Atrial fibrillation is a risk factor for major adverse cardiovascular events in COVID-19.

Background: New-onset atrial fibrillation (AF) during COVID-19 infection is associated with worse cardiovascular outcomes and mortality, with new-onset AF being associated with worse clinical outcomes than recurrent AF. However, it is not known whether a prior history of AF is an independent cardiovascular risk factor predicting worse outcomes in COVID-19 patients. The present investigation sought to determine whether AF should be considered a risk factor for worse outcomes in COVID-19 illness. Methods: From March 2020-September 2021 patients testing positive for SARS-CoV-2 with a prior AF diagnosis (n = 3623) were propensity matched to non-AF SARS-CoV-2 positive patients (n = 3610). Multivariable Cox hazard regression was used to determine subsequent MACE (all-cause death, myocardial infarction, HF and stroke) risk among patients with and without AF. Results: COVID-19 patients with a prior history of AF were more likely to be hospitalized, require ICU care, supplemental oxygen, and ventilator support compared COVID-19 patients without a history of AF. There was a 1.40 times higher rate of MACE in the COVID-19 patients with prior AF compared to patients without prior AF (p < 0.0001). The increased rate of MACE in patients with a prior AF was primarily secondary to increases in heart failure hospitalization and death. This finding was confirmed even after controlling for acute AF during COVID-19 illness (HR 1.22, p = 0.0009). Conclusion: AF history was shown to be an independent risk factor for MACE during a COVID-19 illness. Both recurrent and principally new-onset AF were associated with an increased risk of poor clinical outcomes during COVID-19 illness.

Influence of various water quality parameters on passive sampler accumulation kinetics of different metal valencies in freshwater.

Stabilized liquid membrane devices (SLMDs) have been used for passive integrative sampling of metals in freshwater systems. Field measurements of metal accumulation on SLMDs can provide a time-weighted average mass of labile metals over the deployment period. We exposed SLMDs in the laboratory to 0.5 µM solutions of silver, zinc, or aluminum as nitrate salts at three levels of water hardness, measuring metal accumulation every 4 days for 32 days. We saw linear accumulation in all experimental treatments, except for silver in high hardness (345.9 mg/L as CaCO3). The time-accumulation relationships indicated that metal sorption rates vary across valency with the lower valency metals generally accumulating at greater rates. Water hardness also affected accumulation rates and accumulated mass with greater rates as hardness increased for zinc and aluminum. The accumulated zinc mass at 32 days in soft water was 78% of the mass in hard water for zinc, and accumulated aluminum mass was 29% of the mass in hard water. Factors such as oleate formation on the SLMD surface and solution chemistry, including pH and chemical speciation, were evaluated in explaining our results. Our work supports that SLMDs have utility for sampling metals in freshwater over extended time periods, which may be beneficial when there is limited access to sites; it also provide important interpretive guidance for the use of SLMDs.

Implantable Electronic Cardiac Devices and Compatibility With Magnetic Resonance Imaging.

There is a growing population of patients with implanted electronic cardiac devices and a concomitant increase in the use of magnetic resonance (MR). There are theoretical safety risks posed to such devices by MR. However, there are now considerable laboratory data and clinical experience demonstrating safety in this setting, assuming appropriate device selection and patient monitoring. Herein, we review these data and our safety protocol and the new generation of devices that have been prospectively designed and tested to be safe for MR scanning, assuming certain conditions are met (i.e., devices that are MR-conditional). We also argue that the available data do not support a complete transition to implantation of MR-conditional devices.

The implantable cardioverter-defibrillator: An update.

The implantable cardioverter-defibrillator (ICD) provides life-saving therapy to prevent sudden cardiac death. ICDs have been implanted in millions of patients worldwide since the first human implant in 1980. Clinical trials have helped establish guidelines for ICD implantation in primary and secondary prevention of sudden cardiac death. Recent trials have also tested and compared various programing strategies to avoid unnecessary shocks and improve survival among ICD recipients. ICDs may also assist with monitoring for heart failure management. In this review, we discuss the clinical science to date that has helped define the role of ICDs in current practice.

Feasibility of extended ambulatory electrocardiogram monitoring to identify silent atrial fibrillation in high-risk patients: the Screening Study for Undiagnosed Atrial Fibrillation (STUDY-AF).

BACKGROUND: Identification of silent atrial fibrillation (AF) could prevent stroke and other sequelae. HYPOTHESIS: Screening for AF using continuous ambulatory electrocardiographic (ECG) monitoring can detect silent AF in asymptomatic in patients with known risk factors. METHODS: We performed a single-center prospective screening study using a wearable patch-based device that provides up to 2 weeks of continuous ambulatory ECG monitoring (iRhythm Technologies, Inc.). Inclusion criteria were age ≥55 years and ≥2 of the following risk factors: coronary disease, heart failure, hypertension, diabetes, sleep apnea. We excluded patients with prior AF, stroke, transient ischemic attack, implantable pacemaker or defibrillator, or with palpitations or syncope in the prior year. RESULTS: Out of 75 subjects (all male, age 69 ± 8.0 years; ejection fraction 57% ± 8.7%), AF was detected in 4 subjects (5.3%; AF burden 28% ± 48%). Atrial tachycardia (AT) was present in 67% (≥4 beats), 44% (≥8 beats), and 6.7% (≥60 seconds) of subjects. The combined diagnostic yield of sustained AT/AF was 11%. In subjects without sustained AT/AF, 11 (16%) had ≥30 supraventricular ectopic complexes per hour. CONCLUSIONS: Outpatient extended ECG screening for asymptomatic AF is feasible, with AF identified in 1 in 20 subjects and sustained AT/AF identified in 1 in 9 subjects, respectively. We also found a high prevalence of asymptomatic AT and frequent supraventricular ectopic complexes, which may be relevant to development of AF or stroke. If confirmed in a larger study, primary screening for AF could have a significant impact on public health.

