RESUMEN
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 common and persistent cardiac arrhythmia that impacts morbidity, mortality, disability, quality of life, and healthcare costs. Typically, AF is managed using a three-pillar approach of rate control, rhythm control, and anticoagulation. However, these interventions fail to address the underlying pathophysiological factors that contribute to AF. A compelling body of research expands traditional management by focusing on lifestyle modification to lower the risk of AF incidence, prevalence, progression, and severity. Home healthcare clinicians possess the knowledge and skills to examine and treat a wide range of risk factors that lead to AF, and therefore can substantially reduce incident and persistent AF and facilitate optimal outcomes. This perspective paper presents a clinical paradigm shift by proposing a five-factor Partner, Quantify, Recommend, Support, and Teach (PQRST) framework to support AF risk factor modification in home healthcare. The PQRST framework incorporates a greater focus on patient self-management through education and exercise to reduce incidence, prevalence, progression, and severity of AF.
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Fibrilación Atrial , Humanos , Fibrilación Atrial/terapia , Fibrilación Atrial/epidemiología , Servicios de Atención de Salud a Domicilio , Factores de Riesgo , Calidad de Vida , Gestión de Riesgos/métodosRESUMEN
OBJECTIVE: To explore the safety and effectiveness of electric cardioversion to treat atrial fibrillation in a hospital emergency department (ED). METHODS: Retrospective observational study in a hospital ED. We reviewed episodes of atrial fibrillation in patients aged 18 years orolder treated with cardioversion in our ED or referred for scheduling of cardioversion. Clinical outcome measures were conversion to sinus rhythm, immediate adverse effects (hypotension, arrythmia, or bronchial aspiration), revisiting within 90 days for atrial fibrillation, and complications (stroke, major bleeding, heart failure, or death). We studied factors associated with recurrence and adverse effects according to sex. RESULTS: Cardioversion was used in 365 episodes (median patient age, 67 years); 38.6% were women. Cardioversion was applied in the ED in 75.1% of the episodes, and 24.9% were referred for scheduled cardioversion. Sinus rhythm was restored in 90.7% of the episodes. Emergency cardioversion was more effective than a scheduled procedure (odds ratio [OR], 4.258; 95% CI, 2.046-8.859; P < .001). No serious immediate adverse effects were reported, but 16.7% of the patients revisited for atrial fibrillation within 90 days. Factors associated with revisits were heart failure (hazard ratio [HR], 2.603; 95% CI, 1.298-5.222; P = .007), sleep apnea (HR, 2.598; 95% CI, 1.163-5.803; P = .020), and, in women, hypertension (HR, 3.706; 95% CI, 1.051-13.068; P = .042). Eleven patients developed late adverse events, including stroke (n = 2), major bleeding (n = 1), heart failure (n = 5), and death (n = 3). CONCLUSIONS: Cardioversion is a useful, effective, and safe treatment for atrial fibrillation in the ED, although there are frequent recurrences. Factors associated with recurrence differ according to sex.
OBJETIVO: Conocer la seguridad y eficacia de la cardioversión eléctrica (CVE) en la fibrilación auricular (FA) en un servicio de urgencias hospitalario (SUH). METODO: Estudio observacional y retrospectivo realizado en un SUH. Se revisaron los episodios de FA en pacientes con edad igual o mayor a 18 años a los que se les realizó CVE en el SUH o se les programó de forma diferida. Las variables resultado fueron: reversión a ritmo sinusal (RS), efectos adversos inmediatos (hipotensión, arritmia y broncoaspiración), reconsulta a 90 días por FA y desarrollo de complicaciones (ictus, hemorragia mayor, insuficiencia cardiaca y mortalidad). Se estudiaron los factores asociados a recurrencia y efectos adversos, y se analizaron las diferencias por sexo. RESULTADOS: Se incluyeron 365 episodios de CVE (67 años; 38,6% mujeres); el 75,1% se realizó en el SUH y el 24,9% se derivaron para CVE diferida. El 90,7% revirtieron a RS. La CVE urgente fue más efectiva que la diferida (OR 4,258; IC 95% 2,046-8,859; p < 0,001). No hubo efectos adversos inmediatos graves. El 16,7% de pacientes reconsultaron por FA en los 90 días posteriores. Los factores asociados a reconsulta fueron insuficiencia cardiaca (HR 2,603; IC 95% 1,298-5,222; p = 0,007), apnea del sueño (HR 2,598; IC 95% 1,163-5,803; p = 0,020) y, en mujeres, hipertensión arterial (HR 3,706;IC 95% 1,051-13,068; p = 0,042). Tras la CVE, 11 pacientes presentaron eventos adversos tardíos que incluyeron ictus (n = 2), hemorragia mayor (n = 1), insuficiencia cardiaca (n = 5) y muerte (n = 3). CONCLUSIONES: La CVE es útil, eficaz y segura para la FA en los SUH, aunque las recurrencias son frecuentes. Los factores asociados a recurrencia difieren entre sexos.
