Frailty in patients affected by atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia among elderly people. However its relationship with the frailty syndrome is not well understood. It has been suggested that AF may be a marker of frailty in elderly, leading to the loss of independence in performing of routine daily activities. The aim of this study is to investigate the association between AF, frailty and cognitive decline in elderly patients. A total of 140 hospitalized patients, mean age 79.2 ± 7.4 years were enrolled in our study. Of these, 70 were affected by parossistic, persistent or permanent AF and 70, matched for age and gender, were concurrently studied as control. Cognitive impairment and frailty state has been evaluated in each patient using the Mini Mental State Examination (MMSE) and a standard score of accumulated deficits for constructing a frailty index. We have observed a higher number of frail patients in the AF group as compared with controls (88.6% vs 67.1%, p = 0.004). The group of patients with frailty syndrome had MMSE score significantly lower than those of the nonfrail group (16.8 ± 9.8 vs 22.2 ± 6.4, p = 0.005). Furthermore, a negative correlation between MMSE score and frailty index (rho = −0.517, p < 0.001) has been shown. Our study points out a statistical association between frailty and AF. Atrial fibrillation could worsen the frailty state, but perspective studies are necessary to confirm an increased mortality in patients affected by AF and frailty.     

Short-term functional outcome of ischemic stroke in the elderly: A comparative study of atrial fibrillation and non-atrial fibrillation patients

The purpose of this study was to evaluate whether atrial fibrillation affects the short-term functional outcome of elderly patients with ischemic stroke, undergoing post-acute in-hospital rehabilitation. We studied 919 consecutive patients admitted for ischemic stroke rehabilitation, out of whom 19.6% were diagnosed with atrial fibrillation. The Functional outcome of atrial fibrillation (AF) and non-atrial fibrillation (Non-AF) patients were assessed by the Functional Independence Measurement scale (FIM™) at admission and discharge. Data were analyzed by t-test, Chi-square test and by multiple linear regression analysis. Compared with Non-AF, patients with AF were slightly older (p < 0.001), and had lower Mini-Mental State Examination (MMSE) scores (p = 0.001). Discharge total FIM scores were significantly higher in Non-AF compared with AF patients (84.34 ± 29.44 vs. 79.02 ± 30.68, p = 0.031). However, total and motor FIM gains at discharge were similar in the two groups. A multiple linear regression analysis showed that age (p < 0.001), admission total and motor FIM (p < 0.001) and MMSE score (p < 0.001) emerged as the only independent predictors of total, motor and gain FIM scores at discharge. AF was not predictive, whatsoever, of adverse FIM scores (total, motor, gain) at discharge (β = −0.024, p = 0.303; β = −0.019, p = −0.455 and β = −0.04, p = 0.303, respectively). The finding suggests that Non-AF ischemic stroke elderly show higher total discharge FIM scores, compared with AF patients. However, both groups achieve similar FIM gains during rehabilitation period. AF should not be considered as adversely affecting the short-term rehabilitation process of such patients.     

Analysis of atrial fibrillatory rate during spontaneous episodes of atrial fibrillation in humans using implantable loop recorder electrocardiogram

Atrial fibrillatory rate (AFR) can predict outcome of interventions for atrial fibrillation (AF); however, AFR behavior at AF onset in humans is poorly described. We studied AFR during spontaneous AF episodes in patients with lone paroxysmal AF who received implantable loop recorders and had AF episodes of 1 hour or more recorded (n = 4). Mean AFR per minute was assessed from continuous implantable loop recorder electrocardiogram using spatiotemporal QRST cancellation and time-frequency analysis. Atrial fibrillatory rate increased from 290 ± 20 to 326 ± 39 fibrillations per minute during the first 3 hours (P < .05) and reached plateau then. Atrial fibrillatory rate beyond the initial 3 hours can, therefore, be considered stable and may be evaluated for prediction of intervention effect.     

