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1.
Narut Prasitlumkum Pattara Rattanawong Nath Limpruttidham Chanavuth Kanitsoraphan Natee Sirinvaravong Pichatorn Suppakitjanusant Pakawat Chongsathidkiet Eugene H. Chung 《Journal of electrocardiology》2018,51(5):760-767
Background
Frequent premature atrial complexes (PACs) are associated with higher morbidity and mortality. Recent studies suggest that frequent PACs are associated with new onset atrial fibrillation (AF). However, a systematic review and meta-analysis of the literature has not been done. We assessed the association between frequent PACs and new onset AF by a systematic review and a meta-analysis.Methods
We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published cohort (prospective or retrospective) that compared new onset AF among patients with and without frequent PACs documented by Holter monitoring or 12-lead electrocardiogram. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals.Results
Twelve studies from 2009 to 2017 were included in this meta-analysis involving 109,689 subjects (9217frequent and 100,472 non-frequent PACs). Frequent PACs were associated with increased risk of new onset AF (pooled risk ratio?=?2.76, 95% confidence interval: 2.05–3.73, p?<?0.000, I2?=?90.6%).Conclusion
Frequent PACs are associated with up to three-fold increased risk of new onset AF. Our study suggests that frequent PACs in general population is an independent predictor of new onset AF. 相似文献2.
《The Canadian journal of cardiology》2022,38(12):1962-1975
BackgroundObesity is a significant risk factor for atrial fibrillation (AF), and the gut microbiota is closely related to obesity-induced diseases. However, whether the gut microbiota is involved in regulating obesity-induced AF has not been studied. This study investigated whether gut microbiota dysbiosis affects obesity-related AF.MethodsFecal microbes derived from normal diet (ND)-fed and high-fat diet (HD)-fed mice were transplanted into those fed normally. Morphologic, biochemical, functional, histologic, electrophysiological studies, molecular analysis, 16S rRNA gene amplicon sequencing, and RNA-sequencing were performed.ResultsTransplantation of the HD gut microbes in ND-maintained (THD) mice led to a significant increase in the susceptibility to AF. Gut microbiota analysis showed a significant increase in Desulfovibrionaceae, which generated metabolic endotoxemia in THD mice. Transplantation with HD microbes also resulted in significantly increased levels of circulating lipopolysaccharide (LPS), significant disruption in the histologic architecture of the intestinal tissue, and significantly increased proinflammatory cytokines in the left atrium, indicating that atrial inflammation likely contributed to AF susceptibility. RNA-sequencing showed that the THD group had enhanced activation of ferroptosis and TLR4/NF-κB/NLRP3 inflammasome signalling pathway. Inhibiting the ferroptosis or NLRP3 inflammasome signalling pathway significantly improved atrial fibrosis and reduced susceptibility to obesity-related gut dysbiosis-induced AF.ConclusionsThis study provides evidence showing an original causal role of gut microbiota dysbiosis in the pathogenesis of obesity-related AF, which showed elevated LPS and dysregulation of atrial pathologic remodelling by activating ferroptosis and the TLR4/NF-κB/NLRP3 inflammasome signalling pathway. 相似文献
3.
