bluuebunny/crossref_metadata_2025 huggingface dataset:
The eligibility of patients with an inherited cardiac disease for therapy with a subcutaneous implantable cardioverter-defibrillator
Authors: Proost V M , Van Der Stuijt W , Pepplinkhuizen S , Knops R E , Wilde A A M
Published: October 2022

Introduction

The subcutaneous implantable cardioverter-defibrillator (S-ICD) is considered especially beneficial in young patients with an inherited cardiac disease, but data on these patient groups is limited.

Purpose

To evaluate the eligibility of patients with an inherited cardiac disease for therapy with a subcutaneous implantable cardioverter-defibrillator

Methods

We retrospectively analysed all patients with an inherited cardiac disease who received an S-ICD in our tertiary center between February 2009 and June 2021. ECG parameters and data on appropriate and inappropriate shocks were collected. Different diagnoses were compared using a chi-square test.

Results

We analysed 109 patients who were diagnosed with IVF (DPP6-based, N=41, 37.6%), HCM (N=36, 33.0%), Brugada syndrome (BrS, N=13, 11.9%), ARVC (N=9, 8.3%), PLN (N=3, 2.8%), LQTS (N=2, 1.8%) and other cardiomyopathies (N=5, 4.6%). Mean follow-up was 5.5±3.4 years. ECG parameters did not significantly change during follow-up. HCM patients were most likely to receive an appropriate shock (10/36, P=0.01), followed by ARVC (2/9, P=0.57) and Brugada patients (1/13, P=0.40). Patients with LQTS had most frequently inappropriate shocks (1/2, P=0.06), followed by BrS (4/13, P=0.008) and HCM patients (4/36, P=0.8).

Conclusion

Patients with an inherited cardiac disease are eligible for S-ICD therapy, but comes with a risk of inappropriate shocks, especially in patients with LQTS and BrS.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation (CVON 2018-10 PREDICT2)
Single-chamber versus dual-chamber pacing in very elderly patients with sinus node disease and AV block: a real-world study
Authors: Bedir A , Nageye F , Cherek P , Godley C , Ghani S , Cheong J , D'Souza S , Cecaro F , Petzer E , Martin W , Kabunga P
Published: October 2022

Background

Elderly patients with sinus-node disease, have been reported to have better clinical outcomes with dual-chamber pacing compared with single chamber pacing. In contrast, randomized studies have shown no clinical benefit of dual-chamber pacing compared to single-chamber pacing in the elderly with high grade AV block., For truly elderly patients (>80 years), the optimal choice of pacing mode remains uncertain. In this real-world observational study, we analysed the clinical outcomes in a cohort of very elderly patients.

Methods

We analysed retrospective data of all new pacemaker implantations for sinus node disease or high-grade atrioventricular block in patients ≥80 years a district general hospital in south-east England, UK over a 7-year period. Patients with an existing diagnosis of stroke, congestive cardiac failure and/or atrial fibrillation (AF) were excluded from the study. Patients were categorised into two analysis cohorts based on pacing mode, i.e dual chamber (DDD) pacing versus single chamber (VVI) pacing. Clinical outcome data including all-cause mortality, new onset AF and CCF were recorded.

Results

A total of 208 patients were included in the study, of which 117 received (DDD) pacing vs 91 who underwent VVI pacing. The mean age was 85.8 years (84.63 DDD, 87.3 VVI, p=0.01). Single chamber pacing was associated with greater all-cause mortality (51.7% vs 31.5%, p=0.01). 23.1% of patients who underwent DDD pacing developed AF, vs 21.9% who underwent VVI pacing (p=0.85). Congestive cardiac failure was observed in 6.48% of patients who received DDD pacing vs 8.14% of patients who received VVI pacing, (p=0.66).

Conclusions

In this real-world observational study of very elderly patients with sinus node disease and/or high-grade AV block, single chamber pacing was associated with a greater all-cause mortality. However, the pacing mode did not affect the incidence of atrial fibrillation and congestive cardiac failure.

Funding Acknowledgement

Type of funding sources: None.
Prediction model for left ventricular ejection fraction recovery in atrial fibrillation-induced cardiomyopathy
Authors: Arroyo Monino D F , Izquierdo Bajo A , Fernandez Valenzuela M I , Bastos Amador P , Cozar Leon R , Diaz Infante E
Published: October 2022

Introduction

Arrhythmia-Induced Cardiomyopathy (AIC) is a cardiac disfunction secondary to fast, asynchronous or irregular ventricular contraction. Its diagnosis is usually retrospective, subsequently of the recovery of the left ventricle ejection fraction (LVEF) after controlling the responsible arrythmia (most frequently atrial fibrillation (AF)).

Objective

Our aim is to try to estimate the recovering of LVEF in patients diagnosed of AIC caused by AF, based on individual baseline characteristics.

Methods

Retrospective analysis of patients diagnosed with AIC related to AF between January 2015–2022. Clinical and demographic characteristics, as well as echocardiographic parameters prior to diagnosis and after recovery of ventricular function, were assessed. Recovered LVEF (final minus initial LVEF) was calculated in all patients. The best model was selected from the method of all possible equations, the one with the lowest Mallows Cp index, maintaining a sufficiently high multiple correlation coefficient (R2).

