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1.
Wiad Lek ; 74(3 cz 1): 465-470, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813451

RESUMEN

OBJECTIVE: The aim: To evaluate the structural and functional parameters of the cardiovascular system during atrial fibrillation (AF) in patients after a stroke. PATIENTS AND METHODS: Materials and methods: In the main group, we selected 28 patients with non-valvular AF who had previously suffered an ischemic stroke (IS). The comparison group (30 people) included patients with AF without a stroke, comparable in age and gender. RESULTS: Results: As a result of the study, we discovered an increase in the risk of stroke with an increase in the thickness of the intima-media complex>0.9mm. The thickness of the interventricular septum was 1.19 (1.1; 1.25) in the group of patients with IS, and in the group of patients without IS - 1.09 (1.0; 1.19) cm (p = 0.019), the thickness of the LV posterior wall is greater in the main group 1.14 (1.05; 1.24) and 1.09 (1.01; 1.18) cm in the comparison group (p = 0.038). The myocardial mass index is 123.3 in the main group and 107.4 g/m2 in the comparison group (p = 0.41), which indicates left ventricle (LV) hypertrophy in the main group. CONCLUSION: Conclusions: thus, during AF in stroke patients, changes in the following structural and functional parameters of the cardiovascular system were discovered: an increase in the thickness of the interventricular septum, thickness of the posterior wall of the LV, and in the thickness of the intima-media complex.


Asunto(s)
Fibrilación Atrial , Accidente Cerebrovascular , Fibrilación Atrial/complicaciones , Grosor Intima-Media Carotídeo , Ventrículos Cardíacos , Humanos , Hipertrofia Ventricular Izquierda , Factores de Riesgo , Accidente Cerebrovascular/complicaciones
3.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(2): 274-278, 2021 Mar.
Artículo en Chino | MEDLINE | ID: mdl-33829702

RESUMEN

Objective: To explore for the establishment of an experimental technique for profiling transcription factors, namely transcription factor response elements (TFRE), with high throughput and efficiency using human atrial tissue. Methods: Postoperative right atrial tissues from 2 patients, one with preoperative atrial fibrillation and the one with no preoperative atrial fibrillation, were included in the study. The nucleus protein was extracted from the human atrial tissue, and the protein concentration was then measured. A solution with a complex formed through combining magnetic beads with concatenated tandem array of the consensus transcription factor response element DNA sequence (beads-catTFRE) was prepared, and the beads-catTFREs were then used to enrich transcription factors in the nucleoprotein extraction. SDS-PAGE electrophoresis was performed after dissociating beads-catTFRE from nucleoprotein with high temperature and high salt. The gel was then cut and faded before enzymolysis by trypsin in the gels was performed. Acetonitrile was used to extract the peptides from the gels, and the peptide solution was then dried. After that, we dissolved the peptides and performed mass spectrum tests, and the data were analyzed and processed with Firmiana one-stop proteomic analysis platform. Results: In this study, 220 and 181 transcription factors were identified in the normal right atrial tissue and the right atrial tissue with atrial fibrillation, respectively. A total of 241 transcription factors were identified in the two groups. Among the 241 transcription factors, 12 were in the top 10% of those transcription factors that were above the median expression level of the normal right atrial tissue, and 12 transcription factors were in the top 10% of those above the median expression level of the right atrial tissue with atrial fibrillation. Conclusion: The high-throughput profiling method established in this study has high coverage, and the data collected can be used to support further validation studies.


Asunto(s)
Fibrilación Atrial , Factores de Transcripción , Perfilación de la Expresión Génica , Regulación de la Expresión Génica , Atrios Cardíacos , Humanos , Proteómica , Factores de Transcripción/genética , Factores de Transcripción/metabolismo
4.
s.l; CONETEC; mar. 2021.
No convencional en Español | BRISA/RedTESA | ID: biblio-1151440

