201
|
Rattka M, Kühberger A, Pott A, Stephan T, Weinmann K, Baumhardt M, Aktolga D, Teumer Y, Bothner C, Scharnbeck D, Rottbauer W, Dahme T. Catheter ablation for atrial fibrillation in HFpEF patients-A propensity-score-matched analysis. J Cardiovasc Electrophysiol 2021; 32:2357-2367. [PMID: 34379370 DOI: 10.1111/jce.15200] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/24/2021] [Accepted: 05/15/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are both common conditions associated with high morbidity and mortality, especially if they coexist. Catheter ablation (CA) for AF has been shown recently to induce reverse remodeling and improve symptoms in HFpEF patients. The aim of this study was to compare outcomes of AF patients with HFpEF, who either underwent CA for AF or received medical therapy only. METHODS AND RESULTS We included all AF patients with HFpEF according to current guidelines treated at our hospital between 2013 and 2018. Out of 6614 AF patients, we identified 127 with confirmed HFpEF. After applying propensity score matching to balance patient groups, 43 patients treated by CA and 43 patients receiving medical treatment were compared. Patients in the CA group underwent a mean of 1.5 ± 0.8 ablation procedures. Arrhythmia recurrence occurred significantly less frequently in the CA group (hazard ratio [HR]: 0.47; 95% CI: 0.25-0.87; p = .016). The primary endpoint, a composite of heart failure hospitalization and death, was reduced significantly by CA compared to medical therapy (HR: 0.30; 95% CI: 0.13-0.67; p = .003). This was driven by a decrease in heart failure hospitalization. Clinical and echocardiographic parameters of HFpEF improved significantly only after CA. Remarkably, reassessment of diagnostic HFpEF criteria at the end of follow-up demonstrated HFpEF resolution in 15 out of 43 patients (35%) treated by CA and only 4 out of 43 patients (9%) treated medically (p = .008). CONCLUSION Catheter ablation for AF in HFpEF patients in comparison to medical therapy decreases heart failure hospitalization, heart failure symptoms, and improves diastolic function. AF ablation should be considered in patients with HFpEF and concomitant AF.
Collapse
Affiliation(s)
- Manuel Rattka
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Anna Kühberger
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Alexander Pott
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Tilman Stephan
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Karolina Weinmann
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Michael Baumhardt
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Deniz Aktolga
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Yannick Teumer
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Carlo Bothner
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | | | - Tillman Dahme
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| |
Collapse
|
202
|
Tiver KD, Quah J, Lahiri A, Ganesan AN, McGavigan AD. Atrial fibrillation burden: an update-the need for a CHA2DS2-VASc-AFBurden score. Europace 2021; 23:665-673. [PMID: 33351904 DOI: 10.1093/europace/euaa287] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/16/2020] [Indexed: 01/31/2023] Open
Abstract
Atrial fibrillation (AF) is an established independent risk factor for stroke. Current guidelines regard AF as binary; either present or absent, with the decision for anti-coagulation driven by clinical variables alone. However, there are increasing data to support a biological gradient of AF burden and stroke risk, both in clinical and non-clinical AF phenotypes. As such, this raises the concept of combining AF burden assessment with a clinical risk score to refine and individualize the assessment of stroke risk in AF-the CHA2DS2VASc-AFBurden score. We review the published data supporting a biological gradient to try and construct a putative schema of risk attributable to AF burden.
Collapse
Affiliation(s)
- Kathryn D Tiver
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia
| | - Jing Quah
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia.,College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia 5042, Australia
| | - Anandaroop Lahiri
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia
| | - Anand N Ganesan
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia.,College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia 5042, Australia
| | - Andrew D McGavigan
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia.,College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia 5042, Australia
| |
Collapse
|
203
|
Luo J, Xu S, Li H, Gong M, Li Z, Liu B, Qin X, Shi B, Wei Y. Long-term impact of the burden of new-onset atrial fibrillation in patients with acute myocardial infarction: results from the NOAFCAMI-SH registry. Europace 2021; 23:196-204. [PMID: 32929491 DOI: 10.1093/europace/euaa234] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/15/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS We aimed to investigate the prognostic impact of the burden of new-onset atrial fibrillation (NOAF) on long-term cardiovascular outcomes in patients with acute myocardial infarction (AMI). METHODS AND RESULTS This retrospective analysis consecutively included patients without a documented atrial fibrillation (AF) history who admitted for AMI at Shanghai Tenth People's Hospital between February 2014 and March 2018. Atrial fibrillation burden was measured as the percentage of time spent in AF, and its optimal cut-off value of 10.87% was identified by X-tile software. Of 2399 patients (mean age: 65.8 years, 76.6% of men), 278 (11.6%) developed NOAF during hospitalization. During a median follow-up of 2.7 years, the incidence of all-cause death was 3.19, 9.00, and 17.41 per 100 person-years in the sinus rhythm (SR), low-burden (AF burden ≤ 10.87%), and high-burden (AF burden > 10.87%) groups, respectively. After adjustment for confounders, it was the high-burden NOAF [hazard ratio (HR): 1.94, 95% confidence interval (CI): 1.28-2.95] rather than the low-burden one (HR: 1.47, 95% CI: 0.97-2.21) that was significantly associated with increased mortality compared with SR. Concordant results were obtained in our propensity score-matched analyses [2.55 (1.57-4.16) and 1.32 (0.85-2.05) for high- and low-burden NOAF, respectively). In addition, post-myocardial infarction NOAF was associated with an increased risk of heart failure irrespective of its burden. Only those high-burden individuals were at heightened risk of ischaemic stroke. The restricted cubic spline curves illustrated a dose-response relationship of NOAF burden with outcomes. CONCLUSION In patients with NOAF complicating AMI, high AF burden was strongly associated with long-term outcomes.
Collapse
Affiliation(s)
- Jiachen Luo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| | - Hongqiang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| | - Mengmeng Gong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| | - Zhiqiang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| | - Baoxin Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| | - Xiaoming Qin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| | - Beibei Shi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| | - Yidong Wei
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China
| |
Collapse
|
204
|
Zweerink A, Bakelants E, Stettler C, Burri H. Cryoablation vs. radiofrequency ablation of the atrioventricular node in patients with His-bundle pacing. Europace 2021; 23:421-430. [PMID: 33241283 DOI: 10.1093/europace/euaa344] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Radiofrequency ablation (RFA) of the atrioventricular node (AVN) with His-bundle pacing (HBP) can cause rise in capture thresholds. Cryoablation (CRYO) may offer reversibility in case of threshold rise but has never been tested for AVN ablation in this setting. Our aim was to compare procedural characteristics and outcome of CRYO compared with RFA for AVN ablation in patients with HBP. METHODS AND RESULTS Forty-four patients with HBP underwent AVN ablation for an 'ablate and pace' indication. Cryoablation was performed in the first 22 patients and RFA in the following 22 patients. Procedural characteristics, success rates, and change in His capture thresholds were compared between groups. Distance from the ablation site to the His lead was measured using biplane fluoroscopy. Acute success was 100% with both strategies. Median procedural duration was significantly longer for CRYO {50 [interquartile range (IQR) 38-63] min} compared with RFA [36 (IQR, 30-41) min; P = 0.027]. An acute threshold rise of ≥1 V was observed in four CRYO (one complete loss of capture) and three RFA patients (P = 0.38), with all of the applications being within 6 mm of the His lead tip. During follow-up, nine patients had AVN re-conduction (six CRYO vs. three RFA; P = 0.58), but only four patients required a redo procedure (all CRYO; P = 0.09). CONCLUSION Cryoablation does not offer any advantage over RFA for AVN ablation in patients with HBP and tended to require more redo procedures. If possible, a distance of ≥6 mm should be maintained from the His lead tip to avoid a rise in capture thresholds.
Collapse
Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Elise Bakelants
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Carine Stettler
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| |
Collapse
|
205
|
Lycke M, Kyriakopoulou M, El Haddad M, Wielandts JY, Hilfiker G, Almorad A, Strisciuglio T, De Pooter J, Wolf M, Unger P, Vandekerckhove Y, Tavernier R, de Waroux JBEP, Duytschaever M, Knecht S. Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation. Europace 2021; 23:861-867. [PMID: 33367708 DOI: 10.1093/europace/euaa383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/02/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Catheter ablation of paroxysmal atrial fibrillation (AF) reduces AF recurrence, AF burden, and improves quality of life. Data on clinical and procedural predictors of arrhythmia recurrence are scarce and are flawed by the high rate of pulmonary vein reconnection evidenced during repeat procedures after pulmonary vein isolation (PVI). In this study, we identified clinical and procedural predictors for AF recurrence 1 year after CLOSE-guided PVI, as this strategy has been associated with an increased PVI durability. METHODS AND RESULTS Patients with paroxysmal AF, who received CLOSE-guided PVI and who participated in a prospective trial in our centre, were included in this study. Uni- and multivariate models were plotted to find clinical and procedural predictors for AF recurrence within 1 year. Three hundred twenty-five patients with a mean age of 63 years (CHA2DS2VASc 1 [1-3], left atrium diameter 41 ± 6 mm) were included. About 60.9% were male individuals. After 1 year, AF recurrence occurred in 10.5% of patients. In a binary logistic regression analysis, the diagnosis-to-ablation time (DAT) was found to be the strongest predictor of AF recurrence (P = 0.011). Diagnosis-to-ablation time ≥1 year was associated with a nearly two-fold increased risk for developing AF recurrence. CONCLUSION The DAT is the most important predictor of arrhythmia recurrence in low-risk patients treated with durable pulmonary vein isolation for paroxysmal AF. Whether reducing the DAT could improve long-term outcomes should be investigated in another trial.
