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Medicina (Kaunas, Lithuania) Dec 2023Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as... (Review)
Review
Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as the causative factor or as the consequence or even as an innocent bystander. The interplay between these two clinical conditions is complex, given that they share common pathophysiological pathways and they can reciprocally exacerbate each other, thus triggering a vicious cycle that worsens the prognosis and increases the thromboembolic risk. The optimal management of AF in the context of AHF in the emergency department remains a challenge depending on the time onset, as well as the nature and the severity of the associated symptoms. Acute rate control, along with early rhythm control, when indicated, and anticoagulation represent the main pillars of the therapeutic intervention. The purpose of this review is to elucidate the pathophysiological link between AF and AHF and accordingly present a stepwise algorithmic approach for the management of AF in AHF patients in the emergency setting.
Topics: Humans; Atrial Fibrillation; Anti-Arrhythmia Agents; Heart Failure; Emergency Service, Hospital; Prognosis
PubMed: 38138216
DOI: 10.3390/medicina59122113 -
Europace : European Pacing,... Jul 2023Atrial high-rate episodes (AHRE) are atrial tachyarrhythmias detected by continuous rhythm monitoring by pacemakers, defibrillators, or implantable cardiac monitors....
Atrial high-rate episodes (AHRE) are atrial tachyarrhythmias detected by continuous rhythm monitoring by pacemakers, defibrillators, or implantable cardiac monitors. Atrial high-rate episodes occur in 10-30% of elderly patients without atrial fibrillation. However, it remains unclear whether the presence of these arrhythmias has therapeutic consequences. The presence of AHRE increases the risk of stroke compared with patients without AHRE. Oral anticoagulation would have the potential to reduce the risk of stroke in patients with AHRE but is also associated with a rate of major bleeding of ∼2%/year. The stroke rate in patients with AHRE appears to be lower than the stroke rate in patients with atrial fibrillation. Wearables like smart-watches will increase the absolute number of patients in whom atrial arrhythmias are detected. It remains unclear whether anticoagulation is effective and, equally important, safe in patients with AHRE. Two randomized clinical trials, NOAH-AFNET6 and ARTESiA, are expected to report soon. They will provide much-needed information on the efficacy and safety of oral anticoagulation in patients with AHRE.
Topics: Humans; Aged; Atrial Fibrillation; Risk Factors; Anticoagulants; Heart Atria; Stroke
PubMed: 37345804
DOI: 10.1093/europace/euad166 -
The Lancet. Neurology Apr 2024Atrial fibrillation is one of the most common cardiac arrhythmias and is a major cause of ischaemic stroke. Recent findings indicate the importance of atrial... (Review)
Review
Atrial fibrillation is one of the most common cardiac arrhythmias and is a major cause of ischaemic stroke. Recent findings indicate the importance of atrial fibrillation burden (device-detected, subclinical, or paroxysmal and persistent or permanent) and whether atrial fibrillation was known before stroke onset or diagnosed after stroke for the risk of recurrence. Secondary prevention in patients with atrial fibrillation and stroke aims to reduce the risk of recurrent ischaemic stroke. Findings from randomised controlled trials assessing the optimal timing to introduce direct oral anticoagulant therapy after a stroke show that early start (ie, within 48 h for minor to moderate strokes and within 4-5 days for large strokes) seems safe and could reduce the risk of early recurrence. Other promising developments regarding early rhythm control, left atrial appendage occlusion, and novel factor XI inhibitor oral anticoagulants suggest that these therapies have the potential to further reduce the risk of stroke. Secondary prevention strategies in patients with atrial fibrillation who have a stroke despite oral anticoagulation therapy is an unmet medical need. Research advances suggest a heterogeneous spectrum of causes, and ongoing trials are investigating new approaches for secondary prevention in this vulnerable patient group. In patients with atrial fibrillation and a history of intracerebral haemorrhage, the latest data from randomised controlled trials on stroke prevention shows that oral anticoagulation reduces the risk of ischaemic stroke but more data are needed to define the safety profile.
Topics: Humans; Stroke; Atrial Fibrillation; Brain Ischemia; Secondary Prevention; Anticoagulants; Ischemic Stroke
PubMed: 38508836
DOI: 10.1016/S1474-4422(24)00037-1 -
Journal of Interventional Cardiac... Sep 2023
Topics: Humans; Heart Valve Diseases; Atrial Fibrillation
PubMed: 36705870
DOI: 10.1007/s10840-023-01487-y -
Disease Markers 2023Atrial fibrillation (AF) is an irregular atrial activity and the most prevalent type of arrhythmia. Although AF is easily diagnosed with an electrocardiogram, there is a... (Review)
Review
Atrial fibrillation (AF) is an irregular atrial activity and the most prevalent type of arrhythmia. Although AF is easily diagnosed with an electrocardiogram, there is a keen interest in identifying an easy-to-dose biomarker that can predict the prognosis of AF and its recurrence. Galectin-3 (Gal-3) is a beta-galactoside binding protein from the lectin family with pro-fibrotic and -inflammatory effects and a pivotal role in a variety of biological processes, cell proliferation, and differentiation; therefore, it is implicated in the pathogenesis of many cardiovascular (e.g., heart failure (HF)) and noncardiovascular diseases. However, its specificity and sensitivity as a potential marker in AF patients remain debated and controversial. This article comprehensively reviewed the evidence regarding the interplay between Gal-3 and patients with AF. Clinical implications of measuring Gal-3 in AF patients for diagnosis and prognosis are mentioned. Moreover, the role of Gal-3 as a potential biomarker for the management of AF recurrence is investigated. The association of Gal-3 and AF in special populations (coronary artery disease, HF, metabolic syndrome, chronic kidney disease, and diabetes mellitus) has been explored in this review. Overall, although further studies are needed to enlighten the role of Gal-3 in the diagnosis and treatment of AF, our study demonstrated the high potential of this molecule to be used and focused on by researchers and clinicians.
