Prognostic impact of atrial fibrillation in patients with hypertrophic cardiomyopathy in a community-based Japanese cohort: results from Kochi RYOMA study

Abstract Background The prognostic impact of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) is not fully elucidated. Purpose The aim of this study was to examine the prevalence and prognostic impact of AF in a prospectively assembled community-based HCM patient cohort in an aged Japanese community. Methods In 2004, we established a cardiomyopathy registration network in Kochi Prefecture, Japan, consisting of 9 hospitals, and finally 293 patients with HCM were followed. Results The ages at registration and at diagnosis were 63±14 and 56±16 years, respectively, and 197 patients (67%) were men. 86 patients (29%) showed AF. During follow-up period of 6.1±3.2 years, 44 patients died. In those patients, HCM-related deaths occurred in 23 patients with an annual mortality rate of 1.3%. Regarding HCM-related adverse events including HCM-related deaths, appropriate ICD discharge, heart failure admission and hospitalization for embolic events, a total of 77 cardiovascular events in 70 patients occurred. Multivariate analysis revealed that presence of AF, left ventricular (LV) outflow obstruction, NYHA functional class III, and lower LV fractional shortening at registration were significant predictors of these adverse events. During the follow-up period, additional 31 patients (11%) developed new-onset AF. Importantly, the incidence of HCM-related adverse events was significantly higher in patients with new AF observed from its onset compared with those with AF at registration (log-rank p=0.029) (Figure 1). Conclusions In an unselected HCM registry in an aged Japanese community, presence of AF, particularly new-onset AF, was associated with unfavorable clinical outcomes. AF is not just a marker of the disease stage but an important trigger of HCM-related adverse events. Figure 1 Funding Acknowledgement Type of funding source: None

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POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY I (F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION?

EP Europace ◽

10.1093/europace/euw274 ◽

2016 ◽

Vol 18 (suppl 2) ◽

pp. ii36-ii47

Author(s):

T. Philippsen ◽

M. Orini ◽

C.A. Martin ◽

E. Volkova ◽

J.O.M. Ormerod ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ventricular Tachycardia ◽

Hypertrophic Cardiomyopathy ◽

Pacemaker Implantation ◽

Left Ventricular ◽

Day Case ◽

Single Centre ◽

Subcutaneous Icd

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Abstract 19346: Peak Oxygen Consumption Predicts Outcome in Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.19346 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Carla Contaldi ◽

Raffaella Lombardi ◽

Alessandra Giamundo ◽

Sandro Betocchi

Keyword(s):

Heart Failure ◽

Oxygen Consumption ◽

Hypertrophic Cardiomyopathy ◽

Nyha Class ◽

Left Ventricular ◽

Exercise Intolerance ◽

Peak Oxygen Consumption ◽

Class Iii ◽

Asymptomatic Patients

Introduction: Peak oxygen consumption (VO 2 ) has a strong and independent prognostic value in systolic heart failure; in contrast no data support its prognostic role in hypertrophic cardiomyopathy (HCM). Hypothesis: We assess if peak VO 2 is a long-term predictor of outcome in HCM. Methods: We studied 92 HCM patients (40±15 years). Peak VO 2 was expressed as percentage (%) of the predicted value. Follow up was 76±57 months. The primary composite endpoint (CE) was atrial fibrillation, progression to NYHA class III or IV, myotomy-myectomy (MM), heart transplantation (HT) and cardiac death. An ancillary endpoint (HFE) included markers of heart failure (progression to NYHA class III or IV, MM and HT). Results: At baseline, 62% of patients were asymptomatic, 35% NYHA class II and 3% NYHA class III; 26% had left ventricular outflow tract obstruction. During follow up, 30 patients met CE with 43 events. By multivariate Cox survival analysis, we analyzed 2 models, using the CE, and in turn HFE. For CE, maximal left atrial diameter (LAD) (HR: 1.12; 95% CI: 1.04 to 1.22), maximal wall thickness (MWT) (HR: 0.14; 95% CI: 1.04 to 1.23) and % predicted peak VO 2 (HR: -0.03; 95% CI: 0.95 to 0.99) independently predicted outcome (overall, p<0.0001). For HFE, maximal LAD (HR:0.31; 95% CI: 1.09 to 1.70), MWT (HR: 0.35; 95% CI: 1.08 to 1.84) and % predicted peak VO 2 (HR: -0.06; 95% CI: 0.89 to 0.98) independently predicted outcome (overall, p<0.0001). Only 19% of mildly symptomatic or asymptomatic patients with % predicted peak VO 2 >80% had events, as opposed to 53% of them with % predicted peak VO 2 < 55% (p= 0.04). Event-free survival for both endpoints was significantly lower in patients with % predicted peak VO 2 < 55% as compared to those with it between 55 and 80 and >80% , Figure. Conclusion: In mildly or asymptomatic patients severe exercise intolerance may precede clinical deterioration. In HCM, peak VO 2 provides excellent risk stratification with a high event rate in patients with % predicted value <55%.

