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1
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Kapoor A, Oza H, Doshi B. Left atrial appendage anatomy: clinical implications for cardiac procedures. Anat Sci Int 2025; 100:270-279. [PMID: 39467999 DOI: 10.1007/s12565-024-00805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 09/28/2024] [Indexed: 10/30/2024]
Abstract
The Left Atrial Appendage (LAA) is the most common source of thrombi during atrial fibrillation (AF) leading to stroke. With the increasing prevalence of AF and the growing number of patients requiring LAA involved interventions like exclusion and ablation, understanding LAA's anatomical intricacies becomes paramount importance. This study aims to provide anatomical data regarding LAA in relation to these procedures. Total 50 formalin-fixed cadaveric hearts were examined and various morphological and morphometric parameters were noted. The Cauliflower shape LAA (36%) was most common followed by Chicken Wing (34%), Cactus (18%), and Windsock (12%) shapes. The LAA orifice had greater horizontal diameter compared to the vertical diameter and was oval in shape in 64% cases. Diverticular structures called divots/ pits were present surrounding the LAA orifice in 36% cases with high variation in number, size, and distance from orifice. They were most commonly present towards the septal side and posterior wall side around the LAA orifice. The circumflex artery was the closest structure to LAA orifice with less than 5 mm distance in 76% cases. Other structures present close to the LAA were the Left Superior Pulmonary Vein and Mitral Valve. According to shape, the Non-Chicken Wing morphology of the LAA was associated with close running left circumflex artery, high OI (Ovality Index) of the orifice, and greater presence of divots. The LAA anatomy is complex with high amount of variability making it difficult to perform successful procedures. Given data can help clinicians in better planning and execution of cardiac interventions involving the LAA.
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Affiliation(s)
- Aayush Kapoor
- Department of Anatomy, GMERS Medical College and Hospital, Sola, Ahmedabad, Gujarat, 380060, India
| | - Harshal Oza
- Department of Anatomy, GMERS Medical College and Hospital, Sola, Ahmedabad, Gujarat, 380060, India.
| | - Bhavik Doshi
- Department of Anatomy, GMERS Medical College and Hospital, Sola, Ahmedabad, Gujarat, 380060, India
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2
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Ibrahim A, Shalabi L, Zreigh S, Ramadan S, Mourad S, Eljadid G, Beshr M, Abdelaziz A, Elhadi M, Sabouret P, Mamas M. Comparative Efficacy and Safety of Low-Dose Direct Oral Anticoagulants Versus Dual Antiplatelet Therapy Following Left Atrial Appendage Occlusion in Patients With Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis. Catheter Cardiovasc Interv 2025; 105:1311-1319. [PMID: 39980323 DOI: 10.1002/ccd.31461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 02/04/2025] [Accepted: 02/09/2025] [Indexed: 02/22/2025]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) is an alternative to chronic oral anticoagulation (OAT) for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients with contraindications to OAT. Postprocedure antithrombotic therapy (ATT) is essential to reduce the risk of device-related thrombosis (DRT), but the optimal regimen remains uncertain. AIMS This study aims to compare the safety and efficacy of low-dose direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT) following LAAO. METHODS A comprehensive search of PubMed, Scopus, Cochrane, and Web of Science was conducted in August 2024. Studies comparing low-dose DOACs and DAPT post-LAAO were included. The primary outcomes were a composite efficacy endpoint (DRT, strokes, and systemic embolism [SE]) and major bleeding events as the safety endpoint. Secondary outcomes included all bleeding events, all-cause mortality, and a composite of efficacy and safety endpoints. RESULTS Four studies with 727 patients were included. Low-dose DOACs were associated with lower rates of the primary composite efficacy endpoint compared to DAPT (OR = 0.36; 95% CI [0.16, 0.85], p = 0.01). No significant difference in major bleeding events was observed (OR = 0.36; 95% CI [0.11, 1.18]; p = 0.091; I² = 0%). Compared to DAPT, low-dose DOACs were also associated with lower rates of DRT events (OR = 0.36; 95% CI [0.16, 0.79], p = 0.011). CONCLUSION Low-dose DOACs effectively reduce thromboembolic events post-LAAO without increasing bleeding risk. These findings support their use as a viable ATT option, but larger trials are needed to confirm optimal regimens.
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Affiliation(s)
- Ahmed Ibrahim
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Laila Shalabi
- Faculty of Medicine, Gharyan University, Gharyan, Libya
| | - Sofian Zreigh
- Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | | | - Sohaila Mourad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Mohammed Beshr
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Ali Abdelaziz
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Muhammed Elhadi
- Korea University College of Medicine, Seongbuk-gu, Seoul, Republic of Korea
| | - Pierre Sabouret
- National College of French Cardiologists, Paris, France
- ACTION Study Group, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
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Sikora W, Kanikowska D, Budzianowski J, Kawka E, Rutkowski R, Korybalska K. Assessment of Blood Endothelial Cell Biomarkers in Women and Men with Abnormal Body Mass and Paroxysmal Atrial Fibrillation Based on CHA2DS2-VASC Score: A Retrospective Study. Int J Mol Sci 2025; 26:3627. [PMID: 40332159 PMCID: PMC12027103 DOI: 10.3390/ijms26083627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 04/08/2025] [Accepted: 04/09/2025] [Indexed: 05/08/2025] Open
Abstract
Endothelial dysfunction (ED) promotes and maintains atrial fibrillation (AF). Using a CHA2DS2-VASc score in women and men with paroxysmal AF, we aimed to determine which patients' ED would be more pronounced. We recruited 47 females and 48 males (mean BMI 31 kg/m2 and 30 kg/m2, respectively) with paroxysmal AF and abnormal body mass and divided them into those with low (F < 3; M < 2) and high (F ≥ 3; M ≥ 2) CHA2DS2-VASC score. The blood samples were taken before AF ablation. Using Elisa tests, we measured tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), vascular cell adhesion molecule 1 (sVCAM-1), intercellular adhesion molecule (sICAM-1), von Willebrand factor (vWF), and thrombomodulin (sTM). ED was more pronounced in females, expressed by higher endothelial cell marker concentrations: sVCAM-1 and sTM in low scores and sICAM-1 in high scores, CHA2DS2-VASc. Females were characterized by postmenopausal status, higher risk of thrombosis, lower GFR, and more frequent treatment with antiarrhythmic drugs. In contrast, males have only higher suppression of tumorigenicity 2 (ST2). In conclusion, women with paroxysmal AF exhibited more pronounced ED compared to men, regardless of their CHA2DS2-VASc scores. The soluble pro-inflammatory adhesion molecules and thrombomodulin emerge as the most sensitive biomarkers of ED elevated in females.
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Affiliation(s)
- Wiesław Sikora
- Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (W.S.); (E.K.); (R.R.); (K.K.)
- Department of Cardiology with Internal Disease Subunit, Puszczykowo Hospital, 62-040 Puszczykowo, Poland
| | - Dominika Kanikowska
- Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (W.S.); (E.K.); (R.R.); (K.K.)
| | - Jan Budzianowski
- Department of Cardiology, Collegium Medicum, University of Zielona Góra, Nowa Sól Multidisciplinary Hospital, 67-100 Nowa Sol, Poland;
| | - Edyta Kawka
- Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (W.S.); (E.K.); (R.R.); (K.K.)
| | - Rafał Rutkowski
- Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (W.S.); (E.K.); (R.R.); (K.K.)
| | - Katarzyna Korybalska
- Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (W.S.); (E.K.); (R.R.); (K.K.)
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Wu L, Yuan Z, Zeng Y, Yang L, Hu Q, Zhang H, Li C, Chen Y, Zhang Z, Zhong L, Li Y, Wu N. Routinely available inflammation biomarkers to predict stroke and mortality in atrial fibrillation. Clinics (Sao Paulo) 2025; 80:100610. [PMID: 40073613 PMCID: PMC11950969 DOI: 10.1016/j.clinsp.2025.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 02/23/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND This study aimed to assess the predictive value of 7 routinely available inflammation biomarkers for stroke and all-cause mortality in 229 non-valvular AF patients. METHODS AND RESULTS C-reactive protein, Albumin (ALB), d-dimer, fibrinogen, the number of platelets, lymphocytes, monocyte and neutrophils were measured. The Multivariable Cox proportional hazard model was used to assess the predictive value of the inflammation biomarkers for stroke and all-cause mortality, the c-statistic, Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI) were calculated. Lymphocyte Monocyte Ratio (LMR) was the most informative biomarker for predicting stroke, and adding LMR to the CHA2DS2-VASc score did not improve its predictive ability for stroke, but it did improve its reclassification ability. Similar results were observed when comparing LMR+ CHA2DS2-VASc score with the ABC stroke score. For all-cause mortality, a Systemic Inflammation Score (SIS) score was calculated using ALB, fibrinogen and LMR, and adding SIS to the CHA2DS2-VASc score showed a significant improvement in its predictive ability and reclassification ability. There were no significant differences in predictive and reclassification ability for all-cause mortality between SIS+CHA2DS2-VASc score and ABC death score. CONCLUSIONS Adding routinely available inflammatory biomarkers to the CHA2DS2-VASc score increased its ability to predict all-cause mortality, suggesting this cost-effective biomarker strategy may help to improve decision support in AF.
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Affiliation(s)
- Long Wu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), PR China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China
| | - Zhiquan Yuan
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), PR China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China
| | - Yuhong Zeng
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), PR China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China
| | - Lanqing Yang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), PR China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China
| | - Qin Hu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), PR China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China
| | - Huan Zhang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), PR China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China
| | - Chengying Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), PR China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China
| | - Yanxiu Chen
- Department of Cardiology and the Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University (Third Military Medical University), PR China
| | - Zhihui Zhang
- Department of Cardiology and the Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University (Third Military Medical University), PR China
| | - Li Zhong
- Department of Cardiology, Third Affiliated Hospital of Chongqing Medical University, PR China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), PR China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China
| | - Na Wu
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), PR China.
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5
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Zarębski Ł, Futyma P. Short-term deceleration capacity: a novel non-invasive indicator of parasympathetic activity in patients undergoing pulmonary vein isolation. J Interv Card Electrophysiol 2025; 68:455-464. [PMID: 39162917 PMCID: PMC12043757 DOI: 10.1007/s10840-024-01899-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Subtypes of atrial fibrillation (AF) can differ, and exact mechanisms in which patients benefit from the pulmonary vein isolation (PVI) remain not fully understood. During PVI, vagal innervation of the heart may also be affected. Thus, non-invasive methods of intraprocedural assessment of such PVI impact are sought. METHODS From 1-minute ECG recordings performed before and after PVI, we investigated short-term deceleration capacity (ST-DC) and short-term heart rate variability (ST-HRV) to determine their potential as indicators of parasympathetic activity before and after ablation. RESULTS In 24 consecutive patients with paroxysmal AF included in the study, there were a significant differences in ST-DC and ST-HRV parameters measured before and after PVI. After 3 months, patients with baseline ST-DC ≥ 7.5 ms were less likely to experience AF recurrence when compared to patients with baseline ST-DC < 7.5 ms (0% vs 31%, p = 0.0496). There were no differences in AF recurrence after 12 months of follow-up (36% vs 38%, p = 0.52). CONCLUSION PVI leads to significant changes in ST-DC and ST-HRV, and these parameters can serve as indicators of vagal denervation after AF ablation. Patients with more prominent baseline ST-DC are less likely to experience AF recurrence during the post-PVI 3-month blanking period.
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Affiliation(s)
- Łukasz Zarębski
- St. Joseph's Heart Rhythm Center, Anny Jagiellonki 17, 35-623, Rzeszów, Poland.
- University of Rzeszów, Rzeszów, Poland.
| | - Piotr Futyma
- St. Joseph's Heart Rhythm Center, Anny Jagiellonki 17, 35-623, Rzeszów, Poland
- University of Rzeszów, Rzeszów, Poland
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6
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Silajdzija E, Lund IM, Jensen JB, Sheikh AP, Hansen JL, Tourkaman M, Heinesen V, Kallemose T, Lillqvist J, Steinwender C, Clodi M, Hendrikx T, Engdahl J, Pürerfellner H, Dixen U. Screening of Diabetic and Heart Failure Patients for Silent Atrial Fibrillation. CJC Open 2025; 7:262-269. [PMID: 40182405 PMCID: PMC11963170 DOI: 10.1016/j.cjco.2024.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 11/29/2024] [Indexed: 04/05/2025] Open
Abstract
Background Atrial fibrillation (AF) is a common heart rhythm disorder with various clinical presentations, including asymptomatic AF, known as silent AF. High-risk patients not treated with anticoagulants are at increased risk of stroke. Therefore, systematic screening has been evaluated to reduce death and cardiovascular complications. Concentrating screening efforts on high-risk populations may optimize the effectiveness of future screening strategies. The aim of our study was to determine the prevalence of silent AF in a high-risk population 65 years or older with diabetes mellitus type 2 (DM2) or congestive heart failure (CHF). Methods A multicentre, observational, prospective cohort study of 645 patients with DM2 or CHF screened for AF in primary care and outpatient clinics in Denmark, Sweden, and Austria from 2016 to 2020. Patients were examined by intermittent electrocardiogram (ECG) recordings using a handheld ECG device 4 times daily for 2 weeks. AF was diagnosed with at least 1 recording (30 seconds) of AF. Patients with fewer than 40 recordings were excluded from the analyses. Results Overall 3.3 %, 3.0%, and 3.9%, respectively, of the patients with DM2 and CHF, and 5.5% of patients older than 74 years were diagnosed with previously undetected AF. Conclusions Intermittent handheld ECG screening revealed AF in 1 in every 30 patients in a high-risk population, with an increased observed risk in elderly patients. Clinical Registration Number H-16015331.
