European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

Nielsen, Jens Cosedis; Lin, Yenn‐Jiang; Figueiredo, Márcio Jansen de Oliveira; Shamloo, Alireza Sepehri; Alfie, Alberto; Bovéda, Serge; Dagres, Nikolaos; Toro, Darío Di; Eckhardt, Lee L.; Ellenbogen, Kenneth A.; Hardy, Carina; Ikeda, Takanori; Jaswal, Aparna; Kaufman, Elizabeth S.; Krahn, Andrew D.; Kusano, Kengo; Kutyifa, Valentina; Lim, H.; Lip, Gregory Y.H.; Nava-Townsend, Santiago; Pak, Hui Nam; Rodríguez-Diez, Gerardo; Sauer, William H.; Saxena, Anil; Svendsen, Jesper Hastrup; Vanegas, Diego; Vaseghi, Marmar; Wilde, Arthur A.M.; Bunch, T. Jared; Buxton, Alfred E.; Calvimontes, Gonzalo; Chao, Tze‐Fan; Eckardt, Lars; Estner, Heidi; Gillis, Anne M.; Isa, Rodrigo; Kautzner, Josef; Moss, Joshua D.; Nam, Gi-Byung; Olshansky, Brian; Molano, Luis Fernando Pava; Pimentel, Maurício; Prabhu, Mukund A.; Tzou, Wendy S.; Sommer, Philipp; Swampillai, J.; Vidal, Alejandro; Deneke, Thomas; Hindricks, Gerhard; Leclercq, Christophe

doi:10.1016/j.hrthm.2020.05.004

Cited by 23 publications

(20 citation statements)

References 541 publications

(486 reference statements)

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“…Meanwhile, decreased GLAS and LA strain rates were observed in the AF patients comparing with the age-matched control individuals. LA stiffness index, measured in an invasive method, is considered as a novel index to assess LA dysfunction (15,27,38). The current study measured the LA stiffness index in a non-invasive manner based on strain imaging and systematically described its dynamic changes in AF and control patients in the context of aging.…”

Section: Discussionmentioning

confidence: 99%

Impaired Left Atrial Performance Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment

Lin¹,

Chen²,

Li³

et al. 2021

Front. Cardiovasc. Med.

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Background: Atrial fibrillation (AF) is increasingly considered an age-related degenerative disease, whose process is associated with the development of impaired left atrial (LA) performance. However, the subtle dynamic changes of LA performance in AF during aging have yet to be fully elucidated. Atrial fibrosis is a key substrate for the development of AF, but the progression of fibrosis during aging and its relationship with LA dysfunction need to be further explored.Methods: A total of 132 control individuals and 117 persistent AF patients were prospectively studied. Subjects were further stratified into three age groups (age group 1: younger than 65 years, age group 2: between 65 and 79 years old, and age group 3: older than 80 years). The two-dimensional speckle tracking imaging was carried out for analyzing the alterations in LA function underlying LA remodeling, whereas electroanatomic mapping was performed to investigate LA fibrosis burden. In animal study, aged mice and young mice served as research subjects. Echocardiography and histological staining were used to assess LA performance and fibrosis burden, respectively.Results: Echocardiography showed progressive increases in LA dimension and LA stiffness index, and progressive decreases in LA global longitudinal strain and LA strain rates with advancing age in both AF and control cohorts, which was more prominent in AF cohort. Electroanatomic mapping showed progressive decrease in mean LA voltage and progressive increases in LA surface area, low-voltage area %, and LA volume with advancing age, whereas more significant alterations were observed in AF patients. Moreover, left atrial global longitudinal strain was positively correlated with mean LA voltage, whereas LA stiffness index was negatively related to mean LA voltage. In animal experiment, increased LA size and pulmonary artery dimension as well as longer P-wave duration and more prominent LA fibrosis were found in aged mice.Conclusions: This study provides new evidence of subtle changes in structure and performance of left atrium and their association with atrial fibrosis in both AF and non-AF subjects during physiological aging. In addition, our study also provides normal values for LA structure and performance in both AF and non-AF conditions during aging. These measurements may provide an early marker for onset of AF and LA adverse remodeling.

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Section: Discussionmentioning

confidence: 99%

Impaired Left Atrial Performance Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment

Lin¹,

Chen²,

Li³

et al. 2021

Front. Cardiovasc. Med.

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“…Although atrial flutters and atrial fibrillations are common in older patients with sizeable ASDs [1], VT/VF storm after the correction of ASD is rare. It is often an incidental finding after correction of tetralogy of Fallot (TOF) and left ventricular outflow tract defects [10,11]. To the best of our knowledge, this is the first case in the literature.…”

Section: Discussionmentioning

confidence: 92%

Electrical storm after correction of an uncomplicated congenital atrial septal defect in an adult: a case report

Liang

Hei

Guan

2021

BMC Cardiovasc Disord

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Background There is a paucity of published literature describing electrical storm after the correction of uncomplicated atrial septal defect (ASD) in an adult. Case presentation We present a 49-year-old woman with a congenital ASD combined with mild tricuspid regurgitation who denied any history of arrhythmia or other medical history. She suffered from electrical storm (≥ 3 episodes of ventricular tachycardias or ventricular fibrillations) in the early stage after ASD repair with combined tricuspid valvuloplasty. During electrical storm, her electrolytes were within normal ranges and no ischemic electrocardiographic changes were detected, which suggested that retained air embolism or acute coronary thrombosis were unlikely. Additionally, echocardiographic findings and her central venous pressure (5–8 mmHg during the interval between attacks) failed to support the diagnosis of pericardial tamponade. After a thorough discussion, the surgeons conducted an emergent re-exploration and repeated closure of the ASD with combined DeVega's annuloplasty. Eventually, the patient recovered uneventfully, without reoccurring arrhythmias during follow-up. Although we fail to determine the definite cause, we speculate that the causes probably are iatrogenic injury of the conduction system due to a rare anatomic variation, poor intraoperative protection, latent coronary distortion during tricuspid valvuloplasty, or idiopathic or secondary abnormalities of the conduction system. Conclusions For most surgeons, performing re-exploration without a known etiology is a difficult decision to make. This case illustrates that re-exploration could be an option when electrical storm occurs in the early stage postoperatively. Nevertheless, surgeons should assess the benefit-risk ratio when taking this unconventional measure.

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“…Third, this was a retrospective cohort study and suffered from inadequacy and even loss of patients' medical records. Additionally, the influence of unknown confounding factors including European Heart Rhythm Association (EHRA) symptom classification as a symptom severity of AF [41], should not be disregarded. Some factors such as implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) were also not included in this dataset, as those treatments might influence clinical outcomes of older patients with HF and AF.…”

Section: Limitationsmentioning

confidence: 99%

Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

Son

Kim

Won

2021

IJERPH

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Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

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European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

Abstract: The categorization for our consensus document should not be considered directly similar to the one used for official society guideline recommendations, which apply a classification (I-III) and level of evidence (A, B, and C) to recommendations.

Cited by 23 publications

References 541 publications

Impaired Left Atrial Performance Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment

Impaired Left Atrial Performance Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment

Electrical storm after correction of an uncomplicated congenital atrial septal defect in an adult: a case report

Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

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