Abstract Background Current guidelines strongly recommend that oral anticoagulation should be offered to patients with atrial fibrillation and ≥1 stroke risk factors. The guidelines also recommend ...that oral anticoagulation still should be used in the presence of stroke risk factors irrespective of rate or rhythm control. Methods In an analysis from the dataset of the EURObservational Research Programme on Atrial Fibrillation Pilot Survey (n = 3119), we examined antithrombotic therapy prescribing, with particular focus on the risk factors determining oral anticoagulation or antiplatelet therapy use. Results When oral anticoagulation was used among admitted patients in whom no pharmacologic cardioversion, electrical cardioversion, or catheter ablation was performed or planned, vitamin K antagonist therapy was prescribed in the majority (72.2%), whereas novel oral anticoagulants were used in the minority (7.7%). There was no significant difference in bleeding risk factors among the patients treated with the different types of antithrombotic therapies, except for those with chronic kidney disease, in whom oral anticoagulation was less commonly used ( P = .0318). Antiplatelet therapy was more commonly used in patients with a high Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly score (≥2) ( P < .0001). More oral anticoagulation use was associated with female gender ( P = .0245). Less novel oral anticoagulant use was associated with valvular heart disease ( P < .0001), chronic heart failure ( P = .0010), coronary artery disease ( P < .0001), and peripheral artery disease ( P = .0092). Coronary artery disease was the strongest reason for combination therapy with oral anticoagulation plus antiplatelet drug (odds ratio, 8.54; P < .0001). When the Congestive heart failure, Hypertension, Age ≥75 Doubled, Diabetes, Stroke Doubled-Vascular disease, Age 65-74, and Sex category female score was used, 95.6% of patients with a score ≥1 received antithrombotic therapy, with 80.5% of patients with a score ≥1 receiving oral anticoagulation. Of note, 83.7% of those with a score ≥2 received antithrombotic therapy. Of the latter, 70.9% of those with a score ≥2 received oral anticoagulation, vitamin K antagonists were used in 64.1%, and novel oral anticoagulants were used in 6.9%. Conclusions The EURObservational Research Programme on Atrial Fibrillation Pilot Survey provides contemporary data on oral anticoagulation prescribing by European cardiologists for atrial fibrillation. Although the uptake of oral anticoagulation (mostly vitamin K antagonist therapy) has improved since the Euro Heart Survey a decade ago, antiplatelet therapy is still commonly prescribed, with or without oral anticoagulation, whereas elderly patients are commonly undertreated with oral anticoagulation.
Abbreviations 3D three‐dimensional AF atrial fibrillation AP accessory pathway ARVC arrhythmogenic right ventricular cardiomyopathy AT atrial tachycardia AVB atrioventricular block AVNRT ...atrioventricular nodal reentrant tachycardia AVRT atrioventricular reentrant tachycardia BBR bundle branch reentry BrS Brugada Syndrome CFAE complex fractionated atrial electrogram CHD congenital heart disease CPVT catecholaminergic polymorphic ventricular tachycardia CT computed tomography DSM dynamic substrate map EP electrophysiology EPS electrophysiology study ER early repolarization syndrome FTI force‐time integral ICD implantable cardioverter defibrillator ICE intracardiac echocardiography ICM ischemic cardiomyopathy IPAS inherited primary arrhythmias syndrome IVF idiopathic ventricular fibrillation LAVA local abnormal ventricular activity LBBB left bundle branch block LQTS long QT syndrome LV left ventricle MB moderator band MRI magnetic resonance imaging NCM noncontact mapping NICM nonischemic cardiomyopathy OT outflow tract PCCD progressive cardiac conduction disturbance PM papillary muscle PSI pixel signal intensity PV pulmonary vein PVC premature ventricular contraction PVI pulmonary vein isolation RBBB right bundle branch block RF radiofrequency RFCA radiofrequency catheter ablation RV right ventricle SQTS short QT syndrome SVT supraventricular tachycardia TEE transesophageal echocardiography VA ventricular arrhythmia VF ventricular fibrillation VT ventricular tachycardia PREAMBLE This document describes the use of three‐dimensional mapping systems and includes recommendations regarding their application in clinical practice based on scientific evidence. ...their availability as well as reimbursement practice varies widely across different countries largely depending on the economic situation. The societies involved in the development of this document recognize the existence of these factors and the significant barriers that these may pose in everyday practice and on the decision to use or not use a three‐dimensional mapping system in a given patient. ...in cases where these useful systems are not available or cannot be used in a wide scale due to financial constraints, electrophysiology procedures should certainly be offered to the patients based on established indications. Good catheter contact, correct interpretation of the colors in the map, appropriate choice of reference electrogram, complete mapping of the correct chamber of interest, and strategies to address catheter tip migration with respiration or change in cardiac rhythm and annotation of complex intracardiac signals are all necessary prerequisites for the success of ablation.