Results

134 patients with AIC were gathered in this period, 99 of them AF-related. Baseline characteristics are summarized in Image 1. The changes in the values of LVEF, left ventricle end-diastolic diameter and (LVEDD), tricuspid annular plane systolic excursion (TAPSE), which represents both left and right ventricular ejection fraction are showed in Image 2. The LVEF recoveredwith treatment was 22±8,5%.

The model was selected using up to 16 potential variables: age, sex, chronic kidney disease (CKD), obesity, enolism, hypertension, diabetes, obstructive sleeping apnoea (OSA), LVEF at the diagnosis, heart rate at diagnosis, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists (MRA), ablation performed, rhythm control strategy and the interaction between ablation andrhythm control (the latter being rejected because of collinearity).

32.767 models were estimated. The best model was: Recovered LVEF = 51.79 + 1.15×Female Sex − 1.11×OSA − 4.40×RNI − 091×LVEF at diagnosis + 3.43×Rhythm control. The Cp of the selected model was 2.07 and R2 0.496, which means that 49.6% of individual variability of recovered LVEF was justified by this simple model.

After that, we performed an internal control using cross-validation, which did not show significative differences according to the estimation ability of the model (0.496 − 0.474 = 0.022, <10%).

Conclusion

Female sex, absence of OSA, the lower the LVEF at the diagnosis, the absence of treatment with ARNI and the rhythm control as the treatment strategy predicted higher LEVF recovery in patients with AIC caused by AF, explaining nearly half to the individual variability.

Funding Acknowledgement

Type of funding sources: None.
Atrial fibrillation incidence in SARS-CoV-2 infected patients: predictors and relationship with in-hospital mortality
Authors: Maloberti A , Giannattasio C , Rebora P , Occhino G , Ughi N , Fabbri S , Cartella I , Algeri M , Scarpellini S , Rossetti C , Epis O M , Molon G , Bonfanti P , Valsecchi M G , Genovesi S
Published: October 2022

Background

Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality.

Methods

We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes.

Results

145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn't present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)

Conclusion

AF present as the main arrhythmia in COVID-19 patients and its development during the hospitalization strongly relates with in-hospital mortality.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): ASST GOM Niguarda Ca' Granda, Milan, Italy
Cerebral hemodynamics during atrial fibrillation: computational fluid dynamics (CFD) analysis of lenticulostriate arteries using 7T high-resolution magnetic resonance imaging
Authors: Saglietto A , Scarsoglio S , Tripoli F , Zwanenburg J J M , Biessels G J , Ridolfi L , De Ferrari G M , Anselmino M
Published: October 2022

Background

Lenticulostriate arteries (LSAs) are small perforating arteries (0.1–1 mm diameter), perpendicularly departing from middle cerebral artery (MCA) and supplying blood flow to important cerebral subcortical and basal ganglia areas. LSAs are involved in silent strokes and cerebral small vessel disease, potentially leading to cognitive decline and vascular dementia. There is growing evidence that atrial fibrillation (AF), the most common cardiac arrhythmia, increases the risk of dementia even in the absence of clinical strokes. AF also increase the risk of small vessel disease. AF may alter deep cerebral hemodynamics per se, however no data exists regarding a possible impact of AF on MCA-LSA branching sites hemodynamics.

Purpose

To use computational fluid dynamics (CFD) analysis to study the hemodynamics of LSAs-MCA branching sites.

Methods

7T high-resolution magnetic resonance imaging (HR-MRI) brain scans (Figure 1, panel a) were used to derive detailed geometrical models of LSAs-MCA branching sites. CFD analysis was then conducted, simulating AF conditions as well as sinus rhythm (SR), at different ventricular rates (from 50 to 130 bpm).

Results

Geometrical models were retrieved from HR-MRI scans of 7 patients. By means of the most significant metrics, such as wall shear stress (WSS; Figure 1, panel b), wall shear stress gradient (WSSG), and flow velocity (FV), a comparison between SR and AF was performed.

Conclusion

CFD analysis of LSAs-MCA branching sites using geometrical models derived from HR-MRI brain scans was feasible and allows to quantify the impact of AF on these critical ramifications of the MCA.

Funding Acknowledgement

Type of funding sources: None.
Evaluating the reversibility potential of atrial cardiomyopathy on a clinical and cellular level
Authors: Wiedmann F , Paasche A , Yesilgoez B , Kraft M , Blochberger P L , Frey N , Schmidt C
Published: October 2022

Background

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with various remodelling processes of the electrical and structural properties of the atrium, collectively referred to as atrial cardiomyopathy. Because these remodelling processes contribute significantly to the high recurrence rates and chronification of AF, the exact time course of their development and their reversion potential need to be further characterized.

Purpose

To investigate the time course and reversibility of atrial cardiomyopathy on a clinical, cellular and molecular level.

Methods

A clinically relevant porcine large animal model was used to study the structural and functional implications of atrial cardiomyopathy after different periods of burst pacing-induced AF (2, 4 and 8 weeks) and after a recovery period, following electrical cardioversion. The pigs were clinically characterized at each time point by echocardiography, cardiac MRI, and electrophysiological studies. After extraction of the heart, action potentials (APs) and ionic currents were measured on isolated atrial cardiomyocytes (CM) using the patch-clamp technique.

