Abstract 13274: Predictors of Mortality in Critically Ill Covid-19 Patients - A Multicenter Prospective Analysis of 159 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Randy Ip ◽  
Zulfiqar Qutrio Baloch ◽  
manel boumegouas ◽  
Abdullah Al abcha ◽  
Steven Do ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Critically Ill ◽  
Demographic Data ◽  
Prior History ◽  
Multivariable Logistic Regression Analysis ◽  
Elevated Troponin ◽  
Ischemic Disease ◽  
Patient Status ◽  
History Of

Introduction: Certain patient demographics and biomarkers have been shown to predict survival in patients infected with COVID-19. However, predictors of outcome in patients who are critically ill and require advanced respiratory support are unclear. Methods: We performed a multicenter analysis of 159 consecutive patients with confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) between March 01, 2020 and April 30, 2020. Patients were then followed until May 23, 2020. Demographic data (age, sex, race, BMI) and past medical history (hypertension, diabetes, COPD, CKD, history of cardiac ischemic disease, atrial fibrillation and heart failure) were recorded. Laboratory values (troponin, CPK, pro-BNP, ferritin, LDH and d-dimer) were analyzed. Patient status was classified as either alive or deceased at hospital discharge or the end of follow up period. Results: Mean patient age was 66+/-15 and 53% were male. Mean BMI was 31+/- 9. Mean hospital ICU stay was 11+/-8 days. Mortality rate of this ICU cohort at the end of follow-up was 63%. Fifty-five (34%) patients were discharged from the hospital. A multivariable logistic regression analysis identified four factors (age, prior history of diabetes, prior history of atrial fibrillation and elevated troponin) that had significant and independent contributions to the likelihood of survival. Each increase in decade of age above 40 (p = 0.010) was predicted to reduce survival by 30%, the presence of diabetes (p = 0.041) by 57%, a prior history of atrial fibrillation (p= 0.011) by 75%, and each increase of 0.1 ng/mL of troponin above 0.05 ng/ml (p = 0.001) by 55%. Conclusion: Mortality of critically ill COVID-19 patients is high. Early aggressive treatment of high-risk patients identified in this study (advanced age, history of diabetes and atrial fibrillation and elevated troponin) could improve clinical outcome. The highly predictive value of elevated troponin levels on survival may indicate cardiac involvement of COVID-19 infection as a determinant of mortality. Additionally, of available published literature at this time, this is the first study that suggests a relationship between atrial fibrillation and increased mortality from COVID-19. Larger studies are needed to confirm these findings.

P320Heart failure with mid-range (HFmrEF) or recovered (HFrecEF) ejection fraction: differential determinants of transition

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R De Maria ◽  
F Macera ◽  
M Gorini ◽  
I Battistoni ◽  
M Iacoviello ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Characteristics ◽  
Nyha Class ◽  
Multivariable Logistic Regression Analysis ◽  
Class Iii ◽  
Mild Disease ◽  
Lower Likelihood ◽  
History Of

