New 2019 guidelines for patients with atrial fibrillation

by University of Minnesota

Nearly 3 million Americans are living with atrial fibrillation (AFib), which is described as quivering or irregular heartbeat (arrhythmia). With increasing lifespan and increasing prevalence of risk factors such as obesity, experts believe the number of people living with AFib will increase at an exponential rate in the next decade. This has important public implications since AFib is associated with a higher risk of stroke, heart failure, cognitive decline and dementia, and death.

25 feb 2019--Lin Yee Chen, MD, MS, Associate Professor with Tenure, Cardiovascular Division, in the Department of Medicine with the University of Minnesota Medical School was part of a Writing Committee tasked with updating the 2014 guidelines for patients with AFib. The 2019 American College of Cardiology/American Heart Association/Heart Rhythm Society Guidelines for the Management of Patients with Atrial Fibrillationwere just published in Circulation, the Journal of the American College of Cardiology, and Heart Rhythm as the standard for the management of Afib in the U.S.

"These guidelines are written for all physicians in all specialties," said Chen. "It doesn't matter whether the clinician is an orthopedic surgeon, gynecologist, oncologist or brain surgeon, everyone is bound to encounter AFib in their patients because it is so prevalent."

One section of the new guidelines speaks to guiding practitioners across the whole spectrum of medicine, focusing on the use of new blood thinners or anticoagulants in people with AFib. The new guidelines help determine how and when to use these new agents, including in a situation that involves surgery.

Another portion of the document addresses the management of AFib in different scenarios, such as patients who have developed heart attacks.

"AFib patients are put on blood thinners to prevent stroke. When we need to perform procedures like a coronary angioplasty to open up any blockage in the heart arteries during a heart attack

 in AFib patients, we will also have to prescribe other agents called antiplatelets which when used in combination with blood thinners can elevate significantly the risk of bleeding, which is a real dilemma." said Chen. "Current research is now in favor of double therapy- one antiplatelet agent and one anticoagulant, as opposed to two antiplatelets and an anticoagulant."

A final section addresses the importance of weight-loss and weight management in improving the outcomes in people with AFib. In recent years, there is increasing evidence to suggest that lifestyle modification such as weight loss and physical activity can reduce the frequency and the burden of AFib. This has been incorporated into the new guidelines.

"The University of Minnesota could potentially make some significant contributions in the field of lifestyle modification and AFib," explained Chen. "Currently, I am the Principal Investigator of an Academic Health Center Faculty Research and Development grant which funds a randomized controlled trial aimed at evaluating different exercise protocols in reducing the burden of AFib.

"Being represented on the Writing Committee is a great honor for the University of Minnesota Medical School, because ultimately, the point of our research is to influence and impact the way we practice medicine," said Chen. "I think this is testimony to the outstanding research we perform for AFib at the University of Minnesota which is recognized by the American Heart Association and the American College of Cardiology."

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Provided by University of Minnesota

Apple's smartwatch has a heart monitor now

There will soon be another way to monitor your heart—from your wrist.


The Apple Watch 4 that was unveiled Wednesday will include electrocardiogram testing. Often referred to as an EKG or ECG, this is how health care providers check the electrical signals in a patient's heart. To a layman, these are the squiggly lines across a monitor.

14 sept 2018--Usually, it takes several electrodes patches stuck to a person's chest to get this information. Having it accessible through the watch could lead to quicker diagnosis of atrial fibrillation, an irregular and often rapid heart rate that can increase a person's risk of stroke, heart failure and other heart-related complications.
"This can be an addition to our growing armamentarium to diagnose AFib, which can be intermittent and asymptomatic," said Dr. Lin Yee Chen, co-director of the Atrial Fibrillation Center at University of Minnesota Health Heart Care. He had not seen the device or learned any details beyond the basics provided by Apple.
"We need to make sure that the technology can be validated and that it actually translates to changes in outcomes," he said. "That's not a given. Just because you have a technology, doesn't necessarily mean a public health burden of disease will be reduced."
AFib affects up to 6.1 million people in the United States, a number that researchers expect will double by 2050. Untreated, AFib doubles the risk of heart-related death and increases a person's chance of having a stroke fivefold.
Apple considered this development so important that it invited Dr. Ivor Benjamin, president of the American Heart Association, to be on stage for the announcement at company headquarters in Cupertino, Calif.
"Capturing meaningful data about a person's heart, in real time, is changing the way we practice medicine," said Benjamin, who is also director of the Cardiovascular Center at the Medical College of Wisconsin. "In my experience, people often report symptoms that are absent during their medical visits. That's why information is vital information about a person's daily lifestyle choices and their specific health data."
Every time you heart beats, it sends an electrical impulse—or a "wave"—through your heart. The visual representation of those waves provides two types of crucial information:

1. How long it takes for each electrical wave to pass through the heart. This determines whether a heartbeat is slow, fast, irregular—or normal.
2. How much electricity is passing through the heart. This can indicate if the heart is too large or overworked.

To take the test via the Apple Watch 4, a user must launch the ECG app and follow on-screen instructions to place a finger on the screen for 30 seconds. Using electrodes in the watch face and a new electrical heart rate sensor in the back crystal, the app will determine if the heart is beating normally or whether it detects signs of atrial fibrillation.
All recordings and any noted symptoms are stored in the Health app and can generate a PDF that can be shared with health care experts.
While the watch comes out later this month, Apple said the ECG app will be available in the United States later this year. The company also said the app received a type of classification from the Food and Drug Administration that allows the release of low- to moderate-risk devices.
The Apple Watch joined the market in 2015 and already has become the leader in the crowded field of smartwatches, many of which already measure pulse rate. As competition seeks to catch up or get ahead on the technologies offered, further refinements to heart monitoring could become available.
While the AHA does not endorse the watch, or any other products and had no role in Apple's ECG app—Benjamin said that the organization is all for any advancements in the tools that can help fight heart disease, the No. 1 killer of Americans.

Source: American Heart Association

USPSTF: insufficient evidence to screen for atrial fibrillation

There is insufficient evidence to support screening for atrial fibrillation (AF) with electrocardiography (ECG) in older, asymptomatic patients, according to a U.S. Preventive Services Task Force (USPSTF) final recommendation published in the Aug. 7 issue of the Journal of the American Medical Association.

