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Antidiabetic drugs for preventing atrial fibrillation: A new revolution?
Type 2 diabetes mellitus (DM) and atrial fibrillation (AF) are 2 of the great epidemics of our time. DM affects an estimated 8.5% of adults in the United States1 and is associated with an increased risk of cardiovascular events, including AF.2 AF in turn affects up to an estimated 12.5% of adults older than 65 years in the United States, decreases quality of life, and increases the risks of heart failure, stroke, and death.3,4 In 2015, the EMPA-REG OUTCOME (BI 10773 [Empagliflozin] Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) randomized controlled trial (RCT), which assessed the sodium glucose c...
Source: Heart Rhythm - April 7, 2021 Category: Cardiology Authors: William F. McIntyre, Jeff S. Healey Tags: Editorial Commentary Source Type: research

Who is at risk of atrial fibrillation?
Atrial fibrillation (AF) is a common cause of stroke, with prevalence increasing alongside the aging of our population [1]. Increasing age, hypertension, obesity, heart failure, sleep apnea, diabetes, coronary disease, chronic kidney disease and smoking account for much of the global risk of AF [2 3]. Incident AF is also predicted by both rare and common genetic variants, many of which encode for cardiac structural and electrical proteins, as well as by more complex heritable traits such as height, obesity and race [4-6].
Source: Heart Rhythm - February 24, 2021 Category: Cardiology Authors: Jeff S. Healey, Jason D. Roberts, Thalia S. Field Source Type: research

Connexin45 (GJC1) loss-of-function mutation contributes to familial atrial fibrillation and conduction disease
Atrial fibrillation (AF) represents the most common clinical cardiac arrhythmia and substantially increases the risk for cerebral stroke, heart failure and death. Although causative genes for AF have been identified, the genetic determinants for AF remain largely unclear.
Source: Heart Rhythm - January 8, 2021 Category: Cardiology Authors: Ruo-Gu Li, Ying-Jia Xu, Willy G. Ye, Yan-Jie Li, Honghong Chen, Xing-Biao Qiu, Yi-Qing Yang, Donglin Bai Source Type: research

EP News Clinical October 2020
Kirchhof and colleagues et al. (N Engl J Med. 2020;383(14):1305-1316 PMID: 32865375) randomized patients with early atrial fibrillation (AF) to rhythm control or usual care. The first primary outcome was a composite of cardiovascular death, stroke, or hospitalization with heart failure heart failure or coronary syndrome. The second primary outcome was the number of nights spent in the hospital. The trial was stopped for efficacy after a median of 5.1 years of follow-up of 2789 patients. A first-primary-outcome event occurred in 249 patients with rhythm control (3.9/100 person-years) and in 316 patients with usual care (5.0...
Source: Heart Rhythm - October 10, 2020 Category: Cardiology Authors: N A Mark Estes Source Type: research

EP News: Clinical
Kirchhof et  al (N Engl J Med 2020;383:1305, PMID 32865375) randomized patients with early atrial fibrillation (AF) to rhythm control or usual care. The first primary outcome was a composite of cardiovascular death, stroke, or hospitalization with heart failure or coronary syndrome. The second primary outcome was the number of nights spent in the hospital. The trial was stopped for efficacy after a median of 5.1 years of follow-up of 2789 patients. A first primary outcome event occurred in 249 patients with rhythm control (3.9/100 person-years) and in 316 patients with usual care (5.0/100 person-years) ( P = .005).
Source: Heart Rhythm - October 10, 2020 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

HRS white paper on atrial fibrillation centers of excellence: Rationale, considerations, and goals
Atrial fibrillation (AF) remains an important global problem.1 –3 AF continues to lead to poor health outcomes, including reduced quality of life (QoL) and increased risks of heart failure, cognitive impairment, stroke, and death.4,5 Moreover, it has a significant financial impact on health care systems and their associated economies.6–8 In order to improve care for patients with AF, there is an increasing recognition that current care must evolve. Health care organizations should move from a system of siloed outpatient and inpatient clinicians and health care facilities to a system of integrated, coordinated, and pati...
Source: Heart Rhythm - May 4, 2020 Category: Cardiology Authors: Jonathan P. Piccini, James Allred, T. Jared Bunch, Thomas F. Deering, Luigi Di Biase, Ayman A. Hussein, William R. Lewis, Suneet Mittal, Andrea Natale, Jose Osorio, Douglas L. Packer, Christian Ruff, Andrea M. Russo, Prashanthan Sanders, Amber Seiler, Dav Source Type: research

Rationale, considerations, and goals for atrial fibrillation centers of excellence: A Heart Rhythm Society perspective
Atrial fibrillation (AF) remains an important global problem.1 –3 AF continues to lead to poor health outcomes, including reduced quality of life (QoL) and increased risks of heart failure, cognitive impairment, stroke, and death.4,5 Moreover, it has a significant financial impact on health care systems and their associated economies.6–8 In order to improve care for patients with AF, there is an increasing recognition that current care must evolve. Health care organizations should move from a system of siloed outpatient and inpatient clinicians and health care facilities to a system of integrated, coordinated, and pati...
Source: Heart Rhythm - May 4, 2020 Category: Cardiology Authors: Jonathan P. Piccini, James Allred, T. Jared Bunch, Thomas F. Deering, Luigi Di Biase, Ayman A. Hussein, William R. Lewis, Suneet Mittal, Andrea Natale, Jose Osorio, Douglas L. Packer, Christian Ruff, Andrea M. Russo, Prashanthan Sanders, Amber Seiler, Dav Source Type: research