Admission Norton scale scores (ANSS) correlate with rehabilitation outcome and length in elderly patients following hip arthroplasty

We sought to determine if ANSS used for evaluating pressure sore risk also correlate with rehabilitation outcome and length following hip arthroplasty in elderly patients. This was a retrospective study conducted in a geriatric rehabilitation department during 2009. ANSS, admission albumin serum levels, mini-mental state examination (MMSE) scores, discharge walking functional independence measure (FIM) scores, and rehabilitation length were studied. The final cohort included 201 patients: 160 (79.6%) females and 41 (20.4%) males. Mean age was 82.7 ± 6.5 years. Mean discharge walking FIM score was 5.2 ± 0.9. Mean length of rehabilitation was 19.9 ± 7.8 days. ANSS correlated with discharge walking FIM scores (r = 0.28; p = 0.002), and with length of rehabilitation (r = −0.22; p = 0.014) following adjustment for age, admission albumin serum levels, and MMSE scores. Linear regression analysis showed that ANSS were associated with the discharge walking FIM scores (p < 0.0001) and rehabilitation length (p = 0.027) independent of age, admission albumin serum levels, gender, type of hip surgery, and the appearance of pressure sores. We conclude that the Norton scoring system may be used for predicting the outcome and the duration of rehabilitation in elderly patients following hip arthroplasty.     

Distinct contractile and molecular differences between two goat models of atrial dysfunction: AV block-induced atrial dilatation and atrial fibrillation

Atrial dilatation is an independent risk factor for thromboembolism in patients with and without atrial fibrillation (AF). In many patients, atrial dilatation goes along with depressed contractile function of the dilated atria. While some mechanisms causing atrial contractile dysfunction in fibrillating atria have been addressed previously, the cellular and molecular mechanisms of atrial contractile remodeling in dilated atria are unknown. This study characterized in vivo atrial contractile function in a goat model of atrial dilatation and compared it to a goat model of AF. Differences in the underlying mechanisms were elucidated by studying contractile function, electrophysiology and sarcoplasmic reticulum (SR) Ca²⁺ load in atrial muscle bundles and by analyzing expression and phosphorylation levels of key Ca²⁺-handling proteins, myofilaments and the expression and activity of their upstream regulators. In 7 chronically instrumented, awake goats atrial contractile dysfunction was monitored during 3 weeks of progressive atrial dilatation after AV-node ablation (AV block goats (AVB)). In open chest experiments atrial work index (AWI) and refractoriness were measured (10 goats with AVB, 5 goats with ten days of AF induced by repetitive atrial burst pacing (AF), 10 controls). Isometric force of contraction (FC), transmembrane action potentials (APs) and rapid cooling contractures (RCC, a measure of SR Ca²⁺ load) were studied in right atrial muscle bundles. Total and phosphorylated Ca²⁺-handling and myofilament protein levels were quantified by Western blot. In AVB goats, atrial size increased by 18% (from 26.6 ± 4.4 to 31.6 ± 5.5 mm, n = 7 p < 0.01) while atrial fractional shortening (AFS) decreased (from 18.4 ± 1.7 to 12.8 ± 4.0% at 400 ms, n = 7, p < 0.01). In open chest experiments, AWI was reduced in AVB and in AF goats compared to controls (at 400 ms: 8.4 ±0.9, n = 7, and 3.2 ± 1.8, n = 5, vs 18.9 ± 5.3 mm×mmHg, n = 7, respectively, p < 0.05 vs control). FC of isolated right atrial muscle bundles was reduced in AVB (n = 8) and in AF (n = 5) goats compared to controls (n = 9) (at 2 Hz: 2.3 ± 0.5 and 0.7 ± 0.2 vs 5.5 ± 1.0 mN/mm², respectively, p < 0.05). APs were shorter in AF, but unchanged in AVB goats. RCCs were reduced in AVB and AF versus control (AVB, 3.4 ± 0.5 and AF, 4.1 ± 1.4 vs 12.2 ± 3.2 mN/mm², p < 0.05). Protein levels of protein kinase A (PKA) phosphorylated phospholamban (PLB) were reduced in AVB (n = 8) and AF (n = 8) vs control (n = 7) by 37.9 ± 12.4% and 29.7 ± 10.1%, respectively (p < 0.01), whereas calmodulin-dependent protein kinase II (CaMKII) phosphorylated ryanodine channels (RyR2) were increased by 166 ± 55% in AVB (n = 8) and by 146 ± 56% in AF (n = 8) goats (p < 0.01). PKA-phosphorylated myosin-binding protein-C and troponin-I were reduced exclusively in AVB goat atria (by 75 ± 10% and 55 ± 15%, respectively, n = 8, p < 0.05). Atrial dilatation developing during slow ventricular rhythm after complete AV block as well as AF-induced remodeling are associated with atrial contractile dysfunction. Both AVB and AF goat atria show decreased SR Ca²⁺ load, likely caused by PLB dephosphorylation and RYR2 hyperphosphorylation. While shorter APs further compromise contractility in AF goat atria, reduced myofilament phosphorylation may impair contractility in AVB goat atria. Thus, atrial hypocontractility appears to have distinct molecular contributors in different types of atrial remodeling.     