16 aug 2018--Susan J. Curry, Ph.D., from the University of Iowa in Iowa City, and USPSTF colleagues reviewed the evidence on the benefits and harms of screening for AF with ECG in adults 65 years and older. They also assessed the effectiveness of screening with ECG for detecting previously undiagnosed AF compared with usual care, as well as the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected AF in older adults.
The Task Force found that most older adults with previously undiagnosed AF have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment, which is effective for stroke prevention in symptomatic adults. However, there was inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. The harms of diagnostic follow-up and treatment resulting from abnormal ECG results are well established and include misdiagnosis and invasive testing.
"Clinicians should use their medical judgement on whether to screen for AF in people 65 years and older with no signs or symptoms," Task Force member Michael Barry, M.D., said in a statement.

More information: Final Recommendation
Evidence Report

Wearable, at-home patch could spot your A-fib early

Zio®XT patch. Photo: iRhythm Technologies

The common but dangerous heart rhythm disorder known as atrial fibrillation—or a-fib—can go undetected for years. Now, research suggests a high-tech, wearable patch might spot the condition early.

11 july 2018--Use of the Zio XT wireless patch, made by iRhythm, produced "an almost threefold improvement in the rate of diagnosis of a-fib in those actively monitored compared to usual care," said study lead author Dr. Steven Steinhubl. He directs digital medicine at the Scripps Translational Science Institute, in La Jolla, Calif.
The patch monitors electrocardiogram (ECG) readings via the skin, looking for telltale signs of arrhythmia—an irregular heartbeat.
Spotting the irregular heartbeat is key, Steinhubl said, since a-fib greatly raises stroke risk.
"Timely diagnosis of a-fib more effectively can enable the initiation of effective therapies and help reduce strokes and death," Steinhubl said in a Scripps news release.
One heart specialist not tied to the study said that the late detection of a-fib—which plagues nearly 6 million Americans—is a real issue.
"Many patients who come in with a diagnosis of atrial fibrillation have had it for quite some time prior to seeing a doctor," said Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City. "By catching it early—that is, before symptoms of palpitations, passing out and stroke—one can lower the incidence of stroke related to undiagnosed atrial fibrillation."
The new study was funded by Janssen Pharmaceuticals as well as the U.S. National Institutes of Health. The study involved more than 5,200 people from across the United States, many of whom received and returned the small wearable patch by mail. Participants were all deemed to have risk factors that boosted their odds for a-fib.
About one-third of the participants wore the patch— which adheres to the skin—and were monitored continuously for up to two weeks.
The other two-thirds served as a comparison group. These patients received usual care, typically routine visits to their primary care physician. If they were diagnosed with a-fib that information turned up in their medical claims records.
The result: After one year, a-fib was diagnosed in 109 people in the patch-monitored group (6.3 percent) versus 81 people in the unmonitored group (2.4 percent), Steinbhul's group reported. That's a near tripling of the diagnosis rate, the study authors noted.
"This study demonstrates the utility of a digital approach not only to diagnosing asymptomatic a-fib, but to the clinical research field as a whole," Steinhubl said.
Dr. Marcin Kowalski directs cardiac electrophysiology at Staten Island University Hospital, in New York City. He believes the advent of devices like the Zio XT patch could be a boon to medical care, but it might also bring new problems.
Aside from spotting a-fib, these devices are "capable of diagnosing other arrhythmias," which otherwise might go undetected, Kowalski said.
The potential downside, he said, is more work for an already overloaded health care system.
"One must be mindful of the increase in data volume and the resources necessary to process," Kowalski explained. "This technology could increase the number of transmissions, which may burden a health care provider's limited resources."
The study was published July 10 in the Journal of the American Medical Association.

More information: The U.S. National Heart, Lung, and Blood Institute has more on atrial fibrillation.

Regular nut intake linked to lower risk of heart rhythm irregularity (atrial fibrillation)

Credit: CC0 Public Domain

Eating several servings of nuts every week may help lower the risk of developing the heart rhythm irregularity, atrial fibrillation, also known as heart flutter, finds research published online in the journal Heart.
This level of consumption may also lessen the risk of developing heart failure, although the findings are less consistent, the research indicates.

22 april 2018--Previous studies have suggested that eating nuts regularly is associated with a lower risk of heart disease/stroke and associated death, but it's not clear which particular aspects of cardiovascular disease nut consumption may be linked to.
To explore this in more depth, the researchers drew on the completed Food Frequency Questionnaire responses and lifestyle information from more than 61,000 Swedish 45-83 year olds. Their cardiovascular health was then tracked for 17 years (to the end of 2014) or until death, whichever came first.
People who ate nuts tended to be better educated and to have healthier lifestyles than those who didn't include nuts in their diet. They were less likely to smoke or to have a history of high blood pressure. And they were leaner, more physically active, drank more alcohol and ate more fruit and vegetables.
During the monitoring period, there were 4983 heart attacks, of which 917 were fatal; 3160 cases of heart failure; 7550 cases of atrial fibrillation; 972 cases of aortic valve narrowing; 983 abdominal aortic aneurysms (a bulge or swelling in the aorta, a major artery); and 3782 cases of stroke caused by a blood clot (ischaemic) and 543 caused by a brain bleed (intracerebral haemorrhage).
Nut consumption was associated with a lower risk of heart attack, heart failure, atrial fibrillation and abdominal aortic aneurysm, after taking account of age and sex.
But when several potentially influential known risk factors were accounted for, including lifestyle, general diet, diabetes, and family history, only associations with atrial fibrillation and with heart failure emerged.
The more often nuts were included in the diet, the lower was the associated risk of atrial fibrillation, the findings showed.
Eating a serving of nuts one to three times a month was associated with a lowered risk of just 3 percent, rising to 12 percent when eating them once or twice a week, and to 18 percent when eating them three or more times a week.
The findings for heart failure were less consistent: moderate, but not high, weekly nut consumption was associated with a 20 percent lower risk.
Each additional portion of nuts eaten during the week was associated with a 4 percent lowering in atrial fibrillation risk.
Eating nuts regularly was not associated with a lower risk of the narrowing of the valve serving the heart's largest artery, the aorta, or with the risk of stroke.
This is an observational study, and as such, cannot establish causation. And the researchers emphasise that those who ate nuts had fewer cardiovascular risk factors to start with, which may have affected the findings.
But the strength of the study lies in its large size and the large number of cardiovascular disease cases reported during the monitoring period, they say.
Nuts are a rich source of healthy fats, minerals, and antioxidants, all of which may aid cardiovascular health, they explain.
"Nut consumption or factors associated with this nutritional behaviour may play a role in reducing the risk of atrial fibrillation and possibly heart failure," they write.
And they suggest: "Since only a small proportion of this population had moderate (about 5%) or high (less than 2%) nut consumption, even a small increase in nut consumption may have large potential to lead to a reduction in incidence of atrial fibrillation and heart failure in this population."

