Remote monitoring and early detection of sub-clinical atrial fibrillation in implantable cardioverter defibrillator recipients: incidence, risk factors and prognostic significance (Preprint)

2018 ◽  
Author(s):  
Elodie Surget ◽  
Claude Kouakam ◽  
Ninni Sandro ◽  
Loic Finat ◽  
Cédric Klein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Remote Monitoring ◽  
Left Atrial ◽  
Thyroid Dysfunction ◽  
Anticoagulation Therapy ◽  
Systemic Embolism ◽  
Cardioverter Defibrillator ◽  
Hemorrhagic Complications ◽  
Atrial Enlargement

BACKGROUND Atrial high rate episodes (AHREs) detected by cardiac electronic implantable devices are common. They are significantly associated with mortality and morbidity due to systemic embolism and ischemic stroke. Much earlier detection of AHREs might allow the timely introduction of therapies to protect the patient. OBJECTIVE The aim of this study was to determine the incidence and risk factors of AHREs in patients with implantable defibrillator in the era of remote monitoring (RM), and to analyze the choice of anticoagulant treatment strategies and its potential complications. METHODS 1226 patients with implantable cardioverter defibrillator remotely followed-up were prospectively included from January 2009 to December 2016 at Lille University Hospital. The first phase of the study focuses primarily on the incidence and risk factors of AHREs and the second analysis was confined to patients presenting at least one AHRE. Survey analysis was determined using the Kaplan-Meier method and compared between groups with the Logrank test. RESULTS Among the 1226 patients, 63 presented at least one AHRE detected by RM which corresponds to an incidence of 5.14%. In ¾ of cases, the AHRE was completely asymptomatic. In the remaining quarter, the most common symptom was dyspnea. The main precipitating factor was infection. AHRE risk factors were thyroid dysfunction (p = 0.0047) and left atrial enlargement (p = 0.0317). None of these factors were associated with atrial fibrillation duration. The mean CHA2DS2-VASc score was 2.64 ± 1.38. Oral anticoagulation therapy was introduced in 47 patients (88.7%). The incidence of thromboembolic events was 1.6% and that of anticoagulation-related hemorrhagic complications was 8.5% (n = 4) with ¾ major. CONCLUSIONS AHRE is a common disease. Risk factors are thyroid dysfunction and left atrial enlargement. Its thromboembolism risk seems to be low. The introduction of anticoagulation therapy is based on the evaluation of clinical risk scores for systemic embolism and its indication must be regularly assessed because hemorrhagic complications are common.

scholarly journals Left atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Yasuhiro Hamatani ◽  
Hisashi Ogawa ◽  
Kensuke Takabayashi ◽  
Yugo Yamashita ◽  
Daisuke Takagi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Independent Predictor ◽  
Systemic Embolism ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

scholarly journals Clinical application of the novel 4S-AF scheme for the characterisation of patients with atrial fibrillation: a report from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
W.Y Ding ◽  
M Proietti ◽  
G Boriani ◽  
F Marin ◽  
C Blomstrom-Lundqvist ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Thromboembolic Event ◽  
Stroke Risk ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Atrial Enlargement

