Biomedical subjects

Win-Kuang Shen

Publications and source records attributed to Win-Kuang Shen.

At least 19 recordsLinked to original sources

PubMed2007

Vasovagal syncope in patients with reduced left ventricular function.

Vasovagal syncope (VVS) is mediated by arterial mechanoreceptors, resulting in reflexive changes in heart rate and vascular tone. The Bezold-Jarisch reflex was originally described as enhanced contraction and activation of left ventricular mechanoreceptors, but later studies implicated other triggers, including coronary, carotid, and cerebral arterial mechanoreceptors. VVS is uncommon in patients with left ventricular dysfunction. We hypothesized that VVS could occur in this subset and examined patient characteristics and hemodynamic responses during tilt table testing. From 1996 through 1998, 128 consecutive patients with ejection fraction <40% underwent tilt table testing (70 degrees , 45 min). A total of 15 patients (11.7%) had a positive neurocardiogenic response thought to be the cause of syncope. Clinical data and hemodynamic responses were reviewed. Mean patient age (+/-SEM) was 70.1 +/- 12.2 years. Nine patients were male. Mean ejection fraction was 27.7% +/- 7.1%. Thirteen had electrophysiologic studies with normal findings or abnormal findings insufficient to account for syncope. Hemodynamic analysis of 14 patients who had a vasovagal response during passive tilt table testing showed a mean time to positive response of 17.6 +/- 12.7 min. Cardioinhibitory responses (pauses >3 sec or heart rate < 40 beats/min for > or =10 sec) were not observed. Five responses were classified as mixed type (>10% decrease in heart rate without a cardioinhibitory response) and 9 as vasodepressor type (< or =10% decrease in heart rate). VVS occurs in patients who have clinically significant left ventricular dysfunction. Although this study had a small cohort size, the predominantly vasodepressor response without a cardioinhibitory component warrants further investigation into mechanisms of VVS in these patients.

Aged↗

PubMed2007

Syncope evaluation in the emergency department.

PURPOSE OF REVIEW: In the absence of an established critical pathway to evaluate patients with syncope presenting to the emergency department, this review is timely because of new clinical evidences supporting a specialized syncope management unit in the emergency department, and it is relevant because of the potential impact on a very large and heterogeneous population. RECENT FINDINGS: Three observational syncope studies from Italy showed a high degree of variability in practice patterns, diagnostic yields, and lengths of hospital stay. An appropriate and efficacious syncope management pathway in the emergency department remains far from established. In a randomized trial from a tertiary care hospital in the US, the SEEDS study demonstrated that a designated 'syncope unit' in the emergency department, with a multidisciplinary effort and appropriate resources, significantly improved diagnostic yield, reduced hospital admission and total length of hospital stay in intermediate-risk patients. Long-term follow-up showed that reduced hospital stay did not negatively affect survival and recurrent syncope. SUMMARY: Limited randomized trial data suggest a designated syncope unit in the emergency department holds promise to provide specialized and efficient care for patients with syncope. Additional data are needed to assess the general applicability of this critical pathway in community-based hospitals.

Emergency Service, Hospital↗

PubMed2006

Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly.

AIMS: Trials of rate control vs. rhythm control for atrial fibrillation or flutter included few patients with new-onset arrhythmia. Our objective was to assess the relapse rate and the effect of the relapse of new-onset atrial arrhythmias on mortality after direct-current cardioversion (DCCV). METHODS AND RESULTS: A cohort of 351 patients with atrial fibrillation (new onset in 179) and 126 patients with atrial flutter (new onset in 78) was followed-up after DCCV. Cox proportional hazard models were used. Median age was 74.6 years. Mean follow-up for relapse was 7.7 months; for death, 29.4 months. Patients with new-onset atrial flutter [adjusted hazard ratio (HR) = 1] were more likely to maintain sinus rhythm than the patients with recurrent atrial flutter (adjusted HR = 2.5, P < 0.01), new-onset atrial fibrillation (adjusted HR = 2.4, P < 0.01), or recurrent atrial fibrillation (adjusted HR = 2.7, P < 0.01). Patients with new-onset atrial fibrillation were as likely to have relapses as patients with recurrent atrial fibrillation or flutter. Relapse of atrial arrhythmia after DCCV was associated with increased mortality (adjusted HR= 3.1, P < 0.01). CONCLUSION: DCCV is more successful in maintaining sinus rhythm in patients with new-onset atrial flutter than in patients with new-onset atrial fibrillation. Relapse of atrial arrhythmia after cardioversion is associated with increased mortality.