Bladder management and the functional outcome of elderly ischemic stroke patients

The purpose of this study was to investigate how bladder management, rather than urinary incontinence, may affect the functional outcome of ischemic stroke patients. We studied 919 consecutive patients admitted for ischemic stroke rehabilitation. Level of bladder management was determined by Functional Independence Measurement (FIM TM) sub-scale scores relevant to bladder control. FIM scores less than 5 points was determined as low-bladder management score (Low-BMS) while FIM scores greater than 5 was determined as high-bladder management score (High-BMS). Data were analyzed by t-test, Pearson correlation, and chi-square test as well as by multiple linear regression analysis. There were 594 low-bladder score patients (Low-BMS) and 325 high-bladder score patients (High-BMS), at admission. Compared with High-BMS, Low-BMS patients were slightly older (p = 0.002), had longer rehabilitation stays (p < 0.001) and lower mini-mental state examination (MMSE) scores (p < 0.001). Total FIM at admission and discharge were lower in Low-BMS, yet their total FIM gain upon discharge was higher, compared with High-BMS (19.5 ± 16.46 vs. 17.59 ± 12.55, p = 0.07). Multiple linear regression analyses showed that total FIM at discharge was inversely associated with Low-BMS at admission (beta = −0.407; p < 0.001) and age (beta = −0.127; p < 0.001). A high MMSE score (beta = 0.334; p < 0.001) emerged as predicting higher total FIM scores upon discharge. Low-BMS was independently predictive for total FIM gain at discharge (beta = 0.166; p < 0.001). The findings suggest that Low-BMS should be held as adversely affecting the rehabilitation outcomes of elderly stroke patients. However, Low-BMS patients do obtain significant gains and should not be deprived of rehabilitation.     

Long duration of radiofrequency energy delivery is an independent predictor of clinical recurrence after catheter ablation of atrial fibrillation: Over 500 cases experience

Background

Although radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is an effective rhythm control strategy, there is a substantial amount of recurrence. We explored the predictors of AF recurrence after RFCA with consistent ablation strategy.

Methods and results

This study included 575 patients (77% male, 56 ± 11 years old) with AF (65.7% paroxysmal AF [PAF], 34.3% persistent AF [PeAF]) who underwent RFCA. We evaluated the clinical, serological, and electrophysiological parameters thereof. Results: 1. During 15 ± 7 months of follow-up, patients who experienced AF recurrence (21.8%) were older (58 ± 10 vs. 55 ± 11 years old, p = 0.019) and more likely to have PeAF (50.4% vs. 29.4%, p < 0.001) and greater LA volume (137.3 ± 49.1 vs. 116.6 ± 37.9 mL, p < 0.001). 2. In patients with clinical recurrence after RFCA, both ablation time (110.1 ± 43.8 vs. 92.3 ± 30.1 min, p < 0.001) and procedure time (222.7 ± 79.6 vs. 205.8 ± 58.8 min, p < 0.001) were prolonged, and the early recurrence rate within 3 months of the procedure was higher (63.0% vs. 26.4%, p < 0.001) than those without clinical recurrence. 3. In logistic regression analysis, LA volume (OR 1.008, CI 1.001–1.014), ablation time (per quartile, OR 1.380, CI 1.031–1.847), and early recurrence (OR 3.858, CI 2.420–6.150) were independent risk factors for recurrence of AF after RFCA.

Conclusion

In this single center consistent study of over 500 cases of AF ablation, patients with AF recurrence had a larger atrium, longer ablation time, and a higher chance of early recurrence than those remained in sinus rhythm. Inadvertent, long duration of ablation was an independent predictor of worse clinical outcomes after catheter ablation of AF.     

