RESUMEN
The WATCHMAN™ atrial appendage closure device is designed to reduce the risk of stroke in patients with nonvalvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation therapy. However, the device also carries small risks, including procedural complications such as device migration, embolization, or pericardial effusion. We describe a case of WATCHMAN device migration requiring surgical retrieval.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Remoción de Dispositivos , Migración de Cuerpo Extraño , Humanos , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Fibrilación Atrial/cirugía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Resultado del Tratamiento , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Masculino , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Femenino , Anciano , Ecocardiografía Transesofágica , Diseño de PrótesisRESUMEN
Purpose: This study aimed to investigate the proportion and risk factors of paroxysmal atrial fibrillation (AF) and atrial arrhythmias (AA) in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Vietnam. Patients and Methods: A prospective observational study was conducted at two major hospitals in Hanoi, Vietnam, from January 2022 to January 2023. A total of 197 AECOPD patients were recruited. ECG and 24-hour Holter ECG were used to diagnose paroxysmal AF and AA. Results: The prevalence of paroxysmal AF and AA were 15.2% and 72.6%, respectively. Factors associated with a higher likelihood of paroxysmal AF included aging 75 years old and above (aOR = 3.15; 95% CI: 1.28 to 8.48), Premature atrial complex (PAC) with 500 or more (aOR = 3.81; 95% CI: 1.48 to 10.97) and severity of COPD as group C and D (aOR = 3.41; 95% CI: 1.28 to 10.50). For AA, aging 75 years old and above (aOR = 2.25; 95% CI: 1.28 to 5.20), smoking (aOR = 2.10; 95% CI: 1.07 to 4.23) and P wave dispersion (PWD) with 40 milliseconds or more (aOR = 3.04; 95% CI: 1.54 to 6.19) were associated with a higher likelihood of AA. Conclusion: Overall, our findings highlight the associated factors with the paroxysmal AF and AA among AECOPD patients. This underscores the importance of a multifaceted approach to risk assessment and management in this vulnerable population, focusing not only on respiratory symptoms but also on comprehensive cardiovascular evaluation and intervention.
Asunto(s)
Fibrilación Atrial , Progresión de la Enfermedad , Hospitalización , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Anciano , Fibrilación Atrial/epidemiología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/terapia , Masculino , Prevalencia , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Factores de Riesgo , Vietnam/epidemiología , Hospitalización/estadística & datos numéricos , Factores de Edad , Medición de Riesgo , Anciano de 80 o más Años , Complejos Atriales Prematuros/epidemiología , Complejos Atriales Prematuros/diagnóstico , Complejos Atriales Prematuros/fisiopatología , Electrocardiografía AmbulatoriaRESUMEN
Atrial fibrillation (AF) is a life-threatening heart condition, and its early detection and treatment have garnered significant attention from physicians in recent years. Traditional methods of detecting AF heavily rely on doctor's diagnosis based on electrocardiograms (ECGs), but prolonged analysis of ECG signals is very time-consuming. This paper designs an AF detection model based on the Inception module, constructing multi-branch detection channels to process raw ECG signals, gradient signals, and frequency signals during AF. The model efficiently extracted QRS complex and RR interval features using gradient signals, extracted P-wave and f-wave features using frequency signals, and used raw signals to supplement missing information. The multi-scale convolutional kernels in the Inception module provided various receptive fields and performed comprehensive analysis of the multi-branch results, enabling early AF detection. Compared to current machine learning algorithms that use only RR interval and heart rate variability features, the proposed algorithm additionally employed frequency features, making fuller use of the information within the signals. For deep learning methods using raw and frequency signals, this paper introduced an enhanced method for the QRS complex, allowing the network to extract features more effectively. By using a multi-branch input mode, the model comprehensively considered irregular RR intervals and P-wave and f-wave features in AF. Testing on the MIT-BIH AF database showed that the inter-patient detection accuracy was 96.89%, sensitivity was 97.72%, and specificity was 95.88%. The proposed model demonstrates excellent performance and can achieve automatic AF detection.
