scholarly journals Clinical factors associated with baseline history of atrial fibrillation and subsequent clinical outcomes following initial implantable cardioverter‐defibrillator placement

2020 ◽  
Vol 43 (6) ◽  
pp. 542-550 ◽  
Author(s):  
Shaun Giancaterino ◽  
Marin Nishimura ◽  
Ulrika Birgersdotter‐Green ◽  
Kurt S. Hoffmayer ◽  
Frederick T. Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Clinical Outcomes ◽  
Clinical Factors ◽  
Cardioverter Defibrillator ◽  
Factors Associated ◽  
History Of

scholarly journals Sacubitril/valsartan reduces atrial fibrillation and supraventricular arrhythmias in patients with HFrEF and remote monitoring: preliminary data from the SAVE THE RHYTHM

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Guerra ◽  
L Pimpini ◽  
M Flori ◽  
D Contadini ◽  
G Stronati ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Remote Monitoring ◽  
Preliminary Data ◽  
Premature Ventricular Contractions ◽  
Cardioverter Defibrillator ◽  
Neprilysin Inhibitor ◽  
History Of ◽  
Secondary Endpoints ◽  
The Mean

Abstract Background Sacubitril/valsartan, the first combined angiotensin receptor-neprilysin inhibitor, has demonstrated a significant benefit compared to angiotensin inhibitor in decreasing ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) shocks in patients with heart failure with reduced ejection fraction (HFrEF). At present, there is no study which evaluates the effect of sacubitril/valsartan on the supraventricular arrhythmic burden in HFrEF patients with an ICD or cardiac resynchronisation therapy-defibrillator (CRT-D) and remote monitoring. Purpose To evaluate the effect of sacubitril/valsartan on the supraventricular arrhythmic burden in HFrEF patients with an ICD or CRTD and remote monitoring. Methods The SAVETHERHYTHM ((SAacubitril Valsartan rEal-world registry evaluating THE arRHYTHMia burden in HFrEF patients with implantable cardioverter defibrillator) is a multicentre, observational, prospective registry enrolling all patients with HFrEF, ICD or CRT-D actively followed through remote monitoring and starting treatment with sacubitril/valsartan. All patients are followed-up for at least one year after sacubitril/valsartan start. The primary endpoint is the mean number of sustained atrial tachycardia or atrial fibrillation (AT/AF) episodes per month. Secondary endpoints include the total burden of AT/AF (defined as the percentage of time in AT/AF per day), the mean number of premature ventricular contractions (PVC) per hour and the percentage of biventricular pacing per day (in patients with CRT-D). All primary and secondary endpoints are collected through remote monitoring. Results At the time of the first ad interim analysis, 60 patients (85.2% male, age 69±10 years) were consecutively enrolled. After treatment with sacubitril/valsartan, patients with at least one episode of AT/AF per month decreased from 32.8% to 21.3% (p=0.015). A significant decrease in number of AT/AF episodes (from 4.3 to 1.2 per year), in AT/AF burden (from 12% to 9%) and in number of PVC (from 83 to 74 per hour) were seen in patients with a previous diagnosis of paroxysmal or persistent AF (n=15; all p<0.05). Patients with permanent AF (n=7) experienced no benefits from sacubitril/valsartan therapy in terms of arrhythmic burden reduction. Patients with no previous history of AF (n=38) showed a decrease in number of AT/AF episodes (from 2.0 to 0.8 per year) and in number of PVC (from 77 to 49 per hour, all p<0.05). No new diagnosis of clinical AF was made after starting treatment with sacubitrl/valsartan, and patients with subclinical AT/AF episodes decreased from 8% to 3%. Conclusions Preliminary data suggest that therapy with sacubitril/valsartan could decrease arrhythmic burden in patients with non-permanent AF and reduce subclinical AT/AF episodes in patients with no history of AF. No positive effect has been noted in patients with permanent AF. Funding Acknowledgement Type of funding source: None

Abstract 1122‐000214: Clinical Factors Associated rTPA Administration in Acute Ischemic Stroke Patients with History of Atrial Fibrillation

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Chase A Rathfoot ◽  
Camron Edressi ◽  
Carolyn B Sanders ◽  
Krista Knisely ◽  
Nicolas Poupore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Medical History ◽  
Clinical Decision Making ◽  
Past Medical History ◽  
Clinical Factors ◽  
Stroke Patients ◽  
Factors Associated ◽  
History Of