John M. Miller Vikas Kalra Mithilesh K. Das Rahul Jain Jason B. Garlie Jordan A. Brewster Gopi Dandamudi 《Journal of the American College of Cardiology》2017,69(10):1247-1256
Background
Mounting evidence shows that localized sources maintain atrial fibrillation (AF). However, it is unclear in unselected “real-world” patients if sources drive persistent atrial fibrillation (PeAF), long-standing persistent atrial fibrillation (LPeAF), or paroxysmal atrial fibrillation (PAF); if right atrial sites are important; and what the long-term success of source ablation is.Objectives
The aim of this study was to analyze the role of rotors and focal sources in a large academic registry of consecutive patients undergoing source mapping for AF.Methods
One hundred seventy consecutive patients (mean age 59 ± 12 years, 79% men) with PAF (37%), PeAF (31%), or LPeAF (32%). Of these, 73 (43%) had undergone at least 1 prior ablation attempt (mean 1.9 ± 0.8; range: 1 to 4). Focal impulse and rotor modulation (FIRM) with an endocardial basket catheter was used in all cases.Results
FIRM analysis revealed sources in the right atrium in 85% of patients (1.8 ± 1.3) and in the left atrium in 90% of patients (2.0 ± 1.3). FIRM ablation terminated AF to sinus rhythm or atrial flutter or tachycardia in 59% (PAF), 37% (PeAF), and 19% (LPeAF) of patients, with 15 of 67 terminations due to right atrial ablation. On follow-up, freedom from AF after a single FIRM procedure for the entire series was 95% (PAF), 83% (PeAF), and 82% (LPeAF) at 1 year and freedom from all atrial arrhythmias was 77% (PAF), 75% (PeAF), and 57% (LPeAF).Conclusions
In the Indiana University FIRM registry, FIRM-guided ablation produced high single-procedure success, mostly in patients with nonparoxysmal AF. Data from mapping, acute terminations, and outcomes strongly support the mechanistic role of biatrial rotors and focal sources in maintaining AF in diverse populations. Randomized trials of FIRM-guided ablation and mechanistic studies to determine how rotors form, progress, and regress are needed. 相似文献4.
L. Brubaker S. Luu Kl Hoffman A. Wood M. Navarro Cagigas Q. Yao Jf Petrosino W. Fisher G. Van Buren 《Pancreatology》2021,21(1):1-14
BackgroundAltered intestinal microbiota has been reported in pancreatic disorders, however, it remains unclear whether these changes alter the course of disease in patients with acute (AP) and chronic pancreatitis (CP), or whether these disease states alter the environment to enable pathogenic microbial composition changes to occur. We undertook a systematic review to characterize the gut microbiome in pancreatitis patients.MethodsMEDLINE and EMBASE were searched for studies on microbiota in pancreatitis published from January 1, 2000 to June 5, 2020. Animal studies, reviews, case reports, and non-English articles were excluded. A frequency analysis was performed for outcomes reported in ≥2 studies and studies were analyzed for risk of bias and quality of evidence.Results22 papers met inclusion criteria; 15 included AP, 7 included CP. No studies were appropriately designed to assess whether alterations in the gut microbiome exacerbate pancreatitis or develop as a result of pancreatitis. We did identify several patterns of microbiome changes that are associated with pancreatitis. The gut microbiome demonstrated decreased alpha diversity in 3/3 A P studies and 3/3 C P studies. Beta diversity analysis revealed differences in bacterial community composition in the gut microbiome in 2/2 A P studies and 3/3 C P studies. Functionally, gut microbiome changes were associated with infectious pathways in AP and CP. Several studies suffered from high risk of bias and inadequate quality.ConclusionsDetecting differences in microbial composition associated with AP and CP may represent a diagnostic tool. Appropriately controlled longitudinal studies are needed to determine whether microbiome changes are causative or reactive in pancreatitis. 相似文献
5.