Abstract Background Heart failure with mid-range ejection fraction (HFmrEF) has been identified as a multi-faceted phenotype that may encompass both patients with mild disease or those who from previous HFrEF recover EF (HFrecEF) Purpose To describe clinical characteristics and factors associated with phenotype transition at follow-up. Methods From 2009 to 2016, 1194 patients with baseline EF<50% and a second echocardiographic determination during clinically stability at a median of 6 months were enrolled in the IN-CHF Registry. Based on EF at enrollment, 335 (28%) had HFmrEF and 859 (72%) had HFrEF. We compared baseline clinical characteristics and predictors associated with follow-up reclassification to HFmrEF or full EF recovery Results When compared to HFrEF patients, those with HFmrEF had less often an ischemic etiology, advanced symptoms and a HF admission in the previous year. No other differences were found in clinical characteristics and drug therapy (Table). At a median follow-up of 6 months, 30% of HFrEF patients improved EF by 14 (9) units: 21% showed partial EF recovery (transition to HFmrEF) and 9% had full EF recovery. Conversely among HFmrEF patients 22% improved EF, by 9 (5) units, to full recovery, and 18% deteriorated by 1.5 (5.5) units sloping to HFrEF. By multivariable logistic regression analysis, variables associated with EF recovery at 6-month follow-up differed between baseline phenotypes. Within HFrEF, ischemic etiology (OR 0.46, 95% CI 0.33–0.64) and NYHA class III-IV symptoms (OR 0.57, 95% CI 0.38–0.68) were associated with a lower likelihood of EF recovery, while a history of HF<6 month correlated with a higher likelihood of EF recovery (OR 2.44, 95% CI 1.76–3.39). Within HFmrEF, while ischemic etiology (OR 0.66, 95% CI 0.19–0.68) was also associated with a lower likelihood of EF recovery, a history of atrial fibrillation at enrollment correlated with higher likelihood of EF recovery (OR 2.66, 95% CI 1.37–5.17) by 6 month-follow-up. At a median follow-up of 36+28 months mortality was 4.6% vs 6.9% in HFrecEF vs non-recovered patients (log rank p=0.08). Baseline characteristics HFrEF vs HFmrEF Conclusions HFmrEF patients showed a less severe clinical picture than HFrEF patients, but had EF recovery less often. EF improvement is negatively associated with ischemic etiology in both phenotypes, and positively associated with atrial fibrillation in HFmrEF and a short history of HF in HFrEF.

Abstract 225: Healthcare Burden Associated with Dyspepsia Among Nonvalvular Atrial Fibrillation Patients

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Michael H Kim ◽  
Kelly F Bell ◽  
Dinara Makenbaeva ◽  
Daniel Wiederkehr ◽  
Jay Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Baseline Period ◽  
Charlson Comorbidity Index Score ◽  
Prior History ◽  
Nonvalvular Atrial Fibrillation ◽  
Entire Study ◽  
Healthcare Burden ◽  
History Of ◽  
Study Population

Objective: To evaluate the annual healthcare burden associated with dyspepsia among nonvalvular atrial fibrillation (NVAF) patients Methods: NVAF patients ≥18 years of age with continuous medical/prescription coverage were identified (1/1/2007-12/31/2009) from the MarketScan ® Commercial and Medicare Research Databases. Patients with at least 1 inpatient or 2 outpatient dyspepsia diagnoses within 12 months following any NVAF diagnosis were grouped into the dyspeptic cohort, with patients without any dyspepsia diagnosis during the entire study period grouped into the non-dyspeptic cohort. The date of first dyspepsia diagnosis after NVAF diagnosis and a random date within 12 months after NVAF diagnosis were selected as the index dates for dyspeptic and non-dyspeptic patients, respectively. Baseline and follow-up periods were each 12 months. Of the overall dyspeptic and non-dyspeptic cohorts, patients were matched (1:1) by key patient characteristics. The dyspeptic cohort was further categorized as having a prior history of dyspepsia (chronic) or no dyspepsia (non-chronic) during the baseline period. Healthcare utilization and costs were evaluated and compared during the follow-up for matched cohorts. Results: Of 142,322 NVAF patients included in the overall study population (mean age: dyspeptic: 73.68, non-dyspeptic: 72.09 years, p<0.001), 10.2% were diagnosed with dyspepsia, with 67% of them having no history of prior dyspepsia during the baseline. Among the matched study population (N=28,172), patients had similar baseline characteristics: mean Charlson Comorbidity Index score of 2.3 in both cohorts and mean CHADS 2 scores of 1.9 and 1.8 for the non-dyspeptic and dyspeptic cohort, respectively. During the follow-up period, healthcare resource utilization and related costs were significantly greater for the dyspeptic cohort vs. the non-dyspeptic cohort (Table). Patients with chronic dyspepsia were the least likely to receive warfarin in the follow-up period (non-dyspeptic: 57.2%, non-chronic: 50.4%, chronic: 46.6%, p<0.001). Conclusions: NVAF patients with dyspepsia used healthcare resources to a greater extent and had greater healthcare costs than NVAF patients without dyspepsia. Warfarin usage appeared to be lower among NVAF patients with dyspepsia.

scholarly journals Characteristics of Apixaban-Treated Patients, Evaluation of the Dose Prescribed, and the Persistence of Treatment

