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Atrial Fibrillation/Cardiac Arrhythmia

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• Association Between Coffee Consumption and Incident Atrial Fibrillation (from the Multi-Ethnic Study of Atherosclerosis [MESA]) - Am J Cardiol 2022 Nov 2 - "This study aimed to elucidate a potential dose-dependent relation between coffee intake and atrial fibrillation (AF) incidence in a multi-ethnic setting. Previous studies were comprised mainly of White populations, and an exploration of dose dependency is limited. To address these gaps, we analyzed the Multi-Ethnic Study of Atherosclerosis data, a prospective cohort study ... Subjects who drank ≥1 cup of coffee/week had a higher incidence of AF (adjusted hazard ratio 1.40, p = 0.015) than nonconsumers. Furthermore, in the secondary analysis, there was an overall trend, albeit not consistent, of increasing adjusted hazard ratio with progressively increasing doses of coffee in the following groups: 1 to 3 cups/month, 2 to 4 cups/week, 2 to 3 cups/day and ≥6 cups/day. Notably, AF incidence was highest (9.8%) for the group consuming the most coffee, that is, ≥6 cups/day (p = 0.02). Stratification by race/ethnicity suggested the results may be driven by White and Hispanic rather than Black or Chinese-American subgroups. In conclusion, the findings suggest an association between coffee consumption and incident AF in contrast to most previous studies" - Note: I'm not sure what they're saying here. It's only a problem if you're not white?
  • Good news for coffee lovers: Daily coffee may benefit the heart - Science Daily, 3/24/22 - "Drinking coffee -- particularly two to three cups a day -- is not only associated with a lower risk of heart disease and dangerous heart rhythms but also with living longer ... Participants' average age was 57 years and half were women. In general, having two to three cups of coffee a day was associated with the greatest benefit, translating to a 10%-15% lower risk of developing coronary heart disease, heart failure, a heart rhythm problem, or dying for any reason ... The second study included 34,279 individuals who had some form of cardiovascular disease at baseline. Coffee intake at two to three cups a day was associated with lower odds of dying compared with having no coffee. Importantly, consuming any amount of coffee was not associated with a higher risk of heart rhythm problems, including atrial fibrillation (AFib) or atrial flutter, which Kistler said is often what clinicians are concerned about. Of the 24,111 people included in the analysis who had an arrhythmia at baseline, drinking coffee was associated with a lower risk of death. For example, people with AFib who drank one cup of coffee a day were nearly 20% less likely to die than non-coffee drinkers ... coffee beans actually have over 100 biologically active compounds. These substances can help reduce oxidative stress and inflammation, improve insulin sensitivity, boost metabolism, inhibit the gut's absorption of fat and block receptors known to be involved with abnormal heart rhythm ... In a third study, researchers looked at whether there were any differences in the relationship between coffee and cardiovascular disease depending on whether someone drank instant or ground coffee or caffeinated or decaf. They found, once again, two to three cups a day to be associated with the lowest risk of arrhythmias, blockages in the heart's arteries, stroke or heart failure regardless of whether they had ground or instant coffee ... Decaf coffee did not have favorable effects against incident arrhythmia but did reduce cardiovascular disease, with the exception of heart failure"
  • Coffee Drinking Linked With Fewer Arrhythmias - Medscape, 5/8/20 - "on average each additional daily cup of coffee that people said they drank reduced the incidence of arrhythmic episodes by a statistically significant 3%, compared with those who drank fewer daily cups. The relationship held for people who reported drinking as many as five or six cups of coffee daily"
  • Influence of coffee and caffeine consumption on atrial fibrillation in hypertensive patients - Nutr Metab Cardiovasc Dis. 2010 Feb 16 - "Coffee and caffeine consumption influence spontaneous conversion of atrial fibrillation. Normotensive non-habitual coffee consumers are more likely to convert arrhythmia within 48h from the onset of symptoms. Hypertensive patients showed a U-shaped relationship between coffee consumption and spontaneous conversion of AF, moderate coffee consumers were less likely to show spontaneous conversion of arrhythmia. Patients with left ventricular hypertrophy showed a reduced rate of spontaneous conversion of arrhythmia"
• IV Potassium and Magnesium an Acute Treatment for AF? - Medscape, 10/27/22 - "Suppose I cut my finger while slicing bread. I put a Band-Aid on the cut. That doesn't mean I have fixed it, it means I've helped it temporarily. Atrial fibrillation in this paper is very analogous," he said. "The patient may have episodes, goes to the emergency room, you give them medication, and temporarily alleviate the situation so that the patient does not have to be admitted. It's simple, inexpensive, you make the heart rate go back to normal, not permanently, with few side effects, except perhaps for some pain at the injection site, but that doesn't mean you have fixed the AFib permanently. But for someone who has had a first incidence, or doesn't want to stay in the hospital because it's the weekend, yes, you can use this as a Band-Aid,"
• Four Commonly Abused Drugs Linked With Atrial Fibrillation - Medscape, 10/26/22 - "cannabis (HR, 1.35)"
• Advanced glycation end products induce senescence of atrial myocytes and increase susceptibility of atrial fibrillation in diabetic mice - Aging Cell 2022 Oct 24 - "Diabetes mellitus (DM) is a common chronic metabolic disease caused by significant accumulation of advanced glycation end products (AGEs). Atrial fibrillation (AF) is a common cardiovascular complication of DM. Here, we aim to clarify the role and mechanism of atrial myocyte senescence in the susceptibility of AF in diabetes ... In conclusion, AGEs accelerated atrial electrical remodeling and cellular senescence, contributing to increased AF susceptibility by activating the p16/Rb pathway. Inhibition of RAGE or the p16/Rb pathway may be a potential therapeutic target for AF in diabetes"
• Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation - Eur Heart J 2022 Oct 18 - "Methamphetamine, cocaine, opiate, and cannabis uses were each associated with increased risk of developing incident AF. Efforts to mitigate the use of these substances may represent a novel approach to AF prevention"
• Incident heart failure, arrhythmias and cardiovascular outcomes with sodium glucose co-transporter 2 (SGLT2) inhibitor use in diabetic patients: Insights from a global federated electronic medical record database - Diabetes Obes Metab 2022 Aug 31 - "The risk of incident HF was significantly lower in the SGLT2i cohort compared to the non-SGLT2i cohort (HR 0.70, 95%CI 0.68-0.73). SGLT2i use was also associated with a significantly lower risk of all-cause mortality (HR 0.61, 95% CI 0.58-0.64), cardiac arrest (HR 0.70, 95% CI 0.63-0.78), incident AF (HR 0.81, 95% CI 0.76-0.84), ischaemic stroke/TIA (HR 0.90, 95% CI 0.88-0.93), composite of arterial and venous thrombotic events (HR 0.90, 95% CI 0.88-0.92), and composite of incident VT/VF and cardiac arrest (HR 0.76, 95% CI 0.71-0.81). There were no significant differences for VT/VF (HR 0.94" - See empagliflozin inhousepharmacy.vu.
• Akkermansia muciniphila prevents cold-related atrial fibrillation in rats by modulation of TMAO induced cardiac pyroptosis - EBioMedicine 2022 Jul 4 - "Cold exposure is one of the most important risk factors for atrial fibrillation (AF), and closely related to the poor prognosis of AF patients ... Our findings revealed a novel causal role of aberrant gut microbiota and metabolites in pathogenesis of cold-related AF, which raises the possibility of selectively targeting microbiota and microbial metabolites as a potential therapeutic strategy for cold-related AF" - See Akkermansia muciniphila at Amazon.com.