Daniel Lancini MBBS FRACP Aveechal Prasad MBBS Liza Thomas MBBS FRACP PhD John Atherton MBBS FRACP PhD Paul Martin MB FRACP PhD Sandhir Prasad MBBS FRACP 《Echocardiography (Mount Kisco, N.Y.)》2023,40(6):456-463
Background
Atrial fibrillation (AF) commonly occurs following acute myocardial infarction (AMI). Left atrial (LA) size has been reported to predict new onset AF in this cohort, however, the optimal metric of left atrial size for risk stratification following AMI is unknown.Methods
Patients presenting to a tertiary hospital with incident AMI (NSTEMI or STEMI) and no history of AF were recruited. All patients underwent guideline-based workup and management for AMI, including transthoracic echocardiographic assessment. Three alternative metrics of left atrial size were determined: LA area, maximal and minimal LA volume indexed to body surface area (LAVImax and LAVImin). The primary endpoint was new onset AF diagnoses.Results
Four hundred thirty three patients were included in the analysis, of which 7.1% had a new diagnosis of AF within a median follow-up of 3.8 years. Univariate predictors of incident AF included age, hypertension, revascularization with CABG, NSTEMI presentation, right atrial area, and all three metrics of LA size. Among three multivariable models created for the prediction of new onset AF utilizing alternate metrics of LA size, LAVImin was the only LA size metric found to be an independent predictor.Conclusions
LAVImin is an independent predictor of new onset AF post AMI. LAVImin outperforms echocardiographic assessment of diastolic dysfunction and alternative metrics of LA size (including LA area and LAVImax) for risk stratification. Further studies are needed to validate our findings in post AMI patients, and evaluate whether LAVImin holds similar advantages over LAVImax in other cohorts. 相似文献6.
Hailong Cao Ying Wu Qingguo Li Yanhu Wu Qing Zhou Oluf Dimitri Røe Yijiang Chen Ruxing Wang Dongjin Wang 《International journal of cardiology》2014
Background
Radiofrequency catheter ablation (RFCA) is a widely accepted strategy for eliminating atrial fibrillation (AF). A considerable recurrence rate has partly been ascribed to atrial remodeling. Osteoprotegerin (OPG)/receptor activator of nuclear factor-κB (RANK)/RANK ligand (RANKL) axis may contribute to the development and progression of AF by regulating atrial structural remodeling. This study aimed to determine the relationship between serum soluble RANKL (sRANKL)/OPG and the risk of recurrent arrhythmia after ablation of lone AF.Methods
We enrolled 527 lone AF patients undergoing first-time RFCA with complete follow-up data. Pre-ablation venous blood samples were obtained for measurement of serum sRANKL and OPG.Results
During the follow-up period of 15 (3–64) months, AF recurred in 187 patients (35.5%). Recurrence was associated with an elevation of serum sRANKL level and sRANKL/OPG ratio. In multivariate survival regression, persistent AF, AF duration, left atrial diameter, amiodarone after ablation, particularly serum sRANKL level and sRANKL/OPG ratio independently predicted AF recurrence. According to ROC curve analysis, the best diagnostic values of serum sRANKL level and sRANKL/OPG ratio for predicting recurrence were 4.89 pmol/l and 0.76, respectively.Conclusions
Baseline serum high sRANKL level and sRANKL/OPG ratio are associated with AF recurrence after primary ablation procedure in lone AF patients, and may be used in the prediction of AF recurrence in these patients. 相似文献7.
Mahmut Yesin Macit Kalçık Metin Çağdaş Yavuz Karabağ İbrahim Rencüzoğulları Mustafa Ozan Gürsoy Süleyman Çağan Efe Süleyman Karakoyun 《Journal of electrocardiology》2018,51(1):27-32
Background
Fragmented QRS (fQRS) has been shown to be a marker of local myocardial conduction abnormalities, cardiac fibrosis in previous studies. It was also reported to be a predictor of sudden cardiac death and increased morbidity and mortality in selected populations. However, there is no study investigating the role of fQRS in the development of atrial fibrillation in patients with ST segment elevation myocardial infarction (STEMI). In this study we aimed to investigate the relationship between the presence of fQRS after primary percutaneous coronary intervention (pPCI) and in-hospital development of new-onset atrial fibrilation (AF) in patients with STEMI.Material and methods
This study enrolled 171 patients undergoing pPCI for STEMI. Among these patients 24 patients developed AF and the remaining 147 patients were designated as the controls. All clinical, demographical and laboratory parameters were entered into a dataset and compared between AF group and the controls.Results
The presence of fQRS was higher in the AF group than in the controls (P = 0.001). Diabetes mellitus and fQRS was significantly more common in the AF group (P = 0.003 and P = 0.001 respectively) Logistic regression analysis demonstrated that the presence of fQRS was the independent determinant of AF (OR: 3.243, 95% CI 1.016–10.251, P = 0.042).Conclusions
Increased atrial fibrillation was observed more frequently in STEMI patients with fQRS than in patients without fQRS. fQRS is an important determinant of AF in STEMI after pPCI. 相似文献8.
