scholarly journals 444 Epidemiology of subclinical atrial fibrillation in patients with cardiac implantable electronic devices: a systematic review and meta-regression

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Marco Borgi ◽  
Marco Proietti ◽  
Giulio Francesco Romiti ◽  
Marco Vitolo ◽  
Arianna Di Rocco ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Regression Analysis ◽  
Electronic Devices ◽  
Older Age ◽  
Cardiac Implantable Electronic Devices ◽  
History Of ◽  
Meta Regression ◽  
Meta Regression Analysis

Abstract Aims In recent years, attention to subclinical atrial fibrillation (SCAF), defined as the presence of atrial high-rate episodes (AHREs), in patients with cardiac implantable electronic devices (CIEDs), has gained much interest as a determinant of clinical AF and stroke risk. To perform a systematic review and meta-regression of the available scientific evidence regarding the epidemiology of SCAF in patients receiving CIEDs. Methods and results PubMed and EMBASE were searched for all studies documenting the incidence of AHREs in patients (n = 100 or more) with CIEDs without any previous history of AF from inception to 20 August 2021, screened by two independent blind reviewers. This study was registered in PROSPERO: CRD42019106994. Among the 2614 results initially retrieved, 54 studies were included, with a total of 72 784 patients. Meta-analysis of included studies showed a pooled prevalence of SCAF of 28.1%, with an incidence rate (IR) of 16 new SCAF cases per 100 patient-years (I2 = 100%). Multivariate meta-regression analysis showed that age and follow-up time were the only significant determinants of IR, explaining a large part of the heterogeneity (R2 = 61.5%, P < 0.001), with higher IR at earlier follow-up and in older patients, decreasing over follow-up time and increasing according to mean age. Older age, higher CHA2DS2-VASc score, history of AF, hypertension, CHF, and stroke/TIA were all associated with SCAF occurrence. Conclusions In this systematic review and meta-regression analysis, IR of SCAF increased with age and decreased over longer follow-up times. SCAF was associated with older age, higher thromboembolic risk, and several cardiovascular comorbidities.

scholarly journals Epidemiology of subclinical atrial fibrillation in patients with cardiac implantable electronic devices: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G F Romiti ◽  
B Corica ◽  
M Borgi ◽  
M Vitolo ◽  
K Miyazawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
Electronic Devices ◽  
Incidence Rates ◽  
Cardiac Implantable Electronic Devices ◽  
Pooled Prevalence ◽  
Significant Difference ◽  
Meta Regression

Abstract Background Sub-clinical atrial fibrillation (SCAF) and atrial high-rate episodes (AHREs), seen as high-frequency atrial tachyarrhythmias in patients with cardiac implantable electronic devices (CIEDs), have gained prominence as determinants of clinical atrial fibrillation (AF) and increased stroke risk. As a result, several studies investigating their role in predicting the onset of AF and AHRE-related outcomes have been conducted but uncertainty exists on the epidemiology of AHRE. Purpose To estimate the incidence of SCAF, according to presence of AHREs in patients with CIEDs, through a systematic review and meta-analysis of the available literature. Methods PubMed and EMBASE were searched from inception to 27th January 2021 for all studies documenting the incidence of AHREs in patients with CIEDs. We included all studies with ≥100 patients reporting data on AHREs incidence. Pooled prevalence and incidence rates were computed; we also performed meta-regressions for pooled incidence rates, according to relevant study-level characteristics. This study was registered in PROSPERO: CRD42019106994. Results Among the 2,515 results retrieved, we included 51 studies in the systematic review and meta-analysis, with a total of 68,414 patients. Meta-analysis of included studies showed a pooled prevalence of 28.2% (95% CI: 24.3–32.5%, I2=99%), with a pooled incidence rate (IR) of 15 new AHRE cases per 100 patient-years (95% CI: 12–19, I2=100%). Given the large heterogeneity showed in the pooled estimates we performed additional analyses. Regarding pooled prevalence, we performed several subgroup analyses, according to various studies baseline characteristics, which did not show any significant difference in any of the subgroups examined. Regarding IR, a multivariable meta-regression analysis showed that decreasing follow-up time and increasing age were the only factors significantly associated with AHRE incidence, explaining a large proportion of heterogeneity (R2=68%, p<0.001; Figure 1, Panel A and B respectively). Accordingly, the AHRE IR was highest at 1 year follow-up and in the oldest subjects. Presence of SCAF was significantly associated with older age, higher CHA2DS2-VASc score, and higher prevalence of hypertension, heart failure and history of cerebrovascular disease. Conclusions This systematic review and meta-regression demonstrated that SCAF is very common in patients with CIEDs, with an overall IR for AHREs of up to 15 per 100 patient-years; increasing with age and decreasing with longer follow-up time. Presence of SCAF was associated with an overall higher clinical risk profile compared to those subjects without SCAF. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Meta-regression for AHRE Incidence

scholarly journals Benefits and Harms of Low-Dose Rivaroxaban in Asian Patients With Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-World Studies