Aged↗

PubMed2006

Prevalence of syncope in a population aged more than 45 years.

PURPOSE: Our current understanding of the prevalence of syncope is based on a few small studies of highly selected populations. We sought to estimate the prevalence and recurrence rate of syncope in the general population aged more than 45 years and to analyze their associations with age and sex. METHODS: We performed a cross-sectional survey of 1925 randomly selected residents of Olmsted County, Minn, 45 years or older, from January 1998 to August 2000. RESULTS: The median age of the 1925 participants was 62 years, and 905 (47.0%) were male. Overall, 364 subjects reported an episode of syncope in their lifetime, giving an estimated prevalence of 19% (95% confidence interval, 17%-21%). The age-specific prevalence rates were 45 to 54 years (20%), 55 to 64 years (20%), 65 to 74 years (15%), and 75 years or more (21%) (P = .86). Females reported a higher prevalence of syncope (22% vs 15%, P < .001). CONCLUSIONS: The prevalence of syncope is estimated at 19% in the general population aged more than 45 years. Females have a higher prevalence, and there is no association of syncope prevalence with age.

Aged↗

PubMed2006

Syncope: case studies.

In this series of clinical vignettes, the authors have attempted to provide a "feel" for the varied causes of syncope. The neurologist should be able to diagnose most causes of syncope using a simple algorithmic approach. Initial evaluation includes detailed clinical history, physical examination, and 12-lead ECG. Following initial evaluation, the cause of syncope is usually immediately apparent (typical story for vasovagal syncope, clinically demonstrable autonomic failure, long QT), strongly suspected (syncope preceded by chest pain or palpitations), or uncertain. In the latter group of patients, further workup will depend on the suspicion or documented presence of heart disease. In those with a single episode of syncope and no evidence of heart disease, further workup may not be necessary. In patients over 60 years of age with recurrent episodes and no cardiac history or abnormal ECG, tilt-table testing and carotid sinus massage may be diagnostic. If no diagnosis is found, an implantable loop monitor may be needed. Patients with heart disease will need the most comprehensive evaluations, possibly including exercise testing, cardiac electrophysiology, and tilt-table testing. As better understanding of pathophysiology and epidemiology emerge, under-standing of the diagnosis and treatment of syncope will improve. In the meantime, there is no substitute for astute clinical acumen.

Adult↗

PubMed2006

Neurocardiogenic syncope: latest pharmacological therapies.

Neurocardiogenic syncope is a neurally mediated disorder and is a common cause of syncope. The goal of treatment is to prevent recurrences with the aim of improving quality of life and reducing morbidity. Reassurance, in some cases, may suffice. In others, augmenting central blood volume by increasing fluid and/or salt intake is effective. The role of non-pharmacological physical manoeuvres is increasingly recognised, given the increasing clinical trial data supporting their efficacy. This review summarises the clinical evidence for a variety of pharmacological agents. Of these, midodrine appears to have yielded the most consistent favourable outcome. Its use, however, should be reserved for patients with recurrent and refractory syncope.

Adrenergic alpha-Agonists↗

PubMed2005

Effect of atrial fibrillation pattern on survival in a community-based cohort.

The clinical presentation of recurrent atrial fibrillation (AF) has been categorized into 3 general patterns: paroxysmal, persistent, and permanent AF. This community-based cohort study characterized the effect of the AF pattern on survival. Community residents in Olmsted County, Minnesota, with electrocardiographically proven new-onset AF during 1996 and 1997 were retrospectively identified and prospectively followed. Observed survival was estimated using the Kaplan-Meier method and compared with the expected survival. Log-rank tests were used for group comparisons. The association between the baseline variables and mortality was assessed using Cox proportional hazards models. Of 270 patients (mean +/- SD age 73 +/- 14 years; 148 men [55%]), 143 had paroxysmal AF, 40 had persistent AF, and 87 had permanent AF. The cohort's observed survival was significantly worse than expected (p <0.001). The factors associated with increased mortality included older age, concomitant heart failure, and concomitant chronic obstructive pulmonary disease (all p <0.001). Permanent AF was associated with higher mortality than paroxysmal AF (hazard ratio 1.6, 95% confidence interval 1.1 to 2.3). Persistent AF was associated with better survival (hazard ratio 0.3, 95% confidence interval 0.1 to 0.8). In conclusion, survival among patients with persistent AF was significantly better than that among patients with paroxysmal AF or permanent AF. The ability to maintain sinus rhythm may be associated with better survival.

