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JACC. Cardiovascular Imaging Jan 2022
Topics: Atrial Fibrillation; Humans; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests
PubMed: 34419397
DOI: 10.1016/j.jcmg.2021.07.006 -
Annals of Noninvasive Electrocardiology... Nov 2015Silent or subclinical asymptomatic atrial fibrillation has currently gained wide interest in the epidemiologic, neurologic and cardiovascular communities. The... (Review)
Review
Silent or subclinical asymptomatic atrial fibrillation has currently gained wide interest in the epidemiologic, neurologic and cardiovascular communities. The association of brief episodes of paroxysmal atrial fibrillation or surrogate atrial arrhythmias which predict future clinical adverse events have been established. Nevertheless there exists a confounding array of definitions to indicate its presence without discrete indication of which populations should be examined. Moreover the term "atrial fibrillation burden" (AFB) has emerged from such studies with a plethora of descriptions to prognosticate both arrhythmic and clinical adverse events. This presentation suggests clarification of diagnostic definitions associated with silent atrial fibrillation, and a more precise description of AFB. It examines the populations across the current disease and cardiovascular invasive therapeutic spectrum that lead to both silent atrial fibrillation and AFB. It describes the diagnostic methods of arrhythmia detection utilizing the surface ECG, subcutaneous ECG or intra-cardiac devices and their relationship in seeking meaningful arrhythmic markers of silent atrial fibrillation. Whereas a wide range of clinical risk factors of silent atrial fibrillation have been validated in the literature, there is an ongoing search for those arrhythmic risk factors that precisely identify and prognosticate outcome events in diverse populations at risk of atrial fibrillation and its complications. This presentation identifies this chaos, and focuses attention on the issues to be addressed to facilitate descriptive and comparative scientific studies in the future. It is a call to action specifically to the medical arrhythmic community and its specialty societies (i.e., ISHNE, HRS, EHRA) to begin a quest to unravel the arrhythmic quagmire associated with "silent atrial fibrillation."
Topics: Atrial Fibrillation; Electrocardiography; Humans; Prognosis; Risk Factors
PubMed: 26446367
DOI: 10.1111/anec.12307 -
Archives of Cardiovascular Diseases 2020Obesity is a major risk factor for atrial fibrillation. It also influences the natural history of the disease, leading to more persistent forms and poorer ablation... (Review)
Review
Obesity is a major risk factor for atrial fibrillation. It also influences the natural history of the disease, leading to more persistent forms and poorer ablation outcomes. This article reviews atrial fibrillation ablation in the obese population, focusing on outcomes, complications and periprocedural management. Through an analysis of the possible pathophysiological mechanism linking obesity and atrial fibrillation, we identify potential strategies to improve post-ablation outcomes in this challenging population.
Topics: Ablation Techniques; Adiposity; Animals; Atrial Fibrillation; Body Mass Index; Heart Rate; Humans; Obesity; Risk Factors; Treatment Outcome; Weight Gain
PubMed: 32753124
DOI: 10.1016/j.acvd.2020.03.023 -
Current Problems in Cardiology Jun 2024There has been a significant increase in the prevalence of atrial fibrillation (AF) over the past 30 years. Pulmonary vein isolation (PVI) is an effective treatment for... (Review)
Review
There has been a significant increase in the prevalence of atrial fibrillation (AF) over the past 30 years. Pulmonary vein isolation (PVI) is an effective treatment for AF, but research investigations have shown that AF recurrence still occurs in a significant number of patients after ablation. Heart rhythm outcomes following catheter ablation are correlated with numerous clinical factors, and researchers developed predictive models by integrating risk factors to predict the risk of recurrence of atrial fibrillation. The purpose of this article is to outline the risk scores for predicting cardiac rhythm outcomes after PVI and to discuss the modifiable factors that increase the risk of recurrence of AF, with the hope of further improving catheter ablation efficacy through preoperative identification of high-risk populations and postoperative management of modifiable risk factors.