2021 ◽  
Vol 12 ◽  
Author(s):  
Jun Qian ◽  
Yi-Dan Yan ◽  
Sheng-Yan Yang ◽  
Chi Zhang ◽  
Wen-Yan Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Regression Analysis ◽  
Low Dose ◽  
Meta Analysis ◽  
Systemic Embolism ◽  
Asian Patients ◽  
Meta Regression ◽  
Meta Regression Analysis ◽  
Reduced Risk

Background: Low-dose prescription of rivaroxaban was common among patients with atrial fibrillation (AF) in Asia. However, the benefits and harms of rivaroxaban at a low dosage in Asian patients with AF remains unclear. Accordingly, we aimed to collect and summarize all available evidence to fill this important knowledge gap.Methods: In this systematic review and meta-analysis, we systematically searched databases of MEDLINE, EMBASE, and Cochrane Library for relevant studies from inception until February 23, 2021. Eligible retrospective nationwide or health insurance database studies or prospective registration studies that reported efficacy (stroke/systemic embolism), safety (major bleeding, intracranial hemorrhage, gastrointestinal bleeding), or other outcomes (myocardial infarction, death) of low-dose rivaroxaban in comparison with warfarin in AF patients were enrolled. Data extraction and study quality assessment were conducted by two authors independently. Low dosing of rivaroxaban (15/10 mg) was defined as the received dose lower than the recommended dose (20 mg) approved in most districts. Hazard ratio (HR) with 95% confidence intervals (95% CIs) was pooled using a random-effect model. Subgroup analyses were conducted according to different dose regimens. Sensitivity analyses were conducted by sequential elimination of each study from the pool. Since potential effect modifiers (patient demographics, differences of each study, and others) may lead to bias in primacy outcomes, we performed a meta-regression analysis to explore the influence of these factors on the primary efficacy and safety outcomes.Results: Totally, 12 studies involving 292,815 Asian patients with AF were included. All studies were detected as low to moderate risk bias. Low-dose rivaroxaban treatment in Asian AF patients was associated with a reduced risk of stroke/systemic embolism (HR: 0.76, 95% CI: 0.70–0.84, I2: 57.8%), major bleeding (HR: 0.72, 95% CI: 0.62–0.84, I2: 81.5%), and all-cause death (HR: 0.65, 95% CI: 0.58–0.73, I2: 81.7%) when compared with warfarin. Furthermore, consistent results were observed among different dose regimens (10/15/20 mg) in all the clinical outcomes (Pinteraction > 0.05 for each outcome). Meta-regression analysis failed to detect any potential confounding to impact the primacy outcomes.Conclusion: Insights from the present meta-analysis, we found that low-dose rivaroxaban, even at a dosage of 10 mg daily, was associated with a reduced risk of stroke/SE and bleeding than warfarin in Asian AF patients. However, owing to considerable heterogeneity among included studies, further prospective studies are required to confirm these findings.

scholarly journals Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

2016 ◽  
Vol 17 (2) ◽  
pp. 187-202 ◽  
Author(s):  
Stephen L. Reintjes ◽  
Ernest K. Amankwah ◽  
Luis F. Rodriguez ◽  
Carolyn C. Carey ◽  
Gerald F. Tuite
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Internal Fixation ◽  
Fusion Rate ◽  
Cervical Fusion ◽  
Bone Fusion ◽  
Fixation Techniques ◽  
Meta Regression ◽  
Meta Regression Analysis

