scholarly journals Anterior-Lateral Versus Anterior-Posterior Electrode Position for Cardioverting Atrial Fibrillation

Circulation ◽  
2021 ◽  
Author(s):  
Anders Sjørslev Schmidt ◽  
Kasper Glerup Lauridsen ◽  
Dorthe Svenstrup Møller ◽  
Per Dahl Christensen ◽  
Karen Kaae Dodt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Sinus Rhythm ◽  
Primary Outcome ◽  
Risk Difference ◽  
Electrode Position ◽  
Percentage Points ◽  
Safety Outcomes ◽  
Anterior Posterior ◽  
Posterior Electrode

Background: Smaller randomized studies have reported conflicting results regarding the optimal electrode position for cardioverting atrial fibrillation. However, anterior-posterior electrode position is widely used as a standard and believed to be superior to anterior-lateral electrode position. Therefore, we aimed to compare anterior-lateral and anterior-posterior electrode position for cardioverting atrial fibrillation in a multicenter randomized trial. Methods: In this multicenter, investigator-initiated, open-label trial, we randomly assigned patients with atrial fibrillation scheduled for elective cardioversion to anterior-lateral or anterior-posterior electrode position. The primary outcome was the proportion of patients in sinus rhythm after the first shock. The secondary outcome was the proportion of patients in sinus rhythm after up to four shocks escalating to maximum energy. Safety outcomes were any cases of arrhythmia during or after cardioversion, skin redness, and patient-reported peri-procedural pain. Results: We randomized 468 patients. The primary outcome occurred in 126 patients (54%) assigned to anterior-lateral electrode position and in 77 patients (33%) assigned to anterior-posterior electrode position, a risk difference of 22 percentage-points, 95%-confidence interval: 13-30, P<0.001. The number of patients in sinus rhythm after the final cardioversion shock was 216 patients (93%) assigned to anterior−lateral electrode position and 200 patients (85%) assigned to anterior-posterior electrode position, a risk difference of 7 percentage−points, 95%−confidence interval: 2−12. There were no significant differences between groups in any safety outcomes. Conclusions: Anterior-lateral electrode position was more effective than anterior-posterior electrode position for biphasic cardioversion of atrial fibrillation. There were no significant differences in any safety outcome.

scholarly journals Maximum-fixed energy shocks for cardioverting atrial fibrillation

2019 ◽  
Author(s):  
Anders S Schmidt ◽  
Kasper G Lauridsen ◽  
Peter Torp ◽  
Leif F Bach ◽  
Hans Rickers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Sinus Rhythm ◽  
Energy Group ◽  
Fixed Energy ◽  
Percentage Points ◽  
Direct Current Cardioversion ◽  
Significant Difference ◽  
Patient Reported ◽  
Safety Endpoint

Abstract Aims Direct-current cardioversion is one of the most commonly performed procedures in cardiology. Low-escalating energy shocks are common practice but the optimal energy selection is unknown. We compared maximum-fixed and low-escalating energy shocks for cardioverting atrial fibrillation. Methods and results In a single-centre, single-blinded, randomized trial, we allocated elective atrial fibrillation patients to cardioversion using maximum-fixed (360-360-360 J) or low-escalating (125-150-200 J) biphasic truncated exponential shocks. The primary endpoint was sinus rhythm 1 min after cardioversion. Safety endpoints were any arrhythmia, myocardial injury, skin burns, and patient-reported pain after cardioversion. We randomized 276 patients, and baseline characteristics were well-balanced between groups (mean ± standard deviation age: 68 ± 9 years, male: 72%, atrial fibrillation duration >1 year: 30%). Sinus rhythm 1 min after cardioversion was achieved in 114 of 129 patients (88%) in the maximum-fixed energy group, and in 97 of 147 patients (66%) in the low-escalating energy group (between-group difference; 22 percentage points, 95% confidence interval 13–32, P < 0.001). Sinus rhythm after first shock occurred in 97 of 129 patients (75%) in the maximum-fixed energy group compared to 50 of 147 patients (34%) in the low-escalating energy group (between-group difference; 41 percentage points, 95% confidence interval 30–51). There was no significant difference between groups in any safety endpoint. Conclusion Maximum-fixed energy shocks were more effective compared with low-escalating energy shocks for cardioverting atrial fibrillation. We found no difference in any safety endpoint.

