Prevalence of previous history of atrial fibrillation in patients referred for ablation of atrial flutter

Objectives: Atrial fibrillation (AF) is linked to an increased risk of stroke and dementia. Atrial flutter (AFL) is also linked to an increased risk of stroke but at a different level of risk as compared to AF. Little is known about the difference in the risk of dementia between AF and AFL. This study aims to investigate whether the risk of dementia is different between AF and AFL.Methods: Patients with newly diagnosed AF and AFL during 2001–2013 were retrieved from Taiwan's National Health Insurance Research Database. Patients with incomplete demographic data, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. The incidence of new-onset dementia was set as the primary outcome and analyzed in patients with AF and AFL after propensity score matching (PSM).Results: A total of 232,425 and 7,569 patients with AF and AFL, respectively, were eligible for analysis. After 4:1 PSM, we included 30,276 and 7,569 patients with AF and AFL, respectively, for analysis. Additionally, patients with AF (n = 29,187) and AFL (n = 451) who received oral anticoagulants were enrolled for comparison. The risk of dementia was higher in patients with AF compared with patients with AFL (subdistribution hazard ratio (SHR) = 1.52, 95% CI 1.39–1.66; p < 0.0001) before PSM and remained higher in patients with AF (SHR = 1.14, 95% CI 1.04–1.25; p = 0.0064) after PSM. The risk of dementia was higher in patients with AF without previous history of stroke after PSM but the risk did not differ between patients with AF and AFL with previous history of stroke. Among patients who received oral anticoagulants, the cumulative incidences of dementia were significantly higher in patients with AF than in patients with AFL before and after PSM (all P < 0.05).Conclusions: This study found that, among patients without history of stroke, the risk of dementia was higher in patients with AF than in patients with AFL, and CHA2DS2-VASc score might be useful for risk stratification of dementia between patients with AF and AFL.

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766 Detection of atrial flutter in pacemaker patients with a history of atrial fibrillation: incidence and clinical relevance

EP Europace ◽

10.1016/s1099-5129(05)80510-0 ◽

2005 ◽

Vol 7 ◽

pp. 173-173

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Clinical Relevance ◽

History Of

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Cardiac Arrhythmia Caused by a Kirschner Wire inside the Heart

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80412-3 ◽

1997 ◽

Vol 22 (3) ◽

pp. 402-404 ◽

Cited By ~ 29

Author(s):

T. A. T. HAAPANIEMI ◽

U. S. HERMANSSON

Keyword(s):

Atrial Fibrillation ◽

Thoracic Surgery ◽

Cardiac Disease ◽

Kirschner Wire ◽

Previous History ◽

Kirschner Wires ◽

Left Hand ◽

Plain Chest ◽

History Of ◽

The Right

A 45-year-old woman with no previous history of cardiac disease woke up one morning with an irregular heartbeat and fatigue. An electrocardiogram showed atrial fibrillation and plain chest radiographs revealed the presence of a metallic pin at the position of the heart. A 24 mm-long metallic pin was removed by open thoracic surgery from within the right ventricle of the heart. Postoperative examination of the pin showed it to be one of the 0.8 mm Kirschner wires that had been used for finger osteosynthesis in her left hand 31 months previously.

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Abstract TP138: Chronic Kidney Disease in Heart Failure Patients is Associated with Increased Prevalence of Atrial Fibrillation or Atrial Flutter as well as CVA/TIA

Stroke ◽

10.1161/str.51.suppl_1.tp138 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Christopher Lu ◽

Jack Chan ◽

Zejia Yu ◽

Paula Anzenberg ◽

Mikhail Torosoff

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Risk Assessment ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Atrial Flutter ◽