• Self-reported marijuana use and cardiac arrhythmias (from the Multiethnic Study of Atherosclerosis) - Am J Cardiol 2022 Jun 17 - "Compared with never users, participants reporting current use of marijuana (n = 40, 3%) had more supraventricular tachycardia/day (adjusted geometric mean ratio [GMR] 1.42, 95% confidence interval [CI] 0.87 to 2.32), more premature atrial contractions/hour (GMR 1.22, 95% CI 0.72, 2.13), and more NSVT/day (GMR 1.28, 95% CI 0.95 to 1.73); although, CIs overlapped 1. Additionally, more frequent marijuana use was associated with more runs of NSVT/day (GMR 1.56, 95% CI 1.13, 2.17). In conclusion, our results suggest that current marijuana use may be associated with a greater burden of arrhythmias"
• SGLT2 inhibitor dapagliflozin attenuates cardiac fibrosis and inflammation by reverting the HIF-2α signaling pathway in arrhythmogenic cardiomyopathy - FASEB J 2022 Jul - "Excessive cardiac fibrosis and inflammation aberrantly contribute to the progressive pathogenesis of arrhythmogenic cardiomyopathy (ACM) ... dapagliflozin (DAPA ... DAPA not only significantly ameliorated cardiac dysfunction, adverse remodeling, and ventricular dilation in ACM but also attenuated ACM-associated cardiac fibrofatty replacement, as demonstrated by the echocardiography and histopathological examination ... SGLT2i attenuated the ACM-associated cardiac dysfunction and adverse remodeling in a glucose-independent manner by suppressing cardiac fibrosis and inflammation via reverting the HIF-2α signaling pathway, suggesting that SGLT2i is a novel and available therapy for ACM" - See dapagliflozin at reliablerxpharmacy.com.
  • Arrhythmogenic cardiomyopathy - Wikipedia - "Arrhythmogenic cardiomyopathy (ACM), arrhythmogenic right ventricular dysplasia (ARVD), or arrhythmogenic right ventricular cardiomyopathy (ARVC), most commonly is an inherited heart disease ... ACM is caused by genetic defects of the parts of heart muscle (also called myocardium or cardiac muscle) known as desmosomes, areas on the surface of heart muscle cells which link the cells together. The desmosomes are composed of several proteins, and many of those proteins can have harmful mutations ... ARVC can also develop in intense endurance athletes in the absence of desmosomal abnormalities. Exercise-induced ARVC cause possibly is a result of excessive right ventricular wall stress during high intensity exercise"
• Association of Metformin Use With Risk of Venous Thromboembolism in Adults With Type 2 Diabetes - Medscape, 6/14/22 - "Among 117,472 initiators of metformin and 13,835 initiators of sulfonylureas, 555 (1.3/1,000 person-years) and 75 (2.1/1,000 person-years) VTE cases occurred in each group, respectively. The multivariable-adjusted HR was 0.65 (95% CI: 0.51, 0.84). The corresponding risks for pulmonary embolism (adjusted HR = 0.71, 95% CI: 0.50, 1.01) and deep vein thrombosis (adjusted HR = 0.64, 95% CI: 0.48, 0.87) were also lower in metformin initiators than in sulfonylurea initiators" - See metformin at ReliableRX.
• SGLT2 Inhibitors Cut AFib Risk in Real-Word Analysis - Medscape, 6/14/22 - "But despite documentation like this, real-world evidence also continues to show limited uptake of SGLT2 inhibitors in U.S. patients with type 2 diabetes. Records from more than 1.3 million patients with type 2 diabetes managed in the Veterans Affairs Healthcare System during 2019 or 2022 documented that just 10% of these patients received an agent from this class, even though all were eligible to receive it, according to findings in a separate report at the meeting ... The study's primary endpoint was the incidence of hospitalization for AFib, which occurred a significant 18% less often in the patients who started on an SGLT2, compared with those who started a DPP4 inhibitor during median follow-up of 6.7 months, and a significant 10% less often, compared with those starting a GLP-1 receptor agonist during a median follow-up of 6.0 months ... in an analysis of more than 130,000 matched pairs, treatment with empagliflozin was linked to a significant 30% reduction in the incidence of hospitalization for heart failure, compared with patients treated with a GLP-1 receptor agonist. Analysis of more than 116,000 matched pairs of patients showed that treatment with empagliflozin linked with a significant 29%-50% reduced rate of hospitalization for heart failure, compared with matched patients treated with a DPP4 inhibitor" - See empagliflozin inhousepharmacy.vu.
• Canagliflozin and Atrial Fibrillation in Type 2 Diabetes Mellitus: A secondary analysis from the CANVAS Program and CREDENCE trials and meta-analysis - Diabetes Obes Metab 2022 May 19 - "atrial fibrillation/flutter (AF/AFL) ... Meta-analysis suggests SGLT2 inhibition reduces AF/AFL incidence" - See empagliflozin inhousepharmacy.vu.
• Arginine catabolism metabolites and atrial fibrillation or heart failure risk: two case-control studies within the PREDIMED trial - Am J Clin Nutr 2022 May 16 - "Inverse associations with incident AF were observed for arginine [OR per 1 SD (95% CI): 0.83 (0.73, 0.94)]) and homoarginine [0.87 (0.76, 0.98)], whereas positive associations were found for the asymmetric dimethylarginine/symmetric dimethylarginine ratio (ADMA/SDMA) [1.15 (1.01, 1.31)] and citrulline [1.19 (1.01, 1.39)]. For HF, inverse associations were found for arginine [0.82 (0.69, 0.97)] and homoarginine [0.81 (0.68, 0.96)], and positive associations for the ADMA/SDMA ratio [1.19 (1.02, 1.41)], N1-acetylspermidine [1.34 (1.12, 1.60)], and diacetylspermine [1.20 (1.02, 1.41)]. In the stratified analysis according to the dietary intervention, the lower HF risk associated with arginine was restricted to participants in the MedDiet groups" - See arginine products at Amazon.com.
• FDA Approves Fitbit's AFib-Detection Software - Medscape, 4/12/22 - "The algorithm will be the basis of an upcoming Fitbit feature called Irregular Heart Rhythm Notifications ... The algorithm works by using an optical measurement method called photoplethysmography (PPG), along with heart rate input from the Fitbit's photodetector device ... The upcoming Irregular Heart Rhythm Notifications feature will complement the existing ECG app, providing two ways to detect AFib ... Undiagnosed atrial fibrillation can lead to strokes, and early detection of atrial fibrillation may allow doctors to prescribe medications that are effective at preventing strokes" - See Fitbit at Amazon.com.
• Effects of Vitamin D Supplementation and 25-Hydroxyvitamin D Levels on the Risk of Atrial Fibrillation - Am J Cardiol 2022 Mar 31 - Am J Cardiol 2022 Mar 31 - "vitamin D (Vit-D) deficiency and Vit-D treatment (VDT) ... individuals with low 25-hydroxy-Vit-D ([25-OH]D) levels (<20 ng/ml) were divided into group-A (untreated, levels ≤20 ng/ml), group-B (treated, levels 21 to 29 ng/ml), and group-C (treated, levels ≥30 ng/ml) ... Among the individuals receiving VDT for ≥6 months, the risk of AF was significantly lower in group-B (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80 to 0.98, p = 0.03] and group-C (HR 0.84, 95% CI 0.73 to 0.0.95, p = 0.007] than in group-A. A subgroup analysis of men >65 years showed individuals with hypertension had a significantly lower risk of AF in group-C than in group-B (HR 0.79, CI 0.65 to 0.94, p = 0.02) and group-A (HR 0.78, CI 0.64 to 0.96, p = 0.012). A similar result was found in men >65 years with diabetes mellitus in group-C compared with group-B (HR 0.69, CI 0.51 to 0.93, p = 0.012) and group-A (HR 0.63, CI 0.47 to 0.84" - See vitamin D at Amazon.com.
