Gender-dependent regulation of FABP4 and leptin according to atrial fibrillation burden

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.N Lopez-Canoa ◽  
M Couselo-Seijas ◽  
A Baluja ◽  
L Gonzalez-Melchor ◽  
A Rozados ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Catheter Ablation ◽  
Previous History ◽  
Correlation Coefficients ◽  
Suspected Coronary Artery Disease ◽  
Public Institution ◽  
Funding Source ◽  
Af Recurrence

Abstract Aims Adiposity plays a key role in the pathogenesis of atrial fibrillation (AF). Its associated proteins are differentially released between male and female. FABP4 and leptin are mediators in adipose tissue-inflammatory effects. Our aim was to study their gender differential behavior on mechanisms associated with AF progression. Methods and results Two independent cohorts were analyzed: A) patients referred for AF catheter ablation (n=217) and patients with suspected coronary artery disease referred for a CT scan (without previous history of AF) (n=105). Protein levels were determined by multiplex fluorometric immunoassay. Gene mRNA expression was analyzed by real time polymerase chain reaction. Correlation between biomarkers was explored with heatmaps and Kendall correlation coefficients. Logistic regression and random forest model determined the best predictors of AF recurrence after catheter ablation. Our results showed: 1) a distinctive profile according to gender, with an increment of FABP4 levels in women (20±14, 29±18 and 31±17 ng/mL; p=0.007) and a decrease of leptin levels in men (22±15, 13±16 and 13±11 ng/mL; p=0.001) among control, paroxysmal and persistent AF groups, respectively; 2) sex differences regarding inflammatory profile, oxidative stress and autonomic indirect markers in AF; 3) a prominent role of adipokines to discriminate AF recurrence after ablation. In persistent AF, FABP4 was the best predictor (LR coefficient 1.067, 95% CI 1–1.14, p=0.046). Conclusion The major finding of the present study is the sex differences of FABP4 and leptin according to AF burden. The relationship of these adipokines with oxidative stress, inflammatory and autonomic indirect markers might explain part of the mechanisms underlying the AF perpetuation. Adipokines regarding Gender & AF burden Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Institute of Health Carlos III

scholarly journals Sex differences in the predictors of recurrent atrial fibrillation after catheter ablation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Tanaka ◽  
K Inoue ◽  
A Kobori ◽  
K Kazutai ◽  
T Morimoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Catheter Ablation ◽  
Large Scale ◽  
Funding Source ◽  
Recurrent Atrial Fibrillation ◽  
History Of ◽  
The Impact ◽  
Af Recurrence

Abstract Background The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We previously reported that females experienced more frequent AF recurrences than males after the index and last RFCA procedures. Purpose To identify the risk factors associated with recurrent AF in females and males after RFCA of AF. Methods We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Results The incidence of AF recurrences after a single procedure was 43.3% in females and 39.0% in males. After a multivariate adjustment at baseline, the significant predictors of AF recurrence in females after the index RFCA were non-paroxysmal AF (hazard ration [HR],1.59; 95% confidence interval [CI],1.31–1.93, p<0.0001), a history of AF ≥2 years (HR,1.47; 95% CI,1.24–1.74, p<0.0001), coronary artery disease (HR,1.43; 95% CI,1.03–1.98, p=0.0035), and an estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 (HR,1.46; 95% CI,1.10–1.95, p=0.0086). On the other hand, significant predictors of AF recurrence in males after the index RFCA were non-paroxysmal AF (HR,1.54; 95% CI,1.37–1.73, p<0.0001), a history of AF ≥2 years (HR,1.40; 95% CI,1.26–1.56, p<0.0001), the number of antiarrhythmic drugs (HR,1.06; 95% CI,1.003–1.13, p=0.040), a left atrial diameter≥40mm (HR,1.13; 95% CI,1.007–1.27, p=0.038), and dilated cardiomyopathy (HR,1.55; 95% CI,1.07–2.26, p=0.021), however, an eGFR<60 mL/min/1.73m2 was not associated with AF recurrence in males (HR, 1.00; 95% CI, 0.88–1.13, p=0.97). Conclusion The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the predictors of recurrent AF after RFCA. Non-Paroxysmal AF and a long history of AF were common risk factors both in females and males. However, renal dysfunction was a significant predictor of AF recurrence in females, while it was not a risk of recurrence in males. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.