More information: Nut consumption and incidence of seven cardiovascular diseases, Heart (2018). heart.bmj.com/lookup/oi/10.113 … heartjnl-2017-312819


Provided by British Medical Journal

Mobile application detecting atrial fibrillation reduces the risk of stroke

The app can detect atrial fibrillation when it is held against the person's chest. Credit: Hanna Oksanen / University of Turku

A new smartphone application developed at the University of Turku, Finland, can detect atrial fibrillation that causes strokes. Atrial fibrillation can now be detected without any extra equipment. The mobile application can save lives all over the world as timely diagnosis of atrial fibrillation is crucial for effective stroke prevention.

20 mar 2018--The joint research project of the University of Turku and the Heart Centre of the Turku University Hospital involved 300 heart patients, half of whom had atrial fibrillation. The researchers managed to identify the patients with atrial fibrillation from the other group using the app.
The mobile application detected which patients had atrial fibrillation with 96 percent accuracy. In other words, the application recognised automatically near all cases with atrial fibrillation and the number of false alarms was very low.
"The results are also significant in that the group included different kinds of patients, some of whom had heart failure, coronary disease, and ventricular extrasystole at the same time. The research was conducted as a blind study, which means that the hospital sent us measurement data for analysis without any additional information," says Project Manager Tero Koivisto from the Department of Future Technologies.
The completed analyses were sent back to the hospital where their reliability was checked. This way, additional optimisation during the study on the basis of the data was not possible.
"At first, I was rather anxious about how well the algorithm will do in the blind study, especially because I felt that the patient group was particularly challenging. You could say that I was surprised myself how well it worked in the end," says Mr Koivisto.
The application has been under development for quite some time, requiring seven years of careful research. Detecting atrial fibrillation has been a worldwide medical challenge for years, but affordable solutions available for all have been lacking. When technology researchers at the University of Turku were designing new solutions in collaboration with cardiologists of Turku University Hospital back in 2011, they decided to investigate whether it was possible to detect atrial fibrillation from the micromovements in the chest using small accelerometers . They determined that it is possible.
"Most smartphones have an accelerometer. As nearly everyone has a smart phone, we decided to develop a simple application that could be used for detection. In the future, everyone who owns a smartphone can detect atrial fibrillation," says Mr Koivisto.
According to Chief Physician and Professor of Cardiology Juhani Airaksinen from Turku University Hospital, this is the first time that ordinary consumer electronics have achieved such reliable results that they can be actually beneficial for the patient's medical care. The results are also remarkable in that intermittent atrial fibrillation is not always detected even at the doctor's office.
"If everyone can measure with an ordinary smartphone whether they have atrial fibrillation, we have the possibility to direct patients straight to the doctor and further testing without any delay. Therefore, the potential for economic savings is significant," says Professor Airaksinen.
The researchers want to make the application available for all as quickly as possible, and they believe that it will also spread to the international market. According to Mr Koivisto, the commercialisation of the method is advancing quickly.
The results of the study was published in the Circulation journal.

More information: Jussi Jaakkola et al, Mobile Phone Detection of Atrial Fibrillation With Mechanocardiography: The MODE-AF Study (Mobile Phone Detection of Atrial Fibrillation), Circulation (2018). DOI: 10.1161/CIRCULATIONAHA.117.032804


Provided by University of Turku

USPSTF reviews use of ECG for preventing A-fib, CVD events

The U.S. Preventive Services Task Force (USPSTF) has found that the current evidence is inadequate to assess the benefits and harms of screening with electrocardiogram (ECG) for atrial fibrillation (AF) in older adults; and for low-risk adults, screening with resting or exercise ECG is not recommended for preventing cardiovascular disease (CVD) events. These findings form the basis of two draft recommendation statements published online Dec. 19 by the USPSTF.

21 dec 2017--Researchers from the USPSTF reviewed the evidence on screening for and the treatment of nonvalvular AF among adults aged 65 years and older. The evidence was inadequate to assess whether screening with ECG identified older adults with previously undiagnosed AF more effectively than usual care. The Task Force found adequate evidence that screening is associated with small-to-moderate harms. Based on these findings, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of AF screening with ECG (I statement).
USPSTF researchers also examined the evidence on screening asymptomatic adults for CVD risk using resting or exercise ECG. The evidence was inadequate to examine whether incremental information offered by resting or exercise ECG can reduce CVD events. However, the Task Force found adequate evidence that screening can lead to small or moderate harms. Based on these findings, the USPSTF concludes that the potential harms of screening are equivalent to or exceed the potential benefits among asymptomatic adults at low risk for CVD events (D recommendation).
The two draft recommendation statements have been posted for public comment. Comments can be submitted through Jan. 22, 2018.

More information:

Evidence Review - A-FIB
Draft Recommendation Statement - A-FIB
Comment on Recommendation Statement - A-FIB
Evidence Review - CVD
Draft Recommendation Statement - CVD
Comment on Recommendation Statement - CVD

Major bleeding risk from drugs similar in elderly

The risk of major bleeding is similar for older patients with atrial fibrillation taking either antiplatelet or anticoagulant drugs, according to a review published online April 10 in the Journal of Thrombosis and Haemostasis

18 april 2017--Marc Melkonian, M.D., from the Hôpitaux Universitaires Pitie-Salpêtrière-Charles Foix in France, and colleagues conducted a systematic review and meta-analysis to evaluate major bleeding in randomized and non-randomized controlled trials (RCTs) and parallel cohorts comparing antiplatelet drugs and oral anticoagulants in patients 65 years or older.
Based on seven RCTs (4,550 patients) and four cohort studies (38,649 patients), the researchers found that the risk of major bleeding on aspirin or clopidogrel was equal to that on warfarin in RCTs (relative risk [RR], 1.01; 95 percent confidence interval [CI], 0.69 to 1.48; moderate-quality evidence), lower than on warfarin in non-randomized cohort studies (RR, 0.87; 95 percent CI, 0.77 to 0.99; low-quality evidence), and not different when all studies were combined (RR, 0.86; 95 percent CI, 0.73 to 1.01). Any severity of bleeding (RR, 0.70; 95 percent CI, 0.57 to 0.86) and intracranial bleeding (RR 0.46; 95 percent CI, 0.30 to 0.73) were less frequent on antiplatelet drugs than on warfarin. Major bleeding might be higher with warfarin than aspirin in patients over 80 years old, according to subgroup analysis.
"Elderly patients treated with aspirin or clopidogrel suffer less any-severity bleeding but have a risk of major bleeding similar to that of oral anticoagulants, with the exception of intracranial bleeding," the authors write.

