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Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry.

ABSTRACT: Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.

SUBMITTER: El-Battrawy I

PROVIDER: S-EPMC8475688 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry.

El-Battrawy Ibrahim I Cammann Victoria L VL Kato Ken K Szawan Konrad A KA Di Vece Davide D Rossi Aurelio A Wischnewsky Manfred M Hermes-Laufer Julia J Gili Sebastiano S Citro Rodolfo R Bossone Eduardo E Neuhaus Michael M Franke Jennifer J Meder Benjamin B Jaguszewski Milosz M Noutsias Michel M Knorr Maike M Heiner Susanne S D'Ascenzo Fabrizio F Dichtl Wolfgang W Burgdorf Christof C Kherad Behrouz B Tschöpe Carsten C Sarcon Annahita A Shinbane Jerold J Rajan Lawrence L Michels Guido G Pfister Roman R Cuneo Alessandro A Jacobshagen Claudius C Karakas Mahir M Koenig Wolfgang W Pott Alexander A Meyer Philippe P David Arroja Jose J Banning Adrian A Cuculi Florim F Kobza Richard R Fischer Thomas A TA Vasankari Tuija T Airaksinen K E Juhani KEJ Napp L Christian LC Budnik Monika M Dworakowski Rafal R MacCarthy Philip P Kaiser Christoph C Osswald Stefan S Galiuto Leonarda L Chan Christina C Bridgman Paul P Beug Daniel D Delmas Clément C Lairez Olivier O Gilyarova Ekaterina E Shilova Alexandra A Gilyarov Mikhail M Kozel Martin M Tousek Petr P Winchester David E DE Galuszka Jan J Ukena Christian C Poglajen Gregor G Carrilho-Ferreira Pedro P Hauck Christian C Paolini Carla C Bilato Claudio C Kobayashi Yoshio Y Prasad Abhiram A Rihal Charanjit S CS Liu Kan K Schulze P Christian PC Bianco Matteo M Jörg Lucas L Rickli Hans H Pestana Gonçalo G Nguyen Thanh H TH Böhm Michael M Maier Lars S LS Pinto Fausto J FJ Widimský Petr P Felix Stephan B SB Opolski Grzegorz G Braun-Dullaeus Ruediger C RC Rottbauer Wolfgang W Hasenfuß Gerd G Pieske Burkert M BM Schunkert Heribert H Thiele Holger H Bauersachs Johann J Katus Hugo A HA Horowitz John D JD Di Mario Carlo C Münzel Thomas T Crea Filippo F Bax Jeroen J JJ Lüscher Thomas F TF Ruschitzka Frank F Duru Firat F Borggrefe Martin M Ghadri Jelena R JR Akin Ibrahim I Templin Christian C

Journal of the American Heart Association 20210728 15

Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating center ...[more]

PMID: 34315238

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Project description:BackgroundWe determined the long-term event incidence among elderly patients with nonvalvular atrial fibrillation in terms of history of stroke/transient ischemic attack (TIA) and oral anticoagulation.MethodsPatients aged ≥75 years with documented nonvalvular atrial fibrillation enrolled in the prospective, multicenter, observational All Nippon Atrial Fibrillation in the Elderly Registry between October 2016 and January 2018 were divided into 2 groups according to history of stroke/TIA. The primary end point was the occurrence of stroke/systemic embolism within 2 years, and secondary end points were major bleeding and all-cause death within 2 years. Cox models were used to determine whether there was a difference in the hazard of each end point in patients with/without history of stroke/TIA, and in ischemic stroke/TIA survivors taking direct oral anticoagulants versus those taking warfarin.ResultsOf 32 275 evaluable patients (13 793 women [42.7%]; median age, 81.0 years), 7304 (22.6%) had a history of stroke/TIA. The patients with previous stroke/TIA were more likely to be male and older and had higher hazard rates of stroke/systemic embolism (adjusted hazard ratio, 2.25 [95% CI, 1.97-2.58]), major bleeding (1.25, 1.05-1.49), and all-cause death (1.13, 1.02-1.24) than the other groups. Of 6446 patients with prior ischemic stroke/TIA, 4393 (68.2%) were taking direct oral anticoagulants and 1668 (25.9%) were taking warfarin at enrollment. The risk of stroke/systemic embolism was comparable between these 2 groups (adjusted hazard ratio, 0.90 [95% CI, 0.71-1.14]), while the risk of major bleeding (0.67, 0.48-0.94), intracranial hemorrhage (0.57, 0.39-0.85), and cardiovascular death (0.71, 0.51-0.99) was lower among those taking direct oral anticoagulants.ConclusionsPatients aged ≥75 years with nonvalvular atrial fibrillation and previous stroke/TIA more commonly had subsequent ischemic and hemorrhagic events than those without previous stroke/TIA. Among patients with previous ischemic stroke/TIA, the risk of hemorrhagic events was lower in patients taking direct oral anticoagulants compared with warfarin.RegistrationURL: https://www.Clinicaltrialsgov; Unique Identifier: UMIN000024006.