RESUMEN

INTRODUCCIÓN: La fibrilación auricular (FA) representa un importante problema socio-sanitario, siendo la arritmia cardíaca más frecuente en la práctica clínica con una prevalencia actual del 1 al 2% de la población, y donde la FA no asociada a valvulopatías (FANV) es la forma más frecuente. Esta patología favorece la formación de trombos, cuyas complicaciones más severas son el tromboembolismo arterial periférico, el accidente cerebrovascular (ACV) isquémico, la insuficiência cardiaca (IC) y la muerte. El tratamiento con anticoagulantes antagonistas de la vitamina K (AVK) reduce el riesgo de eventos tromboembólicos, sin embargo, estos tienen una eficacia limitada y requieren controles hematológicos estrictos debido a que una proporción elevada de pacientes no se encuentren en rango óptimo de anticoagulación, siendo el tiempo en rango promedio en Argentina de 66,6% (IC 95%: 54 a 80%). El grupo terapéutico de anticoagulantes orales directos (ACODs), que no requieren de controles hematológicos tan estrictos y poseen rangos terapéuticos más estables, se postulan que serían tan o más efectivos que los AVK en la prevención de eventos tromboembólicos en pacientes FANV y podrían presentar un mejor perfil de seguridad en relación a la incidencia de sangrados asociados a la anticoagulación. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las guías de práctica clínica, políticas de cobertura y económicos del uso de ACODs (apixabán, dabigatrán, rivaroxabán) para pacientes con FANV. METODOLOGIÍA: Como resultado se incluyeron cuatro revisiones sistemáticas con metaanálisis, diez guías de práctica clínica, once políticas de cobertura, una revisión sistemática de evaluación de tecnologías sanitarias, diecisiete estudios de costo-efectividad, y se realizó un análisis de impacto presupuestario (AIP). RESULTADOS: Los resultados sobre eficacia y seguridad basados en ensayos clínicos, y validados en estudios de la vida real, han demostrado que ACODs tienen eficacia similar y un mejor perfil de seguridad que los AVK, debido principalmente al menor riesgo de complicaciones hemorrágicas. Por estos motivos las guías de práctica clínica de las principales sociedades científicas internacionales relevadas (Europa, Estados Unidos, Canadá, Australia, Nueva Zelanda) posicionan a los ACODs como de primera elección frente a los AVK para pacientes con FANV. En relación a la evidencia económica relevada, los países de altos ingresos (Estados Unidos, Europa y Asia) reportan que los ACODs son estrategias costo-efectivas para los umbrales propuestos para cada país. Em América Latina, estudios económicos provenientes de Brasil y Colombia, evidencian resultados dispares especialmente como consecuencia de los costos de adquisición de los ACODs. En Argentina, los estúdios de costo-efectividad de apixabán y dabigatrán frente a AVK (warfarina) los consideran alternativas costoefectivas mientras que el AIP de elaboración propia estima que la incorporación de los ACODs, tanto en primera línea de tratamiento cómo en pacientes refractarios fuera de rango de anticoagulación, generaría un alto impacto presupuestario al sistema de salud argentino, principalmente debido a los elevados precios de adquisición de los ACODs en relación al acenocumarol. Los países de altos ingresos en general brindan cobertura pero existe disparidad entre sí es para primera línea de tratamiento o para pacientes fuera de rango de anticoagulación con AVK. En América Latina, los financiadores de salud relevados no cubren los ACODs para ninguna de las indicaciones evaluadas, mientras que en Colombia y Brasil fueron rechazados explícitamente por el alto costo según estúdios locales. CONCLUSIONES: Apixabán, dabigatrán y rivaroxabán presentan beneficios marcados en la mortalidad y algún grado de beneficio en la prevención de ACV isquémico e infarto de miocardio y presentan menos incidencia de sangrados intracraneales (y en algunos casos también menos sangrados mayores) en comparación con warfarina. Dependiendo del resultado de salud evaluado, varía el grado de certeza de la evidencia. Respecto a políticas de cobertura, los países de altos ingresos relevados brindan cobertura pero varían si es para primera línea de tratamiento o para pacientes fuera de rango de anticoagulación con AVK. En América Latina, los financiadores de salud identificados no cubren los ACODs para ninguna de las indicaciones; mientras que en Colombia y Brasil la cobertura fue rechazada explícitamente por el alto costo de los fármacos, en base a estudios locales.


