Atrial Fibrillation Symptoms Research Articles

Incidence and Predictors of Atrial Fibrillation in Cardiac Sarcoidosis: A Multimodality Imaging Study

BackgroundIn cardiac sarcoidosis (CS), the risk and predictors of new-onset atrial fibrillation (AF) are poorly known. ObjectivesThe authors evaluated the incidence and characteristics of AF in newly diagnosed CS. MethodsThe authors studied 118 patients (78 women, mean age 50 years) with AF-naive CS having undergone cardiac 18F-fluorodexoyglucose positron emission tomography (18F-FDG PET) at the time of diagnosis. Details of patient characteristics and medical or device therapy were collected from hospital charts. The PET scans were re-analyzed for presence of atrial and ventricular inflammation, and coincident cardiac magnetic resonance (CMR) studies and single-photon emission computed tomography (SPECT) perfusions were analyzed for cardiac structure and function, including the presence and extent of myocardial scarring. Detection of AF was based on interrogation of intracardiac devices and on ambulatory or 12-lead electrocardiograms. ResultsAltogether 34 patients (29%) suffered paroxysms of AF during follow-up (median, 3 years) with persistent AF developing in 7 patients and permanent AF in 4. The estimated 5-year incidence of AF was 55% (95% CI: 34%-72%) in the 39 patients with atrial 18F-FDG uptake at the time of diagnosis vs 18% (95% CI: 10%-28%) in the 79 patients without atrial uptake (P < 0.001). In cause-specific Cox regression analysis, atrial uptake was an independent predictor of AF (P < 0.001) with HR of 6.01 (95% CI: 2.64-13.66). Other independent predictors were an increased left atrial maximum volume (P < 0.01) and history of sleep apnea (P < 0.01). Ventricular involvement by PET, SPECT, or CMR was nonpredictive. Symptoms of AF prompted electrical cardioversion in 12 patients (35%). Three of the 34 patients (9%) experiencing AF suffered a stroke versus none of those remaining free of AF. ConclusionsIn newly diagnosed CS, future AF is relatively common and associated with atrial inflammation and enlargement on multimodality cardiac imaging.

Effects of Cognitive Behavior Therapy on Depression, Illness Perception, and Quality of Life in Atrial Fibrillation Patients.

BackgroundAF Patients with depression resulted in a markedly reduced quality of life. The purpose of this study was to evaluate the efficacy of cognitive behavior therapy (CBT) on the health-related quality of life (HRQoL).MethodsIt was A longitudinal randomized controlled trial with a pre and 12-weeks post-test. Ninety persons were randomly assigned to either a CBT group (CBT) (n = 45) or a treatment as usual (TAU) group (n = 45). The outcome were changes in the HRQoL [12-item Short Form Health Survey, SF12, divided into two domains: the physical component summary (PCS) and the mental component summary (MCS)], changes in psychological distress [Hamilton Depression Rating Scale (HAM-D) and Patient Health Questionnaire-9 (PHQ-9)], and Illness Perception [Brief Illness Perception Questionnaire (BIPQ)].ResultsThere were statistically significant differences in score reduction for PHQ-9 (t = 3.186, P = 0.002), HAMD (t = 2.611, P = 0.011), BIPQ (t = 7.660, P < 0.001), and MCS (t = 4.301, P < 0.001) between CBT group and TAU group.ConclusionsCBT improved HRQoL, Illness Perception and reduced Depressive symptoms in atrial fibrillation.

PO-680-08 P-WAVE DURATION AND ATRIAL FIBRILLATION RECURRENCE AFTER CATHETER ABLATION: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS

Atrial fibrillation (AF) is a global health problem with high morbidity and mortality. Catheter ablation (CA) can reduce AF burden and symptoms, but AF recurrence (AFr) remains an issue. Simple AFr predictors like P-wave duration (PWD) could help improve AF therapy.

Efficacy of Cryoballoon Ablation for Atrial Fibrillation and Recurrence Predictors in an Asian Cohort.