Abstract Background Current classification systems recommended by major international guidelines are based on a single domain of atrial fibrillation (AF): temporal pattern, symptom severity or underlying comorbidity. Lack of integration between these various elements limits our approach to patients with AF and acts as a barrier against the delivery of better holistic care. The 4S-AF classification scheme was recently introduced as a means for the characterisation of patients with AF. It comprises of 4 domains: stroke risk (St), symptoms (Sy), severity of AF burden (Sb) and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and effects of individual domains on outcomes in AF. Methods Patients with AF from 250 centres across 27 participating European countries were included. All patients were over 18 years old and had electrocardiographic confirmation of AF within 12 months prior to enrolment. Data on demographics and comorbidities were collected at baseline. Individual domains of the 4S-AF scheme were assessed using the CHA2DS2-VASc score (St), European Heart Rhythm Association classification (Sy), temporal classification of AF (Sb), and cardiovascular risk factors and the degree of left atrial enlargement (Su). Each of these domains were used during multivariable cox regression analysis. Results A total of 6321 patients were included in the present analysis, corresponding to 57.0% of the original cohort of 11096 patients. The median age of patients was 70 (interquartile range [IQR] 62–77) years with 2615 (41.4%) females. Among these patients, 528 (8.4%) had low stroke risk (St=0), 3002 (47.5%) no or mild symptoms (Sy=0), 2558 (40.5%) newly diagnosed or paroxysmal AF (Sb=0), and 322 (5.1%) no cardiovascular risk factors or left atrial enlargement (Su=0). Median follow-up was 24 months. Using multivariable cox regression analysis, independent predictors of all-cause mortality were (St) (adjusted hazard ratio [aHR] 8.21 [95% CI, 2.60–25.9]), (Sb) (aHR 1.21 [95% CI, 1.08–1.35]) and (Su) (aHR 1.27 [95% CI, 1.14–1.41]). For cardiovascular mortality and any thromboembolic event, only (Su) (aHR 1.73 [95% CI, 1.45–2.06]) and (Sy) (aHR 1.29 [95% CI, 1.00–1.66]) were statistically important, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Conclusion Overall, we demonstrated that the 4S-AF scheme may be used to provide clinical characterisation of patients with AF using routinely collected data, and each of the domains within the 4S-AF scheme were independently associated with adverse long-term outcomes of all-cause mortality, cardiovascular mortality and/or any thromboembolic event. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 12799: Left Atrial Enlargement is an Independent Risk Factor of Stroke or Systemic Embolism in Atrial Fibrillation Patients: The Fushimi AF Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yasuhiro Hamatani ◽  
Daisuke Takagi ◽  
Hisashi Ogawa ◽  
Masahiro Esato ◽  
Yeong-Hwa Chun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Left Atrial ◽  
Systemic Embolism ◽  
Left Atrial Diameter ◽  
Left Atrial Enlargement ◽  
Valvular Heart Diseases ◽  
Increased Risk ◽  
Atrial Enlargement

Introduction: Atrial fibrillation (AF) is a common arrhythmic disorder and increasing significantly. Stroke or systemic embolism (SE) is a devastating complication of AF. Controversy exists regarding whether left atrial enlargement is a risk factor of stroke/SE in AF patients. Hypothesis: Left atrial enlargement might be associated with the incidence of stroke/SE. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, which represented a typical urban community in Japan. We started to enroll patients from March 2011, and follow-up data were available for 2,724 patients by April 2015 (median follow-up period 808 days). Left atrial enlargement (LAE) was diagnosed if the left atrial diameter measured by transthoracic echocardiography was >45 mm. We compared the backgrounds and incidences of events during follow-up period between those with LAE and those without it (non-LAE). Results: Backgrounds and incidences of events between LAE and non-LAE are shown in the Table. LAE group showed higher incidence of stroke/SE during follow-up period, compared with non-LAE group (hazard ratio (HR): 1.81, 95% confidence interval (CI): 1.29-2.57, p<0.01). After adjustment by the components of CHADS2 score and oral anticoagulant prescription, LAE was independently associated with higher risk for stroke/SE (HR: 1.70, 95% CI: 1.20-2.43, p<0.01). This was also the case when we defined cut-off as 40 mm (HR: 1.67, 95% CI: 1.12-2.55, p=0.01), and as 50 mm (HR: 1.58, 95% CI: 1.08-2.29, p=0.02), or we analyzed left atrial diameter as continuous variables (HR (per 1mm): 1.03, 95% CI: 1.01-1.05, p<0.01). Even after adjustment by type of AF (paroxysmal or sustained) and valvular heart diseases, LAE remained to be independently associated with the risk of stroke/SE (HR: 1.57, 95% CI: 1.08-2.31, p=0.02). Conclusion: Left atrial enlargement was independently associated with the increased risk of stroke/SE in AF patients.

scholarly journals Moderate chronic kidney disease and left atrial enlargement independently predict thromboembolic events and mortality in elderly patients with atrial fibrillation: a retrospective single-center study

2019 ◽  
Vol 47 (9) ◽  
pp. 4312-4323
Author(s):  
Hai-jun Wang ◽  
Kai-liang Li ◽  
Jian Li ◽  
Kun Lin ◽  
Yang Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Elderly Patients ◽  
Left Atrial ◽  
Thromboembolic Events ◽  
Single Center ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement ◽  
Moderate Chronic Kidney Disease