Topics: Humans; Atrial Fibrillation; Biomarkers; Galectin 3; Heart Atria; Heart Failure; Prognosis
PubMed: 37849915
DOI: 10.1155/2023/2097012 -
European Heart Journal Mar 2024Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal...
Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal right and left ventricular function. Atrial secondary tricuspid regurgitation occurs most commonly in elderly women with atrial fibrillation and in heart failure with preserved ejection fraction in sinus rhythm. In A-STR, the main mechanism of leaflet malcoaptation is related to the presence of a significant dilation of the tricuspid annulus secondary to right atrial enlargement. In addition, there is an insufficient adaptive growth of tricuspid valve leaflets that become unable to cover the enlarged annular area. As opposed to the ventricular phenotype, in A-STR, the tricuspid valve leaflet tethering is typically trivial. The A-STR phenotype accounts for 10%-15% of clinically relevant tricuspid regurgitation and has better outcomes compared with the more prevalent ventricular phenotype. Recent data suggest that patients with A-STR may benefit from more aggressive rhythm control and timely valve interventions. However, little is mentioned in current guidelines on how to identify, evaluate, and manage these patients due to the lack of consistent evidence and variable definitions of this entity in recent investigations. This interdisciplinary expert opinion document focusing on A-STR is intended to help physicians understand this complex and rapidly evolving topic by reviewing its distinct pathophysiology, diagnosis, and multi-modality imaging characteristics. It first defines A-STR by proposing specific quantitative criteria for defining the atrial phenotype and for discriminating it from the ventricular phenotype, in order to facilitate standardization and consistency in research.
Topics: Humans; Female; Aged; Tricuspid Valve Insufficiency; Heart Atria; Tricuspid Valve; Atrial Fibrillation; Heart Failure
PubMed: 38441886
DOI: 10.1093/eurheartj/ehae088 -
Saudi Journal of Kidney Diseases and... Jul 2023This study aimed to evaluate the prevalence and the association between hypertension (HTN) and atrial fibrillation (AF) in hemodialysis (HD) patients. A chart...
This study aimed to evaluate the prevalence and the association between hypertension (HTN) and atrial fibrillation (AF) in hemodialysis (HD) patients. A chart review-based, cross-sectional study was conducted on HD patients who had received HD for at least 6 months. Demographic, hemodynamic, and laboratory data were retrieved from the BestCare system, and the main outcomes were blood pressure before and after dialysis, and the presence of AF. Our sample consisted of 304 HD patients; 162 (53%) were male, and the mean age was 63 ± 18 years. Sixty-eight (20%) had AF, of whom 44 (64.7%) were male, with a mean age of 73 ± 12 years. The risk of AF increased by 0.4 [odds ratio: 1.04; 95% confidence interval (CI): 1.02-1.06; P <0.001] for every year of age. Almost the entire sample (66.45%, n = 202) was hypertensive, and those patients had a mean age of 64 ± 17 years, and nearly one-third had a body mass index in the obese category (28.7%, n = 58). In addition, with every increase in the Charlson comorbidity index score by two points, there was a 40% increased risk of developing HTN (OR: 2.47; 95% CI: 1.17-5.18; P = 0.017). The risk factors for the development of HTN and AF in HD patients were found to be increasing age for AF and female sex for HTN. The presence of HTN and diabetes increased the risk of developing AF seven-fold after HD.
Topics: Humans; Male; Female; Middle Aged; Aged; Aged, 80 and over; Atrial Fibrillation; Cross-Sectional Studies; Hypertension; Blood Pressure; Risk Factors; Renal Dialysis
PubMed: 38345586
DOI: 10.4103/1319-2442.395447 -
Clinical Cardiology Jul 2023Limited data on the efficacy and safety of atrial fibrillation (AF) ablation using an ablation index (AI) for octogenarians is available. We aimed to compare the...
BACKGROUND
Limited data on the efficacy and safety of atrial fibrillation (AF) ablation using an ablation index (AI) for octogenarians is available. We aimed to compare the efficacy and safety of AI-guided AF ablation between AF patients aged ≥80 years (Group 1) and <80 (Group 2).
