bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interatrial block as a prognosticator of new-onset atrial fibrillation: prospective observational study of 8012 adults
Authors: Abdovic E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
There has been an increasing interest in Interatrial block (IAB) in recent years, especially regarding its role in atrial fibrillation (AF). The aim of the present study was to compare the characteristics of inpatients and outpatients who developed new-onset AF versus those who did not.

Material and methods
This single-centre, prospective observational cohort study on consecutive inpatients and outpatients referred to our institution for routine evaluation. ALl participants (n=8012) aged ≥18 years (mean 69.6±13.3 years, male 51.1%) underwent 12-lead ECG and transthoracic echocardiography. Patients were scheduled for the followup visits and new-onset AF was documented as an outcome. Enrollment lasted from June 2000 to June 2013, with the mean follow up time of 7.3 years. AF was defined as irregular RR intervals without any distinct detectable P-waves for at least 30 seconds. New onset AF is defined as a new onset or a first detectable episode of AF whether symptomatic or not. IAB was diagnosed when P-wave duration was ≥120 ms and positive in inferior leads (partial IAB) or biphasic (advanced IAB).

Results
The frequency of new-onset AF was 9.8%. IAB was found in 1251 patients (15.6%); advanced and partial IAB were found in 1.3% and 14.3%, respectively. IAB was more common in AF than in the sinus rhythm (33.1%; n=255 vs. 13.8%; n=996) as AF was more common in patients with IAB than without it (20.4%; n=255 vs. 7.8%; n=525). In the multivariate model, both advanced (OR 7.45, 95% CI 4.97-11.17) and partial IAB (OR 2.75 95% CI 2.31-3.37) were associated with increased risk of AF.

Conclusion
Both partial and advanced IAB are associated with increased risk of AF; however, the risk of AF was lower for partial than advanced IAB.
Role of epicardial adipose tissue volume as predictor of atrial fibrillation recurrence
Authors: Fernandes S , Cruz I , Ladeiras-Lopes R , Diaz S , Silva M , Barros A , Saraiva F , Faria R , Almeida J , Fonseca P , Goncalves H , Oliveira M , Ferreira N , Primo J , Fontes-Carvalho R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Several studies have demonstrated the relation between general obesity and atrial fibrillation (AF). Epicardial adipose tissue (EAT), due to its local paracrine effect and the intimate relation with the atrium, could influence AF recurrence rates, but very few studies have explored this association.

Purpose
In this study we aimed to evaluate if EAT could be a predictor of AF recurrence after an AF ablation procedure.

Methods
We included all consecutive patients submitted to AF ablation (2017-2019) who performed a computed tomography scan prior to the procedure. EAT volume was semi-automatically reconstructed by manually tracing the pericardium. Adipose tissue was defined in the range between -150 and -50 Hounsfield units. Recurrence was defined as any documented (ECG/Holter) episode of AF, atrial flutter or atrial tachycardia after 3 months of the procedure. Logistic regression with a restricted cubic polynomial transformation was used to model the non-linear relationship between recurrence and EAT volumes. Inspection of the partial effect curves suggested that a cutoff for EAT volume ≥80mL could stratify patients at risk of recurrence and a Time-to-event analysis was carried.

Results
A total of 354 patients (66% male, median age 57 years [IQR 48–65] and 21% persistent AF) were included. During a median follow-up of 34 months [IQR 24-43], 117 patients (33%) had AF recurrence. These patients had a significantly greater EAT volume (76 mL [IQR 55-111] vs 72 mL [IQR 48-95], p=0.03) when compared to those without recurrence. Also, patients with higher EAT volume (≥ 80mL) had a higher risk of recurrence compared to patients with lower volume (Figure 1, log-rank test p=0.007). After adjusting for clinical risk factors (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atrial enlargement), higher EAT volume did not remain an independent predictor of AF recurrence (Figure 2, HR 1.25 [95% CI, 0.83-1.86] p=0.3).