• Good news for coffee lovers: Daily coffee may benefit the heart - Science Daily, 3/24/22 - "Drinking coffee -- particularly two to three cups a day -- is not only associated with a lower risk of heart disease and dangerous heart rhythms but also with living longer ... Participants' average age was 57 years and half were women. In general, having two to three cups of coffee a day was associated with the greatest benefit, translating to a 10%-15% lower risk of developing coronary heart disease, heart failure, a heart rhythm problem, or dying for any reason ... The second study included 34,279 individuals who had some form of cardiovascular disease at baseline. Coffee intake at two to three cups a day was associated with lower odds of dying compared with having no coffee. Importantly, consuming any amount of coffee was not associated with a higher risk of heart rhythm problems, including atrial fibrillation (AFib) or atrial flutter, which Kistler said is often what clinicians are concerned about. Of the 24,111 people included in the analysis who had an arrhythmia at baseline, drinking coffee was associated with a lower risk of death. For example, people with AFib who drank one cup of coffee a day were nearly 20% less likely to die than non-coffee drinkers ... coffee beans actually have over 100 biologically active compounds. These substances can help reduce oxidative stress and inflammation, improve insulin sensitivity, boost metabolism, inhibit the gut's absorption of fat and block receptors known to be involved with abnormal heart rhythm ... In a third study, researchers looked at whether there were any differences in the relationship between coffee and cardiovascular disease depending on whether someone drank instant or ground coffee or caffeinated or decaf. They found, once again, two to three cups a day to be associated with the lowest risk of arrhythmias, blockages in the heart's arteries, stroke or heart failure regardless of whether they had ground or instant coffee ... Decaf coffee did not have favorable effects against incident arrhythmia but did reduce cardiovascular disease, with the exception of heart failure"
• Only alcohol -- not caffeine, diet or lack of sleep -- might trigger heart rhythm condition - Science Daily, 11/24/21 - "Participants in the randomized clinical trial utilized a mobile electrocardiogram recording device along with a phone app to log potential triggers like drinking alcohol and caffeine, sleeping on the left side or not getting enough sleep, eating a large meal, a cold drink, or sticking to a particular diet, engaging in exercise, or anything else they thought was relevant to their AF. Although participants were most likely to select caffeine as a trigger, there was no association with AF. Recent research from UCSF has similarly failed to demonstrate a relationship between caffeine and arrhythmias -- on the contrary, investigators found it may have a protective effect ... The new study demonstrated that consumption of alcohol was the only trigger that consistently resulted in significantly more self-reported AF episodes."
• High-Dose Omega-3s Tied to Higher Risk for Atrial Fibrillation - Medscape, 10/11/21 - "Overall, use of omega-3 fatty acids was associated with a 25% increased risk for AF"
• Omega-3 fatty acids in adipose tissue and risk of atrial fibrillation - Eur J Clin Invest 2021 Jul 7 - "Participants in the highest vs. the lowest quintile of EPA experienced a 45% lower risk of AF (men HR 0.55 (95% CI 0.41-0.69); women HR 0.55 (0.41-0.72)). For DHA, no clear association was found in men, whereas in women, participants in the highest quintile of DHA in adipose tissue had a 30% lower risk of incident AF (HR 0.70 (0.54-0.91)) compared to participants in the lowest quintile" - See omega-3 supplements at Amazon.com and iHerb.
• Athletes Face Twice the Odds for A-Fib - WebMD, 7/13/21 - "Overall, athletes had about a 2.5 times higher risk of a-fib than non-athletes. But when the researchers focused on participants without heart disease risk factors (such as type 2 diabetes and high blood pressure), they found that athletes had nearly four times the risk of a-fib compared to non-athletes"
• One small alcoholic drink a day is linked to an increased risk of atrial fibrillation - Science Daily, 1/17/21 - "The study, published today (Wednesday) in the European Heart Journal [1], found that, compared to drinking no alcohol at all, just one alcoholic drink a day was linked to a 16% increased risk of atrial fibrillation over an average (median) follow-up time of nearly 14 years. This means that while four teetotallers in 100 might develop atrial fibrillation over the period of the study, five per 100 might develop the condition if they consumed alcohol starting with slightly more than an alcoholic drink a week and more than 75% of them consumed up to one drink a day [2]. The researchers categorised one alcoholic drink as containing 12 g of ethanol, which is the equivalent of a small (120 ml) glass of wine, a small beer (330 ml) or 40 ml of spirits ... These findings are important as the regular consumption of alcohol, the 'one glass of wine a day' to protect the heart, as is often recommended for instance in the lay press, should probably no longer be suggested without balancing risks and possible benefits for all heart and blood vessel diseases, including atrial fibrillation"
• Coffee Drinking Linked With Fewer Arrhythmias - Medscape, 5/8/20 - "on average each additional daily cup of coffee that people said they drank reduced the incidence of arrhythmic episodes by a statistically significant 3%, compared with those who drank fewer daily cups. The relationship held for people who reported drinking as many as five or six cups of coffee daily"
• Higher Protein Intake Linked to Lower Risk of AF - Medscape, 4/3/20 - "the average American eats an estimated 3600 calories/day — 50% from carbohydrates, 35% from fat, and only 15% from protein ... This translates to 540 calories per day from protein, which is 135 g (since 1 g of protein has 4 calories), "which is more than enough protein for the average person ... There does appear to be a 'sweet spot' with regard to protein intake, at around 58 to 74 grams per day, along with a 'ceiling effect' above 74 grams per day, where more protein intake is no longer beneficial ... most people would be far healthier and leaner by reducing their total caloric intake from carbohydrates and fats while eating a proportionally higher protein diet closer to 25% of their total calories."" - Not sure if that quote makes sense.  The average is 135 but best is 58 to 74 so we need to increase it? - See whey protein at Amazon.com.
• Effects of Omega-3 Fatty Acid Supplements on Arrhythmias - Medscape, 3/13/20 - "In conclusion, evidence from large trials now suggests that omega-3 FA supplementation may have a dose-related protective effect on coronary events. However, systematic reporting of arrhythmia outcomes in existing and future trials is required to clarify whether supplementation also has any adverse effects on nonfatal arrhythmias" - See omega-3 supplements at Amazon.com.
• Brush your teeth to protect the heart - Science Daily, 12/2/19 - "Tooth brushing three or more times a day was associated with a 10% lower risk of atrial fibrillation and a 12% lower risk of heart failure during 10.5-year follow up ... While the study did not investigate mechanisms, one possibility is that frequent tooth brushing reduces bacteria in the subgingival biofilm (bacteria living in the pocket between the teeth and gums), thereby preventing translocation to the bloodstream"
• Randomized study of the effects of cocoa-rich chocolate on the ventricle-arterial coupling and vascular function of young, healthy adults - Nutrition. 2019 Feb 27;63-64:175-183 - "Half of the participants ingested a 20-g dose of lower cocoa chocolate (LCC; ~55%; 12.6 +/- 1.4 mg equivalent of epicatechin/g) and the others ingested a daily dose of 20 g of higher cocoa chocolate (HCC; ~90%; 18.2 +/- 2.6 mg equivalent of epicatechin/g) ... A statistically significant improvement was depicted over the brachial and central systolic and pulse pressures in the HCC group, and a trend for improvement in the reflected waves component (Aix) and the FMS was also observed in the HCC, but not in the LCC group ... regular consumption of HCC has beneficial effects on the cardiovascular system in young, healthy adults, improving vascular function by reducing central brachial artery pressures and promoting vascular relaxation, and thus enhancing the matching of the arterial system with the left ventricle" - See Ghirardelli Chocolate Intense Dark Squares, Midnight Reverie, 4.12 oz., 86% Cacao (Pack of 4) at Amazon.com.
• Fitness Linked to Lower Ventricular Arrhythmia Risk Later - Medscape, 4/26/19 - "That better aerobic fitness apparently protects against potentially fatal arrhythmias in the future, and that it can be easily assessed clinically during an exercise test, supports respiratory gas exchange measurement of CRF as a routine part of patient assessments"
• Melatonin's heart protective effects not related to its antioxidant properties - Science Daily, 4/9/19  - "Antiarrhythmic agents are substances that treat irregular electrical activity in the heart. Melatonin has previously been shown to have antiarrhythmic effects, with the assumption that this was due to its known antioxidant properties ... One group of rats was given 10 mg of melatonin daily for seven days, while another received a placebo. Researchers then measured the electrical activity in the rats' hearts before, during and after a cardiac event. They later examined the hearts for measures of oxidative stress and antioxidant activity ... Ventricular tachycardia (VT) and ventricular fibrillation (VF) are two kinds of dangerous irregular electrical activity in the heart that can result from a heart attack. Incidence of both VT and VF was reduced in melatonin-treated rats. A marker of antioxidant activity was also higher in the treated rats. However, there was no association between the presence of oxidative stress and incidence of irregular electrical activity ... In previous work, the research team observed that blocking melatonin-specific receptors removed the antiarrhythmic benefit of melatonin. When taken together with this current study, these results suggest that melatonin's protective effects for the heart "are related to its antiarrhythmic action, and this effect is related not to antioxidative properties but to melatonin receptor stimulation,"" - See melatonin at Amazon.com.