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3269Impact of type 2 diabetes on incidence and phenotype of heart failure in patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0054 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Polovina ◽

I Milinkovic ◽

G Krljanac ◽

I Veljic ◽

I Petrovic-Djordjevic ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Type 2 Diabetes ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Diabetic Patients ◽

History Of ◽

New Onset

Abstract Background Type 2 diabetes (T2DM) portends adverse prognosis in patients with atrial fibrillation (AF). Whether T2DM independently increases the risk of incident heart failure (HF) in AF is uncertain. Also, HF phenotype developing in patients with vs. those without T2DM has not been characterised. Purpose In AF patients without a history of prior HF, we aimed to assess: 1) the impact of T2DM on the risk of new-onset HF; and 2) the association between T2DM and HF phenotype developing during the prospective follow-up. Methods We included diabetic and non-diabetic AF patients, without a history of HF. Baseline T2DM status was inferred from medical history, haemoglobin A1c levels and oral glucose tolerance test. Study outcome was the first hospital admission or emergency department treatment for new-onset HF during the prospective follow-up. The phenotype of new-onset HF was determined by echocardiographic exam performed following clinical stabilisation (at hospital discharge, or within a month after HF diagnosis). HF phenotype was defined as HFrEF (left ventricular ejection fraction [LVEF] <40%), HFmrEF (LVEF 40–49%) or HFpEF (LVEF≥50%). Cox regression analyses adjusted for age, sex, baseline LVEF, comorbidities, smoking status, alcohol intake, AF type (paroxysmal vs. non-paroxysmal) and T2DM treatment was used to analyse the association between T2DM and incident HF. Results Among 1,288 AF patients without prior HF (mean age: 62.1±12.7 years; 61% male), T2DM was present in 16.5%. Diabetic patients had higher mean baseline LVEF compared with nondiabetic patients (50.0±6.2% vs. 57.6±9.0%; P<0.001). During the median 5.5-year follow-up, new-onset HF occurred in 12.4% of patients (incidence rate, 2.9; 95% confidence interval [CI], 2.5–3.3 per 100 patient-years). Compared with non-diabetic patients, those with T2DM had a hazard ratio of 2.1 (95% CI, 1.6–2.8; P<0.001) for new-onset HF, independent of baseline LVEF or other factors. In addition, diabetic patients had a significantly greater decline in covariate-adjusted mean LVEF (−10.4%; 95% CI, −9.8% to −10.8%) at follow-up, compared with nondiabetic patients (−4.0%; 95% CI, −3.8% to −4.2%), P<0.001. The distribution of HF phenotypes at follow-up is presented in Figure. Among patients with T2DM, HFrEF (56.9%) was the most common phenotype of HF, whereas in patients without T2DM, HF mostly took the phenotype of HFpEF (75.0%). Conclusions T2DM is associated with an independent risk of new-onset HF in patients with AF and confers a greater decline in LVEF compared to individuals without T2DM. HFrEF was the most prevalent presenting phenotype of HF in AF patients with T2DM.

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Apical hypertrophic cardiomyopathy, are low-risk patients really at low risk? A case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa316 ◽

2020 ◽

Vol 4 (5) ◽

pp. 1-4

Author(s):

