.90). Significant differences were not observed for TE, OR 0.27 (95% CI: 0.06-1.27) and major bleeding, OR 2.09 (95% CI: 0.55-7.97). Age and prior major bleeding were significant predictors of ABC noncompliance. Health-related quality of life (QOL) was higher in the ABC compliant group versus the noncompliant group (EQ score 0.83 ± 0.17 vs. 0.78 ± 0.20; p = .004). ABC pathway adherence in secondary prevention AF patients was associated with a significantly lower risk of the composite outcome of all-cause death/TE and all-cause death, as well as better health-related QOL.

Prevalence and prognostic role of L wave and selected clinical and echocardiographic variables in dogs with atrial fibrillation.

Information regarding the frequency of L waves and their prognostic relevance in dogs with secondary atrial fibrillation (AF) is limited. To determine whether L waves occur and ascertain their prognostic role, as well as the role of other clinical and echocardiographic variables in dogs with AF. Fifty-five dogs with AF associated with myxomatous mitral valve disease or dilated cardiomyopathy. Retrospective, multicenter observational study. In addition to L waves analysis, other clinical and echocardiographic variables, including type of antiarrhythmic treatment, were evaluated. A survival analysis was performed to test for predictors of cardiac death and all-cause mortality using Cox proportional hazards regression models. L waves were evident in 33/55 dogs (60%, 95% confidence interval [CI]=47%-72%) but their presence did not influence outcome. Increased left ventricular end-systolic diameter normalized for body weight (LVSDn) was a significant predictor of both cardiac death (hazard ratio [HR]=4.41, 95% CI=1.18-16.54; P=.03) and all-cause mortality (HR=9.39, 95% CI=2.49-35.32; P < .001). Heart rate assessed during echocardiography (Echo-HR) represented an additional significant predictor of cardiac death (HR=1.01, 95% CI=1.00-1.01; P=.04) and all-cause mortality (HR=1.01, 95% CI=1.00-1.01; P=.04). L waves occurred frequently in dogs with AF, but held no prognostic relevance. Conversely, LVSDn and Echo-HR represented independent predictors of negative outcome in these animals.

Abstract 12046: Patient Characteristics and Use of Oral Anticoagulation Therapy in New-Onset Atrial Fibrillation: Results From a Nationwide Registry Study in Finland

Background and Aims: The risk of ischemic stroke associated with atrial fibrillation (AF) can be reduced with oral anticoagulation therapy (OAC). We examined the patient characteristics and nationwide use of OACs in primary and secondary care AF patients. Methods: The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) -study is a nationwide study of AF patients that combines data from several Finnish health care registers. In this study all new-onset AF patients in Finland from January 2011 to December 2018 with laboratory data were analyzed. Comorbidities and CHA 2 DS 2 -VASc -score were recorded until date of AF diagnosis. First OAC therapies from diagnosis of AF to the end of study were analyzed. For warfarin users with sufficient laboratory data, time in therapeutic range (TTR) was calculated and patient quartiles by TTR were assigned. Results: Of the 130 533 (50.7 % male) new-onset AF patients studied, 96 051 (73.6%) used any OAC medication after AF diagnosis. The used OACs were warfarin (n= 56 857; 43.6%), apixaban (n=16 377; 12.5%) rivaroxaban (n=14 821; 11.4%), dabigatran (n=7 224; 5.5%), and edoxaban (n=723; 0.6%). The mean TTR values in warfarin TTR-quartiles were 32% (0-52%) in the 1 st quartile, 65% (56-72%) in the 2 nd quartile, 77% (72-83%) in the 3 rd quartile and 90% (83-100%) in the highest quartile. Among patients with standard dose of direct oral anticoagulants, the mean CHA 2 DS 2 VASc -score was 2.78 for dabigatran and 3.47 for apixaban. For patients with warfarin the mean CHA 2 DS 2- VASc -score was 3.50 in the highest quartile. The mean CHA 2 DS 2- VASc for patients without any OAC was 3.19. Conclusion: In unadjusted analyses patients with dabigatran had the lowest and patients with apixaban the highest mean CHA 2 DS 2- VASc score. In patients with warfarin, the highest TTR quartile had the lowest mean CHA 2 DS 2- VASc -score and mean TTR of 77%. Contrary to the guidelines, a remarkable number of patients with high CHA 2 DS 2- VASc score remained without any OAC treatment.