Objective This study aimed to evaluate the effects of moderate chronic kidney disease (CKD) and left atrial enlargement on the risks of thromboembolic events, and all-cause and cardiovascular mortalities in elderly patients with atrial fibrillation (AF). Methods We retrospectively studied 751 patients (82.16% men, mean age: 79.0±9.1 years) with AF who were followed up for an average of 34.5 months at a single center. Adjusted hazard ratios (HRs) of risk factors for adverse clinical events were calculated using the Cox proportional hazards model. Results The risks of thromboembolic events, and all-cause and cardiovascular deaths were higher in patients with moderate CKD compared with patients with normal renal function after adjusting for other traditional risk factors (HR: 1.63, 95% confidence interval (CI): 1.03–2.58; HR: 1.55, 95% CI: 1.08–2.23; HR: 3.49, 95% CI: 1.57–7.74; respectively). Left atrial volume index >28.0 mL/m2 was an independent risk factor associated with thromboembolic events and all-cause and cardiovascular deaths (HR: 1.62, 95% CI: 1.21–2.33; HR: 1.56, 95% CI: 1.16–2.10; HR: 1.87, 95% CI: 1.07–3.28; respectively). Conclusions Moderate CKD and left atrial enlargement may predict thromboembolic events, and all-cause and cardiovascular mortalities in elderly patients with AF without anticoagulation therapy.

scholarly journals Risk factors for incident atrial fibrillation with and without left atrial enlargement in women

2013 ◽  
Vol 168 (3) ◽  
pp. 1894-1899 ◽  
Author(s):  
David Conen ◽  
Robert J. Glynn ◽  
Roopinder K. Sandhu ◽  
Usha B. Tedrow ◽  
Christine M. Albert
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

scholarly journals Clinical impact of left atrial enlargement in Korean patients with atrial fibrillation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Soo Cho ◽  
Hyoung-Seob Park ◽  
Myung-Jin Cha ◽  
So-Ryoung Lee ◽  
Jin-Kyu Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Clinical Impact ◽  
Volume Index ◽  
Systemic Embolism ◽  
Korean Patients ◽  
Atrial Enlargement ◽  
Anterior Posterior

AbstractWe sought to evaluate the clinical implication of LAE based on left atrial anterior–posterior (LA AP) dimension or LA volume index (LAVI) in Korean patients with atrial fibrillation (AF). We enrolled 8159 AF patients from the CODE-AF registry. The primary outcome was rate of stroke or systemic embolism (SSE). The prevalence of mild, moderate, and severe LAE by LA AP dimension was 30.6%, 18.5%, and 21.4%, and by LAVI (available in 5808 patients) was 15.7%, 12.5% and 37.8%, respectively. Compared with no or mild LAE, patients with significant LAE (moderate to severe LAE, n = 3258, 39.9%) were associated with a higher rate of SSE (2.5% vs. 1.4%, P = 0.001). Multivariable analysis suggested presence of significant LAE by LA AP dimension was associated with a higher risk of SSE in the overall population (HR 1.57, 95% CI: 1.14–2.17, P = 0.005) and in patients using anticoagulants (n = 5836, HR 1.79, 95% CI: 1.23–2.63, P = 0.002). Patients with significant LAE by LAVI were also at higher risk of SSE (HR 1.58, 95% CI: 1.09–2.29, P = 0.017). In conclusion, significant LAE by LA dimension or LAVI was present in 39.9% and 50.2% of AF patients, respectively, and was associated with a higher rate of SSE.