Collapse
Affiliation(s)
- Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Maria Kyriakopoulou
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium.,Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Jean-Yves Wielandts
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Alexandre Almorad
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Teresa Strisciuglio
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Jan De Pooter
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium.,Department of Cardiology, UZ Gent, Ghent, Belgium
| | - Michael Wolf
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Philippe Unger
- Department of Cardiology, CHU Saint Pierre, Brussels, Belgium
| | - Yves Vandekerckhove
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - René Tavernier
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | | | - Mattias Duytschaever
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Sébastien Knecht
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| |
Collapse
|
206
|
Arbelo E, Aktaa S, Bollmann A, D'Avila A, Drossart I, Dwight J, Hills MT, Hindricks G, Kusumoto FM, Lane DA, Lau DH, Lettino M, Lip GYH, Lobban T, Pak HN, Potpara T, Saenz LC, Van Gelder IC, Varosy P, Gale CP, Dagres N, Boveda S, Deneke T, Defaye P, Conte G, Lenarczyk R, Providencia R, Guerra JM, Takahashi Y, Pisani C, Nava S, Sarkozy A, Glotzer TV, Martins Oliveira M. Quality indicators for the care and outcomes of adults with atrial fibrillation. Europace 2021; 23:494-495. [PMID: 32860039 DOI: 10.1093/europace/euaa253] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS To develop quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). METHODS AND RESULTS We followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of AF care for the diagnosis and management of AF (by a group of experts including members of the ESC Clinical Practice Guidelines Task Force for AF); (ii) the construction of candidate QIs (including a systematic review of the literature); and (iii) the selection of the final set of QIs (using a modified Delphi method). Six domains of care for the diagnosis and management of AF were identified: (i) Patient assessment (baseline and follow-up), (ii) Anticoagulation therapy, (iii) Rate control strategy, (iv) Rhythm control strategy, (v) Risk factor management, and (vi) Outcomes measures, including patient-reported outcome measures (PROMs). In total, 17 main and 17 secondary QIs, which covered all six domains of care for the diagnosis and management of AF, were selected. The outcome domain included measures on the consequences and treatment of AF, as well as PROMs. CONCLUSION This document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes), and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.
Collapse
Affiliation(s)
| | | | - Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | - André D'Avila
- Cardiac Arrhythmia Service, Hospital SOS Cardio, Florianopolis, SC, Brazil; Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Inga Drossart
- European Society of Cardiology, Sophia Antipolis, France; ESC Patient Forum, Sophia Antipolis, France
| | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | - Fred M Kusumoto
- Cardiology Department, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maddalena Lettino
- Cardiovascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Trudie Lobban
- Arrhythmia Alliance/AF Association/STARS, Chipping Norton, UK
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Luis C Saenz
- Fundación Cardio Infantil-Instituto de Cardiología, Bogotá, Colombia
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Paul Varosy
- Rocky Mountain Regional Veterans Affairs Medical Center and the University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, 31076 Toulouse, France
| | | | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Centre RHÖN-KLINIKUM Campus Bad Neustadt, Germany
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Radoslaw Lenarczyk
- First Department of Cardiology and Angiology, Silesian Centre for Heart Disease, Curie-Sklodowskiej Str 9, 41-800 Zabrze, Poland
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK and Institute of Health Informatics, University College of London, London, UK
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Yoshihide Takahashi
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Santiago Nava
- Head of Electrocardiology Department, Instituto Nacional de Cardiologia 'Ignacio Chavez', Mexico
| | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - Taya V Glotzer
- Hackensack Meridian-Seton Hall School of Medicine, Rutgers New Jersey Medical School; Director of Cardiac Research, Hackensack University Medical Center, Hackensack, USA
| | - Mario Martins Oliveira
- Hospital Santa Marta, Department of Cardiology, Rua Santa Marta, 1167-024 Lisbon, Portugal
| |
Collapse
|
207
|
Reissmann B, Breithardt G, Camm AJ, Van Gelder IC, Metzner A, Kirchhof P. The RACE to the EAST. In pursuit of rhythm control therapy for atrial fibrillation-a dedication to Harry Crijns. Europace 2021; 23:ii34-ii39. [PMID: 33837756 DOI: 10.1093/europace/euab023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Indexed: 11/12/2022] Open
Abstract
The RACE trial was one of the first landmark trials to establish whether restoring and maintaining sinus rhythm could reduce morbidity and mortality in patients with atrial fibrillation (AF). Its neutral outcome shaped clinical decision-making for almost 20 years. However, there were two important treatment-related factors associated with mortality of rhythm control therapy at that time: One was safety of antiarrhythmic drug therapy, and the other one withdrawal of anticoagulation after restoration of sinus rhythm. Both concerns have been overcome, and, moreover, important knowledge considering the importance of time for the treatment of AF has been gained. These insights led to the concept of the EAST-AFNET 4 trial, and after more than two decades in the pursuit of ongoing therapeutic improvement, early rhythm control therapy has demonstrated to reduce a composite of cardiovascular death, stroke, and hospitalization for worsening of HF or acute coronary syndrome, by 21% (first primary outcome, absolute reduction 1.1 per 100 patient-years). For this entire period, Harry Crijns characterized the treatment of AF patients, and contributed decisively to realizing the benefit of rhythm control therapy. It is almost easier to list the clinical trials without Harry's involvement than to list those which he co-designed and led.
Collapse
Affiliation(s)
- Bruno Reissmann
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Günter Breithardt
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany
| | - A John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Institute, St George's University of London, London, UK
| | - Isabelle C Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andreas Metzner
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Germany
| |
Collapse
|
208
|
Escobar C, Camm AJ. Changing paradigms: from prevention of thromboembolic events to improved survival in patients with atrial fibrillation. Europace 2021; 23:837-843. [PMID: 33221894 DOI: 10.1093/europace/euaa324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation is associated with a five-fold increase in the risk of stroke. Current guidelines recommend the use of the CHA2DS2-VASc score to stratify the risk of stroke. In addition, guidelines recommend the identification of the conditions that increase the risk of haemorrhage to be modified and thus decrease the risk of bleeding. Nevertheless, many patients with a high thromboembolic risk are prescribed antiplatelet treatment or do not receive any antithrombotic therapy. In addition, therapeutic inertia is common in anticoagulated patients taking vitamin K antagonists, and underdosing is an emerging problem with direct oral anticoagulants, probably because many physicians consider the risk of stroke and the risk of major bleeding to be equal. It is necessary to develop a new approach to risk stratification, an approach that moves from morbidity to mortality, i.e., from stratification of the risk of stroke and major bleeding to stratification of the risk of mortality associated with stroke and the risk of mortality associated with bleeding. In this article, we propose a novel risk stratification approach based on the mortality associated with stroke and bleeding, illustrated by data derived from the literature.
Collapse
Affiliation(s)
- Carlos Escobar
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - A John Camm
- Cardiovascular Clinical Academic Group, St. George's University of London, London, UK
| |
Collapse
|
209
|
Táborský M, Dušek L, Kautzner J, Vícha M, Aiglová R, Gloger V, Fedorco M, Duba J, Dušek L, Jarkovský J, Bezděková M, Skála T. SETAP: epidemiology and prevention of stroke and transient ischaemic attack in Czech patients with atrial fibrillation. Europace 2021; 23:539-547. [PMID: 33305813 DOI: 10.1093/europace/euaa261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/04/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of this study is to analyse the prevalence, epidemiology, and anticoagulation prevention of stroke or transient ischaemic attack (TIA) in Czech patients with atrial fibrillation (AF). METHODS AND RESULTS Retrospective observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed Healthcare Services between 2015 and 2018. Prevalence of AF in 2018 was 4.3% of Czech population and the prevalence of stroke/TIA in AF patients was 22.3% with annual incidence of 181.62 cases per 100 000 inhabitants. In 2018, CHA2DS2-ASc score ≥4 was present in 98% AF patients in secondary and 59% in primary prevention, respectively, while the anticoagulation treatment was used by 71-81% of them. Between 2015 and 2018, the percentage of AF patients treated with warfarin monotherapy in primary prevention decreased from 35% to 31%, with acetylsalicylic acid (ASA) monotherapy from 18% to 16% and non-vitamin K antagonist oral anticoagulants (NOACs) monotherapy increased from 7% to 11%. In secondary prevention, the percentage of warfarin monotherapy treatment decreased from 35% to 32%, with ASA monotherapy from 20% to 18% and with NOACs monotherapy increased from 9% to 15%. CONCLUSION This study followed all Czech patients with AF. The unadjusted prevalence and incidence of AF was higher compared with other countries and 2019 European Society of Cardiology Statistics. The study identified several gaps in standard of reimbursed care. 20-30% of AF patients with other risk factors were without any prevention medication and the share of ASA monotherapy in treated patients was 16-18%.
