scholarly journals Incidence and risk factors of post-operative cognitive decline after ablation for atrial fibrillation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Zhang ◽  
Shi-Jun Xia ◽  
Xin Du ◽  
Chao Jiang ◽  
Yi-Wei Lai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cognitive Decline ◽  
Multivariable Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Reliable Change Index ◽  
Study Group ◽  
Practice Group ◽  
Post Operation

Abstract Background Catheter ablation is widely used in atrial fibrillation (AF) management. In this study, we are aimed to investigate the incidence of postprocedural cognitive decline in a larger population undergoing AF ablation under local anesthesia, and to evaluate the associated risk factors. Methods This study included 287 patients with normal cognitive functions, with 190 ablated AF patients (study group) and 97 AF patients who are awaiting ablation (practice group). We assessed the neuropsychological function of each patient for twice (study group: 24 h prior to ablation and 48 h post ablation; practice group: on the day of inclusion and 72 h later but before ablation). The reliable change index was used to analyze the neuropsychological testing scores and to identify postoperative cognitive dysfunction (POCD) at 48 h post procedure. Patients in the study group accepting a 6-month follow up were given an extra cognitive assessment. Results Among the ablated AF patients, 13.7% (26/190) had POCD at 48 h after the ablation procedure. Multivariable analysis revealed that, a minimum intraoperative activated clotting time (ACT) < 300 s (OR 3.82, 95% CI 1.48–9.96, P = 0.006) and not taking oral anticoagulants within one month prior to ablation(OR 10.35, 95% CI 3.54–30.27, P < 0.001) were significantly related to POCD at 48 h post-ablation. In 172 patients of the study group accepting a 6-month follow up, there were 23 patients with POCD at 48 h post-ablation and 149 patients without POCD. The global cognitive scores were decreased in 48 h post-operation tests (0 ± 1 vs − 0.15 ± 1.10, P < 0.001) and improved significantly at 6 months post-operation (0 ± 1 vs 0.43 ± 0.92, P < 0.001). In the 23 patients with POCD at 48 h after the procedure, global cognitive performance at 6 months was not significantly different compared with that at baseline (− 0.05 ± 1.25 vs − 0.19 ± 1.33, P = 0.32), while 13 of them had higher scores than baseline level. Conclusions Incident of POCD after ablation procedures is high in the short term. Inadequate periprocedural anticoagulation are possible risk factors. However, most POCD are reversible at 6 months, and a general improvement was observed in cognitive function at 6 months after ablation.

scholarly journals Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2927
Author(s):  
Amaar Obaid Hassan ◽  
Gregory Y. H. Lip ◽  
Arnaud Bisson ◽  
Julien Herbert ◽  
Alexandre Bodin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Multivariable Analysis ◽  
National Database ◽  
Increased Risk ◽  
Periapical Abscess ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

Analyses of Visuospatial and Visuoperceptual Errors as Predictors of Dementia in Parkinson’s Disease Patients with Subjective Cognitive Decline and Mild Cognitive Impairment

2020 ◽  
pp. 1-11
Author(s):  
Iván Galtier ◽  
Antonieta Nieto ◽  
María Mata ◽  
Jesús N. Lorenzo ◽  
José Barroso
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Poor Performance ◽  
Subjective Cognitive Decline ◽  
Independent Risk Factors

ABSTRACT Objective: Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in Parkinson’s disease (PD) are considered as the risk factors for dementia (PDD). Posterior cortically based functions, such as visuospatial and visuoperceptual (VS-VP) processing, have been described as predictors of PDD. However, no investigations have focused on the qualitative analysis of the Judgment of Line Orientation Test (JLOT) and the Facial Recognition Test (FRT) in PD-SCD and PD-MCI. The aim of this work was to study the VS-VP errors in JLOT and FRT. Moreover, these variables are considered as predictors of PDD. Method: Forty-two PD patients and 19 controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Analyses of errors were conducted following the procedure described by Ska, Poissant, and Joanette (1990). Follow-up assessment was conducted to a mean of 7.5 years after the baseline. Results: PD-MCI patients showed a poor performance in JLOT and FRT total score and made a greater proportion of severe intraquadrant (QO2) and interquadrant errors (IQO). PD-SCD showed a poor performance in FRT and made mild errors in JLOT. PD-MCI and QO2/IQO errors were independent risk factors for PDD during the follow-up. Moreover, the combination of both PD-MCI diagnosis and QO2/IQO errors was associated with a greater risk. Conclusions: PD-MCI patients presented a greater alteration in VS-VP processing observable by the presence of severe misjudgments. PD-SCD patients also showed mild difficulties in VS-SP functions. Finally, QO2/IQO errors in PD-MCI are a useful predictor of PDD, more than PD-MCI diagnosis alone.

scholarly journals DIAGNOSIS OF ATRIAL FIBRILLATION IN HEART FAILURE PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR OR CARDIAC RESYNCHRONISATION THERAPY.