Results

After 4 weeks of AF induction, APD90 of isolated atrial cardiomyocytes was attenuated by 26%. Extending the AF induction period to 8 weeks caused an even stronger APD90 reduction by one-third, compared to SR controls. Accompanying, the TASK-1 current density was strongly upregulated in AF pigs. Those observations were in line with significant changes of the right atrial effective refractory period (AERP). At baseline, AERPS1=400 ms yielded 186 ms, whereas it was reduced to 141 ms after eight weeks of AF. Addressing the reversibility of those changes, following cardioversion of AF and an 8 week long SR recovery period, AERP baseline values were almost restored. Likewise, APD90 shortening was partially reversed. Furthermore, indication of reversibility of AF-associated remodelling was also observed on a structural level. After eight weeks of AF induction, echocardiography revealed severe dilatation of both atria, whereas atrial diameters decreased significantly after restoration of SR.

Conclusion

Remodelling processes underlying atrial cardiomyopathy display a partial reversibility upon restoration and maintenance of SR.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DFG German Research Foundation
Blunted atrial reverse remodeling a year after catheter ablation for atrial fibrillation and their long-term rhythm outcome
Authors: Kim M H , Hwang I , Park J W , Yu H T , Kim T H , Uhm J S , Joung B , Lee M H , Pak H N
Published: October 2022

Background

Although active rhythm control by atrial fibrillation (AF) catheter ablation (AFCA) reduces left atrial (LA) dimension, blunted atrial reverse remodeling can be observed in patients with significant atrial myopathy. We explored the characteristics and long-term outcomes of AF patients who showed blunted atrial reverse remodeling despite no AF recurrence within a year after AFCA.

Methods

Among a total of 2,756 patients with AFCA, we included 1,685 patients (74.8% male, 60.2±10.1 years old, 54.5% paroxysmal AF) who underwent both baseline and 1-year follow-up echocardiogram, baseline LA>40mm, and did not recur within a year. We divided them into tertile groups (T1–T3) based on one-year percent change of LA dimension after propensity matching for age, sex, AF type, and baseline LA dimension. We also investigated the patients' genetic characteristics with blunted LA reverse remodeling (T1) using a genome-wide association study (GWAS).

Results

Patients with blunted LA reverse remodeling (T1, n=424) were independently associated with body mass index (OR 1.082 [1.010–1.160], p=0.025), LA peak pressure (OR 1.010 [1.002–1.019], p=0.019), LA wall thickness (OR 0.448 [0.252–0.789], p=0.006), LA voltage (OR 0.651 [0.463–0.907], p=0.012), and pericardial fat volume (OR 1.004 [1.001–1.008], p=0.014). Throughout 65.9±37.4 months of follow-up, the incidence of AF recurrence a year after the procedure was significantly higher in the T1 group than in T2 or T3 groups (Log-rank p<0.001). Among 894 patients with GWAS, ATXN1, XPO7, KRR1_PHLDA1, ZFHX3, and their polygenic risk score were associated with blunted LA reverse remodeling.

Conclusions

Patients with blunted LA reverse remodeling after AFCA were independently associated with low LA voltage, thin wall thickness, high LA pressure, and fat volume, and have a genetic background. Long-term clinical recurrence a year after AFCA was higher in this patient group with suspicious atrial myopathy.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and WelfareNational Research Foundation of Korea
Micronutrient deficiencies and new-onset atrial fibrillation in a community-based cohort: data from PREVEND
Authors: Al Mubarak A A , Grote Beverborg N , Zwartkruis V , Van Deutekom C , De Borst M H , Gansevoort R T , Bakker S J L , Touw D J , De Boer R A , Van Der Meer P , Rienstra M , Bomer N
Published: October 2022

Background

Impaired nutritional status has been linked to cardiovascular diseases. Both selenium and iron deficiency have been associated with impaired exercise tolerance and worse prognosis in patients with heart failure (HF) as well as mitochondrial dysfunction in human cardiomyocytes. With exception of magnesium, little is known about the role of micronutrients in the development of atrial fibrillation (AFib).

Purpose

To elucidate the association of micronutrient deficiencies with new-onset AFib.

Methods

Selenium, magnesium and iron parameters were measured in a well-characterized Dutch prospective cohort study (N=5452). Selenium deficiency was defined as selenium <70 μg/L, iron deficiency as ferritin <30 μg/L, and magnesium deficiency as magnesium <0.85 mmol/L. New-onset AFib was the primary outcome. All cases with suspected AFib as determined by electronic screening based on 12-lead ECG were manually reviewed and validated by 2 independent cardiologists. Competing-risk regression analyses were performed with death as a competing risk. Additionally, we tested for interaction between selenium deficiency and smoking status on the outcome because of the known lower serum selenium concentrations in smokers in various cohorts.

Results

The mean age was 53.3 (12.0) years and 2843 (52.1%) of all participants were women. During a mean follow-up of 6.2 years, 136 (2.5%) participants developed new-onset AFib. Of the participants who developed AFib, 25.7% had selenium deficiency, 5.1% had iron deficiency, and 75% had magnesium deficiency, compared to 21.1%, 14.9% and 65.8% of those who did not develop AFib, respectively. Smoking status significantly interacted with selenium deficiency on outcome (p=0.075). After multivariable adjustment for components of the CHARGE-AF model, selenium deficiency was associated with new-onset AFib in non-smokers (HR: 1.69, 95% CI: 1.08 to 2.66, p=0.022), but not in smokers (HR: 0.71, 95% CI: 0.27 to 1.90, p=0.494). There was no significant association between the new-onset AFib and magnesium deficiency (HR: 1.40, 95% CI: 0.93 to 2.12, p=0.108) or iron deficiency (HR: 0.59, 95% CI: 0.23–1.49, P=0.266). Participants with two or more deficiencies had higher risk to develop AFib compared to those without deficiencies (HR: 1.75, 95% CI: 1.00 to 3.06, p=0.050).