Stroke Risk ◽

Multivariate Logistic Regression Analysis ◽

History Of ◽

Get With The Guidelines

Background: The CHADS-VASC score does not incorporate renal dysfunction in stroke risk assessment in patients with atrial fibrillation and the prevalence of atrial fibrillation, atrial flutter, and cerebrovascular accidents (CVA) in patients with concurrent CHF and CKD is not well investigated. Objective: Evaluate the prevalence of history of stroke, atrial fibrillation, atrial flutter in patients with CHF and CKD. Methods: Data from the single institution Get With The Guidelines- Heart Failure (GWG-HF) cohort of 2938 consecutive inpatients with known GFR was utilized. CHADS-VASC score was calculated from the GWG-HF variables. Chronic kidney disease (CKD) was defined as GFR <60 ml/min. Results: An overwhelming majority (95%) of GWG-HF patients had elevated >1 CHADS-VASC score, which was also significantly more common in patients with CKD (97.6% vs. 91.7% in patients without CKD, p<0.0001). Average CHADS-VASC score was also significantly increased in patients with CKD (4+/-1.3 vs. 3.3+/-1.4, p<0.0001). Furthermore, CKD was associated with increased prevalence of atrial fibrillation and/or flutter (45.6% vs. 35.3%, p<0.0001) and stroke history (17.5% vs. 12.3%, p=0.002). When stroke and TIA histories were removed from the CHADS-VASC score ("CHAD-VASC score"), the remaining variables were strongly predictive of stroke or TIA (14.2% vs. 3.8%, p<0.0001). In multivariate logistic regression analysis, both CHAD-VASC score (OR 2.6, 95%CI 1.3-5.4, p=0.009) and CKD (OR 1.5, 95%CI 1.2-1.8, p=0.001) were associated significantly increased odds of prior stroke or TIA. Conclusions: In patients admitted with heart failure, CKD is associated with increased prevalence of atrial fibrillation or atrial flutter as well as increased prevalence of CVA/TIA. Further prospective studies are warranted to examine whether CKD history should be included in stroke risk assessment in patients with atrial fibrillation or atrial flutter, in conjunction with existing risk assessment frameworks.

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Abstract 240: Assessing the Lack of Appropriate Anticoagulation in Patients With Atrial Fibrillation - Implications for Cardiology Registry-Based Care

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.240 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Danielle Daly ◽

Jennifer Searl Como ◽

Jason H Wasfy

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Administrative Data ◽

Persistent Atrial Fibrillation ◽

Chronic Atrial Fibrillation ◽

Administrative Claims ◽

Quality Problem ◽

History Of ◽

Problem Lists ◽

Lost To Follow Up

Intro: Anticoagulation is indicated for many patients with atrial fibrillation (AF) for prevention of cardioembolic stroke, although national proportions of eligible patients receiving anticoagulation remain suboptimal. Automated and semi-automated quality improvement techniques including registries and population health coordinators may help identify and increase eligible patients to receive anticoagulation. Methods: We queried our electronic health record to identify patients without anticoagulation but with atrial fibrillation (as identified as either paroxysmal atrial fibrillation, persistent atrial fibrillation, chronic atrial fibrillation, typical atrial flutter, atypical atrial flutter, or unspecified atrial flutter) either on the problem list or as billed administrative claims between September 2016 - September 2019 in MGH outpatient cardiology clinics. All patients were participating in MGH cardiology, with their primary care based either within MGH or outside of MGH. Then, we conducted detailed chart review to calculate thromboembolic risk with respective CHADS-VASC score and confirmed that the patient was not receiving anticoagulation. A typology was developed as charts were reviewed to categorize reasons for lacking anticoagulation. These categories were grouped into broader categories representing a (1) potential quality problem or (2) appropriate lack of anticoagulation. Results: Of 100 patients, 59 were deemed to have a potential quality problem and 41 were deemed to have appropriate lack of anticoagulation. Of the patients with a potential quality problem, 11 have a CHADS VASC score of 1, 18 have a CHADS VASC score of 2, 6 have a CHADS VASC score of 3, 10 have a CHADS VASC score of 4, and 8 have a CHADS of 5, and 6 have a CHADS VASC of 6 or above. Additionally, 3 patients have been lost to follow up, 12 patients had presented with current symptoms of AF within the last year, and 44 patients exhibited acute history of AF symptoms. 41 patients did not present concern for multiple reasons including: CHADS VASC=0, deceased, patients declined medication, followed by outside cardiologist, technology and medication discrepancies, inaccurate administrative data for AF, and prior major bleeding. Conclusions: We found that most un-anticoagulated AF patients identified by administrative claims and EHR problem lists are likely eligible for anticoagulation. Of those, most have a history of paroxysmal AF. As such, registry-based strategies based on queries of past AF may improve rates of anticoagulation in this population. Since automated queries still detect many patients with contraindications such as bleeding or inaccurate administrative data, manual review of administrative queries is likely to be important in quality efforts for AF.