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Affiliation(s)
- Elvira Silajdzija
- Department of Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ida Marie Lund
- Department of Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Julie Bech Jensen
- Department of Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
| | | | | | - Maya Tourkaman
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Valborg Heinesen
- Department of Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jenny Lillqvist
- Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Clemens Steinwender
- Department of Cardiology and Medical Intensive Care Medicine, Kepler University Hospital, Linz, Austria
- Clinical Research Institute for Cardiovascular and Metabolic Diseases, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Martin Clodi
- Clinical Research Institute for Cardiovascular and Metabolic Diseases, Medical Faculty, Johannes Kepler University, Linz, Austria
- Department of Internal Medicine, Hospital St John of God, Linz, Austria
| | - Tijn Hendrikx
- Department of Medicine, Halland Hospital, Halmstad, Sweden
| | - Johan Engdahl
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | | | - Ulrik Dixen
- Department of Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
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Oh EJ, Shim JG, Jeon S, Cho EA, Lee SH, Jeong T, Ahn JH. Deep neuromuscular blockade during radiofrequency catheter ablation under general anesthesia reduces the prevalence of atrial fibrillation recurrence when compared to moderate neuromuscular blockade: A randomized controlled trial. PLoS One 2025; 20:e0302952. [PMID: 39836668 PMCID: PMC11750084 DOI: 10.1371/journal.pone.0302952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 10/25/2024] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND Proper anesthesia management is required to maintain immobilization and stable breathing of the patient to improve catheter contact and stability during catheter ablation for PVI. However, it remains unclear whether the depth of neuromuscular blockade affects the results of RFCA under general anesthesia. METHODS The patients were randomly assigned to either the moderate neuromuscular blockade group (Group M, train-of-four 1 to 2) or the deep neuromuscular blockade group (Group D, posttetanic count 1-2). The primary outcome was the 12-month AF recurrence rate using confirmed electrocardiographic diagnosis after the ablation procedure at two different neuromuscular blockade depths. RESULTS Total 94 patients (47 in each group) were included in the analysis. Recurrence of AF during the A 12-month follow-up was 12 (25%) in group D and 22 (46%) in group M. The AF recurrence rate was significantly higher in group M (p = 0.03). The relative risk (RR) for the risk of 12-month AF recurrence was 0.545 in group D. AF symptom recurrence was observed during the A 12-month follow-up in 12 (25%) and 26 (54%) patients in groups D and M, respectively. CONCLUSIONS Compared to moderate neuromuscular blockade, deep neuromuscular blockade while performing RFCA under general anesthesia reduced 12-month AF recurrence rate. Deep neuromuscular blockade under general anesthesia is thought to increase the success rate by providing a stable surgical environment during the RFCA procedure. TRIAL REGISTRATION Clinical trials of Korea KCT 0003371.
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Affiliation(s)
- Eun Jung Oh
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Geum Shim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suyong Jeon
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Ah Cho
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taeho Jeong
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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8
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Pradella M, Baraboo JJ, Prabhakaran S, Zhao L, Hijaz T, McComb EN, Naidich MJ, Heckbert SR, Nasrallah IM, Bryan RN, Passman RS, Markl M, Greenland P. MRI Investigation of the Association of Left Atrial and Left Atrial Appendage Hemodynamics with Silent Brain Infarction. J Magn Reson Imaging 2025; 61:276-286. [PMID: 38490945 PMCID: PMC11401958 DOI: 10.1002/jmri.29349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Left atrial (LA) myopathy is thought to be associated with silent brain infarctions (SBI) through changes in blood flow hemodynamics leading to thrombogenesis. 4D-flow MRI enables in-vivo hemodynamic quantification in the left atrium (LA) and LA appendage (LAA). PURPOSE To determine whether LA and LAA hemodynamic and volumetric parameters are associated with SBI. STUDY TYPE Prospective observational study. POPULATION A single-site cohort of 125 Participants of the multiethnic study of atherosclerosis (MESA), mean age: 72.3 ± 7.2 years, 56 men. FIELD STRENGTH/SEQUENCE 1.5T. Cardiac MRI: Cine balanced steady state free precession (bSSFP) and 4D-flow sequences. Brain MRI: T1- and T2-weighted SE and FLAIR. ASSESSMENT Presence of SBI was determined from brain MRI by neuroradiologists according to routine diagnostic criteria in all participants without a history of stroke based on the MESA database. Minimum and maximum LA volumes and ejection fraction were calculated from bSSFP data. Blood stasis (% of voxels <10 cm/sec) and peak velocity (cm/sec) in the LA and LAA were assessed by a radiologist using an established 4D-flow workflow. STATISTICAL TESTS Student's t test, Mann-Whitney U test, one-way ANOVA, chi-square test. Multivariable stepwise logistic regression with automatic forward and backward selection. Significance level P < 0.05. RESULTS 26 (20.8%) had at least one SBI. After Bonferroni correction, participants with SBI were significantly older and had significantly lower peak velocities in the LAA. In multivariable analyses, age (per 10-years) (odds ratio (OR) = 1.99 (95% confidence interval (CI): 1.30-3.04)) and LAA peak velocity (per cm/sec) (OR = 0.87 (95% CI: 0.81-0.93)) were significantly associated with SBI. CONCLUSION Older age and lower LAA peak velocity were associated with SBI in multivariable analyses whereas volumetric-based measures from cardiac MRI or cardiovascular risk factors were not. Cardiac 4D-flow MRI showed potential to serve as a novel imaging marker for SBI. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Maurice Pradella
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of RadiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Justin J. Baraboo
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | | | - Lihui Zhao
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Tarek Hijaz
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Erin N. McComb
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Michelle J. Naidich
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Susan R. Heckbert
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Ilya M. Nasrallah
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - R. Nick Bryan
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rod S. Passman
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Division of CardiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Michael Markl
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Philip Greenland
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Division of CardiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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9
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Obeidat O, Ismail MF, Abughazaleh S, Al-Ani H, Tarawneh M, Alhuneafat L, Obeidat A, Obeidat A, Alqudah Q, Daise MA, Alzghoul H, Al-Hammouri M, Althunibat W, Tong A, Alimohamed M. Decoding the evidence: A synopsis of indications and evidence for catheter ablation in atrial fibrillation (Review). MEDICINE INTERNATIONAL 2025; 5:1. [PMID: 39563946 PMCID: PMC11571048 DOI: 10.3892/mi.2024.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 10/24/2024] [Indexed: 11/21/2024]
Abstract
The present study reviews the role of catheter ablation (CA) in the management of atrial fibrillation (AF), a widespread arrhythmia associated with increased morbidity and mortality. The present review explores current indications and recent evidence supporting CA, assessing patient outcomes and identifying common complications associated with the procedure. Emphasis is placed on optimizing risk factors prior to ablation, including weight control and hypertension management, as these measures can significantly enhance post-procedural outcomes. The present review also discusses the use of antiarrhythmic and anticoagulant therapies following CA to minimize recurrence and reduce stroke risk. Additionally, the cost-effectiveness of CA is discussed, comparing its long-term economic impact with that of medical therapy alone. The present comprehensive review provides insight into best practices for AF management, supporting CA as a promising approach when integrated with targeted lifestyle modifications and pharmacological support for improved, patient-centered outcomes.
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Affiliation(s)
- Omar Obeidat
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Mohamed F Ismail
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Saeed Abughazaleh
- St. Elizabeth's Medical Center, Boston University Teaching Hospital, Brighton, MA 02135, USA
| | - Hashim Al-Ani
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Mohammad Tarawneh
- St. Elizabeth's Medical Center, Boston University Teaching Hospital, Brighton, MA 02135, USA
| | - Laith Alhuneafat
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ali Obeidat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Abedallah Obeidat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Qusai Alqudah
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Moh'd Alamin Daise
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Hamza Alzghoul
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Mohammad Al-Hammouri
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ward Althunibat
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida Ocala Hospital, Ocala, FL 34471, USA
| | - Ann Tong
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Department of Cardiology, The Cardiac and Vascular Institute, Gainesville, FL 32605, USA
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10
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Heer T, Zeymer U, Schwarzbach CJ, Seidl K, Rauch-Kröhnert U, Marler S, Teutsch C, Diener HC, Senges J, Lip GYH, Huisman MV. Characteristics of Patients With Asymptomatic Atrial Fibrillation and Ischemic Stroke-Insights From the GLORIA-AF Registry (Phase 2). Pacing Clin Electrophysiol 2025; 48:42-49. [PMID: 39603823 DOI: 10.1111/pace.15113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 10/22/2024] [Accepted: 11/17/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Asymptomatic nonvalvular atrial fibrillation is often suspected in patients with cryptogenic stroke which constitute 20%-30% of ischemic strokes. Detection of atrial fibrillation (AF) and treatment with anticoagulation can reduce the risk of stroke. We sought to investigate the prevalence of asymptomatic atrial fibrillation (aAF) in patients with a history of stroke or an acute stroke on admission. METHODS From November 2011 until December 2014, 15,308 patients with a first episode of AF were enrolled in phase 2 of the international, prospective, multicenter global registry on long-term oral anticoagulation treatment in patients with AF (GLORIA-AF) Registry. For the present analysis, we focused on patients with aAF regarding the prevalence of stroke. RESULTS One third of patients (n = 4892, 32%) had aAF. Of these, 611 (12.5%) had a history of stroke or an acute stroke on admission. In contrast, 519 of 10,416 (5.0%) patients with symptomatic AF (sAF) had a history of stroke or an acute stroke on admission. Higher age, male gender, permanent AF, stroke, and the combination of stroke, TIA or systemic embolism were associated with a higher prevalence of aAF on admission. In a multivariable analysis, patients with aAF had a 2.3-fold (95% confidence interval (CI), 2.02-2.54) risk for stroke compared to patients with sAF. Other independent risk factors for stroke were a history of prior bleeding (odds ratio 1.62, 95% CI, 1.34-1.92), chronic kidney disease (1.38, 1.21-1.56), and diabetes mellitus (1.24, 1.10-1.41). CONCLUSION aAF is reported in about one third of patients with newly diagnosed AF and is associated with a 2.3-fold risk for stroke compared to sAF. Therefore, screening for aAF in high-risk patients might be appropriate to prevent further embolic cerebrovascular events.
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Affiliation(s)
- Tobias Heer
- Department of Cardiology, München Klinik Neuperlach, Academic Teaching Hospital of LMU University of Munich, Munich, Germany
| | - Uwe Zeymer
- Department of Cardiology, Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen, Germany
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | | | - Sabrina Marler
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut, USA
| | | | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Duisburg-Essen, Essen, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Gregory Y H Lip
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, Netherlands
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11
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Liu Y, Pang X, Wang Y, Liu X, Jiang H. Evaluation of the efficacy and safety of acupuncture assisted treatment for atrial fibrillation: A systematic review and meta-analysis based on randomized controlled trials. Medicine (Baltimore) 2024; 103:e40474. [PMID: 39612438 PMCID: PMC11608700 DOI: 10.1097/md.0000000000040474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 10/24/2024] [Indexed: 12/01/2024] Open
Abstract
BACKGROUND To systematically evaluate the efficacy and safety of acupuncture in the treatment of atrial fibrillation (AF). METHODS Eight databases were searched. The search time limit is from January 2000 to November 2023. All randomized controlled trials on acupuncture treatment of AF were included. After the literature screening, data extraction and quality evaluation were carried out independently according to the inclusion and exclusion criteria, and the included literature was analyzed by Meta using RevMan 5.4 software. RESULTS A total of 15 research studies on randomized controlled trials were included, involving 1960 patients. The results of the meta-analysis showed that acupuncture therapy could increase the sinus cardioversion rate of patients with AF, and the difference was statistically significant (relative risk = 1.21, 25% confidence interval (CI) [1.11, 1.31], P < .001). The clinically effective rate of the acupuncture plus drug treatment group was higher than that of the drug treatment group (relative risk = 1.32, 95% CI [1.19, 1.46], P < .01). Acupuncture plus other conventional therapies treatment was more helpful in reducing the ventricular rate of patients with AF (mean difference = -7.89, 95% CI [-14.52, -1.26], P = .006). The cardioversion time of patients with AF treated with acupuncture plus conventional therapies was shorter than those treated with traditional therapies alone (standardized mean difference = -1.82, 95% CI [-3.28, -0.35], P = .01). No severe adverse reactions such as hemorrhage, hematoma, or local infection caused by acupuncture were reported in the study. CONCLUSION The available evidence shows that acupuncture can effectively improve the total clinical effective rate and sinus rhythm recovery rate, shorten the recovery time of sinus rhythm, and reduce the ventricular rate, and there are no apparent adverse reactions. However, a limited number of studies may affect the generalizability of the findings. Future studies should include more extensive and diverse studies to enhance the power and generalizability of the findings.
