HATCH Score and Left Atrial Size Predict Atrial High-Rate Episodes in Patients With Cardiac Implantable Electronic Devices

Background: Patients with sustained atrial high-rate episodes (AHRE) have a high risk of major adverse cardio/cerebrovascular events (MACCE). However, the prediction model and factors for the occurrence of AHRE are unknown. We aimed to identify independent factors and various risk models for predicting MACCE and AHRE.Methods: We retrospectively enrolled 314 consecutive patients who had cardiac implantable electronic devices (CIEDs). The primary endpoint was MACCE after AHRE ≥3, 6 min, and 6 h. Atrial high-rate episodes was defined as >175 bpm (Medtronic®) lasting ≥30 s. Multivariate Cox and logistic regression analysis with time-dependent covariates were used to determine variables associated with independent risk of MACCE and occurrence of AHRE ≥3 min, respectively.Results: One hundred twenty-five patients (39.8%) developed AHRE ≥3 min, 103 (32.8%) ≥6 min, and 55 (17.5%) ≥6 h. During follow-up (median 32 months), 77 MACCE occurred (incidence 9.20/100 patient years, 95% CI 5.66–18.39). The optimal AHRE cutoff value was 3 min for MACCE, with highest Youden index 1.350 (AUC, 0.716; 95% CI, 0.638–0.793; p < 0.001). Atrial high-rate episodes ≥3 min−6 h were independently associated with MACCE. HATCH score and left atrial diameter were independently associated with AHRE ≥3 min. The optimal cutoff for HATCH score was 3 and for left atrial diameter was 4 cm for AHRE ≥3 min.Conclusion: Patients with CIEDs who develop AHRE ≥3 min have an independently increased risk of MACCE. Comprehensive assessment using HATCH score and echocardiography of patients with CIEDs is warranted.

Predictors of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting: A Prospective Cohort Study

Background Postoperative atrial fibrillation (POAF) is common both after cardiothoracic and non cardiothoracic surgery.In patients undergoing cardiothoracic surgery, the incidence of 16–46% has been reported. Even though POAF can be selflimiting, it may be associated with hemodynamic instability, postoperative stroke, myocardial infarction, ventricular arrhythmias and heart failure. Objective To determine the effect of certain predictors on the incidence of postoperative atrial fibrillation during the ICU stay after coronary artery bypass graft surgery. Patients and Methods This prospective cohort study was done after approval of the Institutional Review Board and written informed consent from patients or first kin. Patients undergoing isolated CABG or CABG with valve replacement were included and monitored for POAF during their postoperative ICU stay and the potential predictors of POAF as age, sex, smoking and left atrial diameter, serum Potassium and Magnesium levels, CHA2DS2-VASc score, valve replacement and inotropic support were recorded. Results 123 patients were included in the study, 76.4% were males with a mean age of 57.4 ±8.7 years and mean left atrial diameter 4.1 ±0.52 cm. The incidence of POAF following CABG surgery was almost 33.3%. There was no statistically significant association between POAF and smoking (P = 0.123). However there were statistically significant associations between POAF and CHA2DS2-VASc score, valve replacement (P < 0.001) and inotropic support (P = 0.005). The logistic regression analysis showed that left atrial diameter, CHA2DS2-VASc score and female sex were independent predictors of POAF. In contrary, there were no statistically significant associations between POAF and serum K+ and Mg ++ levels (p > 0.05). Conclusion There are a wide range of significant epidemiological, clinical, and operative predictors for the development of post-CABG AF including older age, female gender, large LA diameter, higher CHA2DS2-VASc score, valve replacement and postoperative inotropic support. Nevertheless, further large-scale studies are still needed to confirm our findings.

Left Atrial diameter Index as a prognostic factor for STEMI: a case-control study

Background：The left atrium has a considerable role in cardiac function because of its unique anatomy and physiological function. We evaluated the role of the size of the left atrium in the prognosis of STEMI by quantifying the left atrium by introducing a left atrial diameter index(LAdI).Methods: This is a retrospective study conducted in a University Affiliated Hospital. Echocardiography is used to evaluate the size of left atrial diameter. It is indexed by body surface(BSA) area to evaluate the significance of LAdI on the prognosis of STEMI.This study was approved by the medical ethics committee of The First Hospital of Jilin University. All subjects in this trial gave written informed consent.Results: A total of 473 patients with a first STEMI within two years met the inclusion criteria to be included in this study. LA（OR=6.945；95%CI 1.398~34.499；P=0.018）and EF （OR=0.931；95%CI 0.904~0.960; P=0.000 ）were independent risk factors for MACEs.Conclusion:Patients with a first STEMI with a greater LAdI have a greater risk of MACEs than patients with a normal left atrium despite well-established PCI therapies.

Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review

Introduction Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibrillation surgery were included. Results A total of 10 observational studies were identified, including 644 patients. Most patients had paroxysmal atrial fibrillation. The proportion with prior unsuccessful ablation ranged from 0 to 19%, and preoperative left atrial diameter ranged from 44 ± 17 to 52 ± 8 mm. Cox–Maze IV (n = 311) was the most common technique used, followed by pulmonary vein isolation (n = 222) and Cox–Maze III (n = 98). Patients with persistent or longstanding atrial fibrillation more frequently received Cox–Maze III/IV. Ranges of early postoperative outcomes included: mortality 0 to 7%, recurrence of atrial tachyarrhythmias 4.4 to 48%, cerebrovascular events 0 to 1.5%, and pacemaker insertion 3 to 21%. Long-term data was limited. Freedom from atrial tachyarrhythmias at 1 year ranged from 74% to 96%, and at 5 years from 52% to 100%. Preoperative predictors of late atrial tachyarrhythmia recurrence included left atrial diameter >45 mm, persistent or longstanding preoperative atrial fibrillation and longer atrial fibrillation duration. Conclusion In patients with atrial fibrillation undergoing septal myectomy, the addition of ablation surgery adds low overall risk to the procedure, and likely reduces the risk of recurrent atrial fibrillation in the long term. Future randomised studies comparing septal myectomy with or without concomitant AF ablation are needed.

1623 Atrial Fibrillation Post Aortic Valve Replacement: Prevalence and Causative Factors

Aim Atrial fibrillation (AF) is the most prevalent arrhythmia. Post-Operative AF (POAF) occurs in a third of patients post cardiac surgery. We aim to explore the incidence of AF post aortic valve replacement (AVR) and whether clinical and echocardiographic parameters can predict the likelihood of AF and therefore influence the management of patients. Method Our study consisted of 985 patients who underwent AVR between 2018 – 2019 from a single major cardiothoracic surgery centre in the UK. Data was collected from the electronic patient records retrospectively. Results Mean age of the cohort was 71.8 years (27-92). There were more males (68.2%, n = 672) than females (31.8%, n = 313). A majority of patients (51.8%, n = 510) developed an episode of AF in the post-operative period, of which 65.1% was new onset (n = 330). Incidence of post-operative AF was associated with more HTN (p = 0.007), poor left ventricular function as well as increased left atrial diameter (P = <0.001). Conclusions There is a high incidence of AF following AVR surgery. Comorbidities as well as left atrial diameter have a statistically significant relationship with this incidence and could be used as predictors of postoperative atrial fibrillation.

Uric Acid and P-Wave Dispersion in Subjects with Heart Failure

Uric acid used as a marker of cardiovascular risk, which is associated with oxidative stress and inflammation. P-wave dispersion (PWD) is an electrocardiographic measure, which shows heterogeneity of atrial depolarization. It has demonstrated that there is an association of increased PWD with atrial fibrillation. This article's goal was to investigate the relationship between PWD and uric acid in subjects with heart failure (HF). Methods This descriptive, cross-sectional study included a total of 315 stable HF outpatients. The subjects were classified into two groups by their PWD: the normal PWD group consisted of subjects with a PWD lower than 40 ms (n = 201), and the increased PWD group consisted of subjects with a PWD higher than or equal to 40 ms (increased PWD) (n = 114). Results Significantly higher uric acid levels determined in the increased PWD group, in comparison with the normal PWD group (7.4 ± 1.6 mg/dL, vs. 6.5 ± 1.6 mg/dL p < 0.001). Univariate analyses revealed an association between uric acid, blood urea nitrogen, systolic pulmonary artery pressure, left atrial diameter, and increased PWD. In multivariate logistic regression analysis, there was an association of uric acid level (OR: 1.293; 95% CI: 1.106-1.511, p: 0.001), systolic pulmonary artery pressure (OR: 1.027; 95% CI: 1.011-1.044, p: 0.001), and left atrial diameter (OR: 1.754; 95% CI: 1.028-2.992, p: 0.039) with PWD. The receiver operating characteristics (ROC) curve analysis demonstrated that the optimal cut-off level of uric acid for predicting increased PWD was ≥ 7.1 mg/dL with a specificity of 77 percent and a sensitivity of 81 percent. Conclusion Our study results suggest that serum uric acid levels independently correlated with PWD in subjects with HF.