Collapse
Affiliation(s)
- Miloš Táborský
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc 775 20, Czech Republic
| | - Ladislav Dušek
- Institute of Health Information and Statistics of the Czech Republic, Palackého nám. 4, Praha 2 128 01, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine - IKEM, Vídeňská 1958, Praha 4 140 21, Czech Republic
| | - Marek Vícha
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc 775 20, Czech Republic
| | - Renata Aiglová
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc 775 20, Czech Republic
| | - Vít Gloger
- Baťa Regional Hospital, Havlíčkovo nábř. 600, Zlín 762 75, Czech Republic
| | - Marián Fedorco
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc 775 20, Czech Republic
| | - Jaroslav Duba
- OAKS Consulting, Nad Rybníkem 90, Praha 9 190 12, Czech Republic
| | - Lukáš Dušek
- OAKS Consulting, Nad Rybníkem 90, Praha 9 190 12, Czech Republic
| | - Jiří Jarkovský
- Institut biostatistiky a analýz Lékařské fakulty Masarykovy univerzity, Kamenice, 126, Bohunice 625 00, Czech Republic
| | - Monika Bezděková
- Institute of Health Information and Statistics of the Czech Republic, Palackého nám. 4, Praha 2 128 01, Czech Republic
| | - Tomáš Skála
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc 775 20, Czech Republic
| |
Collapse
|
210
|
Seewöster T, Kosich F, Sommer P, Bertagnolli L, Hindricks G, Kornej J. Prediction of low-voltage areas using modified APPLE score. Europace 2021; 23:575-580. [PMID: 33279992 DOI: 10.1093/europace/euaa311] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS The presence of low-voltage areas (LVAs) in patients with atrial fibrillation (AF) reflects left atrial (LA) electroanatomical substrate, which is essential for individualized AF management. However, echocardiographic anteroposterior LA diameter included into previous LVAs prediction scores does not mirror LA size accurately and impaired left ventricular ejection fraction (LV-EF) is not directly associated with atrial myopathy. Therefore, we aimed to compare a modified (m)APPLE score, which included LA volume (LAV) and LA emptying fraction (LA-EF) with the regular APPLE score for the prediction of LVAs. METHODS AND RESULTS In patients undergoing first AF catheter ablation, LVAs were determined peri-interventionally using high-density maps and defined as signal amplitude <0.5 mV. All patients underwent cardiovascular magnetic resonance imaging before intervention. The APPLE (one point for Age ≥ 65 years, Persistent AF, imPaired eGFR ≤ 60 mL/min/1.73 m2, LA diameter ≥ 43 mm, and LVEF < 50%) and (m)APPLE (last two variables changed by LAV ≥ 39 mL/m2, and LA-EF < 31%) scores were calculated at baseline. The study population included 219 patients [median age 65 (interquartile range 57-72) years, 41% females, 59% persistent AF, 25% LVAs]. Both scores were significantly associated with LVAs [OR 1.817, 95% CI 1.376-2.399 for APPLE and 2.288, 95% CI 1.650-3.172 for (m)APPLE]. Using receiver operating characteristic curves analysis, the (m)APPLE score [area under the curve (AUC) 0.779, 95% CI 0.702-0.855] showed better LVAs prediction than the APPLE score (AUC 0.704, 95% CI 0.623-0.784), however, without statistically significant difference (P = 0.233). CONCLUSION The modified (m)APPLE score demonstrated good prognostic value for LVAs prediction and was comparable with the regular APPLE score.
Collapse
Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Falco Kosich
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Jelena Kornej
- School of Medicine-Cardiovascular Medicine, Boston University, 72 E Concord Street, Boston, MA 02118, USA
| |
Collapse
|
211
|
Koh KT, Law WC, Zaw WM, Foo DHP, Tan CT, Steven A, Samuel D, Fam TL, Chai CH, Wong ZS, Xaviar S, Bhavnani CD, Tan JSH, Oon YY, Said A, Fong AYY, Ong TK. Smartphone electrocardiogram for detecting atrial fibrillation after a cerebral ischaemic event: a multicentre randomized controlled trial. Europace 2021; 23:1016-1023. [PMID: 33782701 DOI: 10.1093/europace/euab036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is a preventable cause of ischaemic stroke but it is often undiagnosed and undertreated. The utility of smartphone electrocardiogram (ECG) for the detection of AF after ischaemic stroke is unknown. The aim of this study is to determine the diagnostic yield of 30-day smartphone ECG recording compared with 24-h Holter monitoring for detecting AF ≥30 s. METHODS AND RESULTS In this multicentre, open-label study, we randomly assigned 203 participants to undergo one additional 24-h Holter monitoring (control group, n = 98) vs. 30-day smartphone ECG monitoring (intervention group, n = 105) using KardiaMobile (AliveCor®, Mountain View, CA, USA). Major inclusion criteria included age ≥55 years old, without known AF, and ischaemic stroke or transient ischaemic attack (TIA) within the preceding 12 months. Baseline characteristics were similar between the two groups. The index event was ischaemic stroke in 88.5% in the intervention group and 88.8% in the control group (P = 0.852). AF lasting ≥30 s was detected in 10 of 105 patients in the intervention group and 2 of 98 patients in the control group (9.5% vs. 2.0%; absolute difference 7.5%; P = 0.024). The number needed to screen to detect one AF was 13. After the 30-day smartphone monitoring, there was a significantly higher proportion of patients on oral anticoagulation therapy at 3 months compared with baseline in the intervention group (9.5% vs. 0%, P = 0.002). CONCLUSIONS Among patients ≥55 years of age with a recent cryptogenic stroke or TIA, 30-day smartphone ECG recording significantly improved the detection of AF when compared with the standard repeat 24-h Holter monitoring.
Collapse
Affiliation(s)
- Keng Tat Koh
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Wan Chung Law
- Department of Medicine, Neurology Unit, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Win Moe Zaw
- Department of Medicine, Neurology Unit, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Diana Hui Ping Foo
- Clinical Research Centre, Institute for Clinical Research, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Chen Ting Tan
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Anderson Steven
- Department of Medicine, Neurology Unit, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Desmond Samuel
- Department of Medicine, Miri Hospital, Jalan Cahaya, 98000 Miri, Sarawak, Malaysia
| | - Tem Lom Fam
- Department of Medicine, Miri Hospital, Jalan Cahaya, 98000 Miri, Sarawak, Malaysia
| | - Ching Hua Chai
- Department of Medicine, Miri Hospital, Jalan Cahaya, 98000 Miri, Sarawak, Malaysia
| | - Zhai Sing Wong
- Department of Medicine, Miri Hospital, Jalan Cahaya, 98000 Miri, Sarawak, Malaysia
| | - Sivaraj Xaviar
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Chandan Deepak Bhavnani
- Department of Medicine, Bintulu Hospital, Jalan Bukit Nyabau, 97000 Bintulu, Sarawak, Malaysia
| | - Jason Seng Hong Tan
- Department of Medicine, Bintulu Hospital, Jalan Bukit Nyabau, 97000 Bintulu, Sarawak, Malaysia
| | - Yen Yee Oon
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Asri Said
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia.,Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Alan Yean Yip Fong
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia.,Clinical Research Centre, Institute for Clinical Research, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| |
Collapse
|
212
|
Kim M, Yu HT, Kim J, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Atrial fibrillation and the risk of ischaemic strokes or intracranial haemorrhages: comparisons of the catheter ablation, medical therapy, and non-atrial fibrillation population. Europace 2021; 23:529-538. [PMID: 33045047 DOI: 10.1093/europace/euaa235] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/14/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Although atrial fibrillation (AF) catheter ablation (AFCA) is an effective rhythm control strategy, there is limited data on whether ischaemic stroke (IS) or intracranial haemorrhage (ICH) decreases after AFCA compared with medical therapy or non-AF population. We explored the IS and ICH risk after AFCA or medical therapy in the AF population and matched non-AF population. METHODS AND RESULTS We compared 1629 patients with AFCA (Yonsei AF ablation cohort), 3258 with medical therapy [Korean National Health Insurance (NHIS) database], and 3258 non-AF subjects (NHIS database) following a 1:2:2 propensity score matching. All AFCA patients underwent regular rhythm follow-ups for 51 ± 29 months. Among the AFCA group, the incidence rate ratio (IRR) of ISs was significantly higher in patients with sustained AF recurrences after the last ablation (0.87%) than in those remaining in sinus rhythm (0.24%, P = 0.017; log rank P = 0.003). The IRR of ISs was significantly higher in the medical therapy (1.09%) than AFCA (0.30%, P < 0.001, log rank P < 0.001 vs. medical therapy) or non-AF groups (0.34%, P < 0.001, log rank P < 0.001 vs. medical therapy; P = 0.673, log rank P = 0.874 vs. AFCA). The IRR of ICHs was 0.17% in the medical therapy, 0.06% in the AFCA (P = 0.023, log rank P = 0.042 vs. medical therapy), and 0.12% in the non-AF group (P = 0.226, log rank P = 0.241 vs. medical therapy; P = 0.172, log rank P = 0.193 vs. AFCA). CONCLUSION Post-procedural AF control influences the risk of ISs. Atrial fibrillation catheter ablation significantly reduces the risk of both ISs and ICHs to the extent of the non-AF population compared to the medical therapy.
Collapse
Affiliation(s)
- Min Kim
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - JongYoun Kim
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Moon-Hyoung Lee
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| |
Collapse
|
213
|
Inoue K, Hikoso S, Masuda M, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Tanaka N, Oka T, Okada M, Kanda T, Matsuda Y, Kawasaki M, Hayashi K, Kitamura T, Dohi T, Sunaga A, Mizuno H, Nakatani D, Sakata Y. Pulmonary vein isolation alone vs. more extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: the EARNEST-PVI trial. Europace 2021; 23:565-574. [PMID: 33200213 DOI: 10.1093/europace/euaa293] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/12/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Previous studies could not demonstrate any benefit of more intensive ablation in addition to pulmonary vein isolation (PVI) including complex fractionated atrial electrogram (CFAE) and linear ablation for recurrence in the initial catheter ablation of persistent atrial fibrillation (AF). This study aimed to establish the non-inferiority of PVI alone to PVI plus these additional ablation strategies. METHODS AND RESULTS Patients with persistent AF who underwent an initial catheter ablation (n = 512, long-standing persistent AF; 128 cases) were randomly assigned in a 1:1 ratio to either PVI alone (PVI-alone group) or PVI plus CFAE and/or linear ablation (PVI-plus group). After excluding 15 cases who did not receive procedures, we analysed 249 and 248 patients, respectively. The primary endpoint was recurrence of AF, atrial flutter, and/or atrial tachycardia, and the non-inferior margin was set at a hazard ratio of 1.43. In the PVI-plus group, 85.1% of patients had linear ablation and 15.3% CFAE ablation. After 12 months, freedom from the primary endpoint occurred in 71.3% of patients in the PVI-alone group and in 78.3% in the PVI-plus group [hazard ratio = 1.56 (95% confidence interval: 1.10-2.24), non-inferior P = 0.3062]. The procedure-related complication rates were 2.0% in the PVI-alone group and 3.6% in the PVI-plus group (P = 0.199). CONCLUSION This randomized trial did not establish the non-inferiority of PVI alone to PVI plus linear ablation or CFAE ablation in patients with persistent AF, but implied that the PVI plus strategy was promising to improve the clinical efficacy (NCT03514693).