Age Factors↗

PubMed2005

Sinus venosus atrial septal defect: long-term postoperative outcome for 115 patients.

BACKGROUND: Sinus venosus atrial septal defect (SVASD) differs from secundum atrial septal defect by its atrial septal location and its association with anomalous pulmonary venous connection (APVC). Data on long-term outcome after surgical repair are limited. METHODS AND RESULTS: We reviewed outcomes of 115 patients (mean age+/-SD 34+/-23 years) with SVASD who had repair from 1972 through 1996. APVC was present in 112 patients (97%). Early mortality was 0.9%. Complete follow-up was obtained for 108 patients (95%) at 144+/-99 months. Symptomatic improvement was noted in 83 patients (77%), and deterioration was noted in 17 patients (16%). At follow-up, 7 (6%) of 108 patients had sinus node dysfunction, a permanent pacemaker, or both, and 15 (14%) of 108 patients had atrial fibrillation. Older age at repair was predictive of postoperative atrial fibrillation (P=0.033). No reoperations were required during follow-up. Survival was not different from expected for an age- and sex-matched population. Clinical improvement was more common with older age at surgery (P=0.014). Older age at repair (P=0.008) and preoperative New York Heart Association class III or IV (P=0.038) were independent predictors of late mortality. CONCLUSIONS: Operation for SVASD is associated with low morbidity and mortality, and postoperative subjective clinical improvement occurs irrespective of age at surgery. Postoperative atrial fibrillation appears to be related to older age at operation. SVASD repair achieves survival similar to that of a matched population and should be considered whenever repair may impact survival or symptoms.

Adolescent↗

PubMed2005

Programmed ventricular stimulation in patients with idiopathic dilated cardiomyopathy and syncope receiving implantable cardioverter-defibrillators: a case series and a systematic review of the literature.

BACKGROUND: The role of programmed ventricular stimulation (PVS) in patients with idiopathic dilated cardiomyopathy (DCM) and syncope receiving implantable cardioverter-defibrillators (ICD) remains controversial. METHODS AND RESULTS: Between 1994 and July 2002, 20 patients with DCM and syncope underwent PVS and ICD implantation at the Onassis Cardiac Surgery Center or the Alexandra General Hospital. At PVS 10 patients had inducible sustained monomorphic ventricular tachycardia (SMVT), 3 patients had inducible sustained polymorphic ventricular tachycardia or ventricular fibrillation, and 7 patients had no inducible arrhythmia. The latter 7 patients received an ICD because of clinical occurrence of ventricular tachycardia (n=5) or fibrillation (n=2). Mean age was 55+/-14 years; 80% were men. During a mean follow-up of 2.8+/-2.3 years, 12 of the 20 patients received an appropriate shock. The incidence of appropriate shocks at 1 and 3 years was 69% and 84% in the inducible SMVT group, and 56% and 67% in the group without inducible SMVT (p=0.93, log rank test). Overall survival was similar in both groups (p=0.53). In a systematic review of the published literature 18 of 75 (24%) patients with DCM, syncope and a negative PVS had an appropriate ICD shock after a mean follow-up of 27 months. CONCLUSION: PVS has a limited role in risk stratification of patients with DCM and syncope.

Adult↗

PubMed2005

Score indices for predicting electrophysiologic outcomes in patients with unexplained syncope.

INTRODUCTION: Our ability to predict a positive electrophysiologic (EP) study in the evaluation of unexplained syncope is suboptimal. AIMS: In patients with unexplained syncope, we defined clinical predictors of bradyarrhythmia and ventricular tachycardia (VT) diagnosed during EP study, constructed diagnostic score indices for bradyarrhythmia and VT, and evaluated the predictive power of each score index. METHODS: All patients evaluated in the Arrhythmia Clinic for unexplained syncope from January 1, 1996, through December 31, 1998, were identified and enrolled in the study. Five hundred eight patients (325 [64%] men; mean+/-SD age, 64+/-17 years) underwent EP testing. We analyzed elements from historical data and noninvasive laboratory findings as predictors of bradyarrhythmia and VT diagnosed on EP study. RESULTS: Fifty-eight patients (11%) had sinus node dysfunction, 94 (19%) had atrioventricular (AV) node disease, 92 (18%) had His-Purkinje system disease, and 101 (20%) had VT. Models were fit using logistic regression analysis. Predictors were assigned weighted scores, and a score index was formulated. The area under the curve associated with sinus node dysfunction, AV node disease, His-Purkinje system disease, and VT models was 0.64, 0.60, 0.84, and 0.60, respectively. CONCLUSIONS: We have constructed diagnostic score indices for EP outcomes of bradyarrhythmia and VT in syncope. Of all the score indices, the model for His-Purkinje system disease has the highest predictive power.