Meta-Analysis of New-Onset Atrial Fibrillation Versus No History of Atrial Fibrillation in Patients With Noncardiac Critical Care Illness

The incidence of new-onset secondary atrial fibrillation (NOSAF) is as high as 44% in noncardiac critical illness. A systematic review and meta-analysis were performed to evaluate the impact of NOSAF, compared with history of prior atrial fibrillation (AF) and no history of AF in noncardiac critically ill patients. Patients undergoing cardiothoracic surgery were excluded. NOSAF incidence, intensive care unit (ICU)/hospital length of stay (LOS), and mortality outcomes were analyzed. Of 2,360 studies reviewed, 19 studies met inclusion criteria (n=306,805 patients). NOSAF compared with no history of AF was associated with increased in-hospital mortality (risk ratio [RR] 2.06, 95% confidence interval [CI] 1.76 to 2.41, p <0.001), longer ICU LOS (standardized difference in means [SMD] 0.66, 95% CI 0.41 to 0.91, p <0.001), longer hospital LOS (SMD 0.31, 95% CI 0.07 to 0.56, p=0.001) and increased risk of long-term (>1 year) mortality (RR 1.76, 95% CI 1.29 to 2.40, p <0.001). NOSAF compared with previous AF was also associated with higher in-hospital mortality (RR 1.29, 95% CI 1.12 to 1.49, p <0.001), longer ICU LOS (SMD 0.37, 95% CI 0.03 to 0.70, p=0.03) but no difference in-hospital LOS (SMD -0.18, 95% CI -0.66 to 0.31, p=0.47). In conclusion, NOSAF, in the setting of noncardiac critical illness is associated with increased in-hospital mortality compared with no history of AF and previous AF. NOSAF (vs no history of AF) is also associated with increased long-term mortality.

Prevention and Treatment of Atrial Fibrillation via Risk Factor Modification

Atrial fibrillation (AF) is the most common clinically significant arrhythmia, and it increases stroke risk. A preventive approach to AF is needed because virtually all treatments such as cardioversion, antiarrhythmic drugs, ablation, and anticoagulation are associated with high cost and carry significant risk. A systematic review was performed to identify effective lifestyle-based strategies for reducing primary and secondary AF. A PubMed search was performed using articles up to March 1, 2021. Search terms included atrial fibrillation, atrial flutter, exercise, diet, metabolic syndrome, type 2 diabetes mellitus, obesity, hypertension, stress, tobacco smoking, alcohol, Mediterranean diet, sodium, and omega-3 fatty acids. Additional articles were identified from the bibliographies of retrieved articles. The control of hypertension, ideally with a renin-angiotensin-aldosterone system inhibitor, is effective for preventing primary AF and recurrence. Obstructive sleep apnea is a common cause of AF, and treating it effectively reduces AF episodes. Alcohol increases the risk of AF in a dose-dependent manner, and abstinence reduces risk of recurrence. Sedentary behavior and chronic high-intensity endurance exercise are both risk factors for AF; however, moderate physical activity is associated with lower risk of AF. Recently, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 agonists have been associated with reduced risk of AF. Among overweight/obese patients, weight loss of ≥10% is associated with reduced AF risk. Lifestyle changes and risk factor modification are highly effective for preventing AF.