Conclusion

In a community-based cohort, selenium deficiency was associated with new-onset AFib in non-smoking participants. Interventional studies that investigate the effects of optimizing micronutrients status in a population at risk are needed to assess causality, especially in those with selenium deficiency.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): ENW-KLEIN grantthe Junior Scientific Masterclass-MD/PhD program of the UMCG
Impact of sex on the incidence of atrial fibrillation in the community setting: a systematic review and meta-analysis
Authors: Ali O , Sowah Quarshie L , Ali M , Vassiliou V
Published: October 2022

Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with significant morbidity and mortality. By 2060, it is estimated that 18 million adults over 55 years will have AF in the European Union, and significant healthcare costs are projected to accompany this substantial increase in prevalence. Sex plays a major role in its pathogenesis, but conflicting results have been reported on whether the risk of new-onset AF differs between men and women.

Purpose

Undertake a systematic review and meta-analysis of epidemiological studies comparing incidence of new-onset AF between men and women in the community setting.

Methods

We searched PubMed Medline and Ovid Embase for longitudinal studies from their inception to March 2021. We selected studies if they presented sex-specific incidence estimates of new-onset AF for participants without a prior history of AF. We assessed the risk of bias from methodological quality using the Newcastle Ottawa Scale (NOS). We pooled data using a random-effects model with inverse-variance weighting approach, and carried out subgroup analyses to explore heterogeneity based on age and sampling population. Risk ratio (RR) and 95% confidence interval (CI) were generated to compare the incidence of new-onset AF between men and women.

Results

A total of 54 prospective cohort studies met the inclusion criteria and were systematically reviewed. Of these, 45 with data on a total of 10,530,623 participants (40% women) were included in the meta-analysis. Pooled analysis demonstrated that men had a statistically significant higher risk of developing new-onset AF than women (RR 1.53; 95% CI 1.42–1.64; p<0.00001) and this result remained robust on sensitivity analysis. The sampling population subgroup analysis suggests that the risk in men could be even higher based on studies that were part of health screening programmes (RR 2.88; 95% CI 2.16–3.83; p<0.00001). However, the age subgroup analysis suggests that no statistically significant difference exists between the sexes beyond 50 years (RR 1.19; 95% CI 0.96–1.46; p=0.11).

Conclusion

This systematic review unequivocally demonstrates that men have a higher risk of new-onset AF than women in the general population. Future research could address the usefulness of screening programmes and provide more empirical evidence for the elderly.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Wolfson Foundation
Influence of obesity and overweight on the association between sleep-disordered breathing and atrial fibrillation: the DASAP-HF study
Authors: Boriani G , Diemberger I , Pisano' E C L , Pieragnoli P , Locatelli A , Capucci A , Talarico A , Zecchin M , Rapacciuolo A , Piacenti M , Indolfi C , Arias M A , Checchinato C , D'Onofrio A
Published: October 2022

Background

The association between sleep apnea (SA) and atrial fibrillation (AF) has been well described. However, it remains unclear whether the association is causative or primarily dependent on shared comorbidities such as obesity. The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, whether central or obstructive in origin.

Purpose

In the present analysis we studied in patients with heart failure the contribution of obesity in the relationship between SA, measured by RDI, and AF.

Methods

Patients with ejection fraction ≤35% implanted with an ICD endowed with an algorithm (ApneaScan) that calculates the RDI each night, were enrolled and followed-up for 24 months. The weekly mean RDI value was considered, as calculated during the entire follow-up period. The endpoint was daily AF burden of ≥6 hours.

Results

164 patients (age 67±10 years, 75% male, ejection fraction 29±5%) had usable RDI values during the entire follow-up period. Body mass index (BMI) was <25 kg/m2 in 62 patients (normal), 25.0–29.9 kg/m2 in 66 patients (overweight), ≥ 30 kg/m2 in 36 patients (obese). When compared with normal patients (31±11 episodes/h), the average RDI value calculated during the entire follow-up period did not differ in overweight patients (35±13 episodes/h, p=0.114), but was significantly higher in obese patients (39±12 episodes/h, p=0.002). During follow-up, AF burden ≥6 hours/day was documented in 48 (29%) patients (BMI ≥ versus <25 kg/m2; HR: 1.47, 95% CI: 0.83–2.60, p=0.197; BMI ≥ versus <30 kg/m2; HR: 0.98, 95% CI: 0.46–2.09, p=0.963). Based on the ROC curve analysis, average RDI ≥37 episodes/h maximized sensitivity and specificity for the prediction of AF (Area under the curve: 0.63, 95% CI: 0.55–0.70, p=0.011). Device-detected RDI ≥37 episodes/h was associated with the occurrence of AF on univariate analysis (HR: 3.88, 95% CI: 2.02–7.44, p<0.001), as well as after correction for either BMI ≥25 kg/m2 (HR: 3.76, 95% CI: 1.94–7.26, p<0.001), or BMI ≥30 kg/m2 (HR: 4.15, 95% CI: 2.15–8.04, p<0.001).