scholarly journals Apixaban versus No Anticoagulation in Patients Undergoing Long-Term Dialysis with Incident Atrial Fibrillation

2020 ◽  
Vol 15 (8) ◽  
pp. 1146-1154 ◽  
Author(s):  
Thomas A. Mavrakanas ◽  
Katherine Garlo ◽  
David M. Charytan
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Transient Ischemic Attack ◽  
Lower Incidence ◽  
Primary Outcome ◽  
Hazard Ratio ◽  
Intracranial Bleeding ◽  
Nonvalvular Atrial Fibrillation ◽  
Maintenance Dialysis ◽  
Ischemic Attack

Background and objectivesThe relative efficacy and safety of apixaban compared with no anticoagulation have not been studied in patients on maintenance dialysis with atrial fibrillation. We aimed to determine whether apixaban is associated with better clinical outcomes compared with no anticoagulation in this population.Design, setting, participants, & measurementsThis retrospective cohort study used 2012–2015 US Renal Data System data. Patients on maintenance dialysis with incident, nonvalvular atrial fibrillation treated with apixaban (521 patients) were matched for relevant baseline characteristics with patients not treated with any anticoagulant agent (1561 patients) using a propensity score. The primary outcome was hospital admission for a new stroke (ischemic or hemorrhagic), transient ischemic attack, or systemic thromboembolism. The secondary outcome was fatal or intracranial bleeding. Competing risk survival models were used.ResultsCompared with no anticoagulation, apixaban was not associated with lower incidence of the primary outcome: hazard ratio, 1.24; 95% confidence interval, 0.69 to 2.23; P=0.47. A significantly higher incidence of fatal or intracranial bleeding was observed with apixaban compared with no treatment: hazard ratio, 2.74; 95% confidence interval, 1.37 to 5.47; P=0.004. A trend toward fewer ischemic but more hemorrhagic strokes was seen with apixaban compared with no treatment. No significant difference in the composite outcome of myocardial infarction or ischemic stroke was seen with apixaban compared with no treatment. Compared with no anticoagulation, a significantly higher rate of the primary outcome and a significantly higher incidence of fatal or intracranial bleeding and of hemorrhagic stroke were seen in the subgroup of patients treated with the standard apixaban dose (5 mg twice daily) but not in patients who received the reduced apixaban dose (2.5 mg twice daily).ConclusionsIn patients with kidney failure and nonvalvular atrial fibrillation, treatment with apixaban was not associated with a lower incidence of new stroke, transient ischemic attack, or systemic thromboembolism but was associated with a higher incidence of fatal or intracranial bleeding.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_05_29_CJN11650919.mp3

scholarly journals Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

2019 ◽  
Vol 8 (9) ◽  
pp. 1457 ◽  
Author(s):  
Kang-Ho Choi ◽  
Woo-Keun Seo ◽  
Man-Seok Park ◽  
Joon-Tae Kim ◽  
Jong-Won Chung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Secondary Prevention ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Recurrent Stroke ◽  
Primary Outcome Measure ◽  
D Dimer

Background: We investigated the effect of D-dimer levels and efficacy of different antithrombotic therapies according to the baseline D-dimer levels on recurrent stroke in patients with atrial fibrillation (AF)-related stroke and atherosclerosis. Methods: We enrolled 1441 patients with AF-related stroke and atherosclerosis in this nationwide multicenter study. The primary outcome measure was the occurrence of recurrent ischemic stroke over a 3-year period. Results: High D-dimer levels (≥2 μg/mL) were significantly associated with higher risk of recurrent ischemic stroke (adjusted hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.13–2.84; p = 0.012). The risk of recurrent stroke was similar between the anticoagulant and the antiplatelet groups in all subjects (adjusted HR, 0.78; 95% CI, 0.46–1.32; p = 0.369). However, in patients with high D-dimer levels (≥2 μg/mL), risk of recurrent stroke was significantly lower in the anticoagulant group than in the antiplatelet group (adjusted HR, 0.40; 95% CI, 0.18–0.87; p = 0.022). Conclusion: Our findings suggested that baseline D-dimer levels could be used as a risk assessment biomarker of recurrent stroke in patients with AF-related stroke and atherosclerosis. High D-dimer levels would facilitate the identification of patients who are more likely to benefit from anticoagulants to ensure secondary prevention of stroke.