Modulated Calcium Homeostasis and Release Events Under Atrial Fibrillation and Its Risk Factors: A Meta-Analysis

Background: Atrial fibrillation (AF) is associated with calcium (Ca2+) handling remodeling and increased spontaneous calcium release events (SCaEs). Nevertheless, its exact mechanism remains unclear, resulting in suboptimal primary and secondary preventative strategies.Methods: We searched the PubMed database for studies that investigated the relationship between SCaEs and AF and/or its risk factors. Meta-analysis was used to examine the Ca2+ mechanisms involved in the primary and secondary AF preventative groups.Results: We included a total of 74 studies, out of the identified 446 publications from inception (1982) until March 31, 2020. Forty-five were primary and 29 were secondary prevention studies for AF. The main Ca2+ release events, calcium transient (standardized mean difference (SMD) = 0.49; I2 = 35%; confidence interval (CI) = 0.33–0.66; p < 0.0001), and spark amplitude (SMD = 0.48; I2 = 0%; CI = −0.98–1.93; p = 0.054) were enhanced in the primary diseased group, while calcium transient frequency was increased in the secondary group. Calcium spark frequency was elevated in both the primary diseased and secondary AF groups. One of the key cardiac currents, the L-type calcium current (ICaL) was significantly downregulated in primary diseased (SMD = −1.07; I2 = 88%; CI = −1.94 to −0.20; p < 0.0001) and secondary AF groups (SMD = −1.28; I2 = 91%; CI = −2.04 to −0.52; p < 0.0001). Furthermore, the sodium–calcium exchanger (INCX) and NCX1 protein expression were significantly enhanced in the primary diseased group, while only NCX1 protein expression was shown to increase in the secondary AF studies. The phosphorylation of the ryanodine receptor at S2808 (pRyR-S2808) was significantly elevated in both the primary and secondary groups. It was increased in the primary diseased and proarrhythmic subgroups (SMD = 0.95; I2 = 64%; CI = 0.12–1.79; p = 0.074) and secondary AF group (SMD = 0.66; I2 = 63%; CI = 0.01–1.31; p < 0.0001). Sarco/endoplasmic reticulum Ca2+-ATPase (SERCA) expression was elevated in the primary diseased and proarrhythmic drug subgroups but substantially reduced in the secondary paroxysmal AF subgroup.Conclusions: Our study identified that ICaL is reduced in both the primary and secondary diseased groups. Furthermore, pRyR-S2808 and NCX1 protein expression are enhanced. The remodeling leads to elevated Ca2+ functional activities, such as increased frequencies or amplitude of Ca2+ spark and Ca2+ transient. The main difference identified between the primary and secondary diseased groups is SERCA expression, which is elevated in the primary diseased group and substantially reduced in the secondary paroxysmal AF subgroup. We believe our study will add new evidence to AF mechanisms and treatment targets.

Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation

ObjectiveThe study aimed to investigate the functional capacity and hemodynamics at rest and during exercise in patients with chronic atrial fibrillation and severe functional symptomatic tricuspid regurgitation (AF-FTR).BackgroundSymptoms and clinical performance of severe AF-FTR mimic the population of patients with heart failure with preserved ejection fraction (HFpEF). Severe AF-FTR is known to be associated with an adverse prognosis whereas less is reported about the clinical performance including exercise capacity and hemodynamics in patients symptomatic AF-FTR.MethodsRight heart catheterization (RHC) at rest and during exercise was conducted in a group of patients with stable chronic AF-TR and compared with a group of patients with HFpEF diagnosed with cardiac amyloid cardiomyopathy (CA). All patients had preserved ejection fraction and no significant left-sided disease.ResultsPatients with AF-FTR demonstrated a low exercise capacity that was comparable to CA patients (TR 4.9 ± 1.2 METS vs. CA 4. 7 ± 1.5 METS; P = 0.78) with an average peak maximal oxygen consumption of 15 mL/min/kg. Right atrium pressure increased significantly more in the AF-FTR patients as compared to CA patients at peak exercise (25 ± 8 vs 19 ± 9, p < 0.01) whereas PCWP increased significantly to a similar extent in both groups (31 ± 4 vs 31 ± 8 mmHg, p = 0.88). Cardiac output (CO) was significantly lower among AF-FTR at rest as compared to CA patients (3.6 ± 0.9 vs 4.4 ± 1.3 l/min; p < 0.05) whereas both groups demonstrated a poor but comparable CO reserve at peak exercise (7.3 ± 2.9 vs 7.9 ± 3.8 l/min, p = 0.59).ConclusionsAF-FTR contributes to the development of advanced heart failure symptoms and poor exercise capacity reflected in increased atrial filling pressures, reduced cardiac output at rest and during exercise sharing common features seen in HFpEF patients with other etiologies.