Asunto(s)
Algoritmos , Fibrilación Atrial , Electrocardiografía , Redes Neurales de la Computación , Procesamiento de Señales Asistido por Computador , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Humanos , Electrocardiografía/métodos , Aprendizaje Automático , Frecuencia Cardíaca , Aprendizaje ProfundoAsunto(s)
Síndrome Coronario Agudo , Fibrilación Atrial , Humanos , Fibrilación Atrial/terapia , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/complicaciones , Síndrome Coronario Agudo/terapia , Intervención Coronaria Percutánea , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Estenosis de la Válvula Aórtica , Fibrilación Atrial , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Fibrilación Atrial/etiología , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Estenosis de la Válvula Aórtica/cirugía , Resultado del Tratamiento , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Factores de RiesgoRESUMEN
Background: Atrial fibrillation (AFib) detection via mobile ECG devices is promising, but algorithms often struggle to generalize across diverse datasets and platforms, limiting their real-world applicability. Objective: This study aims to develop a robust, generalizable AFib detection approach for mobile ECG devices using crowdsourced algorithms. Methods: We developed a voting algorithm using random forest, integrating six open-source AFib detection algorithms from the PhysioNet Challenge. The algorithm was trained on an AliveCor dataset and tested on two disjoint AliveCor datasets and one Apple Watch dataset. Results: The voting algorithm outperformed the base algorithms across all metrics: the average of sensitivity (0.884), specificity (0.988), PPV (0.917), NPV (0.985), and F1-score (0.943) on all datasets. It also demonstrated the least variability among datasets, signifying its highest robustness and effectiveness in diverse data environments. Moreover, it surpassed Apple's algorithm on all metrics and showed higher specificity but lower sensitivity than AliveCor's Kardia algorithm. Conclusions: This study demonstrates the potential of crowdsourced, multi-algorithmic strategies in enhancing AFib detection. Our approach shows robust cross-platform performance, addressing key generalization challenges in AI-enabled cardiac monitoring and underlining the potential for collaborative algorithms in wearable monitoring devices.
Asunto(s)
Algoritmos , Fibrilación Atrial , Colaboración de las Masas , Electrocardiografía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Humanos , Colaboración de las Masas/métodos , Electrocardiografía/métodos , Dispositivos Electrónicos VestiblesRESUMEN
This case report concerns a 48-year-old man with a history of ischemic stroke at the age of 41 who reported cardiac hypertrophy, registered in his twenties when explained by increased physical activity. Family history was positive for a mother with permanent atrial fibrillation from her mid-thirties. At the age of 44, he had a first episode of persistent atrial fibrillation, accompanied by left atrial thrombosis while on a direct oral anticoagulant. He presented at our clinic at the age of 45 with another episode of persistent atrial fibrillation and decompensated heart failure. Echocardiography revealed a dilated left atrium, reduced left ventricular ejection fraction, and an asymmetric left ventricular hypertrophy. Cardiac magnetic resonance was positive for a cardiomyopathy with diffuse fibrosis, while slow-flow phenomenon was present on coronary angiography. Genetic testing by whole-exome sequencing revealed three variants in the patient, c.309C > A, p.His103Gln in the ACTC1 gene, c.116T > G, p.Leu39Ter in the PLN gene, and c.5827C > T, p.His1943Tyr in the SCN5A gene, the first two associated with hypertrophic cardiomyopathy and the latter possibly with familial atrial fibrillation. This case illustrates the need for advanced diagnostics in unexplained left ventricular hypertrophy, as hypertrophic cardiomyopathy is often overlooked, leading to potentially debilitating health consequences.