The clinical outcome of elderly patients with acute pancreatitis is not different in spite of the different etiologies and severity

The aim of this study was to investigate the overall clinical characteristics of elderly patients with acute pancreatitis. We retrospectively evaluated 227 consecutively enrolled patients who were admitted with acute pancreatitis. The clinical features, the radiological and laboratory data and the clinical outcome were analyzed according to the age groups (≥65 years vs. <65 years). Among the 227 enrolled patients with acute pancreatitis, there were 85 elderly patients and 142 non-elderly. The mean age of the elderly patients was 72.3 ± 5.5 years and that of the non-elderly was 44.7 ± 11.7 (p < 0.001). For the elderly patients, biliary pancreatitis was the most common cause (56.5%), but alcoholic pancreatitis was most common in the non-elderly patients (45.8%). Although the computed tomography (CT) severity index was significantly higher for the non-elderly patients (p < 0.001), the acute physiology and chronic health evaluation (APACHE II) score was significantly higher for the elderly than that for the non-elderly (p < 0.001). However, the duration of the hospital stay (10.3 ± 9.6 days vs. 11.9 ± 10.1 days, p = 0.619) and mortality (3.5% vs. 0.7%, p = 0.148) were not different between the age-groups. In our study, chronological age had no significant influence on the clinical outcome in spite of the different etiologies and severity of acute pancreatitis.     

A proposal for a new scoring system in the prediction of catheter ablation outcomes: Promising results from the Turkish Cryoablation Registry

Background

Although cryoballoon based catheter ablation is an effective therapeutic option in atrial fibrillation (AF), a significant amount of patients failed to remain in sinus rhythm at long term follow-up. Appropriate selection of patients for catheter ablation reduces unnecessary interventions and prevents complications related with catheter ablation. The purpose of our study is to propose a new scoring system in the prediction of recurrence after AF ablation with cryoballoon.

Method

A total of 236 patients (54% male, age 54.6 ± 10.45 years and 79.6% paroxysmal) with symptomatic AF underwent an index cryoablation. The first 3 months after AF ablation is defined as blanking period. Predictors of AF recurrence after cryoablation were analyzed with multivariate Cox regression analysis. BASE-AF₂ score [acronym stands for Body mass index > 28 kg/m² (1); Atrial dilatation > 40 mm (1); current Smoking (1); Early recurrence (1); duration of AF history > 6 years (1) and non-paroxysmal type (1) of AF] is identified by the total number of significant predictors of recurrence in each patient (range = 0–6).

Results

At median 20 (range: 12–30) months follow-up, 74.5% of the patients were free from AF recurrence. Of these patients, 64 (27.1%) patients had a BASE-AF₂ score of ≥ 3. Patients with AF recurrence had a higher mean BASE-AF₂ score (3.27 ± 0.82 vs. 1.1 ± 0.95, p < 0.001) compared to patients without AF recurrence. ROC analysis showed that a BASE-AF₂ score of ≥ 3 well predicted AF recurrence with a sensitivity of 80.8% and a specificity of 91.6% (AUC = 0.94; 95% CI: 0.89–0.97, p < 0.001). A BASE-AF₂ score of ≥ 3 was found to be an independent predictor of AF recurrence (HR: 3.34, 95% CI: 2.34–4.76, p = 0.001).

Conclusion

BASE-AF₂, which was identified as a new scoring system, has well predicted AF recurrence and could be helpful in selecting appropriate patients for interventional strategy.     

Frailty and migration in middle-aged and older Europeans

We evaluated life course influences on health by investigating potential differences in levels of frailty between middle-aged and older European immigrants born in low- and middle-income countries (LMICs), immigrants born in high income countries (HICs), and their native-born European peers. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), we constructed a frailty index from 70 age-related health measures for 33,745 participants aged 50+ (mean = 64.9 ± 10.2 years; 54% women) in 14 European countries. Participants were grouped as native-born or as immigrants born in LMICs or in HICs, and further by current residence in Northern/Western or Southern/Eastern Europe. Seven percent of participants (n = 2369) were immigrants (mean = 64.4 ± 10.2 years; 56% women; LMIC-born = 3.4%, HIC-born = 3.6%). In Northern/Western Europe, after adjustment for age, gender, and education, LMIC-born immigrants demonstrated higher frailty index scores (mean = 0.18, 95% confidence interval = 0.17–0.19) than both HIC-born immigrants (0.16, 0.16–0.17) and native-born participants (0.15, 0.14–0.15 both p < 0.001). In Southern/Eastern Europe, frailty index scores did not differ between groups (p = 0.2). Time since migration explained significant variance in frailty index scores only in HIC-born immigrants to Southern/Eastern Europe (4.3%, p = 0.03). Despite differences in frailty, survival did not differ between groups (p = 0.2). LMIC-born immigrants demonstrated higher levels of frailty in Northern/Western Europe, but not Southern/Eastern Europe. Country of birth and current country of residence were each associated with frailty. Life course influences are demonstrable, but complex.     