Conclusion
In this cohort of patients with AF submitted to catheter ablation, EAT volume ≥80mL was associated with increased risk of AF recurrence. However, it was not an independent predictor of AF recurrence after adjustment to clinical risk factors.
Supraventricular arrhythmias in MINOCA patients
Authors: Santos M , Paula SB , Santos H , Almeida I , Almeida S , Tavares J , Santos L , Almeida ML 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
De novo atrial fibrillation (AF) is a frequent complication of acute coronary syndromes (ACS). However, 5-15% of patients (pts) admitted with suspected acute myocardial infarction have no significant lesions on coronary angiography (&gt;50%) (MINOCA). Contrary to initial beliefs, MINOCA is not a benign disease, given that mortality and incidence of adverse events is similar to ACS.

Objective
To evaluate predictors and prognosis of AF in the setting of MINOCA.

Methods
Based on a multicenter retrospective study, data collected from admissions between 2013 and 2020. Pts without data on cardiovascular history or uncompleted clinical data were excluded. We included 7590 pts with non-ST elevation myocardial infarction (NSTEMI). Between those, 1561 (19.2%) were MINOCA. We divided MINOCA pts in 2 groups (G): GA – MINOCA with de novo AF; GB – MINOCA without de novo AF during in-hospital stay.

Results
MINOCA pts’ mean age was 65±13, 62% were male and 2.1% had de novo AF. GA pts were older (76±10 vs 65±13, p&lt;0.001), had higher rates of Killip-Kimball class (KKC) &gt;I (27.8% vs 9.7%, p=0.027) and kidney function impairment (50% vs 10.2%, p&lt;0.001), lower haemoglobin at admission (13±1.5 vs 13.7±1.8, p=0.038), higher rates of diuretics (56.3% vs 17.6%, p&lt;0.001) and amiodarone usage during hospitalization (31.3% vs 3.6%, p&lt;0.001) and higher rates of left ventricle ejection fraction (LVEF)&lt;50% (47.1% vs 19.1%, p=0.009). The Gs were similar regarding gender, times from symptoms to admission, cardiovascular risk factors and past history of heart failure, stroke or ACS, and heart rate and systolic arterial tension at admission. In the global population, older age (p=0.001, OR 1.87, CI 1.23-2.72), KKC&gt;I (p=0.004, OR 1.76, CI 1.19-2.61) and LVEF&lt;50% (p&lt;0.001, OR 2.25, CI 1.5-3.38) were predictors of AF during hospitalization. In MINOCA pts, only older age (p=0.014, OR 4.2, CI 1.34-13.2) and LVEF&lt;50% (p&lt;0.001, OR 7.44, CI 2.17-25.47) were predictors of de novo AF. Regarding 1 year-prognosis, the occurrence of AF in MINOCA pts was associated with worse outcomes, namely 1year-mortality (log rank=0.002) and 1-year all cause readmission (log rank 0.028)

Conclusion
As expected, AF in the setting of MINOCA is associated with poorer prognosis. Pts with older age and LV dysfunction are at higher risk of de novo AF in this population.
Post-operative atrial fibrillation: not just a transient phenomenon
Authors: Swinn T , Pezard-Snell M , Dimitropoulos G , Sammut E , Barman P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A high proportion of patients undergoing cardiac surgery develop atrial fibrillation (AF) in the immediate post-operative period. To assess whether this translates into long-term AF, studies have used incidence of stroke as a surrogate marker, however the rhythm has not been directly measured. Our study retrospectively reviewed device checks of patients with permanent cardiac devices who underwent cardiac surgery in order to directly measure AF up to 18 months post cardiac surgery.

Purpose
To assess whether the development AF in the immediate post-operative period relates to the prevalence of longer-term AF after cardiac surgery.

Methods
Patients who had undergone a coronary artery bypass graft (CABG) or valve surgery between January 2011 and March 2020 and who had a pre-existing device or a device inserted within 1 year after surgery were identified. Patients were excluded if they had a congenital cardiac condition or a diagnosis of AF pre-operatively. Patients were categorised as having AF in the immediate post-operative period if AF was coded in the electronic ICU observation chart, mentioned on the discharge summary, or found in a device check &lt;6 weeks post-surgery. Device checks were analysed up to 18 months post-surgery and AF was confirmed if lasting &gt;6 minutes and documented on atrial electrogram (EGM). Comorbidities and operation details were gathered from institutional surgical database and medical notes.