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Affiliation(s)
- Yuqing Liu
- Shandong University of Traditional Chinese Medicine, First Clinical Medical College, Jinan City, Shandong Province, China
| | - Xuemeng Pang
- Shandong Provincial Third Hospital, Jinan City, Shandong Province, China
| | - Yajuan Wang
- Shandong University of Traditional Chinese Medicine, Second Clinical Medical College, Jinan City, Shandong Province, China
| | - Xu Liu
- Shandong University of Traditional Chinese Medicine, First Clinical Medical College, Jinan City, Shandong Province, China
| | - Hongju Jiang
- Shandong University of Traditional Chinese Medicine, First Clinical Medical College, Jinan City, Shandong Province, China
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
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12
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Teppo K, Airaksinen KEJ, Jaakkola J, Halminen O, Salmela B, Kouki E, Haukka J, Putaala J, Linna M, Aro AL, Mustonen P, Hartikainen J, Lip GYH, Lehto M. Ischaemic stroke in women with atrial fibrillation: temporal trends and clinical implications. Eur Heart J 2024; 45:1819-1827. [PMID: 38606837 PMCID: PMC11129795 DOI: 10.1093/eurheartj/ehae198] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND AIMS Female sex has been linked with higher risk of ischaemic stroke (IS) in atrial fibrillation (AF), but no prior study has examined temporal trends in the IS risk associated with female sex. METHODS The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study included all patients with AF in Finland from 2007 to 2018. Ischaemic stroke rates and rate ratios were computed. RESULTS Overall, 229 565 patients with new-onset AF were identified (50.0% women; mean age 72.7 years). The crude IS incidence was higher in women than in men across the entire study period (21.1 vs. 14.9 events per 1000 patient-years, P < .001), and the incidence decreased both in men and women. In 2007-08, female sex was independently associated with a 20%-30% higher IS rate in the adjusted analyses, but this association attenuated and became statistically non-significant by the end of the observation period. Similar trends were observed when time with and without oral anticoagulant (OAC) treatment was analysed, as well as when only time without OAC use was considered. The decrease in IS rate was driven by patients with high IS risk, whereas in patients with low or moderate IS risk, female sex was not associated with a higher IS rate. CONCLUSIONS The association between female sex and IS rate has decreased and become non-significant over the course of the study period from 2007 to 2018, suggesting that female sex could be omitted as a factor when estimating expected IS rates and the need for OAC therapy in patients with AF.
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Affiliation(s)
- Konsta Teppo
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Jussi Jaakkola
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Halminen
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Birgitta Salmela
- Department of Internal Medicine, Heart Center, Päijät-Häme Central Hospital, Lahti, Finland
| | - Elis Kouki
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Haukka
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Miika Linna
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Aapo L Aro
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pirjo Mustonen
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Mika Lehto
- Department of Internal Medicine, Jorvi Hospital, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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13
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Götze M, Ebelt H. [Prevalence, incidence and predictive factors of atrial fibrillation in geriatric patients-A prospective observational study]. Z Gerontol Geriatr 2024; 57:120-125. [PMID: 37084091 DOI: 10.1007/s00391-023-02177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/02/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND QUESTION Atrial fibrillation (AF) is the most common cardiac arrhythmia in the total population, and previous studies have already reported the prevalence of AF; however, AF is of special importance in geriatric patients due to demographic changes. Therefore, the aim of this study was to determine how many geriatric patients have a history of AF (prevalence) and how often AF can be newly diagnosed during an inpatient stay (incidence). Additionally, predictive factors for the incidence of AF in geriatric patients are described. STUDY PARTICIPANTS AND METHODS In a monocentric prospective observational study from April 2021 to April 2022, all admissions to a geriatric clinic were included in the study. Data collection was carried out using the patients' digital files. As part of the admission routine, all patients had a 12-lead ECG recorded. Additionally, a 24‑h long-term electrocardiogram (LTECG) was used in a subset of patients depending on the clinical need. RESULTS A total of 1914 participants were included in the study. At the time of admission, 715 (37.4%) patients had a known history of AF. Of the remaining 1199 patients without a history of AF, AF could be newly detected in 73 cases (6.1%). Multivariate regression analysis identified age > 80 years (odds ratio, OR: 2.3) and heart failure (OR: 3.5) as significant risk factors for the incidence of AF (each p < 0.05). CONCLUSION Despite an already high prevalence, AF was newly diagnosed in 6% of patients during the stay at a geriatric clinic. Heart failure and age above 80 years were significantly associated with the presence of AF. This should be taken into account when screening for AF in this patient population.
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Affiliation(s)
- Markus Götze
- Fachklinik für Geriatrie, St. Elisabeth Krankenhaus, Bahnhofstraße 19, 99976, Lengenfeld unterm Stein, Deutschland.
| | - Henning Ebelt
- Klinik für Innere Medizin II, Katholisches Krankenhaus "St. Johann Nepomuk", Erfurt, Deutschland
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14
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Teppo K, Airaksinen KEJ, Jaakkola J, Halminen O, Salmela B, Kalatsova K, Kouki E, Haukka J, Putaala J, Linna M, Aro AL, Mustonen P, Hartikainen J, Lehto M. Temporal trends of gender disparities in oral anticoagulant use in patients with atrial fibrillation. Eur J Clin Invest 2024; 54:e14107. [PMID: 37823410 DOI: 10.1111/eci.14107] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
AIMS To investigate sex-specific temporal trends in the initiation of oral anticoagulant (OAC) therapy among patients diagnosed with atrial fibrillation (AF) in Finland between 2007 and 2018. METHODS The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study included all patients with incident AF in Finland from 2007 to 2018. The primary outcome was the initiation of any OAC therapy. RESULTS We identified 229,565 patients with new-onset AF (50.0% women; mean age 72.7 years). The initiation of OAC therapy increased continuously during the observation period. While women were more likely to receive OAC therapy overall, after adjusting for age, stroke risk factors and other confounding factors, female sex was associated with a marginally lower initiation of OACs (unadjusted and adjusted hazard ratios comparing women to men: 1.08 (1.07-1.10) and 0.97 (0.96-0.98), respectively). Importantly, the gender disparities in OAC use attenuated and reached parity by the end of the observation period. Furthermore, when only patients eligible for OAC therapy according to the contemporary guidelines were included in the analyses, the gender inequalities in OAC initiation appeared minimal. Implementation of direct OACs for stroke prevention was slightly slower among women. CONCLUSION This nationwide retrospective cohort study covering all patients with incident AF in Finland from 2007 to 2018 observed that although female sex was initially associated with a lower initiation of OAC therapy, the sex-related disparities resolved over the course of the study period.
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Affiliation(s)
- Konsta Teppo
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Jussi Jaakkola
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Birgitta Salmela
- Heart Center, Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Elis Kouki
- University of Helsinki, Helsinki, Finland
| | | | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Miika Linna
- Aalto University, Espoo, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Aapo L Aro
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pirjo Mustonen
- Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Hartikainen
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mika Lehto
- Jorvi Hospital, Department of Internal Medicine, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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15
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Lin DS, Lo H, Huang K, Lin T, Lee J. Efficacy and Safety of Direct Oral Anticoagulants for Stroke Prevention in Older Patients With Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2023; 12:e030380. [PMID: 38014696 PMCID: PMC10727327 DOI: 10.1161/jaha.123.030380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/06/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Although older patients with atrial fibrillation are at heightened risk of thromboembolic and bleeding events, their optimal treatment choice remains uncertain. METHODS AND RESULTS This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, EMBASE, and Cochrane databases for randomized controlled trials that compared thromboembolic or bleeding outcomes between a direct oral anticoagulant (DOAC) and a vitamin K antagonist (VKA) and reported outcomes for patients aged ≥75 years with atrial fibrillation. The efficacy outcome was the composite of stroke and systemic embolism. Safety outcomes included major bleeding, any clinically relevant bleeding, and intracranial hemorrhage. Each DOAC and VKA was compared pairwise in a network meta-analysis. High- and low-dose regimens and factor IIa and Xa inhibitors were also compared. Seven randomized controlled trials were included in the analysis. Stroke and systemic embolism risks did not differ significantly among DOACs. There were no significant differences in major bleeding between each DOAC and VKA. Intracranial hemorrhage risk was significantly lower with dabigatran, apixaban, and edoxaban than with VKA and rivaroxaban, which had similar risks. High-dose regimens led to lower risks of stroke or systemic embolism compared with VKA and low-dose regimens, with both doses having similar bleeding risks. CONCLUSIONS In patients aged ≥75 years with atrial fibrillation, DOACs were associated with fewer thromboembolic events compared with VKA, whereas dabigatran, apixaban, and edoxaban were associated with lower risks of intracranial hemorrhage compared with VKA and rivaroxaban. REGISTRATION URL: www.crd.york.ac.uk/prospero/. Unique identifier: CRD42022329557.
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Affiliation(s)
- Donna Shu‐Han Lin
- Division of CardiologyDepartment of Internal MedicineShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Hao‐Yun Lo
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalHsin‐Chu BranchHsinchuTaiwan
| | - Kuan‐Chih Huang
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalHsin‐Chu BranchHsinchuTaiwan
- Department of Internal MedicineNational Taiwan University College of MedicineTaipeiTaiwan
| | - Ting‐Tse Lin
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
- Department of Internal MedicineNational Taiwan University College of MedicineTaipeiTaiwan
| | - Jen‐Kuang Lee
- Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
- Department of Internal MedicineNational Taiwan University College of MedicineTaipeiTaiwan
- Department of Laboratory MedicineNational Taiwan University College of MedicineTaipeiTaiwan
- Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
- Telehealth CenterNational Taiwan University HospitalTaipeiTaiwan
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16
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Genovesi S, Porcu L, Rebora P, Slaviero G, Casu G, Bertoli S, Airoldi F, Buskermolen M, Gallieni M, Pieruzzi F, Rovaris G, Montoli A, Piccaluga E, Molon G, Alberici F, Adamo M, Gaspardone A, D'Angelo G, Merella P, Vezzoli G, Trezzi B, Mazzone P. Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study. Clin Kidney J 2023; 16:2683-2692. [PMID: 38046009 PMCID: PMC10689152 DOI: 10.1093/ckj/sfad221] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk of bleeding often hampers with a correct anticoagulation in ESKD patients with AF, despite high thromboembolic risk. Left atrial appendage (LAA) occlusion is a anticoagulation (OAT) for thromboembolism prevention in AF populations with high hemorrhagic risk. Methods and Results The purpose of the study was to evaluate the efficacy and safety of LAA occlusion in a cohort of dialysis patients undergoing the procedure (LAA occlusion cohort, n = 106), in comparison with two other ESKD cohorts, one taking warfarin (Warfarin cohort, n = 114) and the other without anticoagulation therapy (No-OAT cohort, n = 148). After a median follow-up of 4 years, a Cox regression model, adjusted for possible confounding factors, showed that the hazard ratios (HRs) of thromboembolic events in the LAA occlusion cohort were 0.19 (95%CI 0.04-0.96; p = 0.045) and 0.16 (95%CI 0.04-0.66; p = 0.011) as compared with Warfarin and No-OAT cohorts, respectively. The HR of bleeding in the LAA occlusion cohort was 0.37 (95%CI 0.16-0.83; p = 0.017) compared to Warfarin cohort, while there were no significant differences between the LAA occlusion and the No-OAT cohort (HR 0.51; 95%CI 0.23-1.12; p = 0.094). Adjusted Cox regression models showed lower mortality in patients undergoing LAA occlusion as compared with both the Warfarin cohort (HR 0.60; 95%CI 0.38-0.94; p = 0.027) and no-OAT cohort (HR 0.52; 95%CI 0.34-0.78; p = 0.002). Thromboembolic events in the LAA occlusion cohort were lower than expected according to the CHA2DS2VASc score (1.7 [95%CI 0.3-3.0] vs 6.7 events per 100 person/years, p < 0.001). Conclusion In ESKD patients with AF, LAA occlusion is safe and effective and is associated with reduced mortality compared with OAT or no therapy.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luca Porcu
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Paola Rebora
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Gavino Casu
- Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | - Silvio Bertoli
- Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | - Flavio Airoldi
- Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | | | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy
- Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Federico Pieruzzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy
| | | | | | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Federico Alberici
- Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Pierluigi Merella
- Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | | | - Barbara Trezzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Patrizio Mazzone
- Cardiology 3, “A. De Gasperis” Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
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17
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Jiang X, Xiong Q, Yin Y, Ling Z. Left atrial appendage closure for stroke prevention in atrial fibrillation patients: A promise that came true. Pacing Clin Electrophysiol 2023; 46:1576-1585. [PMID: 37987556 DOI: 10.1111/pace.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
Anticoagulation therapy plays a crucial role in the management of atrial fibrillation (AF), considering the high morbidity and mortality of AF-related ischemic strokes. With the plausible hypothesis that left atrial appendage is the main source of thrombus in AF patients, left atrial appendage closure (LAAC) has been regarded as a potential substitute to oral anticoagulation in order to meet the unmet needs for stroke prevention, particularly in patients with high bleeding risk. Notable advancements in safety, efficacy, and device innovation have been made in recent years, albeit concerns still remain regarding the insufficient efficacy data, device-related complications, and the need for procedural optimization. We aim to review current knowledge about LAAC and provide potential future directions for the remaining key issues.