Obesity, Exercise, Obstructive Sleep Apnea, and Modifiable Atherosclerotic Cardiovascular Disease Risk Factors in Atrial Fibrillation.

Classically, the 3 pillars of atrial fibrillation (AF) management have included anticoagulation for prevention of thromboembolism, rhythm control, and rate control. In both prevention and management of AF, a growing body of evidence supports an increased role for comprehensive cardiac risk factor modification (RFM), herein defined as management of traditional modifiable cardiac risk factors, weight loss, and exercise. In this narrative review, we summarize the evidence demonstrating the importance of each facet of RFM in AF prevention and therapy. Additionally, we review emerging data on the importance of weight loss and cardiovascular exercise in prevention and management of AF.

Diagnostic utility of a novel leadless arrhythmia monitoring device.

Although extending the duration of ambulatory electrocardiographic monitoring beyond 24 to 48 hours can improve the detection of arrhythmias, lead-based (Holter) monitors might be limited by patient compliance and other factors. We, therefore, evaluated compliance, analyzable signal time, interval to arrhythmia detection, and diagnostic yield of the Zio Patch, a novel leadless, electrocardiographic monitoring device in 26,751 consecutive patients. The mean wear time was 7.6 ± 3.6 days, and the median analyzable time was 99% of the total wear time. Among the patients with detected arrhythmias (60.3% of all patients), 29.9% had their first arrhythmia and 51.1% had their first symptom-triggered arrhythmia occur after the initial 48-hour period. Compared with the first 48 hours of monitoring, the overall diagnostic yield was greater when data from the entire Zio Patch wear duration were included for any arrhythmia (62.2% vs 43.9%, p <0.0001) and for any symptomatic arrhythmia (9.7% vs 4.4%, p <0.0001). For paroxysmal atrial fibrillation (AF), the mean interval to the first detection of AF was inversely proportional to the total AF burden, with an increasing proportion occurring after 48 hours (11.2%, 10.5%, 20.8%, and 38.0% for an AF burden of 51% to 75%, 26% to 50%, 1% to 25%, and <1%, respectively). In conclusion, extended monitoring with the Zio Patch for ≤14 days is feasible, with high patient compliance, a high analyzable signal time, and an incremental diagnostic yield beyond 48 hours for all arrhythmia types. These findings could have significant implications for device selection, monitoring duration, and care pathways for arrhythmia evaluation and AF surveillance.

The many faces of Behçet's disease.

A 23-year-old man with fevers, night sweats, lymphadenopathy, worsening vision, and aphthous ulcers was diagnosed with Behçet's disease. Multiple diagnostic imaging modalities were used to identify various multisystem complications associated with Behçet's disease including vascular thomboses, mediastinal fibrosis, chylothoraces, chylopericardium and coronary artery aneurysms.

Increasing the clearance of protein-bound solutes by addition of a sorbent to the dialysate.

The capacity of sorbent systems to increase solute clearances above the levels that are provided by hemodialysis has not been well defined. This study assessed the extent to which solute clearances can be increased by addition of a sorbent to the dialysate. Attention was focused on the clearance of protein-bound solutes, which are cleared poorly by conventional hemodialysis. A reservoir that contained test solutes and artificial plasma was dialyzed first with the plasma flow set at 46 +/- 3 ml/min and the dialysate flow (Q(d)) set at 42 +/- 3 ml/min using a hollow fiber kidney with mass transfer area coefficients greater than Q(d) for each of the solutes. Under these conditions, the clearance of urea (Cl(urea)) was 34 +/- 1 ml/min, whereas the clearances of the protein-bound solutes indican (Cl(ind)), p-cresol sulfate (Cl(pcs)), and p-cresol (Cl(pc)) averaged only 5 +/- 1, 4 +/- 1, and 14 +/- 1 ml/min, respectively The effect of addition of activated charcoal to the dialysate then was compared with the effect of increasing Q(d) without addition of any sorbent. Addition of charcoal increased Cl(ind), Cl(pcs), and Cl(pc) to 12 +/- 1, 9 +/- 2, and 35 +/- 4 ml/min without changing Cl(urea). Increasing Q(d) without the addition of sorbent had a similar effect on the clearance of the protein-bound solutes. Mathematical modeling predicted these changes and showed that the maximal effect of addition of a sorbent to the dialysate is equivalent to that of an unlimited increase in Q(d). These results suggest that as an adjunct to conventional hemodialysis, addition of sorbents to the dialysate could increase the clearance of protein-bound solutes without greatly altering the clearance of unbound solutes.