New-onset atrial fibrillation among COVID-19 patients: A narrative review

Over the last three years,research has focused on examining cardiac issues arising from coronavirus disease 2019(COVID-19)infection,including the emergence of new-onset atrial fibrillation(NOAF).Still,no clinical study was conducted on the persistence of this arrhythmia after COVID-19 recovery.Our objective was to co-mpose a narrative review that investigates COVID-19-associated NOAF,emphasi-zing the evolving pathophysiological mechanisms akin to those suggested for sustaining AF.Given the distinct strategies involved in the persistence of atrial AF and the crucial burden of persistent AF,we aim to underscore the importance of extended follow-up for COVID-19-associated NOAF.A comprehensive search was conducted for articles published between December 2019 and February 11,2023,focusing on similarities in the pathophysiology of NOAF after COVID-19 and those persisting AF.Also,the latest data on incidence,morbidity-mortality,and management of NOAF in COVID-19 were investigated.Considerable overlaps between the mechanisms of emerging NOAF after COVID-19 infection and persistent AF were observed,mostly involving reactive oxygen pathways.With potential atrial remodeling associated with NOAF in COVID-19 patients,this group of patients might benefit from long-term follow-up and different management.Future cohort studies could help determine long-term outcomes of NOAF after COVID-19.

Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft

Objective To identify the factors associated with the development of postoperative atrial fibrillation （POAF） after coronary artery bypass graft （CABG） in elderly patients with coronary artery disease （CAD）. Methods A total of 81 patients with CAD who underwent CABG were enrolled in the study. Patients were divided into two groups： Group 1, without postoperative atrial fibrillation （59 patients, 74.6% men, mean age 65.8 ~ 4.0 years）; Group 2, with early new-onset atrial fibrillation after CABG （22 patients, 90.9% men, mean age 67.7 ＋ 5.4 years）. Interleukin （IL）-6, IL-8, IL-10, C-reactive protein （CRP）, fibrinogen, superoxide dismutase （SOD）, N-terminal pro-B-type natriuretic peptide （NT-proBNP）, and troponin I were studied. Results During the observation period, atrial fibrillation occurred in 27.2% cases, an average of 4.9 ±3.8 days after surgery. In group 2, the left atrium （LA） dimension was larger than in group 1 （43.9 ± 3.4 mm vs. 37.6 ±3.9 rnm, P 〈 0.001）. Patients with POAF had significantly higher IL-6 （72.7 ±60.8 pg/mL vs. 38.0 ± 34.6 pg/mL, P = 0.04）, IL-8 （11.9 ± 6.0 pg/mL vs. 7.7± 5.4 pg/mL, P = 0.01） and SOD （2462.0 ± 2029.3 units/g vs. 1515.0 ± 1292.9 units/g, P = 0.04） compared with group without POAF. The multivariate analysis showed that the odds ratio （OR） for POAF development in patients with left atrium more than 39 mm was 2.1 [95% confidence interval （CI）： 1.2-3.8, P = 0.0004], IL-6 levels more than 65.18 pg/mL-1.4 （95% Ch 1.1-2.7, P = 0.009）, IL-8 levels more than 9.67 pg/mL-1.2 （95% CI： 1.1-3.7, P ： 0.009）, SOD more than 2948 units/g-1.1 （95% Ch 1.01-2.9, P = 0.04）. Conclusions In our study, the independent predictors of postoperative atrial fibrillation after CABG in elderly patients were left atrium dimension and the increased postoperative concentration of IL-6, IL-8 and superoxide dismutase.