2021 ◽  
Author(s):  
Barbara Dominik ◽  
Mitkowski Przemyslaw ◽  
Wojciech Zorawski ◽  
Ilona Kowalik ◽  
Adam Ciesielski
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Resynchronisation Therapy ◽  
Predisposing Factors ◽  
Study Group ◽  
Cardioverter Defibrillator ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

IntroductionImplantable cardioverter defibrillators register various types of arrhythmias. Thus they can be exploited to better identify patients with atrial fibrillation episodes and increase the proportion of patients who may benefit from implementation of pharmacological prophylaxis of thromboembolic events, most of which it turns out are asymptomatic.Material and methodsAssessment of the frequency, symptoms and predisposing factors for the occurrence of atrial fibrillation episodes in patients with implanted ICD (implantable cardioverter defibrillator) and CRT-D (cardiac resynchronisation therapy with defibrillator) based on the analysis of intracardiac electrocardiograms (IEGM) records. The study included 174 consecutive outpatient cases with heart failure, sinus rhythm and Implanted Cardioverter Defibrillator and Cardiac Resynchronisation Therapy with Defibrillator. Control visits with analysis of IEGM records occurred every three months. During mean follow-up of 20 months, 901 visits were carried out. 147 patients had at least one year of follow-up.ResultsAtrial fibrillation episodes in the study group occurred in 54 (31.0%) of patients and 71.4% were asymptomatic. Predisposing factors were: history of paroxysmal atrial fibrillation (37.0% vs 13.3%, p ˂ 0.001), atrioventricular conduction abnormalities (42.6% vs. 20.0%, p = 0.002), intraventricular conduction abnormalities (59.3% vs 40.8%, p = 0.02) and more severe mitral regurgitation (7.4% vs 0.8%, p = 0.04). Chronic renal disease was a risk factor for death in the study group. No stroke occurred during the study.ConclusionsEpisodes of paroxysmal AF in patients with systolic heart failure and implanted cardioverter-defibrillator systems are quite common. The majority of the episodes recorded in the study were asymptomatic.

Risk factors for fecal carriage of IMP-6-producing Enterobacteriaceae at a long-term care hospital in Japan: A follow-up report from the northern Osaka multicentre study group

2018 ◽  
Vol 24 (9) ◽  
pp. 769-772 ◽  
Author(s):  
Hideharu Hagiya ◽  
Norihisa Yamamoto ◽  
Ryuji Kawahara ◽  
Yukihiro Akeda ◽  
Rathina Kumar Shanmugakani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicentre Study ◽  
Long Term Care ◽  
Study Group ◽  
Care Hospital ◽  
Term Care ◽  
Fecal Carriage

Abstract 16704: Leukocyte Telomere Length and Risk of Stroke: The Strong Heart Family Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Caroline Goode ◽  
Jinying Zhao ◽  
Richard B Devereux ◽  
Santosh Murthy ◽  
Alexander E Merkler ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Telomere Length ◽  
Family Study ◽  
Leukocyte Telomere Length ◽  
Potential Biomarker ◽  
Primary Model ◽  
Strong Heart Family Study

Introduction: Leukocyte telomere length (LTL) is a potential biomarker of aging and associated with several age-related diseases. Current research on an association between LTL and incident stroke has had inconclusive results. We hypothesized that LTL is associated with incident stroke among American Indians (AI) in the Strong Heart Family Study (SHFS). Methods: The SHFS is a population-based cohort study of cardiovascular disease (CVD) and its risk factors. Participants (n=2,769) recruited from regions in Arizona, Oklahoma and the Dakotas were assessed for LTL and CVD risk factors during a clinic visit between 2001 and 2003. Incident stroke events were identified through the end of 2018 (mean follow-up: 16.4 years). We assessed the association between LTL and incident stroke using frailty models based on the proportional hazards, accounting for family relatedness and established stroke risk factors that include sex, geographical location, education, smoking, atrial fibrillation, diabetes mellitus, and hypertension. Results: Among 2,769 participants, the mean age was 40.6±17.2 and 41.4% were male. During follow-up, there were 79 (2.9%) incident stroke cases. In the primary model, which adjusted for demographic variables (sex, location and education), the hazard ratios (HR) for stroke in participants in the first and second LTL quartiles were significantly higher than those in the highest (longest) LTL quartile, with HRs of 3.1 (95%CI: 1.4 - 6.6) and 3.5 (95%CI: 1.7 - 7.5), respectively. After adjusting for smoking, atrial fibrillation, diabetes mellitus, and hypertension, the association between LTL and stroke was attenuated, but remained significant when comparing the second shortest LTL quartile to the longest LTL quartile, HR: 2.3 (95% CI: 1.1 – 5.0). Conclusions: In summary, LTL was associated with incident stroke among SHFS participants. Those with shorter LTL have higher risk of stroke. Longer follow-up time may add more power to data analyses since the SHFS is relatively young, with an average baseline age of 40 years. If results are confirmed in other populations, LTL may serve as a biomarker identifying high risk individuals for the purpose of stroke prevention.