Asunto(s)
Humanos , Fibrilación Atrial/tratamiento farmacológico , Inhibidores del Factor Xa/uso terapéutico , Rivaroxabán/uso terapéutico , Dabigatrán/uso terapéutico , Evaluación de la Tecnología Biomédica , Análisis Costo-Beneficio/economía
5.
Vasc Health Risk Manag ; 17: 95-102, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33737810

RESUMEN

Background: Endothelial dysfunction is associated with common risk factors for AF and has been implicated in the pathophysiology of atrial fibrillation (AF) through a variety of mechanisms. We determined the prospective association of brachial flow-mediated dilation (FMD) with incident AF among older adults. Methods: We included 2027 Cardiovascular Health Study participants (mean age=78.3 years, male=39%, Black=17%) who underwent brachial FMD measurement at the 1997 to 1998 clinic visit. Incident AF was ascertained by study electrocardiograms, hospital discharge diagnosis coding and Medicare claims data. Cox regression models were used to examine the association between FMD and incident AF. Results: We identified 754 incident of AF cases (37%) over a median follow-up of 11.0 years. After adjusting for age, sex, race, height, weight, cardiovascular disease, cigarette smoking, hypertension, diabetes, kidney function, c-reactive protein, physical activity, alcohol consumption, and statins, the risk of AF did not differ according to brachial FMD response (4th vs 1st quartile hazard ratio (HR)=1.01, 95% confidence interval (CI): 0.81, 1.26; per FMD unit increment HR=1.01, 95% CI: 0.97, 1.05). Conclusion: We found no relationship between brachial FMD and the risk of developing AF in this elderly cohort. Our findings suggest that the utility of brachial FMD as a risk marker for AF in older individuals is minimal.


Asunto(s)
Fibrilación Atrial/epidemiología , Arteria Braquial/fisiopatología , Frecuencia Cardíaca , Vasodilatación , Factores de Edad , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Arteria Braquial/diagnóstico por imagen , Femenino , Humanos , Incidencia , Masculino , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Estados Unidos/epidemiología
6.
Medicine (Baltimore) ; 100(11): e25130, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725992

RESUMEN

BACKGROUND: Postoperative atrial fibrillation (POAF) occurs commonly after cardiac surgery. Studies suggest that corticosteroid can reduce the incident of POAF. However, the results remain controversial. This meta-analysis aimed to evaluate the efficacy and safety corticosteroid on the prevention of POAF following cardiac surgery. METHODS: Randomized controlled trials were identified through a systematic literature search. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. Primary outcome was the incidence of POAF as well as length of hospital stay and intensive care unit stay, wound and other infection, mortality, duration of ventilation, myocardial infarction, gastrointestinal complications, high blood sugar, stroke, and postoperative bleeding. RESULTS: Fourteen studies with 13,803 patients were finally involved in the present study. Overall, corticosteroid significantly decreased the risk of POAF (relative risk [RR], 0.7; 95% confidence interval [CI], 0.55-0.89; P = .003). There were no significant differences in the incidence of length of intensive care unit stay (RR, -2.32; 95% CI, -5.44 to 0.80; P = .14) and hospital stay (RR, -0.43; 95% CI, -0.84 to -0.02; P = .04), infections (RR, 1.01; 95% CI, 0.83-1.23; P = .9), mortality (RR, 0.87; 95% CI, 0.71-1.06; P = .16), duration of ventilation (RR, -0.29; 95% CI, -0.65 to 0.07; P = .12), gastrointestinal complications (RR, 1.26; 95% CI, 0.91-1.76; P = .16), high blood sugar (RR, 1.98; 95% CI, 0.91-4.31; P = .09), stroke (RR, 0.9; 95% CI, 0.69-1.18; P = .45), postoperative bleeding (RR -44.54; 95% CI, -115.28 to 26.20; P = .22) and myocardial infarction (RR, 1.71; 95% CI, 0.96-1.43; P = .12). CONCLUSION: Our review suggests that the efficacy of corticosteroid might be beneficial to POAF development in patients undergoing cardiac surgery. The strength of this association remains uncertain because of statistical and clinical heterogeneity among the included studies.


