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

Circulation ◽  
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

P6545Pacing as new predictor for atrial high rate episodes in patients with dual-chamber pacemakers and no history of atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Benezet Mazuecos ◽  
A Devesa Arbiol ◽  
C S Garcia Talavera ◽  
J A Iglesias ◽  
E Serrano ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Events ◽  
Pacemaker Implantation ◽  
High Rate ◽  
Prior History ◽  
Dual Chamber ◽  
Cardiac Implantable Electronic Devices ◽  
History Of ◽  
Dual Chamber Pacemakers

Abstract Introduction Both atrial and ventricular pacing (AP/VP) have been related to a higher risk of clinical atrial fibrillation (AF) documented on ECG. Subclinical AF is detected as atrial high rate episodes (AHRE) by cardiac implantable electronic devices and is related to a higher risk of stroke. Purpose The aim of this study was to determine whether the percentage of AP and/or VP in patients with pacemakers and no history of AF is related with the future development of subclinical AF (AHRE) and/or clinical AF (ECG documented). Methods From February 2012 to September 2015 we recruited patients with dual chamber pacemakers and no prior history of AF. Patients were followed at 3 months and every year then after. Subclinical AF, clinical AF and cardiovascular events were registered. AHRE (subclinical AF) was defined as an episode of atrial rate ≥225 bpm with a minimum duration of 5 min. Clinical AF was defined as ECG documented AF. Percentage of AP/VP was determined as the mean AP/VP during the first three visits. Mortality and cardiovascular events (including AF, stroke and hospitalization for heart failure) were also recorded. Results 249 patients (57% men; 75±9 years-old) were included. Mean time from pacemaker implantation was 9 months and the main indication was AV-block in 53% of the patients. Mean CHA2DS2-VASc score was 3.5±1.5. After a mean follow-up of 33±11 months, 38.5% of patients developed subclinical AF and 10.4% clinical AF. Patients with AP≥50% presented significantly higher risk of AHRE (62.5% vs 32.3%, OR 3.48; 95% CI [1.93–6.4] p<0.01) and clinical AF (18.7% vs 8.6%, OR 2.4; 95% CI [1.05–5.52] p<0.05). Patients with VP≥50% presented significantly higher risk of AHRE (46.4% vs 31.6%, OR 1.87; 95% CI [1.10–3.24] p<0.05) and clinical AF (25.9% vs 9.7%, OR 2.7; 95% CI [1.13–7.72] p<0.05). The percentage of AP and VP were not related to a higher risk of cardiovascular events or mortality. Multivariate analysis showed that AP≥50% was an independent predictor for AHRE (OR 2.4; 95% CI [1.19–4.97] p=0.014). Conclusions Pacing is related to a higher risk for developing subclinical and clinical AF in patients with dual-chamber pacemakers and no history of previous AF. Our data suggest, that patients presenting a high percentage of AP and VP should be closely followed during routinely pacemaker check-ups assessing for subclinical AF, especially in those with AP ≥50%.

scholarly journals Atrial high‑rate episodes and risk of major adverse cardiovascular events in patients with dual chamber permanent pacemakers: a retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wei-Da Lu ◽  
Ju-Yi Chen
Keyword(s):  
Cardiovascular Events ◽  
Cox Regression ◽  
Pacemaker Implantation ◽  
Composite Endpoint ◽  
High Rate ◽  
Major Adverse Cardiovascular Events ◽  
Dual Chamber ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
History Of

AbstractPatients with atrial high-rate episodes (AHRE) are at higher risk of major adverse cardiovascular events (MACE). The cutoff threshold for AHRE duration for MACE, with/without history of atrial fibrillation (AF) or myocardial infarction (MI), is unknown. A total of 481 consecutive patients with/without history of AF or MI receiving dual-chamber pacemaker implantation were included. The primary outcome was a composite endpoint of MACE after AHRE ≥ 5 min, ≥ 6 h, and ≥ 24 h. AHRE was defined as > 175 bpm (MEDTRONIC) or > 200 bpm (BIOTRONIK) lasting ≥ 5 min. Cox regression analysis with time-dependent covariates was conducted. Patients’ mean age was 75.3 ± 10.7 years and 188 (39.1%) developed AHRE ≥ 5 min, 115 (23.9%) ≥ 6 h, and 83 (17.3%) ≥ 24 h. During follow-up (median 39.9 ± 29.8 months), 92 MACE occurred (IR 5.749%/year, 95% CI 3.88–5.85). AHRE ≥ 5 min (HR 5.252, 95% CI 2.575–10.715, P < 0.001) and ≥ 6 h (HR 2.548, 95% CI 1.284–5.058, P = 0.007) was independently associated with MACE, but not AHRE ≥ 24 h. Patients with history of MI (IR 17.80%/year) had higher MACE incidence than those without (IR 3.77%/year, p = 0.001). Significant differences were found between MACE patients with/without history of AF in AHRE ≥ 5 min but not AHRE ≥ 6 h or ≥ 24 h. Patients with dual-chamber pacemakers who develop AHRE have increased risk of MACE, particularly after history of AF or MI.

