-
Indian Pacing and Electrophysiology... 2023Annual healthcare expenditures associated with atrial fibrillation (AF) in the United States (US) continue to grow as more symptomatic patients present to emergency...
INTRODUCTION
Annual healthcare expenditures associated with atrial fibrillation (AF) in the United States (US) continue to grow as more symptomatic patients present to emergency departments (ED). Predictors of spontaneous conversion to normal sinus rhythm (ScNSR) remain poorly understood, as well as the timeline of ScNSR remains unclear. We sought to 1) to assess the association of key demographics, anthropometric, and clinical factors to ScNSR and 2) to evaluate the timeline of ScNSR, and 3) determine clinical predictors of ScNSR.
METHODS
This single center, retrospective cohort study analyzed patients aged ≥18 years with symptomatic AF as diagnosed and evaluated through the ED of a rural tertiary care center in West Virginia from September 2015 to December 2018.
RESULTS
Our cohort consisted of 375 AF patients (mean age 65 years, 54% male). A total of 177 patients attained ScNSR either in the ED or after hospital admission with a mean conversion time of 14.7 h (±12). Onset of symptoms <24 hrs has strong positive association to ScNSR 3.97 (95% CI: 2.24-7.05; p < 0.0001). Male gender 0.55 (95% CI: 0.35-0.85; p = 0.007) and hypertension 0.48 (95% CI: 0.31-0.76; p = 0.002), showed a strong negative association to ScNSR. Of the patients that converted spontaneously (177), the majority, 136 (76.8%) achieved ScNSR within 24 h of ED triage without use of electrical or chemical cardioversion.
CONCLUSION
Most patients with AF in the ED converted spontaneously to sinus rhythm within the first 24 h which underscores the importance of earlier watchful waiting over interventions to achieve normal sinus rhythm (NSR).
PubMed: 37739312
DOI: 10.1016/j.ipej.2023.09.002 -
Journal of Atrial Fibrillation 2013Atrial fibrillation (AF) is the manifest outcome of a multifactorial, progressive disease process,secondarily or primarily involving the atrial chambers. The slowly... (Review)
Review
Atrial fibrillation (AF) is the manifest outcome of a multifactorial, progressive disease process,secondarily or primarily involving the atrial chambers. The slowly progressive electrostructural alterations diffusely involve the atrial substrate and lead to persistent and permanent forms of AF. Although the progression of the AF disease process is variable and associated with the development of comorbid conditions, rhythm restoration therapies, particularly catheter ablation,provide higher acute and long-term success rates in paroxysmal than non-paroxysmal AF. This review of literature aims to discuss how early restoration and maintenance of sinus rhythm especially using novel approaches can influence the progressive nature of atrial fibrillation.
PubMed: 28496874
DOI: 10.4022/jafib.849 -
British Journal of Cardiac Nursing Jun 2022One to two percent of the population in developed countries are affected by chronic heart failure and this increases to greater than 10% in those over 70 years old....
The effect of anticoagulants on clinical outcomes of mortality, stroke, myocardial infarction, pulmonary embolism, and major bleeding for patients with heart failure in sinus rhythm.
One to two percent of the population in developed countries are affected by chronic heart failure and this increases to greater than 10% in those over 70 years old. Heart failure (HF) predisposes patients to thromboembolic events. Anticoagulants are often used to prevent thromboembolic events in specific patient populations, such as those with atrial fibrillation. Currently, no guidance exists on the long-term use of anticoagulants for patients with HF in sinus rhythm. This article critically appraises a systematic review which assesses whether the long-term use of oral anticoagulants reduces total mortality and stroke in patients with HF in sinus rhythm.
PubMed: 38808168
DOI: 10.12968/bjca.2022.0049 -
Frontiers in Physiology 2020Circadian rhythms are involved in many physiological and pathological processes in different tissues, including the heart. Circadian rhythms play a critical role in... (Review)
Review
Circadian rhythms are involved in many physiological and pathological processes in different tissues, including the heart. Circadian rhythms play a critical role in adverse cardiac function with implications for heart failure and sudden cardiac death, highlighting a significant contribution of circadian mechanisms to normal sinus rhythm in health and disease. Cardiac arrhythmias are a leading cause of morbidity and mortality in patients with heart failure and likely cause ∼250,000 deaths annually in the United States alone; however, the molecular mechanisms are poorly understood. This suggests the need to improve our current understanding of the underlying molecular mechanisms that increase vulnerability to arrhythmias. Obesity and its associated pathologies, including diabetes, have emerged as dangerous disease conditions that predispose to adverse cardiac electrical remodeling leading to fatal arrhythmias. The increasing epidemic of obesity and diabetes suggests vulnerability to arrhythmias will remain high in patients. An important objective would be to identify novel and unappreciated cellular mechanisms or signaling pathways that modulate obesity and/or diabetes. In this review we discuss circadian rhythms control of metabolic and environmental cues, cardiac ion channels, and mechanisms that predispose to supraventricular and ventricular arrhythmias including hormonal signaling and the autonomic nervous system, and how understanding their functional interplay may help to inform the development and optimization of effective clinical and therapeutic interventions with implications for chronotherapy.