2018 ◽  
Vol 23 (6) ◽  
pp. 494-501 ◽  
Author(s):  
Ainhoa Gomez-Lumbreras ◽  
Jordi Cortes ◽  
Maria Giner-Soriano ◽  
M. Angeles Quijada-Manuitt ◽  
Rosa Morros
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Factor Xa ◽  
Recommended Dose ◽  
Prior History ◽  
Nonvalvular Atrial Fibrillation ◽  
Treatment Naïve ◽  
History Of ◽  
Using Data

Background: Apixaban is a direct oral anticoagulant, which inhibits factor Xa. It has demonstrated clinical efficacy in prevention of stroke and systemic embolism in adult patients with nonvalvular atrial fibrillation and a better safety profile compared to warfarin. Objectives: (1) To describe the characteristics of patients with nonvalvular atrial fibrillation beginning treatment with apixaban, (2) to analyze concomitant prescriptions of medications that could potentially interact with apixaban, (3) to evaluate the level of appropriate usage according to the recommended dosage, and (4) to estimate the level of apixaban persistence among naive and non-naive patients. Methods: Cohort study using data from primary care (System for Research in Primary Care database, users of the Institut Català de la Salut; Catalonia, Spain) from August 2013 to December 2015. Results: Mean age for apixaban-treated patients was 71.8 years (standard deviation = 11.1) and 55.6% were male. In all, 3.2% of patients receiving apixaban were taking drugs described as potentially related to either pharmacokinetic or pharmacodynamic interactions. According to the summary of product characteristics, 81.1% of patients with a recommended dose of 2.5 mg twice daily and 51.8% with a recommended dose of 5 mg twice daily actually took this dose. After 1 year of follow-up, 62.6% of the apixaban users showed good adherence. Conclusion: The prescribed dose of apixaban did not fully follow the recommended dose, particularly in patients who were treatment naive. Patients with a prior history of anticoagulant treatment were more likely to remain persistent to treatment with apixaban.

Atrial Fibrillation in CLL/SLL Patients on Ibrutinib

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2933-2933 ◽  
Author(s):  
Mohammed Farooqui ◽  
Janet Valdez ◽  
Susan Soto ◽  
Amanda Bray ◽  
Xin Tian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Incidence Rate ◽  
Single Agent ◽  
Bleeding Complications ◽  
Prior History ◽  
History Of ◽  
Previously Treated ◽  
Grade 3