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Affiliation(s)
- Xi Jiang
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingsong Xiong
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiyu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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18
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Zhao X, Liu Y, Han X, Wang X, Qu C, Liu X, Yang B. Dapagliflozin attenuates the vulnerability to atrial fibrillation in rats with lipopolysaccharide-induced myocardial injury. Int Immunopharmacol 2023; 125:111038. [PMID: 38149574 DOI: 10.1016/j.intimp.2023.111038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/24/2023] [Accepted: 10/07/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Oxidative stress is an essential component participating in the development and maintenance of atrial fibrillation (AF). Dapagliflozin, a SGLT2 inhibitor, has been shown to exert cardioprotective effects by ameliorating oxidative stress in multiple heart disease models. However, its potential to attenuate lipopolysaccharide (LPS)-induced myocardial injury in rats remains unknown. AIM This study aims to investigate the role of dapagliflozin in LPS-induced myocardial injury and the potential mechanisms involved. METHODS Rats were intraperitoneally administered LPS to induce sepsis-like condition. The intervention was conducted with intraperitoneal injection of dapagliflozin or saline 1 h in advance. The effects of dapagliflozin were detected by electrophysiological recordings, western blot, qPCR, ELISA, HE staining, immunohistochemistry and fluorescence. We further validated the mechanism in vitro using HL-1 cells. RESULTS Dapagliflozin significantly improved LPS-induced myocardial injury, reduced susceptibility to AF, and mitigated atrial tissue inflammatory cell infiltration and atrial myocyte apoptosis. These were correlated with the Nrf2/HO-1 signaling pathway, which subsequently reduced oxidative stress. Subsequently, we used a specific inhibitor of the Nrf2/HO-1 pathway in vitro, reversed the anti-oxidative stress effects of dapagliflozin on HL-1 cells, further confirming the Nrf2/HO-1 pathway's pivotal role in dapagliflozin-mediated cardioprotection. CONCLUSION Dapagliflozin ameliorated myocardial injury and susceptibility to AF induced by LPS through anti-oxidative stress, which relied on upregulation of the Nrf2/HO-1 pathway.
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Affiliation(s)
- Xin Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Yating Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Xueyu Han
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Xiukun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Chuan Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Xin Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China.
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China.
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19
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Komen JJ, Hunt NB, Pottegård A, Hjemdahl P, Wettermark B, Olesen M, Bennie M, Mueller T, Carragher R, Karlstad Ø, Kjerpeseth LJ, Klungel OH, Forslund T. Heterogeneity after harmonisation: A retrospective cohort study of bleeding and stroke risk after the introduction of direct oral anticoagulants in four Western European countries. Pharmacoepidemiol Drug Saf 2023; 32:1223-1232. [PMID: 37280706 DOI: 10.1002/pds.5650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Database heterogeneity can impact effect estimates. Harmonisation provided by common protocols and common data models (CDMs) can increase the validity of pharmacoepidemiologic research. In a case study measuring the changes in the safety and effectiveness of stroke prevention therapy after the introduction of direct oral anticoagulants (DOACs), we performed an international comparison. METHODS Using data from Stockholm, Denmark, Scotland and Norway, harmonised with a common protocol and CDM, two calendar-based cohorts were created: 2012 and 2017. Patients with a diagnosis code of atrial fibrillation 5 years preceding the 1-year cohort window were included. DOAC, vitamin K antagonist and aspirin treatment were assessed in the 6 months prior to the start of each year while strokes and bleeds were assessed during the year. A Poisson regression generated incidence rate ratios (IRRs) to compare outcomes from 2017 to 2012 adjusted for changes in individual-level baseline characteristics. RESULTS In 280 359 patients in the 2012 cohort and 356 779 in the 2017 cohort, treatment with OACs increased on average from 45% to 65%, while treatment with aspirin decreased from 30% to 10%. In all countries except Scotland, there were decreases in the risk of stroke and no changes in bleeding risk, after adjustment for changes in baseline characteristics. In Scotland, major bleeding (IRR 1.09, 95% confidence interval [CI] [1.00; 1.18]) and intracranial haemorrhage (IRR 1.31, 95% CI [1.13; 1.52]) increased from 2012 to 2017. CONCLUSIONS Stroke prevention therapy improved from 2012 to 2017 with a corresponding reduction in stroke risk without increasing the risk of bleeding in all countries, except Scotland. The heterogeneity that remains after methodological harmonisation can be informative of the underlying population and database.
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Affiliation(s)
- J J Komen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden
| | - N B Hunt
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - A Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - P Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - B Wettermark
- Department of Pharmacy, Pharmacoepidemiology & Social Pharmacy, Uppsala University, Uppsala, Sweden
| | - M Olesen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | - T Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - R Carragher
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Ø Karlstad
- Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - L J Kjerpeseth
- Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - O H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - T Forslund
- Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden
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20
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Lenhoff H, Järnbert-Petersson H, Darpo B, Tornvall P, Frick M. Mortality and ventricular arrhythmias in patients on d,l-sotalol for rhythm control of atrial fibrillation: A nationwide cohort study. Heart Rhythm 2023; 20:1473-1480. [PMID: 37598987 DOI: 10.1016/j.hrthm.2023.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Use of d,l-sotalol for rhythm control in patients with atrial fibrillation (AF) has raised safety concerns. Previous randomized studies are few and not designed for mortality outcome. OBJECTIVE The purpose of this study was to compare the incidences of mortality and ventricular arrhythmias in AF patients treated with d,l-sotalol for rhythm control vs matched control patients treated with cardioselective beta-blockers. METHODS This population-based cohort study included AF patients from the Swedish National Patient Registry (2006-2017) who underwent rhythm control after a second cardioversion. Incidence rates (IRs) and adjusted hazard ratios (aHRs) for mortality and a composite endpoint of cardiac arrest/death and ventricular arrhythmias were calculated for the overall cohort and a 1:1 propensity score matched cohort of d,l-sotalol vs beta-blocker treatment. RESULTS Among patient treated with d,l-sotalol (n = 4987) and beta-blocker (n = 27,078) (mean follow-up 458 days), all-cause mortality was lower in patients treated with d,l-sotalol: IR 1.21; 95% confidence interval 0.95-1.52 vs 2.42 (2.26-2.60) deaths per 100 patient-years; aHR 0.66 (0.52-0.83). The difference in mortality persisted in the propensity score matched comparison (n = 4953 in each group): aHR 0.63 (0.48-0.86). No differences were observed in the composite outcome: IR in propensity cohorts 2.13 (1.78-2.52) vs 2.07 (1.73-2.53) events per 100 years; aHR 1.01 (0.78-1.29). CONCLUSION There was no excess mortality with d,l-sotalol compared with cardioselective beta-blockers in patients undergoing rhythm control treatment for AF after a second cardioversion. Our results indicate that the risk associated with d,l-sotalol treatment for AF can be mitigated by careful patient selection and strict adherence to follow-up protocols.
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Affiliation(s)
- Hanna Lenhoff
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden.
| | - Hans Järnbert-Petersson
- Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | | | - Per Tornvall
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
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21
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Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1. Front Cardiovasc Med 2023; 10:1060030. [PMID: 37396596 PMCID: PMC10311453 DOI: 10.3389/fcvm.2023.1060030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia. It was once thought to be benign as long as the ventricular rate was controlled, however, AF is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a MEDLINE search to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched via the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare noninvasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
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Affiliation(s)
- Richard G. Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
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22
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Nadir A, AY NK. Predictive value of CHA2DS2-VASc score in radial artery occlusion after transradial coronary angiography. Front Cardiovasc Med 2023; 10:1157087. [PMID: 37378413 PMCID: PMC10291681 DOI: 10.3389/fcvm.2023.1157087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Background Radial artery occlusion is the most common complication of transradial catheterization. RAO is characterized by thrombus formation due to catheterization and endothelial damage. CHA2DS2-VASc scores are the current scoring systems used to determine the risk of thromboembolism in patients with atrial fibrillation. The aim of this study was to investigate the relationship of CHA2DS2-VASc score with radial artery occlusion. Methods This prospectively designed study was included 500 consecutive patients who underwent coronary artery transradial catheterization for diagnostic or interventional procedures. The diagnosis of radial artery occlusion was made by palpation examination and Doppler ultrasound at the twenty-fourth hour after the procedure. Independent predictors of radial artery occlusion were determined by logistic regression analysis. Results Radial artery occlusion was observed at a rate of 9%. The CHA2DS2-VASc score was higher in the group of the patients who developed radial artery occlusion (p < 0.001). Arterial spasm (OR: 2.76, 95% CI 1.18-6.45, p: 0.01), catheterization time (OR: 1.03, 95% CI 1.005-1.057, p: 0.01) and CHA2DS2-VASc score ≥ 3 (OR: 1.44, 95% CI 1.17-1.78, p: 0.00) as significant independent predictors of radial artery occlusion. A high CHA2DS2-VASc score was associated with the continuity of the occlusion after the treatment (OR:1.37, 95% CI 1.01-1.85, p: 0.03). Conclusions An easily applicable CHA2DS2-VASc score of ≥3 has a predictive value for radial artery occlusion.
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23
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Haas S, Camm JA, Harald D, Steffel J, Virdone S, Pieper K, Brodmann M, Schellong S, Misselwitz F, Kayani G, Kakkar AK. GARFIELD-AF: risk profiles, treatment patterns and 2-year outcomes in patients with atrial fibrillation in Germany, Austria and Switzerland (DACH) compared to 32 countries in other regions worldwide. Clin Res Cardiol 2023; 112:759-771. [PMID: 36094573 DOI: 10.1007/s00392-022-02079-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/29/2022] [Indexed: 06/06/2023]
Abstract
BACKGROUND The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is a worldwide non-interventional study of stroke prevention in patients with non-valvular AF. METHODS AND RESULTS 52,080 patients with newly diagnosed AF were prospectively enrolled from 2010 to 2016. 4121 (7.9%) of these patients were recruited in DACH [Germany (n = 3567), Austria (n = 465) and Switzerland (n = 89) combined], and 47,959 patients were from 32 countries in other regions worldwide (ORW). Hypertension was most prevalent in DACH and ORW (85.3% and 75.6%, respectively). Diabetes, hypercholesterolaemia, carotid occlusive disease and vascular disease were more prevalent in DACH patients vs ORW (27.6%, 49.4%, 5.8% and 29.0% vs 21.7%, 40.9%, 2.8% and 24.5%). The use of non-vitamin K antagonist oral anticoagulants (NOACs) increased more in DACH over time. Management of vitamin K antagonists was suboptimal in DACH and ORW (time in therapeutic range of INR ≥ 65% in 44.6% and 44.4% of patients or ≥ 70% in 36.9% and 36.0% of patients, respectively). Adjusted rates of cardiovascular mortality and MI/ACS were higher in DACH while non-haemorrhagic stroke/systemic embolism was lower after 2-year follow-up. CONCLUSIONS Similarities and dissimilarities in AF management and clinical outcomes are seen in DACH and ORW. The increased use of NOAC was associated with a mismatch of risk-adapted anticoagulation (over-and-undertreatment) in DACH. Suboptimal control of INR requires educational activities in both regional groups. Higher rates of cardiovascular death in DACH may reflect the higher risk profile of these patients and lower rates of non-haemorrhagic stroke could be associated with increased NOAC use.
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Affiliation(s)
- Sylvia Haas
- Formerly Technical University of Munich, Munich, Germany.
| | - John A Camm
- Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK
| | - Darius Harald
- Formerly Vivantes Netzwerk Für Gesundheit, Berlin, Germany
| | - Jan Steffel
- University Hospital, Zurich and University of Zurich, Zurich, Switzerland
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24
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Lee RJ, Hanke T. The Strengths and Weaknesses of Left Atrial Appendage Ligation or Exclusion (LARIAT, AtriaClip, Surgical Suture). Card Electrophysiol Clin 2023; 15:201-213. [PMID: 37076232 DOI: 10.1016/j.ccep.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Left atrial appendage (LAA) epicardial exclusion has been associated with addressing 2 potential deleterious consequences attributed to the LAA, namely, thrombus formation and an arrhythmogenic contributor in advanced forms of atrial fibrillation. With more than 60 years of history, the surgical exclusion of the LAA has been firmly established. Numerous approaches have been used for surgical LAA exclusion including surgical resections, suture ligation, cutting and non-cutting staples, and surgical clips. Additionally, a percutaneous epicardial LAA ligation approach has been developed. A discussion of the various epicardial LAA exclusion approaches and their efficacy will be discussed, along with the salient beneficial affects on LAA thrombus formation, LAA electrical isolation and neuroendocrine homeostasis.