• Novel electrocardiogram uses signals from ear and hand to check heart rhythm - Science Daily, 3/17/19 - "Mobile ECG devices present a major opportunity to detect atrial fibrillation, the most common heart rhythm disorder, and thereby prevent strokes and reduce hospitalisations. All commercially available portable ECG devices require both hands, but what if symptoms happen while driving?" - See heart rate monitors at Amazon.com.
• Low-carb diet tied to common heart rhythm disorder - Science Daily, 3/6/19 - "People getting a low proportion of their daily calories from carbohydrates such as grains, fruits and starchy vegetables are significantly more likely to develop atrial fibrillation (AFib), the most common heart rhythm disorder ... People with AFib are five times more likely to have a stroke than people without the condition. It can also lead to heart failure ... Restricting carbohydrates has become a popular weight loss strategy in recent years. While there are many different low-carbohydrate diets including the ketogenic, paleo and Atkins diets, most emphasize proteins while limiting intake of sugars, grains, legumes, fruits and starchy vegetables ... Low carbohydrate diets were associated with increased risk of incident  regardless of the type of protein or fat used to replace the carbohydrate ... Participants reporting low carbohydrate intake were the most likely to develop AFib. These participants were 18 percent more likely to develop AFib than those with moderate carbohydrate intake and 16 percent more likely to develop AFib than those with high carbohydrate intake"
• 9 Signs of Magnesium Deficiency You Should Know - YouTube - Doctor claims that low magnesium can contribute to AFib.
• The citrus flavanone hesperetin preferentially inhibits slow-inactivating currents of an LQT3 syndrome Na+ channel mutation - Br J Pharmacol. 2019 Jan 16 - "lethal ventricular arrhythmias in the Long QT syndrome subtype 3 (LQT3) ... HSP preferentially inhibits the slow inactivation phase of INa , more markedly in the mutant R1623Q. HSP could be used as a template to develop drugs against lethal cardiac arrhythmias in LQT3" - See hesperidin at Amazon.com.
• Too Much Salt Might Help Spur A-Fib - WebMD, 12/7/18 - "Those with the highest levels of salt in their diet had a higher rate of atrial fibrillation than those with the lowest salt intake. After accounting for several other risk factors -- including age, body fat, blood pressure and smoking -- the researchers found that salt consumption was independently associated with the risk of atrial fibrillation"
• Poor sleep quality linked to atrial fibrillation - Science Daily, 6/26/18 - "individuals with more frequent nighttime awakenings while trying to sleep more often carried a diagnosis of AF ... Within a subset of these individuals who had undergone formal sleep studies, they found that less REM sleep in particular predicted future AF ... These results provide more evidence that sleep quality is important to cardiovascular health and specifically to AF ... While there are several available treatments for AF, prevention of the disease would be ideal. The good news is that sleep quality can be modifiable and is something that at least to some degree is under the control of the individual. It's possible that improving sleep hygiene, such as performing regular exercise, getting to bed at a reasonable hour on a regular basis, and avoiding viewing screens before bed as well as caffeine later in the day, might help stave off AF"
• Substance in Chinese medicine can cause cardiac arrhythmia - Science Daily, 5/2/18 - "A medicinal plant frequently used in Traditional Chinese Medicine (TCM) -- Evodia rutaecarpa -- contains substances that can cause cardiac arrhythmia ... investigated the effect of Evodia extracts in collaboration with pharmacologists and toxicologists from the University of Vienna. The natural substances dehydroevodiamine (DHE) and hortiamine isolated from the plant in Basel proved to be very potent inhibitors of potassium channels in the heart muscle. If these channels are blocked, the excitation processes in the heart muscle change, which can trigger severe heart rhythm disturbances -- so-called Torsade de pointes (TdP) -- and ventricular fibrillation and lead to sudden cardiac death" - But if you search Amazon for Evodia extracts, it doesn't look like a popular product.
• Vitamin D Status at ICU Admission May Predict A-Fib and Bedsores - Medscape, 2/28/17 - "Patients with Vitamin D levels below 20 ng/mL were nearly four times as likely to develop new-onset atrial fibrillation, with an odds ratio of 3.59 (95% CI, 1.01–12.70). On regression analysis, the risk for the condition decreased by 15% for each unit increase in vitamin D ... A second study of 402 surgical ICU patients found that 11 percent developed hospital-acquired pressure ulcers. Patients with vitamin D levels below 20 ng/mL were more than twice as likely to develop the ulcers (OR 2.51; 95% CI, 1.06–5.97). On regression analysis, the risk of ulcers fell by 11% with each unit increase in vitamin D" - See vitamin D at Amazon.com.
• Vitamin C may decrease risk of atrial fibrillation after cardiac surgery - Science Daily, 2/1/17 - "The single study on the recurrence of AF after a successful cardioversion, which was carried out in Greece, found that vitamin C decreased the risk of AF recurrence by 87% ... In the non-US cardiac surgery trials, vitamin C decreased the length of hospital stay by 12.6% and intensive care unit stay by 8.0% ... Oral administration of vitamin C decreased the occurrence of post-operative AF by 73%, whereas intravenous administration decreased it by 36%. On the other hand, oral administration shortened the length of hospital stay by only 7% (0.4 days), whereas intravenous administration decreased it by 16% (1.5 days). Thus, the effect of intravenous vitamin C administration was greater for the length of hospital stay, but less for the occurrence of post-operative AF" - See American Health Products - Ester C W/Citrus Bioflavonoids, 1000 mg, 180 veg tablets at Amazon.com.
• Metformin and Lower AF Risk Among Patients With T2DM - Medscape, 10/13/14 - "After adjusting for co-morbidities and medications, metformin independently protected the diabetic patients from new-onset AF with a hazard ratio of .81 (95% confidence interval 0.76–0.86, p < 0.0001). Metformin significantly decreased the extent of pacing-induced myolysis and the production of reactive oxygen species" - [Abstract] - See metformin at The Antiaging Store.
• U-shaped curve revealed for association between fish consumption and atrial fibrillation - Science Daily, 6/24/13 - "The study found a U-shaped association between consumption of marine n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of developing AF, with people who have both low and high intakes found to suffer more from AF than those with median intakes. The lowest risk of AF was found in those who consumed around 0.63 g marine n-3 PUFA per day, which corresponds to around two servings of fatty (oily) fish per week ... Earlier studies have reported that regular consumption of fish can exert beneficial effects in preventing the development of AF. Notably, in the Cardiovascular Health study², which included 4,815 participants, a 28% lower risk of AF was observed among people who consumed fish one to four times per week compared with those who ate fish less than once per month. However, such observed associations have not been confirmed in all cohort studies"
• CKD and Low Magnesium: Pay Attention - Medscape, 2/6/13 - "When adjusted for differences in age and sex among quartiles, the lowest magnesium group had the highest incidence of new atrial fibrillation events (9.4 episodes per 1000 person-years). The rates for the other 3 quartiles were quite similar (6.9, 7.1, and 6.3 events per 1000 person-years for the second, third, and fourth quartiles, respectively). In multivariable models controlled for the multiple potential differences including glomerular filtration rate, those with the lowest levels of magnesium continued to be at highest risk for the development of atrial fibrillation (hazard ratio, 1.48; 95% confidence interval, 1.02- 2.14; P = .04)" - See magnesium supplements at Amazon.com.