Rui Files Flores ◽

Fernando Mané ◽

Nuno Antunes ◽

Vítor Hugo Pereira

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Left Ventricular ◽

Low Risk ◽

Bundle Branch Block ◽

Case Summary ◽

Risk Patients ◽

Apical Hypertrophy ◽

Genetically Determined ◽

New Onset

Abstract Background Hypertrophic cardiomyopathy (HCM) is a genetically determined myocardial disease that constitutes the main cause of sudden cardiac death (SCD) in young athletes. Apical HCM (ApHCM) represents a complex subset of patients, whose risk of SCD seems not negligible. Most applied scores likely underestimate the risk of heart events in this subset of patients. Case summary We report the case of a 55-year-old man who was admitted in the emergency department after an episode of aborted sudden death due to ventricular fibrillation. The electrocardiogram made at admission was noted for atrial fibrillation and a new-onset left bundle branch block. Emergency coronary angiography was normal. The electrocardiogram was repeated and showed symmetrical and profound inversion of T waves in the lateral leads. Transthoracic echocardiogram and cardiac magnetic resonance revealed left ventricular apical hypertrophy suggestive of apical variant of HCM. A cardiac defibrillator was implanted for secondary prevention of SCD. After 6 months of follow-up no further rhythmic events were noted. Discussion Although low, the risk of SCD of ApHCM patients is not negligible. This case illustrates the need for searching of new predictors of rhythmic risk in patients with ApHCM.

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Pulmonary Vein Enlargement as an Independent Predictor for New-Onset Atrial Fibrillation

Journal of Clinical Medicine ◽

10.3390/jcm9020401 ◽

2020 ◽

Vol 9 (2) ◽

pp. 401

Author(s):

Sunwon Kim ◽

Yong-Hyun Kim ◽

Seung-Hwa Lee ◽

Jin-Seok Kim

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Cox Model ◽

Three Dimensional ◽

Left Ventricular ◽

Aged Subjects ◽

Onset Atrial Fibrillation ◽

Ventricular Dimension ◽

New Onset

Pulmonary vein (PV) enlargement is associated with atrial fibrillation (AF). However, the predictive value of PV volume for new-onset AF has not been determined. We retrospectively assessed and enrolled non-AF subjects who underwent echocardiography and cardiac CT angiography (CCTA) around the same time and evaluated the development of AF longitudinally. PV volume was assessed by estimating the three-dimensional CCTA-derived mid-diastolic PV volume from the ostium to tertiary branches. Overall, 1105 subjects were enrolled. Among them, 29 developed AF during a mean follow-up of 4.28 ± 3.08 years after baseline CCTA and echocardiography. The AF group had a higher proportion of older aged subjects, a higher ratio of early mitral flow velocity (E) to early mitral annular tissue velocity (Em), higher Em, and larger left atrial (LAVI) and PV (PVVI) volume indices. PVVI was independently associated with male sex, left ventricular dimension, E/Em and LAVI. AF incidence increased markedly across each baseline PVVI tertile (2.2%, 5.1%, and 10.8%). In the multivariate Cox model, increased PVVI was independently associated with new-onset AF (hazard ratio (HR) = 5.401, 4.931–6.193, p = 0.007). Based on the analysis of multimodal cardiac imaging, our results provide mechanistic insights into PV remodeling and its potential role as a link between diastolic dysfunction and developing AF.

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Neuromuscular comorbidity, atrial fibrillation and left bundle branch block predict the prognosis of left ventricular hypertrabeculation/noncompaction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1142 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Stoellberger ◽

M Hasun ◽

M Winkler-Dworak ◽

J Finsterer

Keyword(s):

Atrial Fibrillation ◽

Left Bundle Branch Block ◽

Neuromuscular Disorders ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Unknown Etiology ◽

Prognostic Impact ◽

Bundle Branch Block ◽

Predictors Of Mortality

Abstract Background The prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT) is controversially assessed. LVHT is frequently associated with neuromuscular disorders (NMDs). Aim of the study was to assess cardiac and neurological findings as predictors of mortality in LVHT-patients. Methods Included were patients with LVHT diagnosed between June 1995 and December 2019 in one echocardiographic laboratory. They underwent a baseline cardiologic examination and were invited for a neurological investigation. In January 2020, their survival status was assessed. Results LVHT was diagnosed in 310 patients (93 female, aged 53±18 years) with a prevalence of 0.4%/year. A neurologic investigation was performed in 205 patients (67%). A specific NMD was found in 33 of the investigated patients (16%), NMDs of unknown etiology in 123 (60%) and the neurological investigation was normal in 49 (24%) patients. During 86 months of follow-up, 59 patients received implanted electronic devices (cardioverter/defibrillator n=21, antibradycardic pacemakers n=11, cardiac resynchronization device/defibrillator n=22, cardiac resynchronization device n=4). During follow-up 105 patients died and 6 patients underwent heart transplantation. The mortality was 4.7%/year. By multivariate analysis, the following baseline parameters were identified as predictors of mortality: increased age (p=0.0005), inpatient-status when LVHT was diagnosed (p=0.0050), presence of a specific NMD (p=0.0187) or NMD of unknown etiology (p=0.0052), atrial fibrillation (p=0.0007) and left bundle branch block (p=0.0168). Conclusions LVHT patients should be systematically investigated neurologically since neurological comorbidity has a prognostic impact. Electrocardiographic abnormalities like atrial fibrillation and left bundle branch block should be considered when planning pharmacotherapy and device-therapy. It has to be assessed by prospective studies, which measures improve the prognosis of LVHT. Funding Acknowledgement Type of funding source: None

