Atrial Fibrillation Symptoms Research Articles

Abstract 10548: Atrial Fibrillation Worsens Sports Performance in Athletes; Greatest Improvement Seen With Ablation: A Stopafib.org Survey

Introduction: Anecdotally, both atrial fibrillation (AF) and medications for AF, are poorly tolerated in athletes. However, data are lacking. Methods: An internet-based survey, initiated via StopAfib.org, queried the impact of AF and treatment modalities on sports performance, training, and well-being. Performance, (rated in comparison to personal best), frequency of training and competition were categorized ordinally and compared prior to onset of AF symptoms versus when symptoms at worst, via paired Wilcoxon, and then compared in relation to participants’ AF treatments. Results: Between 5/13/19 and 2/29/20, 802 athletes responded, including 78% males, 22% female, median age 61 to 70 years . The most reported sports were cycling (25%) and running (20%). Median time since diagnosis was 3 to 5 years. When participants’ symptomatology was at worst, the median frequency was at least once a week, most commonly palpitations, fatigue, and decreased exercise tolerance. Development of AF was associated with declining sports performance, competition, and training frequency as shown in the table below. Of 471 participants who decreased their exercise regimen, 31% reported no change in symptoms, 56% reported a decreased frequency of AF, and 13% reported no further AF. Among athletes that received treatment, ablation was associated with the greatest improvement in sports performance compared with ablation plus medications or medications alone (see table below). Of 262 athletes currently on medication, 27% reported that it was completely effective, 58% partially effective, and 15% not effective. Of 653 athletes that have taken medication currently and/or in the past, 43% reported side effects, most commonly fatigue, low energy, or decreased athletic performance. Conclusions: In athletes, AF was associated with decline in sports performance. Among AF treatment modalities, ablation was associated with the greatest improvement in sports performance.

Abstract 11919: Differences in the Documentation of Atrial Fibrillation Symptoms in Electronic Health Records Between Patients With and Without Comorbid Heart Failure

Introduction: Atrial fibrillation (AF) causes burdensome symptoms that impact quality of life. One in four AF patients have comorbid heart failure (HF). Understanding whether comorbid HF impacts AF symptom experiences can guide interventions for symptom management. Objective: We aimed to investigate whether patients with AF and comorbid HF will have different symptoms compared to those with AF only. Methods: We used structured and unstructured data (i.e., clinical notes) from electronic health records of patients in a large, urban health system between 2010-2010. We created two cohorts: (1) AF only, and (2) AF and HF. We extracted symptoms from notes written immediately before a catheter ablation to treat AF because of high symptom enrichment in ablation consultation notes compared to general progress notes. To extract symptoms, we applied a natural language processing algorithm with high performance on the corpus of notes (precision=0.73, recall=0.93, F-score=0.81). A team of cardiologists and nurses with cardiology expertise chose 10 symptoms to evaluate. We used Chi squared tests to compare differences in the prevalence of documented symptoms between cohorts. We further characterized each cohort using the structured demographics data. Results: Patients with AF only (n=504) had a mean age of 65.1 (SD 10.5) years, 33.3% were documented as female, and 14.3% documented as non-White. Patients with AF and HF (n=575) had a mean age of 69.4 (SD 12.0) years, 38.8% were documented as female, and 23.5% documented as non-White. The HF and AF cohort had a significantly higher prevalence of 6 symptoms (Table 1). The AF only cohort had a significantly higher prevalence of one symptom (palpitations). Conclusions: There are clear differences in the prevalence of symptoms between cohorts, with HF patients experiencing greater symptom burden overall. Future work exploring differences, such as through symptom clusters, will further illuminate differences in symptom experiences.