Collapse
Affiliation(s)
- Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Shungo Hikoso
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Masaharu Masuda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshio Furukawa
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Akio Hirata
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yasuyuki Egami
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | - Hitoshi Minamiguchi
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Miwa Miyoshi
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Takafumi Oka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Masato Okada
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Takashi Kanda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasuhiro Matsuda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masato Kawasaki
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Kenichi Hayashi
- Department of Cardiology, Osaka Hospital, Japan Community Healthcare Organization, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoharu Dohi
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Akihiro Sunaga
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Hiroya Mizuno
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Daisaku Nakatani
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Yasushi Sakata
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
| | | |
Collapse
|
214
|
Mullens W, Auricchio A, Martens P, Witte K, Cowie MR, Delgado V, Dickstein K, Linde C, Vernooy K, Leyva F, Bauersachs J, Israel CW, Lund LH, Donal E, Boriani G, Jaarsma T, Berruezo A, Traykov V, Yousef Z, Kalarus Z, Nielsen JC, Steffel J, Vardas P, Coats A, Seferovic P, Edvardsen T, Heidbuchel H, Ruschitzka F, Leclercq C. Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care. Europace 2021; 23:1324-1342. [PMID: 34037728 DOI: 10.1093/europace/euaa411] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post-implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains: (i) overcoming CRT under-utilization, (ii) better understanding of pre-implant characteristics, (iii) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (iv) implementing a dedicated post-implant CRT care pathway.
Collapse
Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium
- University Hasselt, Hasselt, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Pieter Martens
- Ziekenhuis Oost Limburg, Genk, Belgium
- University Hasselt, Hasselt, Belgium
| | - Klaus Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), London, UK
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten W Israel
- Department of Medicine - Cardiology, Diabetology and Nephrology, Bethel-Clinic, Bielefeld, Germany
| | - Lars H Lund
- Department of Medicine Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Erwan Donal
- Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1, Rennes, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiny Jaarsma
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | | | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales & Cardiff University, Cardiff, UK
| | - Zbigniew Kalarus
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Jan Steffel
- UniversitätsSpital Zürich, Zürich, Switzerland
| | - Panos Vardas
- Heart Sector, Hygeia Hospitals Group, Athens, Greece
| | | | - Petar Seferovic
- Faculty of Medicine, Serbian Academy of Science and Arts, Belgrade University, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | - Christophe Leclercq
- Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1, Rennes, France
| |
Collapse
|
215
|
Benini Tapias J, Flores-Umanzor E, Cepas-Guillén PL, Regueiro A, Sanchís L, Broseta JJ, Cases A, Freixa X. Prognostic impact of the presence of chronic kidney disease on percutaneous left trial appendage closure for atrial fibrillation: A single center experience. Nefrologia 2021; 42:S0211-6995(21)00130-2. [PMID: 34362613 DOI: 10.1016/j.nefro.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Percutaneous left atrial appendage closure (LAAC) has been proposed as an alternative to anticoagulation therapy in patients with nonvalvular atrial fibrillation to decrease the thromboembolic risk, while avoiding the risks of chronic anticoagulation. This option may be attractive in patients with nonvalvular atrial fibrillation and chronic kidney disease (CKD), since they exhibit both high-thromboembolic and bleeding risks. OBJECTIVE To evaluate the prognostic impact of the presence of CKD in patients with atrial fibrillation undergoing LAAC peri-procedure and during the follow-up as compared with patients with preserved renal function. METHODS Retrospective, observational study that included 124 consecutive patients with atrial fibrillation undergoing LAAC in a university hospital, and the results were evaluated according to the baseline renal function of the patients. RESULTS The median age was 75.5 years (IQR 67.6-80) and 62.1% were men, the median of CHA2DS2-Vasc and HASBLED scores was 4 (IQR 3-4) for both scores. Up to 57.3% of the total sample had CKD. Baseline characteristics were similar between groups, but CKD patients were older and had a higher HASBLED score. During the procedure, no thromboembolic, bleeding events, or deaths were observed. Combining the time of hospitalization and follow-up, no significant differences were observed between groups in the annual rate of thromboembolic events (0.97/100 patient-years [100PY] vs. 4.06/100PY, p=.09), but there was a higher rate of bleeding events (5.67/100PY vs. 13.3/100PY, p=.033) and mortality among CKD patients (6.50/100PY vs. 17.2/100PY, p=.009), with an odds ratio of 2.711 (95% CI 1.96-6.95). In the multivariate analysis, a preserved eGFR was independently associated with a lower mortality risk. CONCLUSIONS LAAC is a valid alternative to oral anticoagulation in patients with CKD and atrial fibrillation, with a low-rate of peri- and post-procedure complications, although CKD patients exhibited a higher risk of bleeding and mortality during the follow-up. However, these higher rates may not be necessarily related to the procedure.
Collapse
Affiliation(s)
| | | | | | - Ander Regueiro
- Servicio de Cardiología, Hospital Clinic, Barcelona, España
| | - Laura Sanchís
- Servicio de Cardiología, Hospital Clinic, Barcelona, España
| | - José Jesús Broseta
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Universitat de Barcelona, Barcelona, España
| | - Aleix Cases
- Departament de Medicina, Universitat de Barcelona, Barcelona, España.
| | - Xavier Freixa
- Servicio de Cardiología, Hospital Clinic, Barcelona, España
| |
Collapse
|
216
|
Paquette M, Fadahunsi O, Wang M, Healey JS, Parkash R, Quayyum S, Khan M, Nieuwlaat R. Systematic review of treatment gaps in oral anticoagulant use in atrial fibrillation. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
217
|
Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
218
|
Onishi N, Kaitani K, Nakagawa Y, Inoue K, Kobori A, Nakazawa Y, Ozawa T, Kurotobi T, Morishima I, Miura F, Watanabe T, Masuda M, Naito M, Fujimoto H, Nishida T, Furukawa Y, Shirayama T, Tanaka M, Okajima K, Yao T, Egami Y, Satomi K, Noda T, Miyamoto K, Haruna T, Higashi Y, Ito M, Horie M, Kusano KF, Shimizu W, Kamakura S, Shimizu Y, Hanazawa K, Tamura T, Izumi C, Morimoto T, Kimura T, Shizuta S. The association between late-phase early recurrence within the blanking period after atrial fibrillation catheter ablation and long-term recurrence: Insights from a large-scale multicenter study. Int J Cardiol 2021; 341:39-45. [PMID: 34343532 DOI: 10.1016/j.ijcard.2021.07.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between the timing of the first early recurrence and late recurrence after a single catheter ablation procedure for atrial fibrillation is controversial. METHODS The Efficacy of Short-Term Use of Antiarrhythmic Drugs After Catheter Ablation for Atrial Fibrillation trial followed 2038 patients who underwent radiofrequency catheter ablation for atrial fibrillation. RESULTS Of the patients, 907 (45%) had early recurrences within 90 days after the initial ablation. We divided these patients into two groups according to the timing of the first early recurrence episode, namely the ER1 group (early recurrence during the early phase; 0-30 days, n = 814) and ER2 group (early recurrence during the late phase; 31-90 days, n = 93). Three years after ablation, patients with early recurrences had a significantly lower event-free rate from late recurrences after a 90-day blanking period than patients without early recurrences (36.2% and 74.2%, respectively; log-rank, P < 0.0001). Three years after ablation, the event-free rate was significantly higher in the ER1 than the ER2 group (38.3% and 17.1%, respectively; log-rank, P < 0.0001). Moreover, the event-free rate at 3 years in the ER2 group was extremely low (5.6%) in patient with non-paroxysmal atrial fibrillation. CONCLUSION Early recurrences were strongly associated with late recurrences, especially in patients with the first recurrence episode at >1 month within the blanking period after a single ablation procedure. Therefore, these patients should undergo close observation during follow-up, when they had especially with non-paroxysmal atrial fibrillation.
Collapse
Affiliation(s)
- Naoaki Onishi
- Division of Cardiology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Japan; Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan
| | - Kazuaki Kaitani
- Division of Cardiology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Japan; Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan.
| | - Yoshihisa Nakagawa
- Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan; Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka 530-0001, Japan; Division of Cardiology, National Hospital Organization Osaka Medical Center, Osaka 540-0006, Japan
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Yuko Nakazawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Tomoya Ozawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Toshiya Kurotobi
- Cardiovascular Center, Namba Kurotobi Heart Clinic, Osaka 542-0076, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki 503-8502, Japan
| | - Fumiharu Miura
- Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Masaharu Masuda
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki 660-8511, Japan
| | - Masaki Naito
- Cardiovascular Center, Naito Hospital, Osaka 537-0002, Japan
| | - Hajime Fujimoto
- Department of Cardiovascular Medicine, Nara Prefecture Western Medical Center, Nara 636-0802, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8522, Japan
| | - Yoshio Furukawa
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya 494-0001, Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman 523-0082, Japan
| | - Mariko Tanaka
- Department of Cardiology, JCHO Kobe Central Hospital, Kobe 651-1145, Japan
| | - Katsunori Okajima
- Department of Cardiology, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Takenori Yao
- Faculty of Human Sciences, Osaka University of Economics, Osaka 533-8533, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka 591-8025, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Takashi Noda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Koji Miyamoto
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Tetsuya Haruna
- Cardiovascular Center, Tazuke Medical Research Institute Kitano Hospital, Osaka 530-8480, Japan
| | - Yukei Higashi
- Department of Cardiovascular Medicine, Okamura Memorial Hospital, Shizuoka 411-0904, Japan
| | - Makoto Ito
- Cardiovascular Center, Ito Medical Clinic, Kusatsu 525-0037, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Kengo F Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan
| | - Shiro Kamakura
- Department of Cardiology, Mahoshi Hospital, Kobe 651-1242, Japan
| | - Yukiko Shimizu
- Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan; Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki 660-8550, Japan
| | - Koji Hanazawa
- Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan; Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama 640-8558, Japan
| | | | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan; Division of Heart Failure, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | | |
Collapse
|
219
|
Rillig A, Magnussen C, Ozga AK, Suling A, Brandes A, Breithardt G, Camm AJ, Crijns HJGM, Eckardt L, Elvan A, Goette A, Gulizia M, Haegeli L, Heidbuchel H, Kuck KH, Ng A, Szumowski L, van Gelder I, Wegscheider K, Kirchhof P. Early Rhythm Control Therapy in Patients with Atrial Fibrillation and Heart Failure. Circulation 2021; 144:845-858. [PMID: 34328366 PMCID: PMC8456351 DOI: 10.1161/circulationaha.121.056323] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Even on optimal therapy, many patients with heart failure and atrial fibrillation experience cardiovascular complications. Additional treatments are needed to reduce these events, especially in patients with heart failure and preserved left ventricular ejection fraction.
