Atrial Fibrillation - Atrial Fibrillation - 308 · atrial-fibrillation · Page 2

Eric Y. Ding, Ms from the Division of Cardiology, Department of Medicine, University of Massachusetts Medical School speaks about the Survey of current perspectives on consumer-available digital health devices for detecting atrial fibrillation.

Link to Article:
https://www.sciencedirect.com/science/article/pii/S2666693620300049#!

Background
Patients have direct access to a variety of digital health services that can detect atrial fibrillation (AF). Heart rhythm healthcare practitioners' (HCPs) adaptation into clinical practice, on the other hand, is uncertain.


Goal
The aim of this study was to look into the perspectives of HCPs on the use of commercial technologies for AF detection and management.



Methodologies
We developed an electronic survey for HCPs to determine practice demographics and attitudes toward digital devices for AF identification and management. The survey was sent to all members of three heart rhythm professional societies via email.



Conclusions
Out of 73,563 e-mails sent, we got 1601 responses, with 43.6 percent coming from cardiologists, 12.8 percent from fellows, and 11.6 percent from advanced practice practitioners. The majority of respondents (62.3 percent) said they had advised patients to use a digital system for AF detection. Many that didn't were worried about their accuracy (29.6%), the clinical usefulness of the findings (22.8%), and incorporation into electronic health records (22.8%). (19.8 percent ). For patients at high risk of stroke, the findings of a 30-second single-lead electrocardiogram were enough for 42.7 percent of HCPs to prescribe oral anticoagulation. More data comparing the accuracy of digital devices versus traditional devices for AF monitoring was requested by respondents (64.9 percent ). A quarter of HCPs (27.3%) had no concerns about recommending digital devices for AF detection, and the majority (53.4%) required guidelines from their professional societies about how to use them properly.



Final Thoughts
Many healthcare professionals have already begun to incorporate digital technologies into their clinical practice. However, when using digital technology for AF detection, HCPs identified difficulties, and professional society guidelines are required.

Todd Chapin, PharmD, BCPS from Sanford Health speaks about Apixaban Versus Warfarin for the Management of Post-operative Atrial Fibrillation.

Link to Study:
https://clinicaltrials.gov/ct2/show/NCT02889562?recrs=dem&cond=Atrial+Fibrillation&cntry=US&phase=123&draw=2&rank=51

Patients who experience atrial fibrillation after isolated coronary artery bypass grafting surgery will be identified in this open-label, prospective, randomized pilot study. Patients with chronic prolonged atrial fibrillation (>2 episodes of atrial fibrillation lasting longer than 30 minutes) or persistent atrial fibrillation (>12 hours) would be qualified. Patients will be randomized to either the standard of care (warfarin per protocol) or the apixaban arms of the trial after meeting research inclusion and exclusion requirements and giving informed consent. Both groups will receive routine postoperative treatment after CABG. The anticoagulation clinic will treat anticoagulation in both classes after discharge. After surgery, patients will be monitored for 30 days.

Carol Chiung-Hui Peng, MD from the University of Maryland Medical Center Midtown Campus, and Kashif Munir, MD from the University of Maryland School of Medicine, associate professor, and Medical Director of the University of Maryland Center for Diabetes and Endocrinology speak about Non‐vitamin K antagonist oral anticoagulants vs. warfarin for AFib patients: What the latest research tells us.

Twitter -

@UMMC @umms @UMmedschool 

Link to Abstract:
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14243


Abstract 
Comparison of the risk of developing diabetes in patients with non-vitamin K antagonist oral anticoagulants (NOACs) treated with atrial fibrillation (AF) and warfarin.



Materials and Methods

Using Taiwan's National Health Insurance Research Database, we carried out a nationwide retrospective cohort analysis. Adult new-onset AF patients treated with NOACs or warfarin between 2012 and 2016 have been included. The NOAC cohort was further categorized into classes of dabigatran, rivaroxaban, and apixaban. Incident diabetes requiring treatment with antidiabetic medications was the primary outcome. Subdistribution hazard models of Fine and Gray were used to estimate the adjusted hazard ratio (aHR). For each head-to-head analysis, propensity score matching was conducted.