Abstract 15633: Differences in Atrial Fibrillation Symptoms Post-Ablation by Age

Introduction: The prevalence of atrial fibrillation (AF) increases with age. Although catheter ablation is a recommended treatment for AF and is safe and effective in older adults, symptom outcomes post-ablation have not been well studied among older adults. The objective of this study was to investigate differences in the prevalence of symptoms post-ablation and the need for repeat ablation by age group. Methods: From electronic health records, we used International Classification of Diseases billion codes to identify all patients with an admitting diagnosis of paroxysmal AF who were treated at NewYork-Presbyterian Hospital between 2010 and 2020. We then used Current Procedural Terminology Codes to identify patients who underwent catheter ablation. We extracted age, gender, race, ethnicity, and prevalence of repeat ablations using structured queries. We extracted symptoms post-ablation from unstructured clinical notes using natural language processing. We separated patients into five age groups and evaluated associations between demographics, symptoms, repeat ablations and age group using Chi-square tests. Results: Of the 1,414 patients studied, 34.4% were female and 58.6% were white, and 4.1% were Hispanic or Latino. Significantly more female patients were age 61-80, and significantly more non-White participants were age 51-70, compared to other age groups. There was a clinically but not statistically significant difference in the prevalence of repeat ablations by age, with nearly half of those with repeat ablations being age 61-70. There were no significant differences in symptom prevalence 6 and 12 months post-ablation. Conclusion: A greater proportion of female and non-White patients undergoing ablation are older adults compared to younger or much older (>80 years) patients. There were no differences in repeat post-ablation symptoms by age, suggesting older adults may experience similar symptom reduction following ablations as younger adults.

Abstract 14310: Patient Reported Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Chronic Kidney Disease

Introduction: Increasingly, catheter ablation for atrial fibrillation (AF) has been utilized for rhythm control and to improve quality of life (QoL). Data are limited on patient-centered ablation outcomes in individuals with chronic kidney disease (CKD). Objective: To examine clinical outcomes and QoL following AF ablation in CKD patients from a large patient-reported outcomes (PRO) database. Methods: All patients undergoing AF ablation (2013-2016) at our center were enrolled and assessed for outcomes using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). This analysis captured data at 1- and 3-year follow-up. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min using the 2021 CKD-EPI equation. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL assessment. In addition, data were collected on clinical improvement by patient report, AF burden, and healthcare utilization. Results: A total of 488 patients were identified (66% male, mean age 68.5, 56.2% persistent AF). QoL was significantly improved from baseline median (IQR) AFSSS of 14 (6-19.5) to 3 (0-9) at 1-year and 4 (0-9.5) at 3-year; P≤0.0001 for both. About 90% of patients reported improvement in their overall AF-related symptoms both at 1- and 3-year follow up. The proportion of patients in AF at the time of completion of the baseline survey was 51.2%, and this decreased to 6.2% at 1-year and 9.7% at 3-year follow up (P<0.0001 for both). AF burden was significantly reduced at 1-year and 3-year including frequency and duration of episodes (P<0.05 for both), with associated decrease in ER visits and hospitalizations; P<0.0001 for all comparisons. The proportion of patients on antiarrhythmics decreased from 61.8% at baseline to 35.6% and 22.7% at 1-year and 3-year, respectively (P<0.0001 for both). Conclusions: In a large AF-specific PRO system, catheter ablation for AF was associated with a significant improvement of QoL in most patients with CKD; with a decrease in AF burden and healthcare utilization.

Impact of redo ablation for atrial fibrillation on patient-reported outcomes and quality of life.

Catheter ablation for atrial fibrillation (AF) is frequently used for the purpose of rhythm control and improved quality of life (QoL). Although success rates are high, a significant proportion of patients require redo ablation. Data are scarce on patient-centered outcomes and QoL in patients undergoing redo AF ablation. We aimed to assess QoL and clinical outcomes using a large prospectively maintained patient-reported outcomes (PRO) registry. All patients undergoing redo AF ablation (2013-2016) at our center were enrolled in a prospective registry for outcomes and assessed for QoL using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). Data were collected over 3 years of follow-up. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL. Additional variables included patient-reported improvement, AF burden, and AF-related healthcare utilization including emergency room (ER) visits and hospitalizations. A total of 848 patients were included (28% females, mean age 63.8, 51% persistent AF). By automated PRO, significant improvement in QoL was noted (baseline median AFSSS of 12 [5-18] and ranged between 2 and 4 on subsequent assessments; p < .0001), with ≥70%of patients reported remarkable improvement in their AF-related symptoms. The proportion of patients in AF at the time of baseline survey was 36%, and this decreased to <8% across all time points during follow-up (p < .0001). AF burden was significantly reduced (including frequency and duration of episodes; p < .0001), with an associated decrease in healthcare utilization after 6 months from the time of ablation (including ER visits and hospitalizations; p < .0001). The proportion of patients on anticoagulants or antiarrhythmics decreased on follow-up across all time points (p < .0001 for all variables). Most patients derive significant QoL benefit from redo AF ablation; with reduction of both AF burden and healthcare utilization.