Abstract
Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. This study aims to evaluate the ...impact of diabetes mellitus severity (expressed as its known duration), antihyperglycemic treatment regimen and glycaemic control on AF prevalence. From the representative sample of 3014 participants (mean age 77.5, 49.1% female) from the cross-sectional NOMED-AF study, 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1 days. The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF prevalence was observed. No differences in the treatment pattern (oral medication vs insulin vs both oral + insulin) among the study population with and without AF were shown (p = 0.106). Metabolic control reflected by HbA1c levels showed no significant association with AF and silent AF prevalence (p = 0.635; p = 0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18–1.53, p < 0.001), p = 0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01–1.08, p = 0.027) and LDL < 100 mg/dl (OR 0.64, 95%CI: 0.42–0.97, p = 0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20–1.75, p < 0.001), LDL < 100 mg/dl (OR 0.43, 95%CI 0.23–0.82, p = 0.011), use of statins (OR 0.51, 95%CI: 0.28–0.94, p = 0.031) and HbA1c ≤ 6.5 (OR 0.46, 95%CI: 0.25–0.85, p = 0.013) were associated with silent AF prevalence. Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤ 6.5 being additional independent predictors for silent AF.
Trial registration: NCT03243474.
Left ventricular noncompaction (LVNC) is a genetically and phenotypically heterogeneous disease and, although increasingly recognized in clinical practice, there is a lack of widely accepted ...diagnostic criteria. We sought to identify novel genetic causes of LVNC and describe genotype-phenotype correlations.
A total of 190 patients from 174 families with left ventricular hypertrabeculation (LVHT) or LVNC were referred for cardiac magnetic resonance and whole-exome sequencing. A total of 425 control individuals were included to identify variants of interest (VOIs). We found an excess of 138 VOIs in 102 (59%) unrelated patients in 54 previously identified LVNC or other known cardiomyopathy genes. VOIs were found in 68 of 90 probands with LVNC and 34 of 84 probands with LVHT (76% and 40%, respectively;
<0.001). We identified 0, 1, and ≥2 VOIs in 72, 74, and 28 probands, respectively. We found increasing number of VOIs in a patient strongly correlated with several markers of disease severity, including ratio of noncompacted to compacted myocardium (
<0.001) and left ventricular ejection fraction (
=0.01). The presence of sarcomeric gene mutations was associated with increased occurrence of late gadolinium enhancement (
=0.004).
LVHT and LVNC likely represent a continuum of genotypic disease with differences in severity and variable phenotype explained, in part, by the number of VOIs and whether mutations are present in sarcomeric or nonsarcomeric genes. Presence of VOIs is common in patients with LVHT. Our findings expand the current clinical and genetic diagnostic approaches for patients with LVHT and LVNC.