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1203Typical atrial flutter is a manifestation of previously silent coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz748.0033 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Iden ◽

S Groschke ◽

R Weinert ◽

R Toelg ◽

G Richardt ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Family History ◽

Atrial Flutter ◽

Smoking Status ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Typical Atrial Flutter ◽

Silent Coronary Artery Disease ◽

History Of

Abstract Background Long-term mortality after ablation of typical atrial flutter has been found to be increased two fold in comparison to atrial fibrillation ablations through a period of five years with unclear mechanism. Methods We analysed 189 consecutive patients who underwent ablation for typical atrial flutter (AFL), in which the incidence of atrial flutter was the first manifestation of cardiac disease. According to clinical standards of our center, the routine recommendation was to evaluate for CAD by invasive angiogram or CT-scan. We compared the AFL patients to 141 patients with paroxysmal atrial fibrillation (AFIB) without known structural heart disease who underwent ablation in the same period and who had routine coronary angiograms performed. Results Out of 189 patients who presented with AFL, coronary status was available in 152 patients (80.4%). Both groups were balanced for mean age (64.9 years in AFL vs. 63.2 years in AFIB; p=0.15), body-mass-index (BMI; 28.8 vs. 28.5 kg/m2; p=0.15), CHA2DS2-VASc-Score (2.20 vs. 2.04; p=0.35), smoking status (22.2% smokers vs. 28.4%; p=0.23) and renal function (GFR >60 ml/min in 96.7% of all patients vs. 95.7%; p=0.76). There were significantly lower values for left-ventricular ejection fraction (52.5% vs. 59.7%; p<0.001), female sex (17.0% vs. 47.5%; p<0.001), hyperlipidemia (37.9% vs. 58.9%; p<0.001) and family history of cardiovascular disease (15.0 vs. 31.9%; p=0.001) in the AFL vs. AFIB cohorts. CAD with stenoses >50% was found in 26.3% of all patients with available coronary status in AFL and in 7.0% in AFIB (p<0.001). CAD with stenoses >75% in 16.4% in AFL whereas only in 1.4% in AFIB (p<0.001). Multivessel disease was detected in 10.5% in AFL and 0.7% in AFIB (p<0.001). After correction for age, LVEF, BMI, CHA2DS2-VASc-Score and it's individual components, smoking status, hyperlipidemia and family history of cardiovascular disease, there was a more than five-fold increase in the likelihood of CAD with stenosis >50% in AFL as compared to AFIB (OR 5.26). A multivariate analysis was performed in the AFL group. Patients with clinically relevant stenoses (>75%) were older (70.6 years vs. 63.8 years; p=0.001), had a higher number of risk factors (3.08 vs. 2.24; p≤0.0016) and a higher CHA2DS2-VASc-Score (3.20 vs 2.00; p<0.0001). With logistic regression, significant CAD could be predicted by higher values for CHA2DS2-VASc-Score with an exponential rise to a pretest-probability of 42.1% at a value of 4 points. Odds ratios of CAD with AFL vs AFIB Discussion This data suggests that typical atrial flutter constitutes a manifestation for previously asymptomatic CAD. Due to the inclusion criteria, CAD has to be considered silent and stable in most of the patients. Therefore, the presence of typical atrial flutter in formerly healthy patients should raise suspicion of otherwise silent CAD and initiate further investigations and risk-stratification with particular emphasis on the individual CHA2DS2-VASc-Scores.

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The results of atrial flutter ablation in patients with and without a history of atrial fibrillation

The American Journal of Cardiology ◽

10.1016/s0002-9149(96)00233-0 ◽

1996 ◽

Vol 78 (1) ◽

pp. 93-96 ◽

Cited By ~ 27

Author(s):

Colin Movsowitz ◽

David J. Callons ◽

David Schwartzman ◽

Charles Gottlieb ◽

Francis E. Marchlinski

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

History Of ◽

Atrial Flutter Ablation

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Antiplatelet Therapy for Preventing Stroke in Patients With Nonvalvular Atrial Fibrillation and No Previous History of Stroke or Transient Ischemic Attacks

Stroke ◽

10.1161/01.str.0000196914.02476.2c ◽

2006 ◽

Vol 37 (1) ◽

pp. 274-275 ◽

Cited By ~ 2

Author(s):

Maria I. Aguilar ◽

Robert G. Hart

Keyword(s):