scholarly journals Sinus node dysfunction associates with atrial high-rate episodes after DDD pacemaker implantation

2019 ◽  
Author(s):  
Qi Xue ◽  
Hai Zou ◽  
Lihong Wang ◽  
Hong Shao ◽  
Yuan Ma
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Structural Heart Disease ◽  
Sinus Node Dysfunction ◽  
High Rate ◽  
Atrial Pacing ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Increased Risk

Abstract Background： Patients implanted with pacemakers frequently develop atrial fibrillation. Pacemaker-detected atrial high-rate episodes or AHREs, where one AHRE is defined as ≥ 160beats/min lasting ≥ 5 minutes, may identify patients at increased risk for stroke and death. In this study, we sought to observe whether patients with sinus node dysfunction or atria-ventricular block are more likely to develop AHREs. Methods: A total of 103 patients (age 69.4±13.5 years，58% female) with DDD/DDDR pacemakers were enrolled for the study. These pacemakers were equipped with features that enabled the detection and storage of information such as the dates, durations and sequential episodes of AHRE. Patients were followed up for 2 years and the time of the first occurrence of AHRE was determined at follow-up visit. Other data such as age, gender, structural heart disease, concomitant non-cardiac diseases, the cumulative percentage of atrial pacing (Cum% AP) and ventricular pacing (Cum% VP) were also collected. Results: Atrial fibrillation developed frequently after the dual-chamber pacemaker implantation. AHRE occurred more often in patients with sinus node disease (SND) than those with atrioventricular block (AVB) （OR, 2.553; 95%CI, 1.122-5.814；P=0.045）. Conclusions: AHRE developed frequently after dual-chamber pacemaker implantation. Patients with SND are more likely to develop AF compared to the patients with AVB.

Prevalence of device-detected atrial fibrillation and stroke in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Fumagalli ◽  
R Ruggieri ◽  
V De Filippo ◽  
F Cappelli ◽  
M Beltrami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
De Novo ◽  
Multivariable Analysis ◽  
Prior History ◽  
Thromboembolic Events ◽  
Cardiac Implantable Electronic Devices ◽  
History Of ◽  
Ischemic Attack

Abstract Introduction Atrial fibrillation (AF) is highly prevalent in patients with hypertrophic cardiomyopathy (HCM) and is associated with adverse outcome, impaired quality of life, loss of productivity, and the risk for embolic stroke. However, still today, the real burden of AF is unresolved due to the unknown frequency of silent asymptomatic episodes. Purpose To assess the prevalence of device-detected AF and stroke in patients with HCM implanted with cardiac implantable electronic devices (CIEDs) at our institution, a long-standing high flow referral center for cardiomyopathies. Methods Clinical and instrumental data of HCM patients implanted with CIEDs (either pacemakers [PM] or implantable cardioverter defibrillator [ICD]) from 1998 to 2019 were retrospectively reviewed. Inclusion criteria were site-designated diagnosis of HCM, age at diagnosis &gt;18 years, &gt;1 follow up visit, follow up &gt;1 year. HCM phenocopies (e.g. Fabry disease) were carefully excluded. Patients were divided into three categories according to presence of AF (“AF prior to CIED implantation” vs “AF after CIED implantation” vs “no arrhythmia detected”). Outcome was measured against prevalence of thromboembolic events (stroke or transient ischemic attack [TIA]) at follow up. All-cause and cardiovascular (CV) mortality were also assessed. Results A total of 255 patients received a CIED (57% men, mean age at implantation 54±17 years). Men were younger at implantation (52±17 vs 56±18 years, p=0.022). At baseline, AF was present in 90 (35.3%) patients. During 5.0±4.1 years, de novo AF was detected in 30 (11.8%) individuals, resulting in an annual incidence rate of 6.1%/year. Overall, 135 (52.9%) of patients remained is sinus rhythm. Stroke/TIAs were reported in 30 (11.8%) patients: 16 (53.3%) occurred in patients with prior history of AF, 3 (10%) in patients with de novo AF (with men being at higher risk, OR 3.73, 95% CI 1.88–6.09, p=0.041), and 11 (36.7%) in patients with no history of arrhythmias. Long term, 45 (17.6%) patients died (CV mortality N=38, 14.9%). At multivariable analysis, history of stroke was directly related to all-cause mortality irrespective of AF in men (OR 4.15, 95% CI 1.35–12.77, p=0.018) but not in women (OR 0.891, 95% CI 0.17–4.64, p=0.801). Conclusions In a large cohort of consecutive high risk HCM patients referred to CIED implantation, the incidence of de-novo AF was high. Thromboembolic events were associated to worse outcome only in men, likely due to competing heart failure related causes in women. Strategies promoting early identification of AF and anticoagulation may play an important role in management and prevention of disease-related complications. Prevalence of AF and Stroke Funding Acknowledgement Type of funding source: None