‘Out of sync’: a qualitative investigation of patients’ experiences of atrial fibrillation and perceptions of weight management

ObjectivesTo explore ways to enhance the design of risk factor management and weight-loss services for people with overweight/obesity and atrial fibrillation (AF).BackgroundAF is the most common cardiac arrhythmia, with serious...

Effect of High-Intensity Interval Training in Patients With Atrial Fibrillation

Patients with atrial fibrillation (AF) experience poor functional capacity and quality of life (QOL). High-intensity interval training (HIIT) has been shown to elicit greater improvements in functional capacity and QOL compared with moderate to vigorous intensity continuous training (MICT) in other cardiovascular populations, yet HIIT remains understudied in AF. To compare the effects of 12 weeks of HIIT and MICT-based cardiovascular rehabilitation (CR) on functional capacity and general QOL in patients with persistent and permanent AF. Disease-specific QOL, resting heart rate (HR), time in AF, and physical activity (PA) levels were also assessed. This randomized clinical trial, conducted between November 17, 2015, and February 4, 2020, at a tertiary-care cardiovascular health center in Ottawa, Canada, recruited 94 patients with persistent and permanent AF. High-intensity interval training (23 minutes: two 8-minute interval training blocks of 30-second work periods at 80%-100% of peak power output interspersed with 30-second recovery) or CR (60 minutes: continuous aerobic conditioning within 67%-95% of peak HR and 12-16 of 20 ratings of perceived exertion) twice weekly for 12 weeks. The primary outcomes were changes in functional capacity (6-minute walk test [6MWT] distance) and general QOL (Short Form 36) from baseline to 12 weeks' follow-up. Secondary outcomes included changes in disease-specific QOL (Atrial Fibrillation Severity Scale), resting HR, time in AF, and PA levels. An intention-to-treat analysis was used to compare changes between groups. Of the 94 patients who consented, 86 participated (mean [SD] age, 69 [7] years; 57 [66.3%] men). No significant differences in improvements in 6MWT distance (mean [SD], 21.3 [34.1] vs 13.2 [55.2] m; P = .42) and general QOL (Physical Component Summary, 0.5 [6.1] vs 1.1 [4.9] points; P = .87) between HIIT and CR were observed. No significant differences in improvements in disease-specific QOL (AF symptoms: -1.7 [4.3] vs -1.5 [4] points, P = .59), resting HR (-3.6 [10.6] vs -2.9 [12.4] beats per minute, P = .63), and moderate to vigorous PA levels (37.3 [93.4] vs 14.4 [125.7] min/wk; P = .35) between HIIT and CR were detected. Participants attended a mean (SD) of 18.3 (6.1) (75.1%) HIIT sessions and 20.0 (4.5) (83.4%) CR sessions (P = .36). In this randomized clinical trial, twice-weekly 23-minute HIIT was as efficacious as twice-weekly 60-minute CR in improving functional capacity, general and disease-specific QOL, resting HR, and PA levels in patients with persistent and permanent AF. ClinicalTrials.gov Identifier: NCT02602457.

A novel deep neural network for detection of Atrial Fibrillation using ECG signals

In healthcare practice, one of the most predominantly occurring dysrhythmia is atrial fibrillation (AF). The anomalous heart rhythm and the deficiency of an evident P-wave signal are the consequences of AF, several cerebral apoplexies, thrombus, blood coagulation, cognitive impairments, and strokes. It is arduous to ascertain the symptoms of AF and clinically silent that might cause death. There are certain liabilities for diagnosis of AF in manual Electrocardiogram (ECG) since it demands high expertise; it is a time demanding and tedious process which is also accompanied by variations between intra- and inter-observer. Hence, to combat with this issue, a novel AF detection models has been proposed a conglomerate parallel structure of Convolutional Neural Network (CNN) and Recurrent Neural Network (RNN) framework which can deepen the understanding of features and classification. To test and legitimize the system, we utilize the data of the MIT-BIH Atrial Fibrillation Database. Parallel models for control subjects have been designed specifically to validate performance in terms of classification for more voracious categorization of 3 classes namely: Non-Atrial Fibrillation (N-AF), Atrial Fibrillation (AF) and Normal Sinus Rhythm (NSR). The model obtained an Accuracy, Sensitivity and Specificity of 99.6%, 98.64% and 99.01% respectively.