Atrial Fibrillation ◽

Antiplatelet Therapy ◽

Previous History ◽

Transient Ischemic Attacks ◽

Nonvalvular Atrial Fibrillation ◽

History Of

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Atrial fibrillation in acute pulmonary embolism: prognostic considerations

Emergency Medicine Journal ◽

10.1136/emermed-2012-202089 ◽

2013 ◽

Vol 31 (4) ◽

pp. 308-312 ◽

Cited By ~ 21

Author(s):

Sérgio Nuno Craveiro Barra ◽

Luís Vilardouro Paiva ◽

Rui Providência ◽

Andreia Fernandes ◽

António Leitão Marques

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Previous History ◽

Mortality Prediction ◽

Prognostic Role ◽

Prediction Ability ◽

All Cause Mortality ◽

Increase Risk ◽

History Of ◽

Acute Pe

AimsAlthough it is accepted that atrial fibrillation (AF) may be both the contributing factor and the consequence of pulmonary embolism (PE), data on the prognostic role of AF in patients with acute venous thromboembolism are scarce. Our aim was to study whether AF had a prognostic role in patients with acute PE.MethodsRetrospective cohort study involving 270 patients admitted for acute PE. Collected data: past medical history, analytic/gasometric parameters, admission ECG and echocardiogram, thoracic CT angiography. Patients followed for 6 months. An analysis was performed in order to clarify whether history of AF, irrespective of its timing, helps predict intrahospital, 1-month and 6-month all-cause mortality.ResultsPatients with history of AF, irrespective of its timing (n=57, 21.4%), had higher intrahospital (22.8% vs 13.1%, p=0.052, OR 2.07, 95% CI 0.98 to 4.35), 1-month (35.1% vs 16.9%, p=0.001, OR 3.16, 95% CI 1.61 to 6.21) and 6-month (45.6% vs 17.4%, p<0.001, OR 4.67, 95% CI 2.37 to 9.21) death rates. The prognostic power of AF was independent of age, NT-proBNP values, renal function and admission blood pressure and heart rate and additive to mortality prediction ability of simplified PESI (AF: p=0.021, OR 2.31, CI 95% 1.13 to 4.69; simplified PESI: p=0.002, OR 1.47, CI 95% 1.15 to 1.89). The presence of AF at admission added prognostic value to previous history of AF in terms of 1-month and 6-month all-cause mortality prediction, although it did not increase risk for intrahospital mortality.ConclusionsThe presence of AF, irrespective of its timing, may independently predict mortality in patients with acute PE. These data should be tested and validated in prospective studies using larger cohorts.

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Different implication in dementia between patients with atrial flutter and atrial fibrillation: a national cohort study

EP Europace ◽

10.1093/europace/euab116.160 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

YL Chen

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Research Database ◽

Funding Sources ◽

Valvular Surgery ◽

Previous Stroke ◽

Included Patient ◽

National Cohort ◽

History Of ◽

The Difference

Abstract Funding Acknowledgements Type of funding sources: None. Importance Atrial fibrillation (AF) has been reported with increasing the risk of stroke and dementia. Atrial flutter (AFL) is also a risk of stroke with different discrepancies in clinical outcome. Little is known about the difference in the risk of dementia between AF and AFL. Objective To investigate if the risk of dementia is difference between AF and AFL. Methods The patients with newly diagnosed AF and AFL during 2001–2013 was retrieved from Taiwan’s National Health Insurance Research Database. Patients with missing information, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. Propensity score matching (PSM) between AF and AFL was performed, which included patient comorbidities, past medical history, medications, and index date stratified by age. Primary outcome was defined as dementia at follow-up. Results A total of 232,425 AF and 7,569 AFL were eligible for analysis. After 4:1 PSM, we included 30,276 AF (aged 67.3 ± 15.7 years) and 100,065 AFL (aged 67.4 ± 16.0 years) for analysis. The risk of dementia was higher in AF patients compared with AFL patients (subdistribution HR (SHR)=1.52, 95% CI 1.39 - 1.66; p <0.0001) before PSM and still higher in AF patients (SHR = 1.14, 95% CI 1.04 to 1.25; p = 0.0064). The risk was higher in AF patients without previous stroke after PSM and there was no difference between AF and AFL patients with previous stroke history. Conclusions and relevance Our finding supports that risk of dementia is higher in AF patients than AFL patients. However, the risk of dementia between patients with AF and AFL varies depending on whether there is a previous stroke history.

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