scholarly journals Effects of catheter ablation on left atrial performance in different types of atrial fibrillation: a strain study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Katbeh ◽  
T De Potter ◽  
P Geelen ◽  
E Stefanidis ◽  
K Iliodromitis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Time Course ◽  
Public Institution ◽  
P Value ◽  
Funding Source ◽  
Functional Changes ◽  
Af Recurrence

Abstract Background Atrial structural and functional changes may develop as a result of catheter ablation (CA) in patients with paroxysmal and persistent atrial fibrillation (AF). However, the relation between AF recurrence and atrial performance following CA is still under debate. Our aim is to describe the long-term effects of CA on LA remodeling and its correlates to the maintenance of sinus rhythm (SR). Methods We prospectively enrolled 178 consecutive patients (age: 63±9 years, 35% females) with paroxysmal AF undergoing first-CA (67%) or redo-CA (22%), and 20 individuals (11%) with long-standing persistent AF (PAF) undergoing first CA. All patients underwent comprehensive transthoracic echocardiography at baseline and at 12-month follow-up, including the assessment of reservoir and contractile strain (LAS) using two dimensional speckle tracking echocardiography in all three apical views. The study population was divided in two sub-groups according to AF recurrence during follow-up. Results During one-year follow-up, 144 (81%) patients maintained SR whereas 34 (19%) patients had AF recurrence [first-CA group 16 (13%), redo-CA group 8 (20%) and PAF group 10 (50%)]. Improvement of LAS was observed only in patients with paroxysmal and long-standing persistent AF who underwent the first CA and who remained in SR (Figure 1A, 1C). In contrast, recurrent AF was associated with absence of LAS improvement (Figure 1A, 1C). Different time course of LA performance was observed in the redo-CA group, i.e. LAS remained unchanged from baseline regardless of long-term maintenance of SR (Figure 1B). Moreover, at follow-up, no significant differences in LAS between redo-CA patients with SR versus AF were observed. Of note, in patients with long-standing persistent AF and SR, follow-up LAS increased to values observed in the redo-CA group. Conclusion LA performance following CA is strongly affected by complex interplay between extent of atrial electro-structural remodeling and CA procedure. Repeated wide CA might affects negatively LA compliance and contractility despite SR restoration. Figure 1. Reservoir and contractile LAS at Baseline and 12-month follow-up in the First-CA (1A), the Redo-CA (1B) and the long-standing persistent AF (1C) groups in patients who maintained SR versus patients who had AF recurrence. *p value <0.05 (baseline vs. follow-up). Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).

scholarly journals The safety of catheter ablation of atrial fibrillation in elderly patients -analysis of the nationwide database in Japan, JROAD-DPC-

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Yokoyama ◽  
K Miyamoto ◽  
M Nakai ◽  
Y Sumita ◽  
N Ueda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Elderly Patients ◽  
Complication Rate ◽  
Safety Data ◽  
Public Institution ◽  
Funding Source ◽  
Chads2 Score ◽  
Aged Patients ◽  
Nationwide Database

Abstract Background “Age” is one of the major concerns and determinants of the indications for catheter ablation (CA) of atrial fibrillation (AF). There are little safety data on CA of AF according to the age. This study aimed to assess the safety of CA in elderly patients undergoing CA of AF. Methods and results We investigated the complication rate of CA of AF for the different age groups (<60 years, 60–65, 65–70, 70–75, 75–80, 80–85, and ≥85) by a nationwide database (Japanese Registry Of All cardiac and vascular Diseases [JROAD]-DPC). The JROAD-DPC included 73,296 patients (65±11 years, 52,883 men) who underwent CA of AF from 516 hospitals in Japan. Aged patients had more comorbidities and a significantly increased CHADS2 score and higher rate of female according to a higher age. The overall complication rate was 2.6% and in-hospital mortality was 0.05%. By comparing each age group, complications occurred more frequently in higher aged groups. A multivariate adjusted hazard ratio revealed an increased age was independently and significantly associated with the overall complications (odds ratio was 1.25, 1.35, 1.72, 1.86, 2.76 and 3.13 respectively; reference <60 years). Conclusions The frequency of complications was significantly higher according to a higher age. We should take note of the indications and procedure for CA of AF in aged patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Intramural Research Fund 17 (Kusano) for Cardiovascular Diseases of the National Cerebral and Cardiovascular Center