Arrhythmias, Cardiac↗

PubMed2005

Impact of the application of the American College of Emergency Physicians recommendations for the admission of patients with syncope on a retrospectively studied population presenting to the emergency department.

BACKGROUND: The goal of our study was to determine the accuracy of the American College of Emergency Physicians (ACEP) clinical policy in identifying patients with a cardiac cause for their syncope and its potential effect on syncope management. METHODS: Adult patients with syncope presenting to the emergency department (ED) from January 1996 to December 1998 were identified. Diagnosis was established retrospectively by reviewing medical records. The ACEP guidelines were applied to this population. RESULTS: Of the 200 patients identified, 115 (57.5%, 95% CI 60-64) were admitted from the ED and 24 (12%) were found to have cardiogenic syncope. Of the 24 patients with cardiac syncope, 23 were admitted. By applying ACEP level B recommendations to our population, all patients who on further workup were found to have cardiac syncope would have been admitted from the ED (100% sensitivity, 95% CI 86-100) and 81% of patients with no cardiac syncope would have been discharged from the ED (81% specificity, 95% CI 75-87). The admission rate would have been 28.5% (95% CI 22-35). By extending admission to patients satisfying level C in addition to level B recommendations, the sensitivity, specificity, and admission rate would have been 100% (95% CI 86-100), 33% (95% CI 26-40), and 71.0% (95% CI 64-77), respectively. CONCLUSION: High sensitivity and specificity in identifying patients with cardiogenic syncope and significant reduction in the hospital admission rate were observed by applying ACEP level B recommendations to patients presenting to our ED. Application of level C recommendations did not offer any advantage.

Adult↗

PubMed2005

Epinephrine-induced T-wave notching in congenital long QT syndrome.

OBJECTIVES: The purpose of this study was to characterize the effect of epinephrine on T-wave morphology in patients with congenital long QT syndrome (LQTS). BACKGROUND: QT prolongation is a paradoxical, LQT1-specific response to low-dose epinephrine infusion. At rest, notched T waves are more common in LQT2. METHODS: Thirty subjects with LQT1, 28 with LQT2, and 32 controls were studied using epinephrine provocation. Twelve-lead ECG was recorded continuously, and QT, QTc, and heart rate were obtained during each stage. Blinded to phenotype and genotype, T-wave morphology was classified as normal, biphasic, G1 (notch at or below the apex), or G2 (distinct protuberance above the apex). RESULTS: At baseline, 97% LQT1, 71% LQT2, and 94% control had normal T-wave profiles. During epinephrine infusion, G1- and G2-T waves were more common in LQT2 than in LQT1 (75% vs 26%, P = .009). However, epinephrine-induced G1-T waves were present in 34% of control. Epinephrine-precipitated biphasic T waves were observed similarly in all groups: LQT1 (6/30), LQT2 (3/28), and control (4/32). During low-dose epinephrine infusion (< or =0.05 microg/kg/min), G1-T waves occurred more frequently in LQT2 (LQT1: 25% vs 3%; control 9%, P = .02). Low-dose epinephrine-induced G2-T waves were detected exclusively in LQT2 (18%). Low-dose epinephrine elicited G1/G2-T waves in 8 of 15 LQT2 patients with a nondiagnostic baseline QTc. CONCLUSIONS: Biphasic and G1-T waves are nonspecific responses to high-dose epinephrine. Changes in T-wave morphology during low-dose epinephrine (<0.05 microg/kg/min) may yield diagnostic information. G2-notched T waves elicited during low-dose epinephrine may unmask some patients with concealed LQT2.

Adult↗

PubMed2005

Effects of omapatrilat on cardiac nerve sprouting and structural remodeling in experimental congestive heart failure.