scholarly journals Targeted Antibiotics for Trachoma: A Cluster-Randomized Trial

2021 ◽  
Author(s):  
Jason S Melo ◽  
Solomon Aragie ◽  
Ambahun Chernet ◽  
Zerihun Tadesse ◽  
Adane Dagnew ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Cluster Randomized Trial ◽  
Risk Difference ◽  
Only Children ◽  
Adjusted Risk ◽  
Percentage Points ◽  
The Mean ◽  
Cluster Randomized ◽  
Current Guidelines ◽  
Noninferiority Margin

Abstract Background Current guidelines recommend community-wide mass azithromycin for trachoma, but a targeted treatment strategy could reduce the volume of antibiotics required. Methods In total, 48 Ethiopian communities were randomized to mass, targeted, or delayed azithromycin distributions. In the targeted arm, only children aged 6 months to 5 years with evidence of ocular chlamydia received azithromycin, distributed thrice over the following year. The primary outcome was ocular chlamydia at months 12 and 24, comparing the targeted and delayed arms (0–5 year-olds, superiority analysis) and the targeted and mass azithromycin arms (8–12 year-olds, noninferiority analysis, 10% noninferiority margin). Results At baseline, the mean prevalence of ocular chlamydia in the 3 arms ranged from 7% to 9% among 0–5 year-olds and from 3% to 9% among 8–12 year-olds. Averaged across months 12–24, the mean prevalence of ocular chlamydia among 0–5 year-olds was 16.7% (95% confidence interval [CI]: 9.0%–24.4%) in the targeted arm and 22.3% (95% CI: 11.1%–33.6%) in the delayed arm (P = .61). The final mean prevalence of ocular chlamydia among 8–12 year-olds was 13.5% (95% CI: 7.9%–19.1%) in the targeted arm and 5.5% (95% CI: 0.3%–10.7%) in the mass treatment arm (adjusted risk difference 8.5 percentage points [pp] higher in the targeted arm, 95% CI: 0.9 pp–16.1 pp higher). Conclusions Antibiotic treatments targeted to infected preschool children did not result in significantly less ocular chlamydia infections compared with untreated communities and did not meet noninferiority criteria relative to mass azithromycin distributions. Targeted approaches may require treatment of a broader segment of the population in areas with hyperendemic trachoma.

Risk of Atrial Fibrillation in Masked and White Coat Uncontrolled Hypertension

2020 ◽  
Author(s):  
Francesca Coccina ◽  
Anna M Pierdomenico ◽  
Matteo De Rosa ◽  
Lorenzo Belli ◽  
Melissa Foglietta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Confidence Interval ◽  
Sinus Rhythm ◽  
Ambulatory Blood Pressure ◽  
White Coat ◽  
Uncontrolled Hypertension ◽  
Hypertensive Patients ◽  
New Onset

Abstract Background Risk of atrial fibrillation (AF) in masked and white coat uncontrolled hypertension (MUCH and WUCH, respectively) has not yet been investigated. We assessed the risk of new-onset AF in MUCH and WUCH detected by ambulatory blood pressure (BP) monitoring. Methods The occurrence of AF was evaluated in 2135 treated hypertensive patients aged &gt;40 years, with baseline sinus rhythm, by electrocardiogram. Controlled hypertension (CH) was defined as clinic BP &lt;140/90 mmHg and daytime BP, regardless of nighttime BP, &lt;135/85 mmHg, MUCH as clinic BP &lt;140/90 mmHg and daytime BP ≥135 and/or ≥85 mmHg, WUCH as clinic BP &gt;140 and/or &gt;90 mmHg and daytime BP &lt;135/85 mmHg and sustained uncontrolled hypertension (SUCH) as clinic BP &gt;140 and/or &gt;90 mmHg and daytime BP &gt;135 and/or &gt;85 mmHg. Results MUCH was identified in 203 patients (9.5% of all the population, 29% of those with normal clinic BP) and WUCH in 503 patients (23.5% of all the population, 35% of those with high clinic BP). During the follow-up (mean 9.7 years), 116 cases of AF occurred. After adjustment for covariates, patients with MUCH (hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.06-3.85) and SUCH (HR 1.83, 95% CI, 1.04-3.21) had higher risk of new-onset AF than those with CH, whereas those with WUCH (HR 1.12, 95% CI, 0.59-2.13) did not. Conclusions When compared to patients with CH, those with MUCH and SUCH are at higher risk (approximately doubled) of new-onset AF, whereas those with WUCH are not.