Trine B. Rounge Roger Meisal Jan Inge Nordby Ole Herman Ambur Thomas de Lange Geir Hoff 《BMC gastroenterology》2018,18(1):171
Background
Associations between colorectal cancer and microbiota have been identified. Archived fecal samples might be valuable sample sources for investigating causality in carcinogenesis and biomarkers discovery due to the potential of performing longitudinal studies. However, the quality, quantity and stability of the gut microbiota in these fecal samples must be assessed prior to such studies. We evaluated i) cross-contamination during analysis for fecal blood and ii) evaporation in stored perforated fecal immunochemical tests (iFOBT) samples, iii) temperature stability as well as iv) comparison of the gut microbiota diversity and composition in archived, iFOBT and fresh fecal samples in order to assess feasibility of large scale microbiota studies.Methods
The microbiota profiles were obtained by sequencing the V3-V4 region of 16S rDNA gene.Results
The iFOBT does not introduce any cross-sample contamination detectable by qPCR. Neither could we detect evaporation during freeze-thaw cycle of perforated iFOBT samples. Our results confirm room temperature stability of the gut microbiome. Diverse microbial profiles were achieved in 100% of fresh, 81% of long-term archived and 96% of iFOBT samples. Microbial diversity and composition were comparable between fresh and iFOBT samples, however, diversity differed significantly between long-term archived, fresh and iFOBT samples.Conclusion
Our data showed that it is feasible to exploit archived fecal sample sets originally collected for testing of fecal blood. The advantages of using these sample sets for microbial biomarker discovery and longitudinal observational studies are the availability of high-quality diagnostic and follow-up data. However, care must be taken when microbiota are profiled in long-term archived fecal samples.9.
Purpose of Review
Obesity and diabetes are worldwide epidemics. There is also a growing body of evidence relating the gut microbiome composition to insulin resistance. The purpose of this review is to delineate the studies linking gut microbiota to obesity, metabolic syndrome, and diabetes.Recent findings
Animal studies as well as proof of concept studies using fecal transplantation demonstrate the pivotal role of the gut microbiota in regulating insulin resistance states and inflammation.Summary
While we still need to standardize methodologies to study the microbiome, there is an abundance of evidence pointing to the link between gut microbiome, inflammation, and insulin resistance, and future studies should be aimed at identifying unifying mechanisms.10.
Divyang Patel MD Archana Rao MD Paul A. Friedman MD FHRS Abhishek J. Deshmukh MD FHRS Jeff Lande PhD Jeffrey A. Murphy MS Mark L. Brown PhD Daniel R. Lexcen PhD Bruce L. Wilkoff MD FHRS 《Journal of cardiovascular electrophysiology》2023,34(2):438-444
Introduction
A current limitation of single chamber implantable cardioverter defibrillators (ICDs) is the lack of an atrial lead to reliably detect atrial fibrillation (AF) episodes. A novel ventricular based atrial fibrillation (VBAF) detection algorithm was created for single chamber ICDs to assess R-R variability for detection of AF.Methods
Patients implanted with Visia AF™ ICDs were prospectively enrolled in the Medtronic Product Surveillance Registry from December 15, 2015 to January 23, 2019 and followed with at least 30 days of monitoring with the algorithm. Time to device-detected daily burden of AF ≥ 6 min, ≥6 h, and ≥23 h were reported. Clinical actions after device-detected AF were recorded.Results
A total of 291 patients were enrolled with a mean follow-up of 22.5 ± 7.9 months. Of these, 212 (73%) had no prior history of AF at device implant. However, 38% of these individuals had AF detected with the VBAF algorithm with daily burden of ≥6 min within two years of implant. In these 80 patients with newly detected AF by their ICD, 23 (29%) had a confirmed clinical diagnosis of AF by their provider. Of patients with a clinical diagnosis of AF, nine (39%) were newly placed on anticoagulation, including five of five (100%) patients having a burden >23 h.Conclusions
Continuous AF monitoring with the new VBAF algorithm permits early identification and actionable treatment for patients with undiagnosed AF that may improve patient outcomes. 相似文献11.
