22 results on '"CHEN LIN"'
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2. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons.
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January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, and Yancy CW
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- Advisory Committees standards, Atrial Fibrillation epidemiology, Atrial Fibrillation physiopathology, Disease Management, Heart Rate physiology, Humans, Research Report standards, United States epidemiology, American Heart Association, Atrial Fibrillation therapy, Cardiology standards, Practice Guidelines as Topic standards, Societies, Medical standards, Thoracic Surgical Procedures standards
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- 2019
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3. Provider Specialty, Anticoagulation, and Stroke Risk in Patients With Atrial Fibrillation and Cancer.
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O'Neal WT, Claxton JS, Sandesara PB, MacLehose RF, Chen LY, Bengtson LGS, Chamberlain AM, Norby FL, Lutsey PL, and Alonso A
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- Administration, Oral, Aged, Comorbidity, Female, Hemorrhage chemically induced, Hemorrhage epidemiology, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Risk Adjustment methods, Risk Factors, Stroke epidemiology, Stroke etiology, United States epidemiology, Anticoagulants therapeutic use, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Cardiology methods, Cardiology statistics & numerical data, Hemorrhage prevention & control, Neoplasms diagnosis, Neoplasms epidemiology, Stroke prevention & control
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Background: It is unknown whether early cardiology involvement shortly after atrial fibrillation (AF) diagnosis is associated with favorable outcomes in AF patients who have cancer., Objectives: The purpose of this study was to examine the relationship between early cardiology involvement after AF diagnosis in patients with history of cancer., Methods: This study examined associations of early cardiology involvement with oral anticoagulation use, stroke, and bleeding among nonvalvular AF patients (n = 388,045; mean age 68 ± 15 years; 59% male) with a history of cancer (past or active) from the MarketScan database (2009 to 2014). International Classification of Disease-9th Revision-Clinical Modification codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill, and Cox regression was used to estimate the risks of stroke and major bleeding., Results: A total of 64,016 (17%) AF patients had a history of cancer. Cardiology involvement was less likely to occur among patients with a history of cancer than those without (relative risk [RR]: 0.92 [95% confidence interval (CI): 0.91 to 0.93]). Patients with history of cancer were less likely to fill prescriptions for anticoagulants (RR: 0.89 [95% CI: 0.88 to 0.90]) than those without cancer, and similar results were observed across cancer types. Patients with cancer were more likely to fill prescriptions for anticoagulants (RR: 1.48 [95% CI: 1.45 to 1.52]) if seen by a cardiologist. A reduced risk of stroke (hazard ratio: 0.89 [95% CI: 0.81 to 0.99]) was observed among all cancer patients who were seen by a cardiology provider, without an increased risk of bleeding (hazard ratio: 1.04 [95% CI: 0.95 to 1.13]). Similar results were observed when the analysis was stratified by active versus remote history of cancer., Conclusions: Although AF patients with cancer were less likely to see a cardiologist, or fill anticoagulant prescriptions, cardiology involvement was associated with increased anticoagulant prescription fills and favorable AF-related outcomes in AF patients with cancer., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2018
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4. Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation: 3‐year follow‐up outcomes
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Chen Lin, Men Tzung Lo, Ta Chuan Tuan, Yun Yu Chen, Chih Min Liu, Cheng I. Wu, Chin Yu Lin, Chye Gen Chin, Yu Feng Hu, Shih Ann Chen, Jennifer Jeanne B. Vicera, Li Wei Lo, Tze Fan Chao, Fa Po Chung, Isaiah C. Lugtu, Yenn Jiang Lin, Jo Nan Liao, Yu Cheng Hsieh, Chun Chao Chen, and Shih Lin Chang
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medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,similarity index ,substrate ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,In patient ,030212 general & internal medicine ,Substrate modification ,Atrial tachycardia ,pulmonary vein isolation ,business.industry ,Atrial fibrillation ,Original Articles ,atrial tachycardia ,medicine.disease ,Ablation ,persistent atrial fibrillation ,Treatment Outcome ,Pulmonary Veins ,Ablation of Atrial Arrhythmias ,Cardiology ,Catheter Ablation ,Original Article ,phase map ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Objectives This study aimed to assess the comparative efficacy of 4 ablation strategies on the incidence rates of freedom from atrial fibrillation (AF) or atrial tachycardia (AT) through a 3-year follow-up in patients with persistent AF. Background The optimal substrate modification strategies using catheter ablation for patients with persistent AF remain unclear. Methods Patients with persistent AF were enrolled consecutively to undergo each of 4 ablation strategies: (a) Group 1 (Gp 1, n=69), pulmonary vein isolation (PVI) plus rotor ablation assisted by similarity index and phase mapping; (b) Gp 2 (n=75), PVI plus linear ablations at the left atrium; (c) Gp 3 (n=42), PVI plus elimination of complex fractionated atrial electrograms; (d) Gp 4 (n=67), PVI only. Potential confounders were adjusted via a multivariate survival parametric model. Results Baseline characteristics were similar across the 4 groups. At a follow-up period of 34.9±38.6 months, patients in Gp 1 showed the highest rate of freedom from AF compared with the other 3 groups (p=0.002), while patients in Gp 3 and 4 showed lower rates of freedom from AT than those of the other two groups (p=0.006). Independent predictors of recurrence of AF were the ablation strategy (p=0.002) and left atrial diameter (LAD) (p=0.01). Conclusion In patients with persistent AF, a substrate modification strategy using rotor ablation assisted by similarity index and phase mapping provided a benefit for maintaining sinus rhythm compared to the other strategies. Both ablation strategy and baseline LAD predicted the 3-year outcomes of freedom from AT/AF This article is protected by copyright. All rights reserved.
