Prognosis in patients with atrial fibrillation and a presumed “temporary cause” in a community-based cohort study

Fauchier, Laurent; Clémenty, Nicolas; Bisson, Arnaud; Stamboul, Karim; Ivanès, Fabrice; Angoulvant, Denis; Babuty, Dominique; Lip, Gregory Y.H.

doi:10.1007/s00392-016-1040-7

Cited by 26 publications

(17 citation statements)

References 35 publications

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“…This may support the need for stroke prevention in patients with AHREs which is currently under evaluation in randomized control trials; two ongoing trials are exploring this issue [19, 20]. Apart from CIEDs, increasingly sophisticated means of monitoring (e.g., implanted loop recorders) to detect AHREs in various clinical settings and high-risk groups, that would merit consideration of stroke prevention, have been recently investigated [21–23]. Of note, a recent consensus document from the European Heart Rhythm Association recommended that patients presenting with subclinical atrial tachyarrhythmias (i.e., AHRE > 5 min) should be considered for oral anticoagulation when ≥ 2 stroke risk factors using the CHA 2 DS 2 -VASc score are present [24].…”

Section: Discussionmentioning

confidence: 99%

Inflammation and the risk of atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices

Pastori

Miyazawa

et al. 2018

Clin Res Cardiol

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IntroductionAtrial high-rate episodes (AHREs) are associated with an increased risk of developing atrial fibrillation and thromboembolism. The characteristics of ‘real world’ patients developing AHREs are poorly known.MethodsWe included 496 consecutive patients with cardiac implantable electronic devices (CIEDs). Primary endpoint was occurrence of AHREs, defined as > 175 bpm and lasting > 5 min, in a median follow-up of 16.5 (IQR 3.9–38.6) months (1082.4 patient-years). We also tested the predictive value of clinical risk scores for AHREs.ResultsMean age was 68.8 ± 14.0 years, and 35.5% were women; AHREs were recorded in 173 patients [34.7%, 16.0%/year, 95% confidence interval (CI) 13.7–18.6]. Multivariable Cox regression analysis showed that age [hazard ratio (HR) 1.020, 95% CI 1.004–1.035, p = 0.011], prior AF (HR 3.521, 95% CI 2.831–5.206, p < 0.001), white cell count (HR 1.039, 95% CI 1.007–1.072, p = 0.016) and high C reactive protein (CRP; HR 1.039, 95% CI 1.021–2.056, p = 0.038) were independently associated with AHREs. ROC curve analysis showed that the APPLE score (C statistic 0.53, 95% CI 0.48–0.59; p = 0.296) ALARMEc score (C statistic 0.51, 95% CI 0.44–0.57; p = 0.810) were non-significantly associated with AHRE. Similar results were obtained for CHADS2 and CHA2DS2VASc scoreConclusionAHREs are common in CIEDs patients, with age, prior AF, inflammatory markers (high CRP, white cell count) being factors associated with AHREs onset. Clinical risk scores showed limited value for AHREs prediction in this cohort.Electronic supplementary materialThe online version of this article (10.1007/s00392-018-1244-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Inflammation and the risk of atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices

Pastori

Miyazawa

et al. 2018

Clin Res Cardiol

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“…Clinical practice guidelines, including those published by the Canadian Cardiovascular Society (CCS), American Heart Association (AHA), and the European Society of Cardiology (ESC), recommend that health care providers risk‐stratify patients with clinical AF to predict their risk‐benefit ratio for taking OAC . However, in many cases where AF is detected transiently while patients are hospitalized for an acute stressor (eg, medical illness or following surgery), OAC is not prescribed . AF in this setting may be due to a combination of underlying myocardial substrate and triggering pathophysiologic factors, but its detection may also be explained in some part by continuous inpatient heart rhythm monitoring …”

Section: Background and Rationalementioning

confidence: 99%

“…AFOTS is detected with variable frequency . In our previous work, we reviewed the incidence of AFOTS and the recurrence of AF following an acute medical stressor .…”