Professor Marian Zembala (1950–2022) Gąsior, Mariusz; Kalarus, Zbigniew; Przybyłowski, Piotr
Kardiochirurgia i torakochirurgia polska,
04/2022, Letnik:
19, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Professor Marian Zembala, MD, PhD — an outstanding Polish cardiac surgeon and transplant surgeon, scientist, long-time academic teacher and educator of young people, director, and also a great lover ...of music, poetry, theater, painting, and sailing. He was born on February 11, 1950, in Krzepice near Częstochowa. He graduated from the Medical University of Wrocław in 1974 with honors and received the Primus Inter Pares award of the Polish Minister of Health, with a possibility to choose the place of work. He chose the Heart Surgery Department of the Medical Academy in Wrocław, which was his dream. Alongside his clinical work, he developed his scientific interests. In 1979, at the age of 29, he defended his doctorate with honors. His work in the Wrocław Clinic also provided an opportunity to go for his dream internship abroad, e.g. to the hospital in Utrecht, the Netherlands, where he worked under the supervision of Prof. F. Hitchcock (1981–1985). During his stay in the Netherlands, he initiated the largest post-World War II program of Polish Heart Poolse hartpatientjes naar Nederland, under which more than 500 Polish children with severe congenital heart defects were operated on free of charge between 1981 and 1992. For this ambitious project, he received an honorary award from Utrecht University and an award from the Primate of Poland, Cardinal Józef Glemp.
Abstract
Background
Left atrial appendage closure (LAAC) procedures prevent cardioembolic stroke in patients with atrial fibrillation who have contraindications to oral anticoagulant medications. ...However, these procedures carry certain risks of peri-procedural complications. One such complication is silent brain infarcts (SBI), which can lead to cognitive impairment and mood disturbances. The implementation of mechanical neuroprotection systems during LAAC procedures may reduce the risk of SBI and associated cognitive and mood disorders.
Methods
The LAAC-SBI trial is a prospective, multicenter, randomized, and double-blind interventional study. The study aims to enroll a total of 240 patients, with 120 patients allocated to each group. The study group will evaluate the use of the Sentinel CPS during LAAC, while the control group will undergo LAAC procedures without the Sentinel CPS. The primary endpoint of the study is the number of new SBIs or stroke foci detected by diffusion-weighted magnetic resonance imaging (DW MRI). Secondary endpoints include deterioration of cognitive function, development of dementia syndrome, and occurrence of depressive disorders. These endpoints will be assessed using questionnaire tools such as the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Controlled Oral Word Association Test (COWAT), and Hospital Anxiety and Depression Scale (HADS). The observational period for patients in the study is 2 years.
Discussion
If the study demonstrates a favorable outcome with reduced incidence of SBI and improved cognitive and mood outcomes in patients receiving cerebral protection devices during LAAC, it will have significant implications for clinical management standards. This would support the use of neuroprotection devices not only for LAAC but also in procedures such as atrial fibrillation ablation or transcatheter mitral valve interventions, where the risk of embolic events and subsequent brain injury may also be present.
Trial registration
ClinicalTrials.gov NCT05369195. Registration on 11.05.2022.
Left atrial appendage closure (LAAC) is an alternative approach to anticoagulants. Nonetheless, data regarding the outcomes of LAAC procedures in patients with thrombocytopenia remain lacking. The ...primary objective was to determine the incidence of the composite endpoint comprising ischemic stroke, intracranial hemorrhage, major bleeding, and cardiac cause of death among patients with atrial fibrillation (AF) and thrombocytopenia who were either undergoing LAAC or receiving oral anticoagulants. The secondary endpoint was the determination of total mortality. Data from a prospective, single-center registry of patients undergoing LAAC procedures were analyzed. A subset of 50 consecutive patients with thrombocytopenia were selected. Thrombocytopenia was defined as a thrombocyte count below 150,000. Subsequently, from patients hospitalized with AF receiving oral anticoagulants, 50 patients were further chosen based on propensity score matching, ensuring comparability with the study group. The primary endpoint occurred in 2% of patients in the LAAC group and 10% of patients in the non-LAAC group (
= 0.097). Additionally, a significant difference was noted in the occurrence of the secondary endpoint, which was observed in 0% of patients in the LAAC group and 10% of patients in the non-LAAC group (
= 0.025). In patients with thrombocytopenia the LAAC procedure improves prognosis compared with continued anticoagulant treatment.