Abstract INTRODUCTION: Ibrutinib is approved for treatment (tx) of CLL in patients (pts) with previously treated disease and CLL with deletion (del) 17p. It has shown substantial improvements in progression free survival (PFS) and overall survival (OS) with a tolerable safety profile. Atrial fibrillation (Afib) has been observed in pts treated with ibrutinib, particularly in pts with cardiac risk factors, acute infections, and history of Afib. In the RESONATE study 3% of pts on ibrutinib developed Afib (median follow-up (f/u) 8.6 months (mo)) while 1% of pts on ofatumumab (median f/u 5.3 mo) developed Afib. Here we assessed the incidence of Afib in an independent cohort of pts with long f/u enrolled in our investigator-initiated trial of single agent ibrutinib. PATIENTS AND METHODS: This phase II trial (NCT01500733) enrolled 86 pts (Cohort 1: ≥ 65 years old (yo) without del 17p (n=35); Cohort 2: ≥ 18 yo with presence of del 17p (n=51)) who were treated with ibrutinib 420 mg daily continuously. Treatment-naive and previously treated pts in need of treatment (tx) were eligible. Safety data for Afib was compiled on all pts who received tx. All pts who developed Afib (per patient report or incidental finding) stopped ibrutinib therapy and underwent a cardiology evaluation which may have included an echocardiogram, stress test, and/or holter monitor at the discretion of the evaluating cardiologist. The annualized exposure adjusted incidence rate of Afib was estimated and compared between subgroups. RESULTS: At a median follow-up of 28 mo, 14 (16%) of 86 patients were found to have Afib while on study, 11 pts were ≥65 yo; 3 pts < 65 yo. In 9 (10%) pts this was the first recorded event, while 5 (6%) had a prior history of Afib. One patient developed Afib during pneumonia and in all other pts no contributing factors were identified. The median time to the first event on study was 18.24 (IQR: 10.8-26.0) mo. The annualized incidence was 0.052 (95% CI, 0.024- 0.099) events per person-year of treatment exposure among pts (n=81) without a prior history of Afib, 0.061 (95% CI: 0.025-0.126) in pts ≥65 yo (n=52), and 0.035 (95% CI: 0.004-0.125) in pts <65 yo (n=29, P =0.43 for difference in incidence based on age). In 11 (79%) of 14 pts Afib was grade 2, and in 3 (21%) grade 3. The grade 3 events required hospitalization and control of Afib through intravenous medications. All 3 pts had resolution of Afib and completed cardiology evaluation prior to restarting ibrutinib at a lower dose (280 mg), one received only aspirin (ASA) 81 mg, one received ASA 81 mg and an antiarrhythmic (sotalol), and one patient was anticoagulated with apixaban. Of 11 pts with grade 2 events, 6 (55%) pts currently do not have any symptoms or EKG findings of Afib, 3 (27%) pts intermittently have symptoms or EKG findings of Afib, and 2 (18%) pts have ongoing Afib. All of these 11 pts restarted ibrutinib at the same dose (420 mg); 5 received ASA 81 mg, 2 were on dabigatran transiently and then continued ASA 81 mg, and the other 4 pts started apixiban. F/u on apixiban ranges from 7-17 mo with no bleeding-related adverse events grade >1. CONCLUSION: The rate of Afib in this study at 16% is higher than previously reported, likely due to longer f/u. Indeed, the estimated Afib rate at 17 mo in RESONATE was 5.1%, similar to 5.6% at the same timepoint in our study. The annualized incidence rate of Afib in our study at 0.052 (95% CI, 0.024- 0.099) is higher than the estimated rate of 0.0124 per person-year in the general population (Schnabel et al, Lancet 2015). Given that the rate of Afib is higher in illness, longer follow-up in randomized studies will be needed to distinguish disease from drug-related factors. Notably, none of our pts had to discontinue ibrutinib because of Afib. Furthermore, there is currently no evidence that the severity of Afib in pts on ibrutinib differs from the general population. Given that the majority of our patients have del 17p and/or previously treated disease we feel that the risk-benefit profile favors continued ibrutinib treatment. In a small number of pts and with limited duration of observation we have not noted any serious bleeding complications in pts on ibrutinib and concurrent apixaban or 81 mg ASA. Research supported by the Intramural Research Program of NHLBI. We thank our patients for participation. We acknowledge Pharmacyclics for providing study drug. Disclosures Wiestner: Pharmacyclics: Research Funding.

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%.

Abstract 14403: Troponin as a Powerful Predictor of Mortality in Critically Ill Covid-19 Patientsmulticenter Analysis in 159 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zulfiqar Qutrio Baloch ◽  
Abbas Ali ◽  
Abdullah Alabcha ◽  
manel boumegouas ◽  
Steven Do ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cardiac Involvement ◽  
Demographic Data ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiac Biomarkers ◽  
Serial Determination ◽  
Patient Status ◽  
Multicenter Analysis

Introduction: Certain cardiac biomarkers have been shown to predict survival in patients infected with COVID-19. However. The use of Troponins, CPK and LDH in predicting the outcome in patients who are critically ill and require advanced respiratory support is less clear. Methods: We performed a multicenter analysis of 159 consecutive patients with confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) between March 01, 2020 and April 30, 2020. Patients were then followed until May 23, 2020. Demographic data (age, sex, race, BMI) were recorded. Cardiac biomarkers (CPK, Troponins, BNP, LDH) were analyzed. Patient status was classified either alive or deceased at the end of follow up period. Results: Mean patient age was 66+/-15 and 53% were male. Mean BMI was 31+/- 9. Mean hospital ICU stay was 11+/-8 days. Mortality rate of this ICU cohort at the end of follow-up was 63%. Fifty-five (34%) patients were discharged from the hospital. A multivariate logistic regression analysis identified 2 factors (Age >62 HR 2.4, 95% CI 1.21-4.676, p<0.01 and elevated Troponin >0.5 HR 3.45, 95% CI 1.01-11.8, p 0.048) has significant and independent contributions to the likelihood of survival (Fig 1 and Fig 2). Fig 1 KM curve of different strata of Troponin levels Fig 2 KM curve of 2 strata of Age Conclusion: Elevated Troponins level are common in critically ill COVID-19 patients. The highly predictive value of Troponins in survival may indicate possible cardiac involvement of COVID-19 infection as a determinant of mortality. Early and serial determination of Troponin values can provide risk stratification for these patients and timely aggressive intervention may decrease mortality.