Asunto(s)
Fibrilación Atrial , Cardiomiopatía Hipertrófica , Hipertrofia Ventricular Izquierda , Humanos , Fibrilación Atrial/genética , Fibrilación Atrial/diagnóstico , Masculino , Persona de Mediana Edad , Cardiomiopatía Hipertrófica/genética , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/complicaciones , Hipertrofia Ventricular Izquierda/genética , Hipertrofia Ventricular Izquierda/diagnóstico , Accidente Cerebrovascular/genética , Accidente Cerebrovascular/diagnóstico , Ecocardiografía , Canal de Sodio Activado por Voltaje NAV1.5/genéticaRESUMEN
OBJECTIVES: The purpose of this study was to demonstrate the discriminating predictive indicators in peripheral blood and left atrium blood for predicting the risk of left atrial spontaneous echo contrast (LASEC) in atrial fibrillation patients underwent catheter ablation. METHODS: A total of 108 consecutive AF patients treated with radiofrequency ablation between July 2022 and July 2023 were enrolled and divided into two groups based on preprocedural transesophageal echocardiography: the non LASEC group (n = 71) and the LASEC group (n = 37). Circulating platelet and endothelial- derived MPs (PMPs and EMPs) in peripheral blood and left atrial blood were detected. Plasma soluble P-selectin (sP-selectin) and von Willebrand factor (vWF) were observed. Diagnostic efficiency was measured using receiver operating characteristic (ROC) curve. RESULTS: Peripheral sP-selectin, vWF and EMPs expressions elevated in all subjects when compared to those in left atrium blood. Levels of sP-selectin and vWF were significantly higher in peripheral blood of LASEC group than those of non LASEC group (p = 0.0018,p = 0.0271). Significant accumulations of peripheral PMPs and EMPs were documented in LASEC group by comparison with non LASEC group (p = 0.0395,p = 0.018). The area under curve(AUC) of combined PMPs and sP-selectin in predicting LASEC was 0.769 (95%CI: 0.678-0.845, sensitivity: 86.49%, specificity: 59.15%), significantly larger than PMPs or sP-selectin alone. CONCLUSIONS: Expressions of PMPs, sP-selectin, EMPs and vWF Increased in NVAF patients with LASEC and that might be potential biomarkers for LASEC prediction.
Asunto(s)
Fibrilación Atrial , Biomarcadores , Ablación por Catéter , Ecocardiografía Transesofágica , Atrios Cardíacos , Selectina-P , Valor Predictivo de las Pruebas , Factor de von Willebrand , Humanos , Fibrilación Atrial/sangre , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Masculino , Femenino , Persona de Mediana Edad , Atrios Cardíacos/diagnóstico por imagen , Selectina-P/sangre , Factor de von Willebrand/metabolismo , Factor de von Willebrand/análisis , Biomarcadores/sangre , Anciano , Resultado del Tratamiento , Función del Atrio Izquierdo , Factores de Riesgo , Medición de RiesgoRESUMEN
Deep learning has shown great promise in predicting Atrial Fibrillation using ECG signals and other vital signs. However, a major hurdle lies in the privacy concerns surrounding these datasets, which often contain sensitive patient information. Balancing accurate AFib prediction with robust user privacy remains a critical challenge to address. We suggest Federated Learning , a privacy-preserving machine learning technique, to address this privacy barrier. Our approach makes use of FL by presenting Fed-CL, a advanced method that combines Long Short-Term Memory networks and Convolutional Neural Networks to accurately predict AFib. In addition, the article explores the importance of analysing mean heart rate variability to differentiate between healthy and abnormal heart rhythms. This combined approach within the proposed system aims to equip healthcare professionals with timely alerts and valuable insights. Ultimately, the goal is to facilitate early detection of AFib risk and enable preventive care for susceptible individuals.