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- 2021
5. Efficacy of Patient-Specific Strategy: Catheter Ablation Strategy of Persistent Atrial Fibrillation Based on Morphological Repetitiveness by Periodicity and Similarity
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Yun Yu Chen, Fa Po Chung, Ta Chuan Tuan, Jo Nan Liao, Chih Min Liu, Ting Yung Chang, Wen Han Cheng, Ling Kuo, Shin Huei Liu, Yu Feng Hu, Yenn Jiang Lin, An Nu Khanh Ton, Chin Yu Lin, Tze Fan Chao, Isaiah C. Lugtu, Shih Ann Chen, Chen Lin, Ankit Jain, Men Tzung Lo, Dony Yugo Hermanto, Li Wei Lo, Chia Hsin Chiang, Cheng I. Wu, and Shih Lin Chang
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Patient-Specific Modeling ,Periodicity ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Clinical Decision-Making ,Action Potentials ,Catheter ablation ,Pattern Recognition, Automated ,Similarity (network science) ,Heart Rate ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Prospective Studies ,business.industry ,Models, Cardiovascular ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,Patient specific ,Ablation ,medicine.disease ,Treatment Outcome ,Persistent atrial fibrillation ,Catheter Ablation ,Cardiology ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
6. Rhythm control better prevents stroke and mortality than rate control strategies in patients with atrial fibrillation - A nationwide cohort study
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Jin Long Huang, Ching-Heng Lin, Chi Jen Weng, Chu Pin Lo, Yu Cheng Hsieh, Shih Lin Chang, Jiunn Cherng Lin, Ying Chieh Liao, Kuo Ching Huang, Cheng Hung Li, Che Chen Lin, and Tsu Juey Wu
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Taiwan ,030204 cardiovascular system & hematology ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Rhythm ,Heart Rate ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Mortality ,Stroke ,Aged ,business.industry ,Hazard ratio ,Rate control ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Defined daily dose ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,Mace ,Follow-Up Studies ,Cohort study - Abstract
Background Atrial fibrillation (AF) increases the risk of stroke and mortality. However, rhythm control strategy did not reduce cardiovascular risks in short-term studies. We hypothesize that rhythm control better prevents stroke and mortality than rate control in AF patients over a long-term period. Methods AF patients aged ≥18 years were identified from Taiwan National Insurance Database. Patients using anti-arrhythmia drugs to control rhythm at a >30 defined daily dose (DDD) were defined as the rhythm control group. Patients who used rate control medications for >30 DDDs constituted the rate control group. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for major adverse cardiovascular events (MACE), including ischemic/hemorrhagic stroke and mortality. Results A total of 11,968 AF patients were enrolled, and 2850 of them (654 in rhythm control group; 2196 in rate control group) were analyzed. During a 6.3 ± 3.7 year's follow-up, a total of 1101 MACE occurred. Compared to rate control group, rhythm control group displayed a lower rate of ischemic stroke (adjusted HR: 0.65, p = 0.002) and mortality (adjusted HR: 0.81, p = 0.009). The rhythm control group showed a lower incidence of MACE than that of the rate control group (adjusted HR: 0.82, p = 0.009). The reduction of stroke (p = 0.004), mortality (p = 0.006), and MACE (p = 0.007) risk was observed particularly in rhythm control patients with a CHA2DS2-VASc score of ≥3. Conclusions In patients with AF, rhythm control better prevents MACE risk than rate control over a long-term period, particularly in those at high risk (CHA2DS2-VASc score ≥3) for stroke.
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- 2018
7. Data for rate versus rhythm control strategy on stroke and mortality in patients with atrial fibrillation
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Jin Long Huang, Yu Cheng Hsieh, Tsu Juey Wu, Chu Pin Lo, Ying Chieh Liao, Chi Jen Weng, Cheng Hung Li, Ching-Heng Lin, Jiunn Cherng Lin, Kuo Ching Huang, Che Chen Lin, and Shih Lin Chang
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medicine.medical_specialty ,Multidisciplinary ,business.industry ,Hazard ratio ,Atrial fibrillation ,Rhythm control ,030204 cardiovascular system & hematology ,medicine.disease ,lcsh:Computer applications to medicine. Medical informatics ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cohort ,medicine ,Cardiology ,lcsh:R858-859.7 ,In patient ,030212 general & internal medicine ,cardiovascular diseases ,business ,lcsh:Science (General) ,Stroke ,Mace ,Cohort study ,lcsh:Q1-390 - Abstract
The data relates to the cohort of patients with atrial fibrillation (AF) from the National Health Insurance Research Database of Taiwan, "Rhythm Control Better Prevents Stroke and Mortality than Rate Control Strategies in Patients with Atrial Fibrillation - A Nationwide Cohort Study" (Weng et al., in press). The AF patients might receive either rate or rhythm control strategy according to the medication used. The baseline medication in rate and rhythm control groups was included in this dataset. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for major adverse cardiovascular events (MACE), including ischemic/hemorrhagic stroke and mortality in AF patients receiving rate or rhythm control. The occurrence of MACE was identified from the ICD-9 CM codes. The data also contains the HR for MACE stratified by the CHA2DS2-VASc score, baseline characteristics, and the duration of strategy employed of the AF patients.
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- 2018
8. Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation
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Ta Chuan Tuan, Chen Lin, Men Tzung Lo, Tze Fan Chao, Yu Feng Hu, Shih Lin Chang, Yenn Jiang Lin, Kazuyoshi Suenari, Li Wei Lo, Van Buu Dan Do, Shih Ann Chen, Norden E. Huang, Suunu Budhi Raharjo, Hsu Wen Vincent Young, Yi Chung Chang, Huan Yu Kuo, Fa Po Chung, Jo Nan Liao, and Chin Yu Lin
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medicine.medical_specialty ,Substrate mapping ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Phase (waves) ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Ablation ,Confidence interval ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Internal medicine ,Cardiology ,medicine ,030212 general & internal medicine ,business ,Biomedical engineering - Abstract
Objectives This prospective study compared the efficacy of atrial substrate modification guided by a nonlinear phase mapping technique with that of conventional substrate ablation. Background The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown. Methods In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the phase mapping algorithm, involving analysis of high-similarity electrogram regions. In addition, we defined rotors and focal AF sources, using the physical parameters of the divergence and curvature forces. In phase 2 study, we enrolled 68 patients with persistent AF undergoing substrate modification into 2 groups, group-1 (n = 34) underwent similarity index (SI) and phase mapping techniques; group-2 (n = 34) received complex fractionated atrial electrogram ablation with commercially available software. Group-1 received real-time waveform similarity measurements in which a phase mapping algorithm was applied to localize the sources. We evaluated the single-procedure freedom from AF. Results In group-1, we identified an average of 2.6 ± 0.89 SI regions per chamber. These regions involved rotors and focal sources in 65% and 77% of patients in group-1, respectively. Group-1 patients had shorter ablation procedure times, higher termination rates, and significant reduction in AF recurrence compared to group-2 and a trend toward benefit for all atrial arrhythmias. Multivariate analysis showed that substrate mapping using nonlinear similarity and phase mapping was the independent predictor of freedom from AF recurrence (hazard ratio: 0.26; 95% confidence interval: 0.09 to 0.74; p = 0.01). Conclusions Our study showed that for persistent AF ablation, a specified substrate modification guided by nonlinear phase mapping could eliminate localized re-entry and non-pulmonary focal sources after pulmonary vein isolation.