scholarly journals Healthcare utilization and outcomes in atrial fibrillation ablation patients with and without insertable cardiac monitoring

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.C Mansour ◽  
E.M Gillen ◽  
A Garman ◽  
S Rosemas ◽  
P.D Ziegler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Healthcare Utilization ◽  
Cardiac Monitoring ◽  
Funding Source ◽  
Detection Rates ◽  
Af Ablation ◽  
Af Recurrence ◽  
Clinic Visits

Abstract Background Atrial fibrillation (AF) is associated with increased risk of stroke and progression to heart failure, and as a result, increased mortality. Catheter ablation can reduce AF burden, potentially allowing discontinuation from anticoagulant medication in some patients. Post ablation, guidelines recommend ECG monitoring in patients discontinuing anticoagulation to monitor potential AF recurrence. Short-term ECG monitors have lower detection rates for AF recurrence, while long-term insertable cardiac monitors (ICM) increase detection rates and the opportunity to manage and treat AF, when it recurs. Whether more intensive monitoring via ICMs translates to improvements in health outcomes or reduced costs is not well understood. Purpose We examined healthcare utilization/costs and anticoagulant discontinuation following AF ablation, in patients with vs. without ICM. Methods Patients with a catheter ablation for AF between January 1, 2011 - March 31, 2018 were identified in a large U.S. administrative claims database. Patients with ICM implant within 1 year pre- or post-ablation were propensity score matched to patients without ICM, based on: demographics, comorbidities, CHAD2S2-VASc score, medication use and healthcare costs in baseline. Results A total of 691 ICM patients were identified and matched 1:3 with 2,073 non-ICM patients. Mean age was 65 years, 38% were female, and mean (SD) CHAD2S2-VASc was 2.29 (1.53). During an average follow-up from ablation discharge of 37 (19) months, ICM patients incurred fewer AF- and HF-related hospitalizations: mean 0.51 (0.91) vs. 0.62 (1.56) AF-related, p=0.018, and 0.14 (0.48) vs. 0.24 (1.30) HF-related hospitalizations per patient, p=0.00. Correspondingly, average per-patient costs for AF- and HF-related hospitalizations were lower in the ICM cohort: $13,041 ($30,831) vs. $17,140 ($55,576), p=0.016 and $3,921 ($17,865) vs. $6,746 ($33,148), p=0.005. The ICM cohort had a greater number of AF-related clinic visits during follow-up: 14.2 (13.0) vs. 10.2 (11.7) visits per patient, p<0.0001. The proportion of patients undergoing a repeat AF ablation during follow-up was higher in the ICM cohort (22.3% vs. 18.3%, P<0.0001), while the proportion with cardioversions was lower (21.0% vs. 25.1%, p=0.031). In patients indicated for anticoagulation (CHAD2S2-VASc≥2), the rate of anticoagulant discontinuation (defined as gap in coverage ≥90 days) was high in both cohorts: 89.5% and 84.6% of patients in ICM and non-ICM groups, respectively. Conclusions AF ablation patients with ICM experienced fewer AF- and HF-related hospitalizations/costs and fewer cardioversions during follow-up. The greater number of AF-related clinic visits and repeat AF ablations observed in ICM patients indicate closer management. Of note, anticoagulant discontinuation was similarly high in the non-ICM cohort despite guidelines recommending rigorous cardiac monitoring for AF recurrence in the context of discontinuation. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