Background: Cryoballoon ablation (CBA) for atrial fibrillation (AF) is a rhythm control procedure used in clinical trials, mostly in Western countries. Its efficacy and the predictors of AF recurrence after CBA remain unclear for Asian populations. We aimed to investigate the efficacy of CBA and the predictors of AF recurrence after CBA in Asian AF patients. Methods: We included consecutive AF patients undergoing CBA for rhythm control between 2014 and 2020. The baseline characteristics, including AF types, symptom severity, and left atrial diameter (LAD), were analyzed. Holter’s monitoring and 12-lead ECG were performed to document AF recurrence. A multivariate Cox hazards regression model was used to evaluate the risk of AF recurrence. Results: A total of 120 AF patients (aged 61.9 ± 9.3 years) were included. The percentage of patients free from AF in the year following CBA was 74.2%. Among the three independent predictors of AF recurrence within one year were the presence of persistent AF (p = 0.025), an LAD ≥ 4.75 cm (p = 0.016), and pre-procedural cardioversion (p = 0.025). All patients survived and none had a stroke after CBA. Conclusion: CBA for AF is an effective and safe procedure in Asian populations. The presence of persistent AF, an LAD ≥ 4.75 cm, and severe symptoms are predictors of AF recurrence in the year following CBA.

Adherence to a Multidisciplinary Lifestyle Program for Patients With Atrial Fibrillation and Obesity: Feasibility Study.

BackgroundAtrial fibrillation is commonly associated with obesity. Observational studies have shown that weight loss is associated with improved prognosis and a decrease in atrial fibrillation frequency and severity. However, despite these benefits, nonadherence to lifestyle programs is common.ObjectiveIn this study, we evaluated adherence to and feasibility of a multidisciplinary lifestyle program focusing on behavior change in patients with atrial fibrillation and obesity.MethodsPatients with atrial fibrillation and obesity participated in a 1-year goal-oriented cardiac rehabilitation program. After baseline assessment, the first 3 months included a cardiac rehabilitation intervention with 4 fixed modules: lifestyle counseling (with an advanced nurse practitioner), exercise training, dietary consultation, and psychosocial therapy; relaxation sessions were an additional optional treatment module. An advanced nurse practitioner monitored the personal lifestyle of each individual patient, with assessments and consultations at 3 months (ie, immediately after the intervention) and at the end of the year (ie, 9 months after the intervention). At each timepoint, level of physical activity, personal goals and progress, atrial fibrillation symptoms and frequency (Atrial Fibrillation Severity Scale), psychosocial stress (Generalized Anxiety Disorder–7), and depression (Patient Health Questionnaire–9) were assessed. The primary endpoints were adherence (defined as the number of visits attended as percentage of the number of planned visits) and completion rates of the cardiac rehabilitation intervention (defined as performing at least of 80% of the prescribed sessions). In addition, we performed an exploratory analysis of effects of the cardiac rehabilitation program on weight and atrial fibrillation symptom frequency and severity.ResultsPatients with atrial fibrillation and obesity (male: n=8; female: n=2; age: mean 57.2 years, SD 9.0; baseline weight: mean 107.2 kg, SD 11.8; baseline BMI: mean 32.4 kg/m2, SD 3.5) were recruited. Of the 10 participants, 8 participants completed the 3-month cardiac rehabilitation intervention, and 2 participants did not complete the cardiac rehabilitation intervention (both because of personal issues). Adherence to the fixed treatment modules was 95% (mean 3.8 sessions attended out of mean 4 planned) for lifestyle counseling, 86% (mean 15.2 sessions attended out of mean 17.6 planned) for physiotherapy sessions, 88% (mean 3.7 sessions attended out of mean 4.1 planned) for dietician consultations, and 60% (mean 0.6 sessions attended out of mean 1.0 planned) for psychosocial therapy; 70% of participants (7/10) were referred to the optional relaxation sessions, for which adherence was 86% (mean 2 sessions attended out of mean 2.4 planned). The frequency of atrial fibrillation symptoms was reduced immediately after the intervention (before: mean 35.6, SD 3.8; after: mean 31.2, SD 3.3), and this was sustained at 12 months (mean 24.8, SD 3.2). The severity of atrial fibrillation complaints immediately after the intervention (mean 20.0, SD 3.7) and at 12 months (mean 9.3, SD 3.6) were comparable to that at baseline (mean 16.6, SD 3.3).ConclusionsA 1-year multidisciplinary lifestyle program for obese patients with atrial fibrillation was found to be feasible, with high adherence and completion rates. Exploratory analysis revealed a sustained reduction in atrial fibrillation symptoms; however, these results remain to be confirmed in large-scale studies.