Sinan S. Tankut MD David T. Huang MD Wojciech Zareba MD PhD Mehmet K. Aktas MD MBA Spencer Z. Rosero MD Jonathan Steinberg MD Jennifer Henchen MS Valentina Kutyifa MD PhD Robert L. Strawderman ScD Ilan Goldenberg MD 《Annals of noninvasive electrocardiology》2023,28(2):e13043
Background
Percutaneous catheter ablation (CA) to achieve pulmonary vein isolation is an effective treatment for drug-refractory paroxysmal and persistent atrial fibrillation (AF). However, recurrence rates after a single AF ablation procedure remain elevated. Conventional management after CA ablation has mostly been based on clinical AF recurrence. However, continuous recordings with insertable cardiac monitors (ICMs) and patient-triggered mobile app transmissions post-CA can now be used to detect early recurrences of subclinical AF (SCAF). We hypothesize that early intervention following CA based on personalized ICM data can prevent the substrate progression that promotes the onset and maintenance of atrial arrhythmias.Methods
This is a randomized, double-blind (to SCAF data), single-tertiary center clinical trial in which 120 patients with drug-refractory paroxysmal or persistent AF are planned to undergo CA with an ICM. Randomization will be to an intervention arm (n = 60) consisting of ICM-guided early intervention based on SCAF and patient-triggered mobile app transmissions versus a control arm (n = 60) consisting of a standard intervention protocol based on clinical AF recurrence validated by the ICM. Primary endpoint is AF burden, which will be assessed from ICMs at 15 months post-AF ablation. Secondary endpoints include healthcare utilization, functional capacity, and quality of life.Conclusion
We believe that ICM-guided early intervention will provide a novel, personalized approach to post-AF ablation management that will result in a significant reduction in AF burden, healthcare utilization, and improvements in functional capacity and quality of life. 相似文献12.
Anees Enayati MBBS Julian H. Gin MD Jithin K. Sajeev MBBS PhD Jennifer C. Cooke MBBS Patrick Carey MBBS Michael MacPherson MBChB Louise Roberts PhD Paul Buntine MBBS MClinRes Andrew W. Teh MBBS PhD Jason Nogic MBBS MMed 《Journal of cardiovascular electrophysiology》2023,34(5):1286-1295
Background
Intravenous magnesium (IV Mg), a commonly utilized therapeutic agent in the management of atrial fibrillation (AF) with rapid ventricular response, is thought to exert its influence via its effect on cellular automaticity and prolongation of atrial and atrioventricular nodal refractoriness thus reducing ventricular rate. We sought to undertake a systematic review and meta-analysis of the effectiveness of IV Mg versus placebo in addition to standard pharmacotherapy in the rate and rhythm control of AF in the nonpostoperative patient cohort given that randomized control trials (RCTs) have shown conflicting results.Methods
Randomized controlled trials comparing IV Mg versus placebo in addition to standard of care were identified via electronic database searches. Nine RCTs were returned with a total of 1048 patients. Primary efficacy endpoints were study-defined rate control and rhythm control/reversion to sinus rhythm. The secondary endpoint was patient experienced side effects.Results
Our analysis found IV Mg in addition to standard care was successful in achieving rate control (odd ratio [OR] 1.87, 95% confidence interval [CI] 1.13−3.11, p = .02) and rhythm control (OR 1.45, 95% CI 1.04−2.03, p = .03). Although not well reported among studies, there was no significant difference between groups regarding the likelihood of experiencing side effects.Conclusions
IV Mg, in addition to standard-of-care pharmacotherapy, increases the rates of successful rate and rhythm control in nonpostoperative patients with AF with rapid ventricular response and is well tolerated. 相似文献13.