Asunto(s)
Fibrilación Atrial , Aprendizaje Profundo , Electrocardiografía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Humanos , Electrocardiografía/métodos , Frecuencia Cardíaca/fisiología , Redes Neurales de la Computación , Aprendizaje Automático , Procesamiento de Señales Asistido por ComputadorRESUMEN
BACKGROUND: There has been no consensus on what power of radiofrequency energy can be used to produce the best surgical results in patients with atrial fibrillation. In addition, patients undergoing local anesthesia and fentanyl analgesia may experience pain when radiofrequency ablation is performed. This study investigated the effect of different power radiofrequency ablations in treatment and postoperative pain in patients with atrial fibrillation. METHODS: A retrospective study was performed with 60 patients who underwent radiofrequency ablation for atrial fibrillation between January and June 2023. Patients were divided into 2 groups according to the power of the radiofrequency ablation catheter used, with 30 patients in the conventional power group (35 W) and 30 patients in the high-power group (50 W). The cardiac electrophysiological indexes and postoperative pain of the 2 groups were compared. RESULTS: Most of the procedural key parameters between the 2 groups had no significant differences. However, the total application time during radiofrequency ablation and pulmonary vein isolation time in the high-power group were significantly shorter than those in the conventional power group (p < 0.001). Patients in the high-power group reported significantly less pain than those in the conventional power group in the immediate postoperative period and the late postoperative period (p < 0.001). CONCLUSIONS: High-power radiofrequency ablation showed a shorter treatment time, and could reduce postoperative pain compared to conventional power ablation.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Dolor Postoperatorio , Humanos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Fibrilación Atrial/fisiopatología , Estudios Retrospectivos , Masculino , Dolor Postoperatorio/etiología , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/prevención & control , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Anciano , Ablación por Catéter/efectos adversos , Factores de Tiempo , Dimensión del Dolor , Frecuencia CardíacaRESUMEN
Recent artificial intelligence (AI) advancements in cardiovascular medicine offer potential enhancements in diagnosis, prediction, treatment, and outcomes. This article aims to provide a basic understanding of AI enabled ECG technology. Specific conditions and findings will be discussed, followed by reviewing associated terminology and methodology. In the appendix, definitions of AUC versus accuracy are explained. The application of deep learning models enables detecting diseases from normal electrocardiograms at accuracy not previously achieved by technology or human experts. Results with AI enabled ECG are encouraging as they considerably exceeded current screening models for specific conditions (i.e., atrial fibrillation, left ventricular dysfunction, aortic stenosis, and hypertrophic cardiomyopathy). This could potentially lead to a revitalization of the utilization of the ECG in the insurance domain. While we are embracing the findings with this rapidly evolving technology, but cautious optimism is still necessary at this point.
Asunto(s)
Inteligencia Artificial , Electrocardiografía , Humanos , Electrocardiografía/métodos , Aprendizaje Profundo , Fibrilación Atrial/diagnósticoRESUMEN
In relation with the published article "Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation", we have issued a comment. The authors of the article addressed a widely discussed topic of "Short episodes of fast arrhythmias initially detected in records on implantable devices". Further, these episodes are studied already by Holter monitoring of different durations with assessment of their clinical significance. This is the subject of the cited article and our comment.
Asunto(s)
Fibrilación Atrial , Ecocardiografía , Electrocardiografía Ambulatoria , Humanos , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Ecocardiografía/métodos , Electrocardiografía Ambulatoria/métodos , Péptido Natriurético Encefálico/sangre , BiomarcadoresRESUMEN
AIM: Atrial fibrillation (AF) is a rhythm disorder characterized by very rapid and disorganized atrial-derived electrical activations with uncoordinated atrial contractions. Very short periods of AF-like activity (micro-AF) may be precursors of undetected, silent episodes of atrial fibrillation. Here, we examined the relationship between natriuretic peptide concentrations and echocardiography findings in patients with micro-AF. MATERIAL AND METHODS: The electrocardiograms (ECGs) of patients complaining of palpitations were recorded with a 24hour Holter monitor, and the patients were consecutively included in the study. Micro-AF was defined as sudden, irregular atrial tachycardia lasting less than 30 sec with episodes of ≥5 consecutive supraventricular depolarizations with the absolute absence of p-waves. After a G-power test, patients were consecutively included in the study: 45 patients in the micro-AF group and 45 patients in the control group. Laboratory parameters, ECG and echocardiographic findings of the two groups were compared. RESULTS: N-terminal pro B-type natriuretic peptide (Pro-BNP) and serum troponin T concentrations were higher in the micro-AF group, (375.5±63.6 pg / ml vs. 63.1±56.8 pg / ml, p<0.001; 13±11.4 ng / dl vs. 4.4±2.4 ng / dl, p<0.001 respectively.) Each 1 pg / ml increase in serum Pro-BNP increased the risk of micro-AF by 1.8 %. In the ROC analysis, the cut-off value of Pro-BNP for the diagnosis of micro-AF was 63.4 pg / ml, with a sensitivity of 91.1 % and a specificity of 73.3 %. Atrial electro-mechanical delay durations were significantly higher in the micro-AF group. To predict micro-AF, the inter-annulus plane electromechanical delay time (inter-annulus plane AEMD) had a cut-off value of 18.5 sec, with a sensitivity of 93.3 % and a specificity of 91.1 %. Left intra-annulus plane electro-mechanical delay time (intra-annulus AEMD LEFT) had a cut-off value of 11.5 sec with a 95.6 % sensitivity and 75.6 % specificity. In the ECG evaluation, maximum P wave duration (Pmax) (113±10.2âms vs. 98±10.4âms; p<0.001), minimum P wave duration (Pmin) (73.8±5.5âms vs.70±6.3âms; p<0.001) and P wave dispersion (PWD) (39.1±7.9âms vs.28±7.6âms; p<0.001) were longer in the micro-AF group. CONCLUSIONS: Micro-AF in patients may be predicted by evaluating ECG, echocardiographic, and serum natriuretic peptide data.