Conclusions

In heart failure patients, we confirmed the association between ICD-detected SA and AF, an association that persisted independent of patient body habitus.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The study is supported by a research grant from Boston Scientific
Prevalence of atrial fibrillation – a comprehensive nationwide analysis in Finland
Authors: Lehto M , Haukka J , Halminen O , Mustonen P , Putaala J , Linna M , Aro A , Hartikainen J , Airaksinen K E J
Published: October 2022

Introduction

Prevalence of atrial fibrillation (AF) is strongly associated with age, and with longer life-time expectancy number of AF patients is worldwide strongly increasing. However, nationwide prevalence of AF is not known when primary care data as well is accessible.

Purpose

The FinACAF-study is a nationwide registry study including of all AF patients searched from all available national health care registers. To our knowledge, this is the first nationwide AF study including both primary, secondary, and tertiary health care register data. The aim of this study was to assess the prevalence of AF in unselected nationwide population in Finland.

Methods

In the FinACAF study we gathered data of all AF patients (hospitalizations and outpatient specialist visits and primary health care, and National Reimbursement Register) from all national health care registers from 01st January 2004 to 31st December 2018. The annual prevalence on December 31st of each year 2007–2018 was calculated as the cumulative number of patients alive with AF divided by the number of Finnish population on the last day of that year. The prevalence is presented for population ≥20 years, and with the entire population as the background population, as well as for populations ≥65 years, and ≥75 years.

Results

In total, 411,387 patients with the diagnosis of AF were documented during 2004–2018 in Finland. The number of adult patients with AF at the end of the study period in 2018 was 226,847, corresponding to an AF prevalence of 5.2% in the age group ≥20 years. The prevalence in the total Finnish population was 4.1%. The prevalence rates increased remarkably with increasing age and were higher in men compared to women (5.9% vs. 4.6%, p<0.001) in all age groups (Figure 1). The prevalence of AF in the adult population increased remarkably from 2.5% in 2007 to 5.2% in 2018 (p<0.001) (Figure 2). Among the population ≥65 years the prevalence in 2018 was 15.3%, and in the elderly, ≥75 years the prevalence of AF was 23.4%.

Conclusions

Based on comprehensive, nationwide data – also including the primary care – we observed extremely increasing prevalence of AF in the older population, as well as remarkably increasing prevalence of AF over time.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District
Prevalence and distribution of non-pulmonary vein atrial fibrillation triggers in real-world clinical settings
Authors: Kawai S , Sakamoto K , Takase S , Noma A , Kisanuki H , Nakashima H , Watanabe T , Sakemi T , Okabe K , Okahara A , Tokutome M , Matsuura H , Matsukawa R , Masuda S , Mukai Y
Published: October 2022

Background

Epidemiology of non-pulmonary vein (PV) triggers of atrial fibrillation (AF) is not fully known.

Purpose

This study aimed to clarify the prevalence and distribution of non-PV triggers in real-world clinical settings of AF catheter ablation.

Methods

One-thousand and twenty patients undergoing AF ablations were retrospectively analyzed (mean age 65 years old, 702 males (69%), 506 paroxysmal and 514 non-paroxysmal). Induction and observation of AF triggers were attempted using intravenous isoproterenol/adenosine triphosphate and repeated direct current cardioversion during AF in each session. Documentable non-PV AF triggers were characterized in the studied population. Premature atrial contractions that did not initiate AF were excluded.

Results

A hundred and twenty-six non-PV triggers were documented in 108 patients (10.6%). Non-PV trigger was documented in 6.3% of 1st session cases, whereas 30.9% of recurrent cases undergoing multiple sessions (p<0.0001). Left atrial (LA) posterior wall was the most prevalent site (N=34), followed by 30 intra-atrial septum (IAS), 29 superior vena cava (SVC), 13 crista terminalis, 7 right atrial (RA) free wall, 6 LA anterior wall, 3 coronary sinus (CS), 3 left atrial appendage, and 1 persistent left superior vena cava (LSVC). We classified those non-PV triggers into 4 groups; 43 LA, 33 thoracic veins (SVC, CS and LSVC), 30 IAS and 20 RA. Thoracic vein/RA origins were more prevalently detected in paroxysmal AF cases (57%) compared to non-paroxysmal AF (28%) (p<0.01). Conversely, LA origin was more prevalently detected in non-paroxysmal AF cases (48%) compared to paroxysmal AF (20%) (p<0.01).

Conclusions

Prevalence of non-PV trigger in cases undergoing multiple sessions is extremely high, suggesting a particular importance of non-PV trigger targeting in patients with recurrent AF undergoing 2nd or 3rd ablation sessions. Progressive nature of AF with newly generated AF triggers should be under consideration. Distributions of non-PV triggers are largely different between paroxysmal and non-paroxysmal AF. These findings may help ablation strategy regarding non-PV trigger targeting in practice.

Funding Acknowledgement

Type of funding sources: None.
New-onset atrial fibrillation in patients with community-acquired pneumonia: a systematic review and meta-analysis
Authors: Corica B , Tartaglia F , Oliva A , Raparelli V , Cangemi R , Basili S , Proietti M , Romiti G F
Published: October 2022

Background

Community-acquired pneumonia (CAP) is the commonest lower respiratory tract infection, often complicated by cardiovascular events and cardiac arrythmias, such as new-onset Atrial Fibrillation (noAF). NoAF, a new or first detactable episode of a chaotic and irregular atrial rhythm, has been associated with increased mortality in CAP patients, especially in critically-ill ones. However, the prevalence of noAF in patients with CAP is still unclear.

