A Novel Contact-Free Atrial Fibrillation Monitor- A Pilot Study

Abstract Aims Atrial fibrillation (AF) is a major cause of morbidity and mortality. Current guidelines support performing ECG screenings to spot atrial fibrillation in high-risk patients. The purpose of this study was to validate a new algorithm aimed to identify AF in patients measured with a recent FDA-cleared contact-free optical device. Methods and results Study participants were measured simultaneously using two devices: a contact-free optical system that measures chest motion-vibrations (investigational device, “Gili”) and a standard reference bed-side ECG monitor (Mindray®). Each reference ECG was evaluated by two board certified cardiologists that defined each trace as: regular rhythm, atrial fibrillation, other irregular rhythm or indecipherable/missing. A total of 3582, 30-sec intervals, pertaining to 444 patients (41.9% with a history of AF) were made available for analysis. Distribution of patients with active AF, other irregular rhythm and regular rhythm was 16.9%, 29.5% and 53.6% respectively. Following application of cross-validated machine learning approach, the observed sensitivity and specificity were 0.92 (95% CI: 0.91-0.93) and 0.96 (95% CI: 0.95-0.96) respectively. Conclusions This study demonstrates for the first time the efficacy of a contact-free optical device for detecting atrial fibrillation.

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Acceleration of opportunistic atrial fibrillation screening for elderly patients in routine primary care

PLoS ONE ◽

10.1371/journal.pone.0244240 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244240

Author(s):

Akifumi Suzuki ◽

Tomonori Okamura ◽

Masahiro Sasaki ◽

Hitoshi Matsuoka ◽

Yoshinobu Ikeda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Ischemic Stroke ◽

Anticoagulation Therapy ◽

Care Practice ◽

Newly Diagnosed ◽

Clinical Value ◽

Risk Patients ◽

History Of ◽

First Time

Cardio-embolic ischemic stroke caused by atrial fibrillation is more severe compared with other types of stroke, such as lacunar infarction and atherothrombotic infarction in patients without atrial fibrillation. Therefore, it is important to prevent cardio-embolic ischemic stroke by detecting atrial fibrillation early in at-risk patients and administering appropriate anticoagulation therapy. This prospective observational study aimed to evaluate the effectiveness of opportunistic atrial fibrillation screening at 12 primary clinics in Japan. The study included a 12-month pre-campaign period and a 12-month campaign period. During the campaign period, an awareness campaign was conducted to encourage physicians to be mindful of screening patients aged ≥65 years for atrial fibrillation by checking their pulses and performing subsequent electrocardiography when an irregular pulse was detected. The primary outcome was the proportion of patients with newly diagnosed atrial fibrillation. A sub-analysis focusing on first-time outpatients was performed. There were 9921 and 10,282 patients with no history of atrial fibrillation in the pre-campaign and campaign periods, respectively. In the whole population, the proportion of patients with newly diagnosed atrial fibrillation was 0.9% throughout the pre-campaign and campaign periods. In the sub-analysis limited to first-time outpatients, the detection proportion increased from 1.6% to 1.9% during the campaign period. In terms of age stratification, a large increase in detection was observed, especially among patients aged 65–74 years (detection increased from 0.9% to 1.5%) and ≥85 years (detection increased from 2.9% to 3.3%) during the campaign period. Our findings suggest the feasibility of opportunistic atrial fibrillation screening in routine primary care practice in Japan. Of note, our findings suggest that opportunistic atrial fibrillation screening targeting first-time outpatients may be of clinical value.

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Variation in VKORC1 Is Associated with Vascular Dementia

Journal of Alzheimer s Disease ◽

10.3233/jad-201256 ◽

2021 ◽

Vol 80 (3) ◽

pp. 1329-1337

Author(s):

Jure Mur ◽

Daniel L. McCartney ◽

Daniel I. Chasman ◽

Peter M. Visscher ◽

Graciela Muniz-Terrera ◽

...