scholarly journals Variation in VKORC1 Is Associated with Vascular Dementia

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.

Predictors Factors of Onset de Novo Heart failure after STEMI

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Abouradi ◽  
H Choukrani ◽  
A Maaroufi ◽  
A Drighil ◽  
R Habbal
Keyword(s):  
Heart Failure ◽  
De Novo ◽  
Microvascular Disease ◽  
Prior History ◽  
Killip Class ◽  
Funding Sources ◽  
Significant Difference ◽  
Primary Coronary Angioplasty ◽  
History Of ◽  
Predictor Factors

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION STEMI gets complicated very often by a heart failure (HF), which it is important to know associated factors. The aim of this study  was to determinate the predictor factors of onset of de novo HF after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS A retrospective, descriptive study from 1 center in Morocco, including 210 patients hospitalized in a cardiology intensive care unit for STEMI from September 2019 to November 2020. The main outcomes were HF Killip class at hospital presentation and intra-hospital mortality. RESULTS The main age was 59.3 ± 7.02 and Sex ratio: 2, 86. The incidence of de novo HF at admission was higher in women (40, 4% vs. 29.5%, [OR 1, 61; 95%, [CI] 0, 83-3, 11). Forty-nine point eight percent were in Killip≥ 2. The method of early revascularization was Thrombolysis in 82, 3% compared to primary coronary angioplasty without significant difference in onset of the novo HF. There was no association of age, comorbidities, delay to hospital presentation and coronary involvement with incidence of onset of de novo HF.  Women had higher mortality than men with the novo HF (28, 6% vs. 20.5%; OR: 1, 55; 95%). CONCLUSION  Gender has appeared associated to onset of de novo HF after STEMI with a superiority of the female sex after controlling for others factors described in the literature. Anterior studies have related this to the increased prevalence of microvascular disease in women predisposing them to heart failure after STEMI.

Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Wesley T O’Neal ◽  
J’Neka Claxton ◽  
Richard MacLehose ◽  
Lin Chen ◽  
Lindsay G Bengtson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Cox Regression ◽  
Prior History ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Increased Risk ◽  
History Of ◽  
Reduced Risk ◽  
History Of Cancer