Heart rate turbulence for predicting new-onset atrial fibrillation in patients undergoing coronary artery bypass grafting

Background

Cardiac autonomic dysfunction reportedly contributes to the AF triggering and maintenance. Heart rate turbulence (HRT) is a promising noninvasive measure of cardiac autonomic function. We investigated whether ambulatory ECG-based HRT measurement could predict in-hospital new-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery.

Methods

HRT onset (TO) and slope (TO) were prospectively measured from 24-h Holter recording in 113 consecutive patients prior to CABG. Abnormal HRT was defined as at least one abnormal value in TO (> 0%) and TS (< 2.5 ms/RR).

Results

Patients with abnormal HRT (n = 60) showed a significantly higher AF incidence (47% versus 21%, P = 0.005) and AF burden (29 ± 9 versus 7 ± 5 h, P = 0.043) than those with normal HRT (n = 53). Abnormal HRT were identified as independent predictors for the new-onset postoperative AF. During the follow-up period (12.0 ± 10.5 months), the abnormal HRT group showed a worse prognosis versus the normal HRT group regarding the AF recurrence/postoperative stroke (P = 0.018). Additionally, the postoperative AF incidence, in-hospital AF burden, and the rate of AF recurrence/postoperative stroke gradually elevated as the number of abnormal HRT values increased from 0 to 2.

Conclusions

Preoperative abnormal HRT was significantly associated with worse short-term (in-hospital new-onset AF) and long-term outcomes (post-discharge AF recurrence/postoperative stroke) after CABG surgery. Additional studies incorporating preventive interventions depending on the preoperative HRT results might be worthwhile in this patient group.     

Effect of lifetime endurance training on left atrial mechanical function and on the risk of atrial fibrillation

Background

Left atrium (LA) dilation and P-wave duration are linked to the amount of endurance training and are risk factors for atrial fibrillation (AF). The aim of this study was to evaluate the impact of LA anatomical and electrical remodeling on its conduit and pump function measured by two-dimensional speckle tracking echocardiography (STE).

Method

Amateur male runners > 30 years were recruited. Study participants (n = 95) were stratified in 3 groups according to lifetime training hours: low (< 1500 h, n = 33), intermediate (1500 to 4500 h, n = 32) and high training group (> 4500 h, n = 30).

Results

No differences were found, between the groups, in terms of age, blood pressure, and diastolic function. LA maximal volume (30 ± 5, 33 ± 5 vs. 37 ± 6 ml/m², p < 0.001), and conduit volume index (9 ± 3, 11 ± 3 vs. 12 ± 3 ml/m², p < 0.001) increased significantly from the low to the high training group, unlike the STE parameters: pump strain − 15.0 ± 2.8, − 14.7 ± 2.7 vs. − 14.9 ± 2.6%, p = 0.927; conduit strain 23.3 ± 3.9, 22.1 ± 5.3 vs. 23.7 ± 5.7%, p = 0.455. Independent predictors of LA strain conduit function were age, maximal early diastolic velocity of the mitral annulus, heart rate and peak early diastolic filling velocity. The signal-averaged P-wave (135 ± 11, 139 ± 10 vs. 148 ± 14 ms, p < 0.001) increased from the low to the high training group. Four episodes of non-sustained AF were recorded in one runner of the high training group.

Conclusion

The LA anatomical and electrical remodeling does not have a negative impact on atrial mechanical function. Hence, a possible link between these risk factors for AF and its actual, rare occurrence in this athlete population, could not be uncovered in the present study.     

Effect of electrical cardioversion on 1‐year outcomes in patients with early recurrence after catheter ablation for atrial fibrillation