scholarly journals Postoperative low molecular weight heparin bridging treatment for patients at high risk of arterial thromboembolism (PERIOP2): double blind randomised controlled trial

BMJ ◽  
2021 ◽  
pp. n1205
Author(s):  
Michael J Kovacs ◽  
Philip S Wells ◽  
David R Anderson ◽  
Alejandro Lazo-Langner ◽  
Clive Kearon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Randomised Controlled Trial ◽  
Confidence Interval ◽  
Major Bleeding ◽  
Heart Valves ◽  
Controlled Trial ◽  
Risk Difference ◽  
Mechanical Heart Valves ◽  
Double Blind ◽  
Randomised Controlled

Abstract Objective To determine the efficacy and safety of dalteparin postoperative bridging treatment versus placebo for patients with atrial fibrillation or mechanical heart valves when warfarin is temporarily interrupted for a planned procedure. Design Prospective, double blind, randomised controlled trial. Setting 10 thrombosis research sites in Canada and India between February 2007 and March 2016. Participants 1471 patients aged 18 years or older with atrial fibrillation or mechanical heart valves who required temporary interruption of warfarin for a procedure. Intervention Random assignment to dalteparin (n=821; one patient withdrew consent immediately after randomisation) or placebo (n=650) after the procedure. Main outcome measures Major thromboembolism (stroke, transient ischaemic attack, proximal deep vein thrombosis, pulmonary embolism, myocardial infarction, peripheral embolism, or vascular death) and major bleeding according to the International Society on Thrombosis and Haemostasis criteria within 90 days of the procedure. Results The rate of major thromboembolism within 90 days was 1.2% (eight events in 650 patients) for placebo and 1.0% (eight events in 820 patients) for dalteparin (P=0.64, risk difference −0.3%, 95% confidence interval −1.3 to 0.8). The rate of major bleeding was 2.0% (13 events in 650 patients) for placebo and 1.3% (11 events in 820 patients) for dalteparin (P=0.32, risk difference −0.7, 95% confidence interval −2.0 to 0.7). The results were consistent for the atrial fibrillation and mechanical heart valves groups. Conclusions In patients with atrial fibrillation or mechanical heart valves who had warfarin interrupted for a procedure, no significant benefit was found for postoperative dalteparin bridging to prevent major thromboembolism. Trial registration Clinicaltrials.gov NCT00432796 .

Left atrial scar burden in sinus rhythm differs from atrial fibrillation using automated voltage analysis during radiofrequency ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Mannion ◽  
SJ Lennon ◽  
A Kenny ◽  
U Boles
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
De Novo ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
Mitral Annulus ◽  
Scar Burden ◽  
Funding Sources ◽  
Anterior Posterior