Keyword(s):

Atrial Fibrillation ◽

Vascular Dementia ◽

Genetic Variant ◽

Warfarin Dose ◽

Uk Biobank ◽

Parental History ◽

Genome Wide ◽

History Of ◽

First Time ◽

The Relationship

Background: The genetic variant rs9923231 (VKORC1) is associated with differences in the coagulation of blood and consequentially with sensitivity to the drug warfarin. Variation in VKORC1 has been linked in a gene-based test to dementia/Alzheimer’s disease in the parents of participants, with suggestive evidence for an association for rs9923231 (p = 1.8×10–7), which was included in the genome-wide significant KAT8 locus. Objective: Our study aimed to investigate whether the relationship between rs9923231 and dementia persists only for certain dementia sub-types, and if those taking warfarin are at greater risk. Methods: We used logistic regression and data from 238,195 participants from UK Biobank to examine the relationship between VKORC1, risk of dementia, and the interplay with warfarin use. Results: Parental history of dementia, APOE variant, atrial fibrillation, diabetes, hypertension, and hypercholesterolemia all had strong associations with vascular dementia (p < 4.6×10–6). The T-allele in rs9923231 was linked to a lower warfarin dose (βperT - allele = –0.29, p < 2×10–16) and risk of vascular dementia (OR = 1.17, p = 0.010), but not other dementia sub-types. However, the risk of vascular dementia was not affected by warfarin use in carriers of the T-allele. Conclusion: Our study reports for the first time an association between rs9923231 and vascular dementia, but further research is warranted to explore potential mechanisms and specify the relationship between rs9923231 and features of vascular dementia.

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Stroke Prevention in Atrial Fibrillation: Where are We Now?

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s8976 ◽

2012 ◽

Vol 6 ◽

pp. CMC.S8976 ◽

Cited By ~ 6

Author(s):

Yousif Ahmad ◽

Gregory Y.H. Lip

Keyword(s):

Atrial Fibrillation ◽

Stroke Prevention ◽

Management Strategies ◽

Bleeding Risk ◽

Long Term Study ◽

Risk Patients ◽

First Time ◽

Major Progress ◽

Made In

Atrial fibrillation is the commonest arrhythmia worldwide and is a growing problem. AF is responsible for 25% of all strokes, and these patients suffer greater mortality and disability. Warfarin has traditionally been the only successful therapy for stroke prevention, but its limitations have resulted in underutilisation. Major progress has been made in AF research, leading to improved management strategies. Better risk stratification permits identification of truly low-risk patients who do not require anticoagulation and we are able to simplify ourevaluation of a patient's bleeding risk. The advent of novel anticoagulants means warfarin is no longer the only choice for stroke prophylaxis. These drugs circumvent many of warfarin's inconveniences, but only long-term study and use will conclusively demonstrate how they compare to warfarin. The landscape of stroke prevention in AF has changed with effective alternatives to warfarin available for the first time in 60 years—but each new option brings new considerations.

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Graves’ Hyperthyroidism-Induced Psychosis Treated With Aripiprazole—A Case Report

Journal of Pharmacy Practice ◽

10.1177/0897190012451934 ◽

2012 ◽

Vol 26 (1) ◽

pp. 59-61 ◽

Cited By ~ 4

Author(s):

Livia R. Macedo ◽

Jehan Marino ◽

Brady Bradshaw ◽

Joseph Henry

Keyword(s):

Atrial Fibrillation ◽

Psychiatric Symptoms ◽

Thyroid Stimulating Hormone ◽

Graves Disease ◽

Long Term Effects ◽

Free T4 ◽

History Of ◽

Antithyroid Peroxidase Antibody ◽

First Time

Graves’ disease is an autoimmune syndrome with symptoms such as tachycardia, atrial fibrillation, and psychiatric symptoms. Limited evidence exists for the treatment of Graves’ hyperthyroidism-induced psychosis with atypical antipsychotics. A 47-year-old female with a psychiatric history of bipolar disorder presented for the first time to the psychiatric hospital. She was agitated and grossly psychotic with delusions. Electrocardiogram showed atrial fibrillation and tachycardia. Drug screen urinalysis was negative. Endocrine workup resulted in a diagnosis of Graves’ disease (thyroid-stimulating hormone [TSH]: 0.005 μIU/mL, triiodothyronine [T3]: 537 ng/dL, thyroxine [T4]: 24 mcg/dL, free T4: 4.5 ng/dL, positive antithyroid peroxidase antibody, and antinuclear antibody). Aripiprazole 10 mg daily was initiated and titrated to 15 mg daily on day 4. On day 16, her suspicious behavior, judgment, and insight improved. Other medications given included aspirin 325 mg daily, metoprolol 25 mg twice daily, titrated to 12.5 mg twice daily, and methimazole 30 mg daily, titrated to 20 mg twice daily, and discontinued on day 29. The patient received radioiodine I-131 treatment 1 week later. We report the first known case on the use of aripriprazole to treat Graves’ hyperthyroidism-induced psychosis. Further studies examining the long-term effects and appropriate dose and duration of aripiprazole in this patient population are needed.

