Trends in Hospitalization for Atrial Fibrillation: Epidemiology, Cost, and Implications for the Future

Sheikh, Azfar Bilal; Patel, Nileshkumar; Nalluri, Nikhil; Agnihotri, Kanishk; Spagnola, Jonathan; Patel, Aashay; Asti, Deepak; Kanotra, Ritesh; Khan, Hafiz; Savani, Chirag; Arora, Shilpkumar; Patel, Nilay; Thakkar, Badal; Patel, Neil; Pau, Dhaval; Badheka, Apurva; Deshmukh, Abhishek; Kowalski, Marcin; Viles-González, Juan F.; Paydak, Hakan

doi:10.1016/j.pcad.2015.07.002

Cited by 81 publications

(69 citation statements)

References 76 publications

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“…1 Although incidence is higher in the elderly, the burden of AF is found throughout the entire adult population and results in major morbidity, mortality, 2 and healthcare costs. 3 Despite the clear global impact of AF, our current understanding of the underlying disease process and mechanism of the arrhythmia remains substantially less than other common cardiac arrhythmias.…”

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confidence: 99%

Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial Fibrillation

Child

Clayton

Roney

et al. 2018

Circ: Arrhythmia and Electrophysiology

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Background: The mechanisms that initiate and sustain persistent atrial fibrillation are not well characterized. Ablation results remain significantly worse than in paroxysmal atrial fibrillation in which the mechanism is better understood and subsequent targeted therapy has been developed. The aim of this study was to characterize and quantify patterns of activation during atrial fibrillation using contact mapping. Methods: Patients with persistent atrial fibrillation (n=14; mean age, 61±8 years; ejection fraction, 59±10%) underwent simultaneous biatrial contact mapping with 64 electrode catheters. The atrial electrograms were transformed into phase, and subsequent spatiotemporal mapping was performed to identify phase singularities (PSs). RESULTS: PSs were located in both atria, but we observed more PSs in the left atrium compared with the right atrium (779±302, 552±235; P =0.015). Although some PSs of duration sufficient to complete >1 rotation were detected, the maximum PS duration was only 1150 ms, and the vast majority (97%) of PSs persisted for too short a period to complete a full rotation. Although in selected patients there was evidence of PS local clustering, overall, PSs were distributed globally throughout both chambers with no clear anatomic predisposition. In a subset of patients (n=7), analysis was repeated using an alternative established atrial PS mapping technique, which confirmed our initial findings. Conclusions: No sustained rotors or localized drivers were detected, and instead, the mechanism of arrhythmia maintenance was consistent with the multiple wavelet hypothesis, with passive activation of short-lived rotational activity. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01765075.

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confidence: 99%

Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial Fibrillation

Child

Clayton

Roney

et al. 2018

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

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“…This fact makes its diagnosis and therapy extremely challenging and, often, poorly efficient [10]. Indeed, AF accounts for approximately one-third of hospitalizations for all cardiac rhythm disorders [11], thus requiring a significant part of the healthcare budget [12].…”

Section: Introductionmentioning

confidence: 99%

Combined Nonlinear Analysis of Atrial and Ventricular Series for Automated Screening of Atrial Fibrillation

et al. 2017

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Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. It often starts with asymptomatic and short episodes, which are difficult to detect without the assistance of automatic monitoring tools. The vast majority of methods proposed for this purpose are based on quantifying the irregular ventricular response (i.e., RR series) during the arrhythmia. However, although AF totally alters the atrial activity (AA) reflected on the electrocardiogram (ECG), replacing stable P-waves by chaotic and time-variant fibrillatory waves, this information has still not been explored for automated screening of AF. Hence, a pioneering AF detector based on quantifying the variability over time of the AA morphological pattern is here proposed. Results from two public reference databases have proven that the proposed method outperforms current state-of-the-art algorithms, reporting accuracy higher than 90%. A less false positive rate in the presence of other arrhythmias different from AF was also noticed. Finally, the combination of this algorithm with the classical analysis of RR series variability also yielded a promising trade-off between AF accuracy and detection delay. Indeed, this combination provided similar accuracy than RR-based methods, but with a significantly shorter delay of 10 beats.

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“…22 AF-related symptoms and morbidity are, moreover, responsible for frequent visits to the physician and hospitalizations leading to substantial and rising costs. 52 At least 15% of the healthcare budget in cardiac diseases is spent on the management of AF. 7 Moreover, this arrhythmia is associated with a five-fold risk of stroke and a three-fold incidence of congestive heart failure, provoking that AF patients have twice the risk of death than a healthy person of the same age.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

2016

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Atrial fibrillation (AF) is the most common arrhythmia in routine clinical practice. Despite many years of research, its mechanisms still are not well understood, thus reducing the effectiveness of AF treatments. Nowadays, pulmonary vein isolation by catheter ablation is the treatment of choice for AF resistant either to pharmacological or electrical cardioversion. However, given that long-term recurrences are common, an appropriate patient selection before the procedure is of paramount relevance in the improvement of AF catheter ablation outcome. The present work studies how several spectral features of the atrial activity (AA) from a single lead of the surface electrocardiogram (ECG) can become potential pre-ablation predictors of long-term (>2 months) sinus rhythm maintenance. Among all the analyzed spectral features, results indicated that the most significant single predictor of paroxysmal AF ablation treatment outcome was related to the amplitude of the first harmonic of the dominant frequency, providing sensitivity (Se), specificity (Sp) and accuracy (Ac) values of 90%, 42.86 and 77.78%, respectively. On the other hand, the AA harmonic structure was the most significant single predictor for persistent AF, with Se, Sp and Ac values of 100%, 54.55 and 77.27%, respectively. A logistic regression analysis, mainly based on spectral amplitudes as well as on the harmonic structure of the AA, provided a higher predictive ability both for paroxysmal AF (Se = 100%, Sp = 57.14% and Ac = 88.89%) and persistent AF (Se = 90.91%, Sp = 72.73 and Ac = 81.82%). In conclusion, the study of key AA spectral features from the surface ECG can provide a significant preoperative prognosis of AF catheter ablation outcome at long-term follow-up.

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Trends in Hospitalization for Atrial Fibrillation: Epidemiology, Cost, and Implications for the Future

Cited by 81 publications

References 76 publications

Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial Fibrillation

Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial Fibrillation

Combined Nonlinear Analysis of Atrial and Ventricular Series for Automated Screening of Atrial Fibrillation

Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

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