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An Observational Study of the Occurrence of Atrial Fibrillation and Hypertension in Patients Treated with Ibrutinib

Blood ◽

10.1182/blood.v124.21.5657.5657 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5657-5657 ◽

Cited By ~ 3

Author(s):

George Binsah ◽

Thompson A Philip ◽

Alessandra Ferrajoli ◽

Burger Jan ◽

Nitin Jain ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Beta Blocker ◽

Research Funding ◽

Left Ventricular ◽

P Wave ◽

Close Monitoring ◽

True Incidence ◽

New Onset

Abstract Background: Ibrutinib (Ib) is active in relapsed/refractory (R/R) Chronic Lymphocytic Leukemia (CLL). Patients receive indefinite therapy until progression. Published reports describe the occurrence of hypertension (HTN) and Atrial Fibrillation (AF) to be 8% and 6-9% respectively in patients treated with Ib. Methods: We evaluated 176 CLL patients treated on investigational protocols with Ib-based regimens from 2010-14 to determine the incidence of AF and HTN while receiving Ib. All pts gave informed consent and studies were conducted according to the Declaration of Helsinki. Blood pressure (BP) was evaluated at baseline and 6 months (mo). New onset HTN was defined as systolic BP (SBP) >140mmHg or diastolic BP (DBP) >90mmHg at 6mo in a pt with normal baseline BP. An increase in baseline SBP by ≥20mmHg and/or increase in DBP by ≥10mmHg was considered separately to be significant regardless of the absolute BP. AF was defined by an R-R interval following no repetitive pattern with no distinct P wave and an atrial rate of more than 300 beats/min. Electrocardiography (EKG) was reviewed to confirm AF. Baseline EKGs were required, but subsequent EKGs were performed only for symptom evaluation. Echocardiography (echo) was not performed at baseline, but was available in 6 of 9 pts at onset of AF. Results: Baseline characteristics are given below: TableCharacteristicAge (median, range)65 (35-87)Male129 (73)Treatment group:Ib monotherapy, n(%)83 (47)Ib + Rituximab, n(%)78 (44)Ib + Bendamustine + Rituximab, n(%)15 (8)Unmutated IGHV gene, n(%)112 (64)FISH hierarchydel(17p), n(%)59 (34)del(11q), n(%)32 (18)Other, n(%)25 (14) The median follow up of the entire patient cohort is 13 months (mo), range, 1-47mo. 9 patients (5%) developed new onset AF after starting Ibrutinib therapy, 7/9 were not on prior Beta blocker. 5 on Ib monotherapy, 3 patients on Ib + R, 1 on Ib+BR. The median time to AF after starting Ibrutinib was 20 weeks (range, 2-101). Six pts had a Hx of paroxysmal AF pre-dating Ib therapy (3.4%) and were already on treatment with Beta blocker of which none had recurrence of AF after or during Ib therapy, after a median follow up of 24 months (range=2-46). Six of 9 pts with new AF had an echo. Echo was normal in 2 pts, while 4 showed mild-severe left atrial (LA) dilatation; severe LA dilatation had developed during Ib treatment in the 1 pt who had had a normal baseline echo. One pt also had moderate left ventricular (LV) failure in addition to LA dilatation, but LV function was normal in the remaining pts. No pt had thyrotoxicosis as a contributing factor. Serial BP results were available in 111 pts. Median BP was 129/73 at baseline and 137/73 after 6mo of Ib therapy (p<0.001). New onset HTN occurred in 26 pts (23%); this was isolated systolic HTN in 23 pts and both systolic and diastolic in 3. Median change in SBP in pts with new-onset HTN was 27mmHg, range 4-55mmHg. Increase in SBP of >20mmHg occurred in 26 pts (23%); 21 of these pts had new onset HTN, while 5 had exacerbation of pre-existing HTN. Of the 9 pts with new AF, 5 had serial BP measurements. One developed new-onset HTN and 2 had a >20mmHg rise in SBP. Conclusions: In our experience, 5% of pts undergoing treatment with Ib develop new-onset AF. This incidence is comparable to prior reported data. Given that AF may be paroxysmal and asymptomatic, routine surveillance was not performed, the true incidence may be higher. The causative mechanism is unclear. 2/3 of pts with new AF, echo results showed significant structural LA abnormalities which have been associated with AF in the general cardiology literature. Twenty-three % of the pts developed new onset HTN, which was usually isolated systolic HTN. Most of these pts had increases in SBP >20mmHg. New onset HTN is likely therapy-related, although the mechanism is unclear. Development of AF did not appear to be dependent on the development of HT, as only 1 of 5 pts with new AF had new-onset HT. AF and HTN were generally manageable with medical intervention and did not require permanent cessation of Ib. Close monitoring of heart rhythm and blood pressure is recommended during treatment with Ib. Disclosures Jan: pharmacyclics: Research Funding. Wierda:Pharmacyclics: Consultancy. O'Brien:Pharmacyclics: Research Funding.