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Affiliation(s)
- Randall J Lee
- Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, Box 1354, San Francisco, CA 94143, USA.
| | - Thorsten Hanke
- Department of Cardiovascular Surgery, ASKLEPIOS Klinikum Harburg, Abteilung Herzchirurgie, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
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25
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Chen Y, Lou L, Zhang X, Jin L, Chen Y, Chen L, Li Z, Zhang F, Fu T, Hu S, Yang J. Association between circulating leukocytes and arrhythmias: Mendelian randomization analysis in immuno-cardiac electrophysiology. Front Immunol 2023; 14:1041591. [PMID: 37090734 PMCID: PMC10113438 DOI: 10.3389/fimmu.2023.1041591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
BackgroundCardiac arrhythmia is a common disease associated with high mortality and morbidity. Circulating leukocyte counts, which serve as a biomarker for assessing systemic immune status, have been linked to arrhythmias in observational studies. However, observational studies are plagued by confounding factors and reverse causality, whether alterations in circulating leukocyte components are causally associated with arrhythmias remains uncertain. The present study explored this question based on genetic evidence.Methods and findingsWe performed Mendelian randomization (MR) analysis to evaluate whether alterations in leukocyte counts affect aggregated risk of all types of arrhythmia or risk of five specific types of arrhythmia. Single-nucleotide polymorphisms serving as proxies for leukocyte differential counts were retrieved from the Blood Cell Consortium, and statistical data on arrhythmias were obtained from the UK Biobank), FinnGenand a meta-analysis of genome-wide association studies for atrial fibrillation. We applied inverse variance-weighted method as the primary analysis, complemented by a series of sensitivity analyses. Bidirectional analyses were conducted to assess reverse causality. Finally, multivariable MR was performed to study the joint effects of multiple risk factors. We found that genetically predicted differential leukocyte counts were not significantly associated with aggregated occurrence of all types of arrhythmia. In contrast, each 1-standard deviation increase in lymphocyte count was associated with 46% higher risk of atrioventricular block (OR 1.46, 95% CI 1.11–1.93, p=0.0065). A similar effect size was observed across all MR sensitivity analyses, with no evidence of horizontal pleiotropy. Reverse MR analysis suggested that atrioventricular block was unlikely to cause changes in lymphocyte count. Primary MR analysis based on the inverse-variance weighted method suggested that changes in neutrophil count alter risk of right bundle branch block, and changes in basophil count alter risk of atrial fibrillation. However, these causal relationships were not robust in sensitivity analyses. We found no compelling evidence that neutrophil or lymphocyte counts cause atrial fibrillation.ConclusionOur data support higher lymphocyte count as a causal risk factor for atrioventricular block. These results highlight the importance of immune cells in the pathogenesis of specific cardiac conduction disorders.
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Affiliation(s)
- Yuxiao Chen
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lian Lou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuan Zhang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luyang Jin
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Chen
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lele Chen
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhihang Li
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fen Zhang
- Department of Cardiology, Jinhua People's Hospital, Jinhua, China
| | - Ting Fu
- Department of Cardiology, Yiwu Central Hospital, Jinhua, China
| | - Shenjiang Hu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Xin Q, Zhang S, Wang C, Yao S, Yun C, Sun Y, Hou Z, Wang M, Zhao M, Tian L, Li Y, Feng Z, Xue H. Prevalence and clinical characteristics of atrial fibrillation in hospitalized patients with coronary artery disease and hypertension: a cross-sectional study from 2008 to 2018. Chin Med J (Engl) 2023; 136:588-595. [PMID: 36914935 PMCID: PMC10106139 DOI: 10.1097/cm9.0000000000002471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF. METHODS This cross-sectional study was conducted in Chinese People's Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or without AF from August 2008 to July 2018. We examined the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns, and blood pressure (BP) control of patients with both HT-CAD and AF. Multivariate logistic regression was used to investigate the associations of cardiovascular risk factors with AF in patients with HT-CAD. RESULTS The overall prevalence of AF in patients with HT-CAD was 4.87% (1011/20,747), and this increased with age; to be specific, the prevalence in women and men increased from 0.78% (2/255) and 1.02% (26/2561) at the age of <50 years to 8.73% (193/2210) and 10.28% (298/2900) at the age of ≥70 years, respectively. HT-CAD patients who had AF had a higher prevalence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, gender (male), body mass index, heart failure, and chronic kidney disease were independently associated with the risk of AF in patients with HT-CAD. For those with both HT-CAD and AF, 73.49% (743/1011) had a CHA 2 DS 2 -VASc score of ≥4, and only about half of them had the BP controlled at <140/90 mmHg, which indicated a high risk of thromboembolism and stroke. The use of oral anticoagulation increased during the study period (10.00% [20/200] in 2008 to 2011 vs. 30.06% [159/529] in 2015 to 2018, P < 0.01), but remained at a relatively low level. CONCLUSIONS AF is highly prevalent among patients with HT-CAD. Patients with both HT-CAD and AF have a higher prevalence of cardiovascular-related comorbidities, lower BP control rate, and lower use of oral anticoagulation.
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Affiliation(s)
- Qian Xin
- Department of Cardiology, The Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
| | - Sijin Zhang
- The School of Medicine, Nankai University, Tianjin 300071, China
| | - Chi Wang
- Department of Cardiology, The Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
- Chinese People's Liberation Army Medical School, Beijing 100853, China
| | - Siyu Yao
- Department of Cardiology, The Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
| | - Cuijuan Yun
- The School of Medicine, Nankai University, Tianjin 300071, China
| | - Yizhen Sun
- Department of Cardiology, The Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
- Chinese People's Liberation Army Medical School, Beijing 100853, China
| | - Ziwei Hou
- The School of Medicine, Nankai University, Tianjin 300071, China
| | - Miao Wang
- The School of Medicine, Nankai University, Tianjin 300071, China
| | - Maoxiang Zhao
- Department of Cardiology, The Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
- Chinese People's Liberation Army Medical School, Beijing 100853, China
| | - Lu Tian
- The School of Medicine, Nankai University, Tianjin 300071, China
| | - Yanjie Li
- The School of Medicine, Nankai University, Tianjin 300071, China
| | - Zekun Feng
- Department of Cardiology, The Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
- Chinese People's Liberation Army Medical School, Beijing 100853, China
| | - Hao Xue
- Department of Cardiology, The Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
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Myrcha P, Kozak M, Myrcha J, Ząbek M, Rocha-Neves J, Głowiński J, Hendiger W, Woźniak W, Taranta I. Clinical Characteristics and Predictors of Long-Term Prognosis of Acute Peripheral Arterial Ischemia Patients Treated Surgically. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3877. [PMID: 36900887 PMCID: PMC10001670 DOI: 10.3390/ijerph20053877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Acute peripheral arterial ischemia is a rapidly developing loss of perfusion, resulting in ischemic clinical manifestations. This study aimed to assess the incidence of cardiovascular mortality in patients with acute peripheral arterial ischemia and either atrial fibrillation (AF) or sinus rhythm (SR). METHODS This observational study involved patients with acute peripheral ischemia treated surgically. Patients were followed-up to assess cardiovascular mortality and its predictors. RESULTS The study group included 200 patients with acute peripheral arterial ischemia and either AF (n = 67) or SR (n = 133). No cardiovascular mortality differences between the AF and SR groups were observed. AF patients who died of cardiovascular causes had a higher prevalence of peripheral arterial disease (58.3% vs. 31.6%, p = 0.048) and hypercholesterolemia (31.2% vs. 5.3%, p = 0.028) than those who did not die of such causes. Patients with SR who died of cardiovascular causes more frequently had a GFR <60 mL/min/1.73 m2 (47.8% vs. 25.0%, p = 0.03) and were older than those with SR who did not die of such causes. The multivariable analysis shows that hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was the predisposing factor for such mortality. CONCLUSIONS Cardiovascular mortality of patients with acute ischemia did not differ between patients with AF and SR. Hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was a predisposing factor for such mortality.
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Affiliation(s)
- Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland
| | - Mariusz Kozak
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland
| | - Jakub Myrcha
- Department of Vascular Surgery and Angiology, Bielanski Hospital, 01-809 Warsaw, Poland
| | - Mirosław Ząbek
- Department of Neurosurgery, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
- Department of Biomedicine—Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Jerzy Głowiński
- Department of Vascular Surgery and Transplantalogy, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Włodzimierz Hendiger
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Witold Woźniak
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland
| | - Izabela Taranta
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland
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Cui C, Li Z, Ju W, Yang G, Gu K, Liu H, Li M, Chen H, Wang J, Chen M. The characteristics of pre-excitation syndrome concomitant with atrial tachyarrhythmia and the effect of radiofrequency ablation. Pacing Clin Electrophysiol 2022; 45:1401-1408. [PMID: 36209460 DOI: 10.1111/pace.14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Wolff-Parkinson-White (WPW) concomitant with atrial tachyarrhythmia (ATA) has not been systemically characterized. METHODS Detailed electroanatomical mapping of the right atrium (RA) and/or left atrium (LA) was performed using three-dimensional mapping and the accessory pathway (AP) was mapped. RESULTS WPW syndrome with ATA was diagnosed in 11 patients (median age 60 years). The characteristic of unidirectional anterograde conduction over the AP was displayed in nine patients, six of whom were intermittent. Sustained atrial tachycardia, that is, counterclockwise atrial flutter (AFL) with a median tachycardia cycle length (TCL) of 225 (220-275) ms, was mapped in eight patients; furthermore, "figure 8" right atrial reentry was mapped with TCL 250 ms in one patient with a surgical history of ventricular septal defect repair. The remaining two patients underwent mitral annulus-dependent AT after paroxysmal atrial fibrillation (PAF) ablation and LA micro-reentry AT, respectively. In four patients, the location of the APs was left posterior. Left-lateral APs were identified in four patients. The locations of the APs in the remaining three patients were the right posterior and middle septum. All ATAs and APs were successfully ablated. After a median follow-up of 37 (15-72) months, no anterograde conduction over the AP was recorded, new onset of PAF was recorded in three patients, and all of them underwent circumferential pulmonary vein isolation. CONCLUSIONS WPW with concomitant ATA frequently had continuous anterograde conduction over the AP with a rapid ventricular rate. Most WPWs displayed the characteristic of unidirectional anterograde conduction.
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Affiliation(s)
- Chang Cui
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhaomin Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Gu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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A Prognostic Score To Predict Atrial fibrillation Recurrence After External Electrical Cardioversion-SLAC Score. Crit Pathw Cardiol 2022; 21:194-200. [PMID: 36413399 DOI: 10.1097/hpc.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) recurrence after a successful external electrical cardioversion (ECV) is common. Assessing an individual's risk of AF recurrence is a critical part of the treatment plan. We aimed to develop a prognostic prediction score to predict AF recurrence in AF patients who underwent successful ECV. METHODS A retrospective cohort study that included AF patients who underwent successful ECV was conducted with a primary outcome of AF recurrence at 6 months. Logistic regression analysis was done to identify variables, and a prognostic prediction score was created and internally validated. RESULTS Four prognostic predictors were identified, including the type of AF, persistent AF (1 point) and long-standing persistent AF (4 points), previous cardioversion (1 point), stroke/transient ischemic attack (3 points), and left atrial volume index ≥40 mL/m 2 (6 points). The total score of 14 was further divided into 3 risk groups; low-risk (0-2 points), moderate-risk (3-7 points), and high-risk (8-14 points). The positive likelihood ratio for a moderate-risk patient was 2.08 (95% CI, 1.64-2.63) and for a high-risk patient was 7.90 (95% CI, 2.48-25.17). The score showed good discrimination power with the c-statistic of 0.74 (95% CI, 0.69-0.79). CONCLUSIONS A simple prognostic prediction score for AF recurrence after successful ECV was created with a promising internally validated discrimination power. An external assessment of its usefulness as a tool to identify patients with low, moderate, and high risk for AF recurrence is warranted.