Mechanisms of long-term recurrence three years after catheter ablation of atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.W Park ◽  
H.T Yu ◽  
T.H Kim ◽  
J.S Uhm ◽  
B.Y Joung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Progressive Disease ◽  
Pulmonary Veins ◽  
Public Institution ◽  
Funding Source ◽  
Regular Rhythm ◽  
Second Procedure ◽  
Repeat Procedures

Abstract Background AF is a progressive disease, and the mechanism underlying long-term recurrence after AFCA is unclear. Purpose This study explored the potential mechanisms of long-term recurrence (LTR) of atrial fibrillation (AF) 3-years after AF catheter ablation (AFCA). Methods Among 2,209 consecutive patients who underwent AFCA, 1,325 (59±11 years, 72.5% male) who underwent regular rhythm follow-ups for >3-years were enrolled. Among them, 659 patients remained in sinus rhythm (SR), 327 recurred after 3–12 months (short-term recurrence; STR), 235 after 1–3 years (mid-term recurrence; MTR), and 104 after 3-years (long-term recurrence; LTR). Two hundred eighteen recurrent patients underwent repeat procedures: 112, 80, and 26 in the STR, MTR, and LTR groups, respectively. Results The pre-ablation left atrial (LA) dimensions were larger in the STR (p<0.001) and MTR groups (p<0.001), but not in the LTR group compared to the SR group. Low LA voltages were independently associated with an LTR (adjusted HR 0.57 [0.36–0.92], p=0.022). Upon the redo-mapping, the number of reconnected pulmonary veins (PVs) was 2.0 (IQR 0–3), 1.5 (IQR 0–3), and 1.0 (IQR 0–2) in the STR, MTR, and LTR groups, respectively (p=0.030). Post-ablation extra-PV triggers were more commonly found in the LTR than STR or MTR groups (LTR 40.9% to STR 19.2%, p=0.014) during the second procedure. Conclusions The LTR group had a similar baseline LA size and significantly lower LA voltage than the SR group. In the repeat procedures, the LTR group had fewer reconnected PVs, but extra-PV triggers were more common than in the STR and MTR groups. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Ministry of Health and Welfare, Ministry of Science, ICT & Future Planning (MSIP).

scholarly journals Potential role of CT-radiomics of epicardial adipose tissue in the prognosis of atrial fibrillation catheter ablation outcome

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
J Ilyushenkova ◽  
AE Shelemekhov ◽  
EV Popov ◽  
SI Sazonova ◽  
RE Batalov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Epicardial Adipose Tissue ◽  
Public Institution ◽  
Slice Thickness ◽  
Tissue Segmentation ◽  
Group 2 ◽  
Af Recurrence ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): None Previous studies have shown that an increase of epicardial adipose tissue (EAT) volume is an independent risk factor of atrial fibrillation (AF) occurrence. However, there is no reliable data about the relationship between EAT and AF recurrence after catheter ablation (CA). Also, there are no studies of the possibility of using of CT radiomics of EAT, in particular of the quantitative assessment of EAT textural changes, for prognosis of CA outcomes in patients with AF.  Thus, the aim of the present study was to estimate the association of CT-radiomics features of EAT with probability of AF recurrence after catheter ablation. Materials and Methods The prospective research included 46 patients (42 males and 4 females, mean age 42.4 ± 9.36) with drug-refractory lone AF referred for catheter ablation (CA). Before CA all patients underwent multislice CT-angiography for preoperative evaluation of cardiac and vessels anatomy and volumes. Images were acquired using a 64-detector CT scanner (GE Discovery NM/CT 570c, GE Healthcare, Milwaukee, WI, USA). Imaging parameters included a gantry rotation time of 400 ms, tube voltage of 120 mA, slice thickness 1.25 mm. For evaluation of EAT only native images (contrast-free scans) without ECG synchronization were analyzed. Epicardial adipose tissue segmentation was performed by 3D-Sliser software and the SliserRadiomics module (version 4.10.2). From CT images we quantified EAT volume and 93 radiomic features, including subgroups of first-order statistics, GLCM, GLDM, GLRLM, GLSZM and NGTDM parameters. All patients were followed-up prospectively for 12 months after the CA. A blanking period of 3 months was applied. The criteria of AF recurrence were AF episodes of more than 30 sec duration. Results. Recurrence of AF was registered in 26 patients. After the end of the follow-up, we divided study population on those with (Group 1) and without (Group 2) AF recurrence. EAT volume and attenuation values for Group 1 were 176.6 ± 56.9 sm3 and -77.47 ± 2.2 HU respectively; for Group 2 were 174.05 ± 73.3 sm3 and -78.42 ± 3.3 HU respectively, with no significant differences (p < 0.05). In the same time, 16 of 93 CT radiomics EAT parameters were significantly different between Group 1 and Group 2 and were significantly associated with AF recurrence after CA according to univariable logistic analyses. Multivariate regression analysis demonstrated that only Gray Level Non-Uniformity Normalized (GLNUN of GLSZM) parameter was an independent predictor of AF recurrence (Odds ratio 1.0022, 95%Cl 1.0006 to 1.0038, p = 0.0013);  ROC-curve analysis data showed that GLNUN > 1227.2 indicates high probability of AF recurrence during 12 months (sensitivity 84.2 %, specificity 70.8 %, AUC:0.765; p = 0.001). Conclusion radiomic biomarkers of EAT have a potential to serve as a predictors of AF recurrence after CA.