Analyses of risk factors and prognosis for new-onset atrial fibrillation in elderly patients after dual-chamber pacemaker implantation

Objective To retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF)after implantation of dual-chamber pacemakers in elderly patients.Methods Consecutive patients aged >65years who underwent their first implantation of a dual-chamber permanent pacemaker in Beijing Anzhen Hospital from October 2013to May 2016were enrolled.Their complete program- ming and follow-up data were recorded.Follow-up end points included new-onset AF and major adverse cardiovascular and cerebrovascular events.Restdts Altogether,322patients were enrolled,with new-onset AF observed in 79(24.5%)during their follow-up.Multivariable analysis identified four independent predictors of new-onset AF in elderly patients after pacemaker implantation:hypertension (HR =3.040, 95%CI:1.09-3.05,P =0.00),age (HR =1.966,95%CI:1.57-3.68,P =0.01);left atrial enlargement (HR =1.645,95%CI:1.05-1.25,P = 0.03);high ventricular pacing rate (HR =1.137,95%CI:1.01-1.06,P =0.01).Univariable analysis indicated that the CHA2DS2-VASc score was also a risk factor for AF (HR =1.368,95%CI:1.178-1.589,P =0.002),whereas multivariable regression analysis did not. Kaplan-Meier survival analysis showed that the risk for ischemic stroke was significantly higher in the new-onset AF group than in the non-AF group (P <0.05).Conclusion Hypertension,age,left atrial enlargement,and high ventricular pacing rate were independent predictors of new-onset AF in elderly patients after implantation of a permanent pacemaker.New-onset AF increased the risk for ischemic stroke.

Associations of new-onset atrial fibrillation and severe visual impairment in type 2 diabetes:A multicenter nationwide study

BACKGROUND Many studies have demonstrated an association between type 2 diabetes mellitus(T2DM)and atrial fibrillation(AF).However,the potential independent contributions of T2DM and AF to the prevalence of visual impairment have not been evaluated.AIM To determine whether such an association between T2DM and incident AF with visual impairment exists,and if so,the prevalence and magnitude of this association.METHODS We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools.This study had evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013.T2DM patients were categorized into two groups:patients without and with incident AF.T2DM patients without AF were selected as the reference group.The association between incident AF and visual impairment among T2DM patients was assessed using multivariate logistic regression.RESULTS A total of 27281 T2DM patients with available eye examination data were included in this analysis.The mean age was 60.7±10.5 years,and 31.2%were male.The incident AF was 0.2%.The prevalence of severe visual impairment in all T2DM patients,T2DM patients without AF,and T2DM patients with incident AF were 1.4%,1.4%,and 6.3%,respectively.T2DM patients with incident AF were associated with an increased OR of 3.89(95%CI:1.17-13.38)for severe visual impairment compared with T2DM patients without AF.CONCLUSION T2DM patients with incident AF were independently associated with increased severe visual impairment.Therefore,early eye screening should be provided for these high-risk individuals.

High Killips Class as a Predictor of New-onset Atrial Fibrillation Following Acute Myocardial Infarction： Systematic Review and Meta-analysis

Background： Recent observational studies have shown that patients with higher Killips score （〉Ⅰ） have higher risk of new-onset atrial fibrillation （NOAF） following acute myocardial infarction （AMI）, while others drew a neutral conclusion. The ultimate predictive value of high Killips class on NOAF remained obscure. Methods： PubMed, Web of Science, China National Knowledge Infrastructure, and the Cochrane Controlled Trials Register Databases were searched until February 2015. Of the 3732 initially identified studies, 5 observational studies with 10,053 patients were analyzed. Results： The meta-analysis of these studies showed that higher Killips score on admission was associated with higher incidence of NOAF following AMI （odds ratio 2.29, 95% confidence intcrwd 1.96 2.67, P 〈 0.00001 ）, while no significant differences exist among individual trials （P =0.14 and I^2= 43%）. Conclusions： Killips class 〉I was associated with the higher opportunity of developing NOAF following AMI.

Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients

BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Atrial fibrillation and prediabetes:A liaison that merits attention!

Atrial fibrillation(AF)and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role.The resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event(MACCE)events.However,the same has not convincingly been verified in real-world settings.In the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE,prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding variables.However,certain questions like the role of metformin,quantifying the risk for MACCE amongst prediabetes compared to diabetes,the positive impact of reversion to normoglycemia remain unanswered.We provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.