Effect of an Exercise and Nutrition Program on Quality of Life in Patients With Atrial Fibrillation: The Atrial Fibrillation Lifestyle Project (ALP)

BackgroundStudies of separate exercise and weight loss interventions have reported improvements in quality of life (QoL) or reduction in atrial fibrillation (AF) burden. We investigated the impact of a structured exercise, nutrition, and risk-factor-modification program on QoL and AF burden. MethodsIn this trial, 81 successive patients with body mass index > 27 kg/m2 and nonpermanent AF were randomized to an intervention (n = 41) or control group (n = 40). The intervention consisted of cardiovascular risk management and a 6-month nutrition and exercise program, followed by a 6-month maintenance program. All participants received usual AF care. The primary end-point was QoL at 6 and 12 months. ResultsAt 6 months, we observed improved QoL among patients in the intervention group, relative to that among control-group patients (intervention (I) n = 34, control (C) n = 38) in the 36-item Short Form Survey Instrument scores on the subscales of vitality (I: 13.2 ± 20.4; C: 1.0 ± 14.9, P < 0.001), social functioning (I: 14.7 ± 24.1; C: 2.4 ± 21.2, P = 0.018), emotional well-being (I: 5.5 ± 14.1 ; C: –1.0 ± 13.3, P = 0.017), and general health perceptions (I: 8.1 ± 12.3; C: 2.7 ± 13.3, P = 0.009). At the 6-month follow-up, improvement in the scores on the subscales of vitality (P = 0.021) and emotional well-being (P = 0.036) remained significant. The burden of AF as measured by Holter monitor and Toronto AF symptom score was not significantly changed. ConclusionsA structured exercise and nutrition program resulted in significant sustained improvements in QoL, without reduction in AF burden. This type of program may provide an additional treatment for people with impaired QoL due to AF.

Automatic classification of atrial fibrillation from short single-lead ECG recordings using a Hybrid Approach of Dual Support Vector Machine

Millions of people worldwide are affected by cardiac arrythmias currently. One of the life threatening arrythmias associated with high morbidity and mortality is Atrial Fibrillation (AFr). Electrocardiogram (ECG) is regularly used in the diagnosis and evaluation of cardiac arrythmias. The goal of the ECG is to improve the outcome as well as reduce time to diagnosis in heart disease identification. Using an ECG makes the diagnosis of a cardiac arrythmia much easier. Cardiologists depend on the ECG signal to determine the appropriate treatment method of the cardiac arrythmia. In this work, cardiac segmentation was used to further evaluate and diagnose AFr based on ECG. The issue with segmentation is that it is complicated due to similarities in amplitude, time among different ECG signals as well as noise. In this paper, a comparative study is made on detection of Atrial Fibrillation using the top five-scoring methods submitted in the PhysioNet/Computing in Cardiology Challenge 2017. A new method based on a Hybrid Approach of Dual Support Vector Machine (HA-DSVM) is used for the detection of atrial fibrillation. This proposed method is accomplished by stochastic gradient descent with cross entropy loss function. The method is tested on the dataset collected from the 2017 Physionet/CinC challenge dataset with performance evaluation on training (99.27 %). Using this technique, an F1 score and accuracy of 0.95 and 99.27% can be obtained on the validation data set. One of the advantages of the proposed technique is the high reliability and accuracy which simplifies the extraction process and removal of detecting ECG signal fiducial points and removing hand-crafted features. This provides screening for a large population with a new method for diagnosing atrial fibrillation. The proposed method can be applied to many the population with symptoms of atrial fibrillation which will improve the accuracy of diagnosis and determine the required treatment.

Abstract P215: A Qualitative Exploration Of Barriers And Facilitators To A Cardiac Rehabilitation-based Weight Loss Program For Patients With Atrial Fibrillation And Obesity.