BackgroundAtrial fibrillation (AF) recurrence is common in the 3‐month blanking‐period after catheter ablation, during which electrical cardioversion (ECV) is usually performed to restore sinus rhythm. Whether ECV can affect the clinical outcome of post‐ablation AF patients is inconsistent, however. We aimed to explore the 1‐year effect of ECV on AF recurrence and rehospitalization in patients experienced recurrence within 3‐month after AF catheter ablation.MethodsPatients who experienced recurrence within 3‐month after AF catheter ablation procedure were enrolled from the China Atrial Fibrillation Registry (China‐AF). A 1:3 Propensity score matching (PSM) method was applying to adjust the confounders between patients who had been treated by ECV or not. Logistic regression models were conducted to evaluate the association of ECV with 1‐year AF recurrence and rehospitalization.ResultsIn this study, 2961 patients experienced AF recurrence within 3‐month after the procedure, and 282 of them underwent successful ECV, 2155 patients did not undergo ECV. One‐year AF recurrence rates were 56.4% in ECV group versus 65.4% in non‐ECV group (p = .003), and were 55.9% versus 65.9%, respectively, after PSM (adjusted odds ratio [OR] 0.66; 95% confidence interval (CI): 0.49–0.88, p = .005). However, the difference of 1‐year rehospitalization rates between two groups were not statistically significant before (ECV group: 23.7% vs. non‐ECV group: 22.3%, p = .595) and after PSM (ECV group: 24.4% vs. non‐ECV group: 21.6%, adjusted OR1.14; 95% CI 0.81–1.62, p = .451).ConclusionsSuccessful ECV was associated with lower rate of one‐year recurrence in patients with early recurrent AF after catheter ablation.     

Social support and long-term mortality in the elderly: Role of comorbidity

Several studies have demonstrated a global increase in morbidity and mortality in elderly subjects with low social support or high comorbidity. However, the relationship between social support and comorbidity on long-term mortality in elderly people is not yet known. Thus, the present study was performed to evaluate the relationship between social support and comorbidity on 12-year mortality of elderly people. A random sample of 1288 subjects aged 65-95 years interviewed in 1992 was studied. Comorbidity by Charlson Comorbidity Index (CCI) score and Social Support by a scale in which total score ranges from 0 to 17, assigning to lowest social support the highest score, were evaluated. At 12-year follow-up, mortality progressively increase with low social support and comorbidity increasing (from 41.5% to 66.7% and from 41.2% to 68.3%, respectively; p < 0.001). Moreover, low social support progressively increases with comorbidity increasing (and 12.4 ± 2.5 to 14.3 ± 2.6; p < 0.001). Accordingly, multivariate analysis shows an increased mortality risk of 23% for each increase of tertile of social support scale (Hazard ratio = HR = 1.23; 95% CI = 1.01-1.51; p = 0.045). Moreover, when the analysis was performed considering different degrees of comorbidity we found that social support level was predictive of mortality only in subjects with the highest comorbidity (HR = 1.39; 95% CI = 1.082-1.78; p = 0.01). Thus, low social support is predictive of long-term mortality in the elderly. Moreover, the effect of social support on mortality increases in subjects with the highest comorbidity.     

Infiltrated atrial fat characterizes underlying atrial fibrillation substrate in patients at risk as defined by the ARIC atrial fibrillation risk score

Background

It is known that expanded epicardial fat is associated with atrial fibrillation (AF). However, infiltrated intraatrial fat has not been previously quantified in individuals at risk as determined by the ARIC AF risk score.

Methods

Patients in sinus rhythm (N = 90, age 57 ± 10 years; 55 men [63.2%]), in 3 groups at risk of AF as determined by the ARIC AF risk score [low (≤ 11 points; n = 15), moderate (12–18 points; n = 40), high (≥ 19 points; n = 23) risk of AF], and paroxysmal AF (n = 12) underwent cardiac magnetic resonance study. Intraatrial and epicardial fat was analyzed with a Dark-blood DIR-prepared Fat-Water-separated sequence in the horizontal longitudinal axis. OsiriX DICOM viewer (Geneva, Switzerland) was used to quantify the intraatrial fat area. Width of the cephalad portion of the interatrial septum was measured at the level of the fossa ovalis.

Results

Intraatrial fat monotonically increased with growing AF risk in study groups (low AF risk 16 ± 4 vs. moderate AF risk 32 ± 18 vs. high AF risk 81 ± 83 mm²; ANOVA P = 0.012). Log-transformed intraatrial fat predicted ARIC AF risk score in multivariate ordered probit regression after adjustment for sex, race, left and right atrial area indices, and body mass index (β-coefficient 0.50 [95% CI 0.03–0.97]; P = 0.037), whereas epicardial fat did not. Interatrial septum width showed similar association (3.0 ± 1.4 vs. 5.0 ± 1.8 vs. 7.1 ± 2.7 mm; ANOVA P < 0.001; adjusted β-coefficient 2.80 [95% CI 1.19–4.41]; P = 0.001).