Outcomes
Our analysis included a total of 10,746 new-onset AF patients. NOACs were associated with a lower risk of developing diabetes than warfarin during the mean 2.4-year follow-up (aHR = 0.80, 95 percent confidence interval [CI]: 0.68-0.94, P = .007). Analyses of the subgroup indicated that dabigatran, rivaroxaban, and apixaban each had a decreased risk of diabetes. Stratified studies found that the lower risk of NOAC-related diabetes was specific for patients 65 years of age or older (aHR = 0.74, 95% CI: 0.62-0.89, P = .002) and those with strong adherence to medication (aHR = 0.70, 95% CI: 0.58-0.84, P < .001).



Findings
In patients with AF, taking NOAC was associated with a lower risk of developing diabetes compared to taking warfarin.

David Conen, MD from the Population Health Research Institute and McMaster University, discusses Alcohol consumption, atrial fibrillation, and cardiovascular disease: finding the right balance.

Link To Study -
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa955/6090247

Atrial fibrillation (AF) is associated with an increased risk of death and cardiovascular complications and has been described as one of the 21st century cardiovascular epidemics.1 AF pathogenesis is complex, but many risk factors for AF have been described previously, explaining the attributable risk of about 50 percent of the population.1-4 Enhancing our understanding of risk factors. Indeed, only oral anticoagulation has so far been undeniably shown to boost difficult results once AF.5 has been established by a patient.

Excessive alcohol intake is a significant modifiable risk factor that predisposes to AF. 6,7 The development of AF has been related to both acute and increased habitual drinking. As is apparent in the Holiday Heart Syndrome, acute alcohol intake has a direct impact on the heart, contributing to atrial tachyarrhythmias.8,9 Chronic alcohol consumption is also associated with an elevated risk of AF.6,7 In the Women's Health Study, women who drank > 2 alcoholic drinks per day had a 60% higher risk of AF incident after the multivariable change, while lower amounts did n.



In this issue of the Journal, in a very broad dataset, Csengeri et al.10 discussed the relationship between alcohol consumption and incident AF. Five prospective community-based cohorts totaling 107,845 individuals free of AF at baseline were combined by Csengeri et al.10, of whom 5854 developed new-onset AF over a median follow-up of 13.9 years. From patient self-report, alcohol intake was determined at baseline, while incident AF was determined from hospitalization data through ICD codes or comorbidities reported on death certificates. The median age was 47.8 years, 48.3 percent were men and 3 g/day was the median intake of alcohol. Consumption of 1 alcoholic beverage (defined as 12 g of alcohol) per day was correlated with a 16 percent increased risk of incident AF in Cox regression models stratified by sex and cohort [hazard ratio 1.16, 95 percent confidence interval (CI) 1.11–1.22, P < 0.001]. Importantly, at very low alcohol consumption levels, there was a substantial association between alcohol and increased AF risk. Even an average 3 g/day intake was closely correlated with the risk of AF (HR 1.04, 95% CI 1.02-1.05). Adjustment for other AF risk factors has not substantially attenuated this relationship. It is important to remember, while not mentioned in the manuscript, that the absolute risk of AF was likely low in participants who drank low to moderate amounts of alcohol.



The authors found a J-shaped association between alcohol intake and heart failure events, with the lowest risk reported at alcohol levels of up to 20 g per day. The relationship between alcohol- and time-dependent heart failure (HF) was not important when evaluating the intermediate function of incident heart failure in developing AF from alcohol intake. Finally, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-I (hsTnI) were weakly associated with alcohol intake and the association between alcohol and AF for these biomarkers was not attenuated.



There are some strengths in the current study 10. Harmonization of the outcome and covariates across five cohorts allowed the authors to conduct standardized studies with very broad sample size and great power to define important associations between alcohol intake and AF, including the lower alcohol consumption range where the probability of AF incident is expected to be minimal. This research, therefore, offers strong evidence that even very low alcohol levels (i.e. < 1 drink per day) remain substantially correlated with an increased risk of new-onset AF.