Background: Cardiac rehabilitation (CR) programs are ideal treatment settings for atrial fibrillation (AF) risk factor management, yet few CR curricula include a behavioral weight loss treatment (BWLT) component for patients with comorbid obesity (BMI ≥ 30 kg/m 2 ). Aim: To identify perceived barriers, facilitators, and preferences regarding CR with added BWLT among patients with AF and obesity using a qualitative descriptive approach. Methods: Patients (18+) with paroxysmal or persistent AF and obesity were recruited from a Canadian AF clinic. Patients completed questionnaires assessing socio-demographic variables and participated in semi-structured interviews to elicit their potential barriers, facilitators, and preferences regarding a proposed 12-week CR+BWLT program (i.e., twice-weekly supervised exercise, risk factor management, and weekly group-based cognitive-behavioral weight management support). Interviews were recorded and transcribed. Conventional content analysis was used to derive themes from qualitative data. Results: Twenty patients (9 women; 63±12 years; BMI=35.50±6.00 kg/m 2 ) participated. Data were categorized to describe patients' barriers, facilitators, and preferences/perspectives (Figure 1). Four overarching themes emerged from the categories: 1) frustration with weight management; 2) AF symptoms are manageable; 3) AF information needs; and 4) desire for program flexibility. Conclusion &amp; Future Directions: The proposal to offer BWLT alongside CR was acceptable to patients with AF and obesity, with most reporting few barriers to participating. The results will inform AF-specific adaptations to an established BWLT (e.g., modules on AF pathophysiology and exercise recommendations). The AF-adapted BWLT will be piloted in the target population prior to testing the full intervention package in a randomized controlled trial. The novel combination of CR+BWLT, tailored to an AF population, has potential to improve AF management and outcomes for patients with comorbid obesity.

Effects of Supervised Exercise Training on Atrial Fibrillation: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.

Atrial fibrillation (AF) is associated with the comorbidities of a sedentary lifestyle. Endurance athletes also show an increased incidence of AF. The role of exercise in the treatment of AF is unknown so this study aimed to examine the effects of supervised exercise on AF. A meta-analysis of randomized controlled trials (RCTs) examining supervised exercise training in participants with AF was performed. The primary outcome was AF recurrence and burden. Secondary outcomes included AF symptoms, quality of life, and cardiorespiratory fitness (CRF). Thirteen RCTs, involving 1155 participants, were included. Paroxysmal AF was present in 34% and persistent AF in 64%. The types of exercise were diverse and included cardiac rehabilitation (64%), aerobic training (7%), Qi Gong (4%), interval training (11%), and yoga (15%). Exercise training reduced AF recurrence (relative risk = 0.77: 95% CI, 0.60-0.99), improved quality of life in 5 of the 10 components of the Short Form 36 survey, and improved CRF (standardized mean difference [SMD] = 0.56: 95% CI, 0.27-0.85). The AF burden was reduced only in studies that included continuous ambulatory monitoring (SMD =-0.49: 95% CI, -0.96 to -0.01) but not when all studies were included (SMD =-0.12: 95% CI, -0.61 to 0.38). There was no difference in adverse events between exercise and control. Supervised exercise training is safe, reduces AF recurrence, and improves quality of life and CRF in participants with AF. Further large RCTs with ambulatory monitoring and robust exercise regimens are needed to assess the effects of exercise training on AF burden and AF symptoms.

Increase in heart rate-dependent left atrial pressure is associated with symptoms in patients with paroxysmal atrial fibrillation.

It remains unclear why some patients with the same heart rate during an atrial fibrillation (AF) have subjective symptoms, whereas others do not. We assessed the hypothesis that different responses of arterial and left atrial blood pressures to rapid stimulation may be associated with the symptoms of AF. A total of 110 patients who underwent catheter ablation for paroxysmal AF were retrospectively studied. Asymptomatic AF was defined as a European Heart Rhythm Association score of Ⅰ for AF-related symptoms. The left atrial pressure (LAP) was measured during sinus rhythm (SR), in 10 pacing per minute (ppm) increments from 100 ppm to the Wenckebach block rate in high right atrial pacing. Asymptomatic AF was observed in 19/110 patients (17%). Patients with symptomatic AF showed higher E/e' ratio and gradual LAP increase that was dependent on the pacing rate. Patients with asymptomatic AF had decreased LAP at 100 ppm compared that at SR, and thereafter, LAP gradually increased depending on the pacing rate. The rate of LAP change compared to that at SR was significantly lower in patients with asymptomatic AF than that in patients with symptomatic AF. The rate of LAP change was independently associated with AF symptoms. Patients with asymptomatic AF showed lower E/e' ratio and decreased LAP at 100 ppm to rapid stimulation, followed by a steady increase in LAP afterwards. Factors other than left ventricular diastolic dysfunction may be involved in AF symptoms.