Hypertension and atrial fibrillation.

Hypertension is the most prevalent cardiovascular risk factor underlying atrial fibrillation and is present in up to 40% of patients with atrial fibrillation. Furthermore, attributable risk studies have shown that a history of hypertension contributes to up to 24% of incident atrial fibrillation. New data suggest that even early forms of hypertension (prehypertension and aortic stiffness) are associated with an increased risk of atrial fibrillation development. Hypertension and prehypertension are therefore critical mediators for the development of atrial fibrillation. Mechanisms for the association between hypertension and atrial fibrillation include diffuse electro-structural changes to the left atrium, driven by the haemodynamic and neurohormonal influences of hypertension and other, frequently coexisting, cardiovascular risk factors. Management of hypertension in atrial fibrillation should focus not only on blood pressure reduction but also on a comprehensive risk factor modification strategy. Such strategies have been shown to be associated with significant improvements in atrial fibrillation symptom burden as well as improved arrhythmia-free survival and reversal of the progression of atrial fibrillation. These strategies should focus on dietary modifications as well as prescribed exercise programmes involving a multidisciplinary team and patient-centred atrial fibrillation care. Risk factor management, supplemented by antihypertensive medications as needed, provides the optimum strategy for improving outcomes and even reversing the natural progression of atrial fibrillation in patients with hypertension.

Management of atrial fibrillation by different medical specialties in the UK: AF-GEN-UK study

Abstract Background The AF-GEN-UK study is an extension of the EURObservational Research Programme (EORP) Long-term Registry on patients with atrial fibrillation (AF) in the UK (AF-GEN). The study aimed to establish a registry of the contemporary management of patients with AF by cardiologists, general practitioners, stroke, acute and emergency medicine physicians at baseline and 1-year of follow-up, to allow comparison between medical specialties. Methods Data on patients with AF diagnosed within the previous 12-months were collected using electronic case records from 101 sites, to permit comparison of patient characteristics and treatments between medical specialties. The impact of guideline-adherent oral anticoagulation (OAC) use on outcomes was assessed using Cox regression analysis. Results 1595 patients (mean (SD) age 70.5 (11.2) years; 60.1% male; 97.4% white) with ECG-documented AF were included (recruited between June 2017 and June 2018) and followed-up for 1-year. Overall OAC prescription rates were 84.2% at baseline and 87.1% at 1-year follow-up, with NOACs predominating (74.9% at baseline and 79.2% at 1-year) Figure, mainly apixaban. Prescription of VKA was significantly higher in primary care, with NOAC prescription higher among stroke physicians. Guideline-adherent OAC (CHA2DS2-VASc ≥2) at baseline significantly reduced risk of composite endpoint of death and stroke at 1-year (adjusted hazard ratio 0.42; 95% confidence intervals 0.25–0.70). Rhythm control was evident in approximately one-quarter, with only 1.6% receiving catheter ablation. Most patients (56.6%) reported AF symptoms, but these were severe in only 17.9%. Symptomatic patients were mainly managed by cardiologists or acute/emergency medicine; among patients managed by stroke physicians, 81.5% were asymptomatic. Quality of life did not appear significantly impaired however there was a slight but significant improvement at follow-up (70.3% vs. 71.5%; p=0.044). Symptomatic patients reported poorer quality of life related to usual activities, mental health and overall quality of life. Conclusion Overall OAC use was high (&amp;gt;80%) with NOAC prescription predominating but rates varied by specialty, with VKA prescription significantly higher in primary care. Guideline-adherent OAC therapy at baseline was associated with significant reduction in composite outcome of death and stroke at 1-year, regardless of specialty. Rhythm control management was only evident in around one-quarter despite AF symptoms being reported in 56.6%. This registry extends the knowledge of contemporary management of AF outside of cardiology by including other specialties and demonstrates good implementation of clinical guidelines for the management of AF, particularly in relation to stroke prevention. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): This project was supported by the BMS/Pfizer European Thrombosis Investigator Initiated Research Program

