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  • 1
    Online Resource
    Online Resource
    Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis
    Oxford University Press (OUP) ; 2021
    In:  EP Europace Vol. 23, No. 11 ( 2021-11-08), p. 1731-1743
    Details
    In: EP Europace, Oxford University Press (OUP), Vol. 23, No. 11 ( 2021-11-08), p. 1731-1743
    Abstract: This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery. Methods and results Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen’s d = 1.4, 95% confidence interval (CI) 0.9–1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen’s d = 0.8, 95% CI 0.6–1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen’s d = 1.4, 95% CI 1.0–1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease. Conclusion This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients.
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    URL: Article
    DOI: 10.1093/europace/euab095
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2002579-8
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  • 2
    Online Resource
    Online Resource
    Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EORP Atrial Fibrillation Ablation Long-Term and Atrial Fibrillation General Pilot Registries
    Oxford University Press (OUP) ; 2020
    In:  EP Europace Vol. 22, No. 2 ( 2020-02-01), p. 250-258
    Details
    In: EP Europace, Oxford University Press (OUP), Vol. 22, No. 2 ( 2020-02-01), p. 250-258
    Abstract: Rhythm control management in patients with atrial fibrillation (AF) may be unequal across Europe. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection. Methods and results Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC EORP AFA-LT) registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC EORP AF-Gen) pilot registry. Data collection was performed using a web-based system. In the AFA and in the Atrial Fibrillation General (AFG) pilot registries, 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger, more commonly male, and had significantly less comorbidities. Atrial Fibrillation Ablation patients often presented without comorbidities, resulting in a lower risk of stroke (CHA2DS2-VASc ≥5: 2.9% vs. 24.5%, all P  & lt; 0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P  & lt; 0.001) but with European Heart Rhythm Association (EHRA) scores & gt;1 and more prevalent AF-related symptoms such as palpitations, fatigue, and weakness (all P  & lt; 0.001) as compared to the general AF patients. Atrial Fibrillation Ablation patients were significantly more often male, had higher left ventricular ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P  & lt; 0.001 each). Conclusion The comparison of the patient cohorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and relatively healthy patients.
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    URL: Article
    DOI: 10.1093/europace/euz291
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2002579-8
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  • 3
    Online Resource
    Online Resource
    Women have less progression of paroxysmal atrial fibrillation: data from the RACE V study
    BMJ ; 2023
    In:  Open Heart Vol. 10, No. 2 ( 2023-12), p. e002534-
    Details
    In: Open Heart, BMJ, Vol. 10, No. 2 ( 2023-12), p. e002534-
    Abstract: Sex differences in atrial fibrillation (AF) are observed in terms of comorbidities, symptoms, therapies received, AF progression and cardiovascular complications. Methods We assessed the differences in prevalence and the determinants of AF progression, as well as the clinical characteristics and quality of life (QoL), between women and men with paroxysmal AF included in the RACE V (Reappraisal of Atrial Fibrillation: Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilisation in the Progression of AF) study. At baseline, extensive phenotyping was done. To assess AF progression, implantable loop recorder (ILR) monitoring was used throughout follow-up. AF progression was defined as (1) progression to persistent or permanent AF or (2) progression of paroxysmal AF ( 〉 3% burden increase). Results 417 patients were included, 179 (43%) of whom were women. Women were older (median 67 years vs 63 years, p 〈 0.001), less often had coronary artery disease (n=11 (6%) vs n=36 (16%), p=0.003), had more obesity (n=57 (32%) vs n=50 (21%), p=0.013), had less epicardial and pericardial fat (median 144 (interquartile range [IQR] 94–191) mL vs 199 (IQR 146–248) mL, p 〈 0.001; and median 89 (ICQ 61–121) mL vs 105 (IQR 83–133) mL, p 〈 0.001, respectively) and had more impaired left atrial function. The median follow-up was 2.2 (1.6–2.8) years. 51 of 417 patients (5.5% per year) showed AF progression (15/179 (8.4%) women and 36/238 (15.1%) men, p=0.032). Multivariable analysis showed tissue factor pathway inhibitor, N-terminal prohormone brain natriuretic peptide (NT-proBNP) and PR interval being associated with AF progression in women and factor XIIa:C1 esterase, NT-proBNP and proprotein convertase subtilisin/kexin type 9 in men. QoL was not different between sexes. Conclusion Despite older age, the incidence of AF progression was lower in women. Parameters associated with AF progression varied in part between sexes, suggesting different underlying pathophysiological mechanisms.
    Type of Medium: Online Resource
    ISSN: 2053-3624
    URL: Article
    DOI: 10.1136/openhrt-2023-002534
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2747269-3
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