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Scar burden in atrial fibrillation (AF) can be overestimated due to many factors. Scar burden has prognostic value and substrates considered for ablation by some electrophysiologists. We compared left atrial (LA) scar voltage in AF to sinus rhythm (SR) using voltage histogram analysis (VHA) of those undergoing pulmonary vein isolation (PVI) for persistent AF (PeAF). We believe this is the first study analysing LA scar location in SR and AF using VHA. Methods We retrospectively analysed 120 anatomical segments (AS) and whole LA voltages (N= 10 patients, mean age 68 ± 7, 4 females) in SR and AF. Fast anatomical maps (FAM) were grouped into 6 AS in AF and SR: Anterior, Posterior, Roof, Floor, Septal and Lateral AS, which were analysed via VHA (Figure 1) in 10 voltage ranges between 0mV-0.5mV. Total LA area in each voltage aliquot was recorded in SR and AF, taking diseased LA as 0.2-0.5mV and dense LA scar as &lt;0.2mV. The pulmonary veins, mitral annulus and trans-septal puncture sites were excluded from analyses. We included patients over age 18 with PeAF who had de novo PVI with no extra ablation lines, maps with &gt;1000 voltage points in both rhythms and uniform procedure involving initial mapping in AF then remapping in SR after PVI. Statistical analyses conducted with IBM SPSS v.26. Results Total LA scar burden was greater in AF (Mean 142.76 mm², SD ± 138.78mm²) than SR (Mean 109mm², SD ± 107.8mm²), p= &lt;0.0001, Table 1. Scar correlation in SR and AF had a good relationship, R = 0.416 (p= &lt;0.001). Every 1mm² of scar identified during SR yielded a mean of 1.54mm² in AF, (p= &lt;0.001). Conclusions AF was associated with higher scar burden in the Roof, Anterior, Lateral and Posterior AS. Dense LA scar (≤ 0.2mV) on the Posterior AS was significantly higher in AF, while in other AS was comparable to SR. Mapping substrate in AF, especially the posterior wall, may be misleading as scar burden may be overestimated when compared to SR. Table 1Voltage&lt; 0.02 mV (mean area ± SD mm2)0.2-0.5mV (mean area mm2)RhythmSRAFp-valueSRAFp-valueEntire LA115.89 ± 113.61143.41 ± 144.230.02*105.78 ± 103.73144.00 ± 135.24&lt;0.0001*Roof82.72 ± 117.3283.68 ± 113.560.95115 ± 77.14150.61 ± 93.170.01*Anterior131.8 ± 169.53126.5 ± 154.570.85158.53 ± 99.22220.87 ± 173.070.002*Lateral70.5 ± 80.0090.57 ± 117.990.3687.52 ± 66.82137.05 ± 104.990.0002*Septal80.99 ± 89.0380.99 ± 89.030.6899.123 ± 73.62115.37 ± 84.830.18Floor105.1 ± 134.91106.42 ± 148.670.96117.62 ± 85.41151.2 ± 110.070.052Posterior102.14 ± 157.47159.03 ± 194.650.02*138.27 ± 112.28234 ± 150.45&lt;0.0001*LA scar distribution in SR and AF, *denotes significant results.Abstract Figure 1

P431Flecainide or propafenone oral bolus to facilitate electrical cardioversion of persistent atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Compagnucci ◽  
A Barbarossa ◽  
M Centanni ◽  
A Urbinati ◽  
G Ciliberti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Electrical Cardioversion ◽  
The Other ◽  
Left Ventricular Ejection ◽  
Drug Ingestion ◽  
Intravenous Amiodarone

Abstract Background  electrical cardioversion (ECV) of atrial fibrillation (AF) is a pivotal component of the rhythm control approach. Although ECV is safe and effective in the majority of patients, approximately one patient out of ten experiences an early or very early recurrence. In order to improve ECV’s success rate, oral or intravenous amiodarone pre-treatment is commonly prescribed and followed by a second ECV attempt. However, due to the long time needed to achieve therapeutic levels and the high risk of phlebitis, faster and safer strategies to facilitate ECV are highly needed. Purpose  to evaluate whether the administration of a flecainide or propafenone oral bolus followed by ECV would prove effective and safe in facilitating conversion to sinus rhythm in patients with persistent AF and a prior ECV failure. Methods we conducted a prospective, open-label, single center observational study. The case group was formed by patients with persistent AF and a prior ECV failure receiving flecainide or propafenone oral bolus (at the same doses used for the "pill-in-the-pocket" approach) followed by a second ECV attempt 3 hours after drug ingestion. For comparison, we selected patients with a prior ECV failure that underwent amiodarone-facilitated ECV. Before ECV, amiodarone was either administered orally for at least 1 month or intravenously for 24 hours. The primary outcome was conversion to sinus rhythm, defined as sinus rhythm persisting for at least 12 hours after ECV. Results patient’s characteristics were well balanced in the 3 groups, apart from slightly lower left ventricular ejection fraction values in the amiodarone groups. The day after ECV failure, 29 patients received oral flecainide at a 200 mg (n = 15) or at a 300 mg (n = 14) dose and one patient received oral propafenone at a 600 mg dose before undergoing a second ECV attempt. In nine patients, amiodarone was given intravenously for 24 hours. Amiodarone was prescribed orally to 22 patients for a median of seven weeks at an average daily dose of 241.4 mg. In the flecainide/propafenone group, one patient converted to sinus rhythm one hour after drug ingestion; among the other 29 subjects, the second ECV was effective in 23 (cumulative effectiveness: 80.0%). In the intravenous amiodarone group, 2 patients converted to sinus rhythm during drug infusion; among the other 7, the second ECV proved effective in 4 (cumulative effectiveness: 66.7%). In the oral amiodarone group, ECV was successful in 17 patients (77.3%). When comparing the three groups, the primary outcome occurred in a similar proportion of patients (Chi-squared test: p = 0.34; Fisher’s exact test: p = 0.24). Serious adverse events were not reported. Conclusions flecainide or propafenone oral bolus quickly facilitated conversion to sinus rhythm in the vast majority of patients with persistent AF and a prior ECV failure with a low inherent risk of adverse events. Flecainide effectiveness proved similar to intravenous or oral amiodarone.