Alleviation of AF related symptoms following acute conversion of recent-onset, symptomatic atrial fibrillation to sinus rhythm with flecainide acetate oral inhalation solution

Abstract Introduction Pharmacological restoration of sinus rhythm (SR) in patients with symptomatic atrial fibrillation (AF) is expected to be accompanied by prompt alleviation of symptoms to avoid the need for electrical cardioversion (ECV) and/or hospitalization. The feasibility and safety of acute cardioversion of recent-onset (≤48 hours) symptomatic AF to SR with flecainide acetate oral inhalation (FlecIH) solution was shown in the Phase 2, open-label INSTANT trial. We examined symptoms, heart rate, time to discharge and need for ECV reported among patients in the INSTANT trial whose AF was successfully converted to SR (“conversion group”; N=25) versus those whose AF did not convert to SR (“no conversion group”; N=29). Methods Conversion success was determined using 12-lead Holter monitoring during a 90-minute observation period. Patients in the no conversion group were offered alternative treatment per the investigator discretion. Symptoms, vital signs, time to discharge, and the need for ECV were evaluated through Day 5. Results Data from 54 patients (33.3% female) with a mean age of 62.1 years and a mean BMI of 26.8 kg/m2 were analyzed. All patients reported at least one AF-related symptoms at baseline (palpitations=85%; dizziness=35%; shortness of breath=37%; chest discomfort=39%) and 83.3% presented with AF symptoms ≤24 hours in duration. At 90 minutes, 80.0% of the conversion group were asymptomatic compared to 37.9% of the no conversion group (p&amp;lt;0.001). Mean (SD) ventricular rate at 90 minutes was 70.6 (12.5) bpm in the conversion group compared to 100.4 (29.4) bpm in the no conversion group (p&amp;lt;0.001). Median time to discharge was 2.3 (IQR: 0.75) hours for the conversion group compared to 3.6 (IQR: 1.02) hours for the no conversion group (p=0.001). By Day 5, 23 (79.3%) patients in the no conversion group had undergone ECV; no patients in the conversion group experienced AF recurrence by Day 5 (0% required ECV; p&amp;lt;0.001). Conclusions Conversion of recent onset AF to SR with inhaled flecainide was associated with a reduction in symptoms, normalization of heart rate, rapid hospital discharge and avoidance of ECV during a 5-day follow-up period. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): InCarda Therapeutics

Atrial fibrillation can be diagnosed using a combined wrist-worn photoplethysmography and electrocardiography

Abstract Background Current ESC Clinical Practice Guideline for management of atrial fibrillation requires a minimum of 30-seconds of atrial fibrillation (AF) to be visually confirmed from an electrocardiography (ECG) recording for diagnosis. Single-channel ECG recorded from any measurement lead is sufficient. The current method of 24–48 h Holter ECG may not detect rarely occurring AF episodes, and thus extended duration recording devices are needed. Intermittent portable ECG devices intended for clinical use exist but those lack continuous rhythm monitoring and are thus unable to notify the user in case of asymptomatic episode. Purpose We evaluated the performance of a wrist-worn solution (Fig. 1) intended for clinical use that combines continuous photoplethysmography (PPG) -based rhythm assessment with intermittent ECG measurements in the detection of atrial fibrillation in ambulatory conditions. Methods 30 adult patients with previous diagnosis of AF were recruited for 48-hour measurements. Simultaneous 5-lead Holter monitoring was used as the reference. The patients were taking intermittent ECG measurements at pre-scheduled times (4 times a day), when notified by the device (irregular rhythm detected by PPG), and if feeling symptoms of AF. Results The obtained sensitivity and specificity for PPG-based AF detection were 95.5% and 99.2%, respectively when evaluated in 5-minute segments. Only the segments during which adequate amount, approximately 30-seconds, of good quality PPG data was available, were considered in the analysis. On average this equals 54% of the segments. Patients took in total 456 30-second ECG measurements. Out of these 411 and 392 were assessed as analysable quality by ECG algorithm and visually by two cardiologists, HS and KK, respectively. Automatic ECG analysis algorithm labelled ECG measurements taken during atrial fibrillation correctly as “Possible arrhythmia” with 95.7% sensitivity and 92.0% specificity. 99.5% of the analysable quality ECGs measured during AF were marked with any type of label e.g., tachycardia that highlights them to the clinician. An example ECG measurement with markings of the analysis algorithm an overall classification is shown in Fig. 2. All patients having AF during the 48-hour monitoring (14/30) were correctly identified based on the wrist device data. Conclusion Based on the obtained results, wrist-worn device combining continuous PPG and intermittent ECG measurements can be reliably used in detecting atrial fibrillation in ambulatory conditions. The user-friendliness and unobtrusiveness of wrist-worn technology enables virtually unlimited monitoring time thus facilitating the detection of rarely occurring AF episodes. The information of continuous rhythm monitoring can also be used for the estimation of AF burden. The solution used in the study has received medical device CE certification in early 2022. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The study was funded by PulseOn company.

