Yu-Feng Hu

Taipei Veterans General Hospital, T’ai-pei, Taipei, Taiwan

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Publications (112)418.93 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown.
    Journal of the American College of Cardiology 10/2014; 64(16):1658-65. · 14.09 Impact Factor
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    ABSTRACT: Background Digoxin and related cardiac glycoside have been used for almost 100 years in atrial fibrillation (AF). However, recent 2 analyses of the “AFFIRM” trial showed non-consistent results about the risk of mortality associated with digoxin use. The goal of the present study is to investigate the relationship between digoxin and the risk of ischemic stroke and mortality in Asians. Methods This study used the “National Health Insurance Research Database” in Taiwan. A total of 4,781 AF patients who did not receive any antithrombotic therapy were selected as the study population. Among the study population, 829 subjects (17.3%) received the digoxin treatment. The risks of ischemic stroke and mortality of patients with or without digoxin use were compared. Results The use of digoxin was associated with an increased risk of clinical events with an adjusted hazard ratio of 1.41 (95% CI =1.17-1.70) for ischemic stroke and 1.21 (95% CI =1.01-1.44) for all-cause mortality. In the subgroup analysis based on the coexistence with heart failure or not, digoxin was a risk factor of adverse events for patients without heart failure, but not for those with heart failure (interaction p<0.001 for either endpoint). Among AF patients without heart failure, the use of beta-blockers was associated with better survival with an adjusted hazard ratio of 0.48 (95% CI = 0.34-0.68). Conclusions Digoxin should be avoided for AF patients without heart failure since it was associated with an increased risk of clinical events. Beta-blockers may be a better choice for controlling ventricular rate.
    The Canadian journal of cardiology 10/2014; · 3.12 Impact Factor
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    ABSTRACT: The risk of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF) having a CHA2DS2-VASc score of 0 (for males) or 1 (for females) has not been previously investigated.
    Heart rhythm: the official journal of the Heart Rhythm Society 08/2014; · 4.56 Impact Factor
  • International journal of cardiology. 08/2014;
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    ABSTRACT: The characteristics of endocardial electrograms needed to detect the overlying abnormal epicardial substrates in arrhythmogenic right ventricular cardiomyopathy with epicardial ventricular tachycardia remain unclear. The current study investigated which of the endocardial electrogram characteristics could predict the overlying abnormal epicardial substrates.
    Journal of Cardiovascular Electrophysiology 07/2014; · 3.48 Impact Factor
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    ABSTRACT: Background:Although the link between sleep-disordered breathing (SDB) and atrial fibrillation (AF) has been reported, a population-based longitudinal cohort study was lacking. The goal of the present study was to investigate the AF risk carried by SDB, using the National Health Insurance Research Database in Taiwan.Methods and Results:From 2000 to 2001, a total of 579,521 patients who had no history of cardiac arrhythmias or significant comorbidities were identified. Among them, 4,082 subjects with the diagnosis of SDB were selected as the study group, and the remaining 575,439 subjects constituted the control group. The study endpoint was the occurrence of new-onset AF. During a follow-up of 9.2±2.0 years, there were 4,023 patients (0.7%) experiencing new-onset AF. The occurrence rate of AF was higher in patients with SDB compared to those without it (1.3% vs. 0.7%, P<0.001). The AF incidences were 1.38 and 0.76 per 1,000 person-years for patients with and without SDB, respectively. After anadjustment for age and sex, SDB was a significant risk factor of AF with a hazard ratio of 1.536. The AF risk increased with increasing clinical severity of SDB, represented by the requirement of continuous positive airway pressure use.Conclusions:SDB itself, without the coexistence of other systemic diseases, was a risk factor of AF.