PubMed: 33519516
DOI: 10.3389/fphys.2020.611860 -
Frontiers in Physiology 2018We investigated cardio-respiratory coupling in patients with heart failure by quantification of bidirectional interactions between cardiac (RR intervals) and respiratory...
We investigated cardio-respiratory coupling in patients with heart failure by quantification of bidirectional interactions between cardiac (RR intervals) and respiratory signals with complementary measures of time series analysis. Heart failure patients were divided into three groups of twenty, age and gender matched, subjects: with sinus rhythm (HF-Sin), with sinus rhythm and ventricular extrasystoles (HF-VES), and with permanent atrial fibrillation (HF-AF). We included patients with indication for implantation of implantable cardioverter defibrillator or cardiac resynchronization therapy device. ECG and respiratory signals were simultaneously acquired during 20 min in supine position at spontaneous breathing frequency in 20 healthy control subjects and in patients before device implantation. We used coherence, Granger causality and cross-sample entropy analysis as complementary measures of bidirectional interactions between RR intervals and respiratory rhythm. In heart failure patients with arrhythmias (HF-VES and HF-AF) there is no coherence between signals ( < 0.01), while in HF-Sin it is reduced ( < 0.05), compared with control subjects. In all heart failure groups causality between signals is diminished, but with significantly stronger causality of RR signal in respiratory signal in HF-VES. Cross-sample entropy analysis revealed the strongest synchrony between respiratory and RR signal in HF-VES group. Beside respiratory sinus arrhythmia there is another type of cardio-respiratory interaction based on the synchrony between cardiac and respiratory rhythm. Both of them are altered in heart failure patients. Respiratory sinus arrhythmia is reduced in HF-Sin patients and vanished in heart failure patients with arrhythmias. Contrary, in HF-Sin and HF-VES groups, synchrony increased, probably as consequence of some dominant neural compensatory mechanisms. The coupling of cardiac and respiratory rhythm in heart failure patients varies depending on the presence of atrial/ventricular arrhythmias and it could be revealed by complementary methods of time series analysis.
PubMed: 29559923
DOI: 10.3389/fphys.2018.00165 -
JACC. Case Reports Aug 2022
PubMed: 35935151
DOI: 10.1016/j.jaccas.2022.07.001 -
European Cardiology Jul 2019AF is a worldwide epidemic, affecting approximately 33 million people, and its rising prevalence is expected to account for increasing clinical and public health costs.... (Review)
Review
AF is a worldwide epidemic, affecting approximately 33 million people, and its rising prevalence is expected to account for increasing clinical and public health costs. AF is associated with an increased risk of MI, heart failure, stroke, dementia, chronic kidney disease and mortality. Preserving sinus rhythm is essential for a better outcome. However, because of the inherent limits of both pharmacological and interventional methods, rhythm strategy management is reserved for symptom and quality-of-life improvement. While 'classical' antiarrhythmic drug therapy remains the first-line therapy for rhythm control, its efficacy and safety are limited by empirical use, proarrhythmic risk and organ toxicity. Ablative techniques have had an impressive development, but AF ablation still failed to demonstrate a significant impact on hard endpoints. Understanding of the complex mechanisms of AF will help to develop new vulnerable targets to therapy. Promising molecules are under development, intended to fill the gap between the current pharmacological treatment aimed at maintaining sinus rhythm and the expectations from rhythm strategy.
PubMed: 31360227
DOI: 10.15420/ecr.2019.8.1 -
JACC. Heart Failure Feb 2013The purpose of this study was to analyze the effect of beta blockade on outcome in patients with heart failure (HF) and atrial fibrillation (AF). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The purpose of this study was to analyze the effect of beta blockade on outcome in patients with heart failure (HF) and atrial fibrillation (AF).
BACKGROUND
Beta-blockers are widely used in patients with HF and AF. Recommendation in current HF guidelines, however, is based on populations in which the most patients had sinus rhythm. Whether beta-blockers are as useful in AF is uncertain.
METHODS
Studies were included that investigated the effect of placebo-controlled, randomized beta-blocker therapy in patients with AF at baseline and HF with reduced systolic left ventricular ejection fraction (LVEF) <40%.
