scholarly journals Combined Effect of Homocysteine and Uric Acid to Identify Patients With High Risk for Subclinical Atrial Fibrillation

2021 ◽  
Author(s):  
Shihao Wang ◽  
Yushan Wei ◽  
Tesfaldet Habtemariam Hidru ◽  
Daobo Li ◽  
Nan Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Uric Acid ◽  
High Risk ◽  
European Society ◽  
Electronic Devices ◽  
Hazard Ratio ◽  
Blood Samples ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
European Society Of Cardiology

Background Subclinical atrial fibrillation (SCAF) is often asymptomatic nonetheless harmful. In patients with cardiac implantable electronic devices, we evaluated the combined performance of homocysteine and uric acid (UA) biomarkers to discriminate high‐risk patients for SCAF. Methods and Results We enrolled 1224 consecutive patients for evaluation of SCAF in patients with cardiac implantable electronic devices in Dalian, China, between January 2013 and December 2019. Clinical data and blood samples were obtained from patients selected according to the absence or presence of atrial high‐rate episodes >6 minutes. Blood samples were obtained, and homocysteine and UA biomarkers were tested in all patients to distinguish their prognostic performance for SCAF. Homocysteine and UA biomarkers were significantly different in SCAF versus no SCAF. On multivariable Cox regression analysis with potential confounders, elevated homocysteine and UA biomarkers were significantly associated with an increased risk of SCAF. A rise of 1 SD in homocysteine (5.7 μmol/L) was associated with an increased risk of SCAF in men and women regardless of their UA levels. Similarly, a 1‐SD increase in UA (91 μmol/L) was associated with an increased risk of SCAF among the patients with high levels of homocysteine in men (hazard ratio, 1.81; 95% CI, 1.43–2.30) and women (hazard ratio, 2.11; 95% CI, 1.69–2.62). The addition of homocysteine and UA to the atrial fibrillation risk factors recommended by the 2020 European Society of Cardiology Guidelines significantly improved risk discrimination for SCAF. Conclusions Homocysteine and UA biomarkers were strongly associated with SCAF. The prediction performance of the European Society of Cardiology model for SCAF was increased by the addition of the selected biomarkers. Registration URL: https://www.chictr.org.cn ; Unique identifier: Chi‐CTR200003837.

scholarly journals Protecting the most vulnerable during COVID-19 and beyond: a case report on the remote management of heart failure patients with cardiac implantable electronic devices

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6
Author(s):  
Fozia Zahir Ahmed ◽  
Carol Crosbie ◽  
Matthew Kahn ◽  
Manish Motwani
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Electronic Devices ◽  
Management Strategies ◽  
Phone Call ◽  
Cardiac Resynchronization ◽  
Physiological Data ◽  
Related Data ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Abstract Background Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic. Case summary An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The ‘Triage Heart Failure Risk Score’ (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any ‘high’ Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient’s home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner. Discussion The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.

scholarly journals Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 611 ◽  
Author(s):  
AlTurki ◽  
Marafi ◽  
Russo ◽  
Proietti ◽  
Essebag
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Electronic Devices ◽  
High Rate ◽  
Cardiac Monitoring ◽  
Stroke Event ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
History Of ◽  
New Evidence

Subclinical atrial fibrillation (SCAF) describes asymptomatic episodes of atrial fibrillation (AF) that are detected by cardiac implantable electronic devices (CIED). The increased utilization of CIEDs renders our understanding of SCAF important to clinical practice. Furthermore, 20% of AF present initially as a stroke event and prolonged cardiac monitoring of stroke patients is likely to uncover a significant prevalence of SCAF. New evidence has shown that implanting cardiac monitors into patients with no history of atrial fibrillation but with risk factors for stroke will yield an incidence of SCAF approaching 30–40% at around three years. Atrial high rate episodes lasting longer than five minutes are likely to represent SCAF. SCAF has been associated with an increased risk of stroke that is particularly significant when episodes of SCAF are greater than 23 hours in duration. Longer episodes of SCAF are incrementally more likely to progress to episodes of SCAF >23 hours as time progresses. While only around 30–40% of SCAF events are temporally related to stroke events, the presence of SCAF likely represents an important risk marker for stroke. Ongoing trials of anticoagulation in patients with SCAF durations less than 24 hours will inform clinical practice and are highly anticipated. Further studies are needed to clarify the association between SCAF and clinical outcomes as well as the factors that modify this association.

scholarly journals Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association

Circulation ◽  
2019 ◽  
Vol 140 (25) ◽  
Author(s):  
Peter A. Noseworthy ◽  
Elizabeth S. Kaufman ◽  
Lin Y. Chen ◽  
Mina K. Chung ◽  
Mitchell S.V. Elkind ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
American Heart ◽  
Electronic Devices ◽  
Heart Association ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
Scientific Statement ◽  
Existing Data

The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated with increased risk of stroke. Thus, detection of subclinical atrial fibrillation may offer an opportunity to reduce stroke risk by initiating anticoagulation. However, it is unknown whether long-term anticoagulation is warranted and in what populations. This scientific statement explores the existing data on the prevalence, clinical significance, and management of subclinical atrial fibrillation and identifies current gaps in knowledge and areas of controversy and consensus.