The correlation between gut microbiome and atrial fibrillation: pathophysiology and therapeutic perspectives

Regulation of gut microbiota and its impact on human health is the theme of intensive research.The incidence and prevalence of atrial fibrillation(AF)are continuously escalating as the global population ages and chronic disease survival rates increase;however,the mechanisms are not entirely clarified.It is gaining awareness that alterations in the assembly,structure,and dynamics of gut microbiota are intimately engaged in the AF progression.Owing to advancements in next-generation sequencing technologies and computational strategies,researchers can explore novel linkages with the genomes,transcriptomes,proteomes,and metabolomes through parallel meta-omics approaches,rendering a panoramic view of the culture-independent microbial investigation.In this review,we summarized the evidence for a bidirectional correlation between AF and the gut microbiome.Furthermore,we proposed the concept of“gut-immune-heart”axis and addressed the direct and indirect causal roots between the gut microbiome and AF.The intricate relationship was unveiled to generate innovative microbiota-based preventive and therapeutic interventions,which shed light on a definite direction for future experiments.

Association between the cumulative triglyceride-glucose index and the recurrence of atrial fibrillation after radiofrequency catheter ablation

BACKGROUND Triglyceride-glucose(TyG)index values are a new surrogate marker for insulin resistance.This study aimed to explore the relationship between cumulative TyG index values and atrial fibrillation(AF)recurrence after radiofrequency catheter ablation(RFCA).METHODS A total of 576 patients with AF who underwent RFCA at the Second Affiliated Hospital of Xi'an Jiaotong University were included in this study.The participants were grouped based on cumulative TyG index values tertiles within 3 months after ablation.Cox regression and restricted cubic spline analyses were used to determine the relationship between cumulative TyG index values and AF recurrence.The predictive value of all risk factors was assessed by receiver operating curve analysis.RESULTS There were 375 patients completed the study(age:63.23±10.73 years,64.27%male).The risk of AF recurrence increased with increasing cumulative TyG index values tertiles.After adjusting for potential confounders,patients in the medium cumulative TyG index group[hazard ratio(HR)=4.949,95%CI:1.778–13.778,P=0.002]and the high cumulative TyG index group(HR=8.716,95%CI:3.371–22.536,P<0.001)had a higher risk of AF recurrence than those in the low cumulative TyG index group.The restricted cubic spline regression model also showed an increased risk of AF recurrence with increasing cumulative TyG index values.When considering cumulative TyG index values,left atrial diameter,and lactate dehydrogenase levels as a comprehensive factor,the model could effectively predict AF recurrence after RFCA[area under the curve(AUC)=0.847,95%CI:0.797–0.897,P<0.001].CONCLUSIONS Cumulative TyG index values were a risk factor for AF recurrence after RFCA.Monitoring longitudinal TyG index values may assist with optimized for risk stratification and outcome prediction for AF recurrence.

GLP-1 receptor agonists and myocardial metabolism in atrial fibrillation

Atrial fibrillation(AF)is the most common cardiac arrhythmia.Many medical conditions,including hypertension,diabetes,obesity,sleep apnea,and heart failure(HF),increase the risk for AF.Cardiomyocytes have unique metabolic characteristics to maintain adenosine triphosphate production.Significant changes occur in myocardial metabolism in AF.Glucagon-like peptide-1 receptor agonists(GLP-1RAs)have been used to control blood glucose fluctuations and weight in the treatment of type 2 diabetes mellitus(T2DM)and obesity.GLP-1RAs have also been shown to reduce oxidative stress,inflammation,autonomic nervous system modulation,and mitochondrial function.This article reviews the changes in metabolic characteristics in cardiomyocytes in AF.Although the clinical trial outcomes are unsatisfactory,the findings demonstrate that GLP-1 RAs can improve myocardial metabolism in the presence of various risk factors,lowering the incidence of AF.