Cardiac troponins and adverse outcomes in European patients with atrial fibrillation: A report from the ESC-EHRA EORP atrial fibrillation general long-term registry

BackgroundCardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear. AimTo assess the factors associated with cTn testing in routine practice and evaluate the association with outcomes. MethodsPatients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into 3 groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), (iii) cTn elevated (>99th percentile). The composite outcome of any thromboembolism /any acute coronary syndrome/cardiovascular (CV) death, defined as Major Adverse Cardiovascular Events (MACE) and all-cause death were the main endpoints. ResultsAmong 10 445 AF patients (median age 71 years, 40.3% females) cTn were tested in 2834 (27.1%). cTn was elevated in 904/2834 (31.9%) and in-range in 1930/2834 (68.1%) patients. Female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease, and atypical AF symptoms were independently associated with cTn testing. Elevated cTn were independently associated with a higher risk for MACE (Model 1, hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.40–2.16, Model 2, HR 1.62, 95% CI 1.28–2.05; Model 3 HR 1.76, 95% CI 1.37–2.26) and all-cause death (Model 1, HR 1.45, 95% CI 1.21–1.74; Model 2, HR 1.36, 95% CI 1.12–1.66; Model 3, HR 1.38, 95% CI 1.12–1.71). ConclusionsElevated cTn levels were associated with an increased risk of all-cause mortality and adverse CV events. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.

Matched comparison of catheter ablation versus conservative management for atrial fibrillation.

It is still controversial whether catheter ablation for atrial fibrillation (AF) could improve clinical outcomes in general AF population. Among 4398 patients with diagnosis of AF in the outpatient department of Kyoto University Hospital between January 2005 and March 2015, we identified 537 pairs of patients who received first-time catheter ablation (ablation group) or conservative management (conservative group), matched for age, gender, AF duration, AF type, AF symptoms, and previous heart failure (HF). The primary outcome measure was a composite of cardiovascular death, HF hospitalization, ischemic stroke, or major bleeding. Most baseline characteristics were well balanced between the 2 groups, except for the higher prevalence of low body weight, history of malignancy, and severe chronic kidney disease in the conservative group. Median follow-up duration was 5.3years. The cumulative 5-year incidence of the primary outcome measure was significantly lower in the ablation group than in the conservative group (5.2% versus 15.6%, log-rank P < 0.001). Even after adjusting for the imbalances in the baseline characteristics, the lower risk of the ablation group relative to the conservative group for the primary outcome measure remained highly significant (HR 0.32, 95% CI 0.21-0.47, P < 0.001). Ablation compared with conservative management was also associated with significantly lower risks for the individual components of the primary outcome. In this matched analysis in AF patients, ablation as compared with conservative management was associated with better long-term clinical outcomes, although we could not deny the possibility of selection bias and unmeasured confounding.

Cryoballoon ablation for paroxysmal atrial fibrillation in Japan: 2-year safety and efficacy results from the Cryo AF Global Registry

PurposeCatheter ablation is a recommended rhythm control therapy after failed or intolerant antiarrhythmic drug (AAD) treatment for patients with atrial fibrillation (AF). This study evaluates clinical performance and safety of pulmonary vein isolation (PVI) using the cryoballoon (Arctic Front Advance) in Japan.MethodsCryo AF Global Registry is a prospective, multi-center registry. Patients with paroxysmal AF (PAF) were treated at 10 Japanese hospitals. Efficacy was evaluated by freedom from a ≥ 30-s recurrence of AF/atrial flutter (AFL)/atrial tachycardia (AT), AF-related symptoms, and quality of life using the EQ-5D-3L questionnaire. The safety endpoint was serious device- and procedure-related adverse events.ResultsThe study included 352 patients with PAF (65 ± 10 years of age, 36% female, 36% without prior failure of AAD). Mean duration since first diagnosis of AF was 3.0 ± 5.5 years. Serious device- and procedure-related adverse event rate was 2.6% (95% CI: 1.2–4.8%). Freedom from AF/AFL/AT was 88.5% (95% CI: 84.7–91.4%) at 12 months and 86.7% (95% CI: 81.1–90.8%) at 24 months. The number of patients with ≥ 1 AF symptom was significantly decreased from 88% at enrollment to 22% (p < 0.01) at 12-month follow-up. General quality of life using EQ-5D did not improve significantly after 12 months in the summary score. However, in the visual analog scale score, there was improvement (5.8 ± 18.4; p < 0.01).ConclusionsThis study demonstrates that cryoablation used for PVI is a safe and effective treatment in real-world use for patients with PAF in Japan.