Results
359 patients at our institution met initial criteria. 94 had device checks available and were used for final analysis. Mean follow up duration was 377 days. In total 41 (44%) patients developed AF in the immediate post-operative period. Patients developing post-op AF were older (69 vs. 64 years old, p=0.01) and had a different spread in operation type (CABG only 27% vs. 28%, valve only 51% vs. 68%, combined CABG & valve 22% vs. 4%, p=0.02) but there was no difference in other relevant characteristics (see Table 1). In total, 24 (26%) patients developed longer term AF, with significantly higher proportion in those who developed immediate post-operative AF (see Figure 1). Immediate post-operative AF and hypertension demonstrated a significant association with longer-term AF on univariate regression analysis using a significance value of 0.1. On multivariate analysis only immediate post-operative AF remained significant (odds ratio 3.75 (95% confidence interval 1.38-10.22), p=0.01).

Conclusion
Developing AF in the post-operative period appears to be an independent predictor of developing clinically significant AF up to 18 months after surgery. This is an important finding in identifying patients who may be at higher risk of thromboembolic events. Further research is required to determine the optimal approach, in particular consideration of anticoagulation in this patient group.
Effect of cardiorenal syndrome and its different subtypes on incidence of atrial fibrillation in a nationwide analysis
Authors: Fauchier L , Bisson A , Maisons V , Bodin A , Herbert JM , Angoulvant D , Halimi JM , Lip GYH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiorenal syndromes (CRS) are associated with increased risks of all-cause and cardiovascular death, end-stage kidney disease (ESKD), myocardial infarction (MI), heart failure (HF) and ischemic stroke. Whether CRS (and different subtypes of CRS) are more prone to develop atrial fibrillation (AF) is unclear.

Methods
This longitudinal cohort study was based on the national hospitalization database covering hospital care from the entire French population. The analysis focused on those with at least 5 years of complete follow-up (or dead earlier) as described by others. We identified 439,787 consecutive patients hospitalized in France in 2012 who had heart failure (HF), chronic kidney disease (CKD) and/or CRS. We estimated incidences of clinical events (including incident AF) during follow-up. Analysis were adjusted for 1) age and sex and 2) all baseline characteristics except cardiac and renal comorbidities.

Results
Overall, 58.2% were male, 67.7% had hypertension, 31.6% had diabetes mellitus and their mean age was 75.3±13.2; 329,154 had isolated HF, 67,939 had isolated CKD, 15,695 had acute concomitant CRS (which could be type 1, 3 or 5 CRS), 15,699 had type 2 CRS (cardiorenal) and 11,300 had type 4 CRS (renocardiac). History of AF was present in 36.4 % of the patients: 39.9% in those with isolated HF, 13.3% in those with isolated CKD, 43.0% in those with concomitant CRS, 57.2% in those with type 2 CRS, 35.3% in those with type 4 CRS (overall p&lt;0.0001).
Incidence and adjusted hazard ratios for of all-cause death, cardiovascular death and incident AF are in Table 1. CRS was associated with a higher risk of death and patients with type 2 CRS had the highest risk of all-cause and cardiovascular mortality. Isolated HF was associated with a higher risk of incident AF than isolated CKD (Table 1). Patients with CRS had higher risk of incident AF than those with isolated HF or isolated CKD. Among patients with CRS, those with concomitant CRS had the numerically highest 5-year risk of incident AF, which was not statistically different than those with type 2 or type 4 CRS in adjusted analysis.

Conclusion
The long-term prognosis of CRS subtypes is poor and may vary, some CRS subtypes being more closely associated with risk of all-cause death and cardiovascular mortality than others. Risk of incident AF is higher in CRS than in isolated HF or isolated CKD and is not statistically different among the various subtypes of CRS.
Neurophysiological status of patients with non-valvular atrial fibrillation
Authors: Shorikov E , Shorikova D , Shorikov P , Ismael A , Bordiyan V 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
The reduction of the risk of stroke in patients with AF is achieved with the help of continuous administration of oral anticoagulants (OAC). The presence of cognitive impairment in a patient may be a significant risk factor for low adherence to antithrombotic therapy, therefore, the medico-social significance of impaired cognitive functions in patients with AF is high. At the same time, it is still unclear which neurophysiological mechanisms and areas of the brain are responsible for the development of cognitive disorders in this pathology. Thus, further studies are needed to assess the state of higher cortical functions in patients with AF.