Strategies for Successful Electrical Cardioversion in Atrial Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in the world, and its management relies on restoring sinus rhythm through external electrical shock and controlling the heart rate. This procedure should be performed under sedation with strict monitoring of blood pressure and saturation after the elimination of thrombus in the left atrium. Objective: The aim of this article is to provide an overview of the impact of anticoagulation and imaging in the periprocedural period, the modalities, and the complications associated with electrical cardioversion (ECV). Research Method: A review of recent literature was conducted using medical databases such as PubMed and Scopus. Searches were performed on articles published between 2003 and 2024, focusing on the new ESC guidelines for 2024. The keywords used included “electrical cardioversion”, “atrial fibrillation”, “orthogonal cardioversion” and “anticoagulation”. Inclusion criteria encompassed clinical trials, meta-analyses, and literature reviews, while studies addressing other treatment forms for AF or lacking information on ECV were excluded. Relevant data were extracted and synthesized to provide an overview of the modalities and complications related to ECV in the context of AF. Results and Conclusion: The use of high-energy biphasic shocks significantly improves rhythm control success and also reduces the incidence of ventricular fibrillation. Furthermore, orthogonal electrical cardioversion (OECV) has proven effective for cases of AF refractory to standard protocols, allowing for a lower defibrillation threshold and promoting better current distribution. However, complications must be considered, particularly thromboembolic events in non-anticoagulated patients. Other complications, such as bradycardia and recurrence of AF, may arise post-procedure. It is therefore crucial to ensure adequate anticoagulation before and after ECV, as well as continuous monitoring, to minimize these risks and optimize clinical outcomes.

Management of cerebral amyloid angiopathy and atrial fibrillation:We are still far from precision medicine

The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrillation(AF).In fact,CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage.Nevertheless,many AF patients require oral systemic dose-adjusted warfarin,direct oral anticoagulants(such as factor Xa inhibitors)or direct thrombin inhibitors to control often associated with cardioembolic stroke risk.The prevalence of both CAA and AF is expected to rise,due to the aging of the population.This clinical dilemma is becoming increasingly common.In patients with coexisting AF and CAA,the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature.This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.

Atrial fibrillation and prediabetes:Interplay between left atrium and systemic diseases

Atrial fibrillation(AF)is associated with multiple other comorbidities,i.e.multimorbidity.Prediabetes is one of the multiple comorbidities observed in patients with AF,whereby these two disease entities share the same pathophysiological mechanisms,namely oxidative stress and inflammation.Although prediabetes is reported to have a negative impact on major adverse cardiac or cerebrovascular events in hospitalized AF patients,information about the interactions between prediabetes and AF remains inconsistent.A more in-depth exploration of pathophysiology and more comprehensive prospective clinical studies of AF and diabetes would provide a thorough understanding of the timing of events and further treatment strategies.Deeper investigations are needed to clarify the interactions and causal relationships between AF and prediabetes.

Pharmacological Treatment for Atrial Fibrillation—Modalities in Equines and Companion Animals

Cardiac arrhythmias are probably more common in horses than in any other domestic animal species where poor performance and exercise intolerance is the most frequent clinical complaint. Atrial fibrillation is a type of cardiac arrhythmia that appears as a common finding during medical examinations in humans, large breed dogs and horses. Clinical presentations are of a particular value in racehorses in high performing activities. Atrial fibrillation is characterized by an irregular heart rhythm, secondary to a primary disease or without any sign of comorbidity. The generation and maintenance of Atrial Fibrillation requires a substrate. Some breeds have a genetic predisposition to developing Atrial Fibrillation. Most cases of Atrial Fibrillation are of the paroxysmal type and self-regulate within a few hours to days without the need for treatment. The focus of this study is on the arrhythmic agents that are used for the treatment of Atrial Fibrillation, therefore other arrhythmic agents may not be included, or are included to demonstrate their effect on increasing, inhibiting or decreasing efficacy when used together with medications for the treatment of Atrial Fibrillation. The “working horse” for the pharmacological treatment of Atrial Fibrillation is Quinidine.

