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Heart failure and atrial flutter: a systematic review of current knowledge and practices.

ABSTRACT: While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which may be managed differently. We reviewed the incidence, prevalence, and predictors of HF in AFL and vice versa, and the outcomes of treatment of AFL in HF. A systematic literature review of PubMed/Medline and EMBASE yielded 65 studies for inclusion and qualitative synthesis. No study described the incidence or prevalence of AFL in unselected patients with HF. Most cohorts enrolled patients with AF/AFL as interchangeable diagnoses, or highly selected patients with tachycardia-induced cardiomyopathy. The prevalence of HF in AFL ranged from 6% to 56%. However, the phenotype of HF was never defined by left ventricular ejection fraction (LVEF). No studies reported the predictors, phenotype, and prognostic implications of AFL in HF. There was significant variation in treatments studied, including the proportion that underwent ablation. When systolic dysfunction was tachycardia-mediated, catheter ablation demonstrated LVEF normalization in up to 88%, as well as reduced cardiovascular mortality. In summary, AFL and HF often coexist but are understudied, with no randomized trial data to inform care. Further research is warranted to define the epidemiology and establish optimal management.

SUBMITTER: Diamant MJ

PROVIDER: S-EPMC8712920 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundType 2 diabetes mellitus (T2D) and heart failure (HF) are closely related to the increased risk of atrial fibrillation (AF)/atrial flutter (AFL). However, massive clinical studies have shown that sodium glucose cotransporter 2 inhibitor (SGLT2i) affects the occurrence of AF/AFL and its complications, but the promoting or inhibitory effect of SGLT2i on AF/AFL and its complications and the exact probability is not clear, meta-analysis can combine the existing research data to easily solve the clinical problems.MethodsWe performed a search in the registers of ClinicalTrials.gov from it,s inception to March 2021 to evaluate the occurrence of AF/AFL adverse events in SGLT2i in patients with T2D/HF. Almost all of the included studies were double-blind parallel allocation randomized controlled studies, and only one was open. The control groups all included placebo, some of which also included glimepiride, metformin, liraglutide, etc. Quality risk assessment of the included randomized controlled trials (RCTs) was conducted using Cochrane RoB 2.0., and the publication bias assessment was conducted using STATA 17.0. The odds ratio (OR) combined effect of 95% confidence interval (CI) was used for bivariate variables.ResultsWe included data from 22 confirmed trials that included 52,951 T2D/HF patients. The studies had no risk of bias. Analysis of the cumulative results showed that compared with placebo, SGLT2i can significantly reduce the incidence of AF/AFL by 18% (OR =0.82, 95% CI: 0.73 to 0.93, P=0.002), and reduce the incidence of arrhythmia by 14% (OR =0.86, 95% CI: 0.79 to 0.94, P=0.0006); among them, the incidence of AF/AFL in T2D patients was reduced by 20% (OR =0.80, 95% CI: 0.69 to 0.92, P=0.002); Dapagliflozin reduced the incidence of AF/AFL by 15% (OR =0.85, 95% CI: 0.74 to 0.98, P=0.03); the incidence of intracardiac thrombosis decreased by 69% (OR =0.31, 95% CI: 0.10 to 0.91, P=0.03), while the incidence of AF/AFL in women decreased by 17% (OR =0.83, 95% CI: 0.72 to 0.94, P=0.004).DiscussionThis article provides a new direction for the use of SGLT2i, and hopefully it can provide certain theoretical basis for the broader clinical indications of SGLT2i in the future.

Project description:IntroductionMeningiomas are primary central nervous system tumours that arise from both cranial and spinal meninges. Spinal meningiomas occur less frequently than their cranial counterparts and are consequently given less attention in the literature. Therefore, systematic studies are needed to summarise the current knowledge on spinal meningiomas, providing a solid evidence base for treatment strategies. This systematic review of the literature will therefore assess studies describing spinal meningiomas, their epidemiology, diagnostics, treatment and outcomes.Methods and analysisElectronic databases, including PubMed, Web of Science and Embase, will be searched using the keywords "spinal" and "meningioma". The search will be set to provide only English studies published after 2000 to avoid any conflicts regarding terminology and classification, as well as to reflect the current status. Case reports, editorials, letters and reviews will also be excluded. Reference lists of relevant records will also be searched. Identified studies will be screened for inclusion, by one reviewer in a first step and then three in the next step to decrease the risk of bias. The results will be categorised to allow for a structured summary of the outcomes and their evidence grade conforming to the Grading of Recommendations, Assessment, Development and Evaluation approach. Categories may include: epidemiology, histopathology, radiological diagnostics, surgery, complications, non-surgical or adjuvant treatments, disease outcomes and predictors, and lastly recurrence. This review will summarise the current knowledge on spinal meningiomas to allow for a better understanding of the disease and contribute to improve its management. For clinicians, the systematic collection and grading of available evidence may aid in decision making and for those seeking to further the scientific field, this review may help to identify areas where knowledge is currently lacking.Ethics and disseminationEthics approval was not required for our systematic review as it is based on existing publications. The results will be disseminated via submission for publication in a peer-reviewed journal.

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Heart failure and atrial flutter: a systematic review of current knowledge and practices.

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