Introduction : Previous research into the administration of rTPA therapy in acute ischemic stroke patients has largely focused on the general population, however the comorbid clinical factors held by stroke patients are important factors in clinical decision making. One such comorbid condition is Atrial Fibrillation. The purpose of this study is to determine the clinical factors associated with the administration of rtPA in Acute Ischemic Stroke (AIS) patients specifically with a past medical history of Atrial Fibrillation (AFib). Methods : The data for this analysis was collected at a regional stroke center from January 2010 to June 2016 in Greenville, SC. It was then analyzed retrospectively using a multivariate logistic regression to identify factors significantly associated with the inclusion or exclusion receiving rtPA therapy in the AIS/AFib patient population. This inclusion or exclusion is presented as an Odds Ratio and all data was analyzed using IBM SPSS. Results : A total of 158 patients with Atrial Fibrillation who had Acute Ischemic Strokes were identified. For the 158 patients, the clinical factors associated with receiving rtPA therapy were a Previous TIA event (OR = 12.155, 95% CI, 1.125‐131.294, P < 0.040), the administration of Antihypertensive medication before admission (OR = 7.157, 95% CI, 1.071‐47.837, P < 0.042), the administration of Diabetic medication before admission (OR = 13.058, 95% CI, 2.004‐85.105, P < 0.007), and serum LDL level (OR = 1.023, 95% CI, 1.004‐1.042, P < 0.16). Factors associated with not receiving rtPA therapy included a past medical history of Depression (OR = 0.012, 95% CI, 0.000‐0.401, P < 0.013) or Obesity (OR = 0.131, 95% CI, 0.034‐0.507, P < 0.003), Direct Admission to the Neurology Floor (OR = 0.179, 95% CI, 0.050‐0.639, P < 0.008), serum Lipid level (OR = 0.544, 95% CI, 0.381‐0.984, P < 0.044), and Diastolic Blood Pressure (OR = 0.896, 95% CI, 0.848‐0.946, P < 0.001). Conclusions : The results of this study demonstrate that there are significant associations between several clinical risk factors, patient lab values, and hospital admission factors in the administration of rTPA therapy to AIS patients with a past medical history of Atrial Fibrillation. Further research is recommended to determine the extent and reasoning behind of these associations as well as their impact on the clinical course for AIS/AFib patients.

Prognosis in patients with history of inappropriate implantable cardioverter-defibrillator therapy

2019 ◽  
Vol 53 ◽  
pp. e9-e10
Author(s):  
Eiichi Watanabe ◽  
Okajima Katsunori ◽  
Akira Shimane ◽  
Tomoya Ozawa ◽  
Itsuro Morishima ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Implantable Cardioverter Defibrillator Therapy ◽  
Cardioverter Defibrillator ◽  
History Of

scholarly journals Differences in characteristics and outcomes after endovascular therapy: A single-center analysis of patients with vertebrobasilar occlusion due to underlying intracranial atherosclerosis disease and embolism

2018 ◽  
Vol 25 (3) ◽  
pp. 254-260 ◽  
Author(s):  
Xuelei Zhang ◽  
Gang Luo ◽  
Baixue Jia ◽  
Dapeng Mo ◽  
Ning Ma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Endovascular Therapy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Factors Associated ◽  
Intracranial Atherosclerotic Disease ◽  
History Of ◽  
Group A ◽  
Baseline Characteristics ◽  
Focal Stenosis

Background Therapeutic strategies and outcomes vary with stroke subtypes for patients with acute vertebrobasilar occlusion (VBAO). This study aimed to compare characteristics and outcomes of VBAO due to intracranial atherosclerotic disease (ICAD) and embolisms and identify baseline predictors of ICAD. Methods Patients with VBAO who received endovascular therapy (EVT) were retrospectively analyzed. Participants fulfilling the criteria were classified as the ICAD group (focal stenosis of >70%, or fixed stenosis >50% in addition to either flow and perfusion impairment on angiography or an evident reocclusion tendency) and the embolism group (defined as no evidence of focal significant stenosis after thrombolysis or thrombectomy). Baseline characteristics and outcomes after EVT were compared between the two groups, and logistic regression was performed to explore the factors associated with ICAD. Results Among the 133 patients enrolled, 95 (71.4%) patients were categorized in the ICAD group, and 38 (28.6%) in the embolism group. A history of atrial fibrillation (odds ratio (OR) 0.142; 95% confidence interval (CI) (0.028–0.707), p = 0.017), distal basilar artery occlusion (OR 0.107; 95% CI (0.040–0.289), p < 0.001) and V4 segment occlusion (OR 3.423; 95% CI (1.172–9.999), p = 0.024) were independently associated with ICAD. Patients with VBAO due to ICAD had a lower rate of recanalization (81.1% vs 100%, p = 0.004), but the 90-day good clinical outcome was comparable (41.1% vs 50.0%, p = 0.347). Conclusions The occlusion sites and a history of atrial fibrillation might be helpful in predicting ICAD in patients with VBAO. Patients with ICAD who were treated by EVT had a lower rate of recanalization but comparable 90-day good outcomes.

