Risk of Thromboembolic Events in Atrial Fibrillation With Chronic Kidney Disease

Zeng, Wenjing; Sun, Xiaochuan; Tang, Kai; Mei, Wei‐Yi; Liu, Lijuan; Xu, Qing; Cheng, Yun‐Jiu

doi:10.1161/strokeaha.114.006881

Cited by 61 publications

(40 citation statements)

References 45 publications

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“…Pooled RRs were expressed with 95% CIs. We calculated the I 2 (95% CI) statistic to assess heterogeneity across studies, applying the following interpretation for I 2 : <50%=low heterogeneity; 50% to 75%=moderate heterogeneity; >75%=high heterogeneity . Subgroup analyses and meta‐regression models were carried out to investigate potential sources of between‐study heterogeneity.…”

Section: Methodsmentioning

confidence: 99%

Role of Early Repolarization Pattern in Increasing Risk of Death

Cheng

Lin

et al. 2016

JAHA

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BackgroundAn early repolarization pattern (ERP) has been hypothesized to be arrhythmogenic in experimental studies, but the prognostic significance of the ERP in the general population is controversial. We performed a meta‐analysis to examine the link between ERP and the risk of sudden cardiac arrest (SCA), cardiac death, and death from any cause.Methods and ResultsWe performed a literature search using MEDLINE (January 1, 1966 to July 31, 2015) and EMBASE (January 1, 1980 to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Sixteen studies involving 334 524 subjects were identified. Compared with those without ERP, subjects with ERP experienced significantly increased risk for developing SCA (RR 2.18; 95% CI 1.29–3.68), cardiac death (RR 1.48; 95% CI 1.06–2.07), and death from any cause (RR 1.21; 95% CI 1.02–1.42), respectively. The increased risk was present predominantly in Asians and whites but not in African Americans. ERP with J‐point elevation in inferior leads, notching configuration, and horizontal or descending ST segment connote higher risk. ERP was associated with an absolute risk increase of 139.6 (95% CI 130.3–149.3) additional SCAs per 100 000 person‐years and responsible for 7.3% (95% CI 1.9–15.2) of SCA in the general population.Conclusions ERP is associated with significant increased risk for SCA, cardiac death, and death from any cause. Future studies should focus on understanding the exact mechanisms for the arrhythmia risk and developing reliable tools for risk stratification.

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Section: Methodsmentioning

confidence: 99%

Role of Early Repolarization Pattern in Increasing Risk of Death

Cheng

Lin

et al. 2016

JAHA

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“…In the present study, two other risk factors associated with the occurrence of ES after AF ablation were poor kidney function and prior TE. A previous meta‐analysis has demonstrated that patients with impaired renal function were significantly at risk of developing TE as those having other well‐known major risk factors . Prior TE is also a well‐known risk factor of recurrent ES after AF ablation and has been reported to increase the risk by 4.5 to 6.3‐folds .…”

Section: Discussionmentioning

confidence: 99%

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Ahn

Shin

Shim

et al. 2019

Cardiovasc electrophysiol

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Introduction Risk factors of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated especially among the Asian subjects, particularly regarding epicardial adipose tissue (EAT) in cardiac imaging. We aimed to assess the incidence of ES during a long‐term follow‐up period after AF ablation and to identify the risk factors associated with postablation ES, specifically focusing on EAT. Methods and Results We enrolled patients who experienced postablation ES and control subjects from a consortium of AF ablation registries from three institutes in Korea. EAT was assessed using multislice computed tomography before AF ablation. A total of 3464 patients who underwent AF ablation were recruited and followed‐up. During a follow‐up of 47.2 ± 36.4 months, ES occurred in 47 patients (1.36%) with a CHA2DS2‐VASc score of 1.48 ± 1.39 and the overall annual incidence of ES was 0.34%. Compared with the control group (n = 190), the ES group showed significantly higher prior thromboembolism (TE) and AF recurrence rates, larger left atrium size, lower creatinine clearance rate (CCr), and greater total and peri‐atrial EAT volume. Multivariate regression analysis demonstrated larger peri‐atrial EAT volume (hazards ratio, 1.065; 95% confidence interval, 1.005‐1.128), in addition to a prior history of TE and lower CCr, was independently associated with postablation ES. When a cut‐off value of peri‐atrial EAT volume of ≥20.15 mL was applied, patients with smaller peri‐atrial EAT volume showed significantly higher ES‐free survival. Conclusion Larger peri‐atrial EAT volume, in addition to prior TE and lower CCr, was independently associated with postablation ES regardless of AF recurrence and CHA2DS2‐VASc score. (ClinicalTrials.gov number, NCT03479073).

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“…Summary RRs were estimated by pooling the study-specific estimates using random rather than fixed effects models in order to take into account the between-study heterogeneity. 11 To assess for heterogeneity of RRs across studies, the I 2 (95% CI) statistic was calculated with the following interpretation: low heterogeneity defined as I 2 <50%; moderate heterogeneity defined as I 2 50% to 75%; high heterogeneity defined as I 2 >75%. 12 Heterogeneity was also calculated by comparing results from studies stratified according to prespecified study-level characteristics with meta-regression and subgroup analyses.…”

Section: Methodsmentioning

confidence: 99%

Digoxin Use and Adverse Outcomes in Patients With Atrial Fibrillation

Zeng

Liu

et al. 2016

Medicine

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Digoxin has long been used for rate control in atrial fibrillation (AF); its safety remains controversial.We performed a literature search using MEDLINE (source PubMed, January 1, 1966, to July 31, 2015) and EMBASE (January 1, 1980, to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Pooled effect estimates were obtained by using random-effects meta-analysis.Twenty-two studies involving 586,594 patients were identified. Patients taking digoxin, as compared with those who took no digoxin, experienced an increased risk of death from any cause (RR: 1.29[95% CI 1.16–1.43]), even after reported adjustment for propensity scores (RR: 1.28[95% CI 1.18–1.39]). The risk of death was increased with patients with or without heart failure (RR: 1.12[95% CI 1.02–1.23] and RR: 1.26[95% CI 1.15–1.29], respectively), and patients taking or not taking beta blockers (RR: 1.17 [95% CI 1.06–1.30] and RR: 1.28 [95% CI 1.08–1.51], respectively). Digoxin use was also associated with increased risk of cardiovascular death (RR: 1.32 [95% CI 1.07–1.64]), arrhythmic death (RR: 1.38 [95% CI 1.07–1.79]), and stroke (RR: 1.20 [95% CI 1.004–1.44]). Digoxin treatment is associated with an absolute risk increase of 19 (95% CI 13–26) additional deaths from any cause per 1000 person-years.Digoxin use is associated with a significant increased risk for death from any cause in patients with AF. This finding suggests a need for reconsideration of present treatment recommendations on use of digoxin in AF.

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Risk of Thromboembolic Events in Atrial Fibrillation With Chronic Kidney Disease

Cited by 61 publications

References 45 publications

Role of Early Repolarization Pattern in Increasing Risk of Death

Role of Early Repolarization Pattern in Increasing Risk of Death

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Digoxin Use and Adverse Outcomes in Patients With Atrial Fibrillation

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