Risk of Atrial Fibrillation and Adverse Outcomes in Patients With Cardiac Implantable Electronic Devices.

Background and objectives: Comprehensive epidemiological data are lacking on the incident atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIEDs). This study aimed to examine the incidence, risk factors, and AF-related adverse outcomes of patients with CIEDs.Methods: This was an observational cohort study that analyzed patients without prevalent AF who underwent CIED implantation in 2009-2018 using a Korean nationwide claims database. The subjects were divided into three groups by CIED type and indication: pacemaker (n=21,438), implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) with heart failure (HF) (n=3,450), and ICD for secondary prevention without HF (n=2,146). The incidence of AF, AF-associated predictors, and adverse outcomes were evaluated.Results: During follow-up, the incidence of AF was 4.3, 7.3, and 5.1 per 100 person-years in the pacemaker, ICD/CRT with HF, and ICD without HF cohorts, respectively. Across the three cohorts, older age and valvular heart disease were commonly associated with incident AF. Incident AF was consistently associated with an increased risk of ischemic stroke (3.8-11.4-fold), admission for HF (2.6-10.5-fold), hospitalization for any cause (2.4-2.7-fold), all-cause death (4.1-5.0-fold), and composite outcomes (3.4-5.7-fold). Oral anticoagulation rates were suboptimal in patients with incident AF (pacemaker, 51.3%; ICD/CRT with HF, 51.7%; and ICD without HF, 33.8%, respectively).Conclusions: A substantial proportion of patients implanted CIED developed newly diagnosed AF. Incident AF was associated with a higher risk of adverse events. The importance of awareness, early detection, and appropriate management of AF in patients with CIED should be emphasized

Nonalcoholic fatty liver disease and the risk of atrial fibrillation stratified by body mass index:a nationwide population-based study

We evaluated the association between nonalcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF) and analyzed the impact of NAFLD on AF risk in relation to body mass index (BMI). A total of 8,048,055 subjects without significant liver disease who were available fatty liver index (FLI) values were included. Subjects were categorized into 3 groups based on FLI: 2), higher FLI raised the risk of AF (by 1.6-fold in 30 ≤ FLI 2. The impact of NAFLD on AF risk was accentuated in lean subjects with underweight

Efficacy and Safety of Oral Anticoagulants for Atrial Fibrillation Patients With Chronic Kidney Disease:A Systematic Review and Meta-Analysis

BACKGROUND: Data on different direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with renal impairment are insufficient. We aimed to perform pairwise and network meta-analysis comparing oral anticoagulants (OACs) in AF patients with renal impairment, including advanced chronic kidney disease (CKD) with creatinine clearance <30 mL/min. METHODS: PubMed, Embase, Cochrane Database, and references of related articles were searched up to April 2021. We included randomized trials and non-randomized studies using propensity-score or multivariable-model adjustments that compared clinical outcomes among OACs. Hazard ratios (HRs) for stroke or thromboembolism, major bleeding, and all-cause death were pooled using random-effects model. RESULTS: From 19 studies, 124,628 patients were included. In patients with AF and CKD, DOACs presented significantly lower risks of stroke or thromboembolism [HR(pooled) = 0.78, 95% confidence interval (CI) = 0.73–0.85, I(2) = 16.6%] and major bleeding [HR(pooled) = 0.76 (0.64–0.89), I(2) = 85.7%] when compared with warfarin, regardless of the severity of renal impairment. Results were consistent in advanced CKD patients for stroke or thromboembolism [HR(pooled) = 0.60 (0.43–0.85), I(2) = 0.0%] and major bleeding [HR(pooled) = 0.74 (0.59–0.93), I(2) = 30.4%]. In the network meta-analysis, edoxaban and apixaban presented the highest rank probability to reduce the risk of stroke or thromboembolism (edoxaban, P-score = 94.5%) and major bleeding (apixaban, P-score = 95.8%), respectively. Apixaban remained the safest OAC with the highest rank probability for major bleeding (P-score = 96.9%) in patients with advanced CKD. CONCLUSION: DOACs, particularly apixaban and edoxaban, presented superior efficacy and safety than warfarin in AF patients with CKD. Apixaban was associated with the lowest risk of major bleeding among OACs for patients with advanced CKD. SYSTEMATIC REVIEW REGISTRATION: [PROSPERO], identifier [CRD42021241718]