Topics: Atrial Fibrillation; Humans; Catheter Ablation; Risk Factors; Pulmonary Veins; Recurrence; Risk Assessment; Treatment Outcome; Patient Care Team
PubMed: 38518845
DOI: 10.1016/j.cpcardiol.2024.102514 -
JACC. Clinical Electrophysiology Feb 2022
Topics: Atrial Fibrillation; Defibrillators, Implantable; Electronics; Heart Failure; Humans
PubMed: 35210076
DOI: 10.1016/j.jacep.2021.10.009 -
Methodist DeBakey Cardiovascular Journal 2015The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept... (Review)
Review
The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to obtain optimal long-term sinus rhythm control. This article provides an overview of current surgical strategies for patients with atrial fibrillation and addresses the two main goals in its management.
Topics: Ablation Techniques; Animals; Atrial Fibrillation; Heart Conduction System; Humans; Treatment Outcome
PubMed: 26306128
DOI: 10.14797/mdcj-11-2-104 -
Journal of the American College of... Feb 2019Numerous vascular risk factors and vascular diseases contribute to cognitive impairment and dementia. Many studies and registries show an association of atrial... (Review)
Review
Numerous vascular risk factors and vascular diseases contribute to cognitive impairment and dementia. Many studies and registries show an association of atrial fibrillation (AF) with cognitive impairment, cognitive decline, and dementia. This is true for vascular dementia and Alzheimer's disease. The assumed multifactorial mechanisms include ischemic stroke, both apparent and silent, cerebral microinfarcts, cerebral hemorrhage, and reduced cerebral blood flow. A number of retrospective observational and prospective studies support that anticoagulation in patients with AF may reduce the risk of cognitive decline and dementia. This holds for both vitamin K antagonists (e.g., warfarin) and direct oral anticoagulants. However, it still remains unproven if anticoagulation reduces cognitive decline and dementia in AF patients based on randomized trials.
Topics: Anticoagulants; Atrial Fibrillation; Cognition; Cognitive Dysfunction; Humans
PubMed: 30732716
DOI: 10.1016/j.jacc.2018.10.077 -
Journal of the American College of... Feb 2021
Topics: Atrial Fibrillation; Diabetes Mellitus; Humans; Prediabetic State; Stroke
PubMed: 33602471
DOI: 10.1016/j.jacc.2020.12.035 -
Reviews in Cardiovascular Medicine Dec 2021Most of the published literature on Atrial fibrillation (AF) originates from the northern hemisphere and mainly involves Caucasian patients, with limited studies in... (Review)
Review
Most of the published literature on Atrial fibrillation (AF) originates from the northern hemisphere and mainly involves Caucasian patients, with limited studies in certain ethnicities and races. This scoping review was conducted to collect and summarize the pertinent evidence from the published scientific literature on AF in South Asians and Middle Eastern Arabs. MEDLINE, Embase and CENTRAL databases were included in our search. After screening 8995 records, 55 studies were selected; 42 from the Middle East and 13 from South Asia. Characteristics of the included studies were tabulated, and their data were summarized for study design, setting, enrolment period, sample size, demographics, prevalence or incidence of AF, co-morbidities, risk factors, AF types and symptoms, management, outcomes, and risk determinants. Identified literature gaps included a paucity of community or population-based studies that are representative of these two ethnicities/races. In addition, studies that addressed ethnic/racial in-equality and access to treatment were lacking. Our study underscores the urgent need to study cardiovascular disorders, particularly AF, in South Asians and Middle Eastern Arabs as well as in other less represented ethnicities and races.
Topics: Arabs; Asian People; Atrial Fibrillation; Humans; Incidence; Risk Factors
PubMed: 34957762
DOI: 10.31083/j.rcm2204127 -
Journal of the American College of... Jul 2020
Topics: Atrial Fibrillation; Atrial Flutter; Atrial Remodeling; Catheter Ablation; Humans
PubMed: 32703508
DOI: 10.1016/j.jacc.2020.06.004