scholarly journals Shifts in gut microbiome and metabolome are associated with risk of recurrent atrial fibrillation

2020 ◽  
Author(s):  
Kun Zuo ◽  
Jing Li ◽  
Jing Zhang ◽  
Pan Wang ◽  
Jie Jiao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Scoring System ◽  
Model Performance ◽  
Metagenomic Sequencing ◽  
Microbial Composition ◽  
Metabolic Pattern ◽  
Microbial Function ◽  
Recurrent Atrial Fibrillation ◽  
Clinical Scoring ◽  
Af Recurrence

ABSTRACTSpecific alterations of gut microbiota (GM) in atrial fibrillation (AF) patients, including elevated microbial diversity, particularly perturbed composition, imbalanced microbial function, and associated metabolic pattern modifications have been described in our previous report. The current work aimed to assess the association of GM composition with AF recurrence (RAF) after ablation, and to construct a GM-based predictive model for RAF. Gut microbial composition and metabolic profiles were assessed based on metagenomic sequencing and metabolomic analyses. Compared with non-AF controls (50 individuals), GM composition and metabolomic profile were significantly altered between patients with recurrent AF (17 individuals) and the non-RAF group (23 individuals). Notably, discriminative taxa between the non-RAF and RAF groups, including the families Nitrosomonadaceae and Lentisphaeraceae, the genera Marinitoga and Rufibacter, and the species Faecalibacterium sp. CAG:82, Bacillus gobiensis, and Desulfobacterales bacterium PC51MH44, were selected to construct a taxonomic scoring system based on LASSO analysis. An elevated area under curve (0.954) and positive net reclassification index (1.5601) for predicting RAF compared with traditional clinical scoring (AUC=0.6918) were obtained. The GM-based taxonomic scoring system theoretically improves the model performance. These data provide novel evidence that supports incorporating the GM factor into future recurrent risk stratification.

scholarly journals Duration of Persistent Atrial Fibrillation Is Associated with Alterations in Human Gut Microbiota and Metabolic Phenotypes

mSystems ◽  
2019 ◽  
Vol 4 (6) ◽  
Author(s):  
Kun Zuo ◽  
Jing Li ◽  
Pan Wang ◽  
Ye Liu ◽  
Zheng Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gut Microbiota ◽  
Early Stage ◽  
Persistent Atrial Fibrillation ◽  
Metabolic Profiles ◽  
Metagenomic Sequencing ◽  
Microbial Function ◽  
Distinct Structure ◽  
The Common ◽  
The Relationship

ABSTRACT Atrial fibrillation (AF) has been shown to be associated with disordered gut microbiota (GM). The underlying factors governing persistent AF (psAF) are not well understood, and the association between AF duration and GM profiles remains to be characterized. Thus, the present study aimed at investigating the dysbiosis of GM in patients with short and long psAF duration and illuminating the relationship between the GM and psAF maintenance. Based on metagenomic sequencing and metabolomic analyses, we assessed the metabolic and GM signature in 12 patients with psAF of <12 months (Pers<12m), eight patients with psAF of >12 months (Pers>12m), and 20 controls. We found that the GM in patients with both Pers<12m and Pers>12m was significantly perturbed, with an elevated microbial diversity, distinct structure, and discrepant composition. Although Pers<12m and Pers>12m patients shared a large number of common bacteria with controls, including 84 genera and 404 species, certain bacteria were differently enriched at different AF durations. Furthermore, disturbance in gut microbial function and GM-linked metabolic alterations were detected in both the Pers<12m and Pers>12m groups. The connection of GM and metabolites with psAF is consistent with interaction and potential modulation of host metabolic pathways due to GM dysbiosis with AF persistence. Our results showed that patients of the Pers<12m and Pers>12m groups shared many common disordered GM and metabolic features, which might occur in early disease, while prolonged psAF duration was related to certain unique alterations. Preventative strategies targeting GM and microbial metabolites for early intervention to treat AF patients are highly warranted. IMPORTANCE Atrial fibrillation was associated with a disordered gut microbiota in previous research. However, the gut microbiota signature of patients at different stages of atrial fibrillation remains largely unknown. We sought to determine whether the shift in the gut microbiota and metabolic profiles occurs early and remains stable or develops gradually during atrial fibrillation. We found that patients with persistent atrial fibrillation of <12 months and persistent atrial fibrillation of >12 months shared most of the common features of gut microbiota dysbiosis. However, some distinctive and progressive alterations in the gut microbiota and metabolic structure, which may contribute to the progression of atrial fibrillation, were identified. The present study provides a comprehensive description of the dysbiotic gut microbiota and metabolic profiles in patients of short and long persistent atrial fibrillation, and our findings may help identify therapeutic strategies targeting the gut microbiota to treat atrial fibrillation at an early stage.