Non-Contact Atrial Fibrillation Detection From Face Videos by Learning Systolic Peaks.

We propose a non-contact approach for atrial fibrillation (AF) detection from face videos. Face videos, electrocardiography (ECG), and contact photoplethysmography (PPG) from 100 healthy subjects and 100 AF patients are recorded. Data recordings from healthy subjects are all labeled as healthy. Two cardiologists evaluated ECG recordings of patients and labeled each recording as AF, sinus rhythm (SR), or atrial flutter (AFL). We use the 3D convolutional neural network for remote PPG monitoring and propose a novel loss function (Wasserstein distance) to use the timing of systolic peaks from contact PPG as the label for our model training. Then a set of heart rate variability (HRV) features are calculated from the inter-beat intervals, and a support vector machine (SVM) classifier is trained with HRV features. Our proposed method can accurately extract systolic peaks from face videos for AF detection. The proposed method is trained with subject-independent 10-fold cross-validation with 30 s video clips and tested on two tasks. 1) Classification of healthy versus AF: the accuracy, sensitivity, and specificity are 96.00%, 95.36%, and 96.12%. 2) Classification of SR versus AF: the accuracy, sensitivity, and specificity are 95.23%, 98.53%, and 91.12%. In addition, we also demonstrate the feasibility of non-contact AFL detection. We achieve good performance of non-contact AF detection by learning systolic peaks. non-contact AF detection can be used for self-screening of AF symptoms for suspectable populations at home or self-monitoring of AF recurrence after treatment for chronic patients.

'Replace uncertainty with information': shared decision-making and decision quality surrounding catheter ablation for atrial fibrillation.

As a first step in developing a decision aid to support shared decision-making (SDM) for patients with atrial fibrillation (AF) to evaluate treatment options for rhythm and symptom control, we aimed to measure decision quality and describe decision-making processes among patients and clinicians involved in decision-making around catheter ablation for AF. We conducted a cross-sectional, mixed-methods study guided by an SDM model outlining decision antecedents, processes, and outcomes. Patients and clinicians completed semi-structured interviews about decision-making around ablation, feelings of decision conflict and regret, and preferences for the content, delivery, and format of a hypothetical decision aid for ablation. Patients also completed surveys about AF symptoms and aspects of decision quality. Fifteen patients (mean age 71.1 ± 8.6 years; 27% female) and five clinicians were recruited. For most patients, decisional conflict and regret were low, but they also reported low levels of information and agency in the decision-making process. Most clinicians report routinely providing patients with information and encouraging engagement during consultations. Patients reported preferences for an interactive, web-based decision aid that clearly presents evidence regarding outcomes using data, visualizations, videos, and personalized risk assessments, and is available in multiple languages. Disconnects between clinician efforts to provide information and bolster agency and patient experiences of decision-making suggest decision aids may be needed to improve decision quality in practice. Reported experiences with current decision-making practices and preferences for decision aid content, format, and delivery can support the user-centred design and development of a decision aid.

Contemporary management of atrial fibrillation in primary and secondary care in the UK: the prospective long-term AF-GEN-UK Registry.

