Interrupting the Natural History of Atrial Fibrillation. Image from the Future.

Intro: The natural history of cardiac function in atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) is incompletely described, as are heart rate patterns pre- and post-ablation. Goals: Examine autonomic status pre- and post-ablation using cardiac data (n=346) captured by implanted recorders Methods: Daily records (90-day pre to 365-day post ablation) were analyzed to extract parameters viz. heart rate variability (HRV), daytime heart rate (DHR) and nighttime heart rate (NHR). Analysis of variance was used to assess relationships between covariates (age, sex, etc.) and pre-post changes in parameters. We define "success" as patients who had no recurrence during post-ablation period per guidelines (“failed” otherwise). Results: Prior to ablation, mean DHR, NHR, and HRV were 69±10bpm, 60±9bpm, 122±32msec, respectively. After PVI, there was an immediate increase of ~5bpm in DHR (P<1e-4) and a more pronounced increase of ~11bpm in NHR (P<1e-4). HRV exhibited an immediate post-ablation peak decreasing by ~60msec (P<1e-4), with rapid recalibration over the first 10 post ablation days (increase of 20-25msec). Antiarrhythmic drug-use was a significant factor only in explaining changes in HRV (P=0.0126), while age was a significant factor only for the changes in DHR (P<1e-4). Comparing between subgroups, DHR and NHR were generally higher in the success than the failed group. At baseline, older patients (92 patients were of age>65years) had a significantly lower DHR and NHR than younger patients (117 were of age<56years). These age-based differences were amplified post ablation in DHR and NHR, but not HRV. Conclusions: PVI results in significant and sustained changes in heart rate parameters related to autonomic function. This relationship was observed globally, with the success group having significantly greater rises in DHR and NHR when compared to the failed group. Future work will explore whether these patterns exist in different cohorts.

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4. Religion

10.1093/actrade/9780198849780.003.0005 ◽

2021 ◽

pp. 81-103

Author(s):

James A. Harris

Keyword(s):

Natural History ◽

Human Nature ◽

Human Beings ◽

History Of Religion ◽

Natural Religion ◽

Treatise Of Human Nature ◽

The Future ◽

History Of

‘Religion' discusses Hume’s various treatments of religion, particularly in the essay ‘Of Miracles’, Dialogues concerning Natural Religion, and ‘The Natural History of Religion’. Hume's earlier writings show some interesting implications for religion, including A Treatise of Human Nature and the essay ‘Of National Characters’. Looking at ‘Of Miracles’ shows that Hume’s theme was not the possibility of miracles as such, but rather the rational grounds of belief in reports of miracles. Considering the Dialogues emphasizes the distinction between scepticism and atheism. Meanwhile, ‘Natural History’ emphasizes Hume’s interest in the dangerous moral consequences of monotheism. What is the future for religion? Perhaps Hume was unlikely to have supposed that his writings would do anything to reduce religion’s hold on the vast majority of human beings.

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Chapter XXXVI Seeds of the Future (second Sowing)

Man and Wife ◽

10.1093/owc/9780199538171.003.0047 ◽

2008 ◽

Author(s):

Wilkie Collins

Keyword(s):

Natural History ◽

Aquatic Birds ◽

The Future ◽

History Of

And what did the visitors say of the Swans? They said, ‘Oh, what a number of them!’—which was all that was to be said, by persons ignorant of the natural history of aquatic birds. And what did the visitors say of the lake? Some of...

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The natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the manitoba follow-up study

ACC Current Journal Review ◽

10.1016/1062-1458(96)85192-0 ◽

1996 ◽

Vol 5 (1) ◽

pp. 55-56

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Natural History ◽

Follow Up Study ◽

Incidence Risk ◽

History Of

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Cardioversion and subsequent quality of life and natural history of atrial fibrillation

American Heart Journal ◽

10.1016/j.ahj.2016.10.018 ◽

2017 ◽

Vol 185 ◽

pp. 59-66 ◽

Cited By ~ 6

Author(s):

Sean D. Pokorney ◽

Sunghee Kim ◽

Laine Thomas ◽

Gregg C. Fonarow ◽

Peter R. Kowey ◽

...

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Natural History ◽

History Of

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NATURAL HISTORY OF MITRAL ANNULUS REMODELING IN PERMANENT ATRIAL FIBRILLATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60969-9 ◽

2013 ◽

Vol 61 (10) ◽

pp. E969

Author(s):

Michael Yin-Cheung Tsang ◽

Christina Luong ◽

John Jue ◽

Kenneth Gin ◽

Parvathy Nair ◽

...

Keyword(s):

Atrial Fibrillation ◽

Natural History ◽

Mitral Annulus ◽

Permanent Atrial Fibrillation ◽

History Of

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A NATURAL HISTORY OF COMPLICATIONS: CARDIOGENIC SHOCK A DECADE AFTER ATRIAL FIBRILLATION ABLATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)33558-0 ◽

2020 ◽

Vol 75 (11) ◽

pp. 2931

Author(s):

Leslie Appleton ◽

Ryan Orgel ◽

Kara Jo Sprigg ◽

Jason Katz ◽

Anil Gehi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Natural History ◽

Cardiogenic Shock ◽

Atrial Fibrillation Ablation ◽

History Of

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P1014The natural history of atrial fibrillation after the first clinical episode: a prospective observational study via implantable loop recorders

EP Europace ◽

10.1093/europace/euaa162.137 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

P Papakonstantinou ◽

E Simantirakis ◽

E Kanoupakis ◽

F Parthenakis ◽

P Vardas

Keyword(s):

Atrial Fibrillation ◽

Natural History ◽

Clinical Significance ◽

Loop Recorder ◽

Clinical Episode ◽

History Of ◽

Second Year ◽

Af Recurrence

Abstract Funding Acknowledgements The study was supported by Medtronic Inc Background The natural history of paroxysmal atrial fibrillation (AF) after the first clinical AF episode is not well known. AF burden is of clinical significance as it may have clinical implications concerning the long-term management of the arrhythmia and the decision-making on AF patients. Purpose To observe the natural history of AF in patients after their first clinical paroxysmal AF episode. Methods Thirty consecutive patients (age 66.9 ± 10 years; 14 men) received an implantable loop recorder (ILR) after their first symptomatic paroxysmal AF episode. We recorded the AF recurrences and burden (clinical and subclinical AF) during a follow-up period of three years. We excluded patients with persistent or permanent AF and patients with an episode of AF attributed to reversible or transient causes. Results Eight patients (26.6%) did not present any AF recurrence during the first year of the follow-up period. Five patients (16.6%) did not also suffer any AF episode during the second year, while in three patients (10%) no AF episode was recorded during the three-year follow-up period. In 16 patients (53.3%) the AF burden was increased during the second year of follow-up period while in 9 patients (30%) the AF burden was decreased. During the third year of follow-up period the AF burden was increased in 19 patients (63.3%), decreased in 7 patients (23.3%) and remained almost the same in 4 patients (13.3%). Five patients (16.6%) presented at least one episode of persistent AF during the follow-up period. Seven patients (23.3%) suffered only from symptomatic AF episodes, while in nine patients (30%) only asymptomatic AF episodes were recorded. Eleven patients (36.7%) had both types of AF episodes (symptomatic and asymptomatic). Conclusions The AF recurrence and burden increased in most AF patients during the three-year follow-up period. However, some patients did not suffer any AF recurrence or they presented a decrease in AF burden. Paroxysmal AF clinical profile differs among the AF patients significantly and this indicates that an individualized approach via long-term rhythm monitoring may be of clinical significance, at least in some newly diagnosed AF patients.

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