Detection of atrial fibrillation by implantable loop recorders following cryptogenic stroke: A retrospective study of predictive factors and outcomes

PurposeCryptogenic strokes account for 40% of ischemic strokes. Atrial fibrillation (AF) is a known cause of stroke. Current data shows that occult AF is detected by implantable devices at higher rates than conventional monitoring. The objective of this study was to investigate risk factors and outcomes associated with AF detection by implantable loop recorders (ILRs) in patients with cryptogenic stroke. MethodsWe conducted a retrospective study of 172 patients admitted with cryptogenic stroke at Ascension St John and Macomb-Oakland Hospitals who had ILRs placed from 1/1/2016 to 1/31/2020. AF detection was defined as sustained AF for 30 s. ResultsThe incidence of AF detection by ILR was 14% (24/172) over a mean follow-up of 12.75 ± 10.71 months. The mean duration of monitoring prior to AF detection was 4.5 months. The median duration of AF was 6 min. With univariable analysis, older age (p = 0.03), male sex (p = 0.09), embolic stroke pattern on imaging (p = 0.06), and presence of symptoms (p = 0.001) were associated with AF detection. Using multivariable analysis, patients with AF were more likely to be older (OR = 1.04, p = 0.04), male (OR = 3.6, p = 0.03), symptomatic (OR = 6.3, p = 0.01), and had embolic stroke pattern (OR = 3.3, p = 0.04). 95.8% of patients with AF were started on anticoagulation for secondary stroke prevention. ConclusionIn patients with cryptogenic stroke, age, sex, stroke pattern, and presence of AF symptoms are independent predictors of AF detection by ILR. Most patients with AF were started on anticoagulation for secondary stroke prevention.

Comparing Patient and Provider Experiences with Atrial Fibrillation to Highlight Gaps and Opportunities for Improving Care.

Atrial fibrillation (AF), the most common abnormal heart rhythm, places a considerable burden on patients, providers, and the US healthcare system. The purpose of this qualitative study was to compare patients' and providers' interpretations and responses to AF symptoms and to identify where treatment can be improved to better address patient needs and well-being. Qualitative design using focus groups with patients (3 groups) and providers (3 groups). Patients with physician-confirmed AF (n=29) and cardiologists, primary care physicians, and cardiac nurses (n=24). Focus groups elicited patient and provider perspectives regarding the symptom experience of AF, treatment goals, and gaps in care. Patient and provider transcripts were analyzed separately, using a thematic content analysis approach, and then compared. While patients and providers described similar AF symptoms, patients' illness experiences included a wider range of symptoms that elicited anxiety and impacted quality of life (QOL) across many biopsychosocial domains. Patients and providers prioritized different treatment goals. Providers tended to focus on controlling symptoms congruent with objective findings, minimizing stroke risk, and restoring sinus rhythm. Patients focused on improving QOL by reducing medication use or procedures. Both patients and providers struggled with patients' cardiac-related anxiety. Patients expressed an unmet need for education and support. Patients with AF experience a range of symptoms and QOL issues. While guidelines recommend shared-decision making, discordance between patient and provider perspectives on the importance, priority, and impact of patients' perceived AF symptoms and consequent cardiac anxiety may result in differing treatment priorities. Starting from a perspective that contextualizes AF in the broader context of patients' lives, prioritizes QOL, and addresses symptom-specific anxiety as a prime concern may better address patients' unmet needs.