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12-Month Single-Procedure Outcomes after Atrial Fibrillation Catheter Ablation in Phramongkutklao Hospital: A Single Center 10-Year Experience

Siriraj Medical Journal ◽

10.33192/smj.2021.16 ◽

2021 ◽

Vol 72 (2) ◽

pp. 114-120

Author(s):

Sarawuth Limprasert

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Posterior Wall ◽

Efficacy And Safety ◽

Related Complication ◽

Single Procedure ◽

History Of ◽

Artery Disease ◽

Ischemic Attack ◽

First Time

Objective: This study aimed to report the efficacy and safety of 1-year outcome for single-procedure radiofrequency catheter ablation (RFCA) at Phramongkutklao Hospital. Methods: Review of medical records was carried out on consecutive patients with symptomatic atrial fibrillation (AF) who had undergone first-time RFCA in Phramongkutklao Hospital between January 2009 and December 2018. The efficacy and safety of outcomes after 1 year of RFCA were collected, analyzed, and validated using descriptive data. Results: 61 patients underwent RFCA for the first time. 77.05% were male, with a mean age of 58.31 ± 10.83 years. Paroxysmal AF presented in 65.57%. 49.18% had hypertension, 9.84% had a history of ischemic stroke or transient ischemic attack, 6.56% had diabetes, 6.56% had coronary artery disease, and 4.92% had heart failure. 96.72% of RFCA procedures were performed under local anesthesia and conscious sedation. Pulmonary vein isolation was performed in all patients. Roofline, mitral isthmus line, and posterior wall isolation were created in 27.87%, 13.11%, and 3.28%, respectively. Additional complex fractionated atrial electrograms (CFAEs) were targeted in 19.67%. After 12 months, 45.45% remained in sinus rhythm, with only one patient experiencing a procedure-related complication with cardiac tamponade. Conclusion: The 1-year results of single-procedure RFCA for treating AF at our center, while not highly successful in our first decade, were comparable to other series. Notably, there was a relatively low rate of complications.

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Phencyclidine Induced Oculogyric Crisis Responding Well to Conventional Treatment

Case Reports in Emergency Medicine ◽

10.1155/2015/506301 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Hassan Tahir ◽

Vistasp Daruwalla

Keyword(s):

Illicit Drugs ◽

Urine Drug Screen ◽

Oculogyric Crisis ◽

Common Causes ◽

Urine Drug ◽

Risk Patients ◽

History Of ◽

Illicit Drug Abuse ◽

First Time ◽

Upward Deviation

Background. Oculogyric crisis is a form of acute dystonic reaction characterized by involuntary upward deviation of eye ball. Its causes are broad with antipsychotics and antiemetics as the most common causes.Case Presentation. A 25-year-old man with the past medical history of marijuana use presented to ED with involuntary upward deviation of eye 1 day after using phencyclidine (PCP) for the first time. He did not have any other symptoms and was hemodynamically stable. All laboratory investigations were normal except urine drug screen which was positive for PCP. Patient was treated with IV diphenhydramine which improved his symptoms.Conclusion. Illicit drug abuse is a growing problem in our society with increasingly more patients presenting to ED with its complications. The differential diagnosis of acute dystonic reactions should be extended to include illicit drugs as the potential cause of reversible acute dystonias especially in high risk patients.

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Abstract 2648: Transient Atrial Fibrillation Within the First Month After Dual Chamber Pacemaker Implantation

Circulation ◽

10.1161/circ.116.suppl_16.ii_586-d ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Suneet Mittal ◽

Kenneth Stein ◽

Shelly A Christman ◽

Stacia Merkel ◽

Timothy E Meyer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Time Course ◽