• Low Serum Magnesium and the Development of Atrial Fibrillation in the Community: The Framingham Heart Study - Circulation. 2012 Nov 21 - "We studied 3,530 participants (mean age, 44 years; 52% women) from the Framingham Offspring Study who attended a routine examination, and were free of AF and cardiovascular disease ... 20 years of follow-up ... The age- and sex-adjusted incidence rate of AF was 9.4 per 1,000 person-years (95% confidence interval, 6.7 to 11.9) in the lowest quartile of serum magnesium (≤1.77 mg/dl), compared with 6.3 per 1,000 person-years (95% confidence interval, 4.1 to 8.4) in the highest quartile (≥1.99 mg/dl). In multivariable-adjusted models, individuals in the lowest quartile of serum magnesium were approximately 50% more likely to develop AF (adjusted hazard ratio, 1.52, 1.00 to 2.31; P=0.05), compared with those in the upper quartiles ... Because hypomagnesemia is common in the general population, a link with AF may have potential clinical implications" - See Jarrow Formulas, Magnesium Optimizer Citrate, 100 Easy-Solv Tablets at iHerb.
• Association of Plasma Phospholipid Long-Chain Omega-3 Fatty Acids with Incident Atrial Fibrillation in Older Adults: The Cardiovascular Health Study - Circulation. 2012 Jan 26 - "In multivariable Cox models adjusted for other risk factors, the RR in the top versus lowest quartile of total n-3 PUFA (EPA+DPA+DHA) levels was 0.71 (95%CI=0.57-0.89, P-trend=0.004); and of DHA levels, 0.77 (95%CI=0.62-0.96, P-trend=0.01). EPA and DPA levels were not significantly associated with incident AF. Evaluated non-parametrically, both total n-3 PUFA and DHA showed graded and linear inverse associations with incidence of AF" - See Mega Twin EPA at Amazon.com and Jarrow Max DHA at Amazon.com.
• Effect of Dietary Fish Oil on Atrial Fibrillation After Cardiac Surgery - Am J Cardiol. 2011 Jul 13 - "Two hundred patients were randomized to receive fish oil (providing 4.6 g/day of long-chain ω-3 fatty acids) or a control oil starting 3 weeks before surgery; 194 subjects completed the study, with 47 of 97 subjects in the control group and 36 of 97 subjects in the fish oil group developing AF (odds ratio 0.63, 95% confidence interval [CI] 0.35 to 1.11). There was a nonstatistically significant delay in time to onset of AF in the fish oil group (hazard ratio 0.66, 95% CI 0.43 to 1.01). There was a significant decrease in mean length of stay in the intensive care unit in the fish oil group (ratio of means 0.71, 95% CI 0.56 to 0.90). In conclusion, in a mixed cardiac surgery population, supplementation with dietary fish oil did not result in a significant decrease in the incidence of postsurgical AF. However, there was a significant decrease in time spent in the intensive care unit" - See Mega Twin EPA at Amazon.com and Jarrow Max DHA at Amazon.com.
• Slowing a Speedy Heart Rate? - Dr. Weil, 4/29/10
• Influence of coffee and caffeine consumption on atrial fibrillation in hypertensive patients - Nutr Metab Cardiovasc Dis. 2010 Feb 16 - "Coffee and caffeine consumption influence spontaneous conversion of atrial fibrillation. Normotensive non-habitual coffee consumers are more likely to convert arrhythmia within 48h from the onset of symptoms. Hypertensive patients showed a U-shaped relationship between coffee consumption and spontaneous conversion of AF, moderate coffee consumers were less likely to show spontaneous conversion of arrhythmia. Patients with left ventricular hypertrophy showed a reduced rate of spontaneous conversion of arrhythmia"
• Omega-3 fatty acid supplementation reduces one-year risk of atrial fibrillation in patients hospitalized with myocardial infarction - Eur J Clin Pharmacol. 2008 Feb 29 - "N-3 PUFA reduced the relative risk of the hospitalization for AF [hazard ratio (HR) 0.19, 95% CI 0.07-0.51] and was associated with a further and complementary reduction in all-cause mortality (HR 0.15, 95% CI 0.05-0.46)" - See Mega Twin EPA at Amazon.com.
• N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study - Eur Heart J. 2008 Feb 8 - "The result of this study indicates that NAC treatment decreases the incidence of postoperative AF" - See n-acetyl cysteine at Amazon.com.
• Recurrence of Atrial Fibrillation Reduced With Alpha-Linolenic Acid-Enriched Diet - Doctor's Guide, 10/17/07 - "The survival rate was 25.52% in the control group versus 63.09% in the ALA group at the end of the 12-month period" - Note:  ALA is the shorter chain omega-3 found in vegetable sources such as flaxseed.
• Fish Intake and Risk of Incident Atrial Fibrillation - Circulation. 2004 Jul 19 - "Among elderly adults, consumption of tuna or other broiled or baked fish, but not fried fish or fish sandwiches, is associated with lower incidence of AF"
• Fish Containing N-3 Fatty Acids Reduce Risk of AF - Medscape, 7/19/04 - "Intake of fatty fish containing N-3 fatty acids reduces the risk of atrial fibrillation (AF), but fish sandwiches or fried fish are not protective" - See Mega Twin EPA at Vitacost or iHerb.

Other News:

• Outrunning AFIB: A Testimonial - YouTube - Hit me in the heart because he's an athlete like me. It took three ablations. I'm waiting for my first.
• A Life Without Afib: Victor’s Story - YouTube - A retired military officer like me who also worked out all his life.
• Benefits and harms of oral anticoagulants for atrial fibrillation in nursing home residents with advanced dementia - J Am Geriatr Soc 2022 Oct 30 - "In the study sample, 72.0% were female, 82.7% were aged ≥80 years, and 13.5% were nonwhite. Mean CHA2 DS2 VASC score was 6.19 ± 1.58. In multivariable survival analysis, anticoagulation was associated with decreased risk of death (HR 0.71, 95% CI 0.67-0.75) and increased bleeding risk (HR 1.15, 95% CI 1.02-1.29); the association with stroke risk was not significant (HR 1.08, 95% CI 0.80-1.46). Results were similar in models with IPT weighting. While >50% of patients in both groups died within a year, median weighted survival was 76 days longer for anticoagulated individuals ... Persons with advanced dementia and AF derive clinically modest life prolongation from anticoagulation, at the cost of elevated risk of bleeding. The relevance of this benefit is unclear in a group with high dementia-related mortality and for whom the primary goal is often comfort"
• Atrial Fibrillation and Heart Failure: Novel Insights Into the Chicken and Egg Dilemma - Medscape, 10/24/22 - "In summary, clinical trials and our experimental investigations have shown that normofrequent AF per se has distinct detrimental effects on the human LV via adverse remodelling of cardiomyocyte excitation–contraction coupling causing LVSD. These findings could contribute to our understanding of the favourable effects of rhythm control via catheter ablation in patients with AF and concomitant heart failure. Our novel data may represent, however, only a first glimpse into this AF-induced condition, which exceeds the atria and may affect the whole heart as well as other organs"
• Prevalence and Impact of Atrial Fibrillation on Intra-Hospital Mortality in Patients Aged ≥75 Years - Am J Cardiol 2022 Jun 18 - "Propensity score matching (PSM) was performed to account for the individual probability of having AF given a set of covariates ... the prevalence of AF was high (34%) in inpatients aged ≥75 years and increased with age and co-morbidity burden. After PSM, patients with AF had a 17% higher risk of intra-hospital mortality than patients without AF"
• Cost-Effectiveness of Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation: The CABANA Randomized Clinical Trial - Circulation 2022 Jun 21 - "In the CABANA trial (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation), catheter ablation did not significantly reduce the primary end point of death, disabling stroke, serious bleeding, or cardiac arrest compared with drug therapy by intention-to-treat, but did improve the quality of life and freedom from atrial fibrillation recurrence. In the heart failure subgroup, ablation improved both survival and quality of life. Cost-effectiveness was a prespecified CABANA secondary end point ... Catheter ablation of atrial fibrillation was economically attractive compared with drug therapy in the CABANA Trial overall at present benchmarks for health care value in the United States on the basis of projected incremental QALYs but not LYs alone"
• Global AFib study finds simple ablation has best outcomes - Science Daily, 6/21/22 - "using advanced image-guided technology to more aggressively target diseased areas of the heart that cause arrythmias didn't lead to better outcomes for patients -- and put some at higher risk of strokes ... Simplicity is key. Don't ablate too much, especially at advanced stages ... Too much ablation is not helping our patients today. It is putting them at higher risk. This is a practice-changing finding from our study"
• Impact of dronedarone on patients with atrial fibrillation and diabetes: A sub-analysis of the ATHENA and EURIDIS/ADONIS studies - J Diabetes Complications 2022 Jun 8 - "Dronedarone reduced incidence of CV hospitalization/death, AF/AFL recurrence and increased time to these events in AF/AFL patients with/without diabetes" - Note: But why didn't they include amiodarone in addition to the placebo?