Impedance drop determines ablation lesion volume at the same level of ablation index

New parameters such as ablation index (AI) have been developed to create reliable ablation lesions. This study was performed to evaluate whether RF energy delivery with the same ablation index creates the similar ablation lesion volume. Ablation lesions were created in 5 pig hearts at ex-vivo state. Ablation was performed using an external-irrigation contact-force sensing catheter on the epicardial side of the left ventricle with 90-degree of angle. RF ablation time was adjusted for targeting AI 600 at 8 different conditions. Lesion volume created with 0–5g of contact force at 20 W was significantly lower than that of 11–20g at 40W despite of the same AI (125 ± 76.2 vs. 272 ± 49.5 mm3, P < 0.05). Quality of ablation lesion was variable in the condition of poor contact at low power for the ablation of ex-vivo swine left ventricle, and high-quality lesions could be expected when the impedance drop is satisfactory even though the same level of AI is applied during ablation

Clinical outcomes in patients with persistent atrial fibrillation after technologic advances including contact force-guided and ablation index-guided ablation

We aimed to evaluate the influence of technological advances on ablation outcomes in patients with persistent atrial fibrillation (AF) (PeAF). Radiofrequency ablation for patients with AF has advanced, including contact force (CF)-sensing catheters and the ablation index (AI). Between 2009 and 2018, we analyzed 173 patients with PeAF who underwent catheter ablation. We categorized them into three groups: AF ablation without CF and AI information (no-CF group, n = 63), with CF without AI (CF-only group, n = 49), and with optimal AI-guided ablation (AI group, n = 61). Early (within 3months, ER) and late (from 3months to 1year, LR) AF recurrence after ablation was assessed. Procedure-related complications were also evaluated. The baseline characteristics were similar among the 3 groups, excluding the baseline antiarrhythmic drug history. Additional substrate modification after pulmonary vein isolation was significantly low in frequency in the AI group (71.4%, no-CF; 69.4%, CF-only; 41.0%, AI, p = 0.001). The AI group had a shorter mean procedure-related time than the other groups. Both ER and LR of PeAF showed a trend of reduction with technological advances. With a short experience (less than 1year), the CF-only group showed more ER and LR than that shown by the AI group. However, with a long experience (more than 1year), ER and LR occurred similarly in the two groups. Procedure-related complications improved with technological advances. As ablation technology advanced, favorable clinical outcomes with short procedural times were observed. However, prospective, large multicenter studies are needed to verify these results.This work was supported by the Korea Medical Device Development Fund grant funded by the Korean Government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, Republic of Korea, the Ministry of Food and Drug Safety) (Project Number: 202013B14) and by the Korea National Research Foundation funded by the Ministry of Education, Science and Technology (Grant 2020R1F1A106740)

Clustering of Unhealthy Lifestyle and the Risk of Adverse Events in Patients With Atrial Fibrillation

BACKGROUND: Little is known regarding the risk of clinical outcomes depending on the clustering of lifestyle behaviors after atrial fibrillation (AF) diagnosis. This study evaluated the association between a cluster of healthy lifestyle behaviors and the risk of adverse outcomes in patients with AF. METHODS: Using the Korean National Insurance Service database, patients who were newly diagnosed with AF between 2009 and 2016 were included. A healthy lifestyle behavior score (HLS) was calculated by assigning 1 point each for non-current smoking, for non-drinking, and for performing regular exercise from the self-reported questionnaire in health examinations. The primary outcome was defined as major adverse cardiovascular event (MACE), including ischemic stroke, myocardial infarction, and hospitalization for heart failure. RESULTS: A total of 208,662 patients were included; 7.1% in HLS 0, 22.7% in HLS 1, 58.6% in HLS 2, and 11.6% in HLS 3 groups. Patients with HLS 1, 2, and 3 were associated with a lower risk of MACE than those with HLS 0 (adjusted hazard ratio [95% confidence interval (CI)]: 0.788 [0.762–0.855], 0.654 [0.604–0.708], and 0.579 [0.527–0.636], respectively). After propensity score weighting, consistent results were observed. The risk reduction of healthy lifestyle combinations was consistently observed in various subgroups, regardless of the CHA(2)DS(2)-VASc score and oral anticoagulant use. CONCLUSION: Increased number of healthy lifestyle behaviors was significantly associated with lower MACE risk in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in patients with AF