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Torabi F, Harris DE, Bodger O, Akbari A, Lyons RA, Gravenor M, Halcox JP. Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac066. [PMID: 36415305 PMCID: PMC9678205 DOI: 10.1093/ehjopen/oeac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/15/2022] [Indexed: 11/23/2022]
Abstract
Aims Guidelines recommend anticoagulation (AC) in atrial fibrillation (AF) to reduce stroke and systemic embolism (SSE) risk; however, implementation has been slow across many populations. This study aimed to quantify the potential impact of changing prevalence of AF, associated risk, and AC prescribing on SSE hospitalizations and death. Methods and results We evaluated temporal trends of AF, CHA2DS2-VASc, antithrombotic prescriptions, SSE hospitalizations, death, and their associations between 2012 and 2018 in a longitudinal cohort of AF patients in Wales UK. Multi-state Markov models were used to estimate expected SSE rates given the AC coverage, adjusting for CHA2DS2-VASc scores. SSE rates were modelled for various past and future AC scenarios. A total of 107 137 AF patients were evaluated (mean age = 74 years, 45% female). AF prevalence increased from 1.75 to 2.22% (P-value <0.001). SSE hospitalizations decreased by 18% (2.34-1.92%, P-value <0.001). Increased AC coverage from 50 to 70% was associated with a 37% lower SSE rate, after adjustment for individual time-dependent CHA2DS2VASc scores. The observed AC increase accounted for approximately 80 fewer SSE hospitalizations per 100 000/year. If 90% AC coverage had been achieved since 2012, an estimated 279 SSE per 100 000/year may have been prevented. Our model also predicts that improving AC coverage to 90% over the next 9 years could reduce annual SSE rates by 9%. Conclusion We quantified the relationship between observed AC coverage, estimating the potential impact of variation in the timing of large-scale implementation. These data emphasize the importance of timely implementation and the considerable opportunity to improve clinical outcomes in the Wales-AF population.
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Affiliation(s)
- Fatemeh Torabi
- Population Data Science, Swansea University, Swansea SA2 8PP, UK
| | - Daniel E Harris
- Population Data Science, Swansea University, Swansea SA2 8PP, UK
| | - Owen Bodger
- Population Data Science, Swansea University, Swansea SA2 8PP, UK
| | - Ashley Akbari
- Population Data Science, Swansea University, Swansea SA2 8PP, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University, Swansea SA2 8PP, UK
| | - Michael Gravenor
- Population Data Science, Swansea University, Swansea SA2 8PP, UK
| | - Julian P Halcox
- Population Data Science, Swansea University, Swansea SA2 8PP, UK
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Kowalewski M, Wańha W, Litwinowicz R, Kołodziejczak M, Pasierski M, Januszek R, Kuźma Ł, Grygier M, Lesiak M, Kapłon-Cieślicka A, Reczuch K, Gil R, Pawłowski T, Bartuś K, Dobrzycki S, Lorusso R, Bartuś S, Deja MA, Smolka G, Wojakowski W, Suwalski P. Stand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (SALAMANDER): protocol for a prospective observational nationwide study. BMJ Open 2022; 12:e063990. [PMID: 36130748 PMCID: PMC9494590 DOI: 10.1136/bmjopen-2022-063990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is a prevalent disease considerably contributing to the worldwide cardiovascular burden. For patients at high thromboembolic risk (CHA2DS2-VASc ≥3) and not suitable for chronic oral anticoagulation, owing to history of major bleeding or other contraindications, left atrial appendage occlusion (LAAO) is indicated for stroke prevention, as it lowers patient's ischaemic burden without augmentation in their anticoagulation profile. METHODS AND ANALYSIS Stand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (SALAMANDER) will be conducted in 10 heart surgery and cardiology centres across Poland to assess the outcomes of LAAO performed by fully thoracoscopic-epicardial, percutaneous-endocardial or hybrid endo-epicardial approach. The registry will include patients with nonvalvular AF at a high risk of thromboembolic and bleeding complications (CHA2DS2-VASc Score ≥2 for males, ≥3 for females, HASBLED score ≥2) referred for LAAO. The first primary outcome is composite procedure-related complications, all-cause death or major bleeding at 12 months. The second primary outcome is a composite of ischaemic stroke or systemic embolism at 12 months. The third primary outcome is the device-specific success assessed by an independent core laboratory at 3-6 weeks. The quality of life (QoL) will be assessed as well based on the QoL EQ-5D-5L questionnaire. Medication and drug adherence will be assessed as well. ETHICS AND DISSEMINATION Before enrolment, a detailed explanation is provided by the investigator and patients are given time to make an informed decision. The patient's data will be protected according to the requirements of Polish law, General Data Protection Regulation (GDPR) and hospital Standard Operating Procedures. The study will be conducted in accordance with the Declaration of Helsinki. Ethical approval was granted by the local Bioethics Committee of the Upper-Silesian Medical Centre of the Silesian Medical University in Katowice (decision number KNW/0022/KB/284/19). The results will be published in peer-reviewed journals and presented during national and international conferences. TRIAL REGISTRATION NUMBER NCT05144958.
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Affiliation(s)
- Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Michalina Kołodziejczak
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Michal Pasierski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Rafal Januszek
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Krzysztof Reczuch
- Centre for Heart Disease, University Hospital Wroclaw Department of Heart Disease, Wroclaw Medical University, Wrocław, Poland
| | - Robert Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Tomasz Pawłowski
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stanislaw Bartuś
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Andrzej Deja
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
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Halvorsen S, Smith JA, Söderdahl F, Thuresson M, Solli O, Ulvestad M, Jonasson C. Changes in primary care management of atrial fibrillation patients following the shift from warfarin to non-vitamin K antagonist oral anticoagulants: a Norwegian population based study. BMC PRIMARY CARE 2022; 23:214. [PMID: 36008778 PMCID: PMC9404608 DOI: 10.1186/s12875-022-01824-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022]
Abstract
Background To assess baseline characteristics, drug utilisation and healthcare use for oral anticoagulants (OACs) following the introduction of non-vitamin K antagonist oral anticoagulants among patients with atrial fibrillation in primary care in Norway. Methods In this retrospective longitudinal cohort study, 92,936 patients with atrial fibrillation were identified from the Norwegian Primary Care Registry between 2010 and 2018. Linking to the Norwegian Prescription Database, we identified 64,112 patients (69.0%) treated with OACs and 28,824 (31%) who were untreated. Participants were followed until 15 May 2019, death, or loss to follow-up, whichever came first. For each OAC, predictors of initiation were assessed by modelling the probability of initiating the OAC using logistic regression, and predictors of the first switch after index date were assessed using multivariable Cox proportional hazards models. The numbers of primary care visits per quarter by index OAC were plotted and analysed with negative binomial regression analyses offset for the log of days at risk. Results Patients treated with OACs were older, had more comorbidities, and higher CHA2DS2-VASc scores than untreated patients. However, the mean CHA2DS2-VASc in the non-OAC group was 1.58 for men and 3.13 for women, suggesting an indication for OAC therapy. The percentage of patients with atrial fibrillation initiating OACs increased from 59% in 2010 to 79% in 2018. Non-vitamin K antagonist oral anticoagulant use increased throughout the study period to 95% of new OAC-treated patients in 2018, and switches from warfarin to non-vitamin K antagonist oral anticoagulants were common. The persistence of OAC treatment was > 60% after four years, with greatest persistence for apixaban. Patients treated with non-vitamin K antagonist oral anticoagulants had fewer primary care visits compared with those treated with warfarin (incidence rate ratio: 0.73, 95% confidence interval 0.71 to 0.75). Conclusion In this Norwegian primary care study, we found that the shift from warfarin to non-vitamin K antagonist oral anticoagulants was successful with 95% use in patients initiating OACs in 2018, and associated with fewer general practitioner visits. Persistence with OACs was high, particularly for apixaban. However, many patients eligible for treatment with OACs remained untreated. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01824-6.
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Fang R, Li Y, Wang J, Wang Z, Allen J, Ching CK, Zhong L, Li Z. Stroke risk evaluation for patients with atrial fibrillation: Insights from left atrial appendage. Front Cardiovasc Med 2022; 9:968630. [PMID: 36072865 PMCID: PMC9441763 DOI: 10.3389/fcvm.2022.968630] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Left atrial appendage (LAA) is believed to be a common site of thrombus formation in patients with atrial fibrillation (AF). However, the commonly-applied stroke risk stratification model (such as. CHA2DS2-VASc score) does not include any structural or hemodynamic features of LAA. Recent studies have suggested that it is important to incorporate LAA geometrical and hemodynamic features to evaluate the risk of thrombus formation in LAA, which may better delineate the AF patients for anticoagulant administration and prevent strokes. This review focuses on the LAA-related factors that may be associated with thrombus formation and cardioembolic events.
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Affiliation(s)
- Runxin Fang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Yang Li
- Zhongda Hospital, The Affiliated Hospital of Southeast University, Nanjing, China
| | - Jun Wang
- First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zidun Wang
- First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - John Allen
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chi Keong Ching
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Liang Zhong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Zhiyong Li
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- *Correspondence: Zhiyong Li
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Verberk WJ. Atrial fibrillation and 24-h ambulatory blood pressure pattern. J Clin Hypertens (Greenwich) 2022; 24:848-850. [PMID: 35702949 PMCID: PMC9278569 DOI: 10.1111/jch.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Willem J. Verberk
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtthe Netherlands
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Xia Z, Dang W, Yang X, Sun Q, Sun J, Shi L, Sun S, An L, Li X, Peng H, Liu S, Yue L, Chen H. Prevalence of atrial fibrillation and the risk of cardiovascular mortality among hypertensive elderly population in northeast China. J Clin Hypertens (Greenwich) 2022; 24:630-637. [PMID: 35434909 PMCID: PMC9106073 DOI: 10.1111/jch.14483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
Little is known about the epidemiology and impact of atrial fibrillation (AF) on cardiovascular diseases (CVD) mortality among hypertensive elderly population in northeast China. The community‐based study included 4497 hypertensive elderly residents aged ≥65 years who lived in northeast China from September 2017 to March 2019. Information on CVD deaths was obtained from baseline until July 31, 2021. Cox proportional hazard regression models were performed in the evaluation of CVD mortality. We identified 101 persons with AF. The prevalence of AF was 2.2% among elderly hypertensive population, which increased significantly with age. The prevalence of AF was higher in men than in women. The awareness rate was 51.5%, higher in urban areas than in rural areas (68.8% vs 43.5%, P = .018). Only 4.0% patients received oral anticoagulant (OAC) therapy among AF patients. Moreover, diabetes (26.7%) and dyslipidemia (37.6%) were highly prevalent in AF patients. Furthermore, 212 persons died due to CVD (14.7/1000 person‐years) during a median follow‐up of 3.2 years. AF patients had a 3.42 (95% CI: 2.07‐5.63) times higher risk of CVD mortality than the patients without AF in the fully adjusted model. Therefore, the burden of AF among hypertensive elderly population in northeast China was considerable. Long‐term screening and management strategies for AF and related risk factors are required among hypertensive elderly in northeast China.
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Affiliation(s)
- Zhenwei Xia
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Wei Dang
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Xue Yang
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Qun Sun
- Department of Chronic Disease Disease Control and Prevention of Chaoyang City Chaoyang Liaoning China
| | - Jixu Sun
- Department of Chronic Disease Disease Control and Prevention of Dandong City Dandong Liaoning China
| | - Lei Shi
- Department of Chronic Disease Disease Control and Prevention of Liaoyang City Liaoyang Liaoning China
| | - Shize Sun
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Le An
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Xiaojing Li
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Hongbo Peng
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Shuang Liu
- Department of Ultrasound The Fourth Hospital of China Medical University Shenyang Liaoning China
| | - Ling Yue
- Department of Ultrasound The Fourth Hospital of China Medical University Shenyang Liaoning China
| | - Hongyun Chen
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
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Choi J, No JE, Lee JY, Choi SA, Chung WY, Ah YM, Yu YM. Efficacy and Safety of Clinically Driven Low-Dose Treatment with Direct Oral Anticoagulants in Asians with Atrial Fibrillation: a Systematic Review and Meta-analysis. Cardiovasc Drugs Ther 2022; 36:333-345. [PMID: 33725229 DOI: 10.1007/s10557-021-07171-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Although clinically driven low-dose (CDLD) treatment with direct oral anticoagulants (DOACs) is frequently administered to Asian patients with atrial fibrillation, clinical evidence confirming its efficacy remains insufficient. We evaluated the clinical efficacy and safety of CDLD treatment with DOACs compared to on-label dose treatment in Asian patients with atrial fibrillation and assessed the differences in the baseline characteristics between patients receiving these treatments. METHODS We searched the MEDLINE, CENTRAL, EMBASE, Web of Science, and Scopus databases for articles from inception through July 2020. RESULTS Thirteen studies were included in this meta-analysis. The baseline characteristics of the CDLD group were significantly different from those of the standard dose (STD) and standard low-dose (SLD) groups. The incidences of thromboembolic events (risk ratio [RR] 0.46, 95% confidence interval [CI] 0.29-0.73, p < 0.001) and major bleeding (RR 0.55, 95% CI 0.35-0.87, p = 0.01) in the CDLD group were lower than those in the SLD group; however, they were comparable with those in the STD group. The incidence of a composite endpoint in the CDLD group was not significantly different from that in the STD group but was significantly lower than that in the SLD group (RR 0.50, 95% CI 0.38-0.65, p < 0.001). CONCLUSION The clinical outcomes of CDLD treatment showed no difference compared to those of the STD treatment despite the vulnerable baseline characteristics of the CDLD group for thromboembolic and major bleeding events.
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Affiliation(s)
- Jillie Choi
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon, 21983, Republic of Korea
- Graduate Program of Industrial Pharmaceutical Science, Yonsei University, Incheon, Republic of Korea
| | - Jae Eun No
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon, 21983, Republic of Korea
- Graduate Program of Industrial Pharmaceutical Science, Yonsei University, Incheon, Republic of Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Soo An Choi
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong, Republic of Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Seoul National University Boramae Medical Center and College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongsangbuk-do, 38541, Republic of Korea.
| | - Yun Mi Yu
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon, 21983, Republic of Korea.