P3610Prognostic implication of new-onset atrial fibrillation burden in patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J C Luo ◽  
H Q Li ◽  
Z Q Li ◽  
B X Liu ◽  
M M Gong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Sinus Rhythm ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
High Burden ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) can be associated with adverse cardiovascular events. The prognostic implication of the burden of atrial fibrillation has been investigated in various settings. Purpose We aimed to explore the association of the burden of post-MI NOAF with the risk of adverse cardiovascular events during hospitalization. Methods All consecutive patients admitted forAMI between February 2014 and February 2018 were analyzed by continuous electronic monitoring (CEM) through hospitalization. AF burden was calculated by dividing the total AF duration by the total CEM duration. Patients were divided into 3 groups: sinus rhythm group, low burden (AF burden≤8.5%) group, and high burden (AF burden>8.5%) group. The primary outcome was a composite of in-hospital all-cause death, recurrent MI, acute heart failure, or cardiogenic shock. Results Overall, 2405 patients (mean age: 65.8 years; male: 76.6%) were included. NOAF was documented in 11.6% of patients, and the primary outcome was recorded in 288 patients (13.6%) of the sinus rhythm group, 42 (30.0%) in the low burden group, and 71 (50.7%) in the high burden group. Compared with patients with sinus rhythm, a greater burden of NOAF was associated with a higher risk of the primary outcome after multivariable analysis (low burden: hazard ratio, 1.22; 95% confidence interval [CI]: 0.87–1.70; high burden: hazard ratio, 1.90; 95% CI: 1.43–2.51; p for trend<0.001). In-hospital cardiovascular events MACE Patients/Events, n Unadjusted HR (95% CI) Adjusted HR (95% CI)a Sinus rhythm 2125/288 1.00 (reference) 1.00 (reference) Low burden 140/42 2.05 (1.48–2.84) 1.22 (0.87–1.70) High burden 140/71 3.93 (3.03–5.10) 1.90 (1.43–2.51) P for trend – <0.001 <0.001 All-cause death Patients, n Unadjusted HR (95% CI) Adjusted HR (95% CI)a Sinus rhythm 2125/106 1.00 (reference) 1.00 (reference) Low burden 140/10 1.02 (0.53–1.97) 0.52 (0.27–1.02) High burden 140/32 3.62 (2.41–5.42) 1.37 (0.89–2.09) P for trend – <0.001 0.081 aAdjusted for age, sex, current smoking, hypertension, diabetes mellitus, dyslipidemia, CKD, previous MI, previous stroke, previous heart failure, symptom onset to emergency department duration, STEMI, pre-hospital cardiac arrest, LVEF, and on-admission HR, SBP and CS, peak TnT, reperfusion therapy and GPIIb/IIIa inhibitor. Kaplan-Meier plots of in-hospital events Conclusion A greater burden of NOAF complicatingAMI was associated withan increased risks of in-hospital adverse events. Acknowledgement/Funding National Natural Science Foundation of China grant 81270193 and Natural Science Foundation of Shanghai grant 18ZR1429700

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