EP News: Clinical
Diederichsen et  al (J Am Coll Cardiol 2019;74:2771, PMID 31779791) evaluated the natural history of subclinical atrial fibrillation (AF) in at-risk patients from the general population. The authors studied 590 individuals ≥70 years of age with ≥1 of hypertension, diabetes, previous stroke, or heart failure; w ithout a history of AF; and with long-term implantable loop recorder monitoring. End points included AF burden, AF progression, symptoms, and heart rate during AF. In a total of 685,445 monitoring days, AF lasting ≥6 minutes was detected in 205 participants (35%).
Source: Heart Rhythm - January 20, 2020 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

Atrial Ca2+/calmodulin-dependent protein kinase II: A druggable master switch of atrial fibrillation-associated atrial remodeling?
Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased morbidity and mortality, with heart failure (HF) and thromboembolism including stroke being the major consequences.1 Thus, stroke prevention with oral anticoagulants is crucial, but highly challenging, for AF management in many patients.2,3 Although our understanding of the underlying molecular mechanisms promoting AF increased substantially over the years, contemporary approaches using drugs are only moderately effective and have substantial side effects, including proarrhythmia.
Source: Heart Rhythm - February 5, 2019 Category: Cardiology Authors: Dobromir Dobrev Tags: Editorial Commentary Source Type: research

Harmonized Outcome Measures for Use in Atrial Fibrillation Patient Registries and Clinical Practice
Atrial fibrillation (AF) affects an estimated 33 million people worldwide, leading to increased mortality and an increased risk of heart failure and stroke. Many AF patient registries exist, but the ability to link and compare data across registries is hindered by differences in the outcome measures collected by each registry and a lack of harmonization.
Source: Heart Rhythm - November 15, 2018 Category: Cardiology Authors: Hugh Calkins, Richard E. Gliklich, Michelle B. Leavy, Jonathan P. Piccini, Jonathan C. Hsu, Sanghamitra Mohanty, William Lewis, Saman Nazarian, Mintu P. Turakhia Source Type: research

Accessory Pulmonary Vein Insertion into the Left Atrial Appendage Revealed During Intended Interventional LAA Occlusion
A 64-year-old male with paroxysmal atrial fibrillation and a recent stroke presented with internal carotid artery re-stenosis after prior angioplasty. Cardiovascular risk factors included arterial hypertension, hyperlipidemia, obesity, positive family history, heart failure, and active smoking. Due to high risk of cerebral ischemia as well as periinterventional bleeding complications, the patient was scheduled for interventional left atrial appendage (LAA) closure prior to carotid artery surgery.
Source: Heart Rhythm - July 30, 2018 Category: Cardiology Authors: Octavian Maniuc, Jonas M üntze, Maria Moritz, Peter Nordbeck Source Type: research

Seeing is Believing: The Importance of Continuous Monitoring to Unmask the Real-World Atrial Fibrillation Recurrence after Ablation
Atrial fibrillation (AF) is a common arrhythmia encountered in clinical practice that contribute to hemodynamic abnormalities, thromboembolic events and hospitalizations.1 The prevalence of AF is around 1% in the general population, substantially increases with age and is estimated to reach 4% in 2050.2, 3 Compared with patients without AF, patients with AF has an increased risk of dementia (hazard ratio [HR]=1.56), myocardial infarction (HR=1.62), sudden cardiac death (HR=1.83), mortality (HR=2.61), heart failure (HR=3.31) and ischemic stroke (HR=3.34).
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Ting-Yung Chang, Chin-Yu Lin, Shih-Ann Chen Source Type: research

Atrial Fibrillation and Cognitive Decline —Another Piece for a Big Puzzle
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and its prevalence is increasing over time.1, 2 AF is associated with an increased risk of stroke,3 heart failure,4 and death.5-7 In recent years, evidence has emerged to indicate that AF is associated with another growing public health problem: cognitive impairment and dementia.8 Although the evidence is compelling, existing studies suffer from several limitations such as reliance on the Mini-Mental State Examination, cross-sectional design, and lack of attention to domain-specific changes.
Source: Heart Rhythm - October 10, 2017 Category: Cardiology Authors: Lin Y. Chen, Win-Kuang Shen Source Type: research

Atrial fibrillation and cognitive decline: Another piece for a big puzzle
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and its prevalence is increasing over time.1,2 AF is associated with an increased risk of stroke,3 heart failure,4 and death.5 –7 In recent years, evidence has emerged to indicate that AF is associated with another growing public health problem: cognitive impairment and dementia.8 Although the evidence is compelling, existing studies suffer from several limitations, such as reliance on the Mini-Mental State Examination, c ross-sectional design, and lack of attention to domain-specific changes.
Source: Heart Rhythm - October 10, 2017 Category: Cardiology Authors: Lin Y. Chen, Win-Kuang Shen Tags: Editorial Commentary Source Type: research

Utility and Limitations of Long-Term Monitoring of Atrial Fibrillation Using an Implantable Loop Recorder
Atrial fibrillation (AF) is the most common cardiac arrhythmia diagnosed and treated in the world. The treatment of patients ’ symptoms as well as the prevention of stroke and heart failure is dependent on accurate detection and characterization of AF. A variety of electrocardiographic (ECG) monitoring techniques are being used for these purposes. However, these intermittent ECG monitoring techniques have been shown to under diagnose AF events, while having limited ability to characterize AF burden and density.
Source: Heart Rhythm - September 13, 2017 Category: Cardiology Authors: Randall Lee, Suneet Mittal Source Type: research

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