Asunto(s)
Fibrilación Atrial , Cardioversión Eléctrica , Servicio de Urgencia en Hospital , Humanos , Femenino , Masculino , Fibrilación Atrial/terapia , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Factores Sexuales , Resultado del Tratamiento , Recurrencia , Anciano de 80 o más Años , Adulto , Factores de RiesgoRESUMEN
PURPOSE: Improving cardiorespiratory fitness (CRF) through exercise training is associated with lower morbidity and mortality in patients with atrial fibrillation (AF). Smaller CRF improvements have been suggested in females than males with cardiovascular disease following exercise training. This systematic review compared changes in CRF (primary) and additional physical and mental health outcomes following exercise training between females and males with AF. REVIEW METHODS: Five bibliographic databases were searched to identify prospective studies implementing exercise training in patients with AF. The mean difference (MD) in the change following exercise training was compared between sexes using random-effects meta-analyses. SUMMARY: Sex-specific data were obtained from 19 of 63 eligible studies, with 886 participants enrolled in exercise training (n = 259 [29%] females; female: 68 ± 7 years, male: 66 ± 8 years). Exercise training was 6 weeks to 1 year in duration and mostly combined moderate- to vigorous-intensity aerobic and resistance training, 2 to 6 d/wk. Changes in CRF did not differ between sexes (MD = 0.15: 95% CI, -1.08 to 1.38 mL O2/kg/min; P = .81; I2 = 27%). Severity of AF (MD = 1.00: 95% CI, 0.13-1.87 points; I2 = 0%), general health perceptions (MD = -3.71: 95% CI, -6.88 to -0.55 points; I2 = 22%), and systolic blood pressure (MD = 3.11: 95% CI, 0.14-6.09 mmHg; I2 = 42%) improved less in females than in males. Females may benefit from more targeted exercise training programs given their smaller improvement in several health outcomes than males. However, our findings are largely hypothesis-generating, considering the limited sample size and underrepresentation of females (29% females in our review vs 47% females with AF globally).
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Fibrilación Atrial , Capacidad Cardiovascular , Terapia por Ejercicio , Humanos , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/rehabilitación , Fibrilación Atrial/terapia , Capacidad Cardiovascular/fisiología , Terapia por Ejercicio/métodos , Femenino , Masculino , Factores SexualesRESUMEN
BACKGROUND: The aim of this study was to investigate the clinical implication of incidentally induced atrial fibrillation (AF) during programmed electrical stimulation (PES) in patients with left ventricular systolic dysfunction (≤40%) after an acute myocardial infarction (MI). METHODS: In this study, we included 231 patients from the Cardiac Arrhythmias and RIsk Stratification after Myocardial InfArction (CARISMA) study with left ventricular ejection fraction ≤40% and no prior history of AF. These patients underwent PES 6 weeks post-MI as part of the study protocol. Patients all received an implantable cardiac monitor (ICM) 3-21 days post-MI and were continuously monitored for cardiac arrhythmias for 2 years. Induction of AF was unwanted but reported if this incidentally occurred. RESULTS: A total of 61 patients (26%) developed AF within 2 years of follow-up, in which n = 10 (29%) had incidental AF during PES at baseline. The overall risk of AF was not significantly increased in patients with incidental AF (n = 34) during PES compared to patients without incidental AF (n = 197) (HR 1.6 [0.9-3.0], p = 0.14). The risk of bradyarrhythmia (HR = 0.2 [0.0-1.2], p = 0.07), ventricular arrhythmias (HR = 0.7 [0.1-5.8], p = 0.77), and major cardiovascular events (MACE) (HR 0.5 [0.2-1.7], p = 0.28) was not significantly different in patients with versus without incidental AF. CONCLUSIONS: Incidentally induced AF during PES in post-MI patients with reduced LVEF was not significantly associated with a higher risk of long-term atrial fibrillation, other cardiac arrhythmias, or major cardiac events. TRIAL REGISTRATION: NCT00145119.