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- 2016
9. Atrial fibrillation genetic risk differentiates cardioembolic stroke from other stroke subtypes
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Pulit, Sara L., Weng, Lu-Chen, McArdle, Patrick F, Trinquart, Ludovic, Choi, Seung Hoan, Mitchell, Braxton D., Rosand, Jonathan, de Bakker, Paul I W, Benjamin, Emelia J, Ellinor, Patrick T, Kittner, Steven J, Lubitz, Steven A, Anderson, Christopher D, Christophersen, Ingrid E., Rienstra, Michiel, Roselli, Carolina, Yin, Xiaoyan, Geelhoed, Bastiaan, Barnard, John, Lin, Honghuang, Arking, Dan E., Smith, Albert V., Albert, Christine M., Chaffin, Mark, Tucker, Nathan R., Li, Molong, Klarin, Derek, Bihlmeyer, Nathan A, Low, Siew-Kee, Weeke, Peter E., Müller-Nurasyid, Martina, Smith, J. Gustav, Brody, Jennifer A., Niemeijer, Maartje N., Dörr, Marcus, Trompet, Stella, Huffman, Jennifer, Gustafsson, Stefan, Schurmann, Claudia, Kleber, Marcus E., Lyytikäinen, Leo-Pekka, Seppälä, Ilkka, Malik, Rainer, Horimoto, Andrea R. V. R., Perez, Marco, Sinisalo, Juha, Aeschbacher, Stefanie, Thériault, Sébastien, Yao, Jie, Radmanesh, Farid, Weiss, Stefan, Teumer, Alexander, Clauss, Sebastian, Deo, Rajat, Rader, Daniel J., Shah, Svati, Siland, Joylene E., Kubo, Michiaki, Smith, Jonathan D., Van Wagoner, David R., Bis, Joshua C., Perz, Siegfried, Psaty, Bruce M., Ridker, Paul M., Magnani, Jared W., Harris, Tamara B., Launer, Lenore J., Shoemaker, M. Benjamin, Padmanabhan, Sandosh, Haessler, Jeffrey, Bartz, Traci M., Waldenberger, Melanie, Lichtner, Peter, Arendt, Marina, Krieger, Jose E., Kähönen, Mika, Risch, Lorenz, Mansur, Alfredo J., Peters, Annette, Smith, Blair H., Lind, Lars, Scott, Stuart A., Lu, Yingchang, Bottinger, Erwin B., Hernesniemi, Jussi, Lindgren, Cecilia M., Wong, Jorge A, Huang, Jie, Eskola, Markku, Morris, Andrew P., Ford, Ian, Reiner, Alex P., Delgado, Graciela, Chen, Lin Y., Chen, Yii-Der Ida, Sandhu, Roopinder K., Li, Man, Boerwinkle, Eric, Eisele, Lewin, Lannfelt, Lars, Rost, Natalia, Orho-Melander, arju, Hamsten, Anders, Heeringa, Jan, Denny, Joshua C., Kriebel, Jennifer, Darbar, Dawood, Newton-Cheh, Christopher, Shaffer, Christian, Macfarlane, Peter W., Heilmann, Stefanie, Almgren, Peter, Huang, Paul L., Sotoodehnia, Nona, Soliman, Elsayed Z., Uitterlinden, Andre G., Hofman, Albert, Franco, Oscar H., Völker, Uwe, Jöckel, Karl-Heinz, Sinner, Moritz F., Lin, Henry J., Guo, Xiuqing, Dichgans, Martin, Ingelsson, Erik, Kooperberg, Charles, Melander, Olle, Loos, Ruth J. F., Laurikka, Jari, Conen, David, Harst, Pim van der, Lokki, Marja-Liisa, Kathiresan, Sekar, Pereira, Alexandre, Jukema, J. Wouter, Hayward, Caroline, Rotter, Jerome I., März, Winfried, Lehtimäki, Terho, Stricker, Bruno H., Chung, Mina K., Felix, Stephan B., Gudnason, Vilmundur, Alonso, Alvaro, Roden, Dan M., Sun, Albert, Anderson, Christopher D., Kääb, Stefan, Hopewell, Jemma C., Debette, Stephanie, Chauhan, Ganesh, Yang, Qiong, Worrall, Bradford B., Paré, Guillaume, Kamatani, Yoichiro, Hagemeijer, Yanick P., Verweij, Niek, Taylor, Kent D., Campbell, Archie, Magnusson, Patrik K., Porteous, David, Hocking, Lynne J., Vlachopoulou, Efthymia, Pedersen, Nancy L., Nikus, Kjell, Chasman, Daniel I., Heckbert, Susan R., Benjamin, Emelia J., Tanaka, Toshihiro, Lunetta, Kathryn L., Lubitz, Steven A., Ellinor, Patrick T., Smoller, Sylvia, Sorkin, John, Wang, Xingwu, Selim, Magdy, Pikula, Aleksandra, Wolf, Philip, Seshadri, Sudha, Bakker, Paul de, Chasman, Daniel, Rexrode, Kathryn, Chen, Ida, Rotter, Jerome, Luke, May, Sale, Michelle, Lee, Tsong-Hai, Chang, Ku-Chou, Elkind, Mitchell, Goldstein, Larry, James, Michael Luke, Breteler, Monique, O’Donnell, Chris, Leys, Didier, Carty, Cara, Kidwell, Chelsea, Olesen, Jes, Sharma, Pankaj, Rich, Stephen, Tatlisumak, Turgot, Happola, Olli, Bijlenga, Philippe, Soriano, Carolina, Giralt, Eva, Roquer, Jaume, Jimenez-Conde, Jordi, Cotlarcius, Ioana, Hardy, John, Korostynski, Michal, Boncoraglio, Giorgio, Ballabio, Elena, Parati, Eugenio, Mateusz, Adamski, Urbanik, Andrzej, Dziedzic, Tomasz, Jagiella, Jeremiasz, Gasowski, Jerzy, Wnuk, Marcin, Olszanecki, Rafael, Pera, Joanna, Slowik, Agnieszka, Juchniewicz, Karol Jozef, Levi, Christopher, Nyquist, Paul, Cendes, Iscia, Cabral, Norberto, Franca, Paulo, Goncalves, Anderson, Keller, Lina, Crisby, Milita, Kostulas, Konstantinos, Lemmens, Robin, Ahmadi, Kourosh, Opherk, Christian, Duering, Marco, Gonik, Mariya, Staals, Julie, Burri, Philippe, Sadr-Nabavi, Ariane, Romero, Javier, Biffi, Alessandro, Anderson, Chris, Falcone, Guido, Brouwers, Bart, Du, Rose, Kourkoulis, Christina, Battey, Thomas, Lubitz, Steven, Mueller-Myhsok, Bertram, Meschia, James, Brott, Thomas, Pare, Guillaume, Pichler, Alexander, Enzinger, Christian, Schmidt, Helena, Schmidt, Reinhold, Seiler, Stephan, Blanton, Susan, Yamada, Yoshiji, Bersano, Anna, Rundek, Tatjana, Sacco, Ralph, Chan, Yu-Feng Yvonne, Gschwendtner, Andreas, Deng, Zhen, Barr, Taura, Gwinn, Katrina, Corriveau, Roderick, Singleton, Andrew, Waddy, Salina, Launer, Lenore, Chen, Christopher, Le, Kim En, Lee, Wei Ling, Tan, Eng King, Olugbodi, Akintomi, Rothwell, Peter, Schilling, Sabrina, Mok, Vincent, Lebedeva, Elena, Jern, Christina, Jood, Katarina, Olsson, Sandra, Kim, Helen, Lee, Chaeyoung, Kilarski, Laura, Markus, Hugh, Peycke, Jennifer, Bevan, Steve, Sheu, Wayne, Chiou, Hung Yi, Chern, Joseph, Giraldo, Elias, Taqi, Muhammad, Jain, Vivek, Lam, Olivia, Howard, George, Woo, Daniel, Kittner, Steven, Mitchell, Braxton, Cole, John, O’Connell, Jeff, Milewicz, Dianna, Illoh, Kachikwu, Worrall, Bradford, Stine, Colin, Karaszewski, Bartosz, Werring, David, Sofat, Reecha, Smalley, June, Lindgren, Arne, Hansen, Bjorn, Norrving, Bo, Smith, Gustav, Martin, Juan Jose, Thijs, Vincent, Klijn, Karin, van’t