Materials and methods
The study included 50 patients with nonvalvular AF and a high risk of hemorrhagic and ischemic events, with a risk of thromboembolic complications on the CHA2DS2-VASc scale of at least 2 points and a risk of bleeding on the HAS-BLED scale of at least 3 points. The control group consisted of 17 relatively healthy individuals.

Research results
The analysis of indicators of extended neuropsychological testing made it possible to establish that, compared with healthy individuals of the same age, patients with AF perform worse on tests of neurodynamics, attention and short-term memory, Table. Patients with AF have a lower rate of complex sensorimotor reactions, a greater number of errors, especially in tests with biofeedback (brain performance test). Also, patients with AF have worse performance indicators and higher focused attention depletion (characterized by the number of characters processed in the 1st and 4th minutes of the proofreading test, respectively). As for the indicators of short-term memory, healthy subjects were superior to patients with AF in memorizing meaningless syllables and words, but not numbers.
The power indicators of the theta EEG rhythms at rest with eyes closed were taken. The factors were identified - GROUP (2 levels: patients with AF; healthy individuals), AREA (5 levels: (frontal, central, temporal, parietal, occipital) and LATERALITY (2 levels: left, right hemisphere). In patients with cardiac arrhythmias, the increase in the power of the theta-2 rhythm biopotentials in the direction from the anterior to the posterior cortex is significantly pronounced (p = 0.000001), while in healthy individuals the gradient curve is flatter (p = 0.009).

Conclusions
It was found that about half of the examined AF patients have syndrome mild cognitive impairment (MCI). The most significant cognitive decline in these patients compared with relatively healthy individuals was noted for the speed of sensorimotor response, performance control indicators, and short-term memory, while decreased cognitive test scores were associated with a greater representation of slow waves in the resting EEG, mainly in the posterior regions of the cerebral cortex.
Accuracy of AF burden detection with the new Confirm Rx with Sharp-sense technology
Authors: Briosa E Gala A , Pope MTP , Leo M , Ormerod J , Field D , Balasubramaniam R , Thomas H , Gardner RS , Hunter R , Gallagher MM , Wilson D , Paisey JR , Curzen NP , Betts TR 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Implantable cardiac monitors (ICMs) are increasingly used to monitor atrial fibrillation (AF) burden following catheter ablation. AF burden recorded by the Confirm Rx™ ICM cannot be modified even after adjudication of false-positive (FP) episodes. We sought to investigate accuracy of the AF burden detection in a UK cohort.

Methods
This multicentre retrospective study included patients with Confirm Rx™ and at least one episode &gt;6 minutes across 9 UK hospitals. Each episode had a corresponding 120-second EGM (electrogram) and heart rate scatterplot which was considered representative of the whole episode. One cardiologist adjudicated all EGMs as ‘True AF’ or ‘False positive’ and a random sample of 10% was reviewed to account for intra and interobserver variability. AF burden was computed as the duration of all episodes classified as AF by the Confirm-Rx divided by the total duration of follow-up. ‘True-AF’ burden was calculated by dividing the duration of episodes adjudicated as ‘True-AF’ by the total duration of follow-up. We also investigated the accuracy of AF burden according to implantation indication and episode duration.

Results
A total of 16,230 individual AF episodes were included from 232 consecutive patients. Overall, 26,137 hours of AF were recorded and a total follow-up 315 patient-years which equates to an AF burden of 0.95%. However, only 24,404.7 (93.3%) hours represented time in ‘True-AF’ and a ‘True-AF’ burden for the whole cohort of 0.89% (Table 1). Patients with a Confirm-Rx™ for palpitations and suspected AF had the lowest proportion of ‘True-AF’ burden and had a modest contribution to the overall AF burden (Figure 1). Conversely, patients with known AF had the highest proportion of ‘True-AF’ burden recorded. Most AF (84.5%) episodes lasted less than 1 hour with approximately a quarter adjudicated as false-positive detections, but their contribution towards overall AF burden was very small (Figure 2A-2B). In contrast, AF &gt;3 hours accounted for 76.4% of time in AF and the proportion of ‘True-AF’ burden was 98.5%.