- Graduate Program of Industrial Pharmaceutical Science, Yonsei University, Incheon, Republic of Korea.
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Lee RJ, Hanke T. The Strengths and Weaknesses of Left Atrial Appendage Ligation or Exclusion (LARIAT, AtriaClip, Surgical Suture). Interv Cardiol Clin 2022; 11:205-217. [PMID: 35361465 DOI: 10.1016/j.iccl.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Left atrial appendage (LAA) epicardial exclusion has been associated with addressing 2 potential deleterious consequences attributed to the LAA, namely, thrombus formation and an arrhythmogenic contributor in advanced forms of atrial fibrillation. With more than 60 years of history, the surgical exclusion of the LAA has been firmly established. Numerous approaches have been used for surgical LAA exclusion including surgical resections, suture ligation, cutting and non-cutting staples, and surgical clips. Additionally, a percutaneous epicardial LAA ligation approach has been developed. A discussion of the various epicardial LAA exclusion approaches and their efficacy will be discussed, along with the salient beneficial affects on LAA thrombus formation, LAA electrical isolation and neuroendocrine homeostasis.
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Affiliation(s)
- Randall J Lee
- Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, Box 1354, San Francisco, CA 94143, USA.
| | - Thorsten Hanke
- Department of Cardiovascular Surgery, ASKLEPIOS Klinikum Harburg, Abteilung Herzchirurgie, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
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38
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Hoare S, Powell A, Modi RN, Armstrong N, Griffin SJ, Mant J, Burt J. Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care. BMJ Open 2022; 12:e051703. [PMID: 35296474 PMCID: PMC8928318 DOI: 10.1136/bmjopen-2021-051703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES There is insufficient evidence to support national screening programmes for atrial fibrillation (AF). Nevertheless, some practitioners, policy-makers and special interest groups have encouraged introduction of opportunistic screening in primary care in order to reduce the incidence of stroke through earlier detection and treatment of AF. The attitudes of the public towards AF screening are unknown. We aimed to explore why AF screening participants took part in the screening. DESIGN Semistructured longitudinal interview study of participant engagement in the SAFER study (Screening for Atrial Fibrillation with ECG to Reduce stroke). We undertook initial interviews face to face, with up to two follow-up telephone interviews during the screening process. We thematically analysed and synthesised these data to understand shared views of screening participation. SETTING 5 primary care practices in the East of England, UK. PARTICIPANTS 23 people taking part in the SAFER study first feasibility phase. RESULTS Participants were supportive of screening for AF, explaining their participation in screening as a 'good thing to do'. Participants suggested screening could facilitate earlier diagnosis, more effective treatment, and a better future outcome, despite most being unfamiliar with AF. Participating in AF screening helped attenuate participants' concerns about stroke and demonstrated their commitment to self-care and being a 'good patient'. Participants felt that the screening test was non-invasive, and they were unlikely to have AF; they therefore considered engaging in AF screening was low risk, with few perceived harms. CONCLUSIONS Participants assessed the SAFER AF screening programme to be a legitimate, relevant and safe screening opportunity, and complied obediently with what they perceived to be a recommendation to take part. Their unreserved acceptance of screening benefit and lack of awareness of potential harms suggests that uptake would be high but reinforces the importance of ensuring participants receive balanced information about AF screening initiatives. TRIAL REGISTRATION NUMBER ISRCTN16939438; Pre-results.
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Affiliation(s)
- Sarah Hoare
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Powell
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rakesh Narendra Modi
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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39
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Olivieri O, Turcato G, Cappellari M, Stefanoni F, Osti N, Pizzolo F, Friso S, Bassi A, Castagna A, Martinelli N. High Plasma Concentration of Apolipoprotein C-III Confers an Increased Risk of Cerebral Ischemic Events on Cardiovascular Patients Anticoagulated With Warfarin. Front Cardiovasc Med 2022; 8:781383. [PMID: 35187103 PMCID: PMC8854278 DOI: 10.3389/fcvm.2021.781383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Apolipoprotein C-III (Apo CIII) is a crucial regulator of triglyceride-rich lipoproteins (TRLs) and influences the risk of cardiovascular diseases. High levels of Apo CIII have been also associated with cerebrovascular events and earlier works showed procoagulant effects of Apo CIII. The main aim was to assess whether the plasma concentration of Apo CIII could confer an increased risk of cerebral ischemic events in anticoagulated patients at high-risk of cardioembolism. Methods We systematically checked medical records and quantified cerebral ischemic events in a selected cohort of 118 subjects [median age 68 with interquartile range (IQR) 59–75 years, 66.9% males, 52.5% with coronary artery disease (CAD)], taking anticoagulant therapy with warfarin because of atrial fibrillation (AF) and/or mechanical prosthetic heart valves. All the subjects, enrolled between May 1999 and December 2006, were prospectively followed until death or July 31, 2018. Assessments of complete plasma lipid and apolipoprotein profiles, including Apo A-I, B, CIII, and E, were available for all subjects at enrollment. Results After a median follow-up of 109 months (IQR, 58–187), 24 subjects (20.3%) had cerebral ischemic events: stroke (n = 15) and TIA (n = 9). Subjects with plasma concentration of Apo CIII above the median value (10.3 mg/dL) had an about three-fold increased risk of stroke/TIA than those with lower levels of Apo C-III [hazard ratio 3.08 (95%CI, 1.22–7.77)]. This result was confirmed in multiple Cox regression models adjusted for gender, age, CAD, AF, diabetes, hypertension, plasma lipids, and CHA2DS2-VASc score. By stratifying the sample on the basis of Apo CIII level and CHA2DS2-VASc score, an additive effect was observed with the highest risk in subjects with both high Apo C-III concentration and CHA2DS2-VASc score. Conclusion High Apo CIII plasma levels may be associated with an increased risk of ischemic stroke/TIA in high-risk cardiovascular patients anticoagulated with warfarin.
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Affiliation(s)
- Oliviero Olivieri
- Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Oliviero Olivieri
| | - Gianni Turcato
- Department of Emergency Medicine, Franz Tappeiner Hospital, Merano, Italy
| | | | - Filippo Stefanoni
- Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Nicola Osti
- Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Francesca Pizzolo
- Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Simonetta Friso
- Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Antonella Bassi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Annalisa Castagna
- Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Nicola Martinelli
- Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
- Nicola Martinelli
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40
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Yin L, Qi Y, Ge Z, Li J. Effects of direct oral anticoagulants dabigatran and rivaroxaban on the blood coagulation function in rabbits. Open Life Sci 2022; 17:1-9. [PMID: 35128064 PMCID: PMC8800383 DOI: 10.1515/biol-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to explore the effects of dabigatran and rivaroxaban on the activities of various coagulation factors. To achieve that, 60 rabbits were randomly divided into experimental groups that received different doses of dabigatran or rivaroxaban. The effects of dabigatran and rivaroxaban on the activities of FII, FV, FVIII, FX, and activated protein C (APC) were analyzed. In the dabigatran groups, activated partial thromboplastin time and thromboplastin time (TT) were prolonged after drug administration, and the activities of FII, FV, FVIII, and FX were inhibited as the drug concentration increased. Low doses of dabigatran inhibited APC activity. In the rivaroxaban groups, APTT and TT were not significantly prolonged after drug administration. In contrast, the high-dose rivaroxaban group exhibited prolonged PT, and the degree of inhibition of the activities of FII, FV, FVIII, and FX increased as the drug concentration increased. Rivaroxaban had no significant effect on APC activity regardless of dosage. As the drug concentration increased, both NOACs had more significant inhibitory effects on the activities of FII, FV, FVIII, and FX. Low concentrations of dabigatran generated an inhibitory effect on APC activity, while high concentrations of dabigatran had no significant effect. Rivaroxaban had no significant effect on APC activity.
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Affiliation(s)
- Lu Yin
- Department of Cardiology, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200000, China
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yuan Qi
- Department of Cardiology, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200000, China
| | - Zhiru Ge
- Department of Cardiology, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200000, China
| | - Jiajin Li
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China
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Utility of Simultaneous Biatrial Atrial Anti-Tachycardia Pacing for the Termination of Atrial Fibrillation during Catheter Ablation of Atrial Fibrillation. J Clin Med 2022; 11:jcm11030575. [PMID: 35160027 PMCID: PMC8837084 DOI: 10.3390/jcm11030575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Atrial anti-tachycardia pacing (A-ATP) of the right atrium (RA) has been shown to decrease the burden of atrial fibrillation (AF) in patients with dual-chamber pacemakers. The aim of this study is to identify the novel predictors of effective A-ATP for terminating AF in patients with AF undergoing catheter ablation. Methods: This study included 41 consecutive patients undergoing a first ablation procedure for paroxysmal (PAF: n = 21) or persistent (PEF: n = 20) AF. We prospectively evaluated predictors of AF termination after A-ATP. The coefficient of variation (CoV = SD/mean × 100) of the dominant frequencies (DFs) was calculated to evaluate the variability in atrial activation. Results: AF was terminated by A-ATP in 29% of PAF and 5% of PEF patients. In these patients, simultaneous high-rate pacing from the RA and the coronary sinus (CS) terminated AF in 71% of patients, in whom the mean AF cycle length (CL) before A-ATP was longer (214 ± 23 vs. 177 ± 35 ms, p = 0.02) and became slower after A-ATP (234 ± 37 vs. 176 ± 32 ms, p < 0.01), compared to unsuccessful patients. The CoV of the DFs before A-ATP were lower in both RA (6.2 ± 2.0 vs. 15.3 ± 7.9, p = 0.02) and CS (11.0 ± 7.9 vs. 24.3 ± 9.3, p < 0.01) in successful patients. Conclusions: Simultaneous biatrial A-ATP from the RA and CS could terminate AF in patients with PAF. The predictors for successful termination include longer AF CL and higher AF stability.
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42
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Ben H, Changsheng M, Shulin W. 2019 Chinese expert consensus statement on left atrial appendage closure in patients with atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:535-555. [PMID: 35032332 PMCID: PMC9314806 DOI: 10.1111/pace.14448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/09/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
Abstract
The left atrial appendage closure (LAAC), the efficacy and safety of which has been proved by a number of randomized controlled trials and registries, is recommended by several guidelines to prevent stroke in high‐risk patients with non‐valvular atrial fibrillation. However, current guidelines only discuss the indications and contraindications of LAAC, as an emerging technology, there still lacks comprehensive recommendations involved with LAAC, including devices, image assessment modality, identification and treatment of complications, perioperative medication, and postoperative management. Therefore, the Chinese Society of Cardiology (CSC) of Chinese Medical Association (CMA) and the Editorial Board of Chinese Journal of Cardiology jointly issued the expert consensus statement on LAAC in the prevention of stroke in patients with atrial fibrillation after comprehensive discussion by experts with different backgrounds. This consensus provided three levels of recommendations to guide and standardize the clinical application of LAAC based on existing evidence and clinical practice experience, including appropriate (more potential benefits or fewer harms), uncertain (somehow reasonable but need more evidence), and inappropriate (unlikely to benefit, or have more complications).
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Affiliation(s)
- He Ben
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ma Changsheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wu Shulin
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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43
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Beukema JC, de Groot C, Plukker JTM, Vliegenthart R, Langendijk JA, van Luijk P, van Melle JP, Prakken NHJ, Muijs CT. Late cardiac toxicity of neo-adjuvant chemoradiation in esophageal cancer survivors: A prospective cross-sectional pilot study. Radiother Oncol 2021; 167:72-77. [PMID: 34864136 DOI: 10.1016/j.radonc.2021.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Although cure rates in esophageal cancer (EC) have improved since the introduction of neoadjuvant chemoradiation (nCRT), evidence for treatment-related cardiac toxicity is growing, of which the exact mechanisms remain unknown. The primary objective of this study was to identify (subclinical) cardiac dysfunction in EC patients after nCRT followed by surgical resection as compared to surgery alone. MATERIALS AND METHODS EC survivors followed for 5-15 years after curative resection with (n = 20) or without (n = 20) nCRT were enrolled in this prospective cross-sectional pilot study. All patients underwent several clinical and diagnostic tests in order to objectify (sub)clinical cardiac toxicity including cardiac CT and MRI, echocardiography, ECG, 6-minutes walking test, physical examination and EORTC questionnaires. RESULTS We found an increased rate of myocardial fibrosis (Linear late gadolinium enhancement (LGE) 4 vs. 1; p = 0.13; mean extracellular volume (ECV) 28.4 vs. 24.0; p < 0.01), atrial fibrillation (AF) (6 vs. 2; p = 0.07) and conduction changes in ECG among patients treated with nCRT as compared to those treated with surgery alone. The results suggested an impact on quality of life in terms of worse role functioning for this patient group (95.0 vs. 88.8; p = 0.03). CONCLUSION Based on our analyses we hypothesize that in EC patients, radiation-induced myocardial fibrosis plays a central role in cardiac toxicity leading to AF, conduction changes and ultimately to decreased role functioning. The results emphasize the need to verify these findings in larger cohorts of patients.