Recommendations on sports cardiology and exercise in patients with cardiac arrhythmias, channelopathies, CARDIOMOPATHIA AND implanted dEVICES ACCORDING TO THE LATEST GUIDELINES OF European Society of Cardiology – part 1

2021 ◽  
Vol 4 (57) ◽  
pp. 12-17
Author(s):  
Magdalena Bajer ◽  
Agnieszka Kotalczyk ◽  
Michał Mazurek ◽  
Ewa Jędrzejczyk-Patej
Keyword(s):  
Cardiac Death ◽  
Electronic Devices ◽  
Shared Decision ◽  
Sports Cardiology ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
Competitive Athletes ◽  
Esc Guidelines ◽  
European Society Of Cardiology ◽  
Implanted Devices

Competitive athletes should be screened for cardiovascular diseases associated with an increased risk of sudden cardiac death. Patients with arrhythmias, channelopathies, cardiomyopathies and cardiac implantable electronic devices should be assessed, and the level of acceptable physical activity should be established. It is crucial to personalize the guidelines and involve the patients in shared decision making. The following article provides an overview of exercise recommendations for patients with arrhythmias and cardiac implantable electronic devices on the basis of the 2020 ESC Guidelines on Sports Cardiology and Exercise. It was divided into two parts.

scholarly journals Identifying At‐Risk Patients for Sustained Atrial High‐Rate Episodes Using the C 2 HEST Score: The West Birmingham Atrial Fibrillation Project

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Yan‐Guang Li ◽  
Daniele Pastori ◽  
Kazuo Miyazawa ◽  
Farhan Shahid ◽  
Gregory Y. H. Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Electronic Device ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
High Rate ◽  
Cardiac Implantable Electronic Device ◽  
The West ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Background Sustained atrial high‐rate episodes (SAHREs) among individuals with a cardiac implantable electronic device are associated with an increased risk of adverse outcomes. Risk stratification for the development of SAHREs has never been investigated. We aimed to assess the performance of the C 2 HEST (coronary artery disease or chronic obstructive pulmonary disease [1 point each], hypertension [1 point], elderly [age ≥75 years, 2 points], systolic heart failure [2 points], thyroid disease [1 point]) score in predicting SAHREs in patients with cardiac implantable electronic devices without atrial fibrillation. Methods and Results Five Hundred consecutive patients with cardiac implantable electronic devices in the West Birmingham Atrial Fibrillation Project in the United Kingdom were followed since the procedure to observe the development of SAHREs, defined by atrial high‐rate episodes lasting >24 hours. Risk factors and incidence of SAHREs were analyzed. The predictive value of the C 2 HEST score for SAHRE prediction was evaluated. Over a mean follow‐up of 53.1 months, 44 (8.8%) patients developed SAHREs. SAHREs were associated with higher all‐cause mortality ( P <0.001) and ischemic stroke ( P =0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHREs increased by the C 2 HEST score (39% higher risk per point increase). Among patients with a C 2 HEST score ≥4, the incidence of SAHREs was 3.62% per year (95% CI, 2.14–5.16). The C 2 HEST score had moderate predictive capability (area under the curve, 0.73; 95% CI, 0.64–0.81) and discriminative ability (log‐rank P =0.003), which was better than other clinical scores (CHA 2 DS 2 ‐VASc, CHADS 2 , HATCH). Conclusions The C 2 HEST score predicted SAHRE incidence in patients without atrial fibrillation who had an cardiac implantable electronic device, with the highest risk seen in patients with a C 2 HEST score ≥4 The benefit of using the C 2 HEST score in clinical practice in this patient population needs further investigation.

scholarly journals Antiarrhythmic therapy for atrial fibrillation: current guidelines of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (ESC/EACTS)

2021 ◽  
Vol 20 (5) ◽  
pp. 2962
Author(s):  
A. I. Tarzimanova ◽  
V. L. Doshchitsin
Keyword(s):  
Atrial Fibrillation ◽  
Thoracic Surgery ◽  
European Society ◽  
Rate Control ◽  
European Association ◽  
Rhythm Control ◽  
Ventricular Rate ◽  
Thromboembolic Events ◽  
Increased Risk ◽  
European Society Of Cardiology

The treatment of atrial fibrillation (AF) remains one of the most difficult tasks in modern cardiology. In 2020, the European Society of Cardiology (ESC), together with the European Association for Cardio-Thoracic Surgery (EACTS), published guidelines for the diagnosis and management of AF, which include several new directives.ESC experts have formulated a novel concept for treatment of AF patients. The first component of treatment ‘A' (Anticoagulation/ Avoid stroke) is anticoagulant therapy in patients with increased risk of thromboembolic events. The second line of treatment ‘B' (Better symptom control) is the control of arrhythmia symptoms, selection of a rhythm control strategy or ventricular rate control. The third direction ‘C' includes cardiovascular risk factors and comorbid conditions management.The most challenging tasks in AF treatment are the control of arrhythmia symptoms. As in the previous version of 2016 guidelines, the latest ones identify 2 following strategies in treatment of AF: rhythm control and ventricular rate control.According to the current ESC/EACTS guidelines (2020), antiarrhythmic therapy continues to be one of the important directions in AF management. Early prescription f antiarrhythmic and anticoagulant agents with an increased risk of thromboembolic events, catheter ablation can not only improve the quality of life, but also the prognosis of patients with AF.

Sign in / Sign up

Export Citation Format

Share Document