scholarly journals Incidence of Ventricular Arrhythmias and 1‐Year Predictors of Mortality in Patients Treated With Implantable Cardioverter‐Defibrillator Undergoing Generator Replacement

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Andrea Demarchi ◽  
Stefano Cornara ◽  
Antonio Sanzo ◽  
Simone Savastano ◽  
Barbara Petracci ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Ventricular Arrhythmias ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Generator Replacement

Background When implantable cardioverter defibrillator (ICD) battery is depleted most patients undergo generator replacement (GR) even in the absence of persistent ICD indication. The aim of this study was to assess the incidence of ventricular arrhythmias and the overall prognosis of patients with and without persistent ICD indication undergoing GR. Predictors of 1‐year mortality were also analyzed. Methods and Results Patients with structural heart disease implanted with primary prevention ICD undergoing GR were included. Patients were stratified based on the presence/absence of persistent ICD indication (left ventricular ejection fraction ≤35% at the time of GR and/or history of appropriate ICD therapies during the first generator's life). The study included 371 patients (82% male, 40% with ischemic heart disease). One third of patients (n=121) no longer met ICD indication at the time of GR. During a median follow‐up of 34 months after GR patients without persistent ICD indication showed a significantly lower incidence of appropriate ICD shocks (1.9% versus 16.2%, P <0.001) and ICD therapies. 1‐year mortality was also significantly lower in patients without persistent ICD indication (1% versus 8.3%, P =0.009). At multivariable analysis permanent atrial fibrillation, chronic advanced renal impairment, age >80, and persistent ICD indication were found to be significant predictors of 1‐year mortality. Conclusions Patients without persistent ICD indication at the time of GR show a low incidence of appropriate ICD therapies after GR. Persistent ICD indication, atrial fibrillation, advanced chronic renal disease, and age >80 are significant predictors of 1‐year mortality. Our findings enlighten the need of performing a comprehensive clinical reevaluation of ICD patients at the time of GR.

scholarly journals DIAGNOSIS OF ATRIAL FIBRILLATION IN HEART FAILURE PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR OR CARDIAC RESYNCHRONISATION THERAPY.

2021 ◽  
Author(s):  
Barbara Dominik ◽  
Mitkowski Przemyslaw ◽  
Wojciech Zorawski ◽  
Ilona Kowalik ◽  
Adam Ciesielski
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Resynchronisation Therapy ◽  
Predisposing Factors ◽  
Study Group ◽  
Cardioverter Defibrillator ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

IntroductionImplantable cardioverter defibrillators register various types of arrhythmias. Thus they can be exploited to better identify patients with atrial fibrillation episodes and increase the proportion of patients who may benefit from implementation of pharmacological prophylaxis of thromboembolic events, most of which it turns out are asymptomatic.Material and methodsAssessment of the frequency, symptoms and predisposing factors for the occurrence of atrial fibrillation episodes in patients with implanted ICD (implantable cardioverter defibrillator) and CRT-D (cardiac resynchronisation therapy with defibrillator) based on the analysis of intracardiac electrocardiograms (IEGM) records. The study included 174 consecutive outpatient cases with heart failure, sinus rhythm and Implanted Cardioverter Defibrillator and Cardiac Resynchronisation Therapy with Defibrillator. Control visits with analysis of IEGM records occurred every three months. During mean follow-up of 20 months, 901 visits were carried out. 147 patients had at least one year of follow-up.ResultsAtrial fibrillation episodes in the study group occurred in 54 (31.0%) of patients and 71.4% were asymptomatic. Predisposing factors were: history of paroxysmal atrial fibrillation (37.0% vs 13.3%, p ˂ 0.001), atrioventricular conduction abnormalities (42.6% vs. 20.0%, p = 0.002), intraventricular conduction abnormalities (59.3% vs 40.8%, p = 0.02) and more severe mitral regurgitation (7.4% vs 0.8%, p = 0.04). Chronic renal disease was a risk factor for death in the study group. No stroke occurred during the study.ConclusionsEpisodes of paroxysmal AF in patients with systolic heart failure and implanted cardioverter-defibrillator systems are quite common. The majority of the episodes recorded in the study were asymptomatic.

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