More information: Abstract

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Canadian cardiovascular society sets new guidelines for atrial fibrillation management and treatment

A summary of the recommendations for the management of antithrombotic therapy in patients with atrial fibrillation in associationwith Non-ST-elevation acute coronary syndrome or ST-elevation myocardial infarction. ASA, acetylsalicylic acid (aspirin);CHADS2, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack; NOAC, non-vitamin K antagonist oral anticoagulant;OAC, oral anticoagulant; PCI, percutaneous coronary intervention. 

The Canadian Journal of Cardiology has just released the 2016 Focused Update to the Canadian Cardiovascular Society's (CCS) atrial fibrillation (AF) guidelines. This update provides evidence-based guidelines for Canadian practitioners and will impact how they, and the global community of cardiologists, manage and treat this serious condition.

09 sept 2016--AF is an irregular and often rapid heart rate that can increase the risk of stroke, heart failure, and other heart-related complications. It is the most common cardiac arrhythmia and the leading cause of stroke in the elderly.
"The development of guidelines has been a key activity of the CCS for over a decade," explained co-chairs Laurent Macle, MD, of the Montreal Heart Institute, Université de Montréal, Montreal, Quebec, and Atul Verma, MD, of the Southlake Regional Health Centre, Newmarket, Ontario, Canada. "Well-developed guidelines have the potential to improve the quality of cardiovascular care, lead to better patient outcomes, improve cost-effectiveness, and highlight areas for further research."
This update represents the consensus of a multidisciplinary panel of topic experts with a mandate to formulate disease-specific recommendations. The original guidelines were developed in 2010 by the Canadian Cardiovascular Society (CCS) AF Guidelines committee and are reviewed every two years. This is the third Focused Update.
This 2016 Focused Update makes important evidence-based recommendations on:

• Management of antithrombotic therapy for AF patients with various clinical presentations of coronary artery disease (CAD)
• Real-life data with non-vitamin K antagonist oral anticoagulants (NOACs)
• Use of antidotes for the reversal of NOACs
• Digoxin as a rate-control agent
• Perioperative anticoagulation management
• AF surgical therapy including the prevention and treatment of AF following cardiac surgery

An important change in this update is that for patients with AF in association with CAD who are indicated for anticoagulation therapy, a NOAC is preferred over warfarin.
For patients with AF, with an indication for primary CAD prevention or stable CAD/arterial vascular disease, the selection of antithrombotic therapy should be based on their risk of stroke.
For patients with AF and recent elective PCI, the selection of antithrombotic therapy should also be based on their risk of stroke.
For patients with AF in association with non ST-elevation acute coronary syndrome (NSTEACS) or ST-elevation myocardial infarction (STEMI), the management of antithrombotic therapy is based on the risk of stroke and whether PCI is performed.
Details of the updated recommendations are presented, along with their background and rationale. Standards, individual studies, and literature were reviewed for quality and bias. The update also includes a section on concomitant AF and coronary artery disease, which was developed in collaboration with the CCS antiplatelet (APT) guidelines committee. An updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update, are provided in an Online Supplement.

More information: "2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation," by Laurent Macle, MD (Co-chair), John Cairns, MD, Kori Leblanc, PharmD, Teresa Tsang, MD, Allan Skanes, MD, Jafna L. Cox, MD, Jeff S. Healey, MD, Alan Bell, MD, Louise Pilote, MD, Jason G. Andrade, MD, L. Brent Mitchell, MD, Clare Atzema, MD, David Gladstone, MD, Mike Sharma, MD, Subodh Verma, MD, Stuart Connolly, MD, Paul Dorian, MD, Ratika Parkash, MD, Mario Talajic, MD, Stanley Nattel, MD, and Atul Verma, MD (Co-chair) for the CCS Atrial Fibrillation Guidelines Committee,

DOI: dx.doi.org/10.1016/j.cjca.2016.07.591 . Published online in advance of Volume 32/Issue 10 (October 2016) of the Canadian Journal of Cardiology.


Provided by Elsevier

Smartphone detects atrial fibrillation with existing hardware

Smartphones can be used to detect atrial fibrillation with existing hardware, according to research presented at ESC Congress 2016 today. A low-cost application (app) has been developed that uses the phone's own accelerometer and gyroscope to check for atrial fibrillation.

28 aug 2016--"Atrial fibrillation is a dangerous medical condition present in 2% of the global population and accounting for up to seven million strokes per year," said lead author Tero Koivisto, a vice-director of the Technology Research Centre (TRC), University of Turku, Finland. "In the European Union alone this heart rhythm disorder costs approximately USD $19 billion every year."
Around 70% of strokes due to atrial fibrillation could be avoided with pre-emptive medication. However, atrial fibrillation often occurs randomly on/off and is difficult to detect by visiting a doctor. There are relatively large and costly electrocardiogram (ECG) devices that patients can take home for long-term monitoring but they require a patch or wires that are clumsy to use and continuous contact with electrodes tends to irritate the skin.
Due to the above constraints, current methods for detection of atrial fibrillation are infeasible for wide-scale screening of populations or higher risk age groups (60 years and above).
The current study tested the ability of a smartphone to detect atrial fibrillation without any add-on hardware. The study included 16 patients with atrial fibrillation from the Turku Heart Centre. In addition, 20 recordings from healthy people were used as control group data to validate the developed algorithm.
To detect atrial fibrillation, a smartphone was placed on the chest of the patient, and accelerometer and gyroscope recordings were taken. Patients were advised to lie in a prone or supine position during the measurements.
Mr Koivisto said: "We use the accelerometer and gyroscope of the smartphone to acquire a heart signal from the patient. A measurement recording is taken, and the acquired data is pre-processed by signal processing methods. Multiple features such as autocorrelation and spectral entropy are then extracted from the pre-processed data. Finally, a machine learning algorithm (KSVM) is used to determine if the patient suffers from atrial fibrillation."
Using this technology the investigators detected atrial fibrillation with a sensitivity and specificity of more than 95%.
"We measure the actual motion of the heart via miniature accelerometers and gyroscopes that are already installed in today's smartphones," said Mr Koivisto. "No additional hardware is needed and people just need to install an app with the algorithm we developed."
He continued: "If people feel odd and want to check their cardiac status, they can simply lie down, place the phone on their chest, take an accelerometer and gyroscope measurement, then use the app to analyse the result. They will get a simple yes/no answer as to whether they have atrial fibrillation or not."
Mr Koivisto concluded: "This is a low cost, non-invasive way to detect atrial fibrillation that people can do themselves without any help from medical staff. Given the widespread use of smartphones, it has the potential to be used by large populations worldwide. In future, a secure cloud service could be created to store and analyse larger masses of data."

More information: "Detecting atrial fibrillation via existing smartphones without any add-ons" ESC Congress 2016.


