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Purpose: Obstructive sleep apnea (OSA) is a common, potentially modifiable condition implicated in the pathogenesis of atrial fibrillation (AF). The presence and severity of OSA is largely sleep position-dependent, yet there is high variability in positional dependence among patients with OSA. We investigated the prevalence of positional OSA (POSA) and examined associated factors in patients with AF., Methods: We recruited an equal number of patients with and without AF who underwent diagnostic polysomnography. Patients included had ≥ 120 min of total sleep time with 30 min of sleep in both supine and lateral positions. POSA was defined as an overall apnea hypopnea index (AHI) ≥ 5/h, supine AHI (sAHI) ≥ 5/h, and sAHI greater than twice the non-supine AHI. POSA prevalence was compared in patients with and without AF adjusting for age, sex, OSA severity, and heart failure., Results: A total of patients (male: 56%, mean age 62 years) were included. POSA prevalence was similar between the two groups (46% vs. 39%; p = 0.33). Obesity and severe OSA (AHI ≥ 30/h) were associated with low likelihood of POSA (OR [CI] of 0.17 [0.09-0.32] and 0.28 [0.12-0.62]). In patients with AF, male sex was associated with a higher likelihood of POSA (OR [CI] of 3.16 [1.06-10.4])., Conclusion: POSA is common, affecting more than half of patients with AF, but the prevalence was similar in those without AF. Obesity and more severe OSA are associated with lower odds of POSA. Positional therapy should be considered in patients with mild OSA and POSA., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: In the current study, we assess the predictive role of right and left atrial volume indices (RAVI and LAVI) as well as the ratio of RAVI/LAVI (RLR) on mortality following transcatheter mitral valve repair (TMVr)., Methods: Transthoracic echocardiograms of 158 patients who underwent TMVr at a single academic medical center from 2011 to 2018 were reviewed retrospectively. RAVI and LAVI were calculated using Simpson's method. Patients were stratified based on etiology of mitral regurgitation (MR). Cox proportional-hazard regression was created utilizing MR type, STS-score, and RLR to assess the independent association of RLR with survival. Kaplan-Meier analysis was used to analyze the association between RAVI and LAVI with all-cause mortality. Hemodynamic values from preprocedural right heart catheterization were also compared between RLR groups., Results: Among 123 patients included (median age 81.3 years; 52.5% female) there were 50 deaths during median follow-up of 3.0 years. Patients with a high RAVI and low LAVI had significantly higher all-cause mortality while patients with high LAVI and low RAVI had significantly improved all-cause mortality compared to other groups (p = 0.0032). RLR was significantly associated with mortality in patients with both functional and degenerative MR (p = 0.0038). Finally, Cox proportion-hazard modeling demonstrated that an elevated RLR above the median value was an independent predictor of all-cause mortality [HR = 2.304; 95% CI = 1.26-4.21, p = 0.006] when MR type and STS score were accounted for., Conclusion: Patients with a high RAVI and low LAVI had significantly increased mortality than other groups following TMVr suggesting RA remodeling may predict worse outcomes following the procedure. Concordantly, RLR was predictive of mortality independent of MR type and preprocedural STS-score. These indices may provide additional risk stratification in patients undergoing evaluation for TMVr., (© 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

The incidence of new-onset secondary atrial fibrillation (NOSAF) is as high as 44% in noncardiac critical illness. A systematic review and meta-analysis were performed to evaluate the impact of NOSAF, compared with history of prior atrial fibrillation (AF) and no history of AF in noncardiac critically ill patients. Patients undergoing cardiothoracic surgery were excluded. NOSAF incidence, intensive care unit (ICU)/hospital length of stay (LOS), and mortality outcomes were analyzed. Of 2,360 studies reviewed, 19 studies met inclusion criteria (n = 306,805 patients). NOSAF compared with no history of AF was associated with increased in-hospital mortality (risk ratio [RR] 2.06, 95% confidence interval [CI] 1.76 to 2.41, p <0.001), longer ICU LOS (standardized difference in means [SMD] 0.66, 95% CI 0.41 to 0.91, p <0.001), longer hospital LOS (SMD 0.31, 95% CI 0.07 to 0.56, p = 0.001) and increased risk of long-term (>1 year) mortality (RR 1.76, 95% CI 1.29 to 2.40, p <0.001). NOSAF compared with previous AF was also associated with higher in-hospital mortality (RR 1.29, 95% CI 1.12 to 1.49, p <0.001), longer ICU LOS (SMD 0.37, 95% CI 0.03 to 0.70, p = 0.03) but no difference in-hospital LOS (SMD -0.18, 95% CI -0.66 to 0.31, p = 0.47). In conclusion, NOSAF, in the setting of noncardiac critical illness is associated with increased in-hospital mortality compared with no history of AF and previous AF. NOSAF (vs no history of AF) is also associated with increased long-term mortality., Competing Interests: Disclosures The authors have no conflicts of interest to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Prior meta-analyses have shown that new-onset atrial fibrillation (NOAF) occurs in up to 40% of patients following cardiac surgery and is associated with substantial major adverse cardiovascular events. The stroke and mortality implications of NOAF in isolated CABG without concomitant valve surgery is not known. We thought that NOAF would be associated with increased risk of stroke and mortality, even in patients undergoing isolated CABG. A blinded review of studies from MEDLINE, CENTRAL, and Web of Science was done by two independent investigators. Stroke, 30-day/hospital mortality, long-term cardiovascular mortality, and long-term (>1 year) all-cause mortality were analyzed. We used Review Manager Version 5.3 to perform pooled analysis of outcomes. Of 4461 studies identified, 19 studies (n = 129 628) met inclusion criteria. NOAF incidence ranged from 15% to 36%. NOAF was associated with increased risk of stroke (unadjusted OR 2.15 [1.82, 2.53] [P < .00001]; adjusted OR 1.88 [1.02, 3.46] [P = .04]). NOAF was associated with increased 30-day/hospital mortality (OR 2.35 [1.67, 3.32] [P < .00001]) and long-term cardiovascular mortality (OR 2.04 [1.35, 3.09] [P = .0007]) NOAF was associated with increased long-term all-cause mortality (unadjusted OR 1.79 [1.63, 1.96] [P < .00001]; adjusted OR 1.58 [1.24, 2.00] [P = .0002]). We found that the incidence of NOAF following isolated CABG is high and is associated with increased stroke rate and mortality. Early recognition and management of NOAF could improve outcomes., (© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Introduction: Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder with important cardiovascular implications. Left atrial abnormality can be identified by electrocardiographic P-wave morphology and is considered an important risk for atrial fibrillation (AF) and stroke, both of which have been associated with OSA. We hypothesized that severity of OSA would be associated with more abnormal electrocardiographic P-wave morphology as indicated by P-wave terminal force in V 1 (PTFV 1 ) and P-wave area in V 1 (PWAV 1 )., Methods: Patients who underwent clinically indicated polysomnography and had 12-lead ECG were identified through medical record review. Logistic regression was used to determine the associations between the measures of OSA severity (apnea hypopnea index [AHI] and mean nocturnal oxygen [O 2 ] saturation) and abnormal PTFV 1 and PWAV 1 (defined by >75% percentile value of the studied cohort) adjusting for age, sex, body mass index, and hypertension., Results: A total of 261 patients (mean age: 57 years old, male: 52%) were included in the study. Multivariate analysis showed that AHI was associated with abnormal PTFV 1 (>7,280 µV ms) and PWAV 1 (>1,000 µV ms; OR: 1.5; 95% CI [1.1, 2.0], p = 0.008; OR: 1.5 [1.1, 2.1], p = 0.005 per 1 SD increase in AHI, respectively). Mean O 2 saturation was associated with abnormal PWAV 1 (OR: 0.72 [0.54, 0.98], p = 0.03). Results remained unchanged after excluding patients taking AV nodal blocking agents., Conclusion: In a sleep clinic cohort, there was significant association between OSA severity and ECG-defined left atrial abnormality., (© 2019 Wiley Periodicals, Inc.)

We are reporting the use of three-dimensional transesophageal echocardiography as a supplement to two-dimensional transesophageal echocardiography in the percutaneous suture closure of the left atrial appendage., (© 2012, Wiley Periodicals, Inc.)

Introduction: Sleep apnea is highly prevalent in patients with atrial fibrillation (AF). Obstructive sleep apnea (OSA) is the most common type, and best studied in the context of AF. However, recent investigations have indicated that central sleep apnea (CSA) may be a risk factor for incident AF. We evaluated the burden of CSA events in patients referred for diagnostic polysomnography (PSG) and whether AF is associated with CSA. Methods: We identified patients with and without a history of AF who underwent clinically indicated PSG in a matched manner. OSA was defined as obstructive apnea‐hypopnea index (AHI) ≥15/h, and CSA was defined as central apnea index (CAI) ≥5/h. The association between AF and CSA was evaluated using multivariable logistic regression. Results: Among 465 patients included, mean AHI was 25.5/h, and mean CAI was 1.7/h. OSA prevalence was 53.3%, while CSA prevalence was 8.4%. The prevalence of OSA in the AF and non‐AF groups (54.7% vs 52.0%, P =.56) was similar. CSA was more common in the AF group (12.3% vs 4.4%, P =.002). In multivariable analysis, AF (OR: 2.19 [1.02, 5.03], P =.05), male gender (OR: 2.5 [1.17, 5.84], P =.02), and older age (OR: 2.44, [1.16, 5.46], P =.02) were associated with CSA. Conclusion: Though CSA is much less common than OSA in patients with AF, the presence of AF is independently associated with CSA. [ABSTRACT FROM AUTHOR]

Inferior vena cava (IVC) diameter and respirophasic variation are commonly used echocardiographic indices to estimate right atrial pressure. While dilatation of the IVC and reduced collapsibility have traditionally been associated with elevated right heart filling pressures, the significance of isolated IVC dilatation in the absence of raised filling pressures remains poorly understood. We present a case of an asymptomatic 28-year-old male incidentally found to have IVC dilatation, reduced inspiratory collapse, and normal right heart pressures. [ABSTRACT FROM AUTHOR]

The article presents information on atrial fibrillation (AF), its various manifestations which include lone AF, recent-onset AF and permanent AF and approaches to patients with AF. It discusses the etiology of AF which includes atrial fibrosis and loss of atrial muscle, hence explaining its prevalence in the elderly. Several tables are also presented on topics related to secondary causes of AF, use of oral and intravenous drugs in AF and assessment of stroke risk.

The article offers updates on atrial fibrillation (AF) management. It reviews the classification of AF, the epidemiology, etiology, symptoms and manifestations and the strategic objectives in AF management involving rhythm control, rate control and thromboembolism prevention that can be achieved through non-pharmacological and pharmacological means. It also notes oral anticoagulant therapy, antiarrhythmic drugs, pacemaker therapy and implantable atrial defibrillators.

Background: To evaluate predictors ofincreased length-of-stay (LOS) following catheter ablation (CA) of atrial fibrillation (AF)in order to extrapolate high-risk populations for same-day-discharge (SDD). Methods: We conducted a retrospective analysis of 200 patients undergoing AF CA from July 2017-June 2018 at a tertiary academic medical center. Results: Among 200 patients, 11.5% (n = 23) had LOS > 1 day (Group A) while 88.5% had an overnight stay (n = 177, Group B). Group A patients had more persistent AF (50.0% vs. 25.1%, p = 0.017), diabetes mellitus (52.2% vs. 16.4%, p < 0.001), loop diuretic use (60.9% vs. 23.7%, p < 0.001), and warfarin use (26.1% vs. 10.7%, p = 0.037), as well as higher mean CHA2DS2VASc scores (3.91± 1.35vs. 2.65 ± 1.54, p < 0.001) and longer mean procedure times (341 minutes vs. 270 minutes, p = 0.005) requiring more intraprocedural furosemide(51.4 mg vs. 27.6 mg, p = 0.031).30 day heart failure hospitalizations (17.4% vs. 1.13%, p < 0.001), access site complications, (13.0% vs. 1.70%, p < 0.003) and recurrent atrial arrhythmias both pre- and post-discharge (pre: 17.4% vs. 0%, p < 0.001; post: 47.8% vs. 19.8%, p < 0.001) were also more prevalent in Group A. Multivariate modeling demonstrated that diabetes mellitus, warfarin use, and longer procedure times were predictors of increased LOS. Conclusion: This study identified predictors of increased LOS following AF CA in a pre-SDD, pre-COVID cohort and explored how these factors could influence discharge planning for high-risk populations. [ABSTRACT FROM AUTHOR]

Background: Self-reported poor sleep quality has been suggested in patients with AF. Slow wave sleep (SWS) is considered the most restorative sleep stage and represents an important objective measure of sleep quality. The aim of this study was to compare quantity of SWS between patients with and without AF. Methods and Results: We included patients with and without a documented history of AF by reviewing clinically indicated polysomnography data from a single sleep center. Patients on medications with potential influence on sleep architecture were excluded. Logistic regression was performed to determine the association between AF and SWS time (low vs. high) adjusting for age, gender, body mass index, and sleep apnea. In a 2:1 case-control set-up, a total of 205 subjects (139 with AF, 66 without AF) were included. Mean age was 62 (SD: 14.3) years and 59% were men. Patients with AF had lower SWS time (11.1 vs. 16.6 min, p=0.02). In multivariable analysis, prevalent AF was associated with low SWS independent of sleep apnea and other potential confounders (OR 2.5 [1.3, 5.0], p=0.006). Limiting the analysis to patients whose total sleep time was greater than 4 hours (by excluding N=31) resulted in more robust results (OR 3.9 [1.7, 9.7]. p=0.002). Conclusions: AF is associated with more impaired sleep quality as indicated by lower quantity of SWS. More studies are needed to explore the mechanistic interactions between AF and sleep. [ABSTRACT FROM AUTHOR]