Assessment of clinical factors associated with a successful catheter ablation outcome in younger patients with atrial fibrillation

Introduction : Previous research into the administration of rTPA therapy in acute ischemic stroke patients has largely focused on the general population, however the comorbid clinical factors held by stroke patients are important factors in clinical decision making. One such comorbid condition is Atrial Fibrillation. The purpose of this study is to determine the clinical factors associated with the administration of rtPA in Acute Ischemic Stroke (AIS) patients specifically with a past medical history of Atrial Fibrillation (AFib). Methods : The data for this analysis was collected at a regional stroke center from January 2010 to June 2016 in Greenville, SC. It was then analyzed retrospectively using a multivariate logistic regression to identify factors significantly associated with the inclusion or exclusion receiving rtPA therapy in the AIS/AFib patient population. This inclusion or exclusion is presented as an Odds Ratio and all data was analyzed using IBM SPSS. Results : A total of 158 patients with Atrial Fibrillation who had Acute Ischemic Strokes were identified. For the 158 patients, the clinical factors associated with receiving rtPA therapy were a Previous TIA event (OR = 12.155, 95% CI, 1.125‐131.294, P < 0.040), the administration of Antihypertensive medication before admission (OR = 7.157, 95% CI, 1.071‐47.837, P < 0.042), the administration of Diabetic medication before admission (OR = 13.058, 95% CI, 2.004‐85.105, P < 0.007), and serum LDL level (OR = 1.023, 95% CI, 1.004‐1.042, P < 0.16). Factors associated with not receiving rtPA therapy included a past medical history of Depression (OR = 0.012, 95% CI, 0.000‐0.401, P < 0.013) or Obesity (OR = 0.131, 95% CI, 0.034‐0.507, P < 0.003), Direct Admission to the Neurology Floor (OR = 0.179, 95% CI, 0.050‐0.639, P < 0.008), serum Lipid level (OR = 0.544, 95% CI, 0.381‐0.984, P < 0.044), and Diastolic Blood Pressure (OR = 0.896, 95% CI, 0.848‐0.946, P < 0.001). Conclusions : The results of this study demonstrate that there are significant associations between several clinical risk factors, patient lab values, and hospital admission factors in the administration of rTPA therapy to AIS patients with a past medical history of Atrial Fibrillation. Further research is recommended to determine the extent and reasoning behind of these associations as well as their impact on the clinical course for AIS/AFib patients.

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Factors associated with silent cerebral events during catheter ablation for atrial fibrillation in the era of uninterrupted oral anticoagulation therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0577 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Harada ◽

Y Nomura ◽

A Nishimura ◽

Y Motoike ◽

M Koshikawa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Vitamin K ◽

Oral Anticoagulation ◽

Brain Mri ◽

Anticoagulation Therapy ◽

Surrogate Marker ◽

Brain Magnetic Resonance Imaging ◽

Vitamin K Antagonist ◽

Factors Associated

Abstract Background A silent cerebral event (SCE), detected by brain magnetic resonance imaging (MRI), is defined as an acute new brain lesion without clinically apparent neurological deficit, and is frequently observed after catheter ablation in atrial fibrillation (AF) patients. Although the small number of SCEs does not cause neurocognitive dysfunction, the greater volume and/or larger number of SCE lesions are reportedly related to neuropsychological decline; SCE incidence may be a surrogate marker for the potential thromboembolic risk. Thus, strategies to reduce SCEs would be beneficial. Uninterrupted oral anticoagulation strategy for peri-procedural period reportedly reduced the risk of SCEs, but the incidence hovers at 10% to 30%. We sought factors associated with SCEs during catheter ablation for AF in patients with peri-procedural uninterrupted oral anticoagulation (OAC) therapy. Methods AF patients undergoing catheter ablation were eligible (n=255). All patients took non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonist (VKA) for peri-procedural OAC (>4 weeks) without interruption during the procedure. Brain MRI was performed within 2 days after the procedure to detect SCEs. Clinical characteristics and procedure-related parameters were compared between patients with and without SCEs. Results SCEs were detected in 59 patients (23%, SCE[+]) but not in 196 patients (77%, SCE[-]). Average age was higher in SCE[+] than SCE[-] (66±10 years vs. 62±12 years, p<0.05). Persistent AF prevalence, CHADS2/CHA2DS2-VASc scores, and serum NT-ProBNP levels increased in SCE[+] vs. SCE[-]. In transthoracic/transesophageal echocardiography, left-atrial dimension (LAD) was larger and AF rhythm/spontaneous echo contrast were more frequently observed in SCE[+] than SCE[-]. SCE[+] had lower initial activated clotting time (ACT) before unfractionated heparin (UFH) injection and longer time to reach optimal ACT (>300 sec) before trans-septal puncture than SCE [-]. In multivariate analysis, LAD, initial ACT before UFH injection, and time to reach optimal ACT were predictors for SCEs. Conclusions LAD and intra-procedural ACT kinetics affect SCEs during the procedure in patients with uninterrupted OAC for AF ablation. Shortening time to achieve optimal ACT during the procedure may reduce the risk of SCEs. Funding Acknowledgement Type of funding source: None