Asunto(s)
Fibrilación Atrial , Ecocardiografía , Péptido Natriurético Encefálico , Humanos , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Ecocardiografía/métodos , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Electrocardiografía Ambulatoria/métodos , Anciano , Biomarcadores/sangre , Troponina T/sangre , Electrocardiografía/métodosRESUMEN
BACKGROUND: The association between nonalcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) has been inconsistent, and the impact of hepatic fibrosis on this relationship remains uncertain. We investigated the association between NAFLD and the risk of new-onset AF across different age groups. METHODS: A total of 3,179,582 participants from the 2009 Korean National Health Screening Program were divided into five groups based on NAFLD status: no NAFLD (fatty liver index [FLI] < 30); grade 1 NAFLD without advanced fibrosis (FLI 30-59 & BARD < 2); grade 1 NAFLD with advanced fibrosis (FLI 30-59 & BARD ≥ 2); grade 2 NAFLD without advanced fibrosis (FLI ≥ 60 & BARD < 2); and grade 2 NAFLD with advanced fibrosis (FLI ≥ 60 & BARD ≥ 2). The primary outcome was incident AF. RESULTS: During the median follow-up of 9.3 years, 62,542 patients were diagnosed with new-onset AF. In the age- and sex-adjusted model, the risk of new-onset AF increased across NAFLD grades and fibrosis categories: grade 1 NAFLD without advanced fibrosis (hazard ratio [HR] 1.120, 95% confidence interval [CI]: 1.081-1.161); grade 1 NAFLD with advanced fibrosis (HR 1.275, 95% CI 1.251-1.300); grade 2 NAFLD without advanced fibrosis (HR 1.305, 95% CI: 1.252-1.360); and grade 2 NAFLD with advanced fibrosis (HR 1.627, 95% CI: 1.586-1.670). In the multivariate model, the excess risk of AF in patients with NAFLD and advanced fibrosis remained significant, even in participants aged 20-39 years. CONCLUSION: Patients with NAFLD had a higher risk of new-onset AF, which increased progressively with NAFLD severity, particularly in those aged 20-29 years.
Asunto(s)
Fibrilación Atrial , Enfermedad del Hígado Graso no Alcohólico , Humanos , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Adulto , República de Corea/epidemiología , Factores de Riesgo , Factores de Edad , Anciano , Incidencia , Cirrosis Hepática/epidemiología , Cirrosis Hepática/diagnóstico , Índice de Severidad de la Enfermedad , Medición de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Unknown cardioembolic sources are frequent causes of cryptogenic stroke. We analyzed the risk of atrial fibrillation (AF) or high burden of ectopic atrial activity (HBEA) in patients with cryptogenic stroke, assessing atrial function and 1-year outcomes. METHODS AND RESULTS: The ARIES (Atrial Imaging and Cardiac Rhythm in Cryptogenic Embolic Stroke) study is an observational study including patients with cryptogenic stroke. We analyzed the frequency of AF and HBEA (>3000 atrial ectopic beats/day or >2 bursts or atrial tachycardia between 3 beats and ≤30 seconds) in two 30-day Holter-ECGs, comparing advanced echocardiography signs of left atrial (LA) dysfunction according to rhythm: AF, HBEA, and normal sinus rhythm. We also evaluated 1-year stroke recurrence and mortality. The study included 109 patients; 35 (32.1%) patients had AF, 27 (24.8%) HBEA, and 47 (43.1%) normal sinus rhythm. Compared with those with normal sinus rhythm, patients with AF presented higher 2-dimensional and 3-dimensional LA indexed volumes (38.8±11.2 versus 27.3±11.8 mL/m2, and 50.6±17.2 versus 34.0±15.4 mL/m2, respectively, P<0.001), lower 3-dimensional LA ejection fraction (50±14.6 versus 62.7±11.8, P=0.001), LA reservoir strain (22.0±8.6 versus 30.4±10.5, P<0.001), and LA contraction strain (10.5±8.18 versus 17.1±7.5, P<0.001), remaining significant in multivariate analysis. Patients with HBEA showed higher LA indexed volumes and lower LA reservoir strain than patients with normal sinus rhythm only in univariate analysis. There were no differences in ischemic recurrence or mortality among the groups. CONCLUSIONS: Patients with cryptogenic stroke showed a high incidence of AF and HBEA. AF is strongly related to LA volume, LA function, and LA reservoir and contraction strain, whereas HBEA showed milder structural changes. Advanced LA echocardiography could help patient selection for long-term ECG monitoring in suspected cardiac sources.