Consideration of non-valvular atrial fibrillation with left atrial appendage thrombus formation despite under appropriate oral anticoagulation therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Shiraki ◽  
H Tanaka ◽  
K Yamashita ◽  
Y Tanaka ◽  
K Sumimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Thrombus Formation ◽  
Anticoagulation Therapy ◽  
Left Ventricular ◽  
Volume Index ◽  
Oral Anticoagulation Therapy

Abstract Background Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia, with a prevalence of about 2–3% in the general population. In accordance with CHADS2 or CHA2DS2-VASc score, appropriate oral anticoagulation therapy such as warfarin or direct oral anticoagulants (DOAC) significantly reduced the risk of thromboembolic events. However, left atrial (LA) thrombus can be detected in the LA appendage (LAA) in AF patients despite appropriate oral anticoagulation therapy. Purpose Our purpose was to investigate the associated factors of LAA thrombus formation in non-valvular atrial fibrillation (NVAF) patients despite under appropriate oral anticoagulation therapy. Methods We retrospectively studied consecutive 286 NVAF patients for scheduled catheter ablation or electrical cardioversion for AF in our institution between February 2017 and September 2019. Mean age was 67.1±9.4 years, 79 patients (29.5%) were female, and 140 (52.2%) were paroxysmal AF. All patients underwent transthoracic and transesophageal echocardiography before catheter ablation or electrical cardioversion. All patients received appropriate oral anticoagulation therapy including warfarin or DOAC for at least 3 weeks prior to transesophageal echocardiography based on the current guidelines. LAA thrombus was defined as an echodense intracavitary mass distinct from the underlying endocardium and not caused by pectinate muscles by at least three senior echocardiologists. Results Of 286 NVAF patients with under appropriate oral anticoagulation therapy, LAA thrombus was observed in 9 patients (3.3%). Univariate logistic regression analysis showed that age, paroxysmal AF, CHADS2 score ≥3, left ventricular end-diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), LA volume index (LAVI), mitral inflow E and mitral e' annular velocities ratio (E/e'), and LAA flow were associated with LAA thrombus formation. It was noteworthy that multivariate logistic regression analysis showed that LAA flow was independent predictor of LAA thrombus (OR: 0.72, 95% CI: 0.59–0.89, p&lt;0.005) as well as LVEF. Furthermore, receiver operating characteristic (ROC) curve analysis identified the optimal cutoff value of LAA flow for predicting LAA thrombus as ≤15cm/s, with a sensitivity of 88%, specificity of 93%, and area under the curve (AUC) of 0.95. Conclusions LAA flow was strongly associated with LAA thrombus formation even in NVAF patients with appropriate oral anticoagulation therapy. According to our findings, further strengthen of oral anticoagulation therapy or percutaneous transcatheter closure of the LAA may be considered in NVAF patients with appropriate oral anticoagulation therapy but low LAA flow, especially &lt;15cm/s. Funding Acknowledgement Type of funding source: None

scholarly journals Sacubitril/valsartan reduces atrial fibrillation and supraventricular arrhythmias in patients with HFrEF and remote monitoring: preliminary data from the SAVE THE RHYTHM

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Guerra ◽  
L Pimpini ◽  
M Flori ◽  
D Contadini ◽  
G Stronati ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Remote Monitoring ◽  
Preliminary Data ◽  
Premature Ventricular Contractions ◽  
Cardioverter Defibrillator ◽  
Neprilysin Inhibitor ◽  
History Of ◽  
Secondary Endpoints ◽  
The Mean