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Fibrilación Atrial , Infarto del Miocardio , Disfunción Ventricular Izquierda , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/terapia , Electrocardiografía Ambulatoria/métodos , Estudios de Seguimiento , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/complicacionesAsunto(s)
Apéndice Atrial , Fibrilación Atrial , Humanos , Apéndice Atrial/cirugía , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Fibrilación Atrial/cirugía , Fibrilación Atrial/terapia , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Resultado del Tratamiento , Tomografía Computarizada por Rayos X , Dispositivo Oclusor Septal , Masculino , AncianoAsunto(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)
Fibrilación Atrial , Ablación por Catéter , Embolia Aérea , Fístula Esofágica , Oxigenoterapia Hiperbárica , Embolia Intracraneal , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/terapia , Embolia Aérea/etiología , Embolia Aérea/terapia , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Fístula Esofágica/etiología , Oxigenoterapia Hiperbárica/métodos , Embolia Intracraneal/etiología , Masculino , Atrios Cardíacos/diagnóstico por imagen , Fístula/etiología , Persona de Mediana EdadRESUMEN
OBJECTIVES: To explore the acceptability and feasibility of detection of atrial fibrillation (AF) by emergency medical services (EMS) and identify potential barriers and facilitators to implementing a formal pathway to facilitate follow-up in primary care, which could reduce the risk of AF-related stroke. DESIGN: Qualitative study using focus groups and one-to-one interviews guided by a semistructured topic guide. SETTING: North East England. PARTICIPANTS: Focus groups with 18 members of the public and one-to-one online interviews with 11 healthcare and service providers (six paramedics and five experts representing cardiology, general practice (GP), public health, research, policy and commissioning). RESULTS: All participant groups were supportive of a role of EMS in identifying AF as part of routine assessment and formalising the response to AF detection. However, this should not create delays for EMS since rate-controlled AF is non-urgent and alternative community mechanisms exist to manage it. Public participants were concerned about communication of the AF diagnosis and whether this should be 'on scene' or in a subsequent GP appointment. Paramedics reported frequent incidental identification of AF, but it is not always clear 'on scene' that this is a new diagnosis, and there is variation in practice regarding whether (and how) this is communicated to the GP. Paramedics also focused on ensuring the safety of non-conveyed patients and a perceived need for an 'active' reporting process, so that a finding of AF was actioned. Field experts felt that a formal pathway would be useful and favoured a simple intervention without adding to time pressures unnecessarily. CONCLUSIONS: There is support for the development of a formal pathway to ensure follow-up for people with AF that is incidentally detected by EMS. This has the potential to improve anticoagulation rates and reduce the risk of stroke.
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Ambulancias , Fibrilación Atrial , Servicios Médicos de Urgencia , Grupos Focales , Investigación Cualitativa , Humanos , Fibrilación Atrial/terapia , Inglaterra , Masculino , Femenino , Persona de Mediana Edad , Adulto , Accidente Cerebrovascular/prevención & control , Anciano , Entrevistas como Asunto , Atención Primaria de Salud , Actitud del Personal de SaludRESUMEN
BACKGROUND: Patients with atrial fibrillation (AF) often have concomitant long-term conditions that negatively impact their quality of life and the clinical management they receive. The AFFIRMO study aimed to identify the needs, quality performance indicators (QPIs), and outcomes relevant to patients, caregivers and healthcare professionals (HCPs) to improve the care of patients with AF. METHODS: An on-line survey to collect the key needs, QPIs, and outcomes relevant to patients with AF, their caregivers and HCPs, was distributed between May 2022 and January 2023 in five countries (UK, Italy, Denmark, Romania and Spain). Results from the on-line survey were discussed in a three-round Delphi process with international representatives of patients with AF, caregivers, and HCPs to determine the key needs, QPIs and outcomes for the management of patients with AF and multimorbidity. RESULTS: 659 patients (47.2% males, mean (SD) age 70.9 (10.2) years), 201 caregivers (26.9% males, mean (SD) age: 58.3 (SD 15.2) years), and 445 HCPs (57.8% males, mean (SD) age 47.4 (10.6) years) participated in the survey. An initial list of 27 needs, 9 QPIs, and 17 outcomes were identified. Eight patients, two caregivers, and 11 HCPs participated in the Delphi process. Nineteen (70%) needs, 8 (89%) QPIs, and 13 (76%) outcomes reached "consensus in", and were included in the final list. CONCLUSIONS: The final key needs, QPIs and outcomes obtained from the Delphi process will inform the AFFIRMO clinical trial, which aims to test the iABC app which incorporates an empowerment toolbox for patients and their caregivers, providing information to improve patient engagement and empowerment to help improve the clinical and self-management of patients with AF in the context of multimorbidity.