scholarly journals Sex differences in the predictors of recurrent atrial fibrillation after catheter ablation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Tanaka ◽  
K Inoue ◽  
A Kobori ◽  
K Kazutai ◽  
T Morimoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Catheter Ablation ◽  
Large Scale ◽  
Funding Source ◽  
Recurrent Atrial Fibrillation ◽  
History Of ◽  
The Impact ◽  
Af Recurrence

Abstract Background The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We previously reported that females experienced more frequent AF recurrences than males after the index and last RFCA procedures. Purpose To identify the risk factors associated with recurrent AF in females and males after RFCA of AF. Methods We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Results The incidence of AF recurrences after a single procedure was 43.3% in females and 39.0% in males. After a multivariate adjustment at baseline, the significant predictors of AF recurrence in females after the index RFCA were non-paroxysmal AF (hazard ration [HR],1.59; 95% confidence interval [CI],1.31–1.93, p&lt;0.0001), a history of AF ≥2 years (HR,1.47; 95% CI,1.24–1.74, p&lt;0.0001), coronary artery disease (HR,1.43; 95% CI,1.03–1.98, p=0.0035), and an estimated glomerular filtration rate (eGFR)&lt;60 mL/min/1.73m2 (HR,1.46; 95% CI,1.10–1.95, p=0.0086). On the other hand, significant predictors of AF recurrence in males after the index RFCA were non-paroxysmal AF (HR,1.54; 95% CI,1.37–1.73, p&lt;0.0001), a history of AF ≥2 years (HR,1.40; 95% CI,1.26–1.56, p&lt;0.0001), the number of antiarrhythmic drugs (HR,1.06; 95% CI,1.003–1.13, p=0.040), a left atrial diameter≥40mm (HR,1.13; 95% CI,1.007–1.27, p=0.038), and dilated cardiomyopathy (HR,1.55; 95% CI,1.07–2.26, p=0.021), however, an eGFR&lt;60 mL/min/1.73m2 was not associated with AF recurrence in males (HR, 1.00; 95% CI, 0.88–1.13, p=0.97). Conclusion The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the predictors of recurrent AF after RFCA. Non-Paroxysmal AF and a long history of AF were common risk factors both in females and males. However, renal dysfunction was a significant predictor of AF recurrence in females, while it was not a risk of recurrence in males. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.

scholarly journals Forecasting of recurrent atrial fibrillation after radiofrequency ablation of pulmonary veins using preoperative characteristics

2020 ◽  
Vol 7 (5) ◽  
pp. 6-16
Author(s):  
B. B. Bondarenko ◽  
A. V. Grigoryeva ◽  
L. A. Sokolova ◽  
V. A. Bart ◽  
I. A. Gorlova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Veins ◽  
First Year ◽  
Recurrent Atrial Fibrillation ◽  
Design And Methods ◽  
Preoperative Predictors ◽  
Af Recurrence