• Oral anticoagulants and outcomes in adults ≥80 years with atrial fibrillation: A global federated health network analysis - J Am Geriatr Soc 2022 May 19 - "oral anticoagulation (OAC) ... non-vitamin-K antagonist oral anticoagulant (NOAC) ... Use of a NOAC was associated with improved outcomes compared to warfarin, and compared to no OAC, except for a small but statistically significant higher risk of major bleeding"
• The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation: JACC State-of-the-Art Review - J Am Coll Cardiol 2022 May 17 - "typically antiarrhythmic drugs and/or AF ablation ... rhythm control may effectively reduce irreversible atrial remodeling and prevent AF-related deaths, heart failure, and strokes in high-risk patients. It has the potential to halt progression and potentially save patients from years of symptomatic AF; therefore, it should be offered more widely"
• First-Line Catheter Ablation of Monomorphic Ventricular Tachycardia in Cardiomyopathy Concurrent with Defibrillator Implantation: The PAUSE-SCD Randomized Trial - Circulation 2022 May 4 - "Among patients with cardiomyopathy of varied etiologies, early catheter ablation performed at the time of ICD implantation significantly reduced the composite primary outcome of VT recurrence, cardiovascular hospitalization, or death. These findings were driven by a reduction in ICD therapies"
• Impact of early ablation of atrial fibrillation on long-term outcomes: results from phase II/III of the GLORIA-AF registry - Clin Res Cardiol 2022 Apr 29 - "A total of 25,963 patients (11733 [45.2%] females; median age 71 [IQR 64-78] years; 17424 [67.1%] taking non-vitamin K antagonist oral anticoagulants [NOACs]) were included. Over a follow-up period of 3.0 (IQR 2.3-3.1) years, after adjustment for confounders, early AF ablation was associated with a significant reduction in the composite outcome of all-cause death, stroke and major bleeding (HR 0.50 [95% CI 0.30-0.85]) and all-cause death (HR 0.45 [95% CI 0.23-0.91]). There were no statistical differences between the groups in terms of CV death, non-CV death, stroke and major bleeding"
• Late Potential Abolition in Ventricular Tachycardia Ablation - Am J Cardiol 2022 Apr 15 - "Lack of use of a high-density mapping catheter (odds ratio 6.2, 1.2 to 38.1; p = 0.028), the septal substrate (odds ratio 9.34, 2.27 to 38.4; p = 0.002), and larger left ventricular mass (190 ± 58 g vs 156 ± 46 g, p = 0.002) were predictors of incomplete LP abolition"
• Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia - J Am Coll Cardiol 2022 Apr 19 - "Patients were 1:1 randomized to complete endocardial substrate-based catheter ablation or antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers) ... After 24 months, the primary outcome occurred in 28.2% of patients in the ablation group and 46.6% of those in the AAD group (hazard ratio [HR]: 0.52; 95% CI: 0.30-0.90; P = 0.021). This difference was driven by a significant reduction in severe treatment-related complications (9.9% vs 28.8%, HR: 0.30; 95% CI: 0.13-0.71; P = 0.006). Eight patients were hospitalized for heart failure in the ablation group and 13 in the AAD group (HR: 0.56 ... In ICD patients with ischemic cardiomyopathy and symptomatic VT, catheter ablation reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications compared to AAD"
• Pulsed Field Ablation Treats AF With Few Complications - Medscape, 4/14/22 - "In an unselected population of patients with paroxysmal or persistent atrial fibrillation (AF), the pentaspline pulsed field ablation (PFA) catheter achieved pulmonary vein isolation with 99.9% success and good procedure times. ... However, the investigators observed what they called a significant rate of generic catheter complications, often seen with other AF catheter procedures ... The relatively new PFA technology uses trains of microsecond-long, high-amplitude electrical pulses. Rather than destroying tissue with heating as with radio frequency ablation or with cold as with cryoablation, PFA creates microscopic pores (electroporation) in the sarcolemma membrane of the myocardium to ablate without significant heating ... If we look at the effectiveness, the mean acute PVI success rate was quite high, 99.9%. The median was 100%. If you look at the range, the lowest was 98.9%"
• VT Ablation After First ICD Shock - Medscape, 4/11/22 - "After a first appropriate ICD shock, the primary composite endpoint of all-cause death or hospitalization for worsening heart failure occurred over 2 years of follow-up in 4.3% of 24 patients who underwent VT ablation within 2 months compared with 41.7% of 24 patients who received ablation only after an electrical storm"
• Protective Effect of Catheter Ablation of Atrial Fibrillation on the Renal Function in Patients With Hypertrophic Cardiomyopathy - Am J Cardiol 2022 Apr 6 - "During a mean follow-up period of 34 ± 27 months, sinus rhythm was maintained in 36 patients (80%) after 1.7 ± 0.8 ablation procedures. The eGFR significantly decreased from baseline to 3 months (p <0.01) and from baseline to 1 year (p <0.01) in the control group, whereas the eGFR in the ablation group was maintained both from baseline to 3 months (p = 0.94) and from baseline to 1 year (p = 1.00) after the CA. The change in the eGFR between baseline and 12 months was significantly smaller in the ablation group than in the control group (p <0.01). After logistic regression analysis, CA of AF was the independent predictor of an improvement of eGFR (odds ratio 2.81"
• Liver failure caused by intravenous amiodarone and effective intervention measures: A case report - J Clin Pharm Ther 2022 Mar 23 - "Amiodarone is a highly effective antiarrhythmic agent for the treatment and prevention of atrial and ventricular arrhythmias. Acute liver damage after intravenous amiodarone is rare but potentially harmful. Amiodarone loading should be adapted to the necessity of an immediate effect of the drug, and liver function should be monitored closely in critically ill patients. Timely stopped suspected drug and anti-inflammatory liver therapy may reduce the occurrence of drug-induced diseases"
• Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry - Clin Res Cardiol 2022 Mar 16 - "Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death"
• SGLT2 Inhibitor Use Tied to Fewer Atrial Arrhythmias - Medscape, 12/2/21 - "treatment with an SGLT2 inhibitor was tied to a significant 23% relative reduction in atrial arrhythmia events and a 44% relative drop in all-cause death ... "We think that a reduction in left atrial pressure" produced by treatment with an SGLT2 inhibitor "may be linked to the reduction in atrial arrhythmias." - See dapagliflozin at reliablerxpharmacy.com.
• Long-term exposure to low levels of air pollution increases risk of heart and lung disease - Science Daily, 2/22/21 - "Researchers examined hospitalization records for more than 63 million Medicare enrollees in the contiguous Unites States from 2000 to 2016 to assess how long-term exposure to air pollution impacts hospital admissions for specific cardiovascular and respiratory issues. The study measured three components of air pollution: fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3). Using hundreds of predictors, including meteorological values, satellite measurements and land use to estimate daily levels of pollutants, researchers calculated the study participants' exposure to the pollutants based upon their residential zip code ... Data also showed there were surges in hospital admissions for all of the health outcomes studied with each additional unit of increase in particulate matter. Specifically, stroke rates increased by 2,536 for each additional ug/m3 (micrograms per cubic meter of air) increase in fine particulate matter each year ... There was an increased risk of stroke and atrial fibrillation associated with long-term exposure to nitrogen dioxide"
• Randomized Trial of Empagliflozin in Non-Diabetic Patients with Heart Failure and Reduced Ejection Fraction - J Am Coll Cardiol 2020 Nov 9 - "Empagliflozin administration to non-diabetic HFrEF patients significantly improves LV volumes, LV mass, LV systolic function, functional capacity, and quality of life when compared with placebo. Our observations strongly support a role for SGLT2 inhibitors in the treatment of HFrEF patients independently of their glycemic status"
• SCORED and FIDELIO-DKD: Time for Cardiologists to Help, Not Hurt, the Kidney - Medscape, 11/20/20 - 20 minute video on empagliflozin (Jardiance).  I doubt if most cardiologists are even aware of this yet. - "In terms of heart failure with reduced EF, these are really well-tolerated medicines. I've been using dapagliflozin and empagliflozin in my patients and found them to have good clinical outcomes and to be clinically well tolerated, with minimal side effects"
• Diabetes drug can treat and reverse heart failure and reduce hospitalizations - Science Daily, 11/16/20 - "Empagliflozin, a recently developed diabetes drug ... this medication can improve the heart's size, shape, and function, leading to better exercise capacity and quality of life, which will reduce hospitalizations for heart failure patients" - Note:  It's a $500/month medication.