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P3779NT-proBNP adds incremental predictive information on incident atrial fibrillation in patients with asymptomatic aortic stenosis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0628 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C N Bang ◽

A M Greve ◽

K Boman ◽

K Egstrup ◽

M H Olsen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Stenosis ◽

Left Atrial ◽

Pressure Overload ◽

Left Ventricular Pressure ◽

Left Ventricular ◽

Predictor Variables ◽

All Cause Mortality ◽

New Onset

Abstract Background Incident atrial fibrillation (AF) marks an adverse shift in the prognosis of patients with aortic stenosis (AS). Identifying risk factors for AF is therefore of paramount importance for timely intervention in patients with AS. In patients without AS, brain natriuretic peptides (BNP) is a well-established biomarker for left ventricular pressure overload on the pathway to heart failure and atrial fibrillation. However, a potential role of NT-proBNP to predict risk of new-onset AF in asymptomatic patients with mild to moderate AS is not well studied. Methods We included 1,434 patients with mild to moderate AS from the SEAS Study (Simvastatin and Ezetimibe in Aortic Stenosis) without AF or clinically overt heart failure at baseline. The primary endpoint for this substudy was time to incident AF, as determined by the first annual in-study 12-lead ECG with AF. Multivariable Cox model were adjusted for other important predictors of incident AF as selected by Bayesian statistics. Fine and Gray competing risk regression was used to evaluate the influence of all-cause mortality on selected predictor variables of incident AF. Results During a median follow-up of 4.3 years (range 0.1–6.9 years), incident AF occurred in 114 (6.1%) patients (13.8 per 1,000 person-years of follow-up), who at baseline were older (69±10 vs. 67±10 years, p<0.001), had larger systolic left atrial diameter (46±24 vs. 34±18 mm, p<0.001) and higher NT-proBNP level (286 [132; 613] vs. 154 [82; 297] pg/ml, p<0.001); but same left ventricular ejection fraction (66±6 mm vs. 67±6, p=0.4). In multivariable Cox regression, adjusted for age, circumferential end-systolic stress, left atrial volume and ECG PR interval, Ln(NT-proBNP) was associated with higher risk of new-onset AF (HR: 1.9 [95% CI: 1.6–2.3], p<0.001). Similar results were found when using Fine and Gray estimates with all-cause mortality (HR: 2.0 [95% CI: 1.7–2.4], p<0.001 (Figure, panel A). NT-proBNP level added incremental predictive information on incident AF over the other important, as selected by Bayesian statistics, predictor variables (C-index 0.81, p<0.001, Figure, panel B). There was no interaction with aortic valve area (p>0.05). Figure 1 Conclusions In patients with asymptomatic aortic stenosis and sinus rhythm at baseline, NT-proBNP levels were significantly higher in patients who subsequently developed AF. NT-proBNP significantly improved prognostic information of incident AF over other important predictor variables. This supports the notion that incident AF is a marker of left ventricular pressure overload and possibly a novel marker of timely intervention with aortic valve replacement.