This study established a prospective registry of contemporary management of UK patients with atrial fibrillation (AF) by cardiologists, general practitioners, and stroke, acute, and emergency medicine physicians at baseline and 1-year follow-up. Data on patients with recently diagnosed AF (≤12 months) were collected from medical records from 101 UK sites to permit comparison of patient characteristics and treatments between specialities. The impact of guideline-adherent oral anticoagulation (OAC) use on outcomes was assessed using Cox regression analysis. One thousand five hundred and ninety-five AF patients [mean (standard deviation) age 70.5 (11.2) years; 60.1% male; 97.4% white] were recruited in June 2017-June 2018 and followed up for 1 year. Overall OAC prescription rates were 84.2% at baseline and 87.1% at 1 year, with non-vitamin K antagonist oral anticoagulants (NOACs) predominating (74.9 and 79.2% at baseline and 1 year, respectively). Vitamin K antagonist prescription was significantly higher in primary care, with NOAC prescription higher among stroke physicians. Guideline-adherent OAC (CHA2DS2-VASc ≥2) at baseline significantly reduced risk of death and stroke at 1 year [adjusted hazard ratio (95% confidence interval): 0.48 (0.27-0.84) and 0.11 (0.02-0.48), respectively]. Rhythm control is evident in ∼25%; only 1.6% received catheter ablation. High OAC use (>80%, mainly NOACs) rates varied by speciality, with VKA prescription higher in primary care. Guideline-adherent OAC therapy at baseline was associated with significant reduction in death and stroke at 1 year, regardless of speciality. Rhythm-control management is evident in only one-quarter despite AF symptoms reported in 56.6%. This registry extends the knowledge of contemporary AF management outside cardiology and demonstrates good implementation of clinical guidelines for the management of AF, particularly for stroke prevention.

Using Atrial Fibrillation Symptoms to Guide Treatment: Becoming PROs at Improving Quality of Life

Using Atrial Fibrillation Symptoms to Guide Treatment: Becoming PROs at Improving Quality of Life

Perception of atrial fibrillation symptoms: Impact on quality of life and treatment in older adults.

In managing older adults with atrial fibrillation (AF), their symptomatology impacts their well-being and may inform treatment decision-making. We examined AF symptom perception, its impact on quality of life (QoL), and its relation to treatment strategies in older adults with AF. Data were obtained from older adults with AF enrolled in a multicenter study conducted at clinic sites in Massachusetts and Georgia between 2016 and 2018. Participants were stratified into three age groups: 65-74 (youngest-old), 75-84 (middle-old), and ≥85 (oldest). Perception of AF symptoms was assessed by participant self-report during their clinic visit and at study enrollment by the Atrial Fibrillation Effect on Quality-of-Life Questionnaire which assessed cardiac-specific and non-specific, non-cardiac AF symptoms and their impact on QoL. Treatment strategies (rate or rhythm control) utilized were ascertained from electronic medical records. Among the 1184 participants (mean age 75 years, 48% women, 86% Non-Hispanic White), 51% were aged 65-74 years, 36% were 75-84 years, and 13% were ≥ 85 years. The most commonly reported AF symptoms were non-specific, non-cardiac symptoms (fatigue, dyspnea, lightheadedness) with similar prevalence and impact on QoL in all age groups. Cardiac-specific AF symptoms (palpitations, irregular heartbeat, pause in heart activity) were less prevalent, but most commonly reported by the youngest participants (65-74 years), who endorsed considerable impact of these symptoms on their QoL. Overall, those who reported experiencing any AF symptoms during their clinic visit were more likely to have received rhythm compared with rate control (OR: 1.56; 95% CI: 1.18-2.04) with similar findings for all age groups except those aged ≥85 years. Our findings suggest a high prevalence of non-specific, non-cardiac symptoms among older adults with AF and that cardiac-specific AF symptoms may exert considerable impact on their QoL. The presence of any AF symptoms may drive more rhythm control in a majority of older adults.

Prediction of Atrial Fibrillation Being Asymptomatic at First Onset by Cardiac Pacing.

Asymptomatic or silent atrial fibrillation (AF) has long been a clinical problem due to the incidence of ischemic stroke. A method is needed to predict the development of silent AF before the occurrence of ischemic stroke. This study was focused on the symptoms of AF, especially palpitation, in pacemaker patients. We assessed the hypothesis that absence of palpitation during rapid ventricular pacing could be a predictor of future onset AF being asymptomatic.In this study, we assessed the presence of symptoms during RV pacing and AF symptoms on 145 pacemaker patients at the outpatient clinic by VVI pacing at 120 ppm. The relationship between symptoms during RV pacing and symptom during AF was assessed. The predictive value of absence of symptom during RV pacing on AF being asymptomatic was assessed.Of 145 patients, 74 had previous AF episode. Among the AF patients, absence of symptom during VVI pacing was associated with AF being asymptomatic.Of 145 patients, 71 had no previous AF events. There were 14 patients who had new-onset AF or atrial flutter (AFL) after the device implantation. Four of the 14 patients (28.6%) were symptomatic during first AF/AFL episode, and 10 (71.4%) were asymptomatic during first-onset AF. All ten patients who were asymptomatic during cardiac pacing test were asymptomatic during their initial episodes of AF as well.This study showed that absence of symptoms during rapid ventricular pacing was associated with first-onset AF being asymptomatic.