RESULTS
We identified 4 studies, which enrolled 8,680 patients with HF, and 1,677 of them had AF (19%; mean 68 years of age; 30% women); there were 842 patients treated with beta-blocker, and 835 with placebo. In AF patients, beta-blockade did not reduce mortality (odds ratio [OR]: 0.86 [95% confidence interval (CI): 0.66 to 1.13]; p = 0.28), while in sinus rhythm patients, there was a significant reduction (OR: 0.63 [95% CI: 0.54 to 0.73]; p < 0.0001). Interaction analysis showed significant interaction of the effects of beta-blocker therapy in AF versus that in sinus rhythm (p = 0.048). By meta-regression analysis, we did not find confounding by all relevant covariates. Beta-blocker therapy was not associated with a reduction in HF hospitalizations in AF (OR: 1.11 [95% CI: 0.85 to 1.47]; p = 0.44), in contrast to sinus rhythm (OR: 0.58 [95% CI: 0.49 to 0.68]; p < 0.0001). There was a significant interaction of the effects of beta-blocker therapy in AF versus that in sinus rhythm (p < 0.001).
CONCLUSIONS
Our findings suggest that the effect of beta-blockers on outcome in HF patients with reduced systolic LVEF who have AF is less than in those who have sinus rhythm.
Topics: Adrenergic beta-Antagonists; Aged; Atrial Fibrillation; Female; Heart Failure; Hospitalization; Humans; Male; Treatment Outcome; Ventricular Dysfunction, Left
PubMed: 24621795
DOI: 10.1016/j.jchf.2012.09.002 -
Medical Acupuncture Jun 2021Atrial fibrillation, the most commonly treated arrhythmia, results in significant symptom burden, increased stroke risk, and costs 26 billion dollars annually in the...
Atrial fibrillation, the most commonly treated arrhythmia, results in significant symptom burden, increased stroke risk, and costs 26 billion dollars annually in the United States alone. Maintaining sinus rhythm is often preferred, but current interventions have limitations and are associated with adverse effects. There are data suggesting that acupuncture can have a beneficial effect on maintaining sinus rhythm as well as limited data suggesting it can help convert atrial fibrillation to sinus rhythm in the acute setting. An 82-year-old woman with history of heart failure with preserved ejection fraction as well as paroxysmal atrial fibrillation developed atrial fibrillation with rapid ventricular response during a hospitalization for acute exacerbation of heart failure and gastrointestinal bleeding. Given success in converting supraventricular tachycardia using ear Shen Men in a prior case as well as limited data suggesting a benefit of acupuncture in acute atrial fibrillation, acupuncture was utilized in the management of the acute atrial fibrillation. Acupuncture was initiated 4 hours after the arrhythmia began and a total of 8 ear points (4 each side) as well as bilateral pericardium 6 points were utilized. Atrial fibrillation converted to sinus rhythm before the last needle was placed and the patient had no recurrence of atrial fibrillation throughout the remainder of her stay. Acupuncture appears to be solely responsible for the conversion of atrial fibrillation to sinus rhythm in this case, as no β-blockers, calcium channel blockers, or antiarrhythmic medicines were administered before the return to sinus rhythm. The antiarrhythmic effect noted may be from centrally mediated autonomic effects or additional mechanisms. Further study will help to define the role of acupuncture in the management of acute arrhythmias.
PubMed: 34239665
DOI: 10.1089/acu.2021.0022 -
Entropy (Basel, Switzerland) Sep 2020It is known that in pathological conditions, physiological systems develop changes in the multiscale properties of physiological signals. However, in real life, little...
It is known that in pathological conditions, physiological systems develop changes in the multiscale properties of physiological signals. However, in real life, little is known about how changes in the function of one of the two coupled physiological systems induce changes in function of the other one, especially on their multiscale behavior. Hence, in this work we aimed to examine the complexity of cardio-respiratory coupled systems control using multiscale entropy (MSE) analysis of cardiac intervals MSE (RR), respiratory time series MSE (Resp), and synchrony of these rhythms by cross multiscale entropy (CMSE) analysis, in the heart failure (HF) patients and healthy subjects. We analyzed 20 min of synchronously recorded RR intervals and respiratory signal during relaxation in the supine position in 42 heart failure patients and 14 control healthy subjects. Heart failure group was divided into three subgroups, according to the RR interval time series characteristics (atrial fibrillation (HFAF), sinus rhythm (HFSin), and sinus rhythm with ventricular extrasystoles (HFVES)). Compared with healthy control subjects, alterations in respiratory signal properties were observed in patients from the HFSin and HFVES groups. Further, mean MSE curves of RR intervals and respiratory signal were not statistically different only in the HFSin group ( = 0.43). The level of synchrony between these time series was significantly higher in HFSin and HFVES patients than in control subjects and HFAF patients ( < 0.01). In conclusion, depending on the specific pathologies, primary alterations in the regularity of cardiac rhythm resulted in changes in the regularity of the respiratory rhythm, as well as in the level of their asynchrony.
PubMed: 33286811
DOI: 10.3390/e22091042