HYPOTHESIS
We hypothesized that AI-guided AF ablation could complete the procedure with comparable efficiency and safety in patients aged ≥80 years and <80.
METHODS
We retrospectively reviewed 2087 AF patients undergoing their first AI-guided AF ablation in our hospital. We compared the atrial tachyarrhythmia (AT) recurrence and procedure-related complication rate between Group 1 (n = 193) and Group 2 (n = 1894).
RESULTS
The mean age was 83.0 (interquartile range [IQR] 81.0, 84.0) years in Group 1 and 67.0 (IQR 60.0, 72.0) in Group 2. AF type was significantly different between the two groups: Of Group 1 patients, 120 (62.2%) had paroxysmal AF, 61 (31.6%) persistent AF, and 12 (6.2%) long-standing persistent AF, while of Group 2 patients, 1016 (53.6%) paroxysmal AF, 582 (30.7%) persistent AF, and 296 (15.6%) long-standing persistent AF (p = .001). Unadjusted AT recurrence-free survival curves showed similar AT recurrence-free survival between the two groups (p = .67 by log-rank test). After the adjustment for AF type, the survival curve was similar between them (hazard ratio, 1.24; 95% CI [0.92-1.65]; p = .15, Group 1 vs. Group 2). The rate of procedure-related complications was similar between the two groups (3.1% vs. 3.0%, respectively, p = .83).
CONCLUSION
Catheter ablation guided by AI achieved similar AT recurrence and complication rates between elderly AF patients aged ≥80 years and patients <80 years.
Topics: Aged; Aged, 80 and over; Humans; Atrial Fibrillation; Retrospective Studies; Octogenarians; Treatment Outcome; Heart Atria; Catheter Ablation; Pulmonary Veins
PubMed: 37199002
DOI: 10.1002/clc.24031 -
Open Heart Aug 2023Atrial fibrillation (AF) is common in individuals with heart failure (HF). Individuals with HF and AF may have a reduced functional capacity and quality of life (QoL)...
BACKGROUND
Atrial fibrillation (AF) is common in individuals with heart failure (HF). Individuals with HF and AF may have a reduced functional capacity and quality of life (QoL) which leads to hospital admission and burden on clinical services. Evidence supported the effect of exercise training in individuals with HF. However, there is no existing data on the effectiveness of comprehensive cardiac rehabilitation (CR) in individuals with coexisting HF and AF.
AIM
To explore the effect of CR in individuals with HF and AF compared with those with HF and no-coexisting AF.
METHODS
Using CR database, individuals with HF and AF were identified and propensity matched to those with no coexisting AF. The change in incremental shuttle walking test, Heart Disease Quality of Life questionnaire, Hospital Anxiety and Depression Scores were compared between groups pre-CR and post-CR.
RESULTS
149 individuals were propensity matched from each group. The mean±SD age of the matched sample was 73.4±8 years, body mass index 29±5.5 kg/m, left ventricular ejection fraction 35.2±9.8% and 56% were male.A statistically significant improvements in exercise capacity, heart disease QoL, anxiety and depression scores were observed within each group. There were no significant differences between groups for any of these outcome measures.
CONCLUSIONS
Individuals with HF and AF gain a similar improvement in exercise capacity and health related QoL outcomes as individuals with no coexisting AF following CR. The presence of AF did not compromise the effectiveness of CR.
Topics: Humans; Male; Aged; Aged, 80 and over; Female; Atrial Fibrillation; Cardiac Rehabilitation; Quality of Life; Stroke Volume; Ventricular Function, Left; Heart Failure
PubMed: 37567605
DOI: 10.1136/openhrt-2023-002372 -
Current Treatment Options in Oncology Aug 2023Patients with cancer are at risk of developing cardiovascular disease (CVD) including atherosclerotic heart disease (AHD), valvular heart disease (VHD), and atrial... (Review)
Review
Patients with cancer are at risk of developing cardiovascular disease (CVD) including atherosclerotic heart disease (AHD), valvular heart disease (VHD), and atrial fibrillation (AF). Advances in percutaneous catheter-based treatments, including percutaneous coronary intervention (PCI) for AHD, percutaneous valve replacement or repair for VHD, and ablation and left atrial appendage occlusion devices (LAAODs) for AF, have provided patients with CVD significant benefit in the recent decades. However, trials and registries investigating outcomes of these procedures often exclude patients with cancer. As a result, patients with cancer are less likely to undergo these therapies despite their benefits. Despite the inclusion of cancer patients in randomized clinical trial data, studies suggest that cancer patients derive similar benefits of percutaneous therapies for CVD compared with patients without cancer. Therefore, percutaneous interventions for CVD should not be withheld in patients with cancer, as they may still benefit from these procedures.
Topics: Humans; Percutaneous Coronary Intervention; Heart Valve Diseases; Risk Factors; Atrial Fibrillation; Neoplasms; Randomized Controlled Trials as Topic
PubMed: 37296366
DOI: 10.1007/s11864-023-01110-2