    Circulation journal : official journal of the Japanese Circulation Society. 07/2014;
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    ABSTRACT: Renal dysfunction is a significant risk factor of ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence amongst AF patients with end-stage renal disease (ESRD) are unclear.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; · 4.56 Impact Factor
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    ABSTRACT: Radiofrequency catheter ablation (RFCA) is an effective therapeutic strategy in eliminating drug-refractory idiopathic right ventricular outflow tract ventricular arrhythmias (RVOT VAs). It remains unclear what factors influence early and late VA recurrences after ablation.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; · 4.56 Impact Factor
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    ABSTRACT: Signal averaged electrocardiogram (SAECG) is a specific and non-invasive tool useful for arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnosis. However, its role in risk stratification of patients with ARVC remains largely undefined. Sixty-four patients fulfilling Task Force ARVC criteria (mean age: 47±14years-old, 56% male, 50% definite ARVC) were enrolled. The baseline demographic, electrocardiographic, structural, and electrophysiological characteristics were collected. Patients with SAECG fulfilling all 3 Task Force criteria (3+ SAECG) were categorized into group 1, and those fulfilled 2 or less criterion were categorized into group 2. The study endpoints were unstable ventricular arrhythmia (VA), device detectable sustained fast VA (cycle lengths <240ms) and cardiovascular death. During a mean follow-up of 21±20months, 15 primary endpoints including 12 unstable VAs and 3 device-detected fast VAs were met. One patient died of electrical storm, and one patient underwent heart transplantation. The presence of 3+ SAECG predicted malignant events in all patients with definite and non-definite ARVC (p<0.01, OR=30.5, 95% CI=2.5-373.7) and in patients with definite ARVC alone (p=0.03, OR=11.1, 95% CI=1.3-93.9). Patients diagnosed with non-definite ARVC without 3+ SAECG were free from malignant events. SAECG fulfilling all 3 Task Force criteria was an independent risk predictor of malignant events in ARVC patients. SAECG may play a valuable role in ARVC risk stratification.
    International journal of cardiology 04/2014; · 6.18 Impact Factor
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    ABSTRACT: Background: The impact of renal dysfunction has been investigated in patients with non-valvular atrial fibrillation (AF). The aim of this study was to assess its additive prognostic value in low thromboembolic risk AF patients with CHA2DS2-VASc score 0-1. Methods and Results: A total of 617 non-valvular AF patients were enrolled and baseline serum creatinine was measured. Estimated glomerular filtration rate and estimated clearance of creatinine were calculated using the Modification of Diet in Renal Disease equation and Cockcroft-Gault formula, respectively. The primary endpoint was cardiovascular death and systemic thromboembolic events, including acute ischemic stroke, transient ischemic attack, and peripheral artery embolism. Of these, 338 individuals had clinical CHA2DS2-VASc score 0-1. Among these individuals, 23 patients had impaired renal function. During the follow-up period of 53.6±32.1 months, the annual composite outcome rate in AF patients with CHA2DS2-VASc score 0-1 was 0.40%/year. As compared with patients with preserved renal function, the annual composite outcome rate was significantly higher in patients with impaired renal function (2.92%/year vs. 0.21%/year, P<0.001). Moreover, on multivariate Cox regression analysis, renal dysfunction was the only risk predictor in these low-risk patients. Conclusions: Impaired renal function has an additive prognostic value for thromboembolic events and cardiovascular mortality in low-risk AF patients with CHA2DS2-VASc score 0-1.
    Circulation Journal 02/2014; · 3.58 Impact Factor
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    ABSTRACT: Background Renal dysfunction is a significant risk factor of ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence amongst AF patients with end-stage renal disease (ESRD) are unclear. Objective The goal of the present study was to compare the CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in AF patients with ESRD. Methods A total of 10,999 AF patients with ESRD undergoing renal replacement therapy who were not receiving oral anticoagulants or antiplatelet agents were identified from Taiwan’s National Health Insurance Research Database. The study endpoint was occurrence of ischemic stroke. Results The median (IQR) CHADS2 and CHA2DS2-VASc scores for the study cohort were 3 (2-5) and 5 (4-7), respectively. During the follow-up, 1,217 patients (11.7%) experienced ischemic stroke, with an incidence rate of 6.9 per 100 person-years. In Cox regression models, the CHADS2 and CHA2DS2-VASc scores were both significant predictors of ischemic stroke. C-indexes for CHADS2 and CHA2DS2-VASc were 0.608 and 0.682, respectively (p<0.001). CHA2DS2-VASc improved the net reclassification index by 4.8% compared with CHADS2 (p<0.0001). Among 1,409 patients with a CHADS2 score of 0 or 1, the CHA2DS2-VASc score ranged from 1 to 4, with event rates ranging from 2.1 to 4.7 per 100 person-years. Conclusions The CHA2DS2-VASc score was useful in predicting ischemic stroke in AF patients with ESRD undergoing dialysis, and was superior to CHADS2. The net clinical benefit balancing stroke reduction against major bleeding with anticoagulation in these high risk patients remains to be defined.
