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- Andersson, Tommy, 1970-, et al.
(författare)
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Gender-related differences in risk of cardiovascular morbidity and all-cause mortality in patients hospitalized with incident atrial fibrillation without concomitant diseases: A nationwide cohort study of 9519 patients
- 2014
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 177:1, s. 91-99
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies of patients with "lone" and "idiopathic" atrial fibrillation (AF) have provided conflicting evidence concerning the development, management and prognosis of this condition. Methods: In this nation-wide, retrospective, cohort study, we studied patients diagnosed with incidental AF recorded in national Swedish registries between 1995 and 2008. Controls were matched for age, sex and calendar year of the diagnosis of AF in patients. All subjects were free of any in-hospital diagnosis from 1987 and until patients were diagnosed with AF and also free of any diagnosis within one year from the time of inclusion. Follow-up continued until 2009. We identified 9519 patients (31% women) and 12,468 matched controls. Results: Relative risks (RR) versus controls for stroke or transient ischemic attack (TIA) in women were 19.6, 4.4, 3.4 and 2.5 in the age categories <55, 55-64, 65-74 and 75-85, years respectively. Corresponding figures for men were 3.4, 2.5, 1.7 and 1.9. RR for heart failure were 6.6, 6.6, 6.3 and 3.8 in women and 7.8, 4.6, 4.9 and 2.9 in men. All RR were statistically significant with p < 0.01. RR for myocardial infarction and all-cause mortality were statistically significantly increased only in the two oldest age categories in women and 65-74 years in men. Conclusions: Patients with AF and no co-morbidities at inclusion had at least a doubled risk of stroke or TIA and a tripled risk of heart failure, through all age categories, as compared to controls. Women were at higher RR of stroke or TIA than men. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).
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| 2. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Predictors of hospitalization for heart failure and of all-cause mortality after atrioventricular nodal ablation and right ventricular pacing for atrial fibrillation
- 2014
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Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 16:12, s. 1772-1778
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Atrioventricular junction ablation (AVJA) is a highly effective treatment in patients with therapy refractory atrial fibrillation (AF) but renders the patient pacemaker dependent. We aimed to analyse the long-term incidence of hospitalization for heart failure (HF) and all-cause mortality in patients who underwent AVJA because of AF and to determine predictors for HF and mortality.Methods and results: We retrospectively enrolled 162 consecutive patients, mean age 67 +/- 9 years, 48% women, who underwent AVJA because of symptomatic AF refractory to pharmacological treatment (n = 117) or unsuccessful repeated pulmonary vein isolation (n = 45). Hospitalization for HF occurred in 32 (20%) patients and 35 (22%) patients died, representing a cumulative incidence for hospitalization for HF and mortality over the first 2 years after AVJA of 9.1 and 5.2%, respectively. Hospitalization for HF occurred to the same extent in patients who failed pharmacological treatment as in patients with repeated pulmonary vein isolation (PVI), although the mortality was slightly higher in the former group. QRS prolongation >= 120 ms and left atrial diameter were independent predictors of hospitalization for HF, while hypertension and previous HF were independent predictors of death.Conclusion: The long-term hospitalization rate for HF and all-cause mortality was low, which implies that long-term ventricular pacing was not harmful in this patient population, including patients with unsuccessful repeated PVI.
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| 3. |
- Poci, Dritan, 1969
(författare)
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Atrial fibrillation – on its trigger mechanisms, risks and consequences
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Atrial fibrillation (AF) frequently impairs quality of life, but in long-term it is associated with an increased morbidity and mortality. Persistent AF may cause changes in the sinus node function, and if converted to sinus rhythm (SR), there is a substantial risk of recurrence of AF. Atrioventricular junctional ablation (AVJA) is a therapeutic option for patients with drug refractory persistent/permanent AF, but permanent right ventricular pacing after ablation, according to some reports, has been associated with the development of heart failure (HF). Methods: 172 patients with persistent AF underwent elective DC cardioversion and analysis of 5 minutes ECG recordings was made in those converted to sinus rhythm (SR). Another 213 patients were followed for 6±3 years after AVJA. Forty-nine of the patients (23%) were known to have HF before AVJA, and aggravated or new HF was in long-term followed. Of 2335 consecutive patients admitted with acute coronary syndromes (ACS), 442 had known AF (n=204), new AF at admission (n=54) or developed new AF during hospitalization (n=184). The short- and long-term mortality and morbidity were followed in patients with and without AF, and were related to their CHADS2 scores at admission. Results: After successful cardioversion of persistent AF, 30% of the patients had a recurrence of AF within 1 week. Premature atrial contractions (PAC) were equally frequent in patients with and without AF recurrence. A low sinus rate and/or sinus pauses >2 s were observed in 31 patients in the first few minutes but did not predict recurrence of AF. One quarter of the patients with known HF before AVJA showed an aggravation of HF, while 13% developed new symptoms of HF during long-term right ventricular pacing after AVJA. High age and low EF were independent predictors of new HF, while high age and coronary artery disease were independent predictors of all-cause mortality. In patients with ACS and AF, short-term mortality (<30 days) was 13.8%, and differed significantly between the AF subgroups. All-cause 10-year mortality did not differ between subgroups, as opposed to the rate of hospitalization for stroke. The all-cause mortality at 10-years showed a strong association with the CHADS2 scores both in patients with and without AF, although strongest in patients without AF (hazard ratio [HR] and 95% confidence interval per unit increase in the six-graded CHADS2 score 1.53 [1.42-1.64], p<0.0001 vs 1.28 [1.16-1.43], p<0.0001 after adjustment for potential confounders). Conclusions: PACs and transient sinus bradycardia were the most common potential trigger mechanisms after cardioversion of persistent AF, but they did not predict recurrences of AF. AVJA followed by right ventricular pacing was associated with aggravated HF in a quarter of patients with previously known HF, while development of new symptoms of HF occurred much less often. In patients with ACS the type of AF influenced the 30-day mortality and the long-term risk of hospitalization for stroke. The CHADS2 score helped to identify patients with a higher risk for subsequent stroke and death, both in patients with and without AF.