Collapse
Affiliation(s)
- Andreas Rillig
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Anna Suling
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Günter Breithardt
- Atrial Fibrillation Network (AFNET), Münster, Germany; Department of Cardiology II (Electrophysiology), University Hospital Münster, Germany
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, UK
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Netherlands
| | - Lars Eckardt
- Atrial Fibrillation Network (AFNET), Münster, Germany; Department of Cardiology II (Electrophysiology), University Hospital Münster, Germany
| | - Arif Elvan
- Isala Hospital and Diagram Research, Zwolle, The Netherlands
| | - Andreas Goette
- Atrial Fibrillation Network (AFNET), Münster, Germany; St. Vincenz Hospital, Paderborn, Germany; Working Group of Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | | | - Laurent Haegeli
- University Hospital Zurich, Zurich, Switzerland; Division of Cardiology, Medical University Department, Kantonsspital Aarau, Switzerland
| | - Hein Heidbuchel
- University Hospital Antwerp and Antwerp University, Antwerp, Belgium
| | - Karl-Heinz Kuck
- German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany; Atrial Fibrillation Network (AFNET), Münster, Germany; LANS Cardio, Hamburg, Germany
| | - Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Lukasz Szumowski
- Arrhythmia Center of the National Institute of Cardiology; Medical Division of Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland
| | - Isabelle van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Karl Wegscheider
- German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany; Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany; Atrial Fibrillation Network (AFNET), Münster, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany; Atrial Fibrillation Network (AFNET), Münster, Germany; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
220
|
Analysis of the Correlation of Galectin-3 Concentration with the Measurements of Echocardiographic Parameters Assessing Left Atrial Remodeling and Function in Patients with Persistent Atrial Fibrillation. Biomolecules 2021; 11:biom11081108. [PMID: 34439775 PMCID: PMC8392221 DOI: 10.3390/biom11081108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022] Open
Abstract
Galectin-3 (gal-3) is a fibrosis marker and may play a role in fibrosis of the left atrium (LA). Left atrial wall fibrosis may influence the transition from paroxysmal to non-paroxysmal atrial fibrillation (AF). In this study, we assessed the correlation of gal-3 concentration with the main echocardio-graphic parameters evaluating dimensions, volume, compliance, and left atrial contractility during AF and after successful electrical cardioversion (DCCV). The study included 63 patients with left atrial enlargement who qualified for DCCV due to persistent AF. The procedure recovered sinus rhythm in 43 (68.3%) patients. The concentration of gal-3 was negatively correlated with the echocardiographic parameters of LA including dimensions (LA length pre, rho = −0.38; p = 0.003), volume (LAV pre, rho = −0.39; p = 0.003), compliance (LASr mean post, rho = −0.33) and contractility (pLASRct mean post, rho = −0.33; p = 0.038). Negative correlations of gal-3 concentration were also observed in relation to the volume and contractility of the left ventricle. The concentration of gal-3 significantly negatively correlates with the size, systolic function, and compliance of the LA wall in patients with persistent AF. Determining gal-3 concentration in patients with persistent AF may help in the assessment of remodeling of the LA wall.
Collapse
|
221
|
Mongkhon P, Fanning L, Wong KHTW, Man KKC, Wong ICK, Lau WCY. Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis. Europace 2021; 23:39-48. [PMID: 33085751 DOI: 10.1093/europace/euaa242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Comparative fracture risk for non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) among patients with atrial fibrillation (AF) remains unclear. This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs and fracture risk. METHODS AND RESULTS PubMed, EMBASE, and Cochrane Library were searched from 2010 to 26 May 2020. Observational studies investigating the association between NOACs vs. VKAs and fracture risk in patients with AF were included. The adjusted effect estimates were pooled using the DerSimonian-Laird random effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiological (MOOSE) guidelines were followed. Five observational studies comprising 269 922 patients and 4289 fractures were included. Non-vitamin K antagonist oral anticoagulants use was associated with a lower risk of any fractures compared to VKAs use, with moderate heterogeneity [pooled RR = 0.83, 95% confidence interval (CI): 0.75-0.92, P < 0.001, I2 = 73.0%]. When comparing individual NOAC to VKAs, a statistically significant lower risk of any fractures was found for rivaroxaban (pooled RR = 0.79, 95% CI: 0.71-0.88, P < 0.001, I2 = 55.2%) and apixaban (pooled RR = 0.75, 95% CI: 0.60-0.92, P = 0.007, I2 = 54.5%), but not dabigatran (pooled RR = 0.87, 95% CI: 0.74-1.01, P = 0.061, I2 = 74.6%). No differences were observed in all head-to-head comparisons between NOACs. CONCLUSION This large meta-analysis suggests that NOACs use was associated with a lower risk of fractures compared with VKAs. Fracture risks were similar between NOACs. These findings may help inform the optimal anticoagulant choice for patients with AF at high risk of fracture.
Collapse
Affiliation(s)
- Pajaree Mongkhon
- Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Faculty of Pharmacy, Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
| | - Laura Fanning
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.,Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK
| | - Kirstie H T W Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.,Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, UK
| |
Collapse
|
222
|
König S, Svetlosak M, Grabowski M, Duncker D, Nagy VK, Bogdan S, Vanduynhoven P, Sohaib SMA, Malaczynska-Raipold K, Lane DA, Lenarczyk R, Bollmann A, Hindricks G, Potpara TS, Kosiuk J. Utilization and perception of same-day discharge in electrophysiological procedures and device implantations: an EHRA survey. Europace 2021; 23:149-156. [PMID: 33503658 DOI: 10.1093/europace/euaa301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
The aim of this European Heart Rhythm Association (EHRA) survey was to assess the utilization of same-day discharge (SDD) in electrophysiology (EP). An online-based questionnaire was shared with the EHRA community between 12 and 30 June 2020 and recorded institutional information, complication assessment, recent experiences, and opinions regarding possible advantages or concerns with SDD. In total, 218 responses from 49 countries provided information on current SDD management. Overall, SDD was implemented in 77.5%, whereas this proportion was significantly higher in tertiary and high-volume centres (83.8% and 85.3%, both P < 0.01). The concept of SDD was most commonly used following implantations of cardiac event recorders (97%), diagnostic EP procedures (72.2%), and implantations of pacemakers with one or two intracardiac leads (50%), while the lowest SDD utilization was observed after catheter ablations of left atrial or ventricular arrhythmias. Within SDD-experienced centres, ∼90% respondents stated that this discharge concept is recommendable or highly recommendable and reported that rates of increased rehospitalization and complication rates were low. Most respondents assumed a better utilization of hospital resources (78.2%), better cost effectiveness (77.3%), and an improved patients' comfort but were concerned about possible impairment of detection (72.5%) and management (78.7%) of late complications. In conclusion, >75% of respondents already implement SDD following EP interventions with a large heterogeneity with regard to specific procedures. Further research is needed to confirm or disprove existing and expected benefits and obstacles.
Collapse
Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Martin Svetlosak
- Department for Arrhythmias and Cardiostimulation, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Marcin Grabowski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Hannover Heart Rhythm Center, Hannover, Germany
| | - Vivien K Nagy
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Stefan Bogdan
- Clinical Emergency Hospital of Bucharest, Clinical Electrophysiology and Pacing Laboratory, Bucharest, Romania
| | | | | | | | - Deirdre A Lane
- University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Radoslaw Lenarczyk
- Department of Cardiology Congenital Heart Disease and Electrotherapy, Silesian Medical University, Zabrze, Poland
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Jedrzej Kosiuk
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,Department of Cardiology, Helios Hospital Köthen, Köthen, Germany
| |
Collapse
|
223
|
Hohnloser SH, Camm AJ, Cappato R, Diener HC, Heidbüchel H, Mont L, Morillo CA, Lanz HJ, Rauer H, Reimitz PE, Smolnik R, Kautzner J. Periprocedural anticoagulation in the uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation (ELIMINATE-AF) trial. Europace 2021; 23:65-72. [PMID: 33249467 PMCID: PMC7842090 DOI: 10.1093/europace/euaa199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/19/2020] [Indexed: 11/15/2022] Open
Abstract
Aims This post hoc analysis of ELIMINATE-AF evaluated requirements of unfractionated heparin (UFH) and procedure-related bleeding in atrial fibrillation (AF) patients undergoing ablation with uninterrupted edoxaban or vitamin K antagonist (VKA) therapy. Methods and results Patients were randomized 2:1 to once-daily edoxaban 60 mg (or dose-reduced 30 mg) or dose-adjusted VKA (target international normalized ratio: 2.0–3.0). Uninterrupted anticoagulation was mandated for 21–28 days’ pre-ablation and 90 days’ post-ablation. During ablation, UFH administration targeted an activated clotting time (ACT) of 300–400 s. Periprocedural bleeding was differentiated between procedure-related (bleeding at puncture side, cardiac tamponade) and unrelated events. Of 614 randomized patients, 553 received study drug and underwent catheter ablation (edoxaban n = 375; VKA n = 178). The median (Q1–Q3) time from last dose to ablation procedure was 14.8 (13.3–16.5) vs. 16.5 (14.8–19.5) h (edoxaban vs. VKA group, respectively). Mean ACT (SD) ≥300 s was observed in 52% edoxaban- vs. 76% VKA-treated patients, despite a higher mean (SD) UFH dose in the edoxaban vs. VKA group [14 261 (6397) IU vs. 11 473 (4300) IU; exploratory P-value < 0.0001]. In the edoxaban group, 13 patients (3.5%) had procedure-related bleeds of whom 9 had received an UFH dose above the median (13 000 IU). In the VKA arm, 7 patients (3.9%) had procedure-related bleeds of whom 3 had received an UFH dose above the median (10 225 IU). Conclusion The rate of procedure-related major/clinically relevant non-major bleeding did not differ between the treatment arms despite higher doses of UFH used with edoxaban vs. VKA to achieve a target ACT during AF ablation.