Global epidemiology of mental disorder in atrial fibrillation between 1998-2021:A systematic review and meta-analysis

BACKGROUND As the burden of mental disorders among patients with atrial fibrillation(AF)increases,researchers are beginning to pay close attention to the risk and prevalence of these comorbidities.Although studies have independently analyzed the risk of comorbidity with depression and anxiety in patients with AF,no study has systematically focused on the global epidemiology of these two mental disorders.AIM To explore the prevalence of depression and anxiety in patients with AF.METHODS Five databases were searched from their date of establishment until January 2023.Observational studies reporting the comorbidity of AF with depression and anxiety,were included in this study.Basic information,such as the first author/publication year,study year,study type,and prevalence of depression and anxiety,were extracted.STATA SE 15.1 was used to analyze the data.Subgroup,meta-regression,and sensitivity analyses were performed to estimate study heterogeneity.RESULTS After a thorough search,26 studies were identified and included in this metaanalysis.The prevalence rates of depression and anxiety in adults with AF were 24.3%and 14.5%,respectively.Among adult males with AF,the prevalence was 11.7%and 8.7%,respectively,whereas in females it was 19.8%and 10.1%,respectively.In older adults with AF,the prevalence rates of depression and anxiety were 40.3%and 33.6%,respectively.The highest regional prevalence of depression and anxiety was observed in European(30.2%)and North American(19.8%)patients with AF.CONCLUSION In this study,we found that the prevalence of depression and anxiety among patients with AF varies with sex,region,and evaluation scales,suggesting the need for psychological interventions for patients with AF in clinical practice.

Cardiac remodeling in patients with atrial fibrillation reversing bradycardia-induced cardiomyopathy:A case report

BACKGROUND Bradycardia-induced cardiomyopathy(BIC),which is a disease resulting from bradycardia,is characterized by cardiac chamber enlargement and diminished cardiac function.The correction of bradycardia can allow for significant improvements in both cardiac function and structure;however,this disease has been infrequently documented.In this case,we conducted a longitudinal followup of a patient who had been enduring BIC for more than 40 years to heighten awareness and prompt timely diagnosis and rational intervention.CASE SUMMARY A woman who presented with postactivity fatigue and dyspnea was diagnosed with bradycardia at the age of 7.Since she had no obvious symptoms,she did not receive any treatment to improve her bradycardia during the 42-year follow-up,except for the implantation of a temporary pacemaker during labor induction surgery.As time progressed,the patient's heart gradually expanded due to her low ventricular rate,and she was diagnosed with BIC.In 2014,the patient developed atrial fibrillation,her ventricular rate gradually increased,and her heart shape gradually returned to normal.This report describes the cardiac morphological changes caused by the heart rate changes in BIC patients older than 40 years,introduces another possible outcome of BIC,and emphasizes the importance of early intervention in treating BIC.CONCLUSION BIC can induce atrial fibrillation,causing an increased ventricular rate and leading to positive cardiac remodeling.

Relationship of inflammatory indices with left atrial appendage thrombus or spontaneous echo contrast in patients with atrial fibrillation

BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory indices and left atrial appendage thrombus(LAAT)or dense spontaneous echo contrast(SEC)are limited.AIM To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients.METHODS A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence(study group)or absence(control group)of LAAT or dense SEC.Inflammatory indices,including the neutrophil-to-lymphocyte ratio(NLR),platelet–tolymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR),were calculated from complete blood analysis.The associations of inflammatory indices RESULTS LAAT and dense SEC were detected in 11(2.7%)and 42(10.3%)patients,respectively.The PLR only showed an association with LAAT/dense SEC in the univariate model.Elevated NLR(odds ratio[OR]=1.48,95%confidence interval[CI]:1.11-1.98,P=0.007)and reduced LMR(OR=0.59,95%CI:0.41-0.83,P=0.003)were found to be independent risk factors for the presence of LAAT/dense SEC.The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73(95%CI:0.66-0.80,P<0.001)and 0.73(95%CI:0.65-0.81,P<0.001),respectively,while the cutoff values were 2.8(sensitivity:69.8%;specificity:64.0%)and 2.4(sensitivity:71.7%;specificity:60.6%),respectively.CONCLUSION Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.