• EMPEROR-Reduced: Empagliflozin's HFrEF Benefit Holds Steady on Top of Sacubitril/Valsartan - Medscape, 10/7/20 - "When there are two very effective treatments, it's common for people to ask: Which should I use?' The goal of my presentation was to emphasize that the answer is both. We shouldn't choose between neprilysin inhibition [sacubitril inhibits the enzyme neprilysin] and SGLT2 [sodium-glucose transporter 2] inhibition; we should use both"
• Which is the best pulse oximeter for home use? - consumerlab.com, 9/22/20 - "As nicely summarized in an article on MedPage Today by Dr. Anthony Pierson, a cardiologist, a model that has performed relatively well in studies is the Contec CMS50DL (or a similar model the Contec CMS50D, from Contec Medical Systems, China), currently sold on Amazon by a distributor (ClinicalGuard) for just $19.95. As Dr. Pierson points out in his article, the Contec CMS50DL has been shown to be fairly accurate at normal oxygen saturation levels above 90% but, like similar products, it may be less accurate below 90%" - See oximeters at Amazon.com.
  • How Accurate Are Home Blood Oxygen Monitors? - medpagetoday.com, 9/17/20 - "This study has been widely reported as demonstrating that NMU pulse oximeters are inaccurate and unreliable. However, although four of the six oximeters did not meet FDA standards for accuracy, the authors wrote that two "unexpectedly" did meet accuracy standards defined by the FDA and International Organization for Standardization: the Beijing Choice C20 and Contec CMS550DL."
• Identifying, preventing and managing heart rhythm side effects of medicines - AHA, 9/15/20 - "During the COVID-19 pandemic, chloroquine, hydroxychloroquine and azithromycin have been used to manage the novel coronavirus disease, noted the writing group. These medications can cause heart rhythm disturbances, and there have been some clinical trials to assess their effectiveness to treat COVID-19, including one National Institutes of Health trial that was halted in June. In June and July, the U.S. Food and Drug Administration revoked emergency use and issued a warning against the use of hydroxychloroquine or chloroquine for the treatment of COVID-19 outside of a clinical trial or hospital ... Heart rhythm disorders have been reported as a side effect of hydroxychloroquine alone and in combination with azithromycin among patients with COVID-19. Other medications proposed for managing COVID-19 such as lopinavir/ritonavir also have the potential to interfere with the heart’s normal rhythm"
• SAVE-ICD: For Some, Sacubitril/Valsartan May Obviate Need for ICD - Medscape, 7/3/20 - "After 6 months of therapy with the combination drug sacubitril/valsartan (S/V; Entresto, Novartis), one quarter of primary prevention patients with left heart failure and an implantable cardioverter defibrillator (ICD) had a left ventricular ejection fraction (LVEF) > 35% with no arrhythmic events"
• FDA Approves Dapagliflozin (Farxiga) for Low-EF Heart Failure - Medscape, 5/6/20 - "In that study, treatment with dapagliflozin led to about a one fourth reduction in risk of a primary endpoint consisting primarily of CV death or heart-failure hospitalization in patients with chronic HFrEF, in both those with and without diabetes ... The latest approval for patients with NYHA functional class 3-4 HFrEF makes dapagliflozin the only SGLT2 inhibitor to be indicated for heart failure in the absence of diabetes ... We have to think of this as a drug that you would prescribe like an ACE inhibitor, or a beta-blocker, or a mineralocorticoid receptor antagonist, or sacubitril/valsartan [Entresto, Novartis]"
• VICTORIA: Vericiguat Seen as Novel Success in Tough-to-Treat, High-Risk Heart Failure - Medscape, 3/28/20
• FDA Approves New Form of Device Therapy for Heart Failure, the Barostim Neo - Medscape, 8/16/19 - "The approved FDA indication includes adults with medically refractory advanced HF and an ejection fraction ≤ 35%who aren't good candidates for other device therapies, especially cardiac resynchronization therapy."
• Beta blockers can block the effects of stress and anger in patients prone to emotion-triggered atrial fibrillation - Science Daily, 6/4/19 - "patients taking beta blockers experienced anger and stress as often as those not taking these medications, however, these emotional episodes increased the odds of AF by just four times compared with 20 times in those not taking beta blockers. In participants taking beta blockers not including anti-arrhythmic properties the effect was even stronger, completely blocking the pro-arrhythmic effect of anger or stress"
• Should ICDs in Primary Prevention Go the Way of Aspirin? - Medscape, 5/19/19 - "Over nearly 6 years of follow-up, implanting an ICD did not result in a statistically significant reduction in the primary endpoint of death ... The impetus for this research came from a meta-analysis of 12 heart failure trials spanning a 20-year period that showed a statistically significant 44% decline in the rate of sudden death from old to new trials ... Relative to the older trial, the rate of ventricular tachycardia (VT)/ventricular fibrillation (VF) and death decreased by roughly 30% and 60%, respectively in the newer trials ... They observed ICD-related complications in 195 (13.5%) patients, including 113 (7.8%) with major complications. Nearly half the complications occurred after 30 days; 106 (7.3%) patients required surgery to deal with a complication. Five patients died of ICD-related complications ... ICD proponents might push back and cite a systematic review of ICD complications that found a lower 9% rate of complications in randomized, controlled trials (RCTs) and a 3% rate in the National Cardiovascular Data Registry (NCDR).[15] Two reasons you should favor the Dutch and Danish data are that RCTs typically underestimate harms, in part because of the careful selection of "healthier" patients, and the NCDR describes only complications around the time of the implant ... At the same time, real-world data from reliable, contemporary sources suggest significant harms from the device. As the population ages and patients with heart failure live with more comorbid conditions, ICD complication rates will likely increase" - Note:  One of my pet peeves is cardiologists that push ICDs and demonize supplements when the supplements show better results.  Here's an example:
  • Glucosamine Supplements Linked to Lower CVD Event Risks - Medscape, 5/14/19 - "Glucosamine use was associated with a 15% lower risk for total CVD events and a 9% to 22% lower risk for stroke, coronary heart disease (CHD), and CVD death after adjustment for age, sex, body mass index, race, lifestyle factors, diet, medications, and other supplements ... A few other cohort studies have raised this question including the Vitamins and Lifestyle (VITAL) cohort study, in which high glucosamine use (at least 4 days per week for at least 3 years) was associated with a 17% lower adjusted total mortality risk ... the associations may be driven by the anti-inflammatory properties of glucosamine or that the popular supplement may mimic a low carbohydrate diet by decreasing glycolysis and increasing amino acid catabolism" - [New York Times] - See glucosamine products at Amazon.com.
  • That said, something they they're not looking at in these trials are that many of the  patients who get ICDs have a very low pulse and I'm not convinced that  the slow pulse is sufficient enough to keep the organs, skin and hair healthy.