There are drawbacks to the Csengeri et al.10 analysis. First, from hospitalization results, AF episodes were not adjudicated and relied on the international classification of diseases (ICD codes), which may have contributed to bias in misclassification. In addition, AF instances that did not result in hospital presentation or were listed on death certificates may not have been reported. Second, the link between binge drinking and incident AF could not be investigated in this review. Third, absolute risks of AF associated with low levels of alcohol intake were not reported in the study. This important problem must also be taken into account when considering the potentially beneficial associations with other cardiovascular outcomes of moderate alcohol intake.11-14 Finally, the research was not intended to shed more light on the mechanisms that link habitual alcohol consumption and AF production. Although the authors explored the potential role of NT-proBNP and hsTnI in this relationship, only a minority of patients had biomarker data available, and only at baseline. The effects of alcohol on atrial electrophysiology are likely to rely on many variables, including changes in atrial repolarization, vagal sound, and direct myocardial injury and fibrosis.9 More studies are required to investigate how alcohol affects atrial electrophysiology across these possible pathways.



In conclusion, the current Article10 makes a significant contribution to our understanding of the relationship between alcohol intake and AF incidence, especially with the lower alcohol consumption continuum. There was a substantial association between alcohol and AF, and even small amounts of alcohol were associated with an increased, albeit small, risk of AF incidence. Together with a recent randomized study showing that a decrease in alcohol intake resulted in a decrease in AF recurrence,15 these data indicate that reducing alcohol intake may be relevant for AF prevention and management. Importantly, any decrease in low-to-moderate alcohol consumption to potentially prevent AF needs to be balanced with the potentially beneficial association of low amounts of alcohol with other cardiovascular findings (Graphical abstract).11-14 More research is needed for the net clinical advantage of consuming low amounts of alcohol, preferably in adequately powered randomized studies. Until then, each person has to make their own best-educated decision as to whether it is worthwhile and healthy to consume up to 1 alcoholic drink per day.

Jason G. Andrade, MD from Vancouver Costal Health and L’Institut de Cardiologie de Montréal discusses Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation.


Instract
HINTERGROUNDS
Until catheter ablation is considered in patients with atrial fibrillation, guidelines prescribe a trial of one or more antiarrhythmic medicines. The first-line ablation, however, may be more effective in preserving sinus rhythm.



FOR METHODS
303 patients with symptomatic, paroxysmal, untreated atrial fibrillation were randomly assigned to undergo cryothermia balloon catheter ablation or receive antiarrhythmic drug therapy for initial rhythm regulation. To detect atrial tachyarrhythmia, all the patients obtained an implantable cardiac monitoring unit. The time for follow-up was 12 months. The first confirmed recurrence of any atrial tachyarrhythmia (atrial fibrillation, atrial flutter, or atrial tachycardia) between 91 and 365 days after catheter ablation or antiarrhythmic drug onset was the primary endpoint. Independence from symptomatic arrhythmia, the stress of atrial fibrillation and quality of life were the secondary endpoints.



OUTCOMES
At 1 year, 66 of 154 patients (42.9%) assigned to receive ablation, and 101 of 149 patients (67.8%) assigned to receive antiarrhythmic drugs (hazard ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66; P<0.001) had a recurrence of atrial tachyarrhythmia. In 11.0 percent of the patients who underwent ablation and in 26.2 percent of those who administered antiarrhythmic medications, symptomatic atrial tachyarrhythmia recurred (hazard ratio, 0.39; 95 percent CI, 0.22 to 0.68). The median percentage of atrial fibrillation duration was 0 percent with ablation (interquartile range, 0 to 0.08) and 0.13 percent with antiarrhythmic drugs (interquartile range, 0 to 1.60). Five patients (3.2 percent) who underwent ablation and six patients (4.0 percent) who received antiarrhythmic drugs reported severe adverse events.



CONCLUSIONS
There was a substantially lower rate of atrial fibrillation recurrence with catheter cryoballoon ablation in patients undergoing initial care for symptomatic, paroxysmal atrial fibrillation than with antiarrhythmic drug therapy, as measured by continuous cardiac rhythm monitoring. (Funded by Canada's Cardiac Arrhythmia Network and others; the number of EARLY-AF ClinicalTrials.gov, NCT0282597.)