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Fibrilación Atrial , Multimorbilidad , Indicadores de Calidad de la Atención de Salud , Humanos , Fibrilación Atrial/terapia , Fibrilación Atrial/epidemiología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Calidad de Vida , Encuestas y Cuestionarios , Cuidadores , Técnica Delphi , Adulto , Dinamarca/epidemiología , España/epidemiología , Personal de Salud/psicología , Italia/epidemiología , Rumanía/epidemiología , Anciano de 80 o más AñosRESUMEN
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
Atrial fibrillation (AF) is the most common heart rhythm disorder in the Western world. Between the years 2010 and 2019, the global prevalence of AF rose from 33.5 million to 59 million, highlighting the importance of developing equitable treatments for patients. The disease is associated with symptoms such as palpitations, dizziness, fatigue, shortness of breath, and cognitive dysfunction. In addition, AF increases the risk of developing a stroke and heart failure. Despite new insights into risk factors that can lead to the development of AF, the success of current treatments is suboptimal. Numerous risk factors, such as hypertension, diabetes, and obesity, have been associated with the development and progression of AF. As these can be lifestyle-related risk factors, lifestyle modification may be a solution to reduce AF-related symptoms as well as episodes. Research results show that certain dietary changes can reduce AF and numerous risk factors for AF. Increasing attention is being given to Mediterranean and whole, plant-based eating patterns, which emphasize eating grains, legumes, vegetables, fruits, and nuts, while excluding most-or all-animal products. Hence, what are the beneficial aspects of a Mediterranean and plant-based diet which consists mainly of unprocessed foods? In the current review, we discuss the outcomes of diet-based treatments. Moreover, other diet-related treatments, brought up by patient initiatives, are highlighted. These patient-initiated studies include L-glutamine and electrolytes as options to manage AF. Also, we highlight the emerging importance of valuing patient needs and a quality-of-life-centered approach to medicine. As indicated by recent studies and patient experiences, citizen science can create inclusive solutions that lead to patient empowerment and a holistic approach for AF management.
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Fibrilación Atrial , Ciencia Ciudadana , Calidad de Vida , Humanos , Fibrilación Atrial/terapia , Dieta Mediterránea , Participación del Paciente , Factores de RiesgoRESUMEN
BACKGROUND: COVID-19 infections can result in severe acute respiratory distress syndrome (ARDS) requiring admission to the intensive care unit (ICU). Cardiovascular manifestation or exacerbation of cardiovascular diseases could be another complication. Cardiac arrhythmias including New-Onset Atrial Fibrillation (NOAF), have been observed in hospitalized patients with COVID-19 infections. In this analysis, we aimed to systematically compare the complications associated with NOAF in critically ill COVID-19 patients admitted to the ICU. METHODS: MEDLINE, EMBASE, Web of Science, the Cochrane database, http://www. CLINICALTRIALS: gov , Google Scholar and Mendeley were searched for relevant publications based on COVID-19 patients with NOAF admitted to the ICU. Complications including in-hospital mortality, ICU mortality, patients requiring mechanical ventilation, acute myocardial infarction, acute kidney injury, renal replacement therapy and pulmonary embolism were assessed. This is a meta-analysis and the analytical tool which was used was the RevMan software version 5.4. Risk ratios (RR) and 95% confidence intervals (CIs) were used to represent the data post analysis. RESULTS: In critically ill COVID-19 patients with NOAF admitted to the ICU, the risks of ICU mortality (RR: 1.39, 95% CI: 1.07 - 1.80; P = 0.01), in-hospital mortality (RR: 1.56, 95% CI: 1.20 - 2.04; P = 0.001), patients requiring mechanical ventilation (RR: 1.32, 95% CI: 1.04 - 1.66; P = 0.02) were significantly higher when compared to the control group without AF. Acute myocardial infarction (RR: 1.54, 95% CI: 1.31 - 1.81; P = 0.00001), the risk for acute kidney injury (RR: 1.31, 95% CI: 1.11 - 1.55; P = 0.002) and patients requiring renal replacement therapy (RR: 1.83, 95% CI: 1.60 - 2.09; P = 0.00001) were also significantly higher in patients with NOAF. CONCLUSIONS: Critically ill COVID-19 patients with NOAF admitted to the ICU were at significantly higher risks of developing complications and death compared to similar patients without AF.