Asunto(s)
Corticoesteroides/uso terapéutico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/prevención & control , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Posoperatorias , Anciano , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Riesgo , Factores de Tiempo , Resultado del Tratamiento
9.
JAMA ; 325(11): 1061-1073, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33724323

RESUMEN

Importance: Atrial fibrillation (AF) is the most common heart rhythm disturbance, continues to increase in incidence, and results in significant morbidity and mortality. The marine omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and vitamin D have been reported to have both benefits and risks with respect to incident AF, but large-scale, long-term randomized trial data are lacking. Objective: To test the effects of long-term administration of marine omega-3 fatty acids and vitamin D on incident AF. Design, Setting, and Participants: An ancillary study of a 2 × 2 factorial randomized clinical trial involving 25 119 women and men aged 50 years or older without prior cardiovascular disease, cancer, or AF. Participants were recruited directly by mail between November 2011 and March 2014 from all 50 US states and were followed up until December 31, 2017. Interventions: Participants were randomized to receive EPA-DHA (460 mg/d of EPA and 380 mg/d of DHA) and vitamin D3 (2000 IU/d) (n = 6272 analyzed); EPA-DHA and placebo (n = 6270 analyzed); vitamin D3 and placebo (n = 6281 analyzed); or 2 placebos (n = 6296 analyzed). Main Outcomes and Measures: The primary outcome was incident AF confirmed by medical record review. Results: Among the 25 119 participants who were randomized and included in the analysis (mean age, 66.7 years; 50.8% women), 24 127 (96.1%) completed the trial. Over a median 5.3 years of treatment and follow-up, the primary end point of incident AF occurred in 900 participants (3.6% of study population). For the EPA-DHA vs placebo comparison, incident AF events occurred in 469 (3.7%) vs 431 (3.4%) participants, respectively (hazard ratio, 1.09; 95% CI, 0.96-1.24; P = .19). For the vitamin D3 vs placebo comparison, incident AF events occurred in 469 (3.7%) vs 431 (3.4%) participants, respectively (hazard ratio, 1.09; 95% CI, 0.96-1.25; P = .19). There was no evidence for interaction between the 2 study agents (P = .39). Conclusions and Relevance: Among adults aged 50 years or older, treatment with EPA-DHA or vitamin D3, compared with placebo, resulted in no significant difference in the risk of incident AF over a median follow-up of more than 5 years. The findings do not support the use of either agent for the primary prevention of incident AF. Trial Registration: ClinicalTrials.gov Identifiers: NCT02178410; NCT01169259.


Asunto(s)
Fibrilación Atrial/tratamiento farmacológico , Colecalciferol/uso terapéutico , Suplementos Dietéticos , Ácidos Docosahexaenoicos/uso terapéutico , Ácido Eicosapentaenoico/uso terapéutico , Vitaminas/uso terapéutico , Anciano , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia del Tratamiento , Deficiencia de Vitamina D/tratamiento farmacológico
10.
Adv Clin Exp Med ; 30(3): 331-348, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757165

RESUMEN

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia, the most common cause of supraventricular tachycardia in the global population and the most common arrhythmia requiring treatment in an emergency department. OBJECTIVES: To systematically review recent literature and quantify the correlation between the choice of pharmacological cardioversion (PCV) drug and the national or international guidelines. MATERIAL AND METHODS: A systematic review was performed in accordance with the PRISMA statement methodology. The PubMed search engine was used to search for articles regardless of type or language and published in the last 6 years (May 2014-May 2020). In addition, we searched for AF guidelines and recommendations published online by cardiology and emergency medicine societies. RESULTS: The search strategy returned a total of 2615 abstracts. A total of 2598 full texts were screened; 2540 full texts were excluded with reasons and 58 articles from 32 countries were included in the analysis. In 17 of the 58 articles (29%), we noted discrepancies with the AF guidelines, specifically regarding the PCV drug used, the patients' comorbidities and the contraindications associated with the PCV drug. The most common clinical situation for the use of a contraindicated drug was when ibutilide was administered to patients with heart failure. The analysis did not reveal any statistically significant correlations, although the correlation between the sample size and guideline adherence was close to statistical significance (p < 0.06). CONCLUSION: Our systematic analysis revealed substantial non-adherence to AF treatment guidelines.