Background. Atrial fibrillation (AF) is the most frequent arrhythmia. The method of catheter radiofrequency ablation (CRA) of pulmonary veins (PV) does not guarantee the preservation of sinus rhythm. Determination of predictors of AF relapses dictates the need in systemic approach taking into account demographic and clinical-instrumental characteristics of patients. Objective. Determination of preoperative predictors of AF recurrence within 3 year after follow-up CRA PV.Design and methods. The study included 89 patients (50 men, 39 women; mean age 58 and 62 years respectively) followed during 3 years after CRA PV. The methods of principal components and discriminant analysis were used for analytical purposes. Results. The recurrence of AF was observed in 43 patients (48 %): during the first year — in 18 (43 %), during the second — in 16 (37 %), during the third — in 9 (20 %) cases. By consistently using the methods of descriptive and multivariant statistics a set of the preoperative indicators has been identified that distinguishes patients with AF relapses undergone CRA PV. It consists of the longivity of AF, the state of contractive myocardial function, the presence of ICD, cardioversion in the past and thyroid pathology. The contribution of modified risk factors: SBP level, BMI, tobacco smoking also are valued. Conclusion. Using of multivariant statistics allows to determine preoperative characteristics, which provide optimization of management of patients with AF.

scholarly journals Predicting recurrent atrial fibrillation after catheter ablation: a systematic review of prognostic models

EP Europace ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 748-760 ◽  
Author(s):  
Janine Dretzke ◽  
Naomi Chuchu ◽  
Ridhi Agarwal ◽  
Clare Herd ◽  
Winnie Chua ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Assessment Tool ◽  
Model Performance ◽  
Risk Of Bias ◽  
Prognostic Models ◽  
Risk Scores ◽  
Bibliographic Databases ◽  
Recurrent Atrial Fibrillation

Abstract Aims We assessed the performance of modelsf (risk scores) for predicting recurrence of atrial fibrillation (AF) in patients who have undergone catheter ablation. Methods and results Systematic searches of bibliographic databases were conducted (November 2018). Studies were eligible for inclusion if they reported the development, validation, or impact assessment of a model for predicting AF recurrence after ablation. Model performance (discrimination and calibration) measures were extracted. The Prediction Study Risk of Bias Assessment Tool (PROBAST) was used to assess risk of bias. Meta-analysis was not feasible due to clinical and methodological differences between studies, but c-statistics were presented in forest plots. Thirty-three studies developing or validating 13 models were included; eight studies compared two or more models. Common model variables were left atrial parameters, type of AF, and age. Model discriminatory ability was highly variable and no model had consistently poor or good performance. Most studies did not assess model calibration. The main risk of bias concern was the lack of internal validation which may have resulted in overly optimistic and/or biased model performance estimates. No model impact studies were identified. Conclusion Our systematic review suggests that clinical risk prediction of AF after ablation has potential, but there remains a need for robust evaluation of risk factors and development of risk scores.

scholarly journals A Novel Alternately Energy Source Strategy for Re-Ablation of Patients with Recurrent Atrial Fibrillation—Cryoballoon or Radiofrequency Current Energy Ablation. A Case-Control Study

2021 ◽  
Author(s):  
Qinghui Tang ◽  
XiaoGang Guo ◽  
Jian Ma
Keyword(s):  
Atrial Fibrillation ◽  
Energy Source ◽  
Early Recurrence ◽  
Conclusive Evidence ◽  
Radiofrequency Energy ◽  
Cryoballoon Ablation ◽  
Recurrence Rates ◽  
Recurrent Atrial Fibrillation ◽  
Radiofrequency Current ◽  
Af Recurrence