Project description:BackgroundIntracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation may result in Takotsubo syndrome (TS), but the frequency, predisposing factors (age, sex, mental health disorders), and outcomes are currently unknown. This study sought to assess the frequency, predisposing factors, and outcomes of subjects who underwent intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation and were diagnosed with TS.MethodsThis was a retrospective observational cohort study utilizing TriNetX® electronic health record (EHR) data. We included subjects aged older than 18 years who underwent intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation. The study population was divided into two groups (no TS diagnostic code presence and TS diagnostic code presence). We analyzed the distributions of age, sex, race, diagnostic codes, common terminology procedures (CPT), and vasoactive medication codes and examined mortality rate within 30 days.ResultsWe included 69,116 subjects. Of these, 27 (0.04%) had a TS diagnostic code, the cohort was comprised mostly of females [17 (63.0%)], and 1 (3.7%) death within 30 days was reported. There were no significant differences in age and frequency of mental health disorders between those patients in TS and non-TS cohorts. Adjusting for age, sex, race, ethnicity, patient regionality, and mental health disorder diagnostic code, those patients who developed TS had a significantly higher odds of dying in 30 days after catheter ablation compared to those without TS (OR = 15.97, 95% CI: 2.10-121.55, p = .007).ConclusionsApproximately 0.04% of subjects who underwent intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation had a subsequent diagnostic code of TS. Further study is needed to determine whether there are predisposing factors associated with the development of TS in subjects who undergo catheter ablation of atrial fibrillation by pulmonary vein isolation.

Project description:ObjectivesAnaemia has an adverse impact on the outcome in the general patient population undergoing percutaneous coronary intervention (PCI). The aim of this study was to analyse the impact of anaemia on the 12-month clinical outcome of patients with atrial fibrillation (AF) undergoing PCI and therefore requiring intense antithrombotic treatment. We hypothesised that anaemia might be associated with a worse outcome and more bleeding in these anticoagulated patients.SettingData were collected from 17 secondary care centres in Europe.ParticipantsConsecutive patients with AF undergoing PCI were enrolled in the prospective, multicenter AFCAS (Atrial Fibrillation undergoing Coronary Artery Stenting) registry. Altogether, 929 patients participated in the study. Preprocedural haemoglobin concentration was available for 861 (92.7%; 30% women). The only exclusion criteria were inability or unwillingness to give informed consent. Anaemia was defined as a haemoglobin concentration of <12 g/dL for women and <13 g/dL for men.Outcome measuresThe primary endpoint was occurrence of major adverse cardiac and cerebrovascular events (MACCE) or bleeding events.Results258/861 (30%) patients had anaemia. Anaemic patients were older, more often had diabetes, higher CHA2DS2-VASc scores, prior history of heart failure, chronic renal impairment and acute coronary syndrome. Anaemic patients had more MACCE than non-anaemic (29.1% vs 19.4%, respectively, p=0.002), and minor bleeding events (7.0% vs 3.3%, respectively, p=0.028), with a trend towards more total bleeding events (25.2% vs 21.7%, respectively, p=0.059). No difference was observed in antithrombotic regimens at discharge. In multivariate analysis, anaemia was an independent predictor of all-cause mortality at 12-month follow-up (hazard ratio 1.62, 95% CI 1.05 to 2.51, p=0.029).ConclusionsAnaemia was a frequent finding in patients with AF referred for PCI. Anaemic patients had a higher all-cause mortality, more thrombotic events and minor bleeding events. Anaemia seems to be an identification of patients at risk for cardiovascular events and death.Trial registrationClinicalTrials.gov number NCT00596570.

Dataset Information

Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry.

Publications

Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry.

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