Asunto(s)
Fibrilación Atrial , Preparaciones Farmacéuticas , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Cardioversión Eléctrica , Humanos , Sulfonamidas
11.
Zhonghua Yi Xue Za Zhi ; 101(13): 950-955, 2021 Apr 06.
Artículo en Chino | MEDLINE | ID: mdl-33789377

RESUMEN

Objective: To investigate the safety and efficacy of percutaneous left atrial appendage closure (LAAC) in nonvalvular atrial fibrillation patients (NVAF) with left atrial spontaneous echocardiographic contrast (LA SEC). Methods: A total of 95 NVAF patients treated in the Department of Cardiology of Ningbo First Hospital from July 2018 to June 2019 were enrolled in this study. The study population was divided into two group according to the presence or absence of LA SEC detected by transesophageal echocardiography (TEE). TEE was scheduled 45 days post-procedure to detect device-related thrombus (DRT). Stroke and bleeding events were recorded during follow-up. Periprocedural complications and follow-up results were compared between the two groups. Results: LA diameters were smaller in non-LA SEC group than LA SEC group ((44.0±7.4)mm vs (47.3±6.6)mm, P=0.033). Watchman device was successfully implanted into all the enrolled patients. No death, transient ischemic attack (TIA)/stroke, device embolization and major bleeding events occurred. Fifty patients (90.2%) in LA SEC group and 31 patients (91.2%) in non-LA SEC group finished TEE follow-up 45 days post-procedure. No device-related thrombus was detected in non-LA SEC group, while 2 cases (6.5%) were detected in LA SEC group, but there was no significant differences in the incidence between the two groups (P=0.127). The LA SEC group and non-LA SEC group were followed-up for (12.3±3.8) months and (12.9±3.3) months, respectively; and there was no significant differences in the incidence of death, TIA/stroke, major and minor bleeding events between two groups during the follow-up (all P>0.05). Conclusion: LAAC in NVAF patients with LA SEC was safe and effective. However, the incidence of DRT was slightly higher.


Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Procedimientos Quirúrgicos Cardíacos , Accidente Cerebrovascular , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Ecocardiografía Transesofágica , Atrios Cardíacos , Humanos , Resultado del Tratamiento
12.
Medicine (Baltimore) ; 100(11): e25216, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33726018

RESUMEN

BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have been widely used for stroke prevention in atrial fibrillation (AF) and the treatment and prevention of venous thromboembolism. There is an issue with safety, especially in clinically relevant bleeding. We performed a network meta-analysis to evaluate the risk of major gastrointestinal (GI) bleeding associated with NOACs. METHODS: Interventions were warfarin, enoxaparin, apixaban, dabigatran, edoxaban, and rivaroxaban. The primary outcome was the incidence of major GI bleeding. A subgroup analysis was performed according to the following indications: AF, deep venous thrombosis/pulmonary embolism, and postsurgical prophylaxis. RESULTS: A total of 29 randomized controlled trials (RCTs) and 4 large observation population studies were included. Compared with warfarin, apixaban showed a decreased the risk of major GI bleeding (relative risk [RR] 0.54, 95% confidence interval [CI] 0.25-0.76), and rivaroxaban tended to increase this risk (RR 1.40, 95% CI 1.06-1.85). Dabigatran (RR 1.25, 95% CI 0.98-1.60), edoxaban (RR 1.07, 95% CI 0.69-1.65), and enoxaparin (RR 1.24, 95% CI 0.63-2.43) did not significantly increase the risk of GI bleeding than did warfarin. In the subgroup analysis, according to indications, apixaban showed a decreased risk of major GI bleeding (RR 0.50, 95% CI 0.34-0.74) than did warfarin in AF studies. Dabigatran (RR 2.36, 95% CI 1.55-3.60, and rivaroxaban (RR 1.75, 95% CI 1.10-6.41) increased the risk of major GI bleeding than did apixaban. An analysis of studies on venous thromboembolism or pulmonary embolism showed that no individual NOAC or enoxaparin was associated with an increased risk of major GI bleeding compared to warfarin. CONCLUSION: Individual NOACs had varying profiles of GI bleeding risk. Results of analyses including only RCTs and those including both RCTs and population studies showed similar trends, but also showed several differences.


