ATRIAL FIBRILLATION IN PATIENTS WITH PHARMACOLOGICALLY CONTROLLED HYPERTENSION – INDIRECT ANTIARRHYTHMIC EFFECTS FOR SINUS RHYTHM MAINTENANCE AFTER ELECTRICAL CARDIOVERSION

Introduction: Rhythm control in atrial fibrillation (AF) patients with arterial hypertension (AH) remains complicated, attributed to pathogenetic link between both diseases. Indirect antiarrhythmic effects of medications not primarily recognized as sinus rhythm maintaining drugs, referred to as upstream therapies, including blood pressure-lowering agents, receive pathogenetically justified increasing attention. Nevertheless, studies demonstrate diverse success

Impact of Metabolic Status on the Course of Atrial Fibrillation

Publisher Copyright: © 2018 Renate Dresmane, published by Sciendo.Background and aims: Metabolic syndrome (MS) might influence the course of atrial fibrillation (AF) similarly to diabetes (DM). Aim of this research is to evaluate the quality of life, disease burden and medication adherence of patients with different metabolic states. Material and methods: A cross-sectional study of Latvian Center of Cardiology Arrhythmology Department patients with AF, sorting patients in 3 categories according to the National Institutes for Health guidelines criteria for MS. Results: From 133 patients, 51 were in metabolically healthy (MH) group, 58 in MS group and 24 had DM. Average age was 62.59 in MH, 67.59 in MS and 66.25 in DM group. Most common form of AF was persistent - MH 49%, MS 65.5%, DM 75%. Best EHRA median value was observed in DM group (29.2% reporting mild symptoms). Majority of patients had 1-2 comorbidities in MH and MS group and 3-5 in the DM group, with almost all patients using 4-9 drugs daily. Conclusions: A similar course of AF was observed in MS and DM groups. Since the same molecular pathways are involved, MS should be viewed as a cluster of risk factors with a cumulative effect - greater than the effect of a single risk factor.publishersversionPeer reviewe

Impact of body mass index on parameters of the left atrium : Cardiac computed tomography study

Publisher Copyright: © 2022 Viktorija Verhovceva et al., published by Sciendo.Increased Body Mass Index (BMI) is often used as a predictor for cardiovascular diseases, and it is also known to be associated with left atrial enlargement, potentially affecting anatomic structures of the left atrium. The aim of the study was to determine the association between BMI and parameters of the left atrium, including characteristics of the pulmonary veins (PVs), found in cardiac computed tomography (CT) scan. The retrospective study included 140 patients with a mean age of 66.9 years (SD = 7.8). There were statistically significant correlations between BMI and volume changes of the left atrium during the cardiac cycle: Vmax (rs = 0.199, p = 0.023), Vmin (rs = 0.177, p = 0.043), Vmean (rs = 0.190, p = 0.029), which supports previously known data. The study also revealed unique associations regarding the impact of BMI on PV structures. There was a significant correlation between BMI and PV orifice size in the left inferior PV (rs = 0.216, p = 0.032) and the right accessory PV (rs = -0.629, p = 0.012). The right PV angle was positively correlated with BMI (rs = 0.178, p = 0.044), while the angle between left PVs did not show any correlation with BMI (p = 0.436). The results support previously known associations between increased BMI and left atrial enlargement and show a statistically significant effect of increased BMI on the characteristics of pulmonary veins.publishersversionPeer reviewe

Efficacy and safety of non-vitamin K antagonist oral anticoagulants one year after electrical cardioversion

Publisher Copyright: © 2021 Czech Society of Cardiology Z.S. All rights reserved.Introduction: Atrial fibrillation (AF) is the most common arrhythmia in the world, affecting around 33 million people. Warfarin has been the anticoagulant of choice for the prevention of ischemic stroke in AF patients for a long time. Several large studies have shown that non-vitamin K antagonist oral anticoagulants (NOACs) offer numerous advantages regarding safety and effectiveness, such as fixed dose and more predictable pharmacokinetics. Methods: The study was conducted at Pauls Stradins Clinical University Hospital, Latvian Centre of Cardiology. The study took place from October 2015 to June 2017. A total of 356 patients who had undergone electrical cardioversion (ECV) was included in this study. Results: One year after ECV, 27.5% of patients used warfarin, 33.7% of patients used NOACs, whereas 38.8% did not use any oral anticoagulants. Nine (2.5%) of the patients who participated in the study died during the following year. Overall, eight patients (2.2%) suffered from significant bleeding and three patients (0.8%) had a non-fatal ischemic stroke. The rate of non-fatal ischemic stroke in patients who used warfarin was 2% and no cases were observed in patients who used NOACs (p = 0.20). The rate of significant bleeding was 5.1% versus 2.5% in warfarin and NOAC groups, respectively (p = 0.12). Conclusions: Compared with similar studies, our study showed a low rate of ischemic stroke and significant bleeding, and a low total death rate. One year after ECV, the use of warfarin decreased by 2.8% (p = 0.63), the use of rivaroxaban and dabigatran decreased by 17.5% (p = 0.001) and 17.4% (p = 0.001). The study shows that NOACs are a safe and effective alternative to warfarin.publishersversionPeer reviewe