Background
The gut microbiome has emerged as a key player in the modulation of the immune system and metabolism. Changes in the composition of the gut microbial ecosystems have been reported to be associated with metabolic diseases but also with the development and progression of cardiovascular diseases, inflammatory bowel disease, certain types of cancer and psychiatric diseases.Objective
The role of the gut microbiome in the pathophysiology of obesity and type 2 diabetes, and treatment approaches based thereon are discussed.Microbiome and pathophysiology
The pathophysiology in humans is not entirely understood. Studies in mice suggest a strong causal link between changes in the microbiome and the development of metabolic diseases. Potential mechanisms how the microbiome is linked to diseases of the host include signaling through lipopolysaccharides from gram-negative bacteria and interactions with the host immune system, fermentation of indigestible fiber to short chain fatty acids, modulation of bile acids, and bile acid signaling. Interactions between gut microbiota, its products, and the immune system may lead to an increased gut permeability resulting in visceral fat and liver inflammation with subsequent systemic subclinical inflammation (leaky gut hypothesis). Moreover, host-specific factors and environmental factors have been discussed to have a role.Conclusion
Increasing knowledge in this area could contribute to the treatment of obesity and type 2 diabetes with fecal or targeted microbiota transplantation.14.
Background:
Recent evidence suggests that the gut microbiota plays an important role in human metabolism and energy homeostasis and is therefore a relevant factor in the assessment of metabolic health and flexibility. Understanding of these host–microbiome interactions aids the design of nutritional strategies that act via modulation of the microbiota. Nevertheless, relating gut microbiota composition to host health states remains challenging because of the sheer complexity of these ecosystems and the large degrees of interindividual variation in human microbiota composition.Methods:
We assessed fecal microbiota composition and host response patterns of metabolic and inflammatory markers in 10 apparently healthy men subjected to a high-fat high-caloric diet (HFHC, 1300 kcal/day extra) for 4 weeks. DNA was isolated from stool and barcoded 16S rRNA gene amplicons were sequenced. Metabolic health parameters, including anthropomorphic and blood parameters, where determined at t=0 and t=4 weeks.Results:
A correlation network approach revealed diet-induced changes in Bacteroides levels related to changes in carbohydrate oxidation rates, whereas the change in Firmicutes correlates with changes in fat oxidation. These results were confirmed by multivariate models. We identified correlations between microbial diversity indices and several inflammation-related host parameters that suggest a relation between diet-induced changes in gut microbiota diversity and inflammatory processes.Conclusions:
This approach allowed us to identify significant correlations between abundances of microbial taxa and diet-induced shifts in several metabolic health parameters. Constructed correlation networks provide an overview of these relations, revealing groups of correlations that are of particular interest for explaining host health aspects through changes in the gut microbiota. 相似文献15.