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P6577Isolated systolic hypertension versus combined systolic-diastolic hypertension as predictors of atrial fibrillation: data from a 8-year-follow-up study

European Heart Journal ◽

10.1093/eurheartj/ehz746.1165 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Konstantinidis ◽

C Tsioufis ◽

K Dimitriadis ◽

A Kasiakogias ◽

I Liatakis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systolic Hypertension ◽

Left Ventricular Mass Index ◽

Cox Regression ◽

Left Ventricular ◽

Hazard Ratio ◽

Hypertensive Patients ◽

Diastolic Hypertension ◽

New Onset

Abstract Background/Introduction Isolated systolic hypertension (ISH) and combined systolic-diastolic hypertension (CH) are related with increased cardiovascular risk. Purpose The aim of the present study was to compare the predictive role of ISH and CH for the incidence of atrial fibrillation (AF) in a cohort of essential hypertensive patients. Methods We followed up 1605 essential hypertensives with office systolic blood pressure (BP)≥140 mmHg [mean age 58.1 years, 842 males, office BP=153/92 mmHg] for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent echocardiographic study and blood sampling for estimation of metabolic profile. Patients with baseline ISH exhibited office systolic BP ≥140 mmHg and office diastolic BP <90 mmHg, while those with CH had office systolic BP ≥140 mmHg and office diastolic BP ≥90 mmHg. Moreover, new-onset AF was defined as hospitalization for AF or compatible electrocardiographic tracings. Results The incidence of new-onset AF over the follow-up period was 3.4% (n=55). Patients with ISH (n=510) compared to those with CH (n=1095) were older (65±10 vs 55±11 years, p<0.0001), had at baseline lower waist circumference (95.5±12 vs 98±12 cm, p<0.0001), office systolic BP (149±10 vs 155±13 mmHg, p<0.0001), office diastolic BP (80±5 vs 98±7 mmHg, p<0.0001), while did not differ regarding left ventricular mass index and lipid levels (p=NS for all). Univariate Cox regression analysis revealed that baseline ISH (hazard ratio=4.612, p=0.013) and CH (hazard ratio=1.794, p=0.036) predicted new-onset AF. However, in multivariate Cox regression model, age (hazard ratio=1.078, p<0.001), left ventricular mass index (hazard ratio 1.012, p=0.014), left atrium diameter (hazard ratio=1.102, p<0.001) and ISH (hazard ratio=1.551, p=0.035) but not CH turned out to be independent predictors of new-onset AF episodes. Conclusions In essential hypertensive patients, ISH but not CH exhibits independent prognostic value for AF. These findings support that ISH constitutes a hypertensive phenotype of particularly increased arrhythmia risk needing careful evaluation and treatment.

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Assessment of left atrial electro-mechanical delay to predict atrial fibrillation in hypertrophic cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa174 ◽

2020 ◽

Author(s):

Catherina Tjahjadi ◽

Yasmine L Hiemstra ◽

Pieter van der Bijl ◽

Stephan M Pio ◽

Marianne Bootsma ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Left Atrial ◽

Tissue Doppler ◽

P Wave ◽

Doppler Imaging ◽

Conduction Time ◽

Atrial Conduction Time ◽

New Onset

Abstract Aims Atrial fibrillation (AF) is frequently observed in hypertrophic cardiomyopathy (HCM) and is associated with poor clinical outcome. Total atrial conduction time, estimated by tissue Doppler imaging (TDI), the so-called PA-TDI duration, reflects the left atrial (LA) structural and electrical remodelling. The aim of this study was to evaluate the association between PA-TDI and new-onset AF in patients with HCM. Methods and results From a large cohort of patients with HCM, 208 patients (64% male, mean age 53 ± 14 years) without AF were selected. PA-TDI duration was measured from the onset P wave on electrocardiogram to the peak A′ wave of the lateral LA wall using TDI. The incidence of new-onset AF was 20% over a median follow-up of 7.3 (3.5–10.5) years. Patients with incident AF had longer PA-TDI duration when compared with patients without AF (133.7 ± 23.0 vs. 110.5 ± 30.0 ms, P < 0.001). PA-TDI duration was independently associated with new-onset AF (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, P < 0.001). Conclusion Prolonged PA-TDI duration was independently associated with new-onset AF in patients with HCM. This novel parameter could be useful to risk-stratify patients with HCM who are at risk of having AF.

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