Hof, Femke, Algra, Ale, Macleod, Mary, Perry, Rodney, Arnett, Donna, Pezzini, Alessandro, Padovani, Alessandro, Cramer, Steve, Fisher, Mark, Saleheen, Danish, Broderick, Joseph, Kissela, Brett, Doney, Alex, Cathie, Sudlow, Rannikmae, Kristiina, Silliman, Scott, McDonough, Caitrin, Walters, Matthew, Pedersen, Annie, Nakagawa, Kazuma, Chang, Christy, Dobbins, Mark, McArdle, Patrick, Chang, Yu-Ching, Brown, Robert, Brown, Devin, Holliday, Elizabeth, Kalaria, Raj, Maguire, Jane, John, Attia, Farrall, Martin, Giese, Anne-Katrin, Fornage, Myriam, Majersik, Jennifer, Cushman, Mary, Keene, Keith, Bennett, Siiri, Tirschwell, David, Psaty, Bruce, Reiner, Alex, Longstreth, Will, Spence, David, Montaner, Joan, Fernandez-Cadenas, Israel, Langefeld, Carl, Bushnell, Cheryl, Heitsch, Laura, Lee, Jin-Moo, Sheth, Kevin, Cardiovascular Centre (CVC), Department of Medicine, Clinicum, Transplantation Laboratory, Medicum, Neurologian yksikkö, Department of Neurosciences, University of Helsinki, Doctoral Programme in Clinical Research, HUS Neurocenter, Epidemiology, Internal Medicine, Klinische Neurowetenschappen, RS: CARIM - R3.03 - Cerebral small vessel disease, and MUMC+: MA Med Staf Spec Neurologie (9)
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Medizin ,030204 cardiovascular system & hematology ,VARIANTS ,3124 Neurology and psychiatry ,0302 clinical medicine ,Epidemiology ,Genotype ,EPIDEMIOLOGY ,Stroke ,Genetics (clinical) ,0303 health sciences ,Aspirin ,Atrial fibrillation ,ASSOCIATION ,3. Good health ,LIFETIME RISK ,ISCHEMIC-STROKE ,Cardiology ,Biomarker (medicine) ,Medical genetics ,BURDEN ,Medical Genetics ,Life Sciences & Biomedicine ,medicine.drug ,medicine.medical_specialty ,Clinical Neurology ,Single-nucleotide polymorphism ,Article ,03 medical and health sciences ,Internal medicine ,Genetic predisposition ,medicine ,SNP ,cardiovascular diseases ,Genotyping ,030304 developmental biology ,Genetic association ,Medicinsk genetik ,Science & Technology ,business.industry ,3112 Neurosciences ,Heritability ,medicine.disease ,PREVENTION ,ASPIRIN ,Neurology (clinical) ,Neurosciences & Neurology ,business ,030217 neurology & neurosurgery ,CAUSATIVE CLASSIFICATION - Abstract
ObjectiveWe sought to assess whether genetic risk factors for atrial fibrillation (AF) can explain cardioembolic stroke risk.MethodsWe evaluated genetic correlations between a previous genetic study of AF and AF in the presence of cardioembolic stroke using genome-wide genotypes from the Stroke Genetics Network (N = 3,190 AF cases, 3,000 cardioembolic stroke cases, and 28,026 referents). We tested whether a previously validated AF polygenic risk score (PRS) associated with cardioembolic and other stroke subtypes after accounting for AF clinical risk factors.ResultsWe observed a strong correlation between previously reported genetic risk for AF, AF in the presence of stroke, and cardioembolic stroke (Pearson r = 0.77 and 0.76, respectively, across SNPs with p < 4.4 × 10−4 in the previous AF meta-analysis). An AF PRS, adjusted for clinical AF risk factors, was associated with cardioembolic stroke (odds ratio [OR] per SD = 1.40, p = 1.45 × 10−48), explaining ∼20% of the heritable component of cardioembolic stroke risk. The AF PRS was also associated with stroke of undetermined cause (OR per SD = 1.07, p = 0.004), but no other primary stroke subtypes (all p > 0.1).ConclusionsGenetic risk of AF is associated with cardioembolic stroke, independent of clinical risk factors. Studies are warranted to determine whether AF genetic risk can serve as a biomarker for strokes caused by AF.
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- 2018
10. New-onset atrial fibrillation-related ischemic stroke occurring after hospital discharge in septicemia survivors
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Jiunn Tay Lee, Chun-An Cheng, Chun-Gu Cheng, C.-C. Cheng, Hui Chen Lin, Hung Wen Chiu, and Wu-Chien Chien
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Male ,medicine.medical_specialty ,Multivariate analysis ,Databases, Factual ,Taiwan ,Disease ,Comorbidity ,030204 cardiovascular system & hematology ,Logistic regression ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Survivors ,Aged ,Aged, 80 and over ,business.industry ,Incidence ,Atrial fibrillation ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Patient Discharge ,Stroke ,Logistic Models ,Multivariate Analysis ,Cardiology ,Female ,business ,Follow-Up Studies - Abstract
Background Sepsis will induce stroke, new-onset atrial fibrillation (AF) increase ischemic stroke (IS) in in-hospitalization and long-term period after sepsis. Physicians must alert this condition and given suitable treatment. Aim The associated of IS and new-onset AF in septicemia survivors after discharge have to be evaluated. Design The inpatient data was used of the Taiwan National Health Insurance Database (NHIRD) in 2010. We identified patients suffered their first occurrence of septicemia (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] is 038, 003.1, 036.1) and excluded less than 18 years old. Patients had AF (ICD-9-CM to 427.3×) during the same admission or after septicemia hospitalization discharged were defined as new-onset AF. The outcome was IS happened after septicemia discharge (ICD-9-CM as 433-437). Methods The factors related to IS after septicemia survival were established using multivariate logistic regression with forward stepwise selection. Results There were 1286 new-onset AF and 1026 IS happened after septicemia discharge. The crude odds ratio (OR) were 3.88 (95% confidence interval [C.I.]: 1.69-8.89) and 1.62 (95% C.I.: 1.14-2.3) in middle-aged and elderly septicemia survivors with new-onset AF induced IS. The risk of IS after septicemia survivors was noticed adjusted OR 1.74 (95% C.I.: 1.26-2.41) for new-onset AF. Conclusion The middle-aged and elderly septicemia survivors suffered from new-onset AF had increased incidence of IS within three months. New-onset AF was a mediator factor of IS in septicemia survivors of Asian population.
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- 2016
11. Sex and racial differences in cardiovascular disease risk in patients with atrial fibrillation.
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O’Neal, Wesley T., Alam, Aniqa B., Sandesara, Pratik B., Claxton, J’Neka S., MacLehose, Richard F., Chen, Lin Y., Bengtson, Lindsay G. S., Chamberlain, Alanna M., Norby, Faye L., Lutsey, Pamela L., and Alonso, Alvaro
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ATRIAL fibrillation ,PROPORTIONAL hazards models ,SEXUAL dimorphism ,RACIAL differences ,CARDIOVASCULAR diseases ,GENDER - Abstract
Background: Outcomes among atrial fibrillation (AF) patients may differ according to race/ethnicity and sex due to differences in biology, the prevalence of cardiovascular risk factors, and the use and effectiveness of AF treatments. We aimed to characterize patterns of cardiovascular risk across subgroups of AF patients by sex and race/ethnicity, since doing so may provide opportunities to identify interventions. We also evaluated whether these patterns changed over time. Methods: We utilized administrative claims data from the Optum Clinformatics® Datamart database from 2009 to 2015. Patients with AF with ≥6 months of enrollment prior to the first non-valvular AF diagnosis were included in the analysis. Final analysis utilized Cox proportional hazard models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular outcomes stratified by sex and race/ethnicity. An additional analysis stratified outcomes by calendar year of AF diagnosis to evaluate changes in outcomes over time. Results: In a cohort of 380,636 AF patients, women had a higher risk of ischemic stroke [HR (95% CI): 1.25 (1.19, 1.31)] and lower risk of heart failure and myocardial infarction [HR (95% CI): 0.91 (0.88, 0.94) and 0.81 (0.77, 0.86), respectively)] compared to men. Black patients had elevated risk across all endpoints compared to whites, while Hispanics and Asian Americans showed no significant differences in any outcome compared to white patients. These sex and race/ethnic differences did not change over time. Conclusions: We found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time. [ABSTRACT FROM AUTHOR]
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- 2019
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12. Nonlinear Analysis of Fibrillatory Electrogram Similarity to Optimize the Detection of Complex Fractionated Electrograms During Persistent Atrial Fibrillation
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Li-Wei Lo, Norden E. Huang, Yenn-Jiang Lin, Yu-Feng Hu, Fa-Po Chung, Wan-Hsin Hsieh, Shih-Ann Chen, Hsuan-Ming Tsao, Shih-Lin Chang, Tze-Fan Chao, Men Tzung Lo, Yi-Chung Chang, Chen Lin, Cheng-Hung Li, and Hung-Yu Chang
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,medicine.medical_treatment ,Catheter ablation ,Culprit ,Heart Conduction System ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Odds Ratio ,medicine ,Humans ,Sinus rhythm ,Aged ,Fibrillation ,Chi-Square Distribution ,business.industry ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,Treatment Outcome ,Nonlinear Dynamics ,Multivariate Analysis ,Catheter Ablation ,Linear Models ,Cardiology ,Female ,medicine.symptom ,Electrical conduction system of the heart ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Nonlinear Analysis of Atrial Fibrillation. Introduction: Currently, the identification of complex fractionated atrial electrograms (CFEs) in the substrate modification is mostly based on cycle length-derived algorithms. The characteristics of the fibrillation electrogram morphology and their consistency over time are not clear. The aim of this study was to optimize the detection algorithm of crucial CFEs by using nonlinear measure electrogram similarity. Methods and Results: One hundred persistent atrial fibrillation patients that underwent catheter ablation were included. In patients who required CFE ablation (79%), the time-domain fibrillation signals (6 seconds) were acquired for a linear analysis (mean fractionation interval and dominant frequency [DF]) and nonlinear-based waveform similarity analysis of the local electrograms, termed the similarity index (SI). Continuous CFEs were targeted with an endpoint of termination. Predictors of the various signal characteristics on the termination and clinical outcome were investigated. Procedural termination was observed in 39% and long-term sinus rhythm maintenance in 67% of the patients. The targeted CFEs didn't differ based on the linear analysis modalities between the patients who responded and did not respond to CFE ablation. In contrast, the average SI of the targeted CFEs was higher in termination patients, and they had a better outcome. Multivariate regression analysis showed that a higher SI independently predicted sites of termination (≥0.57; OR = 4.9; 95% CI = 1.33–18.0; P = 0.017). Conclusions: In persistent AF patients, a cycle length-based linear analysis could not differentiate culprit CFEs from bystanders. This study suggested that sites with a high level of fibrillation electrogram similarity at the CFE sites were important for AF maintenance. (J Cardiovasc Electrophysiol, Vol. 24, pp. 280-289, March 2013)
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- 2012
13. Differential left-to-right atria gene expression ratio in human sinus rhythm and atrial fibrillation: Implications for arrhythmogenesis and thrombogenesis
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Yun Shien Lee, Shang-Hung Chang, Feng Chun Tsai, Yu-Juei Hsu, Gwo Jyh Chang, Yung Hsin Yeh, Yuan Min Lin, Chun-Li Wang, and Yen-Chen Lin
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0301 basic medicine ,Male ,medicine.medical_specialty ,Atrial Appendage ,030204 cardiovascular system & hematology ,Ryanodine receptor 2 ,Sarcoplasmic Reticulum Calcium-Transporting ATPases ,Transcriptome ,Transforming Growth Factor beta1 ,03 medical and health sciences ,0302 clinical medicine ,Apolipoproteins E ,Downregulation and upregulation ,Internal medicine ,Atrial Fibrillation ,Medicine ,Humans ,Sinus rhythm ,Calcium Signaling ,Aged ,Atrium (architecture) ,business.industry ,Gene Expression Profiling ,Atrial fibrillation ,Thrombosis ,Atrial Remodeling ,Middle Aged ,medicine.disease ,Receptors, Purinergic P2Y12 ,Gene expression profiling ,030104 developmental biology ,Endocrinology ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Signal Transduction - Abstract
Background Atrial fibrillation (AF) causes atrial remodeling, and the left atrium (LA) is the favored substrate for maintaining AF. It remains unclear if AF remodels both atria differently and contributes to LA arrhythmogenesis and thrombogenesis. Therefore, we wished to characterize the transcript profiles in the LA and right atrium (RA) in sinus rhythm (SR) and AF respectively. Methods Paired LA and RA appendages acquired from patients receiving cardiac surgery were used for ion-channel- and whole-exome-based transcriptome analysis. The ultrastructure was evaluated by immunohistochemistry. Results Twenty-two and twenty ion-channels and transporters were differentially expressed between the LA and RA in AF and SR, respectively. Among these, 15 genes were differentially expressed in parallel between AF and SR. AF was associated with increased LA/RA expression ratio in 9 ion channel-related genes, including genes related to calcium handling. In microarray, AF was associated with a differential LA/RA gene expression ratio in 309 genes, and was involved in atherosclerosis-related signaling. AF was associated with the upregulation of thrombogenesis-related genes in the LA appendage, including P2Y12, CD 36 and ApoE. Immunohistochemistry showed higher expressions of collagen-1, oxidative stress and TGF-β1 in the RA compared to the LA. Conclusions AF was associated with differential LA-to-RA gene expression related to specific ion channels and pathways as well as upregulation of thrombogenesis-related genes in the LA appendage. Targeting the molecular mechanisms underlying the LA-to-RA difference and AF-related remodeling in the LA appendage may help provide new therapeutic options in treating AF and preventing thromboembolism in AF.