Purpose

We aimed to estimate the pooled prevalence of noAF in patients with CAP through a systematic review and meta-analysis of the literature.

Methods

PubMed and EMBASE were systematically searched from inception to 27th January 2022. All studies reporting the prevalence of noAF in CAP patients were included. The pooled prevalence of noAF, 95% Confidence Intervals (CI) and 95% Prediction Intervals (PI), were computed using generalized linear mixed models. The inconsistency index (I2) was calculated to measure heterogeneity. Subgroup analyses according to the study design and the geographical location were also performed. A protocol for this study was registered on PROSPERO (CRD42022307422).

Results

We retrieved 4,947 records from the literature search, with 11 studies were finally included, with a total of 346,192 CAP patients; 5 (45%) studies were conducted in Europe, while 4 (36%) were prospective studies. Pooled prevalence of noAF in CAP population was 6.6% (95% CI 4.1–10.6, 95% PI 1.0–33.6, I2=99%) [Figure 1]. No significant difference according to geographical location of the included studies or study design was found at subgroup analyses.

Conclusions

NoAF is common in CAP patients, being found in 1 out of 15 patients with CAP, with the 95% PI pointing towards potential higher prevalence in specific clinical scenarios. No significant subgroup differences were observed according to study design and geographical location.

Funding Acknowledgement

Type of funding sources: None.
External validation of the biomarker based ABCD score in atrial fibrillation patients with a non gender CHA2DS2 VASc score 0 to 1, A Korean multicenter retrospective cohort
Authors: Shin S Y , Jung M , Byeon K , Kang K , Park Y , Hwang Y , Lee S , Jin E , Roh S , Kim J , Ahn J , Lee S , Choi E , Ahn M , Lip G
Published: October 2022

Background

Patients with low to intermediate risk atrial fibrillation (AF), defined as non-gender CHA2DS2-VASc score of 0–1, are still at risk of stroke. This study verified the usefulness of ABCD score (Age [≥60 years], B-type natriuretic peptide [BNP] or N-terminal pro-BNP [≥300 pg/ml], Creatinine clearance [<50 ml/min/1.73 m2], and Dimension of the left atrium [≥45 mm]) for stroke risk stratification in non-gender CHA2DS2-VASc score 0–1.

Methods

This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA2DS2-VASc score 0–1. The primary endpoint was the incidence of stroke with or without anti-thrombotic treatment (ATT). An ABCD score was also validated.

Results

Overall, 2694 patients (56.3±9.5 years; female, 726 [26.9%]) were followed-up for 4.0±2.8 years. The overall stroke rate was 0.84/100 person-years (P-Y), stratified as follows: 0.46/100P-Y for an ABCD score 0; 1.02/100P-Y for an ABCD score≥1. The ABCD score was superior to the non-gender CHA2DS2-VASc score in stroke risk stratification (C-index=0.618, P=0.015; net reclassification improvement=0.576, P=0.040; integrated differential improvement=0.033, P=0.066). ATT was prescribed in 2353 patients (86.5%), and the stroke rate was significantly lower in patients receiving non-vitamin K antagonist oral anticoagulant (NOAC) therapy and an ABCD score≥1 than in those without ATT (0.44/100P-Y versus 1.55/100 P-Y; hazard ratio=0.26, 95% confidence interval 0.11–0.63, P=0.003).

Conclusion

The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA2DS2-VASc score 0–1. Furthermore, NOAC with an ABCD score≥1 was associated with significantly lower stroke rate in AF patients with a non-gender CHA2DS2-VASc score 0–1.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Disease Control and Prevention Agency
Outcomes in patients with ischaemic stroke undergoing endovascular thrombectomy: impact of atrial fibrillation
Authors: Alobaida M , Harrison S L , Lane D A , Hill A , Lip G Y H
Published: October 2022

Background/Introduction

Endovascular thrombectomy (EVT) has become the standard of care for the management of acute ischaemic stroke, but the risk of intracerebral haemorrhage and mortality still remains common following ischaemic stroke. The effect of concomitant atrial fibrillation (AF) on clinical outcomes in patients with acute ischaemic stroke after receiving EVT remains unclear.

Purpose

To investigate associations between AF and intracerebral haemorrhage (ICH) and all-cause mortality at 90 days in patients with ischaemic stroke undergoing EVT.

Methods

A retrospective cohort was conducted using TriNetX, a global health research network. The network was searched for people aged ≥18 years with ischaemic stroke, EVT and AF recorded in electronic medical records between 01/09/2018 and 01/09/2021. These patients were compared to controls with ischaemic stroke, EVT and no AF. Propensity score matching for age, sex, race, comorbidities, National Institutes of Health Stroke Scale (NIHSS) scores, and prior use of anticoagulation was used to balance the cohorts with and without AF.