Collapse
Affiliation(s)
- Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - A John Camm
- Department of Cardiology, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, Blackshaw Road, London SW17 0QT, UK
| | - Riccardo Cappato
- Department of Cardiovascular Diseases, Arrhythmia and Electrophysiology Research Center, Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano, Milan 20089, Italy
| | | | - Hein Heidbüchel
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Lluís Mont
- Department of Cardiology, Cardiovascular CIBER, Hospital Clinic, University of Barcelona, Carrer de Villarroel 170, 08003 Barcelona, Spain
| | - Carlos A Morillo
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Hans-Joachim Lanz
- Department of Global Medical Affairs, Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 München, Germany
| | - Heiko Rauer
- Department of Global Medical Affairs, Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 München, Germany
| | - Paul-Egbert Reimitz
- Department of Biostatistics & Data Management, Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 München, Germany
| | - Rüdiger Smolnik
- Department of Global Medical Affairs, Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 München, Germany
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
| |
Collapse
|
224
|
Rottner L, Nodorp M, Jessica W, Schleberger R, Sinning C, Lemoine M, Dinshaw L, Münkler P, Lin T, Meyer C, Reissmann B, Metzner A, Rillig A. High anatomical accuracy of a novel high-resolution wide-band dielectric imaging system in cryoballoon-based ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1504-1515. [PMID: 34289168 DOI: 10.1111/pace.14324] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/29/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Recently, a novel cardiac imaging system based on a wide-band dielectric technology (KODEX-EPD) was introduced to guide catheter ablation. The aim of the study was to evaluate this 3D wide-band dielectric imaging system (WDIS) during cryoballoon (CB)-based atrial fibrillation (AF) ablation focusing on accuracy of pulmonary vein (PV)-anatomy. METHODS In consecutive patients with symptomatic AF, CB-based ablation was performed in conjunction with the 3D WDIS. Selective PV-angiographies were performed, and 3D anatomy of the left atrium (LA) and PVs using the 3D WDIS was created. The ostial diameters of the ipsilateral right-sided and left-sided PVs and ostial diameters of the right-/left-sided upper/lower PVs demonstrated by selective angiographies were analyzed and compared to 3D WDIS-based PV visualization. RESULTS In 65 patients (42/65 (65%) male, age 65 ± 9 years, 29/65 (45%) paroxysmal AF) a total of 260 PVs were identified. Median ostial PV-diameters for the ipsilateral left- and right-sided PVs were 38 [34; 43] and 37 [34; 40.3] mm when assessed fluoroscopically and 40 [35.7; 43] and 39 [35.0; 43] mm as demonstrated by 3D WDIS. There was no statistically significant difference between both methods regarding PV-diameter measurements. KODEX-EPD overestimated fluoroscopy measurements by 1.08 mm (95% limits of agreement of -1.93 mm and 4.1 mm). CONCLUSION The novel wide-band dielectric 3D-imaging system is feasible to create high-resolution images of cardiac structures during CB ablation procedures and accurately visualizes PV-anatomy.
Collapse
Affiliation(s)
- Laura Rottner
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Milena Nodorp
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Weimann Jessica
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Ruben Schleberger
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Sinning
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lemoine
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Lin
- Department of Cardiology, Genesiscare, Melbourne, Australia
| | - Christian Meyer
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Bruno Reissmann
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, Universitäres Herz- und Gefäßzentrum Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
225
|
Rabinstein AA, Yost MD, Faust L, Kashou AH, Latif OS, Graff-Radford J, Attia IZ, Yao X, Noseworthy PA, Friedman PA. Artificial Intelligence-Enabled ECG to Identify Silent Atrial Fibrillation in Embolic Stroke of Unknown Source. J Stroke Cerebrovasc Dis 2021; 30:105998. [PMID: 34303963 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105998] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Embolic strokes of unknown source (ESUS) are common and often suspected to be caused by unrecognized paroxysmal atrial fibrillation (AF). An AI-enabled ECG (AI-ECG) during sinus rhythm has been shown to identify patients with unrecognized AF. We pursued this study to determine if the AI-ECG model differentiates between patients with ESUS and those with known causes of stroke, and to evaluate whether the AF prediction by AI-ECG among patients with ESUS was associated with the results of prolonged ambulatory cardiac rhythm monitoring. MATERIALS AND METHODS We reviewed consecutive patients admitted with acute ischemic stroke to a comprehensive stroke center between January 2018 and August 2019 and employed the TOAST classification to categorize the mechanisms of ischemia. Use and results of ambulatory cardiac rhythm monitoring after discharge were gathered. We ran the AI-ECG model to obtain AF probabilities from all ECGs acquired during the hospitalization and compared those probabilities in patients with ESUS versus those with known stroke causes (apart from AF), and between patients with and without AF detected by ambulatory cardiac rhythm monitoring. RESULTS The study cohort had 930 patients, including 263 patients (28.3%) with known AF or AF diagnosed during the index hospitalization and 265 cases (28.5%) categorized as ESUS. Ambulatory cardiac rhythm monitoring was performed in 226 (85.3%) patients with ESUS. AF probability by AI-ECG was not associated with ESUS. However, among patients with ESUS, the probability of AF by AI-ECG was associated with a higher likelihood of AF detection by ambulatory monitoring (P = 0.004). A probability of AF by AI-ECG greater than 0.20 was associated with AF detection by ambulatory cardiac rhythm monitoring with an OR of 5.47 (95% CI 1.51-22.51). CONCLUSIONS AI-ECG may help guide the use of prolonged ambulatory cardiac rhythm monitoring in patients with ESUS to identify those who might benefit from anticoagulation.
Collapse
Affiliation(s)
| | - Micah D Yost
- Neurology, Mayo Clinic, 200 First Street SW, Mayo W8B, Rochester, MN 55905, USA.
| | - Louis Faust
- Health Science Research, Mayo Clinic, Rochester, MN 55905, USA; Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | - Omar S Latif
- Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | - Xiaoxi Yao
- Health Science Research, Mayo Clinic, Rochester, MN 55905, USA.
| | | | - Paul A Friedman
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
| |
Collapse
|
226
|
CHA 2DS 2-VASc and HAS-BLED scores are not associated with cardiac defibrillators therapies. COR ET VASA 2021. [DOI: 10.33678/cor.2021.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
227
|
Wintgens LIS, Klaver MN, Maarse M, Spitzer SG, Langbein A, Swaans MJ, Van Dijk VF, Balt JC, Wijffels MCEF, Tijssen JGP, Elvan A, Boersma LVA. Efficacy and safety of the GOLD FORCE multicentre randomized clinical trial: multielectrode phased radiofrequency vs. irrigated radiofrequency single-tip catheter with contact force ablation for treatment of symptomatic paroxysmal atrial fibrillation. Europace 2021; 23:1931-1938. [PMID: 34279627 DOI: 10.1093/europace/euab168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/15/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Pulmonary vein isolation (PVI) for atrial fibrillation (AF) has become increasingly safe and effective with the evolution of single-tip ablation catheters aided by contact force sensing (ST-CF) and single-shot devices such as the second-generation pulmonary vein ablation catheter (PVAC) Gold multi-electrode array. The multicentre randomized GOLD FORCE trial was conducted to evaluate non-inferiority of safety and efficacy of PVAC Gold PVI compared to ST-CF ablation for paroxysmal AF. METHODS AND RESULTS The primary efficacy endpoint documented AF recurrence ≥30 s was assessed by time-to-first-event analysis after a 90-day blanking period using repeated 7-day Holters. Secondary endpoints include acute success and procedural characteristics. Safety endpoints included procedural complications, stroke/transient ischaemic attack (TIA), tamponade, bleeding, and access site complications. Two hundred and eight patients underwent randomization and PVI (103 assigned to PVAC Gold, 105 to ST-CF). Acute success rates were 95% and 97% for PVAC Gold and ST-CF, respectively. At 12 months, AF recurrence was observed in 46.6% of the PVAC Gold group and in 26.2% of the ST-CF group [absolute efficacy difference 20.4% (95% confidence interval, CI 7.5-33.2%), hazard ratio 2.05 (95% CI 1.28-3.29), P = 0.003]. PVAC Gold had significantly shorter procedure and ablation times. Complication rates were 5.7% and 4.9% for PVAC Gold and ST-CF, respectively (P = 0.782). CONCLUSION In this multicentre randomized clinical trial, ablation with ST-CF and PVAC Gold ablation catheters non-inferiority for efficacy was not met. AF recurrence was significantly more frequent in the PVAC Gold group compared to single-tip contact force group. Both groups had similarly low rates of adverse events. PVAC Gold ablation had significantly shorter procedure and ablation times.