Provided by European Society of Cardiology

Study sheds light on atrial fibrillation symptoms, quality of life

Most patients with atrial fibrillation—the most common type of abnormal heart rhythm—experience multiple symptoms and decreased quality of life, according to a large, nationally representative study. The findings may lead to more targeted interventions in these patients, says a Yale researcher.

13 jun 2015--Atrial fibrillation (AF) is an irregular, rapid heart rate that affects circulation and raises the risk of stroke and death in patients. Prior to the study, research on AF symptoms and quality of life had generally been done on smaller, select patient groups, said lead author and assistant professor of medicine (cardiology) Dr. James V. Freeman. To confirm previous findings and evaluate patient outcomes in a larger population, the researchers used data on more than 10,000 patients from the Outcomes Registry for Better Informed Treatment of AF.

The researchers found that in most cases—62%—patients had symptoms (palpitations, difficulty breathing with exertion, fatigue, lightheadedness) and 17% had severe or disabling symptoms. They noted a clear correlation between the burden of the AF symptoms and patient reports of diminished quality of life.

The most novel finding was that patients with the worst symptoms were younger and generally healthier, yet more likely to be hospitalized. "That's unusual," said Freeman. "This means that by targeting interventions to control the AF rhythm and impact symptoms, we may be able to keep these patients out of the hospital and have an impact on healthcare utilization." 

The study published this week online in Circulation: Cardiovascular Quality and Outcomes.

More information: "Association Between Atrial Fibrillation Symptoms, Quality of Life, and Patient Outcomes: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)." Circ Cardiovasc Qual Outcomes. DOI: 10.1161/CIRCOUTCOMES.114.001303

Provided by Yale University

'Face time' for the heart diagnoses cardiac disease

To the careful observer, a person's face has long provided insight into what is going on beneath the surface. Now, with the assistance of a web camera and software algorithms, the face can also reveal whether or not an individual is experiencing atrial fibrillation, a treatable but potentially dangerous heart condition.

30 aut 2014--A pilot project, the results of which were published online today in the journal Heart Rhythm, demonstrates that subtle changes in skin color can be used to detect the uneven blood flow caused by atrial fibrillation. The technology was developed in a partnership between the University of Rochester School of Medicine and Dentistry and Xerox.

"This technology holds the potential to identify and diagnosis cardiac disease using contactless video monitoring," Jean-Philippe Couderc, Ph.D., with the University of Rochester's Heart Research Follow-up Program. "This is a very simple concept, but one that could enable more people with atrial fibrillation to get the care the care they need."

Atrial fibrillation is an irregular or sometimes rapid heart rate that commonly causes poor blood flow to the body. This occurs when erratic cardiac electrical activity causes the upper and lower chambers of the heart to beat out of sync. More than three million Americans suffer from the disease.

While, the condition can be readily diagnosed, in many people it goes undetected, either because it comes and goes or because the symptoms – fatigue and weakness – are too general to warrant concern. Consequently, it is estimated that 30 percent of the people with atrial fibrillation do not know they have the condition.

Furthermore, while atrial fibrillation is treatable if detected – both by medication and through a procedure that essentially resets the heart's electrical activity – many individuals with the condition will experience a re-occurrence. If untreated, the condition places individuals at a significantly higher risk for blood clots and stroke.

The technology described in the study employs a software algorithm developed by Xerox that scans the face and can detect changes in skin color that are imperceptible to the naked eye. All this requires is that the subject remain still for 15 seconds.

Sensors in digital cameras are designed to record three colors: red, green, and blue. Hemoglobin – a component of blood – "absorbs" more of the green spectrum of light and this subtle change can be detected by the camera's sensor. In turns out that the face is the ideal place to detect this phenomenon, because the skin is thinner than other parts of the body and blood vessels are closer to the surface.

The study participants were simultaneously hooked up to an electrocardiogram (ECG) so results from the facial scan could be compared to the actual electrical activity of the heart.

The researchers found that the color changes detected by video monitoring corresponded with an individual's heart rate as detected on an ECG. Essentially, the irregular electrical activity of the heart found in people with atrial fibrillation could be identified by "observing" the pulses of blood flowing through the veins on the face as it absorbed or reflected green light with each heartbeat.

The study found that the video monitoring technique – which researchers have dubbed videoplethymography – had an error rate of 20 percent, comparable to the 17 to 29 percent error rate associated with automated ECG measurements.

While the pilot study was only conducted on 11 people and intended to demonstrate that the technology was feasible, the researchers are now in the process of evaluating the technology on a larger study population, including those without atrial fibrillation.

Couderc contends that these new studies – coupled with the application of image stabilizing technology and the ongoing improvement in the resolution of cameras – will lower the error rate. "This study was intended to be a proof of concept and, as is the case with many new technologies, we believe that we can significantly improve its accuracy and the usability," said Couderc.

Like many other personal health technologies that have emerged in recent years, the authors see this as a way to diagnose or monitor people at risk for atrial fibrillation and alert them and/or their physicians when the condition is detected. The contactless nature of the technology and the proliferation of web cameras could even eventually allow the screening to occur without interrupting the user. For example, the program could run in the background while someone is reading their email on their tablet, computer, or smart phone.

Provided by University of Rochester Medical Center

Digoxin tied to increased risk of death in patients with atrial fibrillation

In An Account of the Foxglove and Some of its Medical Uses, published in 1785, Sir William Withering cautioned readers that extracts from the plant foxglove, also called digitalis, was not a perfect drug. "Time will fix the real value upon this discovery," he wrote.

12 aug 2014--Now, more than 200 years later, researchers at the Stanford University School of Medicine have validated Withering's warning with the discovery that patients with atrial fibrillation—a rapid and irregular heart rhythm—who are treated with the digitalis-derivative digoxin are more likely to die than similar patients who received different treatments.

"The take-home point is to question whether people should really be on this drug," said the study's lead author, Mintu Turakhia, MD, assistant professor of cardiology at Stanford and director of cardiac electrophysiology at the Veterans Affairs Palo Alto Health Care System. "These data challenge the current guidelines."

The study will be published online Aug. 11 in the Journal of the American College of Cardiology, and will appear in the Aug. 19 print issue of the journal.

Turakhia and his team analyzed records from 122,465 patients who received a new diagnosis of atrial fibrillation from the U.S. Department of Veterans Affairs health-care system between 2003 and 2008. Doctors prescribed digoxin to 23 percent of the patients, and 70 percent of those patients were still on the drug one year later. Patients treated with digoxin were 1.2 times more likely to die than comparable patients prescribed other therapies. Patients receiving digoxin were more likely to die regardless of age; use of other drugs such as beta-blockers, amiodarone or warfarin; or the presence of other factors such as kidney disease, heart attack or heart failure, the study found.