Background
Although high alcohol consumption has been associated with increased risk of atrial fibrillation (AF), the role of light to moderate drinking remains unclear.Objectives
The study sought to investigate the association between alcohol consumption and AF risk in a prospective study of Swedish men and women and to conduct a meta-analysis of prospective studies to summarize available evidence.Methods
We followed 79,019 men and women who, at baseline, were free from AF and had completed a questionnaire about alcohol consumption and other risk factors for chronic diseases. Incident AF cases were ascertained by linkage to the Swedish Inpatient Register. For the meta-analysis, studies were identified by searching PubMed through January 10, 2014, and by reviewing references of pertinent publications. Study-specific relative risks (RRs) were combined using a random effects model.Results
Over 859,420 person-years of follow-up (1998 to 2009), 7,245 incident AF cases were identified in our own cohort study. The association between alcohol consumption and AF did not differ by sex (p for interaction = 0.74). Compared with current drinkers of <1 drink/week (12 g alcohol/drink), the multivariable RRs of AF were 1.01 (95% confidence interval [CI]: 0.94 to 1.09) for 1 to 6 drinks/week, 1.07 (95% CI: 0.98 to 1.17) for 7 to 14 drinks/week, 1.14 (95% CI: 1.01 to 1.28) for 15 to 21 drinks/week, and 1.39 (95% CI: 1.22 to 1.58) for >21 drinks/week. Results were similar after excluding binge drinkers. In a meta-analysis of 7 prospective studies, including 12,554 AF cases, the RRs were 1.08 (95% CI: 1.06 to 1.10) for 1 drink/day, 1.17 (95% CI: 1.13 to 1.21) for 2 drinks/day, 1.26 (95% CI: 1.19 to 1.33) for 3 drinks/day, 1.36 (95% CI: 1.27 to 1.46) for 4 drinks/day, and 1.47 (95% CI: 1.34 to 1.61) for 5 drinks/day, compared with nondrinkers.Conclusions
These findings indicate that alcohol consumption, even at moderate intakes, is a risk factor for atrial fibrillation. 相似文献16.
H. Zuo O. Nygård S. E. Vollset P. M. Ueland A. Ulvik Ø. Midttun K. Meyer J. Igland G. Sulo G. S. Tell 《Journal of internal medicine》2018,283(1):73-82
Background
Cigarette smoking has been identified as a major modifiable risk factor for coronary heart disease and mortality. However, findings on the relationship between smoking and atrial fibrillation (AF ) have been inconsistent. Furthermore, findings from previous studies were based on self‐reported smoking.Objective
To examine the associations of smoking status and plasma cotinine levels, a marker of nicotine exposure, with risk of incident AF in the Hordaland Health Study.Methods
We conducted a prospective analysis of 6682 adults aged 46‐74 years without known AF at baseline. Participants were followed via linkage to the Cardiovascular Disease in Norway (CVDNOR ) project and the Cause of Death Registry. Smoking status was assessed by both questionnaire and plasma cotinine levels.Results
A total of 538 participants developed AF over a median follow‐up period of 11 years. Using questionnaire data, current smoking (HR : 1.41, 95% CI : 1.09–1.83), but not former smoking (HR : 1.03, 95% CI : 0.83–1.28), was associated with an increased risk of AF after adjustment for gender, age, body mass index, hypertension, physical activity and education. Using plasma cotinine only, the adjusted HR (95% CI ) was 1.40 (1.12–1.75) for participants with cotinine ≥85 nmol L?1 compared to those with cotinine <85 nmol L?1. However, the risk increased with elevated plasma cotinine levels until 1199 nmol L?1 (HR : 1.55, 95% CI : 1.16–2.05 at the third group vs. the reference group) and plateaued at higher levels.Conclusions
Current, but not former smokers, had a higher risk of developing AF . Use of plasma cotinine measurement corroborated this finding.17.
18.
