Browsing by Subject "Atrial fibrillation"
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Item Open Access Catheter ablation of atrial fibrillation in patients with diabetes mellitus.(Heart rhythm O2, 2020-08) Wang, Allen; Truong, Tracy; Black-Maier, Eric; Green, Cynthia; Campbell, Kristen B; Barnett, Adam S; Febre, Janice; Loring, Zak; Al-Khatib, Sana M; Atwater, Brett D; Daubert, James P; Frazier-Mills, Camille; Hegland, Donald D; Jackson, Kevin P; Jackson, Larry R; Koontz, Jason I; Lewis, Robert K; Pokorney, Sean D; Sun, Albert Y; Thomas, Kevin L; Bahnson, Tristam D; Piccini, Jonathan PBackground
Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM.Objective
The purpose of this study was to compare AF ablation outcomes in patients with and those without DM.Methods
We performed a retrospective analysis of 351 consecutive patients who underwent first-time AF ablation. Clinical outcomes included freedom from recurrent atrial arrhythmia, symptom burden (Mayo AF Symptom Inventory score), cardiovascular and all-cause hospitalizations, and periprocedural complications.Results
Patients with DM (n = 65) were older, had a higher body mass index, more persistent AF, more hypertension, and larger left atrial diameter (P <.05 for all). Median (Q1, Q3) total radiofrequency duration [64.0 (43.6, 81.4) minutes vs 54.3 (39.2, 76.4) minutes; P = .132] and periprocedural complications (P = .868) did not differ between patients with and those without DM. After a median follow-up of 29.5 months, arrhythmia recurrence was significantly higher in the DM group compared to the no-DM group after adjustment for baseline differences (adjusted hazard ratio [HR] 2.24; 95% confidence [CI] 1.42-3.55; P = .001). There was a nonsignificant trend toward higher AF recurrence with worse glycemic levels (HR 1.29; 95% CI 0.99-1.69; P = .064).Conclusion
Although safety outcomes associated with AF ablation were similar between patients with and those without DM, arrhythmia-free survival was significantly lower among patients with DM. Poor glycemic control seems to an important risk factor for AF recurrence.Item Open Access Diagnosis-to-ablation time predicts recurrent atrial fibrillation and rehospitalization following catheter ablation.(Heart rhythm O2, 2022-02) Chew, Derek S; Jones, Kelley A; Loring, Zak; Black-Maier, Eric; Noseworthy, Peter A; Exner, Derek V; Packer, Douglas L; Grant, Jennifer; Mark, Daniel B; Piccini, Jonathan PBackground
Wait times for catheter ablation in patients with symptomatic atrial fibrillation (AF) may influence clinical outcomes.Objective
This study examined the relationship between the duration from AF diagnosis to ablation, or diagnosis-to-ablation time (DAT), on the clinical response to catheter ablation in a large nationwide cohort of patients.Methods
We identified patients with new AF who underwent catheter ablation between January 2014 and December 2017 using the IBM MarketScan databases. Cox proportional hazard models were used to estimate the strength of the association between DAT and the outcomes of AF recurrence and hospitalization at 1 year postablation.Results
Among 11,143 AF patients who underwent ablation, the median age was 59 years, 31% were female, and the median CHA2DS2-VASc score was 2. Median DAT was 5.5 (2.6, 13.1) months. At 1 year postablation, 10.0% (n = 1116) developed recurrent AF. For each year increase in DAT, the risk of AF recurrence increased by 20% after adjustment for baseline comorbidities and medications (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.11-1.30). A longer DAT was associated with an increased risk of hospitalization (HR 1.08 per DAT year, 95% CI 1.02-1.15). DAT was a stronger predictor of AF recurrence postablation than traditional clinical risk factors, including age, prior heart failure, or renal failure.Conclusion
Increasing duration between AF diagnosis and catheter ablation is associated with higher AF recurrence rates and all-cause hospitalization. Our findings are consistent with a growing body of evidence supporting the benefits of prioritizing early restoration of sinus rhythm.Item Open Access Management and outcomes of patients with atrial fibrillation and a history of cancer: the ORBIT-AF registry.(Eur Heart J Qual Care Clin Outcomes, 2017-07-01) Melloni, Chiara; Shrader, Peter; Carver, Joseph; Piccini, Jonathan P; Thomas, Laine; Fonarow, Gregg C; Ansell, Jack; Gersh, Bernard; Go, Alan S; Hylek, Elaine; Herling, Irving M; Mahaffey, Kenneth W; Yu, Anthony F; Peterson, Eric D; Kowey, Peter R; ORBIT-AF Steering CommitteeAims: The presence of cancer can complicate treatment choices for patients with atrial fibrillation (AF) increasing both the risk of thrombotic and bleeding events. Methods and results: Using data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we aimed to characterize AF patients with cancer, to describe their management and to assess the association between cancer and cardiovascular (CV) outcomes. Among 9749 patients, 23.8% had history of cancer (57% solid malignancy, 1.3% leukaemia, 3.3% lymphoma, 40% other type, and 2.2% metastatic cancer). Patients with history of cancer were older, more likely to have CV disease, CV risk factors, and prior gastrointestinal bleeding. No difference in antiarrhythmic and antithrombotic therapy was observed between those with and without cancer. Patients with history of cancer had a significantly higher risk of death (7.8 vs. 4.9 deaths per 100 patient-years follow-up, P = 0.0003) mainly driven by non-CV death (4.2 vs. 2.4 per 100 patient-years follow-up; P = 0.0004) and higher risk of major bleeding (5.1 vs. 3.5 per 100 patient-years follow-up; P = 0.02) compared with non-cancer patients; no differences were observed in risks of strokes/non-central nervous system embolism (1.96 vs. 1.48, P = 0.74) and CV death (2.89 vs. 2.07, P = 0.35) between the two groups. Conclusion: A history of cancer is common among AF patients with up to one in four patients having both. Antithrombotic therapy, rates of cerebrovascular accident, other thrombotic events and cardiac death were similar in AF patients with or without a history of cancer. Patients with cancer, however, were at higher risk of major bleeding and non-CV death.Item Open Access More Frequent Self-Testing of Prothrombin Time Results in Improved Time in Target Range(CIRCULATION, 2012-11-20) Matchar, David B; Dolor, Rowena; Jacobson, Alan; Love, Sean; Edson, Robert; Uyeda, LaurenItem Open Access Sex Differences in the Modifiable Risk Factors for Atrial Fibrillation at Moi Teaching and Referral Hospital(2017) Ng'ang'a, Loise MwihakiBackground: Evidence mainly from high-income countries has demonstrated sex related differences in the incidence, presentation and management of patients with non-valvular AF. Such evidence is scarce in sub-Saharan Africa, yet there is a rising prevalence of AF. This study aimed to determine sex differences in the distribution and treatment pattern for modifiable risk factors in Western Kenya.
Methods: The study included two phases. Phase 1 comprised of secondary data analysis from a case control study – Study of Genetics of Atrial Fibrillation in an African population. Phase 2 included retrospective analysis of medical records at the cardiac clinic in a large referral hospital in Kenya. We determined the distribution and treatment pattern for modifiable risk factors for AF using chi-square and fisher’s exact test.
Results: Hypertension is the most prevalent modifiable risk factor for AF in western Kenya. The prevalence among men and women was 65% and 76% respectively, but this difference was not significant. Three percent of men were obese compared to 24 % of women (p =0.013). Men were more likely to drink alcohol (p = 0.001) and have a history of smoking compared to women (p = <0.001). Among men, tetra choric correlation showed a very strong association between smoking and alcohol intake (correlation coefficient > 0.9), and hypertension and obesity/overweight (correlation coefficient >0.9). These correlations were weaker among women with a correlation coefficient of 0.40 and 0.38 respectively. Among the participants, only 21% had weight and height measurements recorded. Nutritional counselling was recorded for only 3% of those who had a BMI > 29.9. Similarly, less than 10% of those with a history of smoking or alcohol intake received counselling on cessation strategies.
Conclusion: Hypertension is the most common modifiable risk factor for AF in western Kenya. There are significant differences among men and women in the distribution of dyslipidemia, alcohol intake, smoking and obesity. These modifiable risk factors have strikingly low rates of interventions. Management of patients with AF should include both screening and interventions for modifiable risk factors. Packaging of intervention should consider sex-specific differences.
Item Open Access The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.(Eur Heart J, 2015-12-07) O'Brien, Emily C; Simon, DaJuanicia N; Thomas, Laine E; Hylek, Elaine M; Gersh, Bernard J; Ansell, Jack E; Kowey, Peter R; Mahaffey, Kenneth W; Chang, Paul; Fonarow, Gregg C; Pencina, Michael J; Piccini, Jonathan P; Peterson, Eric DBACKGROUND: Therapeutic decisions in atrial fibrillation (AF) are often influenced by assessment of bleeding risk. However, existing bleeding risk scores have limitations. OBJECTIVES: We sought to develop and validate a novel bleeding risk score using routinely available clinical information to predict major bleeding in a large, community-based AF population. METHODS: We analysed data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), a prospective registry that enrolled incident and prevalent AF patients at 176 US sites. Using Cox proportional hazards regression, we identified factors independently associated with major bleeding among patients taking oral anticoagulation (OAC) over a median follow-up of 2 years (interquartile range = 1.6-2.5). We also created a numerical bedside risk score that included the five most predictive risk factors weighted according to their strength of association with major bleeding. The predictive performance of the full model, the simple five-item score, and two existing risk scores (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs/alcohol concomitantly, HAS-BLED, and anticoagulation and risk factors in atrial fibrillation, ATRIA) were then assessed in both the ORBIT-AF cohort and a separate clinical trial population, Rivaroxaban Once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation (ROCKET-AF). RESULTS: Among 7411 ORBIT-AF patients taking OAC, the rate of major bleeding was 4.0/100 person-years. The full continuous model (12 variables) and five-factor ORBIT risk score (older age [75+ years], reduced haemoglobin/haematocrit/history of anaemia, bleeding history, insufficient kidney function, and treatment with antiplatelet) both had good ability to identify those who bled vs. not (C-index 0.69 and 0.67, respectively). These scores both had similar discrimination, but markedly better calibration when compared with the HAS-BLED and ATRIA scores in an external validation population from the ROCKET-AF trial. CONCLUSIONS: The five-element ORBIT bleeding risk score had better ability to predict major bleeding in AF patients when compared with HAS-BLED and ATRIA risk scores. The ORBIT risk score can provide a simple, easily remembered tool to support clinical decision making.Item Open Access The prevalence, management, and thirty-day outcomes of symptomatic atrial fibrillation in a Tanzanian emergency department.