Introduction The coexistence of atrial fibrillation (AF) and chronic kidney disease (CKD) increases the risk of thromboembolic complications, as well as hemorrhagic incidents – percutaneous left ...atrial appendage occlusion (LAAO) is an alternative. Aim To evaluate the long-term outcomes of LAAO performed in patients with CKD and non-valvular AF. Material and methods Two hundred and seventy-two patients with AF who underwent LAAO between 2009 and 2019 were prospectively analyzed. Patients were divided into two groups: CKD (105 patients) and non-CKD (167 patients) (cut-off point: eGFR 60 ml/min/1.73 m2). The mean follow-up period was 25.56 months. Results The LAAO was successful in 269 (98.9%) patients. Seven (2.6%) patients suffered an ischemic stroke, including 2 (1.9%) with CKD and 5 (3.0%) in the non-CKD (p = 0.581) group. The risk of ischemic stroke was 0.25/100 patient-years (PY) for CKD and 0.39/100 PY for the non-CKD (p =0.028) group. The LAAO was associated with a relative risk reduction (RRR) of 96.4% (CKD group) and 91.8% (non-CKD group) on average compared to expected stroke rates. Hemorrhagic stroke occurred in 1 (0.6%) patient of the non-CKD group, whereas major bleeding occurred in 1 (0.6%) non-CKD patient and 1 (1.0%) CKD patient (p = 0.427). The risk of major bleeding was 0.13/100 PY for CKD and 0.15/100 PY for non-CKD (p = 0.768), corresponding to an RRR of 97.9% (CKD) and 97.4% (non-CKD) on average compared to oral anticoagulant therapy. Conclusions Considering the significant reduction in thromboembolic events, with a simultaneous reduction of major bleeding complications, LAAO is a safe and effective alternative for AF patients with CKD.
The global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke. AF often remains undiagnosed due to the occurrence ...in an asymptomatic, silent form, i.e., silent AF (SAF). The study aims to evaluate the relationships between DM and AF prevalence using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population ≥ 65 years for detection of AF, symptomatic or silent.
A representative sample of 3014 participants from the cross-sectional NOMED-AF study was enrolled in the analyses (mean age 77.5, 49.1% female): 881 (29.2%) were diagnosed with DM. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1days.
Overall, AF was reported in 680 (22.6%) of the whole study population. AF prevalence was higher among subjects with concomitant DM (DM+) versus those without DM (DM-) 25%, 95% CI 22.5-27.8% vs 17%; 95% CI 15.4-18.5% respectively, p < 0.001. DM patients were commonly associated with SAF 9%; 95% CI 7.9-11.4 vs 7%; 95% CI 5.6-7.5 respectively, p < 0.001, and persistent/permanent AF 12.2%; 95% CI 10.3-14.3 vs 6.9%; 95% CI 5.9-8.1 respectively, p < 0.001 compared to subjects without DM. The prolonged screening was associated with a higher percentage of newly established AF diagnosis in DM+ vs DM- patients (5% vs 4.5% respectively, p < 0.001). In addition to shared risk factors, DM+ subjects were associated with different AF and SAF independent risk factors compared to DM- individuals, including thyroid disease, peripheral/systemic thromboembolism, hypertension, physical activity and prior percutaneous coronary intervention/coronary artery bypass graft surgery.
AF affects 1 out of 4 subjects with concomitant DM. The higher prevalence of AF and SAF among DM subjects than those without DM highlights the necessity of active AF screening specific AF risk factors assessment amongst the diabetic population.
NCT03243474.
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