Genetic Basis of Early Onset Atrial Fibrillation in Patients without Risk Factors

Funding Information: This research was funded by the Latvian Council of Science, project, “The role of clonal hemato-poiesis of indeterminate potential as a potential driver of cardiovascular diseases and its associ-ation with clinical outcome”, project No. lzp-2021/1-0293. Publisher Copyright: © 2023 by the authors.Background: Atrial fibrillation (AF) is the most common arrhythmia and typically occurs in elderly patients with other cardiovascular and extracardiac diseases. However, up to 15% of AF develops without any related risk factors. Recently, the role of genetic factors has been highlighted in this particular form of AF. Aims: The aims of this study were to determine the prevalence of pathogenic variants in early-onset AF in patients without known disease-related risk factors and to identify any structural cardiac abnormalities in these patients. Materials and Methods: We conducted exome sequencing and interpretation in 54 risk factor-free early-onset AF patients and further validated our findings in a similar AF patient cohort from the UK Biobank. Results: Pathogenic/likely pathogenic variants were found in 13/54 (24%) patients. The variants were identified in cardiomyopathy-related and not arrhythmia-related genes. The majority of the identified variants were TTN gene truncating variants (TTNtvs) (9/13 (69%) patients). We also observed two TTNtvs founder variants in the analysed population—c.13696C>T p.(Gln4566Ter) and c.82240C>T p.(Arg27414Ter). Pathogenic/likely pathogenic variants were found in 9/107 (8%) individuals from an independent similar AF patient cohort from the UK Biobank. In correspondence with our Latvian patients, only variants in cardiomyopathy-associated genes were identified. In five (38%) of the thirteen Latvian patients with pathogenic/likely pathogenic variants, dilation of one or both ventricles was identified on a follow-up cardiac magnetic resonance scan. Conclusions: We observed a high prevalence of pathogenic/likely pathogenic variants in cardiomyopathy-associated genes in patients with risk factor-free early-onset AF. Moreover, our follow-up imaging data indicate that these types of patients are at risk of developing ventricular dilation. Furthermore, we identified two TTNtvs founder variants in our Latvian study population.publishersversionPeer reviewe

Lead-related infective endocarditis in latvia : A single centre experience

Publisher Copyright: © 2019 by the authors. Licensee MDPI, Basel, Switzerland. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.Peer reviewe

Low cardiovascular event rate and high atrial fibrillation recurrence rate one year after electrical cardioversion

Publisher Copyright: © 2017 The Czech Society of CardiologyBackground: Electrical cardioversion is widely used to restore sinus rhythm in patients with atrial fibrillation. However, the long term clinical event and sinus rhythm maintenance rates following electrical cardioversion still remains unclear. This study evaluated one year incidence and risk factors for cardiovascular events and atrial fibrillation recurrence in a single center clinical practice. Methods: In a prospective study 188 patients with atrial fibrillation who underwent electrical cardioversion were enrolled. Patients and their primary care physicians were followed up one year after cardioversion and patient clinical and arrhythmic event rate was evaluated. Data obtained from patients and general practitioners were combined and the results were analyzed with PSPP 0.8.5 software. Results: Electrical cardioversion success rate was 90.4%. Within a year after cardioversion one patient (0.6%) suffered myocardial infarction, three patients (1.9%) had a stroke/transitory ischemic attack (TIA), three patients (1.6%) died and three patients (1.9%) had a bleeding event that required hospitalization. The presence of diabetes mellitus was the only factor with a tendency to increase the risk of combined event of myocardial infarction, stroke/TIA and bleeding (P = 0.096). At follow up 30.0% of patients reported having atrial fibrillation and within a year 62.2% had suffered at least one atrial fibrillation paroxysm. The proportion of patients who underwent additional cardioversions after the initial hospitalization was 32.5%. The factors that significantly increased the risk of atrial fibrillation recurrence were history of stroke/TIA (P = 0.014) and increased left atrial volume index on echocardiography (P = 0.039). Greater left atrial diameter had a tendency toward an increased risk (P = 0.087). Conclusions: Cardiovascular event rate one year after electrical cardioversion was low. Electrical cardioversion had a high immediate success rate, however, maintenance of stable sinus rhythm in the long term was low.publishersversionPeer reviewe

Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population

Publisher Copyright: © 2015 by Kristaps Jurjns.Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Riga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high-40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.publishersversionPeer reviewe

Atrial fibrillation recurrence prevention after electrical cardioversion in high-risk patients – benefits of non-antiarrhythmic drugs

Publisher Copyright: © 2021 Kokina et al.Background: Recurrence prevention after Atrial Fibrillation (AF) termination by Eelectrical Cardioversion (ECV) remains challenging. Increasing attention is paid to pathophysiological effects of non-Antiarrhythmic Drugs (non-AADs), nevertheless, with heterogeneous results. Objective: We evaluated the potential benefits of different non-AADs as adjunctive therapy to Antiarrhythmic Drugs (AADs) for AF recurrence prevention after sinus rhythm restoration by ECV in high-risk patients. Methods: The study was conducted among high-risk AF patients after successful ECV. Prescription of class IC or class III AAD was required. Data were acquired in a face-to-face baseline interview and 1-, 3-, 6-, 9-, 12-month follow-up interviews. Results: 113 patients were included. Total AF recurrence rate reached 48.7%. Angiotensin-Converting Enzyme Inhibitor (ACEI) or angiotensin receptor blocker (ARB) intake, compared with non-use, demonstrated AF recurrence rate reduction by 8.5% (46.3 vs. 54.8%), with odds ratio (OR) reduced by 28.9% (OR 0.711, 95% confidence interval (CI) 0.310-1.631, p = 0.420). Among mineralocorticoid receptor antagonist (MRA) users, AF recurrence rate was reduced by 25.1% (29.6 vs. 54.7%) and OR by 65.1% (OR 0.349, 95%CI 0.138-0.884, p = 0.023). Present statin therapy reduced AF recurrence rate by 4.2% (46.8 vs. 51.0%) and OR by 15.5% (OR 0.845, 95%CI 0.402-1.774, p = 0.656). Diuretic use showed reduction of AF recurrence rate by 10.2% (41.7 vs. 51.9%) and OR by 33.9% (OR 0.661, 95%CI 0.297-1.469, p = 0.308). Conclusion: Non-AADs demonstrated practical benefits as adjunctive therapy to AADs for AF recurrence prevention after ECV in high-risk patients, with statistically significant results established for concomitant MRA intake.publishersversionPeer reviewe

Assessment of Cardiac Resynchronisation Therapy Efficacy Determining Factors for Patients with Moderate and Severe Heart Failure in the Population of Latvia in a 12 and 24 Month Study

Publisher Copyright: © 2018 Maija Vikmane et al.The aim of this study was to evaluate treatment of patients with moderate and severe heart failure (HF) who were resistant to pharmacotherapy in Latvia and to assess the cardiac resynchronisation therapy (CRT) by exploring the predisposing factors which provides CRT efficacy. We accomplished prospective analysis of left ventricle ejection fraction (LVEF) and other parameter changes 12 and 24 months after CRT device implantation, dividing the population into two groups: responders - to whom LVEF improvement was ≥10% and non-responders where ≥ 10% LVEF improvement was not achieved. The study included 50 chronic HF patients with preserved sinus rhythm, who underwent CRT device implantation in Latvia at the Pauls Stradiņš Clinical University Hospital from June 2009 to March 2012. In the group of patients where 12 and 24 months after CRT device implantation LVEF improvement ≥10% was achieved, there were statistically significantly more patients with left bundle branch block (LBBB) QRS morphology, wider QRS complex, nonischemic genesis of HF, and normal systolic blood pressure. Patients with LVEF improvement had more pronounced ventricular dyssynchrony measured by Echo before CRT device implantation and, accordingly, the CRT mode was programmed as left ventricle paced before right ventricle and close to 100% biventricular pacing was achieved and the patient was female.publishersversionPeer reviewe