Conclusion
The accuracy of the estimated AF burden for the whole cohort was excellent (93.3%), driven by the high proportion of ‘True-AF’ burden in AF&gt;3 hours.
Diagnostic accuracy of the Confirm-Rx atrial fibrillation detection algorithm in real-world patients
Authors: Briosa E Gala A , Pope MTB , Leo M , Ormerod J , Field D , Balasubramaniam R , Hunter R , Thomas H , Gardner RS , Gallagher MM , Wilson D , Paisey JR , Curzen NP , Betts TR 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Continuous rhythm monitoring with implantable cardiac monitors (ICMs) is commonly used to detect and characterise atrial fibrillation (AF) episodes. The Confirm Rx™ with SharpSense™ technology offers four new discriminators and second pass analysis aimed at enhancing detection and improving accuracy for cardiac arrhythmias. This study sought to investigate the diagnostic accuracy of the Confirm Rx™ AF detection algorithm in a UK cohort of ‘real-world’ patients.

Methods
This multicentre retrospective study included patients with Confirm Rx™ and at least one episode of AF&gt;6 minutes from August 2018 to August 2021 across 9 UK hospitals. Each episode had a corresponding 120-second electrogram (EGM) and heart rate scatterplot. One cardiologist manually adjudicated all EGMs as ‘True-AF’ or ‘False-positive. To assess for intra and inter-observer variability, 10% of the EGMs were reviewed. Diagnostic accuracy was determined by calculating the raw and patient-averaged positive predictive value (PPV) for AF episode of different durations and implant indications.

Results
During the study 232 patients met inclusion criteria with a total of 315 patient-years of follow-up. 16,320 individual AF episodes were adjudicated; intra- and interobserver variability was excellent (Cohen’s kappa 0.85 and 0.86, respectively). The rate of ‘True-AF’ detection was 3.19 episodes per month corresponding to a raw PPV of 74.5% for the whole cohort. The highest number of episodes per months was observed in patients with a Confirm-Rx for palpitations (5.1) and suspected AF (5.8) but only approximately half of these represented ‘True-AF’ episodes (Figure 1). Patients with known AF had the lowest rate of AF episodes (1.6 episodes per month) but the highest proportion of ‘True-AF’ episodes (PPV of 95.5%). A clear trend of improving diagnostic accuracy was seen with longer AF episodes (Table1). AF&gt;3 hours had a PPV above 94% and all episodes lasting longer than 24 hours were ‘True-AF’. For AF episode of short duration, the PPV varied with the population being monitored; however, for longer AF episodes the PPV increased significantly and irrespective of implant indication (Figure 2).

Conclusion
Overall, the Confirm Rx™ ICM diagnostic accuracy was modest for all AF episodes lasting longer than 6 minutes (74.5%) but improved considerably for longer AF episodes irrespective of implant indication.
Resting heart rate and cardiovascular outcomes in patients with atrial fibrillation: CODE-AF registry
Authors: Park H , Yu HT , Kim TH , Park J , Park JK , Kang KW , Shim J , Kim JB , Kim J , Choi EK , Park HW , Lee YS , Joung B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The prognostic significance of resting heart rate and its therapeutic target in atrial fibrillation (AF) is uncertain.

Purpose
The aim of this study was to investigate the relationships between resting heart rate and cardiovascular outcomes in patients with AF.

Methods
A total of 8,886 patients with AF was included from the COmparison study of Drugs for symptom control and complication prEvention of AF (CODE-AF) registry. Patients were categorized according to baseline heart rate, and cardiovascular outcomes were accessed during a median follow-up of 30 months. The primary outcome was a composite of cardiovascular death, hospitalization due to heart failure, and myocardial infarction/critical limb ischemia.

Results
Compared to heart rate ≥100 beats per minute (bpm), heart rate 80-99 bpm was associated with the lowest risk of primary outcome (adjusted hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.40-0.79, p=0.001). In subgroup of patients with heart failure with preserved ejection fraction (HFpEF), heart rate between 80-99 bpm was associated with reduced risk of primary outcome compared to heart rate ≥100 bpm (HR 0.40, 95% CI 0.16-0.98, p=0.045). However, in patients with heart failure with reduced ejection fraction (HFrEF), there was no association between resting heart rate and cardiovascular outcomes (P for interaction 0.001).

Conclusion
Resting heart rate was associated with cardiovascular outcomes in patients with AF, and those with a resting heart rate between 80-99 bpm had the lowest risk of adverse events. The impact of resting heart rate on adverse events persisted in patients with concomitant HFpEF but was not apparent in those with concomitant HFrEF.