scholarly journals Extensible artificial intelligence model predicts post-ablation AF recurrence using coronary sinus electrogram

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Huang ◽  
Z Zhang ◽  
K Lin ◽  
Z Zuo ◽  
Q Chen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Catheter Ablation ◽  
Coronary Sinus ◽  
Public Health Problem ◽  
Adverse Outcomes ◽  
Funding Source ◽  
Major Public Health Problem ◽  
Deep Convolutional Neural Networks ◽  
F Measure ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) is a major public health problem with significant adverse outcomes and catheter ablation is a widely adopted treatment. The CABANA trial showed that catheter ablation reduced AF recurrence to a greater extent than medications. However, some of patients who underwent this procedure still experience relapse. Here, we present an innovative way to identify this subgroup using an artificial intelligence (AI) -assisted coronary sinus electrogram. Hypothesis Our hypothesis is that credible features in the electrogram can be extracted by AI for prediction, therefore rigorous drug administration, close follow-up or potential second procedure can be applied to these patients. Methods 67 patients from two independent hospitals (SPH & ZSH) with non-valvular persistent AF undergoing circumferential pulmonary vein isolation were enrolled in this study, 23 of which experienced recurrence 6 months after the procedure. We collected standard 2.5-second fragments of coronary sinus electrogram from ENSITE NAVX (SPH) and Carto (ZSH)system before the ablation started. A total of 1429 fragments were obtained and a transfer learning-based ResNet model was employed in our study. Fragments from ZSH were used for training and SPH for validation of deep convolutional neural networks (DCNN). The AI model performance was evaluated by accuracy, recall, precision, F-Measure and AUC. Results The prediction accuracy of the DCNN in single center reached 96%, while that in different ablation systems reached 74.3%. Also, the algorithm yielded values for the AUC, recall, precision and F-Measure of 0.76, 86.1%, 95.9% and 0.78, respectively, which shows satisfactory classification results and extensibility in different cardiology centers and brands of electroanatomic mapping instruments. Conclusions Our work has revealed the potential intrinsic correlation between coronary sinus electrical activity and AF recurrence using DCNN-based model. Moreover, the DCNN model we developed shows great prospects in the relapse prediction for personalized post-procedural management. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The National Natural Science Foundation of China

Reliable detection of atrial fibrillation with a medical wearable under inpatient conditions (CoMMoD-A-fib)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Jacobsen ◽  
T.A Dembek ◽  
A.P Ziakos ◽  
G Kobbe ◽  
M Kollmann ◽  
...  
Keyword(s):  
Neural Network ◽  
Atrial Fibrillation ◽  
Deep Neural Network ◽  
Sampling Rate ◽  
Public Institution ◽  
Funding Source ◽  
Upper Arm ◽  
Recording Time ◽  
Reduced Ejection Fraction ◽  
Non Invasive