Section: Background and Rationalementioning

confidence: 99%

Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) follow‐up cohort study

McIntyre

Mendoza

Belley‐Côté

et al. 2018

Clinical Cardiology

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Atrial fibrillation occurring transiently with stress (AFOTS) describes the first detection of AF in a patient who is hospitalized for a non-cardiac medical illness or following non-cardiac surgery. Uncertainty exists whether episodes of AFOTS are due to reversible precipitants and will not recur after recovery, or if they are paroxysmal atrial fibrillation (AF) that is detected during inpatient cardiac monitoring. Previous studies have used retrospective, non-systematic and ultimately low-sensitivity protocols to investigate the recurrence of AF in patients with AFOTS. The prospective, multi-center, investigator-initiated AFOTS Follow-Up Cohort Study will enroll 138 case patients with AFOTS in the setting of non-cardiac surgery or medical illness, matched 1:1 with control patients for age, sex, stressor, and hospital unit. Participants will wear a 14-day ECG heart monitor at 1 and 6 months after hospital discharge. Over 12 months of follow-up, we will collect data regarding participant's medications, and clinical events. The primary endpoint is detection of 30 or more seconds of AF after hospital discharge. To date, 50% of the target sample has been enrolled. The study is expected to complete enrolment in mid-2019 and conclude 1 year later. The AFOTS follow-up study will employ a systematic protocol to detect AF and will provide a precise and valid estimate of AF recurrence following AFOTS. This study will establish whether patients with AFOTS have an increased propensity to AF after hospitalization as compared to matched controls and may inform the management of this population.

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“…However, in some cases, AF detected after acute IS may be shortlasting and perhaps a nonrecurrent autonomic and inflammatory epiphenomena of stroke, so some patients may face an unnecessary risk of bleeding (Haeusler et al, 2018). In addition, more knowledge is needed to determine the mediating mechanism of AF detected after IS, and to effectively prevent the occurrence of new-onset AF after IS (Sposato et al 2014;Scheitz et al 2015;Fauchier et al 2017). Previous population-based observational studies found that IS has been established as a risk factor of AF (Rizos et al 2015;Luo et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Exploring the causal pathway from ischemic stroke to atrial fibrillation: a network Mendelian randomization study

Hou

et al. 2020

Mol Med

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Background and purpose: Previous studies have found ischemic stroke is associated with atrial fibrillation. However, the causal association between ischemic stroke and atrial fibrillation is not clear. Furthermore, the network relationship among ischemic stroke, atrial fibrillation and its risk factors need further attention. This study aims to examine the potential causal association between ischemic stroke and atrial fibrillation and further to explore potential mediators in the causal pathway from ischemic stroke to atrial fibrillation. Methods: Summary statistics from the ISGC (case = 10,307 and control = 19,326) were used as ischemic stroke genetic instruments, AFGen Consortium data (case = 65,446 and control = 522,744) were used for atrial fibrillation, and other consortia data were used for potential mediators (fasting insulin, white blood cell count, procalcitonin, systolic and diastolic blood pressure, body mass index, waist circumference, and height). Under the framework of network Mendelian randomization, two-sample Mendelian randomization study was performed using summary statistics from several genome-wide association studies. Inverse-variance weighted method was performed to estimate causal effect. Results: Blood pressure mediates the causal pathways from ischemic stroke to atrial fibrillation. The total odds ratio of ischemic stroke on atrial fibrillation was 1.05 (95% confidence interval [CI], 1.02 to 1.07; P = 1.3 × 10 −5). One-unit increase of genetically determined ischemic stroke was associated with 0.02 (DBP: 95% CI, 0.001 to 0.034, P = 0.029; SBP: 95% CI, 0.006 to 0.034, P = 0.003) upper systolic and diastolic blood pressure levels. Higher genetically determined systolic and diastolic blood pressure levels were associated with higher atrial fibrillation risk (DBP: RR, 1.18; 95% CI, 1.03 to 1.35; P = 0.012. SBP: RR, 1.18; 95% CI, 1.01 to 1.38; P = 0.04). Specially, we also found the bidirectional causality between blood pressure and ischemic stroke. Conclusions: Our study provided a strong evidence that raised blood pressure in stroke patients increases the risk of atrial fibrillation and active acute blood pressure lowering can improve the outcome in ischemic stroke patients.

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Prognosis in patients with atrial fibrillation and a presumed “temporary cause” in a community-based cohort study

Abstract: AF patients with presumed temporary cause of AF had a similar risk of stroke/thromboembolism and a worse prognosis for cardiovascular mortality than other AF patients. Use of oral anticoagulation was associated with a better prognosis in these patients.

Cited by 26 publications

References 35 publications

Inflammation and the risk of atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices

Inflammation and the risk of atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices

Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) follow‐up cohort study

Exploring the causal pathway from ischemic stroke to atrial fibrillation: a network Mendelian randomization study

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