Asunto(s)
Anticoagulantes/efectos adversos , Fibrilación Atrial/tratamiento farmacológico , Hemorragia Gastrointestinal/inducido químicamente , Embolia Pulmonar/tratamiento farmacológico , Tromboembolia Venosa/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Fibrilación Atrial/complicaciones , Dabigatrán/efectos adversos , Enoxaparina/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metaanálisis en Red , Estudios Observacionales como Asunto , Embolia Pulmonar/complicaciones , Pirazoles/efectos adversos , Piridinas/efectos adversos , Piridonas/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Rivaroxabán/efectos adversos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Tiazoles/efectos adversos , Tromboembolia Venosa/complicaciones , Warfarina/efectos adversos
15.
Int Heart J ; 62(2): 290-297, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33678796

RESUMEN

Atrial fibrillation (AF) is the most common cardiac arrhythmia; it has been known to increase the risk of stroke and heart failure. The association between air pollutants and AF has remained to be controversial. Thus, in this study, we sought to undertake a systematic review and meta-analysis in order to assess the short- and long-term effects of ambient air pollution on AF.We searched PubMed, Web of Science, Embase, and Ovid for all related studies up to October 2019. We used the random-effects model to estimate the excess risk percentage (ER%) and confidence intervals (CI) for particulate matter with diameter ≤ 2.5 (PM2.5) and ≤ 10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO). Results were further analyzed by subgroups according to location, age, outcome, and gender.In total, 18 studies were included in our meta-analysis: 5 evaluated for long-term effects, 12 for short-term effects, and 1 for both long- and short-term effects. For the short term, ER per 10 µg/m3 increase of pollutants was 1.8% (0%-3.7%) for PM2.5 and 1.1% (-0.2%-2.4%) for PM10; per 10 parts per billion (ppb) increment of gaseous pollutions was 3.2% (0.6%-5.8%) for NO2, 2.9% (0.3%-5.7%) for SO2, 0.5% (-3.4%-4.7%) for O3, and 2.0% (-1.3%-5.4%) for CO per 1000 ppb change. The subgroup analysis showed the short-term effect was significantly different by region, gender, outcome, and age. Meanwhile, in the long term, except for O3, a statistically significant association was noted between AF incidence and all pollutants.Our meta-analysis suggests that short-term exposure to part of pollutants (PM2.5, SO2, and NO2) increases AF attack. Further, long-term exposure to air pollution can significantly contribute to the incidence of AF in a healthy population.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Salud Global , Humanos , Incidencia
16.
Int Heart J ; 62(2): 312-319, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33678799

RESUMEN

This study aims to evaluate the incidence of ischemic stroke or transient ischemic attack (TIA) based on CHA2DS2-VASc scores in non-AF Chinese patients with sinus rhythm.We used health check-up data of 101,510 participants from the Kailuan Cohort Study. Participants' risk levels were defined by their CHA2DS2-VASc scores (range 0-3): Men with scores of 0, 1, or ≥ 2 and women with scores of 1, 2, or ≥ 3 were considered at low, intermediate, or high risk, respectively. Cox proportional hazards model was used to assess the association between the CHA2DS2-VASc-determined risk and the incidence of ischemic stroke/TIA.The mean 7.5 year follow-up examination revealed 2968 ischemic strokes/TIA events. The incidence rates for ischemic stroke/TIA events in men and women were 3.8% and 1.5%, respectively. The incidence of ischemic stroke/TIA increased with elevated predicted risks based on CHA2DS2-VASc scores in men: 2.2% for low-risk, 4.1% for intermediate-risk, and 7.8% for high-risk groups (P < 0.001 for trend). The incidences of ischemic stroke/TIA also increased with elevated predicted risks in women: 0.8% for low-risk, 2.1% for intermediate-risk, and 5.0% for high-risk groups (P < 0.001 for trend). Compared with low-risk group, the crude hazard ratio (95% confidence interval) of ischemic stroke/TIA for men in moderate- and high-risk groups were 1.96 (1.79-2.14; P < 0.001) and 4.18 (3.81-4.57; P < 0.001). Similar findings were observed in women.Risks of ischemic stroke/TIA events was high, particularly among those with high CHA2DS2-VASc scores.