Abstract Background Atrial fibrillation (A-fib) is the most common arrhythmia; however, detection of A-fib is a challenge due to irregular occurrence. Purpose Evaluating feasibility and performance of a non-invasive medical wearable for detection of A-fib. Methods In the CoMMoD-A-fib trial admitted patients with a high risk for A-fib carried the wearable and an ECG Holter (control) in parallel over a period of 24 hours under not physically restricted conditions. The wearable with a tight-fit upper arm band employs a photoplethysmography (PPG) technology enabling a high sampling rate. Different algorithms (including a deep neural network) were applied to 5 min PPG datasets for detection of A-fib. Proportion of monitoring time automatically interpretable by algorithms (= interpretable time) was analyzed for influencing factors. Results In 102 inpatients (age 71.0±11.9 years; 52% male) 2306 hours of parallel recording time could be obtained; 1781 hours (77.2%) of these were automatically interpretable by an algorithm analyzing PPG derived intervals. Detection of A-Fib was possible with a sensitivity of 92.7% and specificity of 92.4% (AUC 0.96). Also during physical activity, detection of A-fib was sufficiently possible (sensitivity 90.1% and specificity 91.2%). Usage of the deep neural network improved detection of A-fib further (sensitivity 95.4% and specificity 96.2%). A higher prevalence of heart failure with reduced ejection fraction was observed in patients with a low interpretable time (p=0.080). Conclusion Detection of A-fib by means of an upper arm non-invasive medical wearable with a high resolution is reliably possible under inpatient conditions. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Internal grant program (PhD and Dr. rer. nat. Program Biomedicine) of the Faculty of Health at Witten/Herdecke University, Germany. HELIOS Kliniken GmbH (Grant-ID 047476), Germany

scholarly journals Non-invasive mid-term ECG monitoring for the detection of atrial fibrillation in an outpatient population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Cai ◽  
K.K Yeo ◽  
P Wong ◽  
C.K Ching
Keyword(s):  
Atrial Fibrillation ◽  
Public Institution ◽  
First Episode ◽  
Prior History ◽  
Funding Source ◽  
Monitoring Device ◽  
Ecg Monitoring ◽  
Non Invasive ◽  
Increased Risk ◽  
The Mean

Abstract Background Atrial fibrillation (AF) is a common arrhythmia with significant morbidity due to an increased risk of ischemic stroke. Outpatient electrocardiogram (ECG) monitoring is an integral part of the diagnosis of AF. Conventional 24 hour Holter monitoring can be cumbersome and often fails to diagnose patients with paroxysmal AF. Spyder ECG is a non-invasive ECG monitoring device that allows wireless transmission of ECG information for analysis. It is small and comfortable, allowing for easy application for the screening and detection of AF over a mid-term duration. Purpose This study aims to evaluate the incidence of AF in patients with no prior AF and CHADsVASC score of at least 1 with the use of the Spyder ECG mid-term ECG monitoring device. Methods Patients aged 21 to 85 years old with no prior history of AF and CHADsVASC score of at least 1 were recruited from outpatient clinics of 3 large tertiary hospitals in Singapore from December 2016 to April 2019. Patients wore the Spyder ECG device for up to 2 weeks, during which continuous ECG information was uploaded onto a central cloud database and analysed. Results There were 363 patients recruited. The mean age was 61±10.0 years and 65.1% were male. There were 80.3% Chinese, 11.6% Malay, 7.5% Indian and 20.6% of other races. 68.3% of the patients were non-smokers and 74.0% of them were non-alcohol drinkers. The mean BMI of 25.5±4.7 kg/m2. The patient population had significant co-morbidities. 76.3% of the patients had hypertension, 69.4% of them had hyperlipidemia and 40.5% of them had diabetes mellitus. 10.0% of them had congestive cardiac failure and 56.7% had ischaemic heart disease. 11.3% of patients had a previous stroke and 20.4% had a prior myocardial infarction. 7.8% of the patients had asthma, 5.8% of them had thyroid disease and 9.9% of them had chronic kidney disease. They were monitored for a mean of 5.4±2.9 days each. There were 15 (4.1%) patients in whom AF was detected. The patients with AF wore the device for a mean of 5.7±2.0 SD days. The mean burden of AF was 9.0% of monitored time. 46.7% of the patients with AF had detection of AF on the first day, 26.7% on the second day, 13.3% on the third day and 13.3% on the seventh day. The mean duration of the first episode of AF was 251±325 minutes. 7 out of 15 (46.7%) of patients had first episodes of AF lasting less than 10 minutes. Conclusion Continuous mid-term ECG monitoring was able to detect AF in 15 (4.1%) of a population of 363 patients with no prior AF and CHADsVASC score of at least one, monitored for a mean of 5.4 days. Most episodes (53.3%) of AF were detected after the first day of ECG monitoring. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Duke-NUS Medical School Singapore