Collapse
Affiliation(s)
- Lisette I S Wintgens
- St. Antonius Hospital, Department of Cardiology , Koekoekslaan 1, 3435 Nieuwegein, the Netherlands
| | - Martijn N Klaver
- St. Antonius Hospital, Department of Cardiology , Koekoekslaan 1, 3435 Nieuwegein, the Netherlands
| | - Moniek Maarse
- St. Antonius Hospital, Department of Cardiology , Koekoekslaan 1, 3435 Nieuwegein, the Netherlands
| | - Stefan G Spitzer
- Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Department of Cardiology, Dresden, Germany.,Brandenburg University of Technology Cottbus-Senftenberg, Institute of Medical Technology, Department of Cardiology, Cottbus, Germany
| | - Anke Langbein
- Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Department of Cardiology, Dresden, Germany
| | - Martin J Swaans
- St. Antonius Hospital, Department of Cardiology , Koekoekslaan 1, 3435 Nieuwegein, the Netherlands
| | - Vincent F Van Dijk
- St. Antonius Hospital, Department of Cardiology , Koekoekslaan 1, 3435 Nieuwegein, the Netherlands
| | - Jippe C Balt
- St. Antonius Hospital, Department of Cardiology , Koekoekslaan 1, 3435 Nieuwegein, the Netherlands
| | - Maurits C E F Wijffels
- St. Antonius Hospital, Department of Cardiology , Koekoekslaan 1, 3435 Nieuwegein, the Netherlands
| | - Jan G P Tijssen
- Amsterdam UMC, Department of Cardiology, Amsterdam, the Netherlands
| | - Arif Elvan
- Isala Clinics, Department of Cardiology, Zwolle, the Netherlands
| | - Lucas V A Boersma
- St. Antonius Hospital, Department of Cardiology , Koekoekslaan 1, 3435 Nieuwegein, the Netherlands.,Amsterdam UMC, Department of Cardiology, Amsterdam, the Netherlands
| |
Collapse
|
228
|
Hornestam B, Adiels M, Wai Giang K, Hansson PO, Björck L, Rosengren A. Atrial fibrillation and risk of venous thromboembolism: a Swedish Nationwide Registry Study. Europace 2021; 23:1913-1921. [PMID: 34279622 DOI: 10.1093/europace/euab180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/30/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is associated with arterial thromboembolism, mainly ischaemic stroke, while venous thromboembolism (VTE) in AF is less well studied. The aim of this study, therefore, was to examine the relationship between AF and VTE, including pulmonary embolism (PE) and deep venous thrombosis (DVT). METHODS AND RESULTS AF cases without previous VTE, ischaemic stroke or pulmonary arterial hypertension were identified from the Swedish Inpatient Registry between 1987 and 2013 and compared to two population controls per case without AF matched for age, sex, and county with respect to the incidence of VTE, PE, and DVT. In total, 463 244 AF cases were compared to 887 336 population controls. In both men and women, VTE rates were higher among AF patients the first 30 days after an AF diagnosis [40.2 vs. 5.7 in men and 55.7 vs. 6.6 in women per 1000 person-years at risk, respectively; hazard ratios 6.64 (95% confidence interval, 5.74-7.69) and 7.56 (6.47-8.83)]; and then decreasing, simultaneously with an increasing number of AF patients being treated with oral anticoagulation. VTE risk was similar to controls after 9 months in men but remained slightly elevated in women. CONCLUSION AF is strongly associated with an increased risk of VTE during the first months after diagnosis. Introduction of anticoagulant therapy soon after AF diagnosis might reduce the risk of VTE as well as of ischaemic stroke.
Collapse
Affiliation(s)
- Björn Hornestam
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Public Health and Community Medicine, Health Metrics Unit, Gothenburg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| |
Collapse
|
229
|
Abstract
PURPOSE OF REVIEW During the last decade, several case series and small reports have indicated that pulmonary vein isolation (PVI) in combination with renal denervation (RDN) may increase the rate of atrial fibrillation (AF) freedom in patients with hypertension. We aimed to provide a contemporary systematic overview on the techniques, and the efficacy/safety of RDN on AF recurrence, and the current landscape of ongoing investigation. RECENT FINDINGS The recent Evaluate Renal Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial has demonstrated convincingly that among patients with paroxysmal AF and poorly controlled (but not "resistant") hypertension, RDN added to catheter ablation, compared with catheter ablation alone, significantly increased the likelihood of freedom from AF at 12 months. RDN has proven to be a unique, effective and safe interventional therapy for the management of AF. Future investigation will likely focus on confirming current findings; expanding the population of eligible patients (eg., non-hypertensives, well controlled hypertensives); determining long-term maintenance of effect and therapeutics.
Collapse
Affiliation(s)
- Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester School of Medicine and Dentistry, 85 Woodland Road, Short Hills, NJ, 07078, USA
| | - Jonathan S Steinberg
- Clinical Cardiovascular Research Center, University of Rochester School of Medicine and Dentistry, 85 Woodland Road, Short Hills, NJ, 07078, USA.
| |
Collapse
|
230
|
Sanjoy S, Choi YH, Holmes D, Herrman H, Terre J, Alraies C, Ando T, Tzemos N, Mamas M, Bagur R. Comorbidity burden in patients undergoing left atrial appendage closure. Heart 2021; 107:1246-1253. [PMID: 33229360 DOI: 10.1136/heartjnl-2020-317741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the risk of in-hospital complications after left atrial appendage closure (LAAC) in relationship with comorbidity burden. METHODS Cohort-based observational study using the US National Inpatient Sample database, 1 October 2015 to 31 December 2017. The main outcome of interest was the occurrence of in-hospital major adverse events (MAE) defined as the composite of bleeding complications, acute kidney injury, vascular complications, cardiac complications and postprocedural stroke. Comorbidity burden and thromboembolic risk were assessed by the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Score (ECS) and CHA2DS2-VASc score. MAE were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The associations of comorbidity with in-hospital MAE were evaluated using logistic regression models. RESULTS A total of 3294 hospitalisations were identified, among these, the mean age was 75.7±8.2 years, 60% were male and 86% whites. The mean CHA2DS2-VASc score was 4.3±1.5 and 29.5% of the patients had previous stroke or transient ischaemic attack. The mean CCI and ECS were 2.2±1.9 and 9.7±5.8, respectively. The overall composite rate of in-hospital MAE after LAAC was 4.6%. Females and non-whites had about 1.5 higher odds of in-hospital AEs as well participants with higher CCI (adjusted OR (aOR): 1.19, 95% CI: 1.13 to 1.24, p<0.001), ECS (aOR: 1.06, 95% CI: 1.05 to 1.08, p<0.001) and CHA2DS2-VASc score (aOR: 1.08, 95% CI: 1.02 to 1.15, p=0.01) were significantly associated with in-hospital MAE. CONCLUSION In this large cohort of LAAC patients, the majority of them had significant comorbidity burden. In-hospital MAE occurred in 4.6% and female patients, non-whites and those with higher burden of comorbidities were at higher risk of in-hospital MAE after LAAC.
Collapse
Affiliation(s)
- Shubrandu Sanjoy
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - David Holmes
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Howard Herrman
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Juan Terre
- Division of Cardiology, Albert Einstein College of Medicine, New York, New York, USA
| | - Chadi Alraies
- Division of Cardiology, Wayne State University, Detroit, Michigan, USA
| | - Tomo Ando
- Division of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Nikolaos Tzemos
- Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University; London Health Sciences Centre, London, Ontario, Canada
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University; London Health Sciences Centre, London, Ontario, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| |
Collapse
|
231
|
Fluoroscopy and contrast media use in cryoballoon ablation of atrial fibrillation using a novel imaging system. Heart Vessels 2021; 37:115-120. [PMID: 34240266 DOI: 10.1007/s00380-021-01902-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
Pulmonary vein (PV) isolation using cryoballoon (CB) catheter is generally characterized by a high radiation and contrast media exposure. A new dielectric imaging system (KODEX-EPD imaging system) allows pulmonary vein (PV) occlusion assessment without dye use. The purpose of this study was to verify the feasibility of reducing the radiation and dye use during CB ablation in patients with atrial fibrillation (AF) using the new dielectric imaging system. In a retrospective, single center study, we enrolled 34 consecutive patients with paroxysmal AF divided in two groups: 17 patients in Conventional Group underwent the procedure under fluoroscopy guidance before the new system introduction, while 17 patient in KODEX-EPD Group underwent the procedure under fluoroscopy and KODEX-EPD imaging system guidance. There were no differences in any clinical and anatomical characteristics between the two study groups. Overall procedure time was comparable between the two groups (69 [IQR 63-98] min in Conventional Group vs. 65 [IQR 58-74] min in KODEX-EPD Group, p = 0.16), while fluoroscopy time (8 [IQR 5-9] min vs. 11 [IQR 9-12] min, p = 0.014) and dye use (35 [IQR 28-45] ml vs. 70 [IQR 57-83] ml, p < 0.001) were significantly lower in the KODEX-EPD Group. No 30-day complications were observed. At 12-month follow-up 7/37 (19%) patients had an atrial arrhythmias recurrence, without any difference between the two study groups (17.6% vs. 23.5%, p = 0.68). The use of a new dielectric imaging system allowed a significantly reduction in radiation exposure and dye use during CB ablation in patients with AF.
Collapse
|
232
|
Delesie M, Desteghe L, Bertels M, Gerets N, Van Belleghem F, Meyvis J, Elegeert I, Dendale P, Heidbuchel H. Motivation of overweight patients with atrial fibrillation to lose weight or to follow a weight loss management program: a cross-sectional study. Acta Cardiol 2021; 76:494-503. [PMID: 33228467 DOI: 10.1080/00015385.2020.1848274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS Overweight increases the risk of recurrence and progression of atrial fibrillation (AF). This study assesses the knowledge of overweight AF patients about the relation between their weight and AF, to gauge their motivation losing weight and/or following weight reduction programs. METHODS A multicenter cross-sectional descriptive study was performed at three Belgian hospitals. A validated self-developed questionnaire was presented to AF patients with a body mass index (BMI) >27 kg/m2 and it addressed: motivation to reduce weight and its related factors; knowledge about the relation between weight and AF; and interest in weight reduction programs. RESULTS One hundred and forty-three patients completed the questionnaire. 75.5% was currently motivated to reduce weight. Multivariate regression analysis showed that a higher BMI, a college/university degree, male gender, without hypertension, previous weight loss attempt(s) and living with a partner, were significantly associated with greater motivation for weight reduction. Only 69.9% of the patients was aware of the positive effect of weight reduction on the progression of AF. A completely home-based/telerehabilitation program was the preferred approach for 57.9% of the patients. CONCLUSIONS AF patients with overweight need to be better informed about overweight as a risk factor for AF. Female AF patients with a lower degree of education, hypertension, living alone, who have never attempted to reduce weight and with a lower but still elevated BMI need more external motivation to lose weight. A tailored weight reduction program (home-based) is the preferred option for patients. This will require further development and validation of telecoaching programs for this patient group.