Abstract Background Sacubitril/valsartan, the first combined angiotensin receptor-neprilysin inhibitor, has demonstrated a significant benefit compared to angiotensin inhibitor in decreasing ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) shocks in patients with heart failure with reduced ejection fraction (HFrEF). At present, there is no study which evaluates the effect of sacubitril/valsartan on the supraventricular arrhythmic burden in HFrEF patients with an ICD or cardiac resynchronisation therapy-defibrillator (CRT-D) and remote monitoring. Purpose To evaluate the effect of sacubitril/valsartan on the supraventricular arrhythmic burden in HFrEF patients with an ICD or CRTD and remote monitoring. Methods The SAVETHERHYTHM ((SAacubitril Valsartan rEal-world registry evaluating THE arRHYTHMia burden in HFrEF patients with implantable cardioverter defibrillator) is a multicentre, observational, prospective registry enrolling all patients with HFrEF, ICD or CRT-D actively followed through remote monitoring and starting treatment with sacubitril/valsartan. All patients are followed-up for at least one year after sacubitril/valsartan start. The primary endpoint is the mean number of sustained atrial tachycardia or atrial fibrillation (AT/AF) episodes per month. Secondary endpoints include the total burden of AT/AF (defined as the percentage of time in AT/AF per day), the mean number of premature ventricular contractions (PVC) per hour and the percentage of biventricular pacing per day (in patients with CRT-D). All primary and secondary endpoints are collected through remote monitoring. Results At the time of the first ad interim analysis, 60 patients (85.2% male, age 69±10 years) were consecutively enrolled. After treatment with sacubitril/valsartan, patients with at least one episode of AT/AF per month decreased from 32.8% to 21.3% (p=0.015). A significant decrease in number of AT/AF episodes (from 4.3 to 1.2 per year), in AT/AF burden (from 12% to 9%) and in number of PVC (from 83 to 74 per hour) were seen in patients with a previous diagnosis of paroxysmal or persistent AF (n=15; all p&lt;0.05). Patients with permanent AF (n=7) experienced no benefits from sacubitril/valsartan therapy in terms of arrhythmic burden reduction. Patients with no previous history of AF (n=38) showed a decrease in number of AT/AF episodes (from 2.0 to 0.8 per year) and in number of PVC (from 77 to 49 per hour, all p&lt;0.05). No new diagnosis of clinical AF was made after starting treatment with sacubitrl/valsartan, and patients with subclinical AT/AF episodes decreased from 8% to 3%. Conclusions Preliminary data suggest that therapy with sacubitril/valsartan could decrease arrhythmic burden in patients with non-permanent AF and reduce subclinical AT/AF episodes in patients with no history of AF. No positive effect has been noted in patients with permanent AF. Funding Acknowledgement Type of funding source: None

Abstract 12707: Chads2 and Chads2vasc Scores Predict the Risk for Left Atrial Thrombus in Patients With Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fengpeng Jia ◽  
Minghuan Fu ◽  
Zhiyu Ling ◽  
Suxin Luo ◽  
Jun Gu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Strong Association ◽  
Anticoagulation Therapy ◽  
Scoring Systems ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Chads2 Score ◽  
Risk Patients ◽  
The Relationship

Background: The study was to evaluate the value of CHADS2 and CHADS2VASC scores on predicting left atrial (LA) thrombus in the patients with atrial fibrillation (AF). Methods and Results: All the non-valvular AF patients undergoing AF ablation from June 2010 to June 2012 were included and divided into two groups: patients without anticoagulation and with Coumadin anticoagulation for at least 4 weeks. The relationship between CHADS2 and CHADS2VASC scores and LA thrombus as identified on transesophageal echocardiography (TEE) was analyzed prior to ablation. A total of 397 patients underwent pre-ablation TEE: 212 patients without anticoagulation, and 185 with anticoagulation. There were no differences in the CHADS2 and CHADS2VASC scores in the two groups. LA thrombus was present in 15.6% and 5.9% for the patients without anticoagulation and for those with anticoagulation, respectively (p = 0.002). There was a strong association between CHADS2 and LA thrombus, and between CHADS2VASC and LA thrombus in the two groups. No thrombus was identified in patients with CHADS2VASC score of 0 in both groups. However, thrombus was detected in 3.5% of patients with CHADS2 score of 0 in the group without anticoagulation, while no thrombus was present in the ones with anticoagulation. CHADS2VASC score of ≥1 (r=2.03, p = 0.04) was the only factor independently associated with LA thrombus in patients without anticoagulation, while both CHADS2VASC score of ≥2 (r=2.61, p=0.02) and CHADS2 score of ≥2 (r=2.73, p=0.01) were independently associated with LA thrombus. Further analyses showed that CHADS2VASC score was a better predictor for LA thrombus than CHADS2 score in patients without anticoagulation. However, there was no difference between the two scoring systems in predicting LA thrombus in patients with anticoagulation. Conclusions: LA thrombus was associated with CHADS2VASC and CHADS2 scores in non-valvular AF patients without anticoagulation. CHADS2VASC score was a better predictor than CHADS2 score for LA thrombus in patients without anticoagulation. The data suggested that it might be unnecessary to undergo a TEE evaluation for LA thrombus in low risk patients identified by CHADS2VASC score regardless anticoagulation therapy prior to cardioversion or ablation.

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