Correlations of Serum MMP-9, TIMP-1, TGF-β and bFGF Levels with Atrial Fibrillation in Patients without Structural Heart Disease

ABSTRACT The researchers aimed in highlighting the correlations of serum MMP-9, TIMP-1, TGF-β1 and bFGF levels with atrial fibrillation (AF) within diseased persons showing no structural heart ailment. A total of 236 eligible diseased persons had been categorized within AF category (n=168) and non-AF category (n=68). Left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) had been measured through cardiac ultrasonography. Comparing concerning non-AF category, AF class had larger LAD and smaller LVEF (P<0.01). MMP-9 and TGF-β1 levels had been higher while TIMP-1 level remained less within AF class as compared to non-AF class (P<0.01). Age, LVEF and left atrial MMP-9/TIMP-1 remained free correlative factors of AF (P<0.01). MMP-9/TIMP-1 remained definitely correlated concerning LAD within AF class (r=0.509, P<0.01). Left atrial MMP-9/TIMP-1 remained higher within diseased persons regarding persistent AF (P<0.01). Left atrial MMP-9/TIMP-1 is correlated with AF within diseased persons having no structural heart ailment, particularly in the case of persistent AF.

Association of Serum Myonectin Concentrations With the Presence of Atrial Fibrillation

Objective: Myonectin, a recently found myokine, has a role of inhibiting inflammation. The aim of this research is to see if myonectin levels are linked to the occurrence of atrial fibrillation (AF).Methods: We examined serum myonectin in a population of 194 patients with AF who were then classified into three subgroups: paroxysmal AF, persistent AF, and permanent AF. Atrial remolding was assessed using left atrial diameter (LAD). Results: Serum myonectin was significantly lower in AF group compared with healthy controls. Logistic regression analysis demonstrated that serum myonectin concentrations were correlated with a decreased risk of AF. Patients with permanent AF displayed decreased serum myonectin than in persistent and paroxysmal AF groups. Serum myonectin was lower in persistent AF group than in paroxysmal AF group. Serum myonectin concentrations in AF patients were negatively associated with body mass index (BMI), systolic blood pressure, diastolic blood pressure, and LAD. BMI and LAD stayed to be correlated with serum myonectin according to multiple stepwise regression analysis. Conclusion: Our study demonstrated a correlation between serum myonectin and AF.

MMP-9 in Myocardial Fibrosis and Structural Remodeling in Rheumatic Heart Disease Patients with Atrial Fibrillation: A Single-center Prospective Case-control Study

Background: Atrial fibrillation (AF) is a common arrhythmia that induces disability or death; however, the underlying pathogenesis is yet unclear. This study aimed to investigate the expression of matrix metalloproteinase-9 (MMP-9) in rheumatic valvular heart disease (RVHD) and its value in predicting AF.Methods: In this single-center, prospective case-control study, 30 patients who received valve replacement for the treatment of RVHD in the Cardiac and Major Vascular Department, Yue Bei People’s Hospital between August 2012 and January 2015 were included in this study. The patients were categorized equally into two groups according to the electrocardiogram characteristics: sinus rhythm (SR) group and chronic atrial fibrillation (AF) group. In patients hospitalized for RVHD, the fasting serum was collected on the following day in the morning, and the tissues of right auricle were collected during the operation. Hematoxylin and eosin staining and Masson staining were performed to assess the pathological structures of myocardial tissues and changes in collagen fibers. Enzyme-linked immunosorbent assay was used to measure the level of MMP-9 in serum, and the distribution of the protein in myocardial tissues was assessed by immunohistochemistry. Echocardiography was performed before the surgery to measure the left atrial diameter and ejection fraction.Results: The MMP-9 expression was significantly higher in the AF group than the SR group (4.2281 ± 0.9165 ng/mg vs. 2.7613 ± 1.2166 ng/mg, p < 0.05). The MMP-9 levels were positively associated with left atrial diameter (LAD) (p < 0.01) and collagen volume fraction (CVF) (p < 0.05).Conclusions: MMP-9 expression is elevated in AF patients and could be one of the major factors involved in the remodeling of atrial structures in AF. MMP-9 influences the metabolism of collagen and promotes the fibrosis of the myocardium, participates in cardiac structural remodeling, and plays a role in the onset and maintenance of AF.