Collapse
Affiliation(s)
- Michiel Delesie
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marianne Bertels
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Noor Gerets
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Jasper Meyvis
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Ivan Elegeert
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| |
Collapse
|
233
|
Chiou WR, Huang CC, Lin PL, Chuang JY, Liu LYM, Su MI, Liao FC, Chen CY, Kuo JY, Tsai CT, Wu YJ, Lee YH. Safety and Effectiveness of Rivaroxaban in Combination with Various Antiarrhythmic Drugs in Patients with Non-Permanent Atrial Fibrillation. Am J Cardiovasc Drugs 2021; 21:459-469. [PMID: 33369716 DOI: 10.1007/s40256-020-00454-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Rivaroxaban reduces the risk of thromboembolism in atrial fibrillation (AF) patients, who often also receive antiarrhythmic drugs (AADs) to maintain sinus rhythm. Current guidelines contraindicate concomitant use of rivaroxaban with the popular AAD dronedarone, despite little data demonstrating interactions with AADs. This study investigates the outcomes of concomitant rivaroxaban and AAD drug use in a real-world cohort. METHODS This retrospective study included 1777 non-permanent AF patients taking rivaroxaban for ≥ 1 month between 2011 and 2016 from a multicenter cohort in Taiwan, and compared concomitant AAD use against clinical outcome endpoints for safety, effectiveness, and major adverse cardiac events (MACE). Multivariate Cox proportional hazard analyses were used to evaluate the association between concomitant AAD use and outcomes. RESULTS Patients were divided into rivaroxaban alone (n = 1205) and with concomitant amiodarone (n = 177), dronedarone (n = 231), or propafenone (n = 164) groups. The proportion of patients using rivaroxaban 10 mg was highest in the concomitant dronedarone group: rivaroxaban alone, 53.6%; with amiodarone, 57.6%; with dronedarone, 77.1%; and with propafenone, 46.3% (p < 0.001). The cumulative incidences of safety (p = 0.892), effectiveness (p = 0.336), and MACE (p = 0.674) were similar between the four groups; however, there were significantly fewer new systemic thromboembolisms in the dronedarone group: rivaroxaban alone, 2.5%; with amiodarone, 0.6%; with dronedarone, 0%; and with propafenone, 1.2% (p = 0.029). The all-cause death rate was also lowest in the dronedarone group: rivaroxaban alone, 9.0%; with amiodarone, 9.6%; with dronedarone, 3.0%; and with propafenone: 6.1% (p = 0.013). After covariate adjustment, there were no differences in the safety, effectiveness, and MACE endpoints between patients receiving or not receiving AADs. CONCLUSION Concomitant use of rivaroxaban with AADs appears to be well tolerated, warranting further investigation into the apparent benefits of a reduced dose of rivaroxaban combined with dronedarone.
Collapse
|
234
|
Sanjoy SS, Choi YH, Sparrow RT, Baron SJ, Abbott JD, Azzalini L, Holmes DR, Alraies MC, Tzemos N, Ayan D, Mamas MA, Bagur R. Sex Differences in Outcomes Following Left Atrial Appendage Closure. Mayo Clin Proc 2021; 96:1845-1860. [PMID: 34218859 DOI: 10.1016/j.mayocp.2020.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effects of female sex on in-hospital outcomes and to provide estimates for sex-specific prediction models of adverse outcomes following left atrial appendage closure (LAAC). PATIENTS AND METHODS Cohort-based observational study querying the National Inpatient Sample database between October 1, 2015, and December 31, 2017. Demographics, baseline characteristics, and comorbidities were assessed with the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index score (ECS), and CHA2DS2-VASc score. The primary outcome was in-hospital major adverse events (MAEs) defined as the composite of bleeding, vascular, cardiac complications, post-procedural stroke, and acute kidney injury. The associations of the CCI, ECS, and CHA2DS2-VASc score with in-hospital MAE were examined using logistic regression models for women and men, respectively. RESULTS A total of 3294 hospitalizations were identified, of which 1313 (40%) involved women and 1981 (60%) involved men. Women were older (76.3±7.7 vs 75.2±8.4 years, P<.001), had a higher CHA2DS2-VASc score (4.9±1.4 vs 3.9±1.4, P<.001) but showed lower CCI and ECS compared with men (2.1±1.9 vs 2.3±1.9, P=.01; and 9.3±5.9 vs 9.9±5.7, P=.002, respectively). The primary composite outcome occurred in 4.6% of patients and was higher in women compared with men (women 5.6% vs men 4.0%, P=.04), and this was mainly driven by the occurrence of cardiac complications (2.4% vs 1.2%, P=.01). In women, older age, higher median income, and higher CCI (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.21 to 1.44; P<.001), ECS (aOR, 1.04; 95% CI, 1.02 to 1.07; P=.002), and CHA2DS2-VASc score (aOR, 1.24; 95% CI, 1.10 to 1.39; P<.001) were associated with increased risk of in-hospital MAE. In men, non-White race/ethnicity, lower median income, and higher ECS (aOR, 1.06; 95% CI, 1.04 to 1.09; P<.001) were associated with increased risk of in-hospital MAE. CONCLUSION Women had higher rates of in-hospital adverse events following LAAC than men did. Women with older age and higher median income, CCI, ECS, and CHA2DS2-VASc scores were associated with in-hospital adverse events, whereas men with non-White race/ethnicity, lower median income, and higher ECS were more likely to experience adverse events. Further research is warranted to identify sex-specific, racial/ethnic, and socioeconomic pathways during the patient selection process to minimize complications in patients undergoing LAAC.
Collapse
Affiliation(s)
- Shubrandu S Sanjoy
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | | | - J Dawn Abbott
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - M Chadi Alraies
- Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | | | - Diana Ayan
- London Health Science Centre, London, ON, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; London Health Science Centre, London, ON, Canada; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom.
| |
Collapse
|
235
|
Osca Asensi J, Izquierdo de Francisco MT, Cano Pérez Ó, Sancho Tello de Carranza MJ, Alberola Rubio J, Planells Palop C, Lozano Vidal JV, Martínez Dolz L. The RITHMI study: diagnostic ability of a heart rhythm monitor for automatic detection of atrial fibrillation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:602-607. [PMID: 32792313 DOI: 10.1016/j.rec.2020.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Early detection of atrial fibrillation (AF) is a priority to reduce embolic events by initiating oral anticoagulation therapy. The aim of this study was to evaluate the diagnostic ability of a wrist device designed for automatic AF detection. METHODS RITHMI is a prospective, comparative, observational study that included 167 patients referred to a cardiology outpatient clinic for a general consultation or for electrical cardioversion. The study evaluated the ability of a wrist monitor that uses a photoplethysmography (PPG) signal and an electrocardiographic lead to automatically detect AF compared with diagnosis established by 2 cardiologists using the 12-lead electrocardiogram. RESULTS The AF detection algorithm based on the PPG signal had a sensitivity of 91% and a specificity of 96% (diagnostic accuracy: 93%). The automatic algorithm based on the electrocardiographic signal had a sensitivity of 94% and a specificity of 96% (diagnostic accuracy: 95%). The 2 algorithms concurred in the diagnosis in 96% of the cases. Overall, the monitor had a sensitivity and specificity of 95% (diagnostic accuracy: 95% and Kappa index: 0.98). CONCLUSIONS This study shows that automatic AF detection through the use of a heart rhythm monitor incorporating sensors and algorithms that analyze the PPG signal and the electrocardiographic signal corresponding to lead I is feasible and has high diagnostic accuracy.
Collapse
Affiliation(s)
- Joaquín Osca Asensi
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | - Óscar Cano Pérez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - José Alberola Rubio
- Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Luis Martínez Dolz
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| |
Collapse
|
236
|
Zeljkovic I, Brusich S, Scherr D, Velagic V, Traykov V, Pernat A, Anic A, Szavits Nossan J, Jan M, Bakotic Z, Pezo Nikolic B, Radeljic V, Bojko A, Benko I, Manola S, Pavlovic N. Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy. Clin Cardiol 2021; 44:1177-1182. [PMID: 34196416 PMCID: PMC8364723 DOI: 10.1002/clc.23681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 02/05/2023] Open
Abstract
Background Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between bleeding and thromboembolic risk. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) with target value >300 s, and there are no guidelines specifying an initial unfractionated heparin (UFH) dose. Methods We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. We conducted an international, multi‐center, registry‐based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analyzed. Before transseptal puncture, UFH bolus of 100 IU/kg was administered regardless of the anticoagulation drug. Results Total of 873 patients were included (median age 61 years, IQR 53–66; female 30%). There were 248, 248, 189, 188 patients on warfarin, dabigatran, rivaroxaban, and apixaban, respectively. Mean initial ACT was 257 ± 50 s, mean overall ACT 295 ± 45 s and total UFH dose 158 ± 60 IU/kg. Patients who were receiving warfarin and dabigatran compared to patients receiving rivaroxaban and apixaban had: (i) significantly higher initial ACT values (262 ± 57 and 270 ± 48 vs. 248 ± 42 and 241 ± 44 s, p < .001), (ii) significantly higher ACT throughout PVI (309 ± 46 and 306 ± 44 vs. 282 ± 37 and 272 ± 42 s, p < .001), and (iii) needed lower UFH dose during PVI (140 ± 39 and 157 ± 71 vs. 171 ± 52 and 172 ± 70 IU/kg). Conclusion There are significant differences in ACT values and UFH dose during PVI in patients receiving different anticoagulants. Patients on warfarin and dabigatran had higher initial and overall ACT values and needed lower UFH dose to achieve adequate anticoagulation during PVI than patients on rivaroxaban and apixaban.
Collapse
Affiliation(s)
- Ivan Zeljkovic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sandro Brusich
- Department of Cardiology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Daniel Scherr
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Vedran Velagic
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Andrej Pernat
- Department of Cardiology, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Ante Anic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | | | - Matevz Jan
- Department of Cardiac Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Zoran Bakotic
- Department of Cardiology, General Hospital Zadar, Zadar, Croatia
| | - Borka Pezo Nikolic
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vjekoslav Radeljic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ana Bojko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivica Benko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Sime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Pavlovic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| |
Collapse
|
237
|
Estudio RITHMI, capacidad diagnóstica de un monitor de ritmo cardiaco para la detección automática de fibrilación auricular. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
238
|
Gach O, Pierard LA. Atrial fibrillation, diabetes and anticoagulation with direct oral anticoagulants: time to reconsider duration of the disease to evaluