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Background/Objectives: The prevalence of atrial fibrillation (AF) has been on the rise over the last 20 years. It is considered to be the most common cardiac arrhythmia and is associated with significant morbidity and mortality. The need for in-hospital management of patients having AF is increasing. Acute decompensation of cardiac rhythm is an indication for hospital admission. In the existing literature, several studies on different pathologies have observed that the risk of death was greater for patients with an increased neutrophil-to-lymphocyte ratio (NLR) and suggested that the NLR can be a useful biomarker to predict in-hospital mortality. This study aims to evaluate the link between the neutrophil-to-lymphocyte ratio at admission and death among the patients admitted to the medical ward for the acute manifestation of AF, and to gain a better understanding of how we can predict in-hospital all-cause death based on the NLR for these patients. Methods: A single-center retrospective study in an academic medical clinic was conducted. We analyzed if the NLR at in-hospital admission can be related to in-hospital mortality among the patients admitted for AF at the Medical Ward of Municipal Emergency University Hospital Timisoara between 2015 and 2016. After identifying a total of 1111 patients, we divided them into two groups: in-hospital death patients and surviving patients. We analyzed the NLR in both groups to determine if it is related to in-hospital mortality or not. One patient was excluded because of missing data. Results: Our analysis showed that patients who died during in-hospital admission had a significantly higher NLR compared to those who survived (p < 0.0001, 95% CI (1.54 to 3.48)). The NLR was found to be an independent predictor of in-hospital death among patients with AF, even for the patients with no raised level of blood leukocytes (p < 0.0001, 95% CI (0.6174 to 3.0440)). Additionally, there was a significant correlation between the NLR and the risk of in-hospital death for patients admitted with decompensated AF (p < 0.0001), with an area under the ROC curve of 0.745. Other factors can increase the risk of death for these patients (such as the personal history of stroke, HAS-BLED score, and age). Conclusions: The NLR is a useful biomarker to predict in-hospital mortality in patients with AF and can predict the risk of death with a sensitivity of 72.8% and a specificity of 70.4%. Further studies are needed to determine the clinical utility of the NLR in risk stratification and management of patients with AF. [ABSTRACT FROM AUTHOR]

BACKGROUND: An unmet need exists to reliably predict the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) treated with oral anticoagulants (OACs). HYPOTHESIS: An externally validated model improves ICH risk stratification. METHODS: Independent factors associated with ICH were identified by Cox proportional hazard modeling, using pooled data from the GARFIELD-AF (Global Anticoagulant Registry in the FIELD-Atrial Fibrillation) and ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registries. A predictive model was developed and validated by bootstrap sampling and by independent data from the Danish National Patient Register. RESULTS: In the combined training data set, 284 of 53 878 anticoagulated patients had ICH over a 2-year period (0.31 per 100 person-years; 95% confidence interval [CI]: 0.28-0.35). Independent predictors of ICH included: older age, prior stroke or transient ischemic attack, concomitant antiplatelet (AP) use, and moderate-to-severe chronic kidney disease (CKD). Vitamin K antagonists (VKAs) were associated with a significantly higher risk of ICH compared with non-VKA oral anticoagulants (NOACs) (adjusted hazard ratio: 1.61; 95% CI: 1.25-2.08; p = .0002). The ability of the model to discriminate individuals in the training set with and without ICH was fair (optimism-corrected C-statistic: 0.68; 95% CI: 0.65-0.71) and outperformed three previously published methods. Calibration between predicted and observed ICH probabilities was good in both training and validation data sets. CONCLUSIONS: Age, prior ischemic events, concomitant AP therapy, and CKD were important risk factors for ICH in anticoagulated AF patients. Moreover, ICH was more frequent in patients receiving VKA compared to NOAC. The new validated model is a step toward mitigating this potentially lethal complication.

Abstract Warfarin remains the most prescribed oral anticoagulant of choice in atrial fibrillation (AF) patient in resource-limited settings. Despite evidence linking Time in Therapeutic Range (TTR) to patient outcomes, its use in clinical practice is not widespread. This prospective study explores the impact of a TTR-INR guided Warfarin adjustment protocol on TTR in AF patients. Conducted at the Warfarin clinic of King Chulalongkorn Memorial Hospital. TTR was calculated using the Rosendaal linear interpolation method at baseline, and then at 6 and 12 months post-protocol implementation. The primary outcome was the improvement in TTR following the protocol’s implementation. The study analyzed 57 patients, with a mean age of 72 years and an even gender distribution. At baseline, 53% of patients had a TTR of less than 65%. However, TTR significantly improved from 65% at baseline to 80% after 12 months of protocol implementation (p

Objective: Older patients with nonvalvular atrial fibrillation (AF) are at high risk for frailty and geriatric syndromes (GSs), which modulate their individual prognosis and are therefore relevant for further management. Because few studies have evaluated the geriatric profile of older AF patients, this secondary analysis aims to further characterize the patterns of GSs and geriatric resources (GRs) in AF patients and their association with anticoagulation use. Methods: Data from 362 hospitalized patients aged 65 years and older with AF (n = 181, 77.8 ± 5.8 years, 38% female) and without AF (non-AF [NAF]; n = 181, 77.5 ± 5.9 years, 40% female) admitted to an internal medicine and nephrology ward of a large university hospital in Germany were included. All patients underwent usual care plus a comprehensive geriatric assessment (CGA) including calculation of the Multidimensional Prognostic Index (MPI) and collection of 17 GSs and 10 GRs. Patients were followed up by telephone 6 and 12 months after discharge to collect data on their health status. Results: The mean MPI score of 0.47 indicated an average risk of poor outcome, and patients with AF had a significantly higher MPI than those without AF (p = 0.040). After adjustment for chronological age, biological sex, Cumulative Illness Rating Scale (CIRS) for relevant chronic diagnoses and MPI as a proxy for biological age, AF patients had significantly more mnestic resources (63.5% vs. 33.1%, p < 0.001), a tendency for less age-appropriate living conditions (56.4% vs. 72.9%, p = 0.051) and more sensory impairment (78.5% vs. 52.5%, p < 0.001) than NAF patients. They also had a higher number of GSs (p = 0.046). AF patients on oral anticoagulants (OACs, n = 91) had less age-appropriate living conditions (48.4% vs. 64.4%, p < 0.05) and mnestic resources (36.3% vs. 54.4%, p < 0.01), but more emotional resources (80.2% vs. 65.6%, p < 0.05) and chronic pain (56% vs. 40%, p < 0.05) than patients without OACs (n = 90). Overall, mortality at 1 year was increased in patients with a higher MPI (p < 0.009, adjusted for age, sex and CIRS), with a diagnosis of AF (p = 0.007, adjusted for age, sex, CIRS and MPI), with of male sex (p = 0.008, adjusted for age, CIRS and MPI) and those with AF and treated with hemodialysis (p = 0.022, compared to AF patients without dialysis treatment). Conclusions: Patients with AF and patients with AF and OACs show differences in their multidimensional frailty degree as well as GR and GS profiles compared to patients without AF or with AF not treated with OACs. Mortality after 1 year is increased in AF patients with a higher MPI and dialysis, independently from OAC use and overall burden of chronic disease as assessed per CIRS. GRs and GSs, especially age-appropriate living conditions, emotional resources, sensory impairment and chronic pain, can be considered as factors that may modify the individual impact of frailty, underscoring the relevance of these parameters in the management of older patients. [ABSTRACT FROM AUTHOR]

Background: Intro-aortic balloon pump (IABP) is widely used in cardiac surgery patients nowadays. This study aimed to analyze the predictor of short-term survival in cardiac valvular surgery patients with intra-aortic balloon pump implantation. Methods: This was a retrospective study and a total of 102 cardiac valvular surgery patients who received intra-aortic balloon pump implantation were consecutively included. We retrospectively collected the baseline characteristics and short-term outcomes. Baseline characteristics were compared between survivors with non-survivors, and logistic regression was performed to identify predictors for short-term mortality. Results: Among all the patients, there were 71 (69.6%) patients successfully weaned from IABP and survived to discharge, the other 31 (30.4%) patients failed to wean from IABP and died within the first 30 days after surgery. When compared with non-survivors, survivors had a higher proportion of males (62% vs 32.3%, p = 0.006), a lower rate of Atrial fibrillation (38% vs 62%, p < 0.03). After IABP implantation, vasoactive drug use was significantly lower in survivors compared with non-survivors, and survivors showed significant improvements in cardiac function and urine volume. Univariate and multivariate logistic regression analysis indicated that atrial fibrillation and combined use of continuous renal replacement therapy (CRRT) were significant independent predictors for short-term mortality. Conclusion: Timely implantation of IABP can improve patients' cardiac and renal function and reduce the dosage of vasoactive drugs. Atrial fibrillation and combined use of CRRT are independent predictors for short-term mortality in patients who underwent cardiac valvular surgery with IABP implantation. [ABSTRACT FROM AUTHOR]

Background: Heart failure, stroke and death are major dangers associated with atrial fibrillation (AF), a common abnormal heart rhythm. Having a gastrointestinal (GI) procedure puts patients at risk for developing AF, especially after large abdominal surgery. Although earlier research has shown a possible connection between postoperative AF and higher mortality, the exact nature of this interaction is yet uncertain. Methods: To investigate the relationship between AF and death after GI procedures, this research carried out a thorough meta-analysis and systematic review of randomized controlled studies or clinical trials. Finding relevant randomized controlled trials (RCTs) required a comprehensive search across many databases. Studies involving GI surgery patients with postoperative AF and mortality outcomes were the main focus of the inclusion criteria. We followed PRISMA and Cochrane Collaboration protocols for data extraction and quality assessment, respectively. Results: After GI surgery, there was no statistically significant difference in mortality between the AF and non-AF groups, according to an analysis of the available trials (p = 0.97). The mortality odds ratio (OR) was 1.03 (95% CI [0.24, 4.41]), suggesting that there was no significant correlation. Nevertheless, there was significant heterogeneity throughout the trials, which calls for careful interpretation. Conclusion: Despite the lack of a significant link between AF and death after GI surgery in our study, contradictory data from other research highlight the intricacy of this relationship. Discrepancies may arise from variations in patient demographics, research methodology and procedural problems. These results emphasize the necessity for additional extensive and varied studies to fully clarify the role of AF in postoperative mortality in relation to GI procedures. Comprehending the subtleties of this correlation might enhance future patient outcomes and contribute to evidence-based therapeutic decision making. [ABSTRACT FROM AUTHOR]

Interleukin (IL)-33, a cytokine involved in immune responses, can activate its receptor, suppression of tumorigenicity 2 (ST2), is elevated during atrial fibrillation (AF). However, the role of IL-33/ST2 signaling in atrial arrhythmia is unclear. This study explored the pathological effects of the IL-33/ST2 axis on atrial remodeling and arrhythmogenesis. Patch clamping, confocal microscopy, and Western blotting were used to analyze the electrical characteristics of and protein activity in atrial myocytes (HL-1) treated with recombinant IL-33 protein and/or ST2-neutralizing antibodies for 48 hrs. Telemetric electrocardiographic recordings, Masson's trichrome staining, and immunohistochemistry staining of the atrium were performed in mice receiving tail vein injections with nonspecific immunoglobulin (control), IL-33, and IL-33 combined with anti-ST2 antibody for 2 weeks. IL-33-treated HL-1 cells had a reduced action potential duration, lower L-type Ca2+ current, greater sarcoplasmic reticulum (SR) Ca2+ content, increased Na+/Ca2+ exchanger (NCX) current, elevation of K+ currents, and increased intracellular calcium transient. IL-33-treated HL-1 myocytes had greater activation of the calcium–calmodulin-dependent protein kinase II (CaMKII)/ryanodine receptor 2 (RyR2) axis and nuclear factor kappa B (NF-κB) / NLR family pyrin domain containing 3 (NLRP3) signaling than did control cells. IL-33 treated cells also had greater expression of Nav1.5, Kv1.5, NCX, and NLRP3 than did control cells. Pretreatment with neutralizing anti-ST2 antibody attenuated IL-33-mediated activation of CaMKII/RyR2 and NF-κB/NLRP3 signaling. IL-33-injected mice had more atrial ectopic beats and increased AF episodes, greater atrial fibrosis, and elevation of NF-κB/NLRP3 signaling than did controls or mice treated with IL-33 combined with anti-ST2 antibody. Thus, IL-33 recombinant protein treatment promotes atrial remodeling through ST2 signaling. Blocking the IL-33/ST2 axis might be an innovative therapeutic approach for patients with atrial arrhythmia and elevated serum IL-33. [ABSTRACT FROM AUTHOR]

Background: High-power short-duration (HPSD) ablation may improve the consistency and efficiency of pulmonary vein isolation (PVI). The novel QDOT Micro™ catheter (Biosense Webster, Inc.) with temperature feedback and microelectrodes aims to enhance PVI efficiency and safety. This study wants to evaluate the feasibility, safety, and efficiency of a standardized single-catheter workflow for PVI using QDOT (Q-FLOW). Methods: The Q-FLOW includes single transeptal access, radiofrequency encircling of the PVs using a power of 50 W in a temperature/flow-controlled mode, and validation of the circles with microelectrodes. A 1:1 propensity-matched cohort of patients treated with conventional power-controlled ablation using a circular mapping catheter (CMC-FLOW) was used to compare procedural and clinical outcomes. Results: A total of 150 consecutive atrial fibrillation patients (paroxysmal 67%, persistent 33%) were included. First-pass isolation rate was 86%. Procedural time, X-ray time, and dose were significantly lower for the Q-FLOW vs the CMC-FLOW (67.2 ± 17.9 vs 88.3 ± 19.2 min, P < 0.001; 3.0 ± 1.9 vs 5.0 ± 2.4 min, P < 0.001; 4.3 ± 1.9 vs 6.4 ± 2.3 Gycm2, P < 0.001). Complications were numerically but not significantly lower in the Q-FLOW group (2 [1.3%] vs 7 [4.7%], P = 0.091). There was no difference in arrhythmia recurrence at 12 months (atrial arrhythmia-free survival rate, 87.5% vs 84.4%, P = 0.565). Conclusion: A streamlined single-catheter workflow for PVI using QDOT was feasible and safe, resulting in a high rate of first-pass isolation and a low complication rate. The Q-FLOW further improved the efficiency of PVI compared to the standard CMC-FLOW, without difference in the 12-month outcome. [ABSTRACT FROM AUTHOR]

Warfarin remains the most prescribed oral anticoagulant of choice in atrial fibrillation (AF) patient in resource-limited settings. Despite evidence linking Time in Therapeutic Range (TTR) to patient outcomes, its use in clinical practice is not widespread. This prospective study explores the impact of a TTR-INR guided Warfarin adjustment protocol on TTR in AF patients. Conducted at the Warfarin clinic of King Chulalongkorn Memorial Hospital. TTR was calculated using the Rosendaal linear interpolation method at baseline, and then at 6 and 12 months post-protocol implementation. The primary outcome was the improvement in TTR following the protocol's implementation. The study analyzed 57 patients, with a mean age of 72 years and an even gender distribution. At baseline, 53% of patients had a TTR of less than 65%. However, TTR significantly improved from 65% at baseline to 80% after 12 months of protocol implementation (p < 0.001). Furthermore, there was a significant increase in the proportion of patients with a TTR of 65% or more, from 47 to 88% (p < 0.001). During the follow-up period in the first 12 months, three patients died, but no ischemic or major bleeding events occurred. The significant improvement in TTR after 12 months of protocol implementation suggests that this strategy could provide additional value in improving TTR and outcomes in AF patients receiving Warfarin. [ABSTRACT FROM AUTHOR]

Background: Subclinical hypothyroidism is associated with elevated TSH with normal T3 and T4 levels. Its effect on cardiac surgery outcome is controversial. Some authors revealed adverse outcome in form of arrythmia and congestive heart failure. This study aimed to investigate the effect of subclinical hypothyroidism on early outcome of patients undergoing coronary artery bypass graft (CABG) surgery. Methods: This study included 27 patients with subclinical hypothyroidism subjected to elective CABG surgery (Group A) and group B that contained 27 patients with normal thyroid function. Both groups were followed up for one month postoperative regarding operative mortality and postoperative outcomes. Results: Cases required prolonged mechanical ventilation and postoperative inotropic support were significantly higher among the SCH group compared to the euthyroid group (p=0.024, 0.018 respectively). The occurrence of postoperative AF and the respiratory complications was significantly higher in SCH group in comparison to the euthyroid group (p=0.039, 0.022 respectively). Mortality was recorded in only one case of SCH group and in 2 cases of the euthyroid group (p=0.998). Conclusion: SCH is associated with increased postoperative AF, need for inotropic support and prolonged mechanical ventilation. Preoperative assessment of thyroid functions is recommended to be performed routinely before surgery. [ABSTRACT FROM AUTHOR]

Tachyarrhythmias are common cardiovascular emergencies encountered in clinical practice. Among these, atrial fibrillation (AF) and ventricular tachycardia (VT) pose significant hazards due to their prevalence and severity. Initially, non-invasive pharmacological antiarrhythmic interventions were the primary treatment modality; however, due to their limited control rates and side effects, invasive therapies have been introduced in recent years. These include catheter ablation, alcohol ablation, cardiac implantable electronic devices, and heart transplantation. Nonetheless, for some patients, invasive treatments do not offer a definitive cure for arrhythmias and carry the risk of recurrence, especially with AF and VT, where the relapse rates are high and the treatment for VT is correlated with the type of tachycardia present. Currently, novel non-invasive treatment methods are emerging, with stereotactic radioablation therapy becoming an effective alternative for the management of refractory tachyarrhythmias. This review provides an overview of the application background of Stereotactic Arrhythmia Radioablation (STAR) therapy and promising results from its use in animal models and clinical applications.

IntroductionThe primary objective of our study was to evaluate the first use of a novel intracardiac echocardiography (ICE) catheter in human subjects. This study aimed to assess its practicality, image clarity, and guidance role during electrophysiology procedures.MethodsTwo patients underwent procedures using the novel ICE catheter. Post-procedure evaluations were conducted by four operators, who assessed the imaging quality and overall performance of the catheter. Anatomical and blood test results were also analyzed to determine the safety and impact on internal cardiac structures.ResultsBoth patients were discharged one day after the procedure without any complications. The novel ICE catheter provided comparable imaging quality to existing commercial catheters. The catheter's advanced design allowed for detailed imaging at short distances, essential for accurate diagnosis and treatment planning. Moreover, it successfully navigated complex anatomical structures like the atrial septum and left atrial appendage.DiscussionThese preliminary studies indicate that the novel ICE catheter achieves a level of safety and effectiveness comparable to previously available commercial catheters. The findings highlight its potential to meet current clinical needs, particularly in sophisticated anatomic interventions. Despite the prolonged thrombin time after anticoagulant administration, both types of ICE catheters were non-damaging to cardiac structures during routine operations. The study underscores the importance of using trans-septal large inner diameter sheaths to minimize complications when advancing the catheter into the left atrium.

Atrial fibrillation (AF) is a common cardiac arrhythmia that seriously affects the quality of life of patients. Effective treatment and prevention are important to control the morbidity and mortality of AF. It has been found that cardiac fibrosis promotes the onset and progression of AF. It is now known that transforming growth factor β (TGF-β), an important fibrotic cytokine, plays an important role in cardiac fibrosis by inducing myofibroblast activation via the activation of classical (SMAD-based) and non-classical (non-SMAD-based) signaling pathways. In addition, specific activation of the Wnt/β-catenin pathway has been shown to promote the transformation of fibroblasts into myofibroblasts. In recent years, a new family of proteins, namely Disheveled-associated antagonist of beta-catenin (DACT) 2, can affect the Wnt/β-catenin and TGF-β signaling pathways by regulating the phosphorylation levels of these target proteins, which in turn affects the progression of fibrosis. The present study focuses on the effect of DACT2-guided β-catenin on atrial fibrosis. It is expected that the summarized information can be helpful in the treatment of AF.

This document discusses the importance of combating stroke prevention in low- and middle-income countries (LMICs). Stroke is a significant cause of death and disability in these nations and places a burden on their healthcare systems. The document explains the different types of stroke, risk factors, and diagnostic tools used in stroke cases. It emphasizes the need for early diagnosis and treatment, as well as the importance of addressing modifiable risk factors such as hypertension, diabetes, and atrial fibrillation. The document also highlights the role of genetics and the potential for gene therapy in stroke prevention. It suggests implementing policies, awareness campaigns, and cost-effective strategies to reduce the burden of stroke in LMICs. The authors emphasize the importance of training healthcare professionals, international collaborations, and research in combating stroke in low-income settings. [Extracted from the article]

Abstract Atrial fibrillation (AF) recurrence has become common in patients who have undergone catheter ablation. High neutrophil lymphocyte ratios (NLR) have been linked to an increased risk of recurrent AF. The research is, however, not conclusive. This meta‐analysis addressed the value of easily accessible and affordable pre‐ and postablation NLR levels as indicators of AF recurrence in patients who had undergone ablation. We searched PubMed, SCOPUS, and Google Scholar for pertinent studies through May 2023. Using random effects models, the aggregated odds ratio (OR) of pre‐ and post‐NLR and AF recurrence was estimated. Inter‐study heterogeneity was described using I2 statistics and leave‐one‐out sensitivity analysis. A p‐value

Atrial fibrillation (AF) recurrence has become common in patients who have undergone catheter ablation. High neutrophil lymphocyte ratios (NLR) have been linked to an increased risk of recurrent AF. The research is, however, not conclusive. This meta-analysis addressed the value of easily accessible and affordable pre-and postablation NLR levels as indicators of AF recurrence in patients who had undergone ablation. We searched PubMed, SCOPUS, and Google Scholar for pertinent studies through May 2023. Using random effects models, the aggregated odds ratio (OR) of pre-and post-NLR and AF recurrence was estimated. Inter-study heterogeneity was described using I² statistics and leave-one-out sensitivity analysis. A p-value < .05 was considered statistically significant. The literature search yielded 270 studies, seven of which were included in this meta-analysis of 1923 patients who experienced AF recurrence after undergoing ablation. There are five retrospective and two prospective studies with a mean follow-up of 20.5 months. The unadjusted odds ratio (OR) of AF recurrence for preablation NLR was 1.33 (95% CI: 1.04-1.71, p < .01, I² = 95.49%), while the adjusted OR was 1.45 (95% CI: 0.87-2.43, p < .01, I² = 95.1%). The unadjusted odds ratio (OR) for postablation NLR was 1.21 (95% CI: 1.09-1.36, p < .01, I² = 85.9%), and the adjusted odds ratio (OR) was 1.28 (95% CI: 0.93-1.76), demonstrating significant heterogeneity (I² = 95.32%) with a p-value < .01. NLR was significantly associated with AF recurrence prediction. To detect AF recurrence, we recommend that clinicians add a simple NLR blood test to their diagnostic modalities. [ABSTRACT FROM AUTHOR]

Aims Pulmonary vein isolation (PVI) is increasingly performed in patients with atrial fibrillation (AF). Both AF phenotype and left atrial (LA) volume have been shown to influence ablation outcome. The inter-relationship of the two is incompletely understood. We aimed to investigate the impact of AF phenotype vs. LA volume on outcome after PVI. Methods and results In a retrospective analysis of a prospective registry of patients undergoing a first PVI, the association of AF phenotype and LA volume index (LAVI) was assessed as well as their impact on AF recurrence during follow-up. Overall, 476 patients were enrolled (median age 63 years, 29% females, 65.8% paroxysmal AF). Obesity, hypertension, chronic kidney disease, and heart failure were all significantly more frequent in persistent AF. After 1 year, single-procedure, freedom from arrhythmia recurrence was 61.5%. Patients with paroxysmal AF had better outcomes compared with patients with persistent AF (65.6 vs. 52.7%, P = 0.003), as had patients with no/mild vs. moderate/severe LA dilation (LAVI <42 mL/m2 67.1% vs. LAVI ≥42 mL/m2 53%, P < 0.001). The combination of both parameters refined prediction of 1-year recurrence (P < 0.001). After adjustment for additional clinical risk factors in multivariable Cox proportional hazard analysis, both AF phenotype and LAVI ≥42 mL/m2 contributed significantly towards the prediction of 1-year recurrence. Conclusion Atrial fibrillation phenotype and LA volume are independent predictors of outcome after PVI. Persistent AF with no/mild LA dilation has a similar risk of recurrence as paroxysmal AF with a moderate/severe LA dilation and should be given similar priority for ablation. [ABSTRACT FROM AUTHOR]

Device therapy is a nonpharmacological approach that presents a crucial advancement for managing patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). This review investigated the impact of device-based interventions and emphasized their potential for optimizing treatment for this complex patient demographic. Cardiac resynchronization therapy, augmented by atrioventricular node ablation with His-bundle pacing or left bundle-branch pacing, is effective for enhancing cardiac function and establishing atrioventricular synchrony. Cardiac contractility modulation and vagus nerve stimulation represent novel strategies for increasing myocardial contractility and adjusting the autonomic balance. Left ventricular expanders have demonstrated short-term benefits in HFpEF patients but require more investigation for long-term effectiveness and safety, especially in patients with AF. Research gaps regarding complications arising from left ventricular expander implantation need to be addressed. Device-based therapies for heart valve diseases, such as transcatheter aortic valve replacement and transcatheter edge-to-edge repair, show promise for patients with AF and HFpEF, particularly those with mitral or tricuspid regurgitation. Clinical evaluations show that these device therapies lessen AF occurrence, improve exercise tolerance, and boost left ventricular diastolic function. However, additional studies are required to perfect patient selection criteria and ascertain the long-term effectiveness and safety of these interventions. Our review underscores the significant potential of device therapy for improving the outcomes and quality of life for patients with AF and HFpEF. [ABSTRACT FROM AUTHOR]

Background: A biological mechanism called inflammation is necessary for reacting to damaging stimuli, but it can also, ironically, play a role in the formation of arrhythmias, or the group of disorders known as arrhythmogenesis. This review delves into the intricate relationship that exists between localized and systemic inflammation and the electrophysiological changes that result in abnormal heart rhythms. Main body: Through oxidative stress, autonomic dysfunction, electrolyte imbalances, and coagulation activation, systemic inflammation may impact arrhythmogenicity. Similar to neuropathic alterations, direct cellular damage, and structural remodeling, localized heart inflammation also predisposes to arrhythmias. Studies demonstrating the impact of cytokines on ion channel expression and function, along with clinical associations between inflammatory indicators and arrhythmia incidence, offer the molecular insights. Immune cells like macrophages that alter cardiac conduction are involved in the interaction between inflammation and electrophysiology, which further complicates the situation. Clinical ramifications include the use of anti-inflammatory drugs to treat arrhythmic episodes and the possible adjustment of arrhythmia treatment based on inflammatory condition. Even yet, further thorough study is necessary to fully understand the efficacy of these medicines. Conclusions: Arrhythmogenesis and inflammation are inherently linked by a number of mechanisms that change the electrical characteristics of the heart. Arrhythmia treatment and prevention may benefit from therapeutic approaches that reduce inflammatory processes. The difficulties that still exist in applying this information to clinical settings highlight the necessity of continuing studies to better comprehend the subtleties of inflammation-induced electrical alterations. Progress in identifying biomarkers of inflammation and developing tailored therapies will be crucial in enhancing the prognosis of individuals suffering from arrhythmogenic disorders that are aggravated by inflammation. [ABSTRACT FROM AUTHOR]

BackgroundPercutaneous interventional left atrial appendage occlusion (LAAO) is a reliable, safe, and effective alternative for stroke prevention in selected patients with atrial fibrillation (AF).MethodsIn a retrospective observational study, 149 patients underwent LAAO between 2016 and 2022 at the Department of Cardiology of the Charité—Universitätsmedizin Berlin, Campus Virchow, with AF for prevention of thromboembolic complications. We compared patient characteristics, intraoperative details and postoperative outcomes between single-occlusive plug-type (SOPT) and dual-occlusive disc-type (DODT) devices.ResultsIn all patients, the device implantation was successful. 60 patients received a SOPT occluder, including Watchman (35%) and Watchman FLX Occluders (65%), while 89 patients received a DODT occluder, including Amplatzer Cardiac Plug (37.1%), the Amplatzer Amulet (25.8%), and the LAmbre occluder (37.1%) systems. Procedure duration was significantly longer for DODT occluder implantation (49 ± 33 vs. 41 ± 25 min, p = 0.018). There were no in-hospital deaths or thromboembolic events reported after LAAO in both groups. Beyond that, a low rate of bleeding or access-side-related complications and pericardial tamponades were observed. Anticoagulation at discharge varied. About 60.8% of patients received dual antiplatelet therapy at hospital discharge, and 33.1% received direct oral anticoagulants. A 6-month follow-up was obtained in 85% of the patients. All implanted devices were in the desired position. However, in 5.7% of the patients, a device-related thrombus formation was detected in the SOPT group, while no thrombus was seen in the DODT group (p = 0.11). Thromboembolic events were noticed in 3.1%, without any difference between the device types. There was a statistically non-significant trend for less residual device leaks after SOPT vs. DODT implantation (no leak in 71.7% vs. 62.2%, p = 0.07; minor leaks

Abstract Regulation of gut microbiota and its impact on human health is the theme of intensive research. The incidence and prevalence of atrial fibrillation (AF) are continuously escalating as the global population ages and chronic disease survival rates increase; however, the mechanisms are not entirely clarified. It is gaining awareness that alterations in the assembly, structure, and dynamics of gut microbiota are intimately engaged in the AF progression. Owing to advancements in next-generation sequencing technologies and computational strategies, researchers can explore novel linkages with the genomes, transcriptomes, proteomes, and metabolomes through parallel meta-omics approaches, rendering a panoramic view of the culture-independent microbial investigation. In this review, we summarized the evidence for a bidirectional correlation between AF and the gut microbiome. Furthermore, we proposed the concept of “gut-immune-heart” axis and addressed the direct and indirect causal roots between the gut microbiome and AF. The intricate relationship was unveiled to generate innovative microbiota-based preventive and therapeutic interventions, which shed light on a definite direction for future experiments.

Background: It has been proved that rheumatoid arthritis (RA) patients have high incidence of atrial fibrillation (AF). Nevertheless, whether they have causal relevance is uncertain. This study aimed to explore and verify the authenticity of causal relationship between RA and AF using Mendelian randomization (MR). Methods: The genome-wide association study (GWAS) summary data from Biobank Japan Project (BBJ) (RA, 4199 cases and 208,254 controls) were regarded as exposure data and the GWAS data from European Bio-informatics Institute database (EBI) (AF, 15,979 cases and 102,776 controls) as outcome data. The causal effect was appraised by the inverse variance weighted (IVW) method, MR-Egger regression, and weighted median estimator. MR-robust adjusted profile score (MR-RAPS) method was delivered to examine the robustness of causal relationship and MR Pleiotropy Residual Sum and Outlier (MR-PRESSO) method to control horizontal (directional) pleiotropy. Results: The results indicated that RA increased the risk of AF (IVW, the odds ratio (OR) = 1.060; 95% confidence interval (CI), 1.028 to 1.092; p = 1.411 × 10−4; weighted median, OR = 1.046, 95% CI, 1.002 to 1.093, p = 0.047). The MR analysis also showed this causal effect through all four IVW methods with various statistical algorithms. Both MR-RAPS and MR-PRESSO supported the causality of RA and AF. Also, the MR-PRESSO result indicated the absence of apparent pleiotropy. Conclusion: There is a causal association between RA and AF. RA patients are genetically more vulnerable to AF. This study may contribute to further exploring early clinical prevention and fundamental mechanism of AF in patients with RA. Key Points • We provided some genetic evidence for the causal link between rheumatoid arthritis (RA) and atrial fibrillation (AF) with multiple Mendelian randomization (MR) methods. • RA patients were genetically more vulnerable to AF. • This study partly shed light on latent fundamental mechanisms underlying RA-induced AF and inspired future studies on RA-AF relationship. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) stands as the most prevalent cardiac arrhythmia, with associated risks of stroke and systemic thromboembolism. While vitamin K antagonists, specifically warfarin, have historically been the mainstay for stroke prevention in AF, they come with inherent limitations. Aim: This review seeks to offer a comprehensive analysis of the efficacy, safety, and clinical advantages of novel oral anticoagulants (NOACs) compared to traditional warfarin in AF management. Method: A meticulous examination of pivotal clinical trials, meta-analyses, and recent research publications was conducted. Four NOACs, namely Dabigatran, Rivaroxaban, Apixaban, and Edoxaban, were compared against warfarin, focusing on parameters like stroke prevention, risk of bleeding, patient compliance, and drug interactions. Results: NOACs, as a collective group, demonstrated a comparable or superior efficacy profile in stroke prevention compared to warfarin. They also showcased a more predictable therapeutic range, fewer drug and food interactions, and, in certain cases, a better safety profile. The challenges associated with frequent monitoring and dose adjustments inherent to warfarin therapy were notably absent with NOACs. Conclusion: NOACs present a robust alternative to warfarin for AF management, demonstrating comparable efficacy and, in certain aspects, heightened safety and practicality. However, the choice of anticoagulant should remain individualized, taking into account patient-specific factors and clinician expertise. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is a powerful technology that can enhance clinical decision-making and the efficiency of global health systems. An AI-enabled electrocardiogram (ECG) is an essential tool for diagnosing heart abnormalities such as arrhythmias. The most prevalent arrhythmia globally is atrial fibrillation (AF), which is an irregular heart rhythm that originates in the atria and can lead to other heart-related complications. A trusted AI classification of AF is explored in this study. Deep learning (DL) has been used to analyze large amounts of publicly available ECG datasets in order to classify normal sinus rhythm (NSR), AF, and other types of arrhythmias. A convolutional neural network (CNN) has been proposed to extract ECG features and classify ECG signals. Based on a 10-fold cross-validation strategy, we conducted experiments involving three scenarios for AF classification: (i) a balanced set, an imbalanced set, and an extremely imbalanced set; (ii) a comparison of ECG denoising algorithms; and (iii) the classification of AF, NSR, and other arrhythmia types (15 classes). As a result, we have achieved 100% accuracy, sensitivity, specificity, precision, and F1-score for the AF, NSR, and non-AF classifications, both for balanced and imbalanced sets. In addition, for the classification of AF, NSR, and other types of arrhythmia (15 classes), the performance results achieved an accuracy of 99.77%, sensitivity of 96.48%, specificity of 99.87%, precision of 97.03%, and F1-score of 96.68%. The results can empower AI diagnosis and assist clinicians in classifying AF on routine screening ECGs. [ABSTRACT FROM AUTHOR]

Background: Direct oral anticoagulants (DOACs) are increasingly recommended over warfarin in stroke prevention for patients with non-valvular atrial fibrillation (AF). However, there is an important evidence gap in choosing the most appropriate DOAC for Chinese patients in clinical practice. Methods: A multi-criteria decision analysis (MCDA) was adopted to build a scoring framework. Attributes and criteria were identified and determined by a scoping literature review, two rounds of Delphi surveys, and a consensus meeting. Weights of each attribute and criterion in the framework were determined using analytic hierarchy process (AHP). Evidence was collected based on the domestic or at least Asian data. Scoring methods for each criterion were developed depended on their characteristics and determined with an expert consensus meeting. Comprehensive scores of each DOAC were calculated based on the utility scores of each criterion and their corresponding weights. Results: A total of 5 attributes, including safety, efficacy, costs/cost-effectiveness, suitability, and accessibility, were determined, and 16 criteria were under the 5 attributes. The safety and efficacy were ranked as the top two important attributes with the weights of 38.8% and 35.9%, respectively, while the suitability received the lowest weight of 7.9%. The comprehensive score for edoxaban was the highest (72.3), followed by dabigatran (49.7), rivaroxaban (37.9), and apixaban (35.8). Conclusions: This study provided a scoring framework developed for comprehensive evaluation of DOACs in China. The ranking of DOACs could help to support the decision-making in clinical practice. The framework could provide a reference for comprehensive evaluation of other drugs. [ABSTRACT FROM AUTHOR]

Regulation of gut microbiota and its impact on human health is the theme of intensive research. The incidence and prevalence of atrial fibrillation (AF) are continuously escalating as the global population ages and chronic disease survival rates increase; however, the mechanisms are not entirely clarified. It is gaining awareness that alterations in the assembly, structure, and dynamics of gut microbiota are intimately engaged in the AF progression. Owing to advancements in next-generation sequencing technologies and computational strategies, researchers can explore novel linkages with the genomes, transcriptomes, proteomes, and metabolomes through parallel meta-omics approaches, rendering a panoramic view of the culture-independent microbial investigation. In this review, we summarized the evidence for a bidirectional correlation between AF and the gut microbiome. Furthermore, we proposed the concept of "gut-immune-heart" axis and addressed the direct and indirect causal roots between the gut microbiome and AF. The intricate relationship was unveiled to generate innovative microbiota-based preventive and therapeutic interventions, which shed light on a definite direction for future experiments. [ABSTRACT FROM AUTHOR]

Background: The effectiveness and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and advanced kidney disease (AKD) has not been fully established. Objectives: To determine the effectiveness and safety related to pooled or specific DOACs to that with warfarin in patients with AF and AKD. Methods: Patients with AF and AKD (estimated glomerular filtration rate < 30 mL/min) who received DOAC or warfarin from July 2011 to December 2020 were retrospectively identified in a medical center in Taiwan. Primary outcomes were hospitalized for stroke/systemic embolism and major bleeding. Secondary outcomes included any ischemia and any bleeding. Results: A total of 1,011 patients were recruited, of whom 809 (80.0%) were in the DOACs group (15.3% dabigatran, 25.4% rivaroxaban, 25.2% apixaban, and 14.1% edoxaban), and 202 (20.0%) in the warfarin group. DOACs had considerably lower risks of stroke/systemic embolism (adjusted hazard ratio [aHR] 0.29; 95% CI, 0.09–0.97) and any ischemia (aHR, 0.42; 95% CI, 0.22–0.79), but had comparable risks of major bleeding (aHR, 0.99; 95% CI, 0.34–2.92) and any bleeding (aHR, 0.74; 95% CI, 0.50–1.09) than warfarin. Apixaban was linked to considerably lower risks of any ischemia (aHR, 0.13; 95% CI, 0.04–0.48) and any bleeding (aHR, 0.53; 95% CI, 0.28–0.99) than warfarin. Conclusion: Among patients with AF and AKD, DOACs were linked to a lower risk of ischemic events, and apixaban was linked to a lower risk of any ischemia and any bleeding than warfarin. Highlights: The effectiveness and safety of direct oral anticoagulants in patients with atrial fibrillation and advanced kidney disease has not been fully established. DOACs were linked to lower risks of ischemic events compared with warfarin in patients with AF and AKD. Apixaban was linked to a lower risk of any ischemia and any bleeding than warfarin in patients with AF and AKD. [ABSTRACT FROM AUTHOR]

Abstract Introduction Treatment adherence and persistence impact the effectiveness of edoxaban for the prevention of thromboembolism in patients with atrial fibrillation (AF). The objective of this analysis was to assess adherence and persistence of edoxaban vs. other non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs). Methods Utilizing a German claims database, adults with AF with the first pharmacy claim identified for edoxaban, apixaban, dabigatran, rivaroxaban, or VKAs from January 2013 to December 2017 were included in a propensity score-matched analysis. The first pharmacy claim was the index claim. Adherence (i.e., proportion of days covered [PDC]) and persistence (proportion of patients who continued therapy) were compared between edoxaban and other therapies. Patients receiving once-daily (QD) vs. twice-daily (BID) NOAC were also analyzed. Results Overall, 21,038 patients were included (1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA). After matching, baseline characteristics were well balanced across cohorts. Adherence was significantly higher for edoxaban vs. apixaban, dabigatran, and VKAs (all P

The incidence of atrial fibrillation (AF) during pregnancy increases with maternal age and with the presence of structural heart disorders. Early diagnosis and prompt therapy can considerably reduce the risk of thromboembolism. The therapeutic approach to AF during pregnancy is particularly challenging, and the maternal and fetal risks associated with the use of antiarrhythmic and anticoagulant drugs must be carefully evaluated. Moreover, the currently used thromboembolic risk scores have yet to be validated for the prediction of stroke during pregnancy. At present, electrical cardioversion is considered to be the safest and most effective strategy in women with hemodynamic instability. Beta-selective blockers are also recommended as the first choice for rate control. Antiarrhythmic drugs such as flecainide, propafenone and sotalol should be considered for rhythm control if atrioventricular nodal-blocking drugs fail. AF catheter ablation is currently not recommended during pregnancy. Overall, the therapeutic strategy for AF in pregnancy must be carefully assessed and should take into consideration the advantages and drawbacks of each aspect. A multidisciplinary approach with a “Pregnancy-Heart Team” appears to improve the management and outcome of these patients. However, further studies are needed to identify the most appropriate therapeutic strategies for AF in pregnancy. [ABSTRACT FROM AUTHOR]

It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug–drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios. [ABSTRACT FROM AUTHOR]

Introduction: Treatment adherence and persistence impact the effectiveness of edoxaban for the prevention of thromboembolism in patients with atrial fibrillation (AF). The objective of this analysis was to assess adherence and persistence of edoxaban vs. other non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs). Methods: Utilizing a German claims database, adults with AF with the first pharmacy claim identified for edoxaban, apixaban, dabigatran, rivaroxaban, or VKAs from January 2013 to December 2017 were included in a propensity score-matched analysis. The first pharmacy claim was the index claim. Adherence (i.e., proportion of days covered [PDC]) and persistence (proportion of patients who continued therapy) were compared between edoxaban and other therapies. Patients receiving once-daily (QD) vs. twice-daily (BID) NOAC were also analyzed. Results: Overall, 21,038 patients were included (1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA). After matching, baseline characteristics were well balanced across cohorts. Adherence was significantly higher for edoxaban vs. apixaban, dabigatran, and VKAs (all P < 0.0001). Significantly more edoxaban patients continued therapy vs. rivaroxaban (P = 0.0153), dabigatran (P < 0.0001), and VKAs (P < 0.0001). Time to discontinuation was significantly longer for edoxaban vs. dabigatran, rivaroxaban, and VKAs (all P < 0.0001). More patients receiving NOACs QD had a PDC ≥ 0.8 compared with those receiving NOACs BID (65.3 vs. 49.6%, respectively; P < 0.05); persistence rates were comparable between QD and BID groups. Conclusions: Patients with AF receiving edoxaban had significantly higher adherence and persistence compared with those receiving VKAs. This trend was also seen in NOAC QD regimens vs. NOAC BID regimens for adherence. These results provide insight into how adherence and persistence may contribute to the effectiveness of edoxaban for stroke prevention in patients with AF in Germany. [ABSTRACT FROM AUTHOR]

Smartphones that can support and assist the screening of various cardiovascular diseases are gaining popularity in recent years. The timely detection, diagnosis, and treatment of atrial fibrillation (AF) are critical, especially for those who are at risk of stroke. AF detection via screening with wearable devices should always be confirmed by a standard 12-lead electrocardiogram (ECG). However, the inability to perform on-site AF confirmatory testing results in increased patient anxiety, followed by unnecessary diagnostic procedures and treatments. Also, the delay in confirmation procedure may conclude the condition as non-AF while it was indeed present at the time of screening. To overcome these challenges, we propose an efficient on-site confirmatory testing for AF with 12-lead ECG derived from the reduced lead set (RLS) in a wireless body area network (WBAN) environment. The reduction in the number of leads enhances the comfort level of patients as well as minimizes the hurdles associated with continuous telemonitoring applications such as data transmission, storage, and bandwidth of the overall system. The proposed method is characterized by segment-wise regression and a lead selection algorithm, facilitating improved P-wave reconstruction. Further, an efficient AF detection algorithm is proposed by incorporating a novel three-level P-wave evidence score with an RR irregularity evidence score. The proposed on-site AF confirmation test reduces false positives and false negatives by 88% and 53% respectively, compared to single lead screening. In addition, the proposed lead derivation method improves accuracy, F 1 -score, and Matthews correlation coefficient (MCC) for the on-site AF detection compared to existing related methods. [ABSTRACT FROM AUTHOR]

Thromboembolic syndrome, the frequency of which is 8–15%, is the main danger for a patient with atrial fibrillation (AF). The left atrial appendage is the most common source of thromboembolia in atrial fibrillation. The frequency of detection of left atrial appendage thrombus in AF is 15.2% in the absence of anticoagulant therapy and 1–8% in patients using this group of drugs. The reason for the formation of thrombi in this localization during anticoagulant therapy today it is not reliably known. This article describes a clinical case of a 67-year-old patient with persistent AF and left atrial appendage thrombosis, who was hospitalized to determine further management strategies. A left atrial appendage thrombus lasted for a year despite continuous anticoagulant therapy with various oral anticoagulants at doses consistent with clinical guidelines due to the patient's absolute refusal to take warfarin, vitamin K antagonist. In addition, this article discusses the use of Thrombodynamics, a new global coagulation test, in patients with AF, which revealed a plasma hypercoagulable state with underlying persistent thrombosis in this patient on continuous oral anticoagulant treatment. The Thrombodynamics test is a promising procedure for assessing the coagulation system state and may be promising as a method for measuring the effectiveness of any oral anticoagulant. However, it is impossible to draw any definite conclusions on the basis of single observations; large clinical studies with the potential of long-term case follow-up of patients are needed.

The aim: To reveal new peculiarities of gut microbiota metabolites in CAD patients with or without AF and to detect special connections toward ones with clinical and laboratory features of investigated groups. Materials and methods: 300 patients were investigated. They were divided into 3 groups: control group - 28 patients without CAD and arrhythmias; main group - 149 patients with CAD but without arrhythmias; comparable group - 123 patients with CAD and AF paroxysm. Plasma TMAO, TMA, fecal SCFA levels was determined by gas chromatography with mass electron detection. Results: Metabolomic analysis of the gut microbiota metabolites (plasma TMA, TMAO, fecal SCFA) and clinic-laboratory factors in patients with CAD and AF paroxysm was done in our study. We checked gut microbiota metabolites changes that are common for patients with CAD and AF comparable with CAD patients: increasing of TMA, TMAO plasma levels, fecal valeric acid level (13,88%, 36,52% and 1128,43% respectively, p<0,05) and decreasing total amount of fecal SCFA, USFA, MCFA, butyric, isovaleric, caprylic acids levels (17,09%, 38,16%, 95,54%, 78,75%, 56,29% and 99,21% respectively, p<0,05). Reliable correlations between CAD and AF with TMA, TMAO plasma and fecal SCFA levels were revealed by them and age, BMI, GFR, total cholesterol, TG, LDL, HDL, ApoB levels (|r|>0,3, p<0,05) were revealed that are known risk factors of CAD and AF. Moreover, TMAO, TMA, butyrate, total SCFA, USFA, MCFA levels are closely connected with IL-6 and CRP levels (|r|>0,3, p<0,05). Conclusions: Gut microbiota metabolites (TMA, TMAO, SCFA, MCFA, USFA, butyric acid) are the new promising therapeutic targets for pathogenetic treatment and prevention AF paroxysm in CAD patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Although inflammation has an important role in the pathogenesis of atrial fibrillation (AF), the effect of novel oral anticoagulants (NOAC) used to reduce the risk of ischemic stroke and embolism on inflammation remains unknown. In this study, we aimed to investigate the effects of NOAC, which have been shown to have anticoagulant properties, on inflammation and platelet reactivation, which have an important role in the pathogenesis of AF. PATIENTS AND METHODS: A total of 530 patients, including 380 patients with nonvalvular AF using NOAC and 150 patients with nonvalvular AF who did not use any NOAC were included in the study. Neutrophil-to-lymphocyte ratio (NLR) was calculated as the ratio of absolute neutrophil count to absolute lymphocyte count. Mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil-to-lymphocyte ratio (NLR) values of both groups were assessed both on admission and at three-month follow-up. RESULTS: When the complete blood count (CBC) changes of the groups included in the study were compared, the RDW, MPV, and NLR values showed a greater decrease in the NOAC group compared to the non-NOAC group (p=0.000 for all). CONCLUSIONS: The results indicated that the NOAC used in anticoagulation treatment do not only act as anticoagulants but also reduce inflammation and platelet reactivation, which have an important role in the pathogenesis of AF and thromboembolism. [ABSTRACT FROM AUTHOR]

Classification of normal sinus rhythm (NSR), paroxysmal atrial fibrillation (PAF), and persistent atrial fibrillation (AF) is crucial in order to diagnose and effectively plan treatment for patients. Current classification models were primarily developed by electrocardiogram (ECG) signal databases, which may be unsuitable for local patients. Therefore, this research collected ECG signals from 60 local Thai patients (age 52.53 ± 23.92) to create a classification model. The coefficient of variance (CV), the median absolute deviation (MAD), and the root mean square of the successive differences (RMSSD) are ordinary feature variables of RR irregularities used by existing models. The square of average variation (SAV) is a newly proposed feature that extracts from the irregularity of RR intervals. All variables were found to be statistically different using ANOVA tests and Tukey's method with a p-value less than 0.05. The methods of artificial neural network (ANN) and adaptive neuro-fuzzy inference system (ANFIS) were also tested and compared to find the best classification model. Finally, SAV showed the best performance using the ANFIS model with trapezoidal membership function, having the highest system accuracy (ACC) at 89.33%, sensitivity (SE), specificity (SP), and positive predictivity (PPR) for NSR at 100.00%, 94.00%, and 89.29%, PAF at 88.00%, 90.57%, and 81.48%, and AF at 80.00%, 96.00%, and 90.91%, respectively. [ABSTRACT FROM AUTHOR]

BackgroundWith the aging of the population, the characterization of frailty and comorbidity burden is increasingly taking on particular importance. The aims of the present study are to analyze such conditions in a population affected by Atrial Fibrillation (AF), matching it with a population without AF, and to recognize potential independent factors associated with such common cardiovascular disease.MethodsThis study included subjects consecutively evaluated over 5 years at the Geriatric Outpatient Service, University Hospital of Monserrato, Cagliari, Italy. A sum of 1981 subjects met the inclusion criteria. The AF-group was made up of 330 people, and another 330 people were randomly selected to made up the non-AF-group. The sample was subjected to Comprehensive Geriatric Assessment (CGA).ResultsIn our sample, severe comorbidity burden (p = 0.01) and frailty status (p = 0.04) were significantly more common in patients with AF than without AF, independently on gender and age. Furthermore, the 5-years follow-up demonstrated that survival probability was significantly higher in AF-group (p = 0.03). The multivariate analysis (AUC: 0.808) showed that the presence of AF was independently positively associated with a history of coronary heart disease (OR: 2.12) and cerebrovascular disease (OR: 1.64), with the assumption of Beta Blockers (OR: 3.39), and with the number of drugs taken (OR: 1.12), and negatively associated with the assumption of antiplatelets (OR: 0.09).ConclusionsElderly people with AF are frailer, have more severe comorbidities, and take more drugs, in particular beta blockers, than people without AF, who conversely have a higher survival probability. Furthermore, it is necessary to pay attention to antiplatelets, especially in AF-group, in order to avoid dangerous under- or over-prescriptions.

Background: Chronic heart failure is commonly associated with inspiratory muscle weakness and reduced functional capacity. However, few studies have investigated the risk factors for inspiratory and expiratory muscle weakness and its correlation with sixminute walk distance (6MWT) in chronic heart failure patients associated with atrial fibrillation. Methods: Fifty male cardiac patients were recruited in this study from the National Heart Institute Outpatient Clinic and Ainshams University Hospital Cardiology Department, aged from 40 to 55 years old. All of them underwent 6-minute walk test and maximum respiratory pressure measurement. Results: there were a significant linear positive moderate correlation between 6MWT maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) in patients with heart failure associated with atrial fibrillation with significant level p =.000 with PImax and p= <0.001 with PEmax. Conclusion: there was a moderate correlation between 6MWT and PImax & PEmax, and they are suitable to be used as risk stratification for functional work capacity in patients with chronic heart failure associated with atrial fibrillation. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) are common pathologies in the elderly patient. The simultaneous occurrence of the two conditions influences the quality of life and increases the rate of exacerbations. About two-thirds of patients with atrial fibrillation have dyspnea. Severe dyspnea in the patient with COPD and AF can be difficult to manage, suggesting an exacerbation of the disease, the onset of atrial fibrillation or even a symptom of associated comorbidities, the most common of which being heart failure. The risk of developing AF in COPD increases with the severity of airflow obstruction. Factors such as smoking, aging, dyslipidemia, the presence of diabetes, hypertension or heart failure influence the prognosis of patients with COPD and AF. Furthermore, oxidative stress, hypoxia, systemic inflammation or immunological changes decrease the survival rate and may favor the recurrence of AF. In the evolution of concomitant COPD-FA cases, proinflammatory cytokines such as tumor necrosis factor α (TNF-α), monocyte chemotactic protein (MCP-1), interleukin-6 (IL-6), interleukin-8 (IL-8) intervene. This paper aims at analyzing data related to the factors that would influence the prognosis of patients with COPD and AF. [ABSTRACT FROM AUTHOR]

An 80-year-old female with a history of diabetes mellitus (DM) and hypertension presented with sudden onset of sequential bilateral visual loss. The best visual acuity was light perception in the right eye and finger counting in the left eye, however, bilateral fundus did not reveal optic disc edema. Diffusion-weighted magnetic resonance imaging (MRI) of the brain revealed acute embolic stroke and diffusion restriction in the posterior portion of both optic nerves. The 24-h Holter monitor showed persistent atrial fibrillation (AF) with rapid ventricular response. The presence of painless and severe visual loss at onset unaccompanied by optic disc edema in the patient with newly detected uncontrolled AF and multiple embolic infarctions favored a diagnosis of non-arteritic posterior ischemic optic neuropathy (PION). The current case contributes to better understanding of PION pathophysiology and associated risk factors, indicating a possible relationship between non-arteritic PION and uncontrolled AF and embolic cerebral infarction. [ABSTRACT FROM AUTHOR]

Atrial fibrosis plays a key role in the initiation and progression of atrial fibrillation (AF). Atrial fibrosis is typically identified by a peak-to-peak amplitude of bipolar electrograms (b-EGMs) lower than 0.5 mV, which may be considered as ablation targets. Nevertheless, this approach disregards signal spatiotemporal information and b-EGM sensitivity to catheter orientation. To overcome these limitations, we propose the dominant-to-remaining eigenvalue dominance ratio (EIGDR) of unipolar electrograms (u-EGMs) within neighbor electrode cliques as a waveform dispersion measure, hypothesizing that it is correlated with the presence of fibrosis. A simulated 2D tissue with a fibrosis patch was used for validation. We computed EIGDR maps from both original and time-aligned u-EGMs, denoted as [Formula: see text] and [Formula: see text], respectively, also mapping the gain in eigenvalue concentration obtained by the alignment, [Formula: see text]. The performance of each map in detecting fibrosis was evaluated in scenarios including noise and variable electrode-tissue distance. Best results were achieved by [Formula: see text], reaching 94% detection accuracy, versus the 86% of b-EGMs voltage maps. The proposed strategy was also tested in real u-EGMs from fibrotic and non-fibrotic areas over 3D electroanatomical maps, supporting the ability of the EIGDRs as fibrosis markers, encouraging further studies to confirm their translation to clinical settings. Upper panels: map of [Formula: see text] from 3×3 cliques for Ψ= 0∘ and bipolar voltage map Vb-m, performed assuming a variable electrode-to-tissue distance and noisy u-EGMs (noise level σv = 46.4 μV ). Lower panels: detected fibrotic areas (brown), using the thresholds that maximize detection accuracy of each map. [ABSTRACT FROM AUTHOR]

Abstract Atrial fibrillation (AF) is the most common and increasing cardiac arrhythmia. AF increases thromboembolic events and hospitalizations and deteriorates quality of life. The mechanism of AF is not completely understood. James Cox proposed a concept of Maze procedure in 1987 which was based on a surgical ablation lesion for electrical conduction pathway. Although surgical ablation offers a higher success rate, it should be performed with minimally invasive techniques because of its high invasiveness. Haissaguerre et al. identified potential sources of AF in the pulmonary veins as triggers and developed the percutaneous catheter ablation as the treatment strategy for paroxysmal AF refractory to pharmaceutical therapy. The atrial remodeling occurs electrically and structurally in persistent or longstanding persistent AF, and the catheter ablation and surgical ablation have variable success rates. Persistent or longstanding persistent AF presents a major challenge. Despite continuous improvements, catheter-based procedures have shown relatively far from satisfactory outcomes and may need to be repeated to achieve sinus rhythm. A hybrid approach consisting of the sequential combination of a surgical minimally invasive epicardial ablation and a transvenous catheter endocardial ablation would be an alternative option that supplements the limitations of endo- and epicardial strategies. Close cooperation between cardiac surgeons and electrophysiologists for optimal selection of patients and management for arrhythmia recurrence seems suggestible for persistent or longstanding persistent AF.

The incidence of atrial fibrillation (AF) during pregnancy increases with maternal age and with the presence of structural heart disorders. Early diagnosis and prompt therapy can considerably reduce the risk of thromboembolism. The therapeutic approach to AF during pregnancy is particularly challenging, and the maternal and fetal risks associated with the use of antiarrhythmic and anticoagulant drugs must be carefully evaluated. Moreover, the currently used thromboembolic risk scores have yet to be validated for the prediction of stroke during pregnancy. At present, electrical cardioversion is considered to be the safest and most effective strategy in women with hemodynamic instability. Beta-selective blockers are also recommended as the first choice for rate control. Antiarrhythmic drugs such as flecainide, propafenone and sotalol should be considered for rhythm control if atrioventricular nodal-blocking drugs fail. AF catheter ablation is currently not recommended during pregnancy. Overall, the therapeutic strategy for AF in pregnancy must be carefully assessed and should take into consideration the advantages and drawbacks of each aspect. A multidisciplinary approach with a “Pregnancy-Heart Team” appears to improve the management and outcome of these patients. However, further studies are needed to identify the most appropriate therapeutic strategies for AF in pregnancy.