Atrial fibrillation, an epiphenomenon of acute Stanford type‐A aortic dissection with suspected intimo‐intimal intussusception

Ciulla, Michele M.; Vivona, Patrizia; Lemos, A.; Sozzi, Fabiola B.; Cioffi, Ugo; Testori, Alberto

doi:10.1002/ccr3.1701

Cited by 4 publications

(3 citation statements)

References 10 publications

(13 reference statements)

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“…AD, which might involve coronary injury, pericardial involvement, and other direct cardiac effects, could increase the risk of AF . However, there is no argument made in support of an association between AD and subsequent AF although several molecular mechanisms involving the atrial remodeling and weakness of the aortic walls might be possible explanations .…”

Section: Discussionmentioning

confidence: 99%

“…Aortic dissection (AD) is a life threating disease once left undiagnosed or untreated . The phenomenon of AD presenting with atrial fibrillation (AF) has indeed been discussed previously; in case of subclinical AD, AF may occur and be a sign of alert. For clinicians who care for patients with AF, it is well known that stroke, heart failure, and death are common AF complications .…”

Section: Introductionmentioning

confidence: 99%

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Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Lin

2019

Clinical Cardiology

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Objective To explore the link between aortic dissection (AD) and atrial fibrillation (AF). Methods Using the National Health Insurance Research Database (NHIRD), cohorts were constructed for evaluating the incidence of AF in patients with AD (study 1) and the incident AD among AF patients (study 2) based on propensity matching analysis. Cox proportion hazard regression models were used to examine the effect of AD on the risk of AF, shown as hazard ratios (HRs) with 95% confidence intervals (CIs). Similar statistical procedures were used for study 2. Results The study 1 consisted of 11 813 patients in the AD cohort and 11 813 controls in the non‐AD cohort and the study 2 consisted of 190 494 patients in the AF cohort and 190 494 controls in the non‐AF cohort. The overall incidence density of AF was 1.32‐fold higher in the AD cohort than in the non‐AD cohort (11.1 and 8.3 per 1000 person‐years), with an adjusted HR (aHR) of 1.74 (95% CI = 1.53‐1.98). The AF cohort had 1.18‐fold higher incidence of AD than the non‐AF cohort (0.55 vs 0.47 per 1000 person‐years), with an aHR of 1.24 (95% CI = 1.07‐1.44). Conclusions Bidirectional association between AD and AF was shown for the first time in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Lin

2019

Clinical Cardiology

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“…After the first modern literature report in 1962, 7 there were approximately 61 aortic intimal intussusception (AII) studies reported until now, and most of them were case reports. Among them, 55 (90%) involved the natural progression of type A aortic dissection, 8–17 and only 1 reported the complication during transcatheter aortic valve replacement. 18 For TBAD, AII was also demonstrated in natural progression, blunt trauma, and iatrogenic cases from angiography catheter injury.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection

Liu

Chen

et al. 2021

J Endovasc Ther

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Background: Aortic intimal intussusception is well described in the natural progression of type A aortic dissection. Only 3 cases of aortic intimal intussusception were reported to be related to thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. In our study, we are reporting a rare but potentially fatal complication, the intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII); this study reports a series of endovascular repair for ISAII cases. By presenting the ISAII definition, the diagnostic steps to rule out or to identify the condition, and the techniques to resolve it, we intended to raise the awareness of this severe complication, so that physicians can adapt to overcome the complications while performing TEVAR. Materials and Methods: ISAII was defined as the partial or circumferential disruption of the distal intimal flap as an intraoperative complication of endovascular treatment. From January 2014 to June 2020, 1,096 patients underwent TEVAR for Stanford type B aortic dissection at our hospital. Among them, 14 ISAII complications were witnessed. All these patients underwent endovascular repair for ISAII lesions, and their data were extracted for analysis. Results: The ISAII lesions were classified into 3 types according to their location in different aortic segments: type I, ISAII was limited within the intended SG coverage segment; type II, ISAII occurred after SG introduction or deployment, and the detached intimal flap extended beyond the intended SG coverage segment but did not affect the abdominal aortic visceral branches; type III, ISAII occurred during SG introduction or deployment, and the detached intimal flap descended to the abdominal aortic segment with visceral branches. Our results showed ISAII as a rare complication with an incidence of 1.28% (14/1096), and endovascular repair for all types of ISAII is an effective treatment. With a mean follow-up of 27.36 months (range 5–71 months), all the ISAII lesions were stable, and all the major aortic branches, SGs, and bare stents were patent. Conclusions: The management of this potentially devastating intraoperative complication relies on accurate diagnosis and prompt management. Our results suggested that endovascular repair for ISAII is effective and durable for correcting this complication. Graphical Abstract [Formula: see text]

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Less Known but Clinically Relevant Comorbidities of Atrial Fibrillation: A Narrative Review

Koraćević

Stojković

Stojanović³

et al. 2022

CVP

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Background: The important risk factors for atrial fibrillation (AF) in the general population are not always equally important in specific and relatively prevalent diseases. Objective: The main goal of this narrative review is to focus attention on the presence and the relationship of AF with several important diseases, such as cancer or sepsis, in order to: 1) stimulate further research in the field, and 2) draw attention to this relationship and search for AF in clinical practice. Methods: We searched PubMed, SCOPUS, Elsevier, Wiley, Springer, Oxford Journals, Cambridge, SAGE, and Google Scholar for less-known comorbidities of AF. The search was limited to publications in English. No time limits were applied. Results: AF is widely represented in cardiovascular and other important diseases, even in those in which AF is rarely mentioned. In some specific clinical subsets of AF patients (e.g., patients with sepsis or cancer), the general risk factors for AF may not be so important. Patients with new-onset AF have a several-fold increase in relative risk of cancer, deep vein thrombosis, and pulmonary thromboembolism (PTE) during the follow-up. Conclusion: AF presence, prognosis, and optimal therapeutic approach are insufficiently recognised in several prevalent diseases, including life-threatening ones. There is a need for a better search for AF in PTE, pulmonary oedema, aortic dissection, sepsis, cancer and several gastrointestinal diseases. Improved AF detection would influence treatment and improve outcomes.

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Atrial fibrillation, an epiphenomenon of acute Stanford type‐A aortic dissection with suspected intimo‐intimal intussusception

Cited by 4 publications

References 10 publications

Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection

Less Known but Clinically Relevant Comorbidities of Atrial Fibrillation: A Narrative Review

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