Факторы, ассоциированные с тяжестью течения тиреотоксической фибрилляции предсердий

Aim: to identify factors associated with the symptom severity of thyrotoxic atrial fibrillation (TAF). Patients and Methods: this retrospective study included 70 patients with overt hyperthyroidism and TAF. The following parameters were used to assess TAF severity: the type of atrial fibrillation (AF); functional class (f.c.) of the heart failure (HF) and the ejection fraction (EF) coexisting with AF; evaluation of AF-related symptoms using the European Heart Rhythm Association score (EHRA); and the ventricular contraction rate (VCR) during AF. Clinical features, medical history and echocardiographic parameters were compared in patients with different TAF severity to determine factors, associated with severe clinical course of TAF, meeting the following criteria: persistent type of AF; III-IV f.c. of the heart failure; EF&lt;50%; EHRA 3–4; and VCR ≥90 per minute. Results: as regards the clinical features and medical history, only male gender was considered as a predictor of the severe course of TAF defined as follows: the persistent type of AF, a decrease in EF&lt;50%, the development of heart failure III-IV f.c., and the severe AF symptoms (EHRA 3–4). The echocardiographic parameters: the left atrium diameter was associated with the type of AF, and the left ventricle mass index was associated with EHRA symptom severity class. Both parameters were associated with the heart failure f.c. and the EF during TAF. Conclusion: factors associated with the symptom severity of TAF, were identified in the study. These findings could be used for predicting the clinical course of TAF and, in the future, for optimizing the guidelines for the management of patients with TAF. KEYWORDS: thyrotoxicosis, hyperthyroidism, atrial fibrillation, thyrotoxic atrial fibrillation, Graves’ disease. FOR CITATION: Ponomartseva D.A., Babenko A.Yu. Factors associated with the symptom severity of thyrotoxic atrial fibrillation. Russian Medical Inquiry. 2022;6(9):494–500 (in Russ.). DOI: 10.32364/2587-6821-2022-6-9-494-500.

684 Cardiac troponins and adverse outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EORP atrial fibrillation general long-term registry

Abstract Aims Cardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear. To assess the factors associated with cTn testing in routine clinical practice and to evaluate the association of elevated levels of cTn with adverse outcomes in a large contemporary cohort of European AF patients. Methods and results Patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into three groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), and (iii) cTn elevated (&amp;gt;99th percentile). The composite outcome of any thromboembolism/any acute coronary syndrome (ACS)/cardiovascular (CV) death, defined as major adverse cardiovascular events (MACE) and all-cause death were the main endpoints. 10 445 (94.1%) AF patients were included in this analysis [median age 71 years, interquartile range (IQR): 63–77; males 59.7%]. cTn were tested in 2834 (27.1%). Overall, cTn was elevated in 904 (8.7%) and in-range in 1930 (18.5%) patients. Patients in whom cTn was tested tended to be younger (P &amp;lt; 0.001) and more frequently presenting with first detected AF and atypical AF-related symptoms (i.e. chest pain, dyspnoea, or syncope) (P &amp;lt; 0.001). On multivariable logistic regression analysis, female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease (CAD), and atypical AF symptoms were independently associated with cTn testing. After a median follow-up of 730 days (IQR: 692–749), 957 (9.7%) composite endpoints occurred while all-cause death was 9.5%. Kaplan–Meier analysis showed a higher cumulative risk for both outcomes in patients with elevated cTn levels (Figure) (Log Rank tests, P &amp;lt; 0.001). On adjusted Cox regression analysis, elevated levels of cTn were independently associated with a higher risk for MACE [hazard ratio (HR): 1.74, 95% confidence interval (CI): 1.40–2.16] and all-cause death (HR 1.45, 95% CI: 1.21–1.74). Elevated levels of cTn were independently associated with a higher occurrence of MACE, all-cause death, any ACS, CV death and hospital readmission even after the exclusion of patients with history of CAD, diagnosis of ACS at discharge, those who underwent coronary revascularization during the admission and/or who were treated with oral anticoagulants plus antiplatelet therapy. Conclusions Elevated cTn levels were independently associated with an increased risk of all-cause mortality and adverse CV events, even after exclusion of CAD patients. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.

Diagnosis difficulties in elderly patients with atrial fibrillation and complete atrioventricular block