    Heart Rhythm. 01/2014;
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    ABSTRACT: Background A new risk model, the R2CHADS2 score, was proposed to be a powerful scoring scheme in predicting stroke or systemic embolism in atrial fibrillation (AF). The goal of the present study is to validate the usefulness of R2CHADS2 score among AF patients after catheter ablations. We also aimed to compare the accuracies of the CHA2DS2-VASc and R2CHADS2 scores for risk stratifications of thromboembolic (TE) events after ablation procedures. Methods We enrolled a total of 526 patients with AF who underwent catheter ablation. The clinical endpoint was the occurrence of TE events (ischemic stroke, transient ischemic attack, or other systemic embolisms) during the post-ablation follow-up. Results During a follow-up of 37.5+21.3 months, 14 patients (2.7%) experienced TE events. The R2CHADS2 score was an independent predictor of TE events in the multivariate analysis. Patients with a R2CHADS2 score of > 2 had a higher event rate compared to those with a score of 0 or 1 (0.5% versus 7.7%). The areas under the ROC curves of CHA2DS2-VASc and R2CHADS2 scores in predicting TE events were 0.832 and 0.872, respectively. The difference between these 2 curves did not reach statistical significance (p value = 0.338). In addition, the R2CHADS2 score did not improve net stroke risk reclassification over the CHA2DS2-VASc score (net reclassification improvement = -0.9%, p value = 0.948). Conclusions The R2CHADS2 and CHA2DS2-VASc scores could be used to predict TE events for AF patients receiving catheter ablations. The predictive accuracies of both scores were similar in this relatively small-sized cohort undergoing ablation.
    The Canadian journal of cardiology 01/2014; · 3.12 Impact Factor
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    ABSTRACT: Background Radiofrequency catheter ablation (RFCA) is an effective therapeutic strategy in eliminating drug-refractory idiopathic right ventricular outflow tract ventricular arrhythmias (RVOT VAs). It remains unclear what factors influence early and late VA recurrences after ablation. Objectives The aim of our study was to elucidate the differences between early and late recurrences after acute successful RFCA of RVOT VAs in a long-term follow-up. Methods A total of 220 patients with acute successful RFCA of RVOT VAs were enrolled. Detailed clinical characteristics and assessments by non-invasive and invasive electrophysiological studies were explored to predict the overall, early (≤ 1 year), and late VA recurrences (>1 year). Results During a mean follow-up of 34.15±33.74 months, 45 of the 220 patients (20.5%) documented recurrence of RVOT VAs after initial RFCA. Of them, 26 (57.8%) recurrent VA showed similar morphology, and 19 (42.2%) were different. Patients with recurrent VAs were associated with higher incidence of hypertension, higher systolic BP, identification of foci by pacemapping alone, shorter earliest activation time, more RF pulses required, and VA originating from anterior free wall. Multivariate analysis demonstrated that mapping strategy and shorter earliest activation time preceding VA were associated with early recurrences (P<0.001, HR:2.26, 95% CI: 1.49~3.42; P=0.008, HR:0.91, 95% CI: 0.85~0.98, respectively), whereas hypertension was associated with late recurrence (P=0.001, HR:3.48, 95% CI: 1.34~9.07). Conclusion RFCA is an effective strategy in elimination of RVOT VAs. However, early and late recurrences occur commonly. Patients with early and late VA recurrences demonstrated non-uniform patterns of clinical characteristics and electrophysiological properties.
    Heart Rhythm. 01/2014;
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    ABSTRACT: Pericardial fat (PCF) may induce local inflammation and subsequent structural remodeling of the left atrium (LA). However, the adverse effects of PCF on LA are difficult to be evaluated and quantified. The atrial electromechanical interval determined by transthoracic echocardiogram was shown to be a convenient parameter which can reflect the process of LA remodeling. The goal of the present study was to investigate the association between the electromechanical interval and PCF.
    PLoS ONE 01/2014; 9(5):e97472. · 3.53 Impact Factor
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    ABSTRACT: It is unclear whether atrial fibrillation (AF) adversely influences the clinical course of patients with hepatocellular carcinoma (HCC). During the period from January 1, 2001 to December 31, 2010, 476 patients (mean ± SD age 60.3 ± 12.9 years) diagnosed with HCC were retrospectively enrolled in our study. The HCC stage, treatment, baseline characteristics, underlying cardiovascular diseases, and corresponding drug treatment were systematically reviewed. The primary endpoint was death from any cause. AF was associated with a significantly reduced survival time in patients with HCC (AF vs. non-AF patients mean ± SD survival time 470.1 ± 89.6 days vs. 1161.2 ± 32.6 days, log-rank p < 0.001; probability of survival 0.20, 95% confidence interval 0.10-0.38, p < 0.001). After adjustment for gender and age, AF was still associated with poorer survival times (hazard ratio 4.131, 95% confidence interval 2.134-5.733, p < 0.001). The causes of death among 22 patients with both HCC and AF included 11 cases of hepatic failure, four cases of ruptured tumor, and two cases of bleeding from esophageal varices. None of these patients with AF used warfarin. Seven bleeding events related to HCC were noted, but none of these patients developed a major thromboembolism. The mean ± SD follow-up period was 645 ± 468 days. Patients with HCC had a significantly reduced survival time with the comorbidity of AF. Tumor rupture was relatively common among patients with both HCC and AF. The anticoagulation treatment of AF in patients with HCC deviated from the current guidelines without an increase in thromboembolic events.