Inhibition of the renin-angiotensin-aldosterone system prevents and cures atrial fibrillation: An overview of systematic reviews.

Background: Atrial fibrillation (AF) is a type of arrhythmia that represents a severe health hazard. The current therapies for AF have achieved success in some conditions. However, because the mechanisms underlying the occurrence and development of this disease remain unclear, the current treatment for AF often does not achieve the desired outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), which exert robust effects on specific cardiovascular diseases, are widely used in the clinic. Several studies are focusing on the effect of ACEIs/ARBs on the prevention and cure of AF. Some systematic reviews have obtained different and even opposite results. An overview is required to obtain a conclusion and provide strong evidence to guide clinical work.Methods: We searched 5 databases, including MEDLINE, EMBASE, Cochrane Library, Web of Science, and CNKI (Chinese), and selected relevant reviews that passed the assessment we performed. Then, we synthesized the data for each result from the included reviews and obtained conclusions.Results: ACEIs/ARBs prevented new-onset AF and AF after heart failure. ACEIs/ARBs performed well in the prevention of secondary AF, especially postoperative AF. However, for patients suffering from hypertension and myocardial infarction, ACEIs/ARBs were not the right choices for preventing AF.Conclusions: We suggest that physicians select ACEIs/ARBs as an anti-AF therapy for patients with heart failure due to their additional benefits. Moreover, for patients who have suffered AF, ACEIs/ARBs may be a routine drug for secondary prevention.

Diseño y características basales del estudio REGUEIFA (Registro Gallego Intercéntrico de Fibrilación Auricular)

Introduction and objectivesTo assess the management and implementation of the European Society of Cardiology Guidelines on atrial fibrillation (AF), in a contemporary cohort of AF patients. MethodsREGUEIFA is a prospective, multicenter and observational study of patients diagnosed with primary or secondary AF, dwelling in the region of Galicia and evaluated by cardiologists. ResultsOne thousand and seven patients have been recruited. Mean age was 67±11 years and 32% were women. Fifty percent of patients have underlying cardiovascular disease. Amiodarone was the antiarrhythmic drug more often used (24,5%). The thromboembolic risk assessed by CHA2DS2-VASc score was 2.3±1.5 and the bleeding risk assessed by HASBLED score was 0.7±0.7. Oral anticoagulant therapy (OAC) was prescribed in 90.1%. CHA2DS2-VASc score, hypertension and AF ablation were independent predictor factors of OAC and paroxysmal AF was associated with no anticoagulation. Age and renal insufficiency, were independent predictor factors of vitamin K antagonists prescription whereas electrical cardioversion and AF ablation were independent predictor factors of direct oral anticoagulation therapy prescription. ConclusionsREGUEIFA registry provides contemporary information on AF management by cardiologists. Prescription of OAC was 91,1%. Independent predictor factors associated with OAC and direct oral anticoagulation prescription were described.

Self-monitoring for recurrence of secondary atrial fibrillation following non-cardiac surgery or acute illness: A pilot study.