The association of atrial fibrillation (AF) with complete atrioventricular block (CAVB) is a common clinical feature in elderly patients. It is characterized by the loss of specific symptoms of AF (palpitations, intermissions); in the first place may come CAVB symptoms: dizziness, Morgagni–Adams–Stokes (MAS) attacks. Aim. The article objective is to illustrate the dynamic changes in the course of AF with the development of CAVB on the example of a clinical case and to discuss the difficulties in timely diagnosis and therapy correction. Case presentation. A 75-year-old male was diagnosed with a rapid ventricular response form of AF. The onset of CAVB caused the transition from rapid ventricular response form of AF to slow ventricular response form, which was initially accompanied by a subjective improvement in the patient’s condition. As the disease progressed, the patient’s condition worsened due to the development of MAS attacks. The elderly patients with a permanent form of AF require constant cardiac monitoring by an experienced specialist who has appropriate vigilance in management of patients with arrhythmias, awareness about possible concomitant conduction disorders. This provides comprehensive cardiac support, including timely pacemaker implantation which gives more options for AF symptoms monitoring and heart rate control, has a positive modifying effect on drug therapy. Conclusions. Changes in the clinical picture of AF after development of CAVB can lead to late diagnosis of CAVB, inadequate therapy and untimely pacemaker implantation, as a consequence, to progression of concomitant pathology and the development of life-threatening complications, as in our clinical case.

Risk factor management of atrial fibrillation using mHealth: The Atrial Fibrillation – Helping Address Care with Remote Technology (AF-HEART) Pilot Study

BackgroundPersonalized treatment of atrial fibrillation (AF) risk factors using mHealth and telehealth may improve patient outcomes.ObjectiveThe purpose of this study was to assess the feasibility of the Atrial Fibrillation Helping Address Care with Remote Technology (AF-HEART) intervention on the following patient outcomes: (1) heart rhythm tracking; (2) weight, alcohol, blood pressure (BP), and sleep apnea reduction; (3) AF symptom reduction; and (4) quality-of-life (QOL) improvement.MethodsA total of 20 patients with AF undergoing antiarrhythmic therapy, cardioversion, and/or catheter ablation were enrolled and followed for 6 months. The AF-HEART intervention included remote heart rhythm, weight, and BP tracking; televisits with a dietician focusing on AF risk factors; and referrals for sleep apnea and hypertension treatment.ResultsPatients transmitted a median of 181 rhythm recordings during the 6-month follow-up period. Patients lost an average of 3.5 kilograms at 6 months (P = .005). Patients had improved SF-12 scores (P = .01), AFSS score (P = .01), EQ-5D score (P = .006), and AFEQT Global Score (P = .03). There was significant correlation between weight loss and decrease in symptom severity (r = -0.45, P = .05), and between % weight loss and decrease in symptom severity (r = -0.49, P = .03).ConclusionThis study described the feasibility of the AF-HEART intervention for (1) consistent remote tracking of heart rhythm, weight, and BP; (2) achievement of weight loss; (3) reduction of symptoms; and (4) improvement in QOL. Expansion to a larger randomized study is planned.

Circulating biomarkers, echocardiographic parameters, and incident subclinical atrial fibrillation in patients with diabetes and hypertension.

Long-term rhythm monitoring (LTRM) can detect undiagnosed atrial fibrillation (AF) in patients at high risk of AF and stroke. Biomarkers and echocardiographic parameters could, however, help identify patients benefitting most from LTRM. The aim of this study was to investigate, whether circulating biomarkers of cardiac and vascular function (brain natriuretic peptide (BNP), cardiac troponin I (cTnI), copeptin, and mid-regional proadrenomedullin (MR-proADM)) and echocardiographic parameters were associated with incident subclinical AF (SCAF) in a population at high risk of stroke in the presence of AF. For this purpose, we investigated individuals ≥65 years of age with hypertension and diabetes mellitus, but no history or symptoms of AF or other cardiovascular disease (CVD). We included 82 consecutive patients (median age 71.3 years (IQR 67.4-75.1)). All patients received an insertable cardiac monitor (ICM) and were followed for a median of 588 days (IQR 453-712). On the day of ICM implantation, a comprehensive echocardiogram and blood samples were obtained. During a median follow-up of 588 days (IQR: 453-712 days), incident SCAF occurred in 17 patients (20.7%) with a median time to first-detected episode of 91 days (IQR 41-251 days). MR-proADM (median 0.87nmol/L (IQR 0.76-1.02) vs 0.78nmol/L (IQR 0.68-0.98)) and copeptin (median 13pmol/L (IQR 9-17) vs 8pmol/L (IQR 4-18)) levels were insignificantly higher in patients with incident SCAF. BNP and cTnI concentrations and echocardiographic parameters were similar in the two groups. MR-proADM, BNP, cTnI, copeptin, and several echocardiographic parameters were not associated with incident SCAF in this cohort of patients with hypertension and diabetes, but without any underlying CVD.