Feasibility of Patient-Managed ECG Recordings to Detect the Time of Atrial Fibrillation Recurrence after Electrical Cardioversion: Results from the PRE-ELECTRIC Study.

BACKGROUND: Electrical cardioversion (ECV) is a common procedure to terminate persistent atrial fibrillation (AF). The recurrence rate is high, and the patients often fail to recognize AF recurrence. OBJECTIVES: The aim of the study was to evaluate the feasibility of patient-managed electrocardiography (ECG) to detect the time to AF recurrence after ECV. METHODS: PRE-ELECTRIC (predictors for recurrence of atrial fibrillation after electrical cardioversion) is a prospective, observational study. Patients ≥18 years of age scheduled for ECV of persistent AF at Bærum Hospital were eligible for inclusion in the study. Time to recurrence of AF was detected by thumb ECG, recorded twice daily and whenever experiencing symptoms. The observation period was 28 days. We defined adherence as the observed number of days with ECG recordings divided by the expected number of days with ECG recordings. Study personnel contacted the participants by phone to assess their awareness of AF recurrence after a recurrence was detected in the thumb ECG. RESULTS: The study enrolled 200 patients scheduled for ECV of persistent AF at Bærum Hospital between 2018 and 2022. The mean age was 66.2 ± 9.3 years, and 21.0% (42/200) were women. The most frequent comorbidities were hypertension (n = 94, 47.0%) and heart failure (n = 51, 25.5%). A total of 164 participants underwent ECV of AF. The procedure was initially successful in 90.9%, of which 50.3% had a recurrence of AF within 4 weeks. The median time to recurrence was 5 days. Among the cardioverted participants, 123 (75.0%) had no missing days of thumb ECG recording during the observation period, and 97.0% had ≤3 missing days. More than a third (37.3%) of the participants with AF recurrence were unaware of the recurrence at the time of contact. Women were older and more symptomatic than men but had similar outcomes after ECV. CONCLUSIONS: Recurrence of AF after ECV was common. Using patient-managed thumb ECG was a feasible method to detect AF recurrence following ECV. Further studies are needed to investigate whether patient-managed ECG after ECV can optimize AF treatment.

The post-prandial pattern of gut hormones is related to magnitude of weight-loss following gastric bypass surgery: a case-control study.

BACKGROUND: The mechanisms of weight loss after gastric bypass, including the role of gastric hormones, are still not completely understood. While postprandial releases of peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) increase post-surgery and ghrelin usually is reduced, their relationship to the magnitude of the weight loss is still obscure. We explored if differing weight loss after Roux Y gastric bypass (RYGB) in morbidly obese were associated with differing postprandial hormonal release. METHODS: We compared patients with large (> 40%) or moderate (< 25%) weight loss three years following RYGP surgery, and an obese control group scheduled for RYGB (six in each group). A 300 kcal mixed meal test was given with blood sampling before and thereafter at 30-min intervals in 180 min. Peak and incremental area under the curve (iAUC) were calculated to characterize postprandial responses. RESULTS: Early postprandial GLP-1 response were significantly higher in the RYGB groups than in the controls, and highest in those with largest weight loss. Postprandial PYY response were also greater for the two RYGB groups vs. controls, but interestingly the controls had higher baseline values. Ghrelin, from similar baseline, was only suppressed in those with the largest weight loss, with close to no reduction in those with modest weight loss or controls. CONCLUSIONS: These results support the hypothesis that the magnitude of weight loss after RYGB surgery might be associated with differing patterns of postprandial responses in GLP-1 and ghrelin, but not PYY. Larger studies are warranted.

Candesartan in the prevention of relapsing atrial fibrillation.

BACKGROUND: Several studies have indicated that treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin II type 1 receptor blockers (ARBs) may reduce the incidence of atrial fibrillation (AF) in hypertensive patients and patients with left ventricular dysfunction. However, there is limited data on the effect of ACE-inhibitors and ARBs in patients undergoing electrical cardioversion for persistent AF. We hypothesized that treatment with the ARB candesartan, without adjunct antiarrhythmic therapy, would reduce the recurrence rate of AF after successful cardioversion. METHODS: In a double blind, placebo-controlled study, 171 patients with persistent AF were randomized to receive candesartan 8 mg once daily (n=86) or placebo (n=85) for 3-6 weeks before and candesartan 16 mg once daily or placebo for 6 months after electrical cardioversion. Primary endpoint was recurrence of AF. RESULTS: A total of 68 patients in the candesartan group and 69 patients in the placebo group were successfully cardioverted. Forty-eight patients (71%) in the candesartan group and 45 (65%) in the placebo group had a recurrence of AF during 6 months follow-up. Median time to recurrence was 8 and 9 days in the candesartan and placebo groups, respectively. The differences between the groups were not statistically significant. CONCLUSION: Treatment with the ARB candesartan for 3-6 weeks before and 6 months after electrical cardioversion had no effect on the recurrence rate of AF.