    Journal of the Chinese Medical Association 12/2013; · 0.75 Impact Factor
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    ABSTRACT: Although hyperuricemia has been reported to be a risk factor of stroke, the relationship between hyperuricemia and stroke in patients with atrial fibrillation (AF) remains uncertain. The goal of the present study was to investigate whether hyperuricemia could potentially refine clinical risk stratification in AF. This study used the "National Health Insurance Research Database" in Taiwan. A total of 7601 AF patients who did not receive antiplatelet agents or oral anticoagulants were identified as the study population. Hyperuricemia was defined as having at least one episode of gout attack necessitating long-term treatment with uric acid-lowering agents. The association between hyperuricemia and ischemic stroke was analyzed. During the follow up of 3.0±2.7years, 1116 patients (14.7%) experienced ischemic stroke with an annual rate of around 4.9%. Hyperuricemia significantly predicts stroke, with a hazard ratio (HR) of 1.280 after adjusting for CHA2DS2-VASc score and other comorbidities. Among the 376 patients with a CHA2DS2VASc score of 0, hyperuricemia can further stratify them into 2 groups with different stroke rates (7.1% versus 1.3%, p=0.020). The adjusted HR of hyperuricemia in predicting ischemic stroke diminished from 7.491 for patients with a CHA2DS2-VASc score of 0 to 1.659 for those with a score of 3, and became insignificant for patients with a score ≥4. Hyperuricemia was a significant risk factor of stroke which could potentially refine the clinical risk stratification in AF. It deserves a prospective trial to investigate whether it would change the current strategy for stroke preventions using oral anticoagulants.
    International journal of cardiology 11/2013; · 6.18 Impact Factor
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    ABSTRACT: Sudden cardiac death (SCD) is the most catastrophic presentation in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). We aimed to investigate the seasonal variations in the frequency of SCD and ventricular tachyarrhythmia in patients with AVRD/C, and to elucidate the meteorological factors that trigger these events. From 1998 to 2012, we enrolled 88 consecutive ARVD/C patients from Taipei City. The cohort included 20 living patients who received implantable cardioverter defibrillator (ICD) and 68 autopsied patients with SCD from the National Forensic Institute Registry. The baseline clinical characteristics, seasonal distribution, and associated meteorological factors were explored to predict the occurrences of events, which include appropriate ICD interventions and SCD. There were 106 events, including 38 appropriate ICD interventions (35.8%, 1.9 episodes per patient) in ARVD/C living patients and 68 SCD (64.2%). The seasonal peak occurred predominantly in the summer (P<0.05) in both groups. For meteorological factors, the onset of event was associated with higher mean daily temperature and longer sunshine duration. Variation of humidity within 3 days of events was significantly increased. After multivariate logistic regression analysis, higher average daily temperature and larger variation of humidity were associated with increase in events (P<0.001, odd ratio [OR]: 1.23, 95% confidence interval [CI]: 1.16~1.31; P<0.001, OR: 1.19, 95% CI: 1.15~1.23, respectively). There was seasonal variation with a summer peak in the occurrence of ventricular arrhythmias and SCD in patients with ARVD/C. Meteorological factors including higher temperature and larger variation of humidity within 3 days of events were independently associated with the development of events.
    Heart rhythm: the official journal of the Heart Rhythm Society 09/2013; · 4.56 Impact Factor
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    ABSTRACT: -Identification of critical atrial substrates in nonparoxysmal atrial fibrillation (AF) patients failing to respond to pulmonary vein isolation (PVI) is important. This study investigated the signal characteristics, substrate nature, and ablation results of rotors during AF. -In total 53 patients (age=55±8), 31 with persistent AF and 22 with long-lasting AF, underwent PVI and substrate modification of complex fractionated atrial electrograms (CFAEs). Small-radius-reentrant rotors were identified from signal analyses of the dominant frequency (DF), fractionation interval (FI) and nonlinear analyses (newly developed, beat-to-beat nonlinear measurement of the repetitiveness of the electrogram morphology over 6 seconds). In 15% of the patients, activation maps demonstrated occurrences of rotor-like small-radius reentrant circuits (N=9, 1.1 per patient, cycle length=110±21 ms; diameter=11±6 mm) with fibrillation occurring outside these areas. Rotors were identified by conventional point-by-point mapping and signal analyses, and were subsequently eradicated by catheter ablation in these patients. Persistent AF for <1 year, a smaller left atrial size, substrates with higher mean voltages and shorter total activation durations predicted a higher incidence of rotors (all p <0.05). In the multivariable model, areas of reentrant circuits exhibited a higher DF, kurtosis, and higher degree of a beat-to-beat electrogram similarity than areas without or outside the rotors (all p <0.05). -Rotors-like reentry with fibrillatory conduction were found in a limited number of patients with nonparoxysmal AF after PVI. Those areas were characterized by rapid repetitive activity with a high degree of electrogram similarity.