Asunto(s)
Fibrilación Atrial , Función del Atrio Izquierdo , Electrocardiografía Ambulatoria , Accidente Cerebrovascular Embólico , Recurrencia , Humanos , Masculino , Femenino , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/diagnóstico , Anciano , Persona de Mediana Edad , Accidente Cerebrovascular Embólico/etiología , Accidente Cerebrovascular Embólico/fisiopatología , Función del Atrio Izquierdo/fisiología , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Frecuencia Cardíaca/fisiología , Factores de Riesgo , Complejos Atriales Prematuros/fisiopatología , Complejos Atriales Prematuros/diagnóstico , Complejos Atriales Prematuros/complicaciones , Complejos Atriales Prematuros/epidemiología , Ecocardiografía/métodos , Factores de Tiempo , Medición de Riesgo/métodosRESUMEN
BACKGROUND: Increased left atrial pressure (LAP) contributes to dyspnea and heart failure with preserved ejection fraction in patients with atrial fibrillation (AF). The purpose of this study was to investigate the differences in baseline LAP and LAP response to rapid pacing between paroxysmal and persistent AF. METHODS AND RESULTS: This observational study prospectively enrolled 1369 participants who underwent AF catheter ablation, excluding those with reduced left ventricular ejection fraction. H2FPEF score was calculated by echocardiography and baseline characteristics. Patients underwent LAP measurements during AF, sinus rhythm, and heart rates of 90, 100, 110, and 120 beats per minute (bpm), induced by right atrial pacing and isoproterenol. The baseline LAP-peak in the persistent AF group consistently exceeded that in the paroxysmal AF (PAF) group across each H2FPEF score subgroup (all P<0.05). LAP-peak increased with pacing (19.5 to 22.5 mm Hg) but decreased with isoproterenol (20.4 to 18.4 mm Hg). Under pacing, patients with PAF exhibited a significantly lower LAP-peak (90 bpm) than those with persistent AF (17.7±8.2 versus 21.1±9.3 mm Hg, P<0.001). However, there was no difference in LAP-peak (120 bpm) between the 2 groups (22.1±8.1 versus 22.9±8.4 mm Hg, P=0.056) because the LAP-peak significantly increased with heart rate in the group with PAF. CONCLUSIONS: Patients with PAF exhibited lower baseline LAP with greater increases during rapid pacing compared with individuals with persistent AF, indicating a need to revise the H2FPEF score for distinguishing PAF from persistent AF and emphasizing the importance of rate and rhythm control in PAF for symptom control. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02138695.