B-Type natriuretic peptide predicts major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kato ◽  
K Usuda ◽  
H Tada ◽  
T Tsuda ◽  
K Takeuchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Natriuretic Peptide ◽  
Cardiovascular Events ◽  
Curve Analysis ◽  
Funding Source ◽  
Coronary Syndrome ◽  
Cerebrovascular Events

Abstract Background High plasma B-Type natriuretic peptide (BNP) level is associated with cardiac events or stroke in patients with atrial fibrillation (AF). However, it is still unknown whether BNP predicts worse clinical outcomes after catheter ablation ofAF. Purpose We aimed to see if plasma BNP level is associated with major adverse cardiac and cerebrovascular events (MACCE) after catheter ablation of AF. Methods We retrospectively analyzed 1,853 participants (73.1% men, mean age 63.3±10.3 years, 60.7% paroxysmal AF) who received first catheter ablation of AF with pre-ablation plasma BNP level measurement and completed follow-up more than 3 months after the procedure from AF Frontier Ablation Registry, a multicenter cohort study in Japan. We evaluated an association between plasma BNP level before catheter ablation and first MACCE in cox-regression hazard models adjusted for known risk factors. MACCE were defined as stroke/transient ischemic attack (TIA), cardiovascular events or all-cause death. Results The mean plasma BNP level was 120.2±3.7 pg/mL. During a mean follow-up period of 21.9 months, 57 patients (3.1%) suffered MACCE (ischemic stroke 8 [14.0%], hemorrhagic stroke 5 [8.8%], TIA 5 [8.8%], hospitalization for heart failure 11 [19.2%], acute coronary syndrome 9 [15.8%], hospitalization for other cardiovascular events 8 [14.0%] and all-cause death 11 [19.2%]). Plasma BNP level of patients with MACCE were significantly higher than those without MACCE (291.7±47.0 vs 114.7±3.42 pg/mL, P<0.001). Multivariate analysis revealed that plasma BNP level (hazard ratio [HR] per 10 pg/mL increase 1.014; 95% confidence interval [CI] 1.005–1.023; P=0.001), baseline age (HR 1.052; 95% CI 1.022–1.084; P=0.001), heart failure (HR 2.698; 95% CI 1.512–4.815; P=0.001), old myocardial infarction (HR 3.593; 95% CI 1.675–7.708; P=0.001) and non-ischemic cardiomyopathy (HR 2.676; 95% CI 1.337 - 5.355; P=0.005) were independently associated with MACCE. At receiver-operating characteristic curve analysis, plasma BNP level before catheter ablation ≥162.7 pg/mL was the best threshold to predict MACCE (area under the curve: 0.71). Kaplan-Meier curve analysis (Figure) showed that the cumulative incidence of MACCE was significantly higher in patients with a BNP ≥162.7 pg/mL than in those with a BNP below 162.7 pg/mL (HR 4.85; 95% CI 2.86–8.21; P<0.001). Conclusions Elevation of plasma BNP level was independently related to the increased risk of MACCE after catheter ablation ofAF. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bristol-Meiers Squibb

Sign in / Sign up

Export Citation Format

Share Document