BACKGROUND: Congestive heart failure (CHF) results in decreased cardiac sympathetic innervation. OBJECTIVES: The purpose of this study was to test the hypothesis that therapy with the vasopeptidase inhibitor omapatrilat (OMA) attenuates cardiac neuronal remodeling in CHF. METHODS: We induced CHF in dogs with rapid ventricular pacing for 5 weeks with (CHF+OMA group, n = 8) or without (CHF group, n = 10) concomitant OMA treatment (10 mg/kg twice daily). Cardiac catheterization and echocardiography were performed to determine cardiac structure and hemodynamic parameters. Myocardial nerve density was determined by immunocytochemical staining with anti-growth associated protein 43 (GAP43) and anti-tyrosine hydroxylase (TH) antibodies. Seven normal dogs were used as histologic controls. RESULTS: In the CHF group, ascites developed in 3 dogs and 4 dogs died, compared with no ascites or death in the CHF+OMA group (P = .07). In the 6 CHF dogs that survived, all had atrial fibrosis, severely depressed left ventricular systolic function, and increased atrial and ventricular chamber size. OMA treatment decreased the atrial and ventricular chamber sizes and the degree of atrial fibrosis. Most CHF dogs showed severe myocardial denervation, although some showed normal or abnormally high nerve counts. OMA treatment prevented heterogeneous reduction of nerve density. The left ventricular TH-positive nerve densities were 128 +/- 170 microm(2)/mm(2), 261 +/- 185 microm(2)/mm(2), and 503 +/- 328 microm(2)/mm(2) (P < .05), and the atrial GAP43-positive nerve densities were 1,683 +/- 1,365 microm(2)/mm(2), 305 +/- 368 microm(2)/mm(2), and 1,278 +/- 1,479 microm(2)/mm(2) (P < .05) for the control, CHF, and CHF+OMA groups, respectively. CONCLUSION: CHF results in heterogeneous cardiac denervation. Long-term OMA treatment prevented the reduction of nerve density and promoted beneficial cardiac structural remodeling.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2005

Use of advanced mapping systems to guide ablation in complex cases: experience with noncontact mapping and electroanatomic mapping systems.

OBJECTIVE: This report describes our experience with noncontact mapping and electroanatomic mapping in complex ablations, which are defined as ablations done after failure of conventional ablation. MATERIAL AND METHODS: Patients were included (N = 68; 49% with structural heart disease) in whom previous ablation failed and in whom a second procedure was done with advanced mapping. Non-contact mapping was used in 17 patients, electroanatomic mapping in 36, and both noncontact and electroanatomic mapping in 15. Arrhythmias included focal atrial tachycardia (n = 16), reentrant atrial tachycardia (n = 14), right ventricular outflow tachycardia (n = 10), post-myocardial infarction ventricular tachycardia (n = 9), and others (n = 19). RESULTS: Acute success at the second ablation was achieved in 79% of patients. At 20 +/- 9 months after the procedure, 69% of these patients reported having significantly fewer symptoms than before the second ablation, and 51% were free of symptoms. Only 16% were using antiarrhythmic medications. Complications included a small pericardial effusion in two patients, hypotension in one patient, and a femoral pseudoaneurysm in another. CONCLUSIONS: Advanced mapping is a useful and safe adjunct for catheter ablation after ablation has failed in patients with complex substrate.

Arrhythmias, Cardiac↗

PubMed2005

Noninvasive assessment of acute changes in atrial electrophysiology after cardioversion by signal-averaged P-wave electrocardiography.

BACKGROUND: Atrial remodeling secondary to atrial fibrillation (AF) may be important in the arrhythmogenic process. Unfortunately, the study of electrophysiologic remodeling in humans has been limited by the invasive nature of most tests of electrophysiologic characteristics. We sought to determine whether changes in atrial electrophysiology occur acutely (within the first hour) after cardioversion and whether these changes could be detected noninvasively by measuring the signal-averaged P-wave. METHODS: The filtered P-wave duration (FPD) was measured by signal-averaged electrocardiography (ECG) at 20 and 60 minutes after cardioversion in 46 patients with AF, and the difference between the two values was calculated. The root-mean-square voltage of the terminal 40 ms of the signal-averaged P-wave at 20 and 60 minutes and the difference between them were also determined. RESULTS: The FPD at 20 minutes was significantly different from that at 60 minutes (153.0 +/- 19.1 vs 159.7 +/- 24.8 ms; P = 0.02). In a univariate linear regression model, none of the clinical variables studied was significantly associated with the change in FPD. The root-mean-square voltage at 20 minutes was not significantly different from that at 60 minutes (5.8 +/- 3.0 vs 5.5 +/- 2.7; P = 0.14). CONCLUSIONS: We conclude that significant changes in atrial electrophysiology occur within the first hour after cardioversion of AF. These changes can be detected by measuring the FPD.