Asunto(s)
Fibrilación Atrial/complicaciones , Isquemia Encefálica/epidemiología , Frecuencia Cardíaca/fisiología , Ataque Isquémico Transitorio/epidemiología , Medición de Riesgo/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/etiología , China/epidemiología , Femenino , Humanos , Incidencia , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
17.
Int Heart J ; 62(2): 298-304, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731524

RESUMEN

Radiofrequency and cryoballoon applications around the pulmonary veins (PVs) could provoke a vagal reflex (VR) by modulating the intrinsic cardiac autonomic nervous system (ICANS).This study aimed to investigate the incidence, timing, and clinical impact of a VR provoked by a laser balloon application for a PV isolation (PVI).A total of 92 consecutive paroxysmal atrial fibrillation (PAF) patients underwent a laser balloon PVI of PAF. Acute changes in the heart rate and blood pressure were recorded. The heart rate variability (HRV) was tested by Holter ECGs before and at three months following the ablation. Three hundred forty-five out of 363 PVs were successfully isolated (97%) with laser balloon applications. A VR such as sinus bradycardia (26.1%), transient sinus arrest (9.8%), transient atrioventricular block (1.1%), or a blood pressure reduction (8.7%) was observed during the laser balloon applications for the PVI. The follow-up ended at 12 months. The HRV attenuation was comparable before and at three months after the ablation procedure between that with and without a VR (P = 0.14). The PAF recurrence rate was also comparable between the two groups (P = 0.882).The laser balloon PVI often provoked a VR, however, the modulation of the ICANS was temporary and for up to three months as measured by the HRV changes after the ablation, and the freedom from any atrial fibrillation recurrence was comparable regardless of the occurrence of a VR.


Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Frecuencia Cardíaca/fisiología , Terapia por Láser/métodos , Taquicardia Paroxística/cirugía , Nervio Vago/fisiopatología , Anciano , Fibrilación Atrial/fisiopatología , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Taquicardia Paroxística/fisiopatología , Factores de Tiempo
18.
Int Heart J ; 62(2): 305-311, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731528

RESUMEN

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI). Although previous studies have investigated mortality rates and the incidences of adverse events associated with new-onset AF (NOAF) in patients with AMI, the effects of emergency percutaneous coronary intervention (PCI) on the incidence of NOAF in patients with AMI remain unclear. The purpose of this study was to investigate the relationship of clinical characteristics, medical history, and the coronary flow disturbance phenomenon (TIMI < 3) following emergency PCI with NOAF in patients with AMI. Between 2012 and 2016, 731 patients with AMI underwent PCI at our facility. Among these, 52 had a history of chronic/paroxysmal AF before admission and were excluded. The remaining 679 patients (mean age 66.4 years, 532 males) were analyzed in this retrospective observational study.New-onset AF was observed in 45 patients (6.6%). In univariate analysis, the hazard ratios (HRs) for patient age (HR 1.04, 95%CI 1.02-1.07), Killip II-IV (HR 2.34, 95%CI 1.29-4.23), elevated D-dimer level (> 1.0 µg/mL; HR 3.32; 95%CI 1.77-6.23), and coronary flow disturbance phenomenon (HR 5.61; 95%CI 2.88-10.9) were significantly higher in the NOAF group. In multivariate analysis, an elevated D-dimer level (> 1.0 µg/mL; HR 2.44; 95%CI 1.17-5.11) and coronary flow disturbance phenomenon (HR 4.61; 95%CI 2.29-9.27) were found to be independent risk factors for NOAF. An elevated D-dimer level at admission and the presence of coronary flow disturbance phenomenon after PCI were risk factors for NOAF following emergency PCI in patients with AMI.