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- 2016
14. Initial Presentation Sites as Predictors of Herpes Zoster Complications: A Nationwide Cohort Study
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I-Jong Wang, Wen-Yi Wang, Meng-Yin Lin, Sing-Huh Liu, and Che-Chen Lin
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Male ,Viral Diseases ,Chronic Hepatitis ,lcsh:Medicine ,Blood Pressure ,Pathology and Laboratory Medicine ,Vascular Medicine ,Chronic Liver Disease ,Cohort Studies ,030207 dermatology & venereal diseases ,0302 clinical medicine ,Atrial Fibrillation ,Medicine and Health Sciences ,030212 general & internal medicine ,lcsh:Science ,education.field_of_study ,Multidisciplinary ,Liver Diseases ,Hazard ratio ,Middle Aged ,Prognosis ,Stroke ,Infectious Diseases ,Hyperlipidemia ,Neurology ,Cohort ,Hypertension ,Female ,Arrhythmia ,Shingles ,Cohort study ,Research Article ,Risk ,medicine.medical_specialty ,Cerebrovascular Diseases ,Population ,Taiwan ,Cardiology ,Gastroenterology and Hepatology ,Herpes Zoster ,03 medical and health sciences ,Signs and Symptoms ,Diagnostic Medicine ,Internal medicine ,medicine ,Humans ,education ,Retrospective Studies ,Heart Failure ,Postherpetic neuralgia ,business.industry ,lcsh:R ,Retrospective cohort study ,medicine.disease ,Comorbidity ,Surgery ,Age Groups ,People and Places ,Population Groupings ,lcsh:Q ,business - Abstract
Herpes zoster (HZ) is associated with complications such as postherpetic neuralgia (PHN) and HZ ophthalmicus (HZO). However, few studies have focused on identifying patients having a high risk of PHN and HZO according to the initial presentation sites. The current study investigated these factors in a nationwide population-based cohort derived from Taiwan’s Longitudinal Health Insurance Database. The results indicate that the initial presentation sites can predict the complication site of HZ. In this study, elderly patients were found to be more susceptible to HZ and were the first to present with neurological signs (HZN). Furthermore, compared with patients with HZO and other signs (HZT), those with HZN had a higher comorbidity risk. Patients with HZN showed a significantly higher visceral complication risk than did those with HZO (adjusted hazard ratio [HR] = 1.47, 95% confidence interval [CI] = 1.27–1.71). In addition, patients with HZT showed lower risks of ocular and neurological complications than did those with HZN after stratification by age and sex (adjusted HR = 0.46, 95% CI = 0.31–0.68 and HR = 0.73, 95% CI = 0.59–0.91, respectively).
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- 2016
15. A new model to predict major bleeding in patients with atrial fibrillation using warfarin or direct oral anticoagulants.
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Claxton, J’Neka S., MacLehose, Richard F., Lutsey, Pamela L., Norby, Faye L., Chen, Lin Y., O’Neal, Wesley T., Chamberlain, Alanna M., Bengtson, Lindsay G. S., and Alonso, Alvaro
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HEMORRHAGE risk factors ,ATRIAL fibrillation ,ANTICOAGULANTS ,CONFIDENCE intervals ,WARFARIN ,DRUG therapy ,PATIENTS - Abstract
Background: No scores presently exist to predict bleeding in atrial fibrillation (AF) populations using direct oral anticoagulants (DOACs). We used data from two independent healthcare claims databases to develop and validate a predictive model of major bleeding in a contemporary AF population. Methods: Patients with non-valvular AF initiating oral anticoagulation were identified in the MarketScan databases from 2007–2014. Using Cox regression models in 1000 bootstrapped samples, we developed a model that selected variables predicting major bleeding in the first year after anticoagulant initiation. The final model was validated in patients with non-valvular AF in the Optum Clinformatics database in the period 2009–2015. The discriminative ability of existing bleeding scores were individually evaluated and compared with the new bleeding model termed Anticoagulation-specific Bleeding Score (ABS) in both MarketScan and Optum. Results: Among 119,083 patients with AF initiating oral anticoagulation in the derivation cohort, 4,030 experienced a bleeding event. The variable selection model identified 15 variables (including individual type of oral anticoagulant) associated with major bleeding. Discrimination of the model was modest [c-statistic 0.68, 95% confidence interval (CI) 0.67–0.69]. The model was subsequently applied to 81,285 AF patients in the validation data set (3,238 bleeding events), showing similar discrimination (c-statistic 0.68, 95% CI 0.67–0.69). In both cohorts, the predictive performance of the ABS was better than the existing models for bleeding prediction in AF. Conclusions: We developed a model that uses administrative healthcare data for the identification of AF patients at higher risk of bleeding after initiation of oral anticoagulation, taking into account the lower bleeding risk in DOAC compared to warfarin users. [ABSTRACT FROM AUTHOR]
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- 2018
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16. Prevalence, characteristics, mapping, and catheter ablation of potential rotors in nonparoxysmal atrial fibrillation
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Shih Lin Chang, Shih Ann Chen, Chen Lin, Norden E. Huang, Yun Yu Chen, Yenn Jiang Lin, Men Tzung Lo, Jo Nan Liao, Wen Yu Lin, Dicky Armein Hanafy, Fa Po Chung, Li Wei Lo, Hung Yu Chang, Yu Feng Hu, and Wan Hsin Hsieh
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Pulmonary vein ,Electrocardiography ,Left atrial ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Prevalence ,Humans ,Atrium (heart) ,Aged ,Fibrillation ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,medicine.anatomical_structure ,Pulmonary Veins ,Cardiology ,Catheter Ablation ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac - Abstract
Background— Identification of critical atrial substrates in patients with nonparoxysmal atrial fibrillation (AF) failing to respond to pulmonary vein isolation is important. This study investigated the signal characteristics, substrate nature, and ablation results of rotors during AF. Methods and Results— In total, 53 patients (age=55±8), 31 with persistent AF and 22 with long-lasting AF, underwent pulmonary vein isolation and substrate modification of complex fractionated atrial electrograms. Small-radius-reentrant rotors were identified from signal analyses of the dominant frequency and fractionation interval and nonlinear analyses (newly developed, beat-to-beat nonlinear measurement of the repetitiveness of the electrogram morphology >6 seconds). In 15% of the patients, activation maps demonstrated occurrences of rotor-like small-radius reentrant circuits (n=9; 1.1 per patient; cycle length=110±21 ms; diameter=11±6 mm) with fibrillation occurring outside these areas. Rotors were identified by conventional point-by-point mapping and signal analyses and were subsequently eradicated by catheter ablation in these patients. Persistent AF for P P Conclusions— Rotor-like re-entry with fibrillatory conduction was found in a limited number of patients with nonparoxysmal AF after pulmonary vein isolation. Those areas were characterized by rapid repetitive activity with a high degree of electrogram similarity.