Abstract 360: Neighborhood-level Poverty and Incident Atrial Fibrillation: Analysis of Electronic Health Records From 2005-2018

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Utibe R Essien ◽  
Megan McCabe ◽  
Sadiya S Khan
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Census Tract ◽  
Individual Level ◽  
Neighborhood Poverty ◽  
Cardiovascular Morbidity And Mortality ◽  
Race Ethnicity ◽  
Neighborhood Level

Introduction: Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality. Disparities in AF outcomes have been related to individual-level social determinants of health, including race/ethnicity and socioeconomic status. While neighborhood-level factors, such as poverty, have been related to prevalence of key risk factors (e.g. obesity, hypertension), the association between neighborhood poverty and incident AF has not been previously examined. Methods: Using the Northwestern Medicine Enterprise Data Warehouse, we identified adults free of cardiovascular disease, with at least 5 years of follow-up from January 1, 2005 - December 31, 2013. Residential addresses were geocoded and matched to census tract level poverty estimates from the American Community Survey. Neighborhood poverty was defined as the proportion of residents in the census tract living below the US-defined poverty threshold. We categorized neighborhood poverty levels into tertiles. Generalized linear mixed effects models were used to examine the association between tertiles of neighborhood poverty and incident AF, adjusting for demographic (age, sex, race/ethnicity, insurance type) and AF risk factors (hypertension, diabetes, obesity and smoking status). Results: The cohort comprised 29,069 adults with a mean (SD) age of 51.4 (11.3) years, which included 58% women and 10% non-Hispanic Blacks. Higher rates of obesity, diabetes, hypertension, and smoking were observed in higher poverty groups. Approximately, 3.4% of patients developed incident AF over a follow-up of 5 years. The adjusted odds of incident AF were higher for the medium poverty compared to the low poverty group (adjusted odds ratio, aOR 1.30 (95% CI 1.05-1.56). The aOR of incident AF was similarly higher in the high poverty compared to low poverty group though not statistically significant (Table). Conclusions: In a cohort of adults free of cardiovascular disease at baseline, we found that residence in a more deprived neighborhood was associated with higher rates of incident AF, even after adjustment for traditional risk factors. Understanding how neighborhood and individual-level clinical factors interact to increase the incidence of AF is critical to developing equitable prevention strategies in this increasingly common condition.

scholarly journals Immunoglobulin Abnormalities in Gaucher Disease: an Analysis of 278 Patients Included in the French Gaucher Disease Registry

2020 ◽  
Vol 21 (4) ◽  
pp. 1247 ◽  
Author(s):  
Yann Nguyen ◽  
Jérôme Stirnemann ◽  
Florent Lautredoux ◽  
Bérengère Cador ◽  
Monia Bengherbia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gaucher Disease ◽  
Multivariable Analysis ◽  
Autosomal Recessive Disorder ◽  
Hematologic Malignancies ◽  
Severe Thrombocytopenia ◽  
Cox Models ◽  
Non Hodgkin Lymphoma ◽  
Polyclonal Gammopathy

Gaucher disease (GD) is a rare lysosomal autosomal-recessive disorder due to deficiency of glucocerebrosidase; polyclonal gammopathy (PG) and/or monoclonal gammopathy (MG) can occur in this disease. We aimed to describe these immunoglobulin abnormalities in a large cohort of GD patients and to study the risk factors, clinical significance, and evolution. Data for patients enrolled in the French GD Registry were studied retrospectively. The risk factors of PG and/or MG developing and their association with clinical bone events and severe thrombocytopenia, two markers of GD severity, were assessed with multivariable Cox models and the effect of GD treatment on gammaglobulin levels with linear/logarithmic mixed models. Regression of MG and the occurrence of hematological malignancies were described. The 278 patients included (132 males, 47.5%) were followed up during a mean (SD) of 19 (14) years after GD diagnosis. PG occurred in 112/235 (47.7%) patients at GD diagnosis or during follow-up and MG in 59/187 (31.6%). Multivariable analysis retained age at GD diagnosis as the only independent risk factor for MG (> 30 vs. ≤30 years, HR 4.71, 95%CI [2.40–9.27]; p < 0.001). Risk of bone events or severe thrombocytopenia was not significantly associated with PG or MG. During follow-up, non-Hodgkin lymphoma developed in five patients and multiple myeloma in one. MG was observed in almost one third of patients with GD. Immunoglobulin abnormalities were not associated with the disease severity. However, prolonged surveillance of patients with GD is needed because hematologic malignancies may occur.