BackgroundAtrial fibrillation (AF) secondary to non-cardiac surgery and medical illness is common and, although often transient, is associated with an increased risk of stroke and mortality. This pilot study tested the feasibility of self-monitoring to detect recurrent AF in this setting and the frequency with which it occurred.MethodsPatients with new secondary AF after non-cardiac surgery or medical illness that reverted to sinus rhythm before discharge were recruited in three tertiary hospitals in Australia. Participants performed self-monitoring for AF recurrence using a Handheld single-lead ECG device 3–4 times/day for 4-weeks.ResultsFrom 16,454 admissions, 224 (1.4%) secondary AF cases were identified. Of these, 94 were eligible, and 29 agreed to participate in self-monitoring (66% male; median age 67 years). Self-monitoring was feasible and acceptable to participants in this setting. Self-monitoring identified AF recurrence in 10 participants (34%; 95% CI, 18% −54%), with recurrence occurring ≤ 9 days following discharge in 9/10 participants. Only 4 participants (40%) reported associated palpitations with recurrence. Six participants (60%) with recurrence had a CHA2DS2-VA score ≥ 2, suggesting a potential indication for oral anticoagulation.ConclusionsApproximately 1 in 3 patients with transient secondary AF will have recurrent AF within nine days of discharge. These recurrent episodes are often asymptomatic but can be detected promptly using patient self-monitoring, which was feasible and acceptable. Future research is warranted to further investigate the incidence of secondary AF, the rate of recurrence after discharge and its prognosis, and whether use of oral anticoagulation can reduce stroke in this setting.

Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association.

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity, mortality, and healthcare use. Great strides have been made in stroke prevention and rhythm control strategies, yet reducing the incidence of AF has been slowed by the increasing incidence and prevalence of AF risk factors, including obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, and other modifiable lifestyle-related factors. Fortunately, many of these AF drivers are potentially reversible, and emerging evidence supports that addressing these modifiable risks may be effective for primary and secondary AF prevention. A structured, protocol-driven multidisciplinary approach to integrate lifestyle and risk factor management as an integral part of AF management may help in the prevention and treatment of AF. However, this aspect of AF management is currently underrecognized, underused, and understudied. The purpose of this American Heart Association scientific statement is to review the association of modifiable risk factors with AF and the effects of risk factor intervention. Implementation strategies, care pathways, and educational links for achieving impactful weight reduction, increased physical activity, and risk factor modification are included. Implications for clinical practice, gaps in knowledge, and future directions for the research community are highlighted.

Serum Metabolomics and Incidence of Atrial Fibrillation (from the Atherosclerosis Risk in Communities Study)

We have previously identified associations of 2 circulating secondary bile acids (glycocholenate and glycolithocolate sulfate) with atrial fibrillation (AF) risk in 1,919 blacks in the Atherosclerosis Risk in Communities cohort. We aimed to replicate these findings in an independent sample of 2,003 white and black Atherosclerosis Risk in Communities participants, and performed a new metabolomic analysis in the combined sample of 3,922 participants, followed between 1987 and 2013. Metabolomic profiling was done in baseline serum samples using gas and liquid chromatography mass spectrometry. AF was ascertained from electrocardiograms, hospitalizations, and death certificates. We used multivariable Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of AF by 1 standard deviation difference of metabolite levels. Over a mean follow-up of 20 years, 608 participants developed AF. Glycocholenate sulfate was associated with AF in the replication and combined samples (HR 1.10, 95% CI 1.00, 1.21 and HR 1.13, 95% CI 1.04, 1.22, respectively). Glycolithocolate sulfate was not related to AF risk in the replication sample (HR 1.02, 95% CI 0.92, 1.13). An analysis of 245 metabolites in the combined cohort identified 3 additional metabolites associated with AF after multiple-comparison correction: pseudouridine (HR 1.18, 95% CI 1.10, 1.28), uridine (HR 0.86, 95% CI 0.79, 0.93) and acisoga (HR 1.17, 95% CI 1.09, 1.26). In conclusion, we replicated a prospective association among a previously identified secondary bile acid, glycocholenate sulfate, and AF incidence, and identified new metabolites involved in nucleoside and polyamine metabolism as markers of AF risk.