Background: Early cardiology involvement within 90 days of atrial fibrillation (AF) diagnosis is associated with greater likelihood of oral anticoagulant use and a reduced risk of stroke. Due to variation in cardiovascular care for patients with cancer, it is possible that a similar association does not exist for AF patients with cancer. Methods: We examined the association of early cardiology involvement with oral anticoagulation use among non-valvular AF patients with history of cancer (past or active), using data from 388,045 patients (mean age=68±15 years; 59% male) from the MarketScan database (2009-2014). ICD-9 codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill and Cox regression was used to estimate the risk of stroke and major bleeding. Results: A total of 64,016 (17%) AF patients had a prior history of cancer. Cardiology involvement was less likely to occur among patients with history of cancer than those without (relative risk=0.92, 95% confidence interval (0.91, 0.93)). Similar differences were observed for cancers of the colon (0.90 (0.88, 0.92)), lung (0.76 (0.74, 0.78)), pancreas (0.74 (0.69, 0.80)), and hematologic system (0.88 (0.87, 0.90)), while no differences were observed for breast or prostate cancers. Patients with cancer were less likely to fill prescriptions for anticoagulants (0.89 (0.88, 0.90)) than those without cancer, and similar results were observed for cancers of the colon, lung, prostate, pancreas, and hematologic system. However, patients with cancer were more likely to fill prescriptions for anticoagulants (1.48 (1.45, 1.52)) if seen by a cardiology provider, regardless of cancer type. A reduced risk of stroke (hazard ratio=0.89 (0.81, 0.99)) was observed among all cancer patients who were seen by a cardiology provider than among those who were not, without an increased risk of bleeding (1.04 (0.95, 1.13)). Conclusion: AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.

Abstract WP226: Short Lasting Runs (<30 sec) of Atrial Fibrillation are More Commonly Observed in Ischemic Stroke Patients in Comparison to Controls

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ethem Murat Arsava ◽  
Ezgi Yetim ◽  
Ugur Canpolat ◽  
Necla Ozer ◽  
Kudret Aytemir ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Multivariate Analyses ◽  
Holter Monitoring ◽  
Female Gender ◽  
Prior History ◽  
Consecutive Series ◽  
Stroke Patients ◽  
Cross Sectional ◽  
History Of

Background: The role of short-lasting (<30 sec) runs of atrial fibrillation (AF) in ischemic stroke pathophysiology is currently unknown. Although these non-sustained attacks are considered as a risk factor for future development of longer lasting, classical AF episodes, prior research has highlighted that associated clinical stroke features are not entirely similar between these two types of arrhythmias. In this study we determined the prevalence of short-lasting AF in stroke-free controls and compared it to a consecutive series of ischemic stroke patients. Methods: A total 235 controls, without any prior history stroke or AF, were evaluated with ECG and 24-hour Holter monitoring for the presence of <30-sec or ≥30-sec lasting AF episodes. The results were compared to a consecutive series of ischemic stroke patients without prior history of AF (n=456). Univariate and multivariate analyses were performed to determine demographic and cardiovascular factors related to <30-sec lasting AF and its association with ischemic stroke. Results: Expectedly, the frequency of newly diagnosed ≥30-sec lasting AF, detected either on ECG or Holter monitoring, was significantly higher in patients with ischemic stroke (18% vs. 2%; p<0.01). Non-sustained AF was positively related to old age (p<0.01), female gender (p=0.01) and hypertension (p<0.01) in univariate analyses. In multivariate analyses, after adjustment for demographic and cardiovascular risk factors, presence of non-sustained AF was significantly higher among both cryptogenic (OR 1.78; 95% CI 1.02-3.10) and non-cryptogenic (OR 1.84; 95% CI 1.15-2.94) stroke patients with respect to controls. Conclusion: Our study shows a higher prevalence of non-sustained AF episodes in ischemic stroke patients in comparison to controls. Whether this cross-sectional association translates into causality in terms of stroke pathophysiology will be the subject of future studies.

Extramedullary Plasmacytoma of The Frontal Sinus: A Case Report

FACE ◽  
2021 ◽  
pp. 273250162110536
Author(s):  
Joshua Harrison ◽  
Samantha Marley ◽  
Shawhin Shahriari ◽  
Christian Bowers ◽  
Anil Shetty
Keyword(s):  
Frontal Sinus ◽  
Surgical Excision ◽  
Extramedullary Plasmacytoma ◽  
High Rate ◽  
Solitary Plasmacytoma ◽  
Case Presentation ◽  
Long Term Follow Up ◽  
History Of

We report a rare case of an extramedullary plasmacytoma (EMP) in the frontal sinus with an indolent clinical presentation. Although a history of trauma was absent, the initial diagnosis was a mucocele, based on the radiological findings. Upon surgical excision, the patient was found to have an EMP. EMP, a form of solitary plasmacytoma, has a significantly high rate of conversion to multiple myeloma. This mandates long-term follow-up, even after successful radiotherapy and/or resection. While radiation therapy is generally considered a first line treatment for EMP, surgical intervention may provide optimal treatment in complicated cases. This case presentation highlights the prognosis of patients diagnosed with EMP.

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