Conclusions

Infiltrated intraatrial fat characterizes evolving substrate in individuals at risk of AF.     

Body composition,physical performance and muscle quality of active elderly women

Fat gain is one of the major factors aggravating physical disability in the elderly population, which presents an increase in fat mass and a decrease in lean mass compared to the young population. For this reason it is important to assess body composition and the effects of these alterations in obese elderly women. The purpose of this study was to assess body composition, physical performance and muscle quality in active elderly women. Cross-sectional study included 75 elderly women (29 eutrophic and 46 obese) 65–80 years old. Body composition was evaluated by dual energy X-ray absorptiometry (DXA) and the physical performance was determined by 6-minute walk test (6MWT), handgrip strength (HS) and knee extension strength (KES). Muscle quality was calculated as the ratio between muscle strength and lean mass. Fat free mass, lean mass, fat mass and percent body fat were significantly higher in the obese group (p < 0.05). Furthermore, the obese group showed a poorer performance than the eutrophic group in the 6MWT (432.31 ± 66.13 m and 472.07 ± 74.03 m, respectively, p = 0.01). HS and KES did not differ between groups, however, regarding muscle quality, the obese group exhibited a impaired in comparison to the eutrophic group in the upper (11.45 ± 2.57 kg and 13.31 ± 2.03 kg, respectively, p < 0.01) and lower limb (2.91 ± 1.16 kg and 3.44 ± 0.97 kg, respectively, p = 0.05). The increase in muscle mass detected in the obese elderly was not sufficient to maintain adequate muscle quality and physical function, showing a negative influence of the excess of body fat.     

Screening cognitive impairment among institutionalized older Chinese men in Taiwan: a new minimum data set-based dementia screening tool is needed

Dementia screening is of great importance in various health settings for older people, long-term care facilities are no exception. The need for an effective dementia screening tool being culture sensitive is important. Minimum data set (MDS) is a population instrument for health care management in the world, which also covers dementia screening. The main purpose of this study was to evaluate the effectiveness of the MDS-based dementia screening tools among older Chinese men in the Veteran Home in Taiwan. Overall, 576 participants (mean age: 80.9 ± 5.3 years, all males, 92.7% physically independent), 18.6% had cognitive impairment according to the mini-mental state examination (MMSE) (mean score: 26.7 ± 3.9). However, the prevalence of cognitive impairment was 5.5% by MDS cognitive performance scale (CPS) and 18.9% by MDS cognition scale (MDS-COGS). The screening results of CPS and MDS-COGS were highly interrelated (γ = 0.93, p < 0.001), and MMSE scores were also significantly associated with CPS and MDS-COGS status (γ = −0.50, p < 0.001 and γ = −0.52, p < 0.001, respectively). Although the prevalence of cognitive impairment by MMSE and MDS-COGS are similar, the results are significantly inconsistent (p < 0.001). In conclusion, both MDS-COGS and CPS were significantly correlated with MMSE scores, but significant inconsistence was noted between screening results of MMSE, CPS and MDS-COGS. Further study is needed to develop MDS-based dementia screening tools for older Chinese men in Taiwan.     

Combined circular multielectrode catheter and point-by-point ablation is superior to point-by-point ablation alone in eliminating atrial fibrillation

Background

Besides conventional point-by-point ablation, novel multielectrode catheters emerge for ablation of atrial fibrillation (AF). We sought to evaluate the clinical utility of a pulmonary vein (PV) isolation approach combining the advantages of both technologies.

Methods

The study included 240 consecutive AF patients (60 ± 11 years, 68% males, 62% paroxysmal). In the combined ablation group (n = 120), PV isolation was performed with a circular multielectrode catheter (PVAC, Medtronic Ablation Frontiers) and completed by conventional point-by-point ablation (NaviStar ThermoCool Catheter, Lasso/CARTO technology, Biosense Webster). In the point-by-point ablation group (n = 120), PV isolation was performed with point-by-point ablation alone.

Results

Complete 1-year ablation success (freedom from any atrial arrhythmia off antiarrhythmic drugs) was more frequently observed in the combined ablation group (58.0% versus 43.3%, hazard ratio 1.72, 95% confidence interval 1.19–2.48, p = 0.004). Also clinical success (≥ 90% reduction of arrhythmia burden on/off antiarrhythmic drugs) was significantly associated with the combined ablation approach (p = 0.001). These associations remained significant after multivariable adjustment (both p ≤ 0.005) and were not dependent on the type of AF. The rate of major adverse events (3.3% versus 2.5%) and the procedure time did not differ between groups. The fluoroscopy time, however, was significantly shorter in the combined ablation group (p < 0.001) reflecting the reduced need for radiation during multielectrode catheter ablation.

