scholarly journals A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

2018 ◽  
Vol 21 (6) ◽  
pp. E489-E496 ◽  
Author(s):  
Sophie Z Lin ◽  
Todd C Crawford ◽  
Alejandro Suarez-Pierre ◽  
J Trent Magruder ◽  
Michael V Carter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Integer Point ◽  
Significant Risk ◽  
Point System ◽  
Left Atrial Diameter ◽  
Derivation Cohort ◽  
Echocardiographic Measurement ◽  
New Onset

Background: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. Methods: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80%) and validation (20%) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system. Results: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27%) developed new onset AF including 165/611 (27%) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm (4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92). Conclusion: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.

P1766Clinical impact of atrial fibrillation and heart failure in a cohort of patients with hypertrophic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Esteve Ruiz ◽  
H Llamas Gomez ◽  
I M Esteve Ruiz ◽  
M J Romero Reyes ◽  
R Pavon Jimenez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Atrial Diameter ◽  
Myocardial Thickness ◽  
Worse Prognosis ◽  
Echocardiographic Findings

Abstract Background Atrial fibrillation (AF) and heart failure (HF) are common complications in Hypertrophic Cardiomyopathy (HCM) patients, leading to a worsening of their quality of life, need of hospitalization and prognosis. Purpose To analyze clinical variables associated with the presence of AF and HF in HCM patients. Methods HCM patients followed-up in cardiological visits from 2005 to 2017 were included and a descriptive analysis of those with AF and HF was performed. Results Out of 168 patients, 28% had reported AF. They were older than those without arrhythmia (68±15 years (yrs) vs 56±20 yrs, p<0.001) and had more comorbidities such as diabetes (27.7% vs 12.4%, p=0.02) and chronic renal disease (21.3% vs 6.6%, p=0.006). Echocardiographic findings are summarized in Table 1. In our cohort, 27.4% of the patients had HF with a functional class according to the New York Heart Association criteria ≥2. They were older than those without HF (69.3±11.6 yrs vs 55.9±20.6 yrs, p<0.001) and had higher rate of cardiovascular (CV) risk factors such as hypertension (65.2% vs 44.3%, p=0.015). The presence of HF was directly associated with the presence of AF: 52.2% of the patients with HF and 18.9% of the patients without HF developed this arrhythmia (p<0.001). HF patients associated larger left atrial diameter (48±8.1 vs 41.6±7.2mm, p<0.001), myocardial thickness (21.7±3.9 vs 19.2±5.8mm, p=0.002) and higher left ventricular outflow obstruction (LVOO) (55±32 vs 34.3±31.3mmHg, p=0.021), without any differences in the left ventricular ejection fraction. HF patients had a worse prognosis (Picture 1). Multivariate analysis showed that the presence of AF (OR 2.6, CI 95% 1.1–6.3) and LVOO (OR 4.8, CI 95% 1.5–14.8) were independent risk factors of developing HF. Table 1. Echocardiographic findings AF (n=47) Non AF (n=121) p LVOO 27.7 19 0.22 Aortic regurgitation 12.8 3.3 0.02 Mitral regurgitation 27.7 12.4 0.02 Left atrial diameter (mm) 48.8±7.2 40.7±7 <0.001 Myocardial thickness (mm) 20±5.4 19±5.2 0.02 Qualitative variables are expressed as percentages (%) and quantitative variables as mean and standard deviation (M ± SD). Picture 1. Main outcomes of HF patients Conclusions AF and HF were directly associated in our cohort, especially in elderly patients with higher comorbidities, leading to a worse prognosis with a higher hospitalization rate and CV death. This emphasizes the importance of a thorough search of both complications in order to initiate early treatment and improve the prognosis of HCM patients.

Abstract 15729: Effect of Metformin on Outcomes of Catheter Ablation for Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amrish Deshmukh ◽  
Elif Oral ◽  
Michael Ghannam ◽  
Jackson Liang ◽  
Mohammed Saeed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Blood Glucose ◽  
Catheter Ablation ◽  
Glycemic Control ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Fasting Blood Glucose ◽  
Lower Probability ◽  
Left Atrial Diameter

Background: Diabetes mellitus (DM) and glycemic control are risk factors for atrial fibrillation (AF). Metformin may have antifibrillatory properties by altering atrial metabolism. It is unknown whether metformin has favorable effects on the outcomes of catheter ablation (CA) for AF. Objective: To determine whether metformin use is associated with maintenance of sinus rhythm after CA for AF. Methods and Results: A 1 st CA was performed in 271 consecutive patients with DM and AF (age: 65±9 years, women: 34 %; and paroxysmal AF: 50%). A total of 182 (67%) patients were treated with metformin and 79/182 were also receiving other antidiabetics or insulin. HbA1c and preprocedural fasting blood glucose were similar among the patients treated with and without metformin (7.2±1.4% vs. 7.2±1.3%, P=0.95 and 162± 61 vs. 159±66 mg/dL, P=0.72). At a median of 10 months (IQR: 5-23, mean 15±13 months) after CA, 100/182 patients (55%) on metformin remained in sinus rhythm without concomitant antiarrhythmic drugs (AAD) compared to 36/89 patients (40%) not receiving metformin (P=0.03). On K-M analysis, patients on metformin were more likely to stay in sinus rhythm after CA, with or without AADs (P<0.001, log-rank, Figure). On Cox proportional hazards analysis, adjusted for age, gender, BMI, type of AF(paroxysmal vs. non-paroxysmal), fasting blood glucose, AAD use, obstructive sleep apnea, chronic kidney disease, and left atrial diameter, metformin use was associated with a ~35% lower probability of recurrent atrial arrhythmia(HR: 0.65, ±95% CI: 0.44-0.97, P=0.04). Increase in left atrial diameter (per mm, HR: 1.05, ±95% CI:1.01-1.08, P=0.001) and non-paroxysmal AF (HR: 1.9, ±95% CI: 1.3-2.9, P=0.001) were associated with a higher risk of recurrence after CA of AF. Conclusion: In patients with DM, the use of metformin was associated with a significant reduction in recurrent atrial arrhythmias after CA for AF independent of the other risk factors, including preprocedural glycemic control.

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