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Fibrilación Atrial , COVID-19 , Enfermedad Crítica , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , COVID-19/mortalidad , COVID-19/complicaciones , COVID-19/terapia , COVID-19/diagnóstico , Humanos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/mortalidad , Fibrilación Atrial/terapia , Factores de Riesgo , Respiración Artificial , SARS-CoV-2 , Masculino , Femenino , Medición de Riesgo , Persona de Mediana Edad , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/terapia , Lesión Renal Aguda/etiología , Lesión Renal Aguda/diagnóstico , AncianoAsunto(s)
Amiloidosis , Ecocardiografía Transesofágica , Cardioversión Eléctrica , Humanos , Ecocardiografía Transesofágica/métodos , Masculino , Cardioversión Eléctrica/métodos , Amiloidosis/diagnóstico por imagen , Amiloidosis/terapia , Femenino , Anciano , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/terapia , Persona de Mediana Edad , Fibrilación Atrial/terapia , Fibrilación Atrial/diagnóstico por imagenRESUMEN
Atrial fibrillation (AF) and heart failure (HF)-specifically, heart failure with reduced ejection fraction (HFrEF)-often coexist, and each contributes to the propagation of the other. This relationship extends from the mechanistic and physiological to clinical syndromes, quality of life, and long-term cardiovascular outcomes. The risk factors for AF and HF overlap and create a critical opportunity to prevent adverse outcomes among patients at greatest risk for either condition. Increasing recognition of the linkages between AF and HF have led to widespread interest in designing diagnostic, predictive, and interventional strategies targeting all aspects of disease, from identifying genetic predisposition to addressing social determinants of health. Advances across this spectrum culminated in updated multisociety guidelines for management of AF, which includes specific consideration of comorbid AF and HF. This review expands on these guidelines by further highlighting relevant clinical trial findings and providing additional context for the evolving recommendations for management in this important and growing population.
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Fibrilación Atrial , Insuficiencia Cardíaca , Volumen Sistólico , Humanos , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/diagnóstico , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Fibrilación Atrial/complicaciones , Volumen Sistólico/fisiología , Factores de Riesgo , Calidad de Vida , Comorbilidad , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Percutaneous left atrial appendage closure (LAAC) has been suggested as an alternative to long-term oral anticoagulation for nonvalvular atrial fibrillation, but comparative data remain scarce. We aimed to assess ischemic and bleeding outcomes of LAAC compared with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for the prevention of cardioembolic events in patients with atrial fibrillation. METHODS AND RESULTS: Embase and MEDLINE were searched for randomized trials comparing LAAC, VKAs, and DOACs. The primary efficacy end point was any stroke or systemic embolism. Treatment effects were calculated from a network meta-analysis and ranked according to the surface under the cumulative ranking curve. Seven trials and 73 199 patients were included. The risk of the primary end point was not statistically different between LAAC versus VKAs (odds ratio [OR], 0.92 [95% CI, 0.62-1.50]) and LAAC versus DOACs (OR, 1.11 [95% CI, 0.71-1.73]). LAAC and DOACs resulted in similar risk of major or minor (OR, 0.93 [95% CI, 0.61-1.42]) and major bleeding (OR, 0.92 [95% CI, 0.58-1.46]); however, after exclusion of procedural bleeding, bleeding risk was significantly lower in those undergoing LAAC. Both LAAC and DOACs reduced the risk of all-cause death compared with VKAs (LAAC versus VKAs: OR, 0.70 [95% CI, 0.53-0.91]; DOACs versus VKAs: OR, 0.90 [95% CI, 0.85-0.95], respectively). DOACs ranked as the best treatment for stroke or systemic embolism prevention (66.9%) and LAAC for reducing major bleeding (63.9%) and death (96.4%). CONCLUSIONS: As a nonpharmacological alternative to oral anticoagulation for atrial fibrillation, LAAC showed similar efficacy and safety compared with VKAs or DOACs. Prospective confirmation from larger studies is warranted.