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- 2013
17. Predictors of sudden cardiac death in atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study.
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Koene, Ryan J., Norby, Faye L., Maheshwari, Ankit, Rooney, Mary R., Soliman, Elsayed Z., Alonso, Alvaro, and Chen, Lin Y.
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CARDIOVASCULAR diseases ,ATRIAL fibrillation ,HEART failure ,ATHEROSCLEROSIS ,CAROTID intima-media thickness - Abstract
We previously reported that incident atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death (SCD) in the general population. We now aimed to identify predictors of SCD in persons with AF from the Atherosclerosis Risk in Communities (ARIC) study, a community-based cohort study. We included all participants who attended visit 1 (1987–89) and had no prior AF (n = 14,836). Incident AF was identified from study electrocardiograms and hospitalization discharge codes through 2012. SCD was physician-adjudicated. We used cause-specific Cox proportional hazards models, followed by stepwise selection (backwards elimination, removing all variables with p>0.10) to identify predictors of SCD in participants with AF. AF occurred in 2321 (15.6%) participants (age 45–64 years, 58% male, 18% black). Over a median of 3.3 years, SCD occurred in 110 of those with AF (4.7%). Predictors of SCD in AF included higher age, body mass index (BMI), coronary heart disease, hypertension, diabetes, current smoker, left ventricular hypertrophy, increased heart rate, and decreased albumin. Predictors associated only with SCD and not other cardiovascular (CV) death included increased BMI (HR per 5-unit increase, 1.15, 95% CI, 0.97–1.36, p = 0.10), increased heart rate (HR per SD increase, 1.18, 95% CI 0.99–1.41, p = 0.07), and low albumin (HR per SD decrease 1.23, 95% CI 1.02–1.48, p = 0.03). In the ARIC study, predictors of SCD in AF that are not associated with non-sudden CV death included increased BMI, increased heart rate, and low albumin. Further research to confirm these findings in larger community-based cohorts and to elucidate the underlying mechanisms to facilitate prevention is warranted. [ABSTRACT FROM AUTHOR]
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- 2017
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18. Past alcohol consumption and incident atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study.
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Dixit, Shalini, Alonso, Alvaro, Vittinghoff, Eric, Soliman, Elsayed, Chen, Lin Y., and Marcus, Gregory M.
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ALCOHOL drinking ,ATRIAL fibrillation ,ALCOHOLIC beverages ,ATRIAL arrhythmias ,ARRHYTHMIA - Abstract
Background: Although current alcohol consumption is a risk factor for incident atrial fibrillation (AF), the more clinically relevant question may be whether alcohol cessation is associated with a reduced risk. Methods and results: We studied participants enrolled in the Atherosclerosis Risk in Communities Study (ARIC) between 1987 and 1989 without prevalent AF. Past and current alcohol consumption were ascertained at baseline and at 3 subsequent visits. Incident AF was ascertained via study ECGs, hospital discharge ICD-9 codes, and death certificates. Of 15,222 participants, 2,886 (19.0%) were former drinkers. During a median follow-up of 19.7 years, there were 1,631 cases of incident AF, 370 occurring in former consumers. Former drinkers had a higher rate of AF compared to lifetime abstainers and current drinkers. After adjustment for potential confounders, every decade abstinent from alcohol was associated with an approximate 20% (95% CI 11–28%) lower rate of incident AF; every additional decade of past alcohol consumption was associated with a 13% (95% CI 3–25%) higher rate of AF; and every additional drink per day during former drinking was associated with a 4% (95% CI 0–8%) higher rate of AF. Conclusions: Among former drinkers, the number of years of drinking and the amount of alcohol consumed may each confer an increased risk of AF. Given that a longer duration of abstinence was associated with a decreased risk of AF, earlier modification of alcohol use may have a greater influence on AF prevention. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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19. Novel assessment of temporal variation in fractionated electrograms using histogram analysis of local fractionation interval in patients with persistent atrial fibrillation
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Tze Fan Chao, Men Tzung Lo, Yasuki Kihara, Chen Chuan Cheng, Wei Shiang Lin, Norden E. Huang, Chen Lin, Ambrose Kibos, Beny Hartono, Shih-Lin Chang, Shih Ann Chen, Wan Hsin Hsieh, Yenn Jiang Lin, Li Wei Lo, Kazuyoshi Suenari, Yu Feng Hu, Tsu Juey Wu, and Ke-Hsin Hsu
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Catheter ablation ,Pulmonary vein ,Electrocardiography ,Interquartile range ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,Coronary sinus ,Retrospective Studies ,Fibrillation ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Survival Rate ,Treatment Outcome ,Data Interpretation, Statistical ,Cardiology ,Catheter Ablation ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac - Abstract
Background— The characteristics of atrial electrograms associated with atrial fibrillation (AF) termination are controversial. We investigated the electrogram characteristics that indicate procedural AF termination during continuous complex fractionated electrogram ablation. Methods and Results— Fifty-two consecutive patients with persistent AF (47 men; aged 54±9 years), who underwent electrogram-based catheter ablation in the left atrium and coronary sinus after pulmonary vein isolation, were enrolled. The intracardiac bipolar atrial electrogram recordings were characterized by (1) fractionation interval (FI) analysis (>6 seconds), (2) kurtosis (shape of the FI histogram), and (3) skewness (asymmetry of the FI histogram). Sites showing complex, fractionated electrograms (mean FI ≤60 ms) were targeted, and AF was terminated in 20 patients (38%) after the pulmonary vein isolation. The conventional complex fractionated electrogram sites (mean ≤120 ms) in patients with AF termination exhibited higher median kurtosis (2.69 [interquartile range, 2.03–3.46] versus 2.35 [interquartile range, 1.79–2.48]; P =0.024) and higher complex fractionated electrogram-mean interval (102.7±19.8 versus 87.7±15.0; P =0.008) than patients without AF termination. Furthermore, AF termination sites had higher median kurtosis than targeted sites without AF termination (5.13 [interquartile range, 3.51–6.47] versus 4.18 [interquartile range, 2.91–5.34]; P P =0.007). Conclusions— A kurtosis analysis using the FI histogram may be a useful tool in identifying the critical substrate for persistent AF and potential responders to catheter ablation.