Benefit of atrial fibrillation ablation on symptoms and quality of life does not differ between patients with paroxysmal and persistent atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Indications for atrial fibrillation (AF) ablation in current ESC and ACC/HRS guidelines are different for paroxysmal and persistent AF patients. Although previous research has established that the AF recurrence rate after AF ablation is lower in paroxysmal AF patients, there is little data on differences in post-ablation improvement of quality of life (QoL) and AF-related symptoms. Purpose This study aimed to determine whether QoL and symptom improvement differ between patients with paroxysmal and persistent AF after AF ablation. Methods From December 2017 to June 2020, patients undergoing first AF ablation at a medical center were included in a prospective registry. Circumferential pulmonary vein isolation (PVI) was performed using radiofrequency ablation with a contact force-sensing catheter. Patient reported outcomes were assessed at baseline, 4 months follow-up, and 1 year follow-up using the Toronto Atrial Fibrillation Severity Scale (AFSS). The AFSS was used to quantify global well-being (scale 1-10), patient-perceived AF burden (scale 3-30), and AF symptom severity (scale 0-35). AF symptom severity was based on 7 questions (scale 0-5) leading to a 0-35 scale. AF recurrence was defined as any documented episode of AF or atrial flutter after a blanking period of 3 months. Results The study population consisted of 306 AF patients (66% paroxysmal AF, 68% male, mean age 64±8 years). AF recurrence during 1 year follow-up occurred in 29% of paroxysmal AF patients and in 42% of persistent AF patients (p=0.021). At baseline, patient perceived AF burden was lower in paroxysmal AF patients than in persistent AF patients (18.4±3.7 vs. 20.2±5.0, p=0.001), whereas symptom severity (10.6±6.5 vs. 9.9±6.7, p=0.384) and global well-being (7.1±1.5 vs. 7.3±1.4, p=0.327) were similar. Paroxysmal AF patients reported more palpitations (2.4±1.3 vs. 1.6±1.5, p&amp;lt;0.001) and less shortness of breath during physical activity (1.9±1.6 vs. 2.3±1.7, p=0.048) than patients with persistent AF. Significant improvements in global well-being (0.5±1.7, p&amp;lt;0.001), symptom severity (3.8±7.2, p&amp;lt;0.001), and patient-perceived AF burden (7.2±7.5, p&amp;lt;0.001) were found in the entire study cohort between baseline and 1 year follow-up, without differences between paroxysmal and persistent patients (Figure). Conclusion Although persistent AF patients have a higher chance of recurrent AF after AF ablation, symptom severity and QoL improve equally in paroxysmal and persistent AF patients. These results suggest that different recommendations for AF ablation to improve symptoms in paroxysmal and persistent AF patients may not be justified.

Long-term amelioration of an early-onset familial atrial fibrillation model with AAV-mediated in vivo gene therapy

Atrial fibrillation (AF) is a common cardiac disease with high prevalence in the general population. Despite a mild manifestation at the onset stage, it causes serious consequences, including sudden death, when the disease progresses to the late stage. Most available treatments of AF focus on symptom management or alleviation, due to a lack of fundamental knowledge and the fact that considerable variations of AF exist. With the popularisation of the next-generation sequencing technology, several causal genetic factors, including MYL4, have been discovered to contribute to AF, giving hope to developing its gene therapies. In this study, we attempted to treat a previously established rat AF model, which carried Myl4E11K/E11K loss of function mutation, via overexpression of exogenous wild-type Myl4 by AAV9 vectors. Our results showed that delivery of Myl4 expressing AAV9 to postnatal rat models rescued the symptoms of AF, indicating the therapeutic potential that early gene therapy intervention can achieve long-term effects in treating cardiac arrhythmias caused by gene mutations.