Ibrutinib and atrial fibrillation:An in-depth review of clinical implications and management strategies

Ibrutinib,a targeted therapy for B-cell malignancies,has shown remarkable efficacy in treating various hematologic cancers.However,its clinical use has raised concerns regarding cardiovascular complications,notably atrial fibrillation(AF).This comprehensive review critically evaluates the association between ibrutinib and AF by examining incidence,risk factors,mechanistic links,and management strategies.Through an extensive analysis of original research articles,this review elucidates the complex interplay between ibrutinib’s therapeutic benefits and cardiovascular risks.Moreover,it highlights the need for personalized treatment approaches,vigilant monitoring,and interdisciplinary collaboration to optimize patient outcomes and safety in the context of ibrutinib therapy.The review provides a valuable resource for healthcare professionals aiming to navigate the intricacies of ibrutinib’s therapeutic landscape while prioritizing patient well-being.

Severe hypoxemia after radiofrequency ablation for atrial fibrillation in palliatively repaired tetralogy of Fallot: A case report

BACKGROUND Patients with tetralogy of Fallot(TOF)often have arrhythmias,commonly being atrial fibrillation(AF).Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia,but the risk of complications may increase in patients with conditions such as TOF.CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt.The patient subsequently underwent atrial septal occlusion and eventually recovered.CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury;thus possible complications should be predicted in order to ensure successful treatment and patient safety.

Role of a new inflammation predictor in predicting recurrence of atrial fibrillation after radiofrequency catheter ablation

BACKGROUND Radiofrequency catheter ablation(RFCA)has become an important strategy for treating atrial fibrillation(AF),and postoperative recurrence represents a significant and actively discussed clinical concern.The recurrence after RFCA is considered closely related to inflammation.Systemic immune inflammation index(SII)is a novel inflammation predictor based on neutrophils,platelets,and lymphocytes,and is considered a biomarker that comprehensively reflects the immune inflammatory status of the body.AIM To explore the predictive effect of the SII on AF recurrence after RFCA and its predictive value in combination with the existing APPLE score for AF recurrence after RFCA in patients with non-valvular AF(NVAF).METHODS We retrospectively included 457 patients with NVAF first receiving RFCA and classified them into the recurrent or non-recurrent group.We also investigated the predictive role of SII on AF recurrence following RFCA.Finally,we explored and compared the additional predictive value of the SII after combining with the APPLE score.RESULTS After 12 months of follow-up,113(24.7%)patients experienced recurrence.High SII has been demonstrated to be an independent predictor for postoperative AF recurrence.Receiver operating characteristic and decision curve analysis(DCA),as well as net reclassification improvement(NRI)and integrated discrimination improvement(IDI)results,showed that SII combined with the APPLE score had higher predictive efficiency than using the SII or APPLE score alone.The area under the curve of the combined model(0.662,95%confidence interval:0.602-0.722)significantly increased compared with that of the SII and APPLE scores alone(P<0.001).The combined model resulted in an NRI of 29.6%and 34.1%and IDI of 4.9%and 3.5%in predicting AF recurrence compared with the SII and APPLE scores alone,respectively(all P<0.001).The SII,APPLE score,and their combination demonstrated greater clinical utility than did the treat-all and treat-none strategies over the 20–80%risk threshold according to the DCA.CONCLUSION The SII was a predictor of recurrence after RFCA of AF.Moreover,the SII enhanced the predictability of the APPLE score for post-RFCA AF recurrence,providing valuable insights for physicians to optimise patient selection and develop personalised treatment plans.