"This is going to be as close to proof positive as we get because we may never have a randomized trial of this drug," Turakhia said. Pharmaceutical companies lack the incentive to finance studies on a long-accepted, generic drug.

Although recent studies showed mixed results, doctors and patients trusted digoxin because of its historic status, Turakhia said.

"There's an evidence gap," he said, adding that he launched the investigation because digoxin hasn't been rigorously tested like the many other atrial fibrillation treatment options.

The VA patient pool was predominantly male—only 1,980, or 1.6 percent, were female—and Turakhia has called for additional studies to establish whether the results are applicable to women as well.

Turakhia said many other drugs with better safety results are available to treat atrial fibrillation. Digoxin slows the heart rate but does not correct it to a normal rhythm. "We are not asserting this drug should never be used," he said. "However, in light of the many other drugs that can be used to slow down the heart rate in atrial fibrillation, patients and providers need to ask whether digoxin should be the treatment of choice when there are other, safer drugs. "

Provided by Stanford University Medical Center

Study supports 3-D MRI heart imaging to improve treatment of atrial fibrillation

A University of Utah-led study for treatment of patients with atrial fibrillation (A-fib) provides strong clinical evidence for the use of 3-D MRI to individualize disease management and improve outcomes.

07 feb 2014--Results of the Delayed-Enhancement MRI Determinant of Successful Radio-frequency Catheter Ablation of Atrial Fibrillation (DECAFF) study will be published Wednesday in the Journal of the American Medical Association.

Atrial fibrillation is a common arrhythmia, or an irregular heartbeat, which is a major cause of stroke, heart failure and death. For treatment, doctors have mostly relied on drugs, or more recently, on catheter ablation. Despite those two treatment options, outcomes remain mediocre mainly due to poor patient selection, says Nassir F. Marrouche, M.D., founder of the U's interdisciplinary Comprehensive Arrhythmia Research & Management Center (CARMA) and associate professor of internal medicine at the University's School of Medicine. "We've been treating A-fib based on patients' symptoms, duration of arrhythmia and associated comorbidities. Instead we should be integrating the diseased, fibrotic heart tissue itself into our management plan."

"Every cardiologist in the world knows that A-fib and atrial tissue disease are intertwined. But, until recently, we have been lacking noninvasive tools to define this relationship," he says. "We at CARMA have developed a significant breakthrough in the way A-fib is managed."

The DECAFF study built on innovative work from CARMA, which invented the technology enabling heart tissue imaging with MRI. With these images, physicians can assess the extent of the disease using a novel staging system similar to the ones developed for cancer. "This is a major step for individualizing arrhythmia management."

Conducted in partnership with 15 major medical centers across the United States, Europe, and Australia, Marrouche's landmark study demonstrated that the amount of atrial injury can effectively predict whether patients were likely to benefit from A-fib catheter ablation procedure. Using the enhanced MRI and the Utah Staging System, the hearts of 329 patients were scanned and staged on a scale of 1-4 before undergoing ablation and procedure outcomes were assessed at follow-up.

What Marrouche and his worldwide study partners found reflected early published findings from CARMA at the U of U: that those with less extensive fibrotic tissue had a greater chance of responding to ablative treatment.

According to the data, patients with less than 10 percent left atrial wall fibrosis (Utah Stage 1) showed good outcomes with ablation therapy while those with greater than 30 percent fibrosis (Stage 4) experienced significantly higher failure rates.

Marrouche believes the study findings will encourage a shift in the way physicians treat patients with atrial fibrillation, specifically by integrating MRI into their A-fib management protocols.

"MRI scanning of heart tissue is more and more becoming a screening test to predict people at risk for arrhythmias and its associated complications like stroke and heart failure," he says. He also believes atrial disease-causing arrhythmias should be screened for just like cancers and other common diseases.

Provided by University of Utah Health Sciences

Mass screening identifies untreated AF in 5% of 75-76 year olds

Stroke is the second cause of death worldwide. Atrial fibrillation is the most common clinically relevant cardiac arrhythmia in Europe, affecting approximately 1.5-2% of the general population.1 Prevalence is estimated to double in the next 50 years as the population ages.

04 sept 2013--Patients with atrial fibrillation have a five-fold increased risk of ischaemic stroke even though around 30% have no symptoms. As blood is less adequately shifted from the heart during atrial fibrillation, blood clots can form and cause large ischaemic strokes. Strokes that occur in association with atrial fibrillation are often fatal, and survivors are left more disabled and at a high risk of a recurrent stroke.

Dr Svennberg said: "There is hope, however, as oral anticoagulant medication reduces the risk of atrial fibrillation related stroke by 64-70%. But more than 50% of high-risk patients with atrial fibrillation do not receive any treatment. We are looking at an epidemic of atrial fibrillation related strokes if nothing is done to improve treatment levels."

The STROKESTOP trial is a mass screening programme of all 75-76 year olds in Stockholm County and Region Halland in Sweden. It aims to identify patients with undiagnosed atrial fibrillation and find out if oral anticoagulation(OAC) therapy reduces their risk of ischaemic stroke.

For the trial, more than 25,000 people born in 1936 and 1937 were randomised 1:1 to screening for atrial fibrillation or a control group. Screening is done at home with a handheld ECG device and takes 1 minute per day for 2 weeks. When atrial fibrillation is diagnosed, patients are offered OAC treatment. Both screening and control groups will be followed prospectively for 5 years for thromboembolic events, bleeding and mortality.

Preliminary results from STROKESTOP are presented today. A year into the trial, 6,496 (50%) of the 13,000 inhabitants in the screening arm agreed to screening for atrial fibrillation. A lower proportion of patients agreed to screening in Stockholm (49%) than in rural areas (65%). Dr Svennberg said: "We will investigate factors related to participation, in an effort to increase uptake."

More than 11% of the screening group had atrial fibrillation. Of these, previously undiagnosed atrial fibrillation was found in 192 (3%) of patients while in 129 (2%) of patients, atrial fibrillation had been diagnosed but they were not on OAC. More than 90% of the patients with undiagnosed atrial fibrillation were started on OAC.

Dr Svennberg said: "We found that 5% of patients in the screening arm had untreated atrial fibrillation. We successfully started oral anticoagulation treatment in more than 90% of the patients with newly diagnosed atrial fibrillation. This should reduce their risk of a stroke by up to 70%. We are still collecting data on patients with known atrial fibrillation but not on OAC."