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Sociodemographic, behavioral, and clinical factors associated with low atrial fibrillation knowledge among older adults with atrial fibrillation: The SAGE-AF study

Patient Education and Counseling ◽

10.1016/j.pec.2020.07.008 ◽

2021 ◽

Vol 104 (1) ◽

pp. 194-200

Author(s):

Colleen Sedney ◽

Hawa O. Abu ◽

Katherine Trymbulak ◽

Jordy Mehawej ◽

Ziyue Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Older Adults ◽

Clinical Factors ◽

Factors Associated

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Characterizing Clinical Outcomes and Factors Associated with Conduction Gaps in VISITAG SURPOINT-Guided Catheter Ablation for Atrial Fibrillation

10.22541/au.160331916.60957873/v1 ◽

2020 ◽

Author(s):

Koichi Inoue ◽

Nobuaki Tanaka ◽

Yusuke Ikada ◽

Akinobu Mizutani ◽

Kazuhiko Yamamoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Clinical Outcomes ◽

Factors Associated

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Stroke Risk Factors, Subtypes and Outcome in Elderly Thai Patients

10.21203/rs.3.rs-140400/v1 ◽

2021 ◽

Author(s):

Chatpol Samuthpongtorn ◽

Tul Jereerat ◽

Nijasri Suwanwela

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

The Elderly ◽

P Value ◽

Younger Patients ◽

Factors Associated ◽

Stroke Risk Factors ◽

History Of ◽

Ischemic Attack

Abstract Background: Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients.Method: All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied.Result: 542 patients were included. The average age was 68.78±12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%). Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths) compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value<0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient's death.Conclusion: The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

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P1035Factors associated with quality-of-life improvement after catheter ablation of atrial fibrillation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

European Heart Journal ◽

10.1093/eurheartj/ehz747.0626 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Kanda ◽

M Masuda ◽

S Shizuta ◽

A Kobori ◽

K Inoue ◽

...

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Heart Rate ◽

Multivariate Analysis ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Diameter ◽

Factors Associated ◽

Af Recurrence

Abstract Background Improving the quality of life (QoL) is one of the main purposes of catheter ablation (CA) of persistent atrial fibrillation (AF). Factors associated with QoL improvement after CA of AF patients have not been clarified. The Kansai Plus Atrial Fibrillation (KPAF) Registry is a multi-center registry enrolling more than 5,000 consecutive patients undergoing the first radiofrequency catheter ablation of AF. Purpose The aim of this study was to investigate the QoL change after AF ablation and its associated factors. Methods A total of 2030 patients in whom the QoL score was assessed before and one year after the ablation were enrolled from the KPAF registry (age 64±10 years, 75% male, paroxysmal 66%, CHADS2 score 1.1±1.1). The QoL was evaluated using the AF specific QoL evaluation method (AFQLQ), which scores the patient QoL within a range of 0–98 points. Results Overall, catheter ablation showed a significant increase in the AFQLQ score (68±19 vs. 86±13 points, P<0.01). AF recurrence was observed in 372 cases (18%) during a 1-year follow-up period. A multivariate analysis showed that AF recurrence, symptomatic AF, long AF duration, high preprocedural heart rate (>110 bpm) and small left atrial diameter were independent predictors of a QoL improvement defined as a >10% score increase. Multivariate analysis Conclusions CA of AF significantly improved the QoL. AF recurrence was one of the strong factors associated with QoL improvement. Symptomatic AF, long AF duration, high preprocedural heart rate and small left atrial diameter were independent predictors of QoL improvement.

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