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- 2012
20. Association of Lipid-Related Genetic Variants with the Incidence of Atrial Fibrillation: The AFGen Consortium.
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Norby, Faye L., Eryd, Samuel Adamsson, Niemeijer, Maartje N., Rose, Lynda M., Smith, Albert V., Yin, Xiaoyan, Agarwal, Sunil K., Arking, Dan E., Chasman, Daniel L., Chen, Lin Y., Eijgelsheim, Mark, Engström, Gunnar, Franco, Oscar H., Heeringa, Jan, Hindy, George, Hofman, Albert, Lutsey, Pamela L., Magnani, Jared W., McManus, David D., and Orho-Melander, Marju
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ATRIAL fibrillation ,BLOOD lipids ,LIPOPROTEINS ,COHORT analysis ,EUROPEANS - Abstract
Background: Several studies have shown associations between blood lipid levels and the risk of atrial fibrillation (AF). To test the potential effect of blood lipids with AF risk, we assessed whether previously developed lipid gene scores, used as instrumental variables, are associated with the incidence of AF in 7 large cohorts. Methods: We analyzed 64,901 individuals of European ancestry without previous AF at baseline and with lipid gene scores. Lipid-specific gene scores, based on loci significantly associated with lipid levels, were calculated. Additionally, non-pleiotropic gene scores for high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc) were calculated using SNPs that were only associated with the specific lipid fraction. Cox models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CI) of AF per 1-standard deviation (SD) increase of each lipid gene score. Results: During a mean follow-up of 12.0 years, 5434 (8.4%) incident AF cases were identified. After meta-analysis, the HDLc, LDLc, total cholesterol, and triglyceride gene scores were not associated with incidence of AF. Multivariable-adjusted HR (95% CI) were 1.01 (0.98–1.03); 0.98 (0.96–1.01); 0.98 (0.95–1.02); 0.99 (0.97–1.02), respectively. Similarly, non-pleiotropic HDLc and LDLc gene scores showed no association with incident AF: HR (95% CI) = 1.00 (0.97–1.03); 1.01 (0.99–1.04). Conclusions: In this large cohort study of individuals of European ancestry, gene scores for lipid fractions were not associated with incident AF. [ABSTRACT FROM AUTHOR]
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- 2016
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21. Association of Sick Sinus Syndrome with Incident Cardiovascular Disease and Mortality: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study.
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Alonso, Alvaro, Jensen, Paul N., Lopez, Faye L., Chen, Lin Y., Psaty, Bruce M., Folsom, Aaron R., and Heckbert, Susan R.
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SICK sinus syndrome ,ARRHYTHMIA ,CARDIAC pacemakers ,CARDIOVASCULAR diseases ,ATRIAL fibrillation ,ATHEROSCLEROSIS risk factors - Abstract
Background: Sick sinus syndrome (SSS) is a common indication for pacemaker implantation. Limited information exists on the association of sick sinus syndrome (SSS) with mortality and cardiovascular disease (CVD) in the general population. Methods: We studied 19,893 men and women age 45 and older in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), two community-based cohorts, who were without a pacemaker or atrial fibrillation (AF) at baseline. Incident SSS cases were validated by review of medical charts. Incident CVD and mortality were ascertained using standardized protocols. Multivariable Cox models were used to estimate the association of incident SSS with selected outcomes. Results: During a mean follow-up of 17 years, 213 incident SSS events were identified and validated (incidence, 0.6 events per 1,000 person-years). After adjustment for confounders, SSS incidence was associated with increased mortality (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.14–1.70), coronary heart disease (HR 1.72, 95%CI 1.11–2.66), heart failure (HR 2.87, 95%CI 2.17–3.80), stroke (HR 1.56, 95%CI 0.99–2.46), AF (HR 5.75, 95%CI 4.43–7.46), and pacemaker implantation (HR 53.7, 95%CI 42.9–67.2). After additional adjustment for other incident CVD during follow-up, SSS was no longer associated with increased mortality, coronary heart disease, or stroke, but remained associated with higher risk of heart failure (HR 2.00, 95%CI 1.51–2.66), AF (HR 4.25, 95%CI 3.28–5.51), and pacemaker implantation (HR 25.2, 95%CI 19.8–32.1). Conclusion: Individuals who develop SSS are at increased risk of death and CVD. The mechanisms underlying these associations warrant further investigation. [ABSTRACT FROM AUTHOR]
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- 2014
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22. Decade-long Trends in Atrial Fibrillation Incidence and Survival: A Community Study.
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Chamberlain, Alanna M., Gersh, Bernard J., Alonso, Alvaro, Chen, Lin Y., Berardi, Cecilia, Manemann, Sheila M., Killian, Jill M., Weston, Susan A., and Roger, Véronique L.
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ATRIAL fibrillation , *DISEASE incidence , *HEART disease related mortality , *EPIDEMIOLOGY , *CARDIOLOGY , *MEDICAL research - Abstract
Background Contemporary data on temporal trends in incidence and survival after atrial fibrillation are scarce. Methods Residents of Olmsted County, Minn., with a first-ever atrial fibrillation or atrial flutter event between 2000 and 2010 were identified. Age- and sex-adjusted incidence rates were standardized to the 2010 US population, and the relative risk of atrial fibrillation in 2010 versus 2000 was calculated using Poisson regression. Standardized mortality ratios of observed versus expected survival were calculated, and time trends in survival were examined using Cox regression. Results We identified 3344 patients with incident atrial fibrillation/atrial flutter events (52% were male, mean age 72.6 years, 95.7% were white). Incidence did not change over time (age- and sex-adjusted rate ratio, 1.01; 95% confidence interval [CI], 0.91-1.13 for 2010 vs 2000). Within the first 90 days, the risk of all-cause mortality was greatly elevated compared with individuals of a similar age and sex distribution in the general population (standardized mortality ratios 19.4 [95% CI, 17.3-21.7] and 4.2 [95% CI, 3.5-5.0] for the first 30 days and 31 to 90 days after diagnosis, respectively). Survival within the first 90 days did not improve over the study period (adjusted hazard ratio, 0.96; 95% CI, 0.71-1.32 for 2010 vs 2000); likewise, no difference in mortality between 2010 and 2000 was observed among 90-day survivors (hazard ratio, 1.05; 95% CI, 0.85-1.31). Conclusions In the community, atrial fibrillation incidence and survival have remained constant over the last decade. A dramatic and persistent excess risk of death was observed in the 90 days after atrial fibrillation diagnosis, underscoring the importance of early risk stratification. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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