Carlos Kalil Eduardo Bartholomay Anibal Borges Guilherme Gazzoni Edimar de Lima Renata Etchepare Rafael Moraes Carolina Sussenbach Karina Andrade Renato Kalil 《Arquivos brasileiros de cardiologia》2014,102(1):30-38
Background
Radiofrequency catheter ablation guided by electroanatomical mapping is currently an important therapeutic option for the treatment of atrial fibrillation. The complexity of the procedure, the several techniques used and the diversity of the patients hinder the reproduction of the results and the indication for the procedure.Objective
To evaluate the efficacy and factors associated with recurrence of atrial fibrillation.Methods
Prospective cohort study with consecutive patients submitted to atrial fibrillation ablation treatment guided by electroanatomical mapping. The inclusion criteria were as follows: minimum age of 18 years; presence of paroxysmal, persistent or long-standing persistent AF; AF recording on an electrocardiogram, exercise testing or Holter monitoring (duration longer than 15 minutes); presence of symptoms associated with AF episodes; AF refractoriness to, at least, two antiarrhythmic drugs, one of which being amiodarone, or impossibility to use antiarrhythmic drugs.Results
The study included 95 patients (age 55 ± 12 years, 84% men, mean CHADS2 = 0.8) who underwent 102 procedures with a median follow-up of 13.4 months. The recurrence-free rate after the procedure was 75.5% after 12 months. Atrial fibrillation recurred as follows: 26.9% of patients with paroxysmal and persistent atrial fibrillation; 45.8% of patients with long-standing persistent atrial fibrillation (p = 0.04). Of the analyzed variables, the increased size of the left atrium has proven to be an independent predictor of atrial fibrillation recurrence after the procedure (HR = 2.58; 95% CI: 1.26-4.89). Complications occurred in 4.9% of the procedures.Conclusion
Atrial fibrillation ablation guided by electroanatomical mapping has shown good efficacy. The increase in left atrium size was associated with atrial fibrillation recurrence. 相似文献19.
ABSTRACT
Background and Aims
Alcoholic hepatitis is the most severe form of alcohol-related liver disease. While the gut microbiome is known to play a role in disease development and progression, less is known about specific compositional changes of the gut bacterial microbiome associated with disease severity. Therefore, the aim of our study was to correlate gut microbiota features with disease severity in alcoholic hepatitis patients. 相似文献20.
Jongnarangsin K Suwanagool A Chugh A Crawford T Good E Pelosi F Bogun F Oral H Morady F 《Journal of cardiovascular electrophysiology》2012,23(1):9-14
Ablation and Progression of Atrial Fibrillation. Objective: The objective was to determine the effect of radiofrequency catheter ablation (RFA) on progression of paroxysmal atrial fibrillation (AF). Background: Progression to persistent AF may occur in up to 50% of patients with paroxysmal AF receiving pharmacological therapy. Hypertension, age, prior transient ischemic event, chronic obstructive pulmonary disease, and heart failure (HATCH score) have been identified as independent risk factors for progression of AF. Methods: RFA was performed in 504 patients (mean age: 58 ± 10 years) to eliminate paroxysmal AF. A repeat RFA procedure was performed in 193 patients (38%). Clinical variables predictive of outcome and their relation to progression of AF after RFA were assessed using multivariate analysis. Results: At a mean follow‐up of 27 ± 12 months after RFA, 434/504 patients (86%) were in sinus rhythm; 49/504 patients (9.5%) continued to have paroxysmal AF; and 14 (3%) were in atrial flutter. Among the 504 patients, 7 (1.5%) progressed to persistent AF. In patients with recurrent AF after RFA, paroxysmal AF progressed to persistent AF in 7/56 (13%, P < 0.001). The progression rate of AF was 0.6% per year after RFA (P < 0.001 compared to 9% per year reported in pharmacologically treated patients). Age >75 years, duration of AF >10 years and diabetes were independent predictors of progression to persistent AF. The HATCH score was not significantly different between patients with paroxysmal AF who did and did not progress to persistent AF (0.7 ± 0.8 vs 1.0 ± 0.5, P = 0.3). Conclusions: Compared to a historical control group of pharmacologically treated patients with paroxysmal AF, RFA appears to reduce the rate of progression of paroxysmal AF to persistent AF. Age, duration of AF, and diabetes are independent risk factors for progression to persistent AF after RFA. (J Cardiovasc Electrophysiol, Vol. 23, pp. 9‐14, January 2012) 相似文献