    Circulation Arrhythmia and Electrophysiology 08/2013; · 5.95 Impact Factor
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    ABSTRACT: Although hyperuricemia was associated with several cardiovascular diseases, the role of uric acid (UA) in left atrial (LA) remodeling and new-onset atrial fibrillation (AF) has not been fully explored. The goal of the present study is to investigate the relationship between UA, LA diameter and the development of AF in the large-scale cohort. The study consisted of 2 parts. First, we investigated the association between serum UA and LA diameter in a single-center database (n=3043). Second, we studied and compared the risk of new-onset AF among patients with and without hyperuricemia in the nationwide longitudinal cohort in Taiwan (n=122,524). Elevated serum level of UA was associated with an increased systemic inflammation, and insulin resistance. The LA diameter was significantly correlated with serum UA (r=0.341, p value<0.001). The linear correlation between LA dimension and UA level remained significant after the adjustment for clinical, biochemical and echocardiographic variables. In the nationwide cohort, there were 2339 patients (1.9% of the study population) developing AF during the follow-up of 6.3±3.0years. The AF occurrence rate was higher in patients with hyperuricemia than those without it (2.1% versus 1.7%; p value<0.001). Hyperuricemia was a significant risk factor of new-onset AF with a hazard ratio of 1.191 (95% confidence interval=1.098-1.292, p value<0.001) in the multivariate Cox regression analysis. Hyperuricemia was associated with a larger LA size and may be a novel risk factor for the development of AF.
    International journal of cardiology 07/2013; · 6.18 Impact Factor
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    ABSTRACT: Background: Dyspepsia is not uncommon in patients undergoing ablation of atrial fibrillation (AF). The purpose of this study was to investigate the change in gastric myoelectrical activity and its relationship to the outcome after ablation by electrogastrography (EGG). Methods and Results: The study prospectively enrolled 32 patients: 16 patients (Group 1) had AF and 16 (Group 2) had paroxysmal supraventricular tachycardia. The myoelectricity-like signals of the gastrointestinal tract were recorded using EGG before, immediately, and 3 months after ablation. Both fasting and postprandial abnormal gastric wave percentages increased immediately after ablation in Group 1 when compared with before ablation. Increased fasting (12.8±15.2% vs. 22.3±21.0%, P=0.04) and postprandial (10.4±6.2% vs. 21.2±14.5%, P=0.01) bradygastria percentages were noted immediately after ablation in Group 1 when compared with before ablation. These findings were not observed in Group 2. The normal gastric wave percentage returned to baseline 3 months after procedure. In total, 4 (25%) patients in Group 1 had a recurrence of AF after a follow-up of 18±3 months; those without recurrence had a significantly higher percentage of postprandial abnormal gastric waves immediately after ablation when compared with recurrence. Conclusions: Transient gastric dysrhythmias with bradygastria does occur in AF patients after ablation, which may indicate periesophageal vagal plexus damage after ablation. Careful application of radiofrequency energy to prevent esophageal injury is important.
    Circulation Journal 05/2013; · 3.58 Impact Factor

Publication Stats

616 Citations
418.93 Total Impact Points

Institutions

  • 2007–2014
    • Taipei Veterans General Hospital
      • Cardiology Division
      T’ai-pei, Taipei, Taiwan
    • National Yang Ming University
      • • School of Medicine
      • • Institute of Clinical Medicine
      T’ai-pei, Taipei, Taiwan
  • 2013
    • Mackay Memorial Hospital
      • Department of Internal Medicine
      T’ai-pei, Taipei, Taiwan
  • 2012
    • Cheng Hsin General Hospital
      T’ai-pei, Taipei, Taiwan
  • 2010
    • Cathay General Hospital
      T’ai-pei, Taipei, Taiwan
    • Taipei City Hospital
      T’ai-pei, Taipei, Taiwan
  • 2009
    • Taipei Medical University
      • Division of Cardiology
      T’ai-pei, Taipei, Taiwan
  • 2008
    • Taichung Veterans General Hospital
      臺中市, Taiwan, Taiwan