OBJECT Fusion rates are high for children undergoing posterior cervical fusion (PCF) and occipito-cervical fusion (OCF). Autologous bone has been widely used as the graft material of choice, despite the risk of donor-site morbidity associated with harvesting the bone, possibly because very low fusion rates were reported with posterior allograft cervical fusions in children several decades ago. Higher overall fusion rates using allograft in adults, associated with improvements in internal fixation techniques and the availability of osteoinductive substances such as bone morphogenetic protein (BMP), have led to heightened enthusiasm for the use of bank bone during pediatric PCF. A systematic review was performed to study factors associated with successful bone fusion, including the type of bone graft used. METHODS The authors performed a comprehensive PubMed search of English-language articles pertaining to PCF and OCF in patients less than 18 years old. Of the 561 abstracts selected, 148 articles were reviewed, resulting in 60 articles that had sufficient detail to be included in the analysis. A meta-regression analysis was performed to determine if and how age, fusion technique, levels fused, fusion substrate, BMP use, postoperative bracing, and radiographic fusion criteria were related to the pooled prevalence estimates. A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS A total of 604 patients met the specific inclusion and exclusion criteria. The overall fusion rate was 93%, with a mean age of 9.3 years and mean follow-up of 38.7 months. A total of 539 patients had fusion with autograft (94% fusion rate) and 65 patients with allograft (80% fusion rate). Multivariate meta-regression analysis showed that higher fusion rates were associated with OCF compared with fusions that excluded the occiput (p < 0.001), with the use of autograft instead of allograft (p < 0.001), and with the use of CT to define fusion instead of plain radiography alone. The type of internal fixation, the use of BMP, patient age, and the duration of follow-up were not found to be associated with fusion rates in the multivariate analysis. CONCLUSIONS Fusion rates for PCF are high, with higher rates of fusion seen when autograft is used as the bone substrate and when the occiput is included in the fusion construct. Further study of the use of allograft as a viable alternative to autograft bone fusion is warranted because limited data are available regarding the use of allograft in combination with more rigid internal fixation techniques and osteoinductive substances, both of which may enhance fusion rates with allograft.

P1841Left cardiac sympathetic denervation in patients with long QT syndrome and catecholaminergic polymorphic ventricular tachychardia: a systematic review and meta-regression

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Lopez Ayala ◽  
A Sgro ◽  
T M Drake ◽  
K Phan
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Open Surgery ◽  
Cardiac Events ◽  
Long Qt ◽  
Meta Regression ◽  
Qt Syndrome ◽  
Meta Regression Analysis ◽  
Cardiac Sympathetic Denervation

Abstract Background The evidence of benefit and safety of open surgery or Video-Assisted Thoracoscopic Surgery (VATS) for Left Cardiac Sympathetic Denervation (LCSD), for the management of patients with refractory Long QT Syndrome (LQTS) and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), is not consistent. Purpose To undertake a systematic review and meta-regression to assess the current evidence for LCSD and to estimate the effects of the open surgery versus the VATS approach on outcomes following LCSD. Methods Databases (MEDLINE, EMBASE and Cochrane library) were searched without language or date restriction, from inception to December 2018, for studies reporting the long-term outcomes of LCSD in LQTS and CPVT patients. The number of patients experiencing cardiac events (CEs) before and after surgery, the change in QTc interval in milliseconds (ms), and the incidence of CEs and surgical complications after surgery were pooled to estimate the efficacy of LCSD in both LQTS and CPVT. A meta-regression analysis of outcomes based on the type of surgical approach (open vs VATS) was performed. Results Of 557 potentially relevant studies, 27 retrospective case series studies met our inclusion criteria, enrolling 647 patients (VATS, n=408 and Open, n=239). Average follow-up was 32 months. At the end of the follow-up period, 398/585 patients (68.0%) were free of CEs and QTc had decreased from 522±61.6 ms to 494±52.3 ms. Meta-regression analysis (14 studies, n=507) showed no differences between the two approaches in patients' responsiveness to surgery and the incidence of CEs or surgical complications. Open surgery had a statistically significant greater reduction in QTc duration than VATS (β −20.04, 95% CI −36.82 to −3.27, *p=0.019). Conclusions LCSD was associated with a reduction in the incidence of cardiac events in LQTS and CPVT patients and in the duration of QTc. Meta-regression analysis showed open surgery to be associated with a greater reduction in QTc. Higher evidence research studies are warranted to fully establish the safety and efficacy of LCSD. Acknowledgement/Funding None

scholarly journals Temporal trends in sperm count: a systematic review and meta-regression analysis

2017 ◽  
Vol 23 (6) ◽  
pp. 646-659 ◽  
Author(s):  
Hagai Levine ◽  
Niels Jørgensen ◽  
Anderson Martino-Andrade ◽  
Jaime Mendiola ◽  
Dan Weksler-Derri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Sperm Count ◽  
Temporal Trends ◽  
Meta Regression ◽  
Meta Regression Analysis
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