Asunto(s)
Fibrilación Atrial , Presión Atrial , Insuficiencia Cardíaca , Volumen Sistólico , Humanos , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Fibrilación Atrial/cirugía , Femenino , Masculino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Volumen Sistólico/fisiología , Presión Atrial/fisiología , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Frecuencia Cardíaca/fisiología , Ablación por Catéter , Ecocardiografía , Estimulación Cardíaca Artificial , Función del Atrio Izquierdo/fisiología , Función Ventricular Izquierda/fisiología , Isoproterenol/administración & dosificaciónRESUMEN
BACKGROUND: Short and rare episodes of atrial fibrillation (AF) are commonly detected using implanted devices (device-detected AF) in patients with prior stroke or transient ischemic attack (TIA). The effectiveness and safety of oral anticoagulation in patients with prior stroke or TIA and device-detected AF but with no ECG-documented AF is unclear. METHODS AND RESULTS: This prespecified analysis of the NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) trial with post hoc elements assessed the effect of oral anticoagulation in patients with device-detected AF with and without a prior stroke or TIA in the randomized, double-blind, double-dummy NOAH-AFNET 6 trial. Outcomes were stroke, systemic embolism, and cardiovascular death (primary outcome) and major bleeding and death (safety outcome). A prior stroke or TIA was found in 253 patients with device-detected AF randomized in the NOAH-AFNET 6 (mean age, 78 years; 36.4% women). There was no treatment interaction with prior stroke or TIA for any of the primary and secondary time-to-event outcomes. In patients with a prior stroke or TIA, 14 out of 122 patients experienced a primary outcome event with anticoagulation (5.7% per patient-year). Without anticoagulation, there were 16 out of 131 patients with an event (6.3% per patient-year). The rate of stroke was lower than expected (anticoagulation: 4 out of 122 [1.6% per patient-year]; no anticoagulation: 6 out of 131 [2.3% per patient-year]). Numerically, there were more major bleeding events with anticoagulation in patients with prior stroke or TIA (8 out of 122 patients) than without anticoagulation (2 out of 131 patients). CONCLUSIONS: Anticoagulation appears to have ambiguous effects in patients with device-detected AF and a prior stroke or TIA in this hypothesis-generating analysis of the NOAH-AFNET 6 in the absence of ECG-documented AF, partially due to a low rate of stroke without anticoagulation.
Asunto(s)
Anticoagulantes , Fibrilación Atrial , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Humanos , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Ataque Isquémico Transitorio/prevención & control , Ataque Isquémico Transitorio/etiología , Femenino , Anciano , Masculino , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Método Doble Ciego , Administración Oral , Anciano de 80 o más Años , Resultado del Tratamiento , Hemorragia/inducido químicamente , Factores de Tiempo , Marcapaso ArtificialRESUMEN
BACKGROUND: Left atrial (LA) fibrosis is a marker of atrial cardiomyopathy and has been reported to be associated with both atrial fibrillation and ischemic stroke. Elucidating this relationship is clinically important as LA fibrosis could serve as a surrogate biomarker of LA cardiomyopathy. The objective of this study is to investigate the association of LA fibrosis and embolic stroke of undetermined source (ESUS) using cardiac magnetic resonance imaging. METHODS AND RESULTS: Following an International Prospective Register of Systematic Reviews-registered protocol, 3 blinded reviewers performed a systematic review for studies that quantified the degree of LA fibrosis in patients with ESUS as compared with healthy patients from inception to February 2024. A meta-analysis was conducted in the mean difference. From 7 studies (705 patients), there was a significantly higher degree of LA fibrosis in patients with ESUS compared with healthy controls (MD, 5.71% [95% CI, 3.55%-7.87%], P<0.01). The degree of LA fibrosis was significantly higher in patients with atrial fibrillation than healthy controls (MD, 8.22% [95% CI, 5.62%-10.83%], P<0.01). A similar degree of LA fibrosis was observed in patients with ESUS compared with patients with atrial fibrillation (MD, -0.92% [95% CI, -2.29% to 0.44%], P=0.35). CONCLUSIONS: A significantly higher degree of LA fibrosis was found in patients with ESUS as compared with healthy controls. This suggests that LA fibrosis may play a significant role in the pathogenesis of ESUS. Further research is warranted to investigate LA fibrosis as a surrogate biomarker of atrial cardiomyopathy and recurrent stroke risk in patients with ESUS.
