Posts Tagged ‘atrial fibrillation’


Marrouche et al report the full results of the CASTLE-AF trial. This randomized clinical trial assessed the effect of catheter ablation in patients with symptomatic atrial fibrillation and heart failure with LVEF<35%.



Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment.


We randomly assigned patients with symptomatic paroxysmal or persistent atrial
fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for
worsening heart failure.


After a median follow-up of 37.8 months, the primary composite end point occurred
in significantly fewer patients in the ablation group than in the medicaltherapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P = 0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P = 0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P = 0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P = 0.009).


Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy.



Chocolate Consumption and Apparent Atrial Fibrillation

Mostofsky et al (Heart Online First, published on May 23, 2017 as 10.1136/heartjnl-2016-310357) report a large population cohort study and assess the relationship between chocolate consumption and risk of apparent atrial fibrillation.



To evaluate the association between chocolate intake and incident clinically apparent atrial fibrillation or flutter (AF).


The Danish Diet, Cancer, and Health Study is a large population-based prospective cohort study. The present study is based on 55 502 participants (26 400 en and 29 102 women) aged 50–64 years who had provided information on chocolate intake at baseline.
Incident cases of AF were ascertained by linkage with nationwide registries.


During a median of 13.5 years there were 3346 cases of AF. Compared with chocolate intake less than once per month, the rate of AF was lower for people consuming 1–3 servings/month (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.82 to 0.98), 1
serving/week (HR 0.83, 95% CI 0.74 to 0.92), 2–6 servings/week (HR 0.80, 95% CI 0.71 to 0.91) and ≥1 servings/day (HR 0.84, 95% CI 0.65 to 1.09; p-linear trend <0.0001), with similar results for men and women.


Accumulating evidence indicates that moderate chocolate intake may be inversely associated with AF risk, although residual confounding cannot be ruled out.



Events Rates: Paroxysmal versus Persistent/Permanent AF. Insights from ENGAGE AF-TIMI 48

Link et al report on the relationship between types of atrial fibrillation and outcomes in the ENGAGE AF TIMI 48 trial.



Whether the pattern of atrial fibrillation (AF) modifies the risk/benefit of anticoagulation is controversial. In ENGAGE AF-TIMI 48 trial (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation– Thrombolysis in Myocardial Infarction 48), the factor Xa inhibitor edoxaban was noninferior to warfarin in preventing stroke or systemic embolic events and significantly reduced bleeding and cardiovascular mortality. However, detailed
analyses by AF pattern have not been reported.

Methods and Results

The 21 105 patients were categorized as having paroxysmal (


In ENGAGE AF-TIMI 48 trial, patients with paroxysmal AF suffered fewer thromboembolic events and deaths compared with those with persistent and permanent AF. The efficacy and safety profile of edoxaban as compared with warfarin was consistent across the 3 patterns of AF.



Alcohol and Atrial Fibrillation

Voskoboinik et al review the relationship between alcohol and atrial fibrillation. This is an interesting and useful paper.


Alcohol, Left Atrial Size and Atrial Fibrillation

September 15, 2016 Leave a comment

McManus et al report on the relationship between alcohol consumption (questionnaire-> dose in g/day), left atrial diameter and subsequent atrial fibrillation. The authors use the original Framingham Heart Study and the Offspring study with longitudinal assessment.

The authors found a positive relationship between alcohol consumption and left atrial diameter. This disappeared in models for covariates (see figure labelled table 3). Left atrial diameter was correlated with the incidence of atrial fibrillation with follow up.



Alcohol consumption has been associated with atrial fibrillation (AF) in several epidemiologic studies, but the underlying mechanisms remain unknown. We sought to test the hypothesis that an atrial myopathy, manifested by echocardiographic left atrial enlargement, explains the association between chronic alcohol use and AF.

Methods and Results

We evaluated the relationship between cumulative alcohol consumption and risk of incident AF in 5220
Offspring and Original Framingham Heart Study participants (mean age 56.3 years, 54% women) with echocardiographic left atrial size measurements. The incidence of AF was 8.4 per 1000 person-years, with 1088 incident AF cases occurring over a median 6.0 years (25th–75th percentiles 4.0–8.7 years) of follow-up. After multivariable adjustment for potential confounders, every additional 10 g of alcohol per day (just under 1 drink per day) was associated with a 0.16 mm (95% CI, 0.10–0.21 mm) larger left atrial dimension. Also in multivariable adjusted analysis, every 10 g per day of alcohol consumed was associated with a 5% higher risk of developing new-onset AF (hazard ratio, 1.05; 95% CI, 1.01–1.09). An estimated 24% (95% CI, 8–75) of the association between alcohol and AF risk was explained by left atrial enlargement.


Our study of a large, community-based sample identified alcohol consumption as a predictor of left atrial enlargement and subsequent incident AF. Left atrial enlargement may be an intermediate phenotype along the causal pathway linking long-term alcohol consumption to AF.



Almanac on Atrial Fibrillation

Heart has published an open-access almanac of atrial fibrillation (a collection of research related to atrial fibrillation 2014-2015). A selection of items follow, e.g. use of ivabradine in AF; temporal characteristics of paroxysms of AF in dialysis patients; the relationship between risk score and biomarkers; neuroimaging findings in patients with AF unsuitable for anticoagulation (no control).



Traumatic Intracranial Hemorrhage in the Elderly with AF on Warfarin

A retrospective cohort study of US Veterans attending an anticoagulation clinic (age \ge 75 years, atrial fibrillation, on warfarin) characterized the incidence and risk factors for traumatic intracranial hemorrhage in this group.

There was an almost constant hazard (modest increase with time). The rate was similar across CHA2DS2-VASc scores. The correlates (adjusted) were: dementia, depression, anemia and labile INRs.