De Novo ◽

Pacemaker Implantation ◽

High Rate ◽

Prior History ◽

Dual Chamber ◽

Long Term Follow Up ◽

History Of ◽

First Time

Background: Following pacemaker (PPM) implant, atrial fibrillation (AF) is often diagnosed for the first time based on detection of stored atrial high rate episodes (AHRE). However, there are no prospective data regarding the time course of developing AF following dual chamber PPM implantation. Methods: We evaluated data from the Silent Atrial Fibrillation Detection with Stored EGMs (SAFE) registry, which was a multi-center, prospective registry of patients undergoing dual chamber PPM implant. No patient had prior history of AF . Device interrogations were performed at 2-week, 3-, 6-, and 12-months post-implantation. An AHRE was defined as an atrial rate ≥ 180 bpm lasting ≥ 5 minutes. Results: 1488 patients (55% male, 74 ± 12 years) underwent PPM implantation. During the first month, 47 (3.7%) patients were diagnosed with AF for the first time. In 33 (70%) of these 47 patients, AF lasted between 5 and 60 minutes. Overall, the mean duration of AF was 133 ± 276 minutes (range: 5.4 minutes – 22.9 hours). A majority (81%) of these early episodes occurred within the first 15 days of implant. Twenty-four (51%) of these 47 patients did not have AF beyond this first month. Patients who did and did not have AF beyond the first month were similar with respect to baseline demographics, the use of active versus passive atrial leads, duration of first AF event, and time to first AF episode (Table ). Conclusions: In the SAFE registry, nearly 4% of patients with no history of AF exhibited AF in the first 30 days after PPM implant, with a majority occurring within the first 15 days post-implant. However, half of these patients failed to have another AHRE after the first month. These ``transient” episodes of AF may represent proarrhythmia from atrial lead insertion, de novo AF, or simply first-detection AF that was previously silent. Long-term follow-up studies are needed to determine the clinical significance of these transient episodes. SAFE: Demographics Among Patients with AF within 30 Days of Implant

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Abstract MP13: Polygenic Susceptibility to Atrial Fibrillation is Associated With Silent Cerebrovascular Disease in Stroke-Free Persons Without Atrial Fibrillation

Stroke ◽

10.1161/str.52.suppl_1.mp13 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Cameron Both ◽

Julian Acosta ◽

Natalia Szejko ◽

Kevin N Vanent ◽

Audrey C Leasure ◽

...

Keyword(s):

Atrial Fibrillation ◽

White Matter ◽

Cerebrovascular Disease ◽

Genetic Risk ◽

Community Dwelling ◽

Uk Biobank ◽

High Genetic Risk ◽

History Of ◽

The Uk ◽

Study Participants

Introduction: Clinically silent cerebrovascular disease is present in 40% of persons over the age of 60. We hypothesize that polygenic susceptibility to atrial fibrillation is associated with the burden of white matter disease in persons without atrial fibrillation or history of ischemic stroke. Methods: We conducted a nested genetic and neuroimaging study within the UK Biobank, a large cohort study that enrolled community dwelling Britons aged 40 to 65 at recruitment. We used data on a subcohort of patients evaluated with brain MRIs. The volume of white matter hyperintensities (WMH) was estimated using the BIANCA lesion segmentation tool. Genomic data was ascertained via genotyping with the Affymetrix UK Biobank Axiom array followed by imputation with 1000 Genomes reference panels. To model the polygenic susceptibility to atrial fibrillation (AFIB), we constructed a polygenic risk score (PRS) using 957 independent genetic risk variants known to significantly associate with atrial fibrillation. We used logistic and linear regression to test for association between the PRS and WMH. Results: A total of 38,914 study participants underwent brain MRI imaging in the UK Biobank. Of these, we excluded 124 (0.3%) with a history of stroke and 926 (2.4%) with AFIB. 37,864 study participants were included in this study, of which 19,059 (50.3%) had WMH. High genetic risk of AFIB was not associated with no-versus-any WMH (p=0.51). When evaluating persons with WMH lesions, high genetic risk of AFIB was associated with higher WMH volume (per 1 SD increase of the PRS, beta 0.019, SE 0.006; p=0.01). Gender was an important effect modifier of this association (interaction p=0.03): while high genetic risk of AFIB was associated with a significant increase in WMH volume in females (per 1 SD increase of the PRS, beta 0.03, SE 0.008; p<0.001), no association was found for males (p=0.99). Conclusions: Polygenic susceptibility to atrial fibrillation is associated with more severe silent cerebrovascular disease in persons without atrial fibrillation. Further research should evaluate whether this genetic information can be used to identify persons for tailored diagnostic or therapeutic interventions.