scholarly journals P1441 Predictors of systemic embolisms in a large cohort of left ventricular noncompaction patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Casas ◽  
G Oristrell ◽  
J Limeres ◽  
R Barriales ◽  
J R Gimeno ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Severe Phenotype ◽  
Ventricular Noncompaction ◽  
Increased Risk

Abstract BACKGROUND Left ventricular noncompaction (LVNC) is associated with an increased risk of systemic embolisms (SE). However, incidence and risk factors are not well established. PURPOSE To evaluate the rate of SE in LVNC and describe risk factors. METHODS LNVC patients were included in a multicentric registry. Those with SE were considered for the analysis. RESULTS 514 patients with LVNC from 10 Spanish centres were recruited from 2000 to 2018. During a median follow-up of 4.2 years (IQR 1.9-7.1), 23 patients (4.5%) had a SE. Patients with SE (Table 1) were older at diagnosis, with no differences in gender and had similar cardiovascular risk factors. They were more frequently under oral anticoagulation (OAC). Besides, they had a more reduced LVEF, and more dilated LV and left atrium (LA). Late gadolinium enhancement (LGE) was more frequent, altogether suggesting a more severe phenotype. Patients with SE had non-significantly higher rates of hospitalization for heart failure (33% Vs 24%, p = 0.31) and atrial fibrillation (35% Vs 19%, p = 0.10). In multivariate analysis, only LA diameter was an independent predictor of SE (OR 1.04, p = 0.04). A LA diameter &gt; 45 mm had an independent 3 fold increased risk of SE (OR 3.04, p = 0.02) (Image 1). CONCLUSIONS LVNC carries a moderate mid-term risk of SE, which appears to be irrespective of atrial fibrillation and associated with age, LV dilatation and systolic dysfunction and mainly LA dilatation. This subgroup of patients should be considered for oral anticoagulation in primary prevention. Table 1 Systemic embolisms (n = 23) No systemic embolisms (n = 491) p Men, n (%) 15 (65) 289 (56) 0.52 Median age at diagnosis (IQR) - yr 60 (48-76) 48 (30-64) 0.02 Median follow up (IQR) - yr 5.9 (3.1-7.8) 4.2 (1.8-7.1) 0.18 OAC, n (%) 19 (83) 118 (24) 0.01 LVEF (SD) - % 37 (15) 48 (17) 0.01 LVEDD (SD) - mm 58 (11) 54 (10) 0.04 LA diameter (SD) - mm 46 (9) 39 (9) 0.01 Characteristics of patients with and without systemic embolisms Abstract P1441 Figure. Image 1

scholarly journals Studying the effects of fish oil infusion to prevent atrial fibrillation after cardiac surgery: data from implantable continuous cardiac monitor

2015 ◽  
Vol 18 (3) ◽  
pp. 12
Author(s):  
S. M. Yefremov ◽  
Ye. A. Pokushalov ◽  
A. B. Romanov ◽  
A. M. Chernyavskiy ◽  
A. N. Shilova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Fatty Acids ◽  
Polyunsaturated Fatty Acids ◽  
Postoperative Atrial Fibrillation ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Omega 3 ◽  
Cardiac Monitor

The study was aimed at testing the hypothesis that perioperative infusion of omega-3 polyunsaturated fatty acids would reduce the incidence of postoperative atrial fibrillation in CAD patients operated under CPB. The authors carried out a prospective, randomised, double-blind, placebo-controlled study. 39 CAD patients who had undergone surgery under cardiopulmonary bypass were randomized into 2 groups. 18 patients were infused with omega-3 polyunsaturated fatty acids (Omegaven, Fresenius Kabi, Germany) starting with 200 mg/kg/day before anaesthesia induction for 24 hours followed by 100 mg/kg/day from second to seventh day postoperatively. 21 patients received an equivalent dose of placebo (Intralipid, Fresenius Kabi, Germany). The primary endpoint was freedom from atrial fibrillation at 2-year follow-up. A Reveal cardiac monitor was implanted subcutaneously in all patients. Data from cardiac monitor was collected on the 10th day and at 3, 6, 12 and 24 months postoperatively. Postoperative atrial fibrillation developed in 4 (19%) patients in the control group and in 5 (27.8%) patients in the study group at 10-day follow-up (p = 0.88). At 2-year follow-up, 5 (27.8%) patients in the control group and 6 (35.3%) patients in the study group had atrial fibrillation (p = 0.9). The results of our research do not confirm the efficiency of perioperative infusion of omega-3 polyun-saturated fatty acids to prevent the occurrence of atrial fibrillation.

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