Professor Mårten Rosenqvist, chair of the STROKESTOP steering committee, said: "Without appropriate treatment atrial fibrillation is a ticking bomb. We hope the STROKESTOP study will show that screening for atrial fibrillation reduces the risk of stroke. Our final results should be available by November 2018."

More information: 1 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. European Heart Journal. 2012;33:2719-3747.

2 SBU—Swedish Council on Health Technology Assessment—report 2013 "Förmaksflimmer- Förekomst och risk för stroke".

Provided by European Society of Cardiology

Depression screening in AF Clinics recommended by study

Electrophysiologists (EPs) rate the quality of life of patients with Paroxysmal atrial fibrillation (AF) significantly better than the patients themselves do, with the greatest level of disagreement about mental health. The abstract study, presented at the EHRA EUROPACE meeting, 23 to 26 June, in Athens, Greece, found that patients with paroxysmal AF, even in the absence of significant concomitant cardiac disease, showed signs of depression, sleeping disorders and low levels of physical activity.

24 jun 2013--Since neither rate or rhythm control strategies for AF have been shown to be superior to the other in survival or stroke outcomes, decisions need to be made about which approach is better for each patient's long-term management.

"EPs generally decide whether to take a more or less aggressive treatment approach according to the patient's disease burden. Here, not only physical symptoms need to be taken into consideration, but also the patient's mental health and quality of life in general. If EPs don't know that their patients are suffering from depression they may not be offering them optimum treatments," says Professor Karl Ladwig, the first author of the study. "Good communication between physicians and patients is of paramount importance for adherence to medications and long term prognosis."

In the current study, Ladwig and colleagues set out to assess the degree of congruence between patient and physician assessment of the patients' subjective health status, which, the authors say, provides a good indicator of patient-physician communication and shared understanding. Data for the analysis was taken for patients enrolled in the Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF) trial. The ANTIPAF trial, conducted by Professor Andreas Goette within the German Competence NETwork on Atrial Fibrillation (AFNET), examined whether angiotensin II receptor blockers reduced the incidence of paroxysmal AF. The analysis also specifically explored discordance between AF patients and their doctors.

Between February 2004 and September 2008, 334 patients (41% female and 59% male) with paroxysmal AF, without significant concomitant heart disease, and their physicians from 43 participating centres were asked to rate the patients' heath related quality of life (HRQoL). Patients filled in the SF-12 self rating scale in the clinic or home; while physicians complete the SF8 scale after the patient had left the clinic. Physicians had no access to the patient's answer sheets.

Intra-Class Correlations (ICC) were used to assess the consistency or conformity of the measures made by multiple observers, and Bland Altman graphs plotted the strength of concordance for each patient against average ratings for both physicians and patients.

"When one considers the importance placed on quality of life in the AF literature these levels of discordance between physicians and patients are surprisingly large. They underline the need for physician to be trained to recognize depression in patients and for the introduction of systematic screening for depression in all AF clinics," says Ladwig, from the Helmholtz Centre, Munich, Germany.

Future studies should explore whether interventions such as physician training and screening, improve both quality of life and the underlying disease status of patients with AF, he said.

More information: K Ladwig, A Eisenhart-Rothe, T Meinertz,et al. How well do electrophysiologists estimate the degree of quality of life impairment of their patients with paroxysmal atrial fibrillation? Results from the ANTIPAF Trial. FP 175.

Provided by European Society of Cardiology

Atrial fibrillation: Drugs or ablation?

5 sept 2009--Barcelona, Spain: Atrial fibrillation ablation is one of the fastest growing techniques in cardiology and due to the very high number of patients that might be candidates to this procedure, a significant number of resources will have to be devoted to it to be able to treat them in the following years.

Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia. Its prevalence increases with age affecting more than 5% of the population older than 75 years of age. Overall it is estimated that more than 3.000.000 patients in Europe suffer from atrial fibrillation. Atrial fibrillation doubles the possibility of death mainly due to the higher incidence of thromboembolic events and occurrence of heart failure in patients suffering this arrhythmia.

One treatment objective is directed to avoid the negative consequences of the arrhythmia by trying to maintain normal sinus rhythm. Two strategies exist to obtain this result:

1. Chronic treatment with antiarrhythmic drugs (AAD)

2. Catheter ablation of atrial fibrillation

1. AAD treatment tries to block or modulate the electrical activity of the heart avoiding initiation and perpetuation of the arrhythmia. It is effective in about 60% of patients and requires long-term treatment. Many of the drugs used have side effects, some of them disabling for the patient. Many drugs are available and combination of them might be used in case of failure. Compliance of the treatment is basic for long-term success.

2. Catheter ablation has emerged as an alternative to obtain stable sinus rhythm in this population. It has been demonstrated that a significant number of AFepisodes initiate in the area of the pulmonary veins located in the left atrium. Using one or several catheters inserted through the femoral veins, they are inserted into the heart and brought to the left atrium through a transseptal approach. Once in the left atrium energy (radiofrequency, cold) is delivered in different areas (mainly around the pulmonary veins) to create lesions that block the electrical activity responsible for the arrhythmia. The effectiveness of this technique is around 70% and in about 25% a second procedure is needed to finish the ablation lines. As any invasive procedure some major complications may occur like cardiac tamponade (1%), thromboembolic events (0.5%) or atrio-esophageal fistula (1/1000). In case of success the patient does not requires continuation with AAD and the arrhythmia is cured.

The decision of which treatment to be used will have to be based on a number of considerations: type of patient, willingness of the patient, experience of the centre in ablative techniques, etc.

It is estimated than more than 10.000 atrial fibrillation ablation procedures are performed annually in Europe and the number is increasing exponentially since over the last years availability of more sophisticated techniques and equipment has produced a marked increase in the number of centres performing atrial fibrillation ablation. Three dimensional mapping systems, robotic techniques, new energy sources and new and more reliable catheters are easing the procedure and improving efficacy and safety.

Atrial fibrillation in endurance athletes still poses problems for sports cardiologists

New research efforts to prevent and treat arrhythmias associated with endurance sports

22 june 2009--The fulfilment which so many people increasingly derive from competitive sports and endurance training comes with a real – even if rare – twist. Because, while most people will enjoy the benefits and pleasures of exercise, there are a few for whom regular athletic training will increase the risk of cardiac arrhythmias and even sudden death, especially among those in middle-age or with pre-existing cardiac diseases.

"It's for this reason that sports medicine has focused on pre-participation screening," says Dr Luis Mont from the Hospital Clínic de Barcelona, Spain, "in an attempt to detect any hidden heart disease." On the other hand, disturbances in heart rhythm, particularly atrial fibrillation, which represent one of the major cardiovascular reasons for hospital admission, is more common among cyclists, marathon runners and other athletes with a long history of endurance training.