(African journal of emergency medicine : Revue africaine de la medecine d'urgence, 2021-12) Oyediran, Isaac O; Prattipati, Sainikitha; Sakita, Francis M; Kweka, Godfrey L; Tarimo, Tumsifu G; Peterson, Timothy; Loring, Zak; Limkakeng, Alexander T; Bloomfield, Gerald S; Hertz, Julian TIntroduction
Data describing atrial fibrillation (AF) care in emergency centres (ECs) in sub-Saharan Africa is lacking. We sought to describe the prevalence and outcomes of AF in a Tanzanian EC.Methods
In a prospective, observational study, adults presenting with chest pain or shortness of breath to a Tanzanian EC were enrolled from January through October 2019. Participants underwent electrocardiogram testing which were reviewed by two independent physician judges to determine presence of AF. Participants were asked about their medical history and medication use at enrollment, and a follow-up questionnaire was administered via telephone thirty days later to assess mortality, interim stroke, and medication use.Results
Of 681 enrolled patients, 53 (7.8%) had AF. The mean age of participants with AF was 68.1, with a standard deviation (sd) of 21.1 years, and 23 of the 53 (43.4%) being male. On presentation, none of the participants found to have AF reported a previous history of AF. The median CHADS-VASC score among participants was 4 with an interquartile range (IQR) of 2-4. No participants were taking an anticoagulant at baseline. On index presentation, 49 (92.5%) participants with AF were hospitalised with 52 (98.1%) participants completing 30-day follow-up. 18 (34%) participants died, and 5 (9.6%) suffered a stroke. Of the surviving 31 participants with AF and a CHADS-VASC score ≥ 2, none were taking other anti-coagulants at 30 days. Compared to participants without AF, participants with AF were more likely to be hospitalised (OR 5.25, 95% CI 2.10-17.95, p < 0.001), more likely to die within thirty days (OR 1.93, 95% CI 1.03-3.50, p = 0.031), and more likely to suffer a stroke within thirty days (OR 5.91, 95% CI 1.76-17.28, p < 0.001).Discussion
AF is common in a Tanzanian EC, with thirty-day mortality being high, but use of evidence-based therapies is rare. There is an opportunity to improve AF care and outcomes in Tanzania.Item Open Access Volumetric Acoustic Radiation Force Impulse Imaging Using Intracardiac Echocardiography(2020) Kim, Young-JoongIntracardiac echocardiography (ICE) based elastography methods have the potential to be useful for a number of clinical purposes including monitoring of ablation lesion formation and myocardial substrate characterization. However, 2-D field-of-view ICE catheters currently in use in the clinic have difficulties imaging face-on regions of myocardial tissue, requiring meticulous and time-consuming translational and rotational scanning of the array. This dissertation investigates the use of helicoid array transducers to perform ICE-based acoustic radiation force impulse (ARFI) imaging on multiple elevation planes at once, improving on current methods in terms of speed and ease-of-use.
The Siemens Acuson SC2000 ultrasound scanner was programmed with sequences to perform SWEI imaging on the Soundstar 8F linear array ICE catheter and to perform volumetric ARFI scans using the AcuNav V helicoid array catheter. These sequences were used respectively to characterize the stiffness contrast in ablated human atrial tissue and to characterize the performance of volumetric ARFI at detecting gaps in atrial tissue phantoms.
The first research chapter is a clinical study showing that shear wave elastography (SWE) using a traditional 2-D field-of-view ICE catheter can be used to distinguish between baseline and ablated left atrial (LA) tissue in patients undergoing radiofrequency ablation (RFA) for atrial fibrillation (AF). Shear wave velocities of baseline LA and right atrium (RA), low electrogram voltage areas of the LA, and ablated LA are reported. The second chapter investigates through simulation and experiments the volumetric B-mode imaging performance of helicoid array transducers. Experimental verification of pressure field simulations is done by the use of the Siemens Acuson AcuNav V, a 128-element helicoid array transducer. Guided by these results, a discussion of the design of helicoid array transducer imaging sequences is presented. The final chapter is about the use of the helicoid array transducer for volumetric ARFI imaging. Experiments in tissue phantoms of varying elasticities and inclusions demonstrate that it is possible to identify gaps as narrow as 1 mm when the contrast is similar to that of baseline and ablated human LA myocardium.
This work demonstrates the feasibility of using helicoid array transducers for volumetric elastography imaging of the heart and establishes a foundation for future clinical investigations using this technology.