Results

In total 1,388 patients were identified with history of ischaemic stroke treated by EVT. After propensity-score matching, 832 patients (mean age 68±13; 47% female) with ischaemic stroke, EVT and AF, were compared to 832 patients (mean age 67±12; 47% female) with ischaemic stroke, EVT and no history of AF. In the cohort with AF, 11.5% (n=96) experienced ICH within 90 days following EVT, compared with 12.3% (n=103 patients) in patients without AF (Odds Ratio (OR) 0.92, 95% confidence interval (CI) 0.68–1.24; p=0.59). In the patients with AF, mortality within 90 days following EVT was 18.7% (n=156), compared with 22.5% in patients without AF (n=187) (OR 0.79, 95% CI 0.63–1.01; p=0.06).

Conclusion

In patients with ischaemic stroke undergoing EVT, AF was not significantly associated with intracerebral haemorrhage or all-cause mortality at 90-day follow-up.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship.
Predicting new-onset heart failure hospitalization of patients with atrial fibrillation: development and external validations of a risk score
Authors: Ishii K , Matsue Y , Miyauchi K , Miyazaki S , Hidemori H , Nishizaki Y , Nojiri S , Saito Y , Nagashima K , Okumura Y , Daida H , Minamino T
Published: October 2022

Background

Atrial fibrillation (AF) is a well-known risk factor for heart failure (HF), and HF development as a complication of AF is associated with a decline in the quality of life and poor prognosis. However, unlike thrombotic events, incidence of HF in patients with AF has not changed for decades, and a preventive strategy has yet to be developed.

Purpose

We sought to develop a risk model for new-onset HF admission in patients with AF and without a history of HF. Additionally, we attempted to externally validate the developed risk model.

Methods

We utilized two multicenter, prospective, observational registries of AF and analyzed the patients without a history of AF. One of which is defined as a derivation cohort, which included 2,857 patients, and the other is defined as a validation cohort, which included 2,516 patients. We developed a risk model by selecting variables with regularized regression and weighing coefficients by Cox regression analysis with the derivation cohort. The external validity was tested in the validation cohort.

Results

During the follow-up period, 148 patients (5.2%) in the derivation cohort and 104 patients (4.1%) in the validation cohort developed HF during the median follow-up period of 1,396 (interquartile range [IQR]: 1,078–1,820) days and 1,168 (IQR: 844–1,309) days, respectively. In the derivation cohort, four predictors (age, hemoglobin, serum creatinine, and log-transformed brain natriuretic peptide) were identified as potential risk factors for HF development. The developed risk model showed good discrimination and calibration in both the derivation (area under the curve [AUC], 0.77 [95% confidence interval (CI) 0.73–0.81]; Hosmer-Lemeshow test, P=0.257) and validation cohorts (AUC: 0.76 [95% CI 0.72–0.81]; Hosmer-Lemeshow test, P=0.475). Considering death not due to HF as a competing risk, the cumulative incidence curves for HF admission stratified by the risk score were generated, which showed higher HF hospitalization rate for the higher risk score categories.

Conclusion

The newly developed risk model with four readily available clinical characteristics and biomarkers performed well in the prediction of new-onset HF admission of patients with AF in both derivation and validation cohort.

Funding Acknowledgement

Type of funding sources: None.
Echocardiographic parameters of left atrial structure and function in elderly patients with atrial fibrillation, and clinical outcomes at 2 years: the ANAFIE echocardiographic substudy
Authors: Hiasa K , Ikeda S , Tsutsui H
Published: October 2022

Background

Previous studies have shown an association between echocardiographic parameters of cardiac structure and function and prognosis in patients with atrial fibrillation (AF). However, only limited data are available for elderly patients (age, ≥75 years).

Purpose

The All Nippon Atrial Fibrillation In the Elderly (ANAFIE) Registry (UMIN000024006) was a prospective, multicenter, observational study which collected real-world data on the clinical status and prognosis of 33,062 Japanese patients aged ≥75 years and with non-valvular AF (NVAF). A prospective substudy of 1,474 patients who underwent transthoracic echocardiography at baseline was conducted to investigate relations between echocardiographic parameters of left atrial structure and function and clinical outcomes at 2 years.

Methods

Cumulative incidences and adjusted hazard ratios (HRs) of clinical outcomes were calculated using Kaplan–Meier analysis and the Cox proportional-hazards model, respectively. The data were analysed by left atrial volume index (LAVi) category, left atrial emptying fraction (LAEF) category, and direct oral anticoagulant (DOAC) use vs warfarin (WF) use. Cardiovascular (CV) events was a composite of stroke, myocardial infarction (MI), cardiac interventions, heart failure (HF) hospitalization, CV death. Cardiac events was a composite of MI, cardiac intervention, HF hospitalization, and CV death.

Results

Baseline characteristics were mean age of 80.7 years; male, 59.2%; paroxysmal AF, 45.9%; mean CHA2DS2-VASc score, 4.3; mean HAS-BLED score, 1.9; median LAVi, 48.7 mL/m2; median LAEF, 26.6%; comorbidity or history of HF, 32.2%; oral anticoagulant use, 92.7%; DOAC use, 68.7%; and WF use, 24.0%. Incidences (/100 patient-years) and HRs (95% CIs) for each clinical outcome according to LAVi and LAEF category are summarized in Table. Compared with patients with LAEF >45.0% (n=224), those with LAEF ≤45.0% (n=1,213) were at higher risk of CV events (2.19 [1.13–4.27], p=0.021) and HF hospitalization (2.25 [1.02–4.96], p=0.045). Risk of all-cause death was higher in patients with LAVi >48.0 mL/m2 (n=656) than in those with LAVi ≤48.0 mL/m2 (n=621) (1.69 [1.00–2.83], p=0.048). In the subgroups with LAEF ≤45.0% or LAVi >48.0 mL/m2, patients receiving a DOAC had significantly lower risk of cardiac events, CV events, and HF hospitalization than patients receiving warfarin.