• Association between depression and the risk of developing ventricular arrhythmias: A meta-analysis - Int J Clin Pharmacol Ther. 2019 Apr 16 - "Overall, participants with depression, as compared to those who had no depression, experienced a significantly increased risk of developing ventricular arrhythmia (combined HR, 1.33; 95% CI, 1.02 - 1.73; p = 0.037). In a subgroup analysis, a statistically-significant relation between depression and risk of ventricular arrhythmia was observed in coronary heart disease (CHD) patients and in studies with adjustment for confounding factors, with pooled HR at a 95% CI of 1.78 (1.31 - 2.42) and 1.52 (1.11 - 2.08), respectively"
• Treatment to restore natural heartbeat could be on the horizon for heart failure - Science Daily, 5/10/19
• ECG Challenge: Why Is His Pulse so Slow? - Medscape, 4/26/19
• Association between depression and the risk of developing ventricular arrhythmias: A meta-analysis - Int J Clin Pharmacol Ther. 2019 Apr 16 - "Overall, participants with depression, as compared to those who had no depression, experienced a significantly increased risk of developing ventricular arrhythmia (combined HR, 1.33; 95% CI, 1.02 - 1.73; p = 0.037). In a subgroup analysis, a statistically-significant relation between depression and risk of ventricular arrhythmia was observed in coronary heart disease (CHD) patients and in studies with adjustment for confounding factors, with pooled HR at a 95% CI of 1.78 (1.31 - 2.42) and 1.52 (1.11 - 2.08), respectively"
• DHS issues warning about Medtronic implantable defibrillator flaws - Engadget, 3/22/19 - "The vulnerabilities allow bad actors to change or inject data sent between a defib and its programming device. Medtronic's affected products don't use use formal authentication or authorization protections, which means attackers can alter the implant's settings and potentially harm the patient"
• Systolic blood pressure increases in patients with atrial fibrillation regaining sinus rhythm after electrical cardioversion - J Clin Hypertens (Greenwich). 2019 Feb 14 - "Systolic BP increased by 9 (±16) mm Hg (P < 0.01) and diastolic BP decreased by 3 (±9) mm Hg (P < 0.01) after conversion to SR. In the group of patients with restored SR, there was a 40% increase in the proportion of patients with a hypertensive BP level (≥140/90 mm Hg) after DC cardioversion compared to before. Patients still in AF had no significant change in BP. Systolic BP increases and diastolic BP slightly decreases when persistent AF is converted to SR" - Note: I think it's saying that a pacemaker will raise your systolic blood pressure by 9 points and lower diastolic by 3.  It doesn't know the reason but it makes sense.  If you have all chamber firing at the same time there is going to be more systolic and less diastolic.
• Doctors: Newer Blood Thinners Best Against A-Fib - WebMD, 1/28/19 - "The newer drugs are called non-vitamin K oral anticoagulants (NOACs). Examples include dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). They don't require the same frequent monitoring of blood-clotting levels as the older clot-preventing drug warfarin (Coumadin) does. They also don't have the same drug and food interactions that warfarin does"
• Can 'Normal' T4 Levels Increase AF Risk? - Medscape, 12/11/18 - "After adjustment, the relative risk for prevalent AF in the highest normal free T4 quartile group was double that of the lowest group. No similar associations were seen between the quartiles for free T3. Thyroid-stimulating hormone (TSH) results were mixed."
• Have an irregular heartbeat? You may have an increased risk of dementia - Science Daily, 10/10/18 - "those who had atrial fibrillation had a faster rate of decline in thinking and memory skills than those without the condition and were 40 percent more likely to develop dementia ... Assuming that there was a cause-and-effect relationship between using blood thinners and the reduced risk of dementia, we estimated that about 54 percent of the dementia cases would have been hypothetically prevented if all of the people with atrial fibrillation had been taking blood thinners"
• Ideal Blood Pressure in Patients With Atrial Fibrillation - J Am Coll Cardiol. 2018 Sep 11 - "BP of 120 to 129/<80 mm Hg was the optimal BP treatment target for patients with AF undergoing hypertension treatment"
• Stressful jobs are associated with a higher risk of heart rhythm disorders - Science Daily, 6/4/18 - "The study found that being stressed at work was associated with a 48% higher risk of atrial fibrillation, after adjustment for age, sex, and education"
• Moderate alcohol use associated with increased risk for atrial fibrillation - Science Daily, 7/14/14 - "Consistent with previous research, the study found an association between high alcohol consumption, defined as more than three drinks per day, and increased risk for atrial fibrillation and a strong association with binge drinking ... the risk for atrial fibrillation increased 8 percent with each additional drink per day"
• Thyroid problems linked to irregular heart rhythm - Science Daily, 11/28/12
• Moderate alcohol consumption may increase risk of atrial fibrillation in people with heart disease - Science Daily, 10/1/12 - "Moderate alcohol consumption was measured as one to 14 drinks a week for women and one to 21 drinks a week for men. Binge drinking was classified as five or more drinks a day ... The incidence rate of atrial fibrillation rose to 6.3% of the low intake group, 7.8% in the moderate and 8.3% in the high intake groups"
• Irregular Heart Rhythm Linked to Mental Problems - WebMD, 2/27/12 - "More people with AF than without showed signs of mental decline and had problems performing activities of daily living, such as showering, dressing, and feeding themselves. They were also at greater risk for being diagnosed with dementia than their AF-free counterparts"
• Moderate-to-heavy alcohol intake may increase risk of atrial fibrillation - Science Daily, 2/14/11
• Better treatment of atrial fibrillation and its risks - Science Daily, 8/31/10
• Cardiac procedure significantly reduces risk of Alzheimer's disease and stroke, researchers find - Science Daily, 5/13/10 - "patients with atrial fibrillation treated with catheter ablation are less likely to develop Alzheimer's disease or other forms of dementia, and have a significantly reduced risk of stroke and death compared to A-fib patients with who are not treated with ablation"
• People with diabetes are at higher risk of atrial fibrillation - Science Daily, 4/25/10
• High prevalence of atrial fibrillation found among cross-country skiers - Science Daily, 2/9/10
• Study: Ablation Beats Drugs for Atrial Fibrillation - WebMD, 1/26/10
• Atrial Fibrillation Linked To An Increased Risk Of Death In Diabetic Patients - Science Daily, 3/11/09
• Low Testosterone Levels Associated With Lone Atrial Fibrillation in Men - Medscape, 2/20/09 - "Mean testosterone levels in men with lone AF were significantly lower than those in healthy controls, the authors report, but mean estradiol levels did not differ significantly between the 2 groups"
• Surgeons Announce Advance In Atrial Fibrillation Surgery - Science Daily, 4/7/08
• Reduced incidence of new-onset atrial fibrillation with angiotensin II receptor blockade: the VALUE trial - J Hypertens. 2008 Mar;26(3):403-411 - "These findings suggest that angiotensin II receptor blockers may result in greater benefits than calcium antagonists in hypertensive patients at risk of new-onset AF"
• Elevated IL-6 Levels Associated With Increased Atrial Fibrillation Risk - Medscape, 2/26/08 - "a doubling of IL-6 level was independently associated with a 49% increase in the odds of developing AF"
• Focus On Atrial Fibrillation Recognizes Growing Importance Of Common Arrhythmia - Science Daily, 2/18/08
• High Blood Pressure Or Irregular Heartbeat Linked To Alzheimer's Disease Progression - Science Daily, 11/5/07 - "10 with high blood pressure (systolic pressure over 160) at the time of AD diagnosis showed a rate of memory loss roughly 100 percent faster than those with normal blood pressure ... 10 with atrial fibrillation at the time of the diagnosis showed a rate of memory decline that was 75 percent faster than those with normal heartbeats"
• Incidence of Atrial Fibrillation Significantly Reduced by Candesartan Cilexetil Therapy in Heart Failure Patients - Doctor's Guide, 7/5/06
• Dabigatran Etexilate Has Long-Term Safety and Efficacy in Patients With Atrial Fibrillation - Doctor's Guide, 5/19/06
• Taller People More Likely To Develop Atrial Fibrillation - Science Daily, 4/13/06
• Magnetically Guided Catheter Zaps Atrial Fibrillation - Doctor's Guide, 3/31/06
• Atrial Fibrillation Undertreated in the Elderly - Doctor's Guide, 3/15/06
• One in Four Adults Over 40 Could Develop Irregular Heartbeat - Doctor's Guide, 8/17/04
• Rate Control May Edge Out Rhythm Control For Atrial Fibrillation - Doctor's Guide, 12/5/02
• Simpler Way To Treat Abnormal Heart Beat - Intelihealth, 12/5/02