Dr Mont reports that atrial fibrillation is more frequent in middle-aged individuals who formerly took part in competitive sports and continue to be active, or simply in those involved in regular endurance training without having actually participated in competitive sports. "So we have to look at the effects of endurance or athletic training with a more open view," says Dr Mont.

However, he adds that the cost-effectiveness of routine pre-participation screening in a broad population of athletes and endurance sports participants has not yet been clarified. A debate on the subject takes place at this Congress on Sunday 21st June at 16.00.

What does seem clearer, however, is that long-term endurance sport participation may well increase the incidence of cardiac arrhythmias, particularly atrial fibrillation, atrial flutter, sinus node dysfunction, and right ventricular premature beats. "Given the fact that an increasing number of individuals engage in regular endurance sports," says Dr Mont, "it is certainly of great interest to define which recommendations for sport should be implemented in an individual patient, and how best to manage arrhythmias in participants." Atrial fibrillation is the most common arrhythmic condition, and sudden cardiac death remains a risk.

Three papers presented at this congress by Dr Mont's group reflect the research effort now being directed towards sports cardiology and the prevention and treatment of rhythm disorders.

1. Efficacy of the circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes. CPVA is a recently introduced technique which identifies the signals causing the atrial fibrillation and isolates their source in the pulmonary veins from the left ventricle of the heart. The technique has been successfully used in routine patients with atrial fibrillation and, according to new data presented here in Berlin, is now as effective in AF secondary to endurance sports as in other causes. A series of 182 patients in Dr Mont's Barcelona clinic found that freedom of arrhythmias following CPVA was similar in the sports participants as in the regular patients. Left atrial size and long-standing atrial fibrillation were the only independent predictors for arrhythmia recurrence after the treatment, not sports participation.

2. Deconditioning reverses expression of cardiac fibrosis markers in an animal model of endurance training. A more basic science study from Dr Mont's group in Barcelona also suggests that those with a history of arrhythmias following endurance training may benefit from a period of "deconditioning" following their efforts. The suggestion follows a study in animal models which found that markers of cardiac fibrosis in rats whose treadmill exercise was followed by a period of inactivity returned to control levels. Endurance exercise causes cardiac structural changes, including atrial and right ventricular fibrosis – and this fibrosis may play a role in the development of arrhythmias. Although it has been noted that the athlete's heart regresses after inactivity it is not known if the sport-induced atrial and right ventricular fibrosis also reverses after deconditioning. This study suggests that it does and that a period of inactivity might be of benefit in those with a history of fibrillation.

3. Losartan attenuates heart fibrosis induced by chronic endurance training in an animal model. Just as inactivity after training may inhibit cardiac fibrosis in animal models, a similar study suggests that the anti-hypertensive drug losartan prevents the heart fibrosis induced by endurance exercise. The anti-fibrotic effect of losartan, an angiotensin type-II receptor antagonist, appears to be mediated suppression of angiotensin II-induced proliferation of fibroblasts. Again, markers of fibrosis were reduced by administration of losartan.

###

Notes:

1. EHRA, the European Heart Rhythm Association, aims to serve as the leading organisation in the field of arrhythmias and electrophysiology in Europe, and to attract physicians from all of Europe and beyond to foster the development of this area of expertise. EHRA is a registered branch of the European Society of Cardiology (ESC). EHRA is based in Sophia Antipolis, France. Visit us at www.escardio.org/EHRA

2. The European Society of Cardiology (ESC) represents more than 50,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe. Visit us at www.escardio.org

Strenuous Exercise Linked to Atrial Fibrillation

Risk for developing atrial fibrillation appears to increase as frequency of exercise increases

09 june 2009-- Regular strenuous exercise increases the risk of developing atrial fibrillation, according to a study published in the June 1 issue of the American Journal of Cardiology.

Anthony Aizer, M.D., of Brigham and Women's Hospital in Boston, and colleagues assembled data on 16,921 apparently healthy men who took part in the Physicians' Health Study. In 12 years of follow-up, 1,661 men in the cohort developed atrial fibrillation. The researchers used logistic regression to assess the association between vigorous exercise and risk of developing atrial fibrillation.

The researchers found that the relative risk of atrial fibrillation increased with the frequency of vigorous exercise: zero days/week, relative risk, 1.0 (referent); one day/week, relative risk, 0.90; one to two days/week, relative risk, 1.09; three to four days/week, relative risk, 1.04; five to seven days/week, relative risk, 1.20. In subgroup analysis, the risk was found to increase further in men less than 50 years old (relative risks, 1.0, 0.94, 1.20, 1.05, and 1.74, respectively) and in joggers (relative risks, 1.0, 0.91, 1.03, 1.30, and 1.53, respectively).

"In conclusion, frequency of vigorous exercise was associated with an increased risk of developing atrial fibrillation in young men and joggers. This risk decreased as the population aged and was offset by known beneficial effects of vigorous exercise on other atrial fibrillation risk factors," the authors write.

Abstract
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Death Rate After Ablation of Atrial Fibrillation 1 in 1,000

Most patients with atrial tachycardia recover left ventricular function after ablation

09 may 2009-- While most patients with focal atrial tachycardia recover left ventricular function after catheter ablation, 1 in 1,000 patients with atrial fibrillation die, according to two studies in the May 12 issue of the Journal of the American College of Cardiology.

In the first study, Caroline Medi, from the University of Melbourne in Australia, and colleagues examined the characteristics and outcomes of 345 patients with focal atrial tachycardia, where 30 had tachycardia-mediated cardiomyopathy. They found that the frequency of incessant or very frequent paroxysmal tachycardia was much higher in patients with cardiomyopathy (100 versus 20 percent). Left ventricle function was restored in nearly all patients (97 percent) at a mean of three months after successful catheter ablation of the tachycardia focus.

In the second study, Riccardo Cappato, M.D., from Policlinico San Donato in Milan, Italy, and colleagues examined the incidence and causes of death in 32,569 patients who had undergone catheter ablation of atrial fibrillation. They found that 32 patients died (0.98 per 1,000 patients). The most common causes were tamponade, stroke, atrioesophageal fistula, and massive pneumonia.

"The data reported by Cappato et al. are of great clinical interest, and the authors should be congratulated for a contribution that will certainly raise awareness in the electrophysiologic community of the state of contemporary atrial fibrillation ablation," Bernard Belhassen, M.D., from Tel Aviv University in Israel writes in an accompanying editorial.

Several authors disclosed financial and consulting relationships with makers of ablation equipment and catheters, including Ablation Frontiers and Biosense Webster.

Abstract - Medi
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Abstract - Cappato
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