scholarly journals Ultrasound Guided Percutaneous Nephrolithotomy in Mesh-Repaired Incisional Hernia

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Seyed Hassan Inanloo ◽  
Mohammad Reza Nikoobakht ◽  
Hamed Akhavizadegan ◽  
Mojgan Karbakhsh
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Percutaneous Nephrolithotomy ◽  
Demographic Data ◽  
Flank Region ◽  
Renal Stones ◽  
Prior History ◽  
Ultrasound Guided ◽  
History Of

Objectives. To describe our technique of percutaneous nephrolithotomy (PNL) in patients with mesh-repaired flank incisional hernia. Polypropylene mesh which is used for fascia strengthening in hernia repair elicits intense inflammatory reaction and the consequent fibrosis alters the characteristics of abdominal wall. Thus, prior history of flank hernia repair with mesh may result in percutaneous nephrolithotomy failure. Materials and Methods. Demographic data, renal stones characteristics, and any complication during surgery and follow-up of patients who were treated by PNL during 2011 to 2020 and had mesh in their flank region were collected. Results. Percutaneous nephrolithotomy was performed without any problem in 8 patients with guide of ultrasonography. Conclusion. Based on our experience, ultrasound-guided PNL is feasible and hypothetically superior to fluoroscopy in such circumstances.

Abstract 14375: Does Race Provide Protection From New Onset Atrial Fibrillation After Typical Flutter Ablation in Male Veteran Patients?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aung N Lin ◽  
Gary Peng ◽  
Edmond Obeng-Gyimah ◽  
Naga K Pothineni ◽  
Soe P Winn ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Rank Test ◽  
Prior History ◽  
Study Cohort ◽  
Typical Atrial Flutter ◽  
History Of ◽  
Common Risk Factors ◽  
Onset Atrial Fibrillation ◽  
Male Veteran

Introduction: Patients undergoing typical atrial flutter (AFL) ablation remain at risk of developing atrial fibrillation (AF). However, it is unknown whether common risk factors associated with AF occurrence, particularly race, bear out in this population. Hypothesis: We sought to compare the occurrence of new AF in male veteran African-American (AA) and Caucasian (Cau) patients with AFL following successful cavo-tricuspid isthmus ablation. Methods: A retrospective review of patients undergoing AFL ablation between 2002 and 2019 was performed. Patients with prior history of AF were excluded. Records were reviewed and demographics, comorbidities and post-ablation outcomes including new AF and stroke were recorded. The overall incidence of AF and cases per 1000 person-years (CPTPY) were determined. Results: The study cohort comprised 217 patients (age: 66±9.3 years, AA: 97 [45%], Cau:108 [50%]; see Table) with a mean follow-up of 55±42 months after AFL ablation. New AF was detected in 30 (31%) AA and 45 (42%) Cau patients (p=0.21 by Log Rank test). Overall incidence of AF was 78 CPTPY (67 and 91 CPTPY cases in AA and Cau patients, respectively). Time to occurrence of AF was earlier in Cau than AA patients (p=<0.001). New stroke events occurred in 9 (4.4%) patients (4 AA, 5 Cau; p=0.86). Conclusions: Male AA and Cau patients have similar significant risks for developing AF and experiencing stroke after AFL ablation.

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 Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

2021 ◽  
Author(s):  
Shinwan Kany ◽  
Johannes Brachmann ◽  
Thorsten Lewalter ◽  
Ibrahim Akin ◽  
Horst Sievert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial Appendage ◽  
Systemic Embolism ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
The One

Abstract Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract

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