Aged↗

PubMed2005

Acute blood pressure changes after the onset of atrioventricular nodal reentrant tachycardia: a time-course analysis.

INTRODUCTION: We aimed to characterize blood pressure (BP) response at the beginning of atrioventricular nodal reentrant tachycardia (AVNRT) and its relationship to orthostatic challenge and variable atrioventricular interval. METHODS AND RESULTS: In this prospective study of 17 consecutive patients with documented AVNRT, mean BP was analyzed in the supine and upright positions during sinus rhythm, AVNRT, and pacing with atrioventricular delay of 150 msec (AV150) and 0 msec (AV0). Mean BPs were compared at 3-5 seconds, 8-10 seconds, and 28-30 seconds after the onset of AVNRT or pacing. BP decreased immediately after AVNRT initiation, with gradual recovery during the first 30 seconds from 71.9 +/- 16.5 mmHg to 86 +/- 13.8 mmHg, P < 0.01. A similar pattern was observed during AV0, but not during AV150, pacing. While supine, mean BP decrease was more pronounced during AVNRT and AV0 pacing (-26.1% and -32.1%, respectively) than during AV150 pacing (-8%, P = 0.02 and P = 0.07, respectively). This difference subsided 30 seconds after the onset of AVNRT or pacing. When upright, the mean BP time course was similar, but mean BP recovery during AVNRT was slower, and the difference between mean BP during AVNRT and AV150 persisted at 30 seconds. CONCLUSIONS: The initial mean BP decrease during AVNRT recovered gradually within 30 seconds. A short atrioventricular interval is associated with a greater mean BP decrease at the onset of tachycardia. These observations may explain clinical symptoms immediately after the onset of AVNRT.

Adult↗

PubMed2004

Upper limit of vulnerability determination during implantable cardioverter-defibrillator placement to minimize ventricular fibrillation inductions.

The defibrillation threshold (DFT) and upper limit of vulnerability (ULV) were determined using step-down protocols in 50 patients who underwent implantable cardioverter-defibrillator placement or testing. The sensitivity and specificity of each ULV energy level was assessed for detecting an increased DFT, correlation of the DFT and ULV, and optimal shock timing for ULV determination. A ULV <10 or 11 J (failure to induce ventricular fibrillation with 10- to 11-J shocks) was 100% predictive of an acceptable DFT and may be sufficient to exclude unacceptable DFTs in 60% of implantable cardioverter-defibrillator recipients. All 4 shocks used to scan the peak of the T wave during ULV testing were necessary for accurate ULV determination.

Aged↗

PubMed2004

Outcome of patients with newly diagnosed atrial fibrillation at the Mayo Clinic and residing in that area.

This study examined the prognostic significance of atrial fibrillation (AF) in a community-based cohort. AF, the most common cardiac dysrhythmia, frequently occurs in the presence of concomitant medical illness. Population-based studies have associated AF with excess mortality, and this risk of death is independent of concomitant cardiovascular disease. The effect of noncardiovascular medical illnesses on mortality in patients who have AF has not been determined. We examined a community-based cohort of 390 residents of Olmsted County, Minnesota, who had newly diagnosed AF; patients were identified retrospectively but followed prospectively. The cohort included all patients who had electrocardiographically proved first-onset AF; patients were not excluded on the basis of medical illness. Mean age of the cohort was 73 +/- 14 years (56% were men). Mean follow-up was 2.7 +/- 1.7 years. Onset of AF frequently occurred during hospitalization (78%). One hundred sixty-six deaths occurred, a death rate significantly higher than expected for the cohort. Most deaths had a noncardiovascular cause. This trend was maintained for patients who had no previous cardiovascular disease and for those who had a cardiovascular diagnosis at the time AF was diagnosed. AF is observed frequently among hospitalized patients who are medically ill. The survival rate of these patients is low, but AF may be only a minor component of the excess mortality.

Aged↗