Abstract Background: Atrial fibrillation recurrence after circumferential pulmonary vein (PV) isolation was common. Which ablation technique is better for repeat ablation in patients with recurrent atrial fibrillation (AF) remains unclear. We aimed to investigate long-term efficacy of repeat ablation using a novel alternately energy source sequence for re-ablation of patients with recurrent atrial fibrillation: cryoballoon (CB) re-ablation for patients with a failed radiofrequency (RFC) ablation (RFC-CB redo group); radiofrequency energy re- ablation for patients with a failed cryoballoon ablation (CB-RFC redo group).Method: Recurrent AF patients received a repeat ablation procedure in our hospital were enrolled into the study. Demographic and re-ablation procedural characteristics and outcomes were compared among groups.Results: A total of 156 patients were enrolled into the study, 60 patients (38.5%) were in the CB-RFC-redo group and 96 patients (61.5%) were in the RFC-CB-redo group. Longer duration of AF (69.31±64.69 vs 50.78 ±51.48 months; P=0.039) and longer time from first ablation to re-ablation (54.02 ±38.10 vs 14.2 ±10.5 months; P=0.001) were observed in the RFC-CB-redo group as compared with the CB-RFC redo group. Early recurrence rates of atrial fibrillation following initial ablation were equal among groups (RFC-CB-redo group: 42.7% vs CB-RFC-redo group:48.3% , p=0.515).The number of reconnected PVs was significantly higher in the RFC-CB redo group than the CB-RFC redo group (3.36 ± 0.96 vs 1.50 ± 0.81, p=0.01). During the average follow-up of 10.7 ±2.41 months, significantly less AF recurrence was observed in the CB-RFC redo group (16.7% vs 31.3%, p=0.045). In the multivariate analysis, different energy ablation sequence, AF type and early recurrence after the initial ablation were independent predictors of AF recurrence after re-ablation.Conclusions: Alternate energy source sequence strategy for re-ablation of patients with recurrent atrial fibrillation was safe and moderately effective. However, Large multi-center studies must be warranted to provide conclusive evidence.

Whole Food Plant-Based Diet as a Treatment of Recurrent Atrial Fibrillation Following Catheter Ablation

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
John W Schleifer ◽  
R. Dhawan
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Antiarrhythmic Drug ◽  
Case Reports ◽  
Food Plant ◽  
Effective Intervention ◽  
Antiarrhythmic Drug Therapy ◽  
Recurrent Atrial Fibrillation ◽  
Af Recurrence

Atrial fibrillation (af) may recur despite antiarrhythmic drug therapy or catheter ablation. is case reports such a scenario of a patient with recurrent paroxysms of af following catheter ablation that resolved following institution of a whole-food, plant-based diet. us, a change to a whole-food, plant-based diet may be an effective intervention for reducing or eliminating af recurrence.

scholarly journals Significance of mitral L wave to predict late recurrence of atrial fibrillation after radiofrequency catheter ablation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Wada ◽  
M Shinohara ◽  
S Yao ◽  
K Yano ◽  
K Akitsu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Late Recurrence ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Recurrent Atrial Fibrillation ◽  
Af Recurrence

Abstract Background Mitral L wave, prominent mid-diastolic filling wave in echocardiographic examinations, is associated with severe left ventricular diastolic dysfunction, and that has been reported to predict recurrent atrial fibrillation (AF) after cardioversion. However, association between mitral L wave and the outcome of AF after radiofrequency catheter ablation (RFCA) has not been established. Objective The aim of this study is to evaluate the predictive value of mitral L wave on AF recurrence after RFCA. Methods 250 patients including 164 paroxysmal AF (65.6%) and 86 non-paroxysmal AF (34.4%) who received RFCA in single center from January 2015 to December 2016 were enrolled consecutively. Echocardiographic examinations before RFCA were recorded, and the mitral L wave was defined as a distinct mid-diastolic flow velocity with a peak velocity ≥20 cm/s following the E wave. Systematic follow-up was conducted after RFCA. Univariate and multivariate analyses were carried out to determine the factors predicting late recurrence of AF (LRAF) which means AF recurrence after 3 months. Enrolled patients were divided into groups with the L wave (L-group; n=57) or without the L wave (NL-group; n=193) based on the findings of echocardiographic examinations. Results During a follow-up of 35.0±17.6 months, the ratio of LRAF in the L-group was significantly higher than that in the NL-group (32 (56.1%) vs. 41 (21.2%), Hazard ratio [HR]: 3.55, 95% confidence interval [CI]: 2.33 - 5.42, p&lt;0.001). Among the clinical factors, presence of mitral L wave, BNP value, non-paroxysmal AF and moderate-severe mitral regurgitation were related to LRAF. A multivariate analysis using a Cox proportional hazard model found that presence of mitral L wave (HR: 2.67, 95% CI: 1.30 - 5.48, p=0.007) was significantly associated with LRAF. Conclusion This study revealed that mitral L wave predicts late recurrence of AF after RFCA. FUNDunding Acknowledgement Type of funding sources: None.

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