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P2845Recurrent atrial flutter and incidence of atrial fibrillation ablation after first-time ablation for typical atrial flutter: a nation-wide Danish cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.1155 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Giehm-Reese ◽

M B Kronborg ◽

P Lukac ◽

S B Kristiansen ◽

J M Nielsen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Atrial Flutter ◽

Cox Regression Analysis ◽

Af Ablation ◽

Typical Atrial Flutter ◽

Procedural Time ◽

History Of ◽

First Time

Abstract Introduction Cavo tricuspid isthmus ablation (CTIA) is an effective first-line treatment for typical atrial flutter (AFL). However, many patients develop atrial fibrillation (AF) after successful CTIA. Knowledge about recurrent arrhythmia after CTIA mainly comes from small cohort studies with limited follow-up. Purpose To describe incidences of AFL re-ablation and AF-ablation after first-time CTIA in a nation-wide cohort. Method In the Danish National Ablation Registry we identified patients undergoing first-time CTIA during 2010–2016. Subsequent CTIA and AF-ablation procedures were identified until March 1st, 2018. We gathered information on patient comorbidities in the Danish National Patient Registry. Results We identified 2409 patients undergoing first-time CTIA. Median age was 66 (IQR 58–72) years, and 1952 (81%) were men. 78 (3%) had a history of AF. Acute procedural succes was achieved in 2288 (95%) patients. During mean follow-up of 4±1.7 years, 242 (10%) patients underwent CTI re-ablation and 326 (13.5%) ablation for AF. Baseline characteristics associated with CTI re-ablation included prolonged procedural time, unsuccessful first CTIA, age<75 years and CHA2DS2-VASc score<2. Hypertension, history of AF, age<65 years and CHA2DS2-VASc score<2 were associated with later AF-ablation (Table). Predictive characteristics Characteristics associated with CTI re-ablation HR 95% CI p-value Procedural time 1.003 (1.001–1.006) 0.01 Unsuccesful first CTIA procedure 3.42 (2.10–5.55) <0.0001 Age <75 years 1.52 (1.03–2.26) 0.04 CHA2DS-VAS2c score <2 1.45 (1.11–1.90) 0.01 Characteristics associated with later AF-ablation Hypertension 1.31 (1.02–1.69) 0.04 History of AF 1.70 (1.07–2.71) 0.03 Age <65 years 2.38 (1.89–3.01) <0.0001 CHA2DS-VAS2c score <2 1.77 (1.40–2.45) <0.0001 AF: Atrial fibrillation; HR: Hazard ratio. All HR's are adjusted for age, gender, hypertension, diabetes, heart failure, iscemic heart disease, valvular heart disease, chronic obstructive lung disease, chronic kidney disease and history of AF using Cox regression analysis. Conclusion In a nation-wide cohort undergoing CTIA for AFL, 10% of patients underwent CTI re-ablation and 13.5% were ablated for AF during mean follow-up of 4±1.7 years. Probability of undergoing a second ablation procedure was higher in younger patients with less comorbidity.

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Patient Perceptions of Osteoporosis Treatment Thresholds

The Journal of Rheumatology ◽

10.3899/jrheum.130548 ◽

2014 ◽

Vol 41 (3) ◽

pp. 516-522 ◽

Cited By ~ 9

Author(s):

Joan M. Neuner ◽

Marilyn M. Schapira

Keyword(s):

Perceived Risk ◽

Treatment Guidelines ◽

Osteoporosis Treatment ◽

Treatment Side Effects ◽

Risk Patients ◽

History Of ◽

Risk Thresholds ◽

Current Guidelines ◽

Treatment Risks ◽

Fracture Risks

Objective.Many older patients express concerns about medication risks, and have higher risk thresholds than physicians for cardiovascular preventive medications. We hypothesized that patients have relatively high risk thresholds for fracture preventive medications.Methods.Women ≥ 60 years old were recruited from 3 primary care internal medicine clinics in Wisconsin. Participants were provided information regarding fracture risks and treatment risks and benefits, followed by a series of vignettes depicting a 70-year-old woman at baseline fracture risks between 5–50%. Fracture risks were shown graphically and treatment side effects were provided for each vignette, and participants were asked to respond regarding whether they would accept treatment. The association of vignette treatment acceptance with participant beliefs regarding medication risks was examined in analyses adjusted for perceived risk of medications, patient numeracy, and prior respondent experience with osteoporosis.Results.The mean age of women in the cohort was 69.4 years (SD 7.29). Ninety-one percent were non-Hispanic whites, 34% reported a history of fracture, and 20.3% a history of osteoporosis. Subjects varied substantially in their responses to vignettes, but only 51% reported they would accept prescription osteoporosis treatment at the threshold currently recommended by national physician treatment guidelines, and fewer would accept treatment at lower risks. Belief that medications are generally not worth their risks was associated with lower acceptance of treatment at all levels of fracture risk.Conclusion.There is substantial variability in preferences for postmenopausal osteoporosis treatment. Presentation of individualized fracture risks as recommended by current guidelines has potential to allow better targeting to higher-risk patients, but further work is needed regarding how to present this information and counsel patients.

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