Conclusion

In elderly Japanese patients with NVAF, those with LAEF ≤45.0% are at higher risk of CV events and HF hospitalization, and those with LAVi >48.0 mL/m2 are at higher risk of all-cause death. Thus, the higher risk differs between patients with LAEF ≤45.0% and those with LAVi >48.0 mL/m2.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.
Artificial intelligence analysis of ECG signals to predict arrhythmia recurrence after cryoballoon ablation of atrial fibrillation
Authors: Warminski G , Kalinczuk L , Orczykowski M , Urbanek P , Bodalski R , Zielinski K , Gandor M , Palka F , Jaworski M , Mintz G S , Kowalik I , Hasiec A , Bilinska M , Plawiak P , Szumowski L
Published: October 2022

Introduction

Cryoballoon-based pulmonary vein isolation (CB) is an effective option for rhythm control in atrial fibrillation (AF). There have been multiple attempts to predict arrhythmia recurrence, but with moderate success.

Purpose

To use artificial intelligence (AI) deep electrocardiogram (ECG) analysis to predict arrythmia recurrence after CB.

Methods

In a single-center study of 250 consecutive pts (58.2±12.6 years, 30% female) treated with CB for AF (05.2017–04.2019), 60% had paroxysmal AF (PAF), 66.5% had hypertension, and 27.2% had a redo CB. Analyses included left atrial volume (LA vol: indexed for BSA and assed by angio-MSCT in 76% and the rest with echo), left ventricle ejection fraction (LVEF) and hypertrophy (LVH: septal/posterior wall thickness ≥11mm in ♂ and ≥10mm in ♀) along with 30s arrhythmia recurrence at 2-yr follow-up. Baseline 500Hz raw 12-lead digital ECG signals were analyzed by means of convolutional neural network (CNN) architecture that was taught to process the 12-channel ECG signal (XML). The transfer learning method of CNN parameters learned on a very large number of coded consecutive training ECG samples (n=1,000) was adopted to analyze current sample of ECG signals.

Results

Arrhythmia recurrence at 2-yrs was 46.0% (n=115). There was gradual increase in predictive performance being the lowest if only baseline clinical data were analyzed and the highest combing all baseline clinical data plus anatomical and functional parameters (Table 1: #1–#3). AI baseline ECG analysis alone offered predictive performance similar to that made upon analysis of all baseline clinical data or joint analysis of LA vol, LVH, and LVEF (Table 1: #4). AI results added substantially to predictive performance of models using baseline clinical data alone (#1 vs #5, p<0.001) and joint analysis of baseline clinical plus LA vol, LVH and LVEF (#3 vs #6, p=0.0130) (Fig. 1).

Conclusions

Prediction of recurrence after CB using raw ECG data with deep AI analysis is feasible. Joint analysis of results of AI of baseline ECG and basic clinical data offers predictive performance similar to that made upon analysis of clinical data including advanced information on LA volume and LVH and function. AI analysis of baseline ECG adds significantly to models aimed at recurrent AF prediction.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): National Institute of Cardiology, Warsaw, Poland
Sex differences in the use of rhythm control strategies in patients with atrial fibrillation in FinACAF study
Authors: Kalatsova K , Lehto M , Inkovaara J , Aro A L , Halminen O , Jaakkola J , Penttila T , Salmela B , Airaksinen K E J
Published: October 2022

Aim

Women with atrial fibrillation (AF) have been reported to receive less antiarrhythmic therapies (AAT) than men. We assessed sex differences in AAT use in Finland.

Methods

The FinACAF registry linked data from several nationwide registries covering all levels of care in addition to drug purchases and included records on all patients diagnosed with incident AF in Finland during 2007–2018. The outcomes of interest (use of antiarrhythmic drugs (AAD), cardioversions (CV), catheter ablation procedures and any AAT including all aforementioned rhythm control modalities) were identified based on procedure-specific codes and drug purchases. Sex differences in AAT use were analyzed in the entire cohort and separately in three age groups: <65 years, 65–74 years and ≥75 years using Fine-Gray subdistribution hazard regression with death as a competing risk and adjustments made for comorbidities, age and levels of income and education.

Results

Altogether, 229565 patients (50.0% female; mean age 68.90±13.44 in men and 76.57±11.79 in women) with incident AF were identified. In the entire patient population, female sex was associated a higher incidence of AAD use and lower incidence of CVs and ablation procedures contributing to an overall slightly lower incidence of any AAT compared to men (Table 1). In the age group specific analyses, the lower incidence of CVs and higher incidence of AAD use in females were observed only in patients <65 years and <75 years, respectively, whereas the association of female sex with lower incidence of catheter ablation procedures was observed only in the age group ≥75 years.

Conclusion

Our nationwide data showed no considerable sex difference in overall use of AAT in Finland. Despite a lower number of CVs in women, ablation procedures were performed almost equally and AADs were used more frequently in women compared to men.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Sydäntutkimussäätiö