Conclusions

A combined PV isolation approach based on multielectrode catheter ablation and complementary point-by-point ablation is superior to point-by-point ablation alone and reveals to be safe. A potential explanation for these findings is the improved durability of ablation lesion after the combined ablation approach.     

Calreticulin overexpression correlates with integrin-α5 and transforming growth factor-β1 expression in the atria of patients with rheumatic valvular disease and atrial fibrillation

Objectives

The aim of this study was to determine whether altered calreticulin expression and distribution contribute to the pathogenesis of atrial fibrillation (AF) associated with valvular heart disease (VHD).

Background

AF affects electrophysiological and structural changes that exacerbate AF. Atrial remodeling reportedly underlies AF generation, but the precise mechanism of atrial remodeling in AF remains unclear.

Methods

Right and left atrial specimens were obtained from 68 patients undergoing valve replacement surgery. The patients were divided into sinus rhythm (SR; n = 25), paroxysmal AF (PaAF; n = 11), and persistent AF (PeAF; AF lasting > 6 months; n = 32) groups. Calreticulin, integrin-α5, and transforming growth factor-β1 (TGF-β1) mRNA and protein expression were measured. We also performed immunoprecipitation for calreticulin with either calcineurin B or integrin-α5.

Results

Calreticulin, integrin-α5, and TGF-β1 mRNA and protein expression were increased in the AF groups, especially in the left atrium in patients with mitral valve disease. Calreticulin interacted with both calcineurin B and integrin-α5. Integrin-α5 expression correlated with TGF-β1 expression, while calreticulin expression correlated with integrin-α5 and TGF-β1 expression. Despite similar cardiac function classifications, calreticulin expression was greater in the PeAF group than in the SR group.

Conclusions

Calreticulin, integrin-α5, and TGF-β1 expression was increased in atrial tissue in patients with AF and was related to AF type, suggesting that calreticulin is involved in the pathogenesis of AF in VHD patients.     

Histone-deacetylase inhibition reverses atrial arrhythmia inducibility and fibrosis in cardiac hypertrophy independent of angiotensin

Atrial fibrosis influences the development of atrial fibrillation (AF), particularly in the setting of structural heart disease where angiotensin-inhibition is partially effective for reducing atrial fibrosis and AF. Histone-deacetylase inhibition reduces cardiac hypertrophy and fibrosis, so we sought to determine if the HDAC inhibitor trichostatin A (TSA) could reduce atrial fibrosis and arrhythmias. Mice over-expressing homeodomain-only protein (HopX^Tg), which recruits HDAC activity to induce cardiac hypertrophy were investigated in 4 groups (aged 14-18 weeks): wild-type (WT), HopX^Tg, HopX^Tg mice treated with TSA for 2 weeks (TSA-HopX) and wild-type mice treated with TSA for 2 weeks (TSA-WT). These groups were characterized using invasive electrophysiology, atrial fibrosis measurements, atrial connexin immunocytochemistry and myocardial angiotensin II measurements. Invasive electrophysiologic stimulation, using the same attempts in each group, induced more atrial arrhythmias in HopX^Tg mice (48 episodes in 13 of 15 HopX^Tg mice versus 5 episodes in 2 of 15 TSA-HopX mice, P < 0.001; versus 9 episodes in 2 of 15 WT mice, P < 0.001; versus no episodes in any TSA-WT mice, P < 0.001). TSA reduced atrial arrhythmia duration in HopX^Tg mice (1307 ± 289 ms versus 148 ± 110 ms, P < 0.01) and atrial fibrosis (8.1 ± 1.5% versus 3.9 ± 0.4%, P < 0.001). Atrial connexin40 was lower in HopX^Tg compared to WT mice, and TSA normalized the expression and size distribution of connexin40 gap junctions. Myocardial angiotensin II levels were similar between WT and HopX^Tg mice (76.3 ± 26.0 versus 69.7 ± 16.6 pg/mg protein, P = NS). Therefore, it appears HDAC-inhibition reverses atrial fibrosis, connexin40 remodeling and atrial arrhythmia vulnerability independent of angiotensin II in cardiac hypertrophy.