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Affiliation(s)
- Jannet C Beukema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.
| | - Crystal de Groot
- Department of Radiation Oncology, Isala Hospital, Zwolle, The Netherlands
| | - John T M Plukker
- Department of Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Niek H J Prakken
- Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
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Schlögl S, Schlögl KS, Haarmann H, Bengel P, Bergau L, Rasenack E, Hasenfuss G, Zabel M. Remote magnetic navigation versus manual catheter ablation of atrial fibrillation: A single center long-term comparison. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:14-22. [PMID: 34687054 DOI: 10.1111/pace.14392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/07/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data comparing remote magnetic catheter navigation (RMN) with manual catheter navigation (MCN) ablation of atrial fibrillation (AF) is lacking. The aim of the present prospective observational study was to compare the outcome of RMN versus (vs.) MCN ablation of AF with regards to AF recurrence. METHODS The study comprised 667 consecutive patients with a total of 939 procedures: 287 patients were ablated using RMN, 380 using MCN. RESULTS There was no significant difference between the groups at baseline. After 2.3 ± 2.3 years of follow-up, 23% of the patients in the MCN group remained free of AF recurrence compared to 13% in the RMN group (p < .001). After analysis of 299 repeat ablations (133 MCN, 166 RMN) there was a significantly higher reconnection rate of pulmonary veins after RMN ablation p < .001). In multivariable Cox-regression analysis, RMN ablation was an independent risk factor for AF recurrence besides age, persistent AF, number of isolated pulmonary veins, and left atrial diameter. Procedure time, radiofrequency application time and total number of ablation points were higher in the RMN group. Total fluoroscopy time and total fluoroscopy dose were significantly lower for RMN. Complication rates did not differ between groups (p = .842), although the incidence of significant pericardial effusion was higher in the MCN group (seven cases vs. three in RMN group). CONCLUSIONS In our study the AF recurrence rate and pulmonary vein reconnection rate is higher after RMN ablation with a similar complication rate but reduced probability of pericardial effusion when compared to MCN.
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Affiliation(s)
- Simon Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Klaudia Stella Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Helge Haarmann
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Philipp Bengel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,Clinic for Electrophysiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Eva Rasenack
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
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Jost N, Christ T, Magyar J. New Strategies for the Treatment of Atrial Fibrillation. Pharmaceuticals (Basel) 2021; 14:ph14090926. [PMID: 34577626 PMCID: PMC8466466 DOI: 10.3390/ph14090926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the clinical practice. It significantly contributes to the morbidity and mortality of the elderly population. Over the past 25-30 years intense effort in basic research has advanced the understanding of the relationship between the pathophysiology of AF and atrial remodelling. Nowadays it is clear that the various forms of atrial remodelling (electrical, contractile and structural) play crucial role in initiating and maintaining the persistent and permanent types of AF. Unlike in ventricular fibrillation, in AF rapid ectopic firing originating from pulmonary veins and re-entry mechanism may induce and maintain (due to atrial remodelling) this complex cardiac arrhythmia. The present review presents and discusses in detail the latest knowledge on the role of remodelling in AF. Special attention is paid to novel concepts and pharmacological targets presumably relevant to the drug treatment of atrial fibrillation.
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Affiliation(s)
- Norbert Jost
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, 6725 Szeged, Hungary
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, 6725 Szeged, Hungary
- Correspondence:
| | - Torsten Christ
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - János Magyar
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
- Department of Sport Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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46
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Shen J, Li M, Cao S, Lu Z, Xia Y, Chen S, Bi Y, Cai Z, Hu B, Cao F. Neurologists' attitudes and options for anticoagulation therapy in central China. Int J Clin Pract 2021; 75:e14305. [PMID: 33930249 DOI: 10.1111/ijcp.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS We aim to find out the factors affecting the use of anticoagulants and the intensity of their choices, and to establish a basis for improving neurologists' effective implementation of the guidelines. METHODS A cross-sectional study is conducted in Hubei province in central China. Each neurologist completes a standard-structured anonymous questionnaire through face-to-face interviews. The problems include the attitude and options about anticoagulant therapy. RESULTS A total of 611 neurologists from 38 hospitals respond to this survey. For the best treatment of atrial fibrillation, more than 80% of physicians choose anticoagulant therapy. For patients with atrial fibrillation and cerebral infarction, physicians think that Warfarin is the preferred drug as high as 93.8%. Among the anticoagulant drugs ever used by clinicians, the use rate of Warfarin is 93.8%, but the use rate of direct oral anticoagulants is insufficient. The use of direct oral anticoagulants is related to the educational level and the geographical location of the hospital. Bleeding risk is the first reason influencing clinicians' choice of Warfarin, accounts for 88.9%. 97.7% of the clinicians recommend patients with Warfarin to regularly monitor the INR, but the frequency of monitoring is inconsistent. Clinicians have a high willingness to learn about AF, but the proportion of hospitals that carry out appropriate training is low. CONCLUSIONS There are still some gaps with the guidelines on the choice of anticoagulant drugs. Neurologists have positive attitude towards anticoagulant therapy and a strong willingness to learn, but the corresponding training is lacking. Continuous professional training is necessary.
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Affiliation(s)
- Jing Shen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanpeng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengcai Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuoyuan Cai
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Cao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Celi S, Gasparotti E, Capellini K, Vignali E, Fanni BM, Ali LA, Cantinotti M, Murzi M, Berti S, Santoro G, Positano V. 3D Printing in Modern Cardiology. Curr Pharm Des 2021; 27:1918-1930. [PMID: 32568014 DOI: 10.2174/1381612826666200622132440] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND 3D printing represents an emerging technology in the field of cardiovascular medicine. 3D printing can help to perform a better analysis of complex anatomies to optimize intervention planning. METHODS A systematic review was performed to illustrate the 3D printing technology and to describe the workflow to obtain 3D printed models from patient-specific images. Examples from our laboratory of the benefit of 3D printing in planning interventions were also reported. RESULTS 3D printing technique is reliable when applied to high-quality 3D image data (CTA, CMR, 3D echography), but it still needs the involvement of expert operators for image segmentation and mesh refinement. 3D printed models could be useful in interventional planning, although prospective studies with comprehensive and clinically meaningful endpoints are required to demonstrate the clinical utility. CONCLUSION 3D printing can be used to improve anatomy understanding and surgical planning.
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Affiliation(s)
- Simona Celi
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Katia Capellini
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Benigno M Fanni
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Lamia A Ali
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
| | | | - Michele Murzi
- Adult Cardiosurgery Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Sergio Berti
- Adult Interventional Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
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Atrial Fibrillation Management in 2021: An Updated Comparison of the Current CCS/CHRS, ESC, and AHA/ACC/HRS Guidelines. Can J Cardiol 2021; 37:1607-1618. [PMID: 34186113 DOI: 10.1016/j.cjca.2021.06.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/24/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
Given its complexity, the management of atrial fibrillation (AF) has relied increasingly on expert guideline recommendations; however, discrepancies among these professional societies can lead to confusion among practicing clinicians. This article compares the recommendations in the 2019 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS), the 2020 European Society of Cardiology (ESC), and the 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society (CCS/CHRS) AF guidelines. Although many of the recommendations are fundamentally similar, there are important differences between guidelines. Specifically, key differences are present in: 1) Definitions and classification of AF; 2) The role of opportunistic detection; 3) Symptom and quality-of-life evaluation; 4) Stroke-risk stratification, and the indication for oral anticoagulation (OAC) therapy; 5) the role of aspirin in stroke prevention for AF patients; 6) the antithrombotic regimens employed in the context of coronary artery disease; 7) the role of OAC, and specifically non-vitamin K direct-acting oral anticoagulants (DOACs), in patients with chronic and end-stage renal disease; 8) the target heart rate for patients treated with a rate-control strategy, along with the medications recommended to achieve the heart-rate target; and 9) the role of catheter ablation as first-line therapy or in patients with heart failure. These differences highlight areas of continuing clinical uncertainty where there are important needs and opportunities for future investigative work.
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Wu J, Alsaeed ES, Barrett J, Hall M, Cowan C, Gale CP. Prescription of oral anticoagulants and antiplatelets for stroke prophylaxis in atrial fibrillation: nationwide time series ecological analysis. Europace 2021; 22:1311-1319. [PMID: 32778878 DOI: 10.1093/europace/euaa126] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/27/2020] [Indexed: 02/05/2023] Open
Abstract
AIMS To investigate trends in the prescription of oral anticoagulants (OACs) and antiplatelet agents for atrial fibrillation (AF). METHODS AND RESULTS Prescription data for 450 518 patients with AF from 3352 General Practices in England, was obtained from the GRASP-AF registry, 2009-2018. Annualized temporal trends for OAC and antiplatelet prescription were reported according to eligibility based on stroke risk (CHADS2 or CHA2DS2-VASc scores ≥1 or >2, respectively). From 2009 to 2018, the prevalence of AF increased from 1.6% [95% confidence interval (CI) 1.5-1.7%] to 2.4% (2.3-2.5%), and for those with AF the proportion prescribed OAC increased from 47.6% to 75.0% (P-trend < 0.001; relative risk 1.57, 95% CI 1.55-1.60) and for antiplatelet decreased from 37.4% to 9.2% (P-trend < 0.001). In early-years (2009-2013), eligible patients aged ≥80 years were less likely to be prescribed OAC than patients aged <80 years [odds ratio (OR) 0.55, 95% CI 0.51-0.59 for CHADS2≥1 in 2009] (all P-trends < 0.001). This 'OAC prescription gap' reduced over the study period (OR 0.93, 0.90-0.96 in 2018). Whilst the prescription of direct oral anticoagulant (DOAC) as a proportion of all OAC increased from 0.1% (95% CI 0.0-0.2%) in 2011 to 58.8% (58.4-59.2%) in 2018, it was inversely associated with patient age (P-trend < 0.001) and their risk of stroke. CONCLUSION Between 2009 and 2018, in England, the use of OAC for stroke prophylaxis in AF increased, with DOAC accounting for over half of OAC uptake in 2018. Despite a reduction in the OAC-prescription gap, a new paradox exists relating to DOAC prescription for the elderly and those at higher risk of stroke.
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Affiliation(s)
- Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Eman S Alsaeed
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds LS2 9JT, UK
| | - James Barrett
- PRIMIS, Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Marlous Hall
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds LS2 9JT, UK
| | - Campbell Cowan
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds LS2 9JT, UK.,Department of Cardiology, Leeds General Infirmary, Leeds, UK
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50
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de Jong Y, Fu EL, van Diepen M, Trevisan M, Szummer K, Dekker FW, Carrero JJ, Ocak G. Validation of risk scores for ischaemic stroke in atrial fibrillation across the spectrum of kidney function. Eur Heart J 2021; 42:1476-1485. [PMID: 33769473 PMCID: PMC8046502 DOI: 10.1093/eurheartj/ehab059] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/18/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
Aims The increasing prevalence of ischaemic stroke (IS) can partly be explained by the likewise growing number of patients with chronic kidney disease (CKD). Risk scores have been developed to identify high-risk patients, allowing for personalized anticoagulation therapy. However, predictive performance in CKD is unclear. The aim of this study is to validate six commonly used risk scores for IS in atrial fibrillation (AF) patients across the spectrum of kidney function. Methods and results Overall, 36 004 subjects with newly diagnosed AF from SCREAM (Stockholm CREAtinine Measurements), a healthcare utilization cohort of Stockholm residents, were included. Predictive performance of the AFI, CHADS2, Modified CHADS2, CHA2DS2-VASc, ATRIA, and GARFIELD-AF risk scores was evaluated across three strata of kidney function: normal kidney function [estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2], mild CKD (eGFR 30–60 mL/min/1.73 m2), and advanced CKD (eGFR <30 mL/min/1.73 m2). Predictive performance was assessed by discrimination and calibration. During 1.9 years, 3069 (8.5%) patients suffered an IS. Discrimination was dependent on eGFR: the median c-statistic in normal eGFR was 0.75 (range 0.68–0.78), but decreased to 0.68 (0.58–0.73) and 0.68 (0.55–0.74) for mild and advanced CKD, respectively. Calibration was reasonable and largely independent of eGFR. The Modified CHADS2 score showed good performance across kidney function strata, both for discrimination [c-statistic: 0.78 (95% confidence interval 0.77–0.79), 0.73 (0.71–0.74) and 0.74 (0.69–0.79), respectively] and calibration. Conclusion In the most clinically relevant stages of CKD, predictive performance of the majority of risk scores was poor, increasing the risk of misclassification and thus of over- or undertreatment. The Modified CHADS2 score performed good and consistently across all kidney function strata, and should therefore be preferred for risk estimation in AF patients.
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Affiliation(s)
- Ype de Jong
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.,Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Edouard L Fu
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Marco Trevisan
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Karolina Szummer
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Gurbey Ocak
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.,Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
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