Asunto(s)
Anticoagulantes , Fibrilación Atrial , Cierre del Apéndice Auricular Izquierdo , Humanos , Administración Oral , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/terapia , Hemorragia/inducido químicamente , Cierre del Apéndice Auricular Izquierdo/efectos adversos , Cierre del Apéndice Auricular Izquierdo/métodos , Metaanálisis en Red , Factores de Riesgo , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Resultado del TratamientoRESUMEN
OBJECTIVE: Most published studies have aimed to compare the effectiveness of different treatment strategies for atrial fibrillation (AF), while few articles have comprehensively compared the safety of therapeutic measures.The aim of the article was to assess the safety of different therapeutic measures (different ablation techniques, antiarrhythmic drugs and surgery) in patients with AF. METHOD: A comprehensive and systematic search was undertaken across various databases, namely PubMed, Embase, Cochrane Library, and Web of Science, with the aim of identifying pertinent randomized controlled trials (RCTs) that delve into the safety aspects of diverse atrial fibrillation treatment strategies. The search was conducted up until December 1st, 2023. R4.2.3 software gemtc package was used for data analysis, Review Manager 5.3 was used for quality assessment of included studies, and stata15.0 was used for publication bias.Safety is defined as the adverse outcomes that occur in different treatment strategies for atrial fibrillation, with specific adverse events as described below. RESULT: 22 RCTs (involving 5073 subjects) with interventions including cryoballoon ablation (CA), radiofrequency ablation (RF), laser balloon ablation (LB), pulmonary vein ablation catheter (PVAC), antiarrhythmic drugs (AADS), and surgery (SA) were included in this study. In this article, medication and surgery were combined into the same intervention (non-traditional treatment measure, UT). UT was not associated with pericardial effusion (OR:4.27e-10, 95%CI:4.91e-30-0.0663), infections (OR:0.248, 95%CI:0.0584-0.89), arrhythmias (OR:0.609,95%CI:0.393-0.936), pseudoaneurysms (OR:5.57e-10, 95%CI:1.16e-31-0.934) and pulmonary vein stenosis (OR:1.16e-09, 95%CI:6.56e-24-0.194). Complications of the procedure were mainly mechanical injuries. Among the various ablation strategies, radiofrequency ablation had a lower incidence of phrenic nerve palsy and pain (OR:4.01e-06, 95%CI:1.18e-17-0.710) than cryoballoon ablation, which was superior to radiofrequency ablation in terms of infection rates. Finally, there were no significant differences between the various ablation techniques in terms of other complication rates. CONCLUSION: Because the interventions in the UT group were predominantly AADS and antiarrhythmic drug therapy didn't have some of the common aggressive complications of ablation strategies, the UT group had a low rate of complications such as pericardial effusion, postprocedural arrhythmia, pseudoaneurysm, and pulmonary vein stenosis compared with various catheter ablation strategies. Additionally, we also discovered between the various ablation technology groups, there was no significant difference in the incidence of major adverse events. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registry number:CRD42024566530.
Asunto(s)
Antiarrítmicos , Fibrilación Atrial , Ablación por Catéter , Metaanálisis en Red , Fibrilación Atrial/cirugía , Fibrilación Atrial/terapia , Humanos , Antiarrítmicos/uso terapéutico , Antiarrítmicos/efectos adversos , Ablación por Catéter/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiologíaRESUMEN
AIMS: Physiological activation of the heart using algorithms to minimize right ventricular pacing (RVPm) may be an effective strategy to reduce adverse events in patients requiring anti-bradycardia therapies. This systematic review and meta-analysis aimed to evaluate current evidence on clinical outcomes for patients treated with RVPm algorithms compared to dual-chamber pacing (DDD). METHODS AND RESULTS: We conducted a systematic search of the PubMed database. The predefined endpoints were the occurrence of persistent/permanent atrial fibrillation (PerAF), cardiovascular (CV) hospitalization, all-cause death, and adverse symptoms. We also aimed to explore the differential effects of algorithms in studies enrolling a high percentage of atrioventricular block (AVB) patients. Eight studies (7229 patients) were included in the analysis. Compared to DDD pacing, patients using RVPm algorithms showed a lower risk of PerAF [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.57-0.97] and CV hospitalization (OR 0.77, 95% CI 0.61-0.97). No significant difference was found for all-cause death (OR 1.01, 95% CI 0.78-1.30) or adverse symptoms (OR 1.03, 95% CI 0.81-1.29). No significant interaction was found between the use of the RVPm strategy and studies enrolling a high percentage of AVB patients. The pooled mean RVP percentage for RVPm algorithms was 7.96% (95% CI 3.13-20.25), as compared with 45.11% (95% CI 26.64-76.38) of DDD pacing. CONCLUSION: Algorithms for RVPm may be effective in reducing the risk of PerAF and CV hospitalization in patients requiring anti-bradycardia therapies, without an increased risk of adverse symptoms. These results are also consistent for studies enrolling a high percentage of AVB patients.