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| 4. |
- Poci, Dritan, 1969, et al.
(författare)
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Role of the CHADS(2) Score in Acute Coronary Syndromes Risk of Subsequent Death or Stroke in Patients With and Without Atrial Fibrillation
- 2012
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Ingår i: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 141:6, s. 1431-1440
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) is common in patients with acute coronary syndromes (ACS). We aimed to describe the value of the CHADS(2) (congestive heart failure, hypertension, age >= 75 years, diabetes, prior stroke or transient ischemic attack) score as a risk assessment tool for mortality and stroke in patients with ACS, irrespective of the presence or absence of AF. Methods: Consecutive patients with ACS admitted to the coronary care unit were prospectively included in a risk stratification study. We calculated the CHADS(2) scores from the data collected at admission, and all patients were followed until January 1, 2007, or death. Results: Of 2,335 patients with ACS in this study, 442 (age 71 +/- 8 years, 142 women) had AF. Their mean CHADS(2) score was 1.6 +/- 1.4 vs 1.0 +/- 1.1 in patients without AF (P < .0001). The all-cause mortality at 10 years was strongly associated with the CHADS(2) score in patients with AF (hazard ratio [HR] and 95% CI per unit increase in the six-grade CHADS(2) score, 1.21 [1.07-1.36]; P = .002), hut the same association was also present in patients without AF (HR 1.38 [1.28-1.48], P < .0001), after adjustment for potential confounders. The more complicated GRACE (Global Registry Of Acute Coronary Events) risk score provided a better prediction for short- and long-term mortality than the simpler CHADS(2) score (P < .0001). Hospitalization for stroke was significantly associated with the CHADS(2) score in patients without AF (but not in those with AF) after adjustment (HR 1.46 [1.27-1.68], P <.0001). Conclusions: In patients with ACS, AF is associated with poor prognosis. The CHADS(2) score developed for AF has even greater prognostic value in patients who do not have AF, and it may help to identify patients with high risk for subsequent stroke or death and a need for optimization of risk-reducing treatment. CHEST 2012; 141(6):1431-1440
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| 6. |
- Wecke, Liliane, et al.
(författare)
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Vectorcardiography shows cardiac memory and repolarization heterogeneity after ablation of accessory pathways not apparent on ECG
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 166:1, s. 152-157
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pacing induced cardiac memory is an established phenomenon, but following successful WPW ablation, cardiac memory was present on ECG in variable proportions of patients depending on accessory pathway (AP) location. We hypothesized that vectorcardiography (VCG), which is more sensitive than ECG, would show cardiac memory after WPW ablation independent of AP location. METHODS: Thirty-six patients were followed after successful AP ablation, 11 with overt posteroseptal (PS), 13 with overt left-sided (LS) and 12 with concealed APs (controls). VCGs were recorded the day before and after the procedure, ≥once/week for 6-8weeks and after ≥3months. T vector and T-vector loop parameters were analyzed and compared. RESULTS: After ablation of overt APs, there was a correlation between the directions of the preexcited maximum QRS-vector and the post-ablation maximum T-vector, confirming the presence of cardiac memory. Ablation of overt APs was followed by cardiac memory apparent in different directions. Thus, ablation of PS APs was followed by most pronounced changes in T-vector elevation and LS APs with significant changes only in T-vector azimuth. Cardiac memory disappeared within a month in >80% of cases. Furthermore, T-vector loop morphology changes suggested a period of repolarization heterogeneity immediately after ablation of overt APs. CONCLUSIONS: According to VCG analysis cardiac memory was present after ablation of overt APs independent of location as consistently as after ventricular pacing, and disappeared within a similar time frame during normal ventricular activation. In addition, signs of transient repolarization heterogeneity were observed after ablation of overt APs.
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