Asunto(s)
Fibrilación Atrial/fisiopatología , Circulación Coronaria/fisiología , Vasos Coronarios/fisiopatología , Infarto del Miocardio/cirugía , Intervención Coronaria Percutánea , Complicaciones Posoperatorias/fisiopatología , Anciano , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos
19.
Int Heart J ; 62(2): 320-328, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731538

RESUMEN

Second-generation cryoballoon (CB) ablation is effective in achieving pulmonary vein (PV) isolation (PVI) in atrial fibrillation (AF) patients. The "crosstalk" (CST) phenomenon has been reported to reduce unnecessary applications during CB ablation. Nevertheless, it is unclear under what conditions the CST phenomenon occurs.To seek the predictors of the CST phenomenon during CB-guided PVI, CST phenomenon in achieving ipsilateral superior PVI during inferior PV ablation was analyzed in AF patients who underwent de novo ablation using CB. CB occlusion status and nadir balloon temperature (NT) were compared in these patients, and all ablated superior PVs were categorized into three groups according to the necessity of the touch up ablation and effectiveness of the phenomenon.Of 1082 superior PVs, 16, 40, and 1026 were classified into the CST success, CST failure, and control groups (unnecessary CST), respectively. The proportion of superior PVs ablated with complete occlusion using the CB was significantly higher in the CST success group than in the other two groups. The proportion of superior PVs ablated with NT ≤ -46°C was higher in the CST success group than in the CST failure group. The CST phenomenon was always observed if CB ablation of the superior PVs was performed with both complete occlusion and NT ≤ -46°C and was almost always ineffective if it did not meet these two criteria (sensitivity, 100%; specificity, 93%).Successful CST ablation was highly predicted if complete PV occlusion and NT ≤ -46°C during CB ablation of the superior PVs were achieved.


Asunto(s)
Fibrilación Atrial/cirugía , Criocirugia/métodos , Sistema de Conducción Cardíaco/fisiopatología , Venas Pulmonares/cirugía , Anciano , Fibrilación Atrial/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
20.
Isr Med Assoc J ; 23(3): 169-173, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33734630

RESUMEN

BACKGROUND: Elevated C-reactive protein (CRP) was shown to be associated with an increased risk for new-onset atrial fibrillation (AF) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI); however, the optimal time frame to measure CRP for risk stratification is not known. OBJECTIVES: To evaluate the relation between the change in CRP over time (CRP velocity [CRPv]) and new-onset AF among STEMI patients treated with primary PCI. METHODS: We included 801 STEMI patients who underwent PCI between 2007 and 2017 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24 hours after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in hours) between the two measurements. Patient medical records were reviewed for occurrence of new-onset AF. RESULTS: New onset AF occurred in 45 patients (6%). Patients with new onset AF had significantly higher median CRPv (1.27 vs. 0.43 mg/l/h, P = 0.002). New-onset AF during hospitalization occurred in 3.4%, 4.5 %, and 9.1% of patients in the first, second and third CRPv tertiles, respectively (P for trend = 0.006). In a multivariable logistic regression, adjusting for clinical variables the odds ratios for new onset AF was 1.93 (95% confidence interval 1.0-3.59, P = 0.04) for patients in the third CRPv tertile. CONCLUSIONS: CRPv might be an independent and rapidly measurable biomarker for new-onset AF following primary PCI in STEMI patients.


Asunto(s)
Fibrilación Atrial/sangre , Fibrilación Atrial/etiología , Proteína C-Reactiva/metabolismo , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST/sangre , Infarto del Miocardio con Elevación del ST/complicaciones , Anciano , Fibrilación Atrial/diagnóstico , Biomarcadores/sangre , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/terapia , Factores de Tiempo
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