Introduction: Obesity is an established risk factor for recurrent atrial fibrillation (AF) after ablation. The impact of pre-procedure weight changes on freedom from AF (FFAF) after ablation in obese and nonobese patients is unknown.Methods: A single-center retrospective cohort study of patients undergoing pulmonary vein isolation was performed. Before ablation, all candidates were encouraged to adopt healthy lifestyle habits according to American Heart Association guidelines, including weight loss, by their physician. The primary endpoint was FFAF through 1-year after completion of the 3-month blanking period.Results: Of the 601 patients (68% male; average age 62.1 ± 10.3 years) included in analysis, 234 patients (38.9%) were obese (body mass index ≥ 30) and 315 (52.4%) had paroxysmal AF. FFAF was observed in 420 patients (69.9%) at 15 months. Percent change in weight that occurred during the year before ablation independently predicted FFAF through 15-months in all patients (adjusted odds ratio = 1.17, 95% confidence interval: 1.11-1.23). Subgroup analyses based on paroxysmal vs persistent AF, presence of obesity, and history of prior ablation were performed. Percent change in weight over the year before ablation was independently associated with FFAF in all subgroups except nonobese patients with persistent AF. Conclusion:Pre-ablation weight loss was associated with FFAF in both obese and nonobese patients. Further studies are needed to define the optimal approach to weight loss before AF ablation.
Introduction:The Apple watch (AW) irregular rhythm notification (IRN) feature uses photoplethysmography to identify prolonged episodes of irregular rhythm suggestive of atrial fibrillation (AF). IRN is FDA cleared for those with no previous history of AF, however, these devices are increasingly being used for AF management. The objective of the present study was to determine the accuracy of the IRN in subjects with a previous diagnosis of nonpermanent AF.Methods: Subjects with a history of nonpermanent AF and either an insertable cardiac monitor (ICM) or cardiac implanted electronic device (CIED) with <5% ventricular pacing were fitted with an AW Series 5 for 6 months. AF episodes were compared between the ICM/CIED and IRN. The primary endpoints were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the IRN by subject for AF ≥1 h. Secondary endpoints were sensitivity and PPV by AF episode ≥1 h. Analysis was limited to a maximum of 10 ICM/CIED episodes per subject and included only those AF episodes occurring during active AW use confirmed by activity data.Results: Thirty participants were enrolled. Mean age was 65.4 ± 12.2 years and 40% were female. There were 10 ICMs and 20 CIEDs. Eleven subjects had AF on ICM/ CIED while the AW was worn, of whom 8 were detected by IRN. There were no false positive IRN detections by subject ("by subject" 72% sensitivity, 100% specificity, 100% PPV, and 90% NPV). Five subjects had AF only when the AW was not worn. There were a total of 70 AF episodes on ICM/CIED, 35 of which occurred while the AW was being worn. Of these, 21 were detected by IRN with 1 false positive ("by episode" sensitivity = 60.0%, PPV = 95.5%). Conclusion:In a population with known AF, the AW IRN had a low rate of false positive detections and high specificity.
Aims Cardiac magnetic resonance (CMR) was used to assess whether cardiac function or tissue composition was affected in patients with well-functioning metal-on-metal hip resurfacing arthroplasties (MoMHRA) when compared with a group of controls, and to assess if metal ion levels correlated with any of the functional or structural parameters studied. Patients and Methods In all, 30 participants with no significant cardiac history were enrolled: 20 patients with well-functioning MoMHRA at mean follow-up of 8.3 years post-procedure (ten unilateral, ten bilateral; 17 men, three women) and a case-matched control group of ten non-MoM total hip arthroplasty patients (six men, four women). The mean age of the whole cohort (study group and controls) at the time of surgery was 50.6 years (41.0 to 64.0). Serum levels of cobalt and chromium were measured, and all patients underwent CMR imaging, including cine, T2* measurements, T1 and T2 mapping, late gadolinium enhancement, and strain measurements. Results None of the MoMHRA patients showed clinically significant cardiac functional abnormality. The MoMHRA patients had larger indexed right and left end diastolic volumes (left ventricular (LV): 74 ml/m2 vs 67 ml/m2, p = 0.045; right ventricular: 80 ml/m2 vs 71 ml/m2, p = 0.02). There was a small decrease in T2 time in the MoMHRA patients (median 49 ms vs 54 ms; p = 0.0003). Higher metal ion levels were associated with larger LV volumes and with shorter T2 time. Conclusion Although cardiac function is not clinically adversely affected in patients with well-functioning MoMHRA, modern imaging is able to demonstrate subtle changes in structure and function of the heart. As these changes correlate with systemic ion measurements, they may be consequences of wear debris deposition. Longer, longitudinal studies are necessary to determine whether cardiac function will become affected. Cite this article: Bone Joint J 2019;101-B:540–546.
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