Hybrid approach to treatment of patients with severe heart failure and arrhythmia

Management of patients with terminal heart failure is one of the most serious ongoing problems in cardiac surgery. In addition, the clinical progression of heart failure is often characterized by cardiac rhythm disturbances, with atrial fibrillation and atrial flutter being the most common types of these disorders. The prognosis may be extremely unfavorable if inappropriate tactics of treatment is used. Development of interventional and minimally invasive surgery expanded the possibilities of treatment of such patients. The article looks at some application features of a hybrid approach to treatment of a patient with atrial flutter and a terminal stage of chronic heart failure.Received 3 May 2017. Accepted 24 June 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

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BURDEN OF ATRIAL FIBRILLATION OR ATRIAL FLUTTER IN DIASTOLIC HEART FAILURE HOSPITALIZATIONS: INSIGHT FROM 2017 NATIONAL INPATIENT SAMPLE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)01642-9 ◽

2021 ◽

Vol 77 (18) ◽

pp. 283

Author(s):

Harshith Thyagaturu ◽

Kashyap Shah ◽

Bishesh Shrestha ◽

Sittinun Thangjui ◽

Meghnath Reddy

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Atrial Flutter ◽

Diastolic Heart Failure ◽

National Inpatient Sample

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Abstract TP138: Chronic Kidney Disease in Heart Failure Patients is Associated with Increased Prevalence of Atrial Fibrillation or Atrial Flutter as well as CVA/TIA

Stroke ◽

10.1161/str.51.suppl_1.tp138 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Christopher Lu ◽

Jack Chan ◽

Zejia Yu ◽

Paula Anzenberg ◽

Mikhail Torosoff

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Risk Assessment ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Atrial Flutter ◽

Stroke Risk ◽

Multivariate Logistic Regression Analysis ◽

History Of ◽

Get With The Guidelines

Background: The CHADS-VASC score does not incorporate renal dysfunction in stroke risk assessment in patients with atrial fibrillation and the prevalence of atrial fibrillation, atrial flutter, and cerebrovascular accidents (CVA) in patients with concurrent CHF and CKD is not well investigated. Objective: Evaluate the prevalence of history of stroke, atrial fibrillation, atrial flutter in patients with CHF and CKD. Methods: Data from the single institution Get With The Guidelines- Heart Failure (GWG-HF) cohort of 2938 consecutive inpatients with known GFR was utilized. CHADS-VASC score was calculated from the GWG-HF variables. Chronic kidney disease (CKD) was defined as GFR <60 ml/min. Results: An overwhelming majority (95%) of GWG-HF patients had elevated >1 CHADS-VASC score, which was also significantly more common in patients with CKD (97.6% vs. 91.7% in patients without CKD, p<0.0001). Average CHADS-VASC score was also significantly increased in patients with CKD (4+/-1.3 vs. 3.3+/-1.4, p<0.0001). Furthermore, CKD was associated with increased prevalence of atrial fibrillation and/or flutter (45.6% vs. 35.3%, p<0.0001) and stroke history (17.5% vs. 12.3%, p=0.002). When stroke and TIA histories were removed from the CHADS-VASC score ("CHAD-VASC score"), the remaining variables were strongly predictive of stroke or TIA (14.2% vs. 3.8%, p<0.0001). In multivariate logistic regression analysis, both CHAD-VASC score (OR 2.6, 95%CI 1.3-5.4, p=0.009) and CKD (OR 1.5, 95%CI 1.2-1.8, p=0.001) were associated significantly increased odds of prior stroke or TIA. Conclusions: In patients admitted with heart failure, CKD is associated with increased prevalence of atrial fibrillation or atrial flutter as well as increased prevalence of CVA/TIA. Further prospective studies are warranted to examine whether CKD history should be included in stroke risk assessment in patients with atrial fibrillation or atrial flutter, in conjunction with existing risk assessment frameworks.

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