Asunto(s)
Fibrilación Atrial , Fibrosis , Atrios Cardíacos , Accidente Cerebrovascular Isquémico , Humanos , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Atrios Cardíacos/fisiopatología , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/etiología , Imagen por Resonancia Magnética , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/etiología , Función del Atrio Izquierdo , Imagen por Resonancia Cinemagnética/métodosRESUMEN
BACKGROUND: Atrial fibrillation (AF) is a stroke risk factor that often remains undetected at hospital admission. Long-term Holter monitoring helps to identify patients with previously unrecognized AF. Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) are elevated in AF in cross-sectional studies. We analyzed ADMA, SDMA, and other L-arginine metabolites to assess their association with AF in the Find-AF trial. METHODS AND RESULTS: We included 280 patients presenting with acute cerebral ischemia. Patients presenting in sinus rhythm received 7-day Holter-ECG. Biomarkers were quantified by ultra-performance liquid chromatography-tandem mass spectrometry. We also analyzed protein methylation and L-arginine-related metabolites in human induced pluripotent stem cell-derived cardiomyocytes in vitro. ADMA and SDMA were elevated in 44 patients who presented with AF. SDMA, but not ADMA, was significantly elevated in patients newly diagnosed with AF in Holter-ECG as compared with those in sinus rhythm. SDMA plasma concentration >0.571 µmol/L significantly predicted presence of AF in Holter-ECG (area under the curve=0.676 [0.530-0.822]; P=0.029; sensitivity 0.786, specificity 0.572). SDMA levels further increased in patients with AF during the first 24 hours in hospital, and ADMA levels remained stable. In vitro, induced pluripotent stem cell-derived cardiomyocytes showed increased symmetric protein methylation and elevated SDMA during rapid pacing (2.0 Hz versus 0.5 Hz), whereas asymmetric protein methylation and ADMA were unchanged. CONCLUSIONS: SDMA at admission was significantly elevated in stroke patients presenting with AF and showed a moderate but significant prospective association with previously unrecognized AF. Thus, stroke patients with elevated SDMA concentration at admission may specifically benefit from extended Holter-ECG monitoring.
Asunto(s)
Arginina , Fibrilación Atrial , Biomarcadores , Electrocardiografía Ambulatoria , Accidente Cerebrovascular Isquémico , Humanos , Fibrilación Atrial/sangre , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/complicaciones , Arginina/análogos & derivados , Arginina/sangre , Masculino , Femenino , Accidente Cerebrovascular Isquémico/sangre , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/etiología , Anciano , Biomarcadores/sangre , Persona de Mediana Edad , Miocitos Cardíacos/metabolismo , Valor Predictivo de las Pruebas , Espectrometría de Masas en Tándem , Células Madre Pluripotentes Inducidas/metabolismoRESUMEN
BACKGROUND: Despite oral anticoagulation, patients with atrial fibrillation (AF) remain at risk of ischemic stroke and systemic embolism (SE) events. For patients whose residual risk is sufficiently high, additional therapies might be useful to mitigate stroke risk. METHODS AND RESULTS: Individual patient data from 5 landmark trials testing oral anticoagulation in AF were pooled in A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in AF (COMBINE AF). We calculated the rate of ischemic stroke/SE among oral anticoagulation-treated patients with a CHA2DS2-VASc score≥2, across strata of CHA2DS2-VASc score, stroke history, and AF type, as either paroxysmal or nonparoxysmal. We included 71 794 patients with AF (median age 72 years, interquartile range, 13 years, 61.3% male) randomized to a direct oral anticoagulant or vitamin K antagonist, and followed for a mean of 2.1 (±0.8) years. The median CHA2DS2-VASc score was 4 (interquartile range, 3-5), 18.8% had a prior stroke, and 76.4% had nonparoxysmal AF. The overall rate of stroke/SE was 1.33%/y (95% CI, 1.27-1.39); 1.38%/y (95% CI, 1.31-1.45) for nonparoxysmal AF, and 1.15%/y (95% CI, 1.05-1.27) for paroxysmal AF. The rate of ischemic stroke/SE increased by a rate ratio of 1.36 (95% CI, 1.32-1.41) per 1-point increase in CHA2DS2-VASc, reaching 1.67%/y (95% CI, 1.59-1.75) ≥4 CHA2DS2-VASc points. Patients with both nonparoxysmal AF and CHA2DS2-VASc ≥4 had a stroke/SE rate of 1.75%/y (95% CI, 1.66-1.85). In patients with a prior stroke, the risk was 2.51%/y (95% CI, 2.33-2.71). CONCLUSIONS: AF type, CHA2DS2-VASc score, and stroke history can identify patients with AF, who despite oral anticoagulation have a residual stroke/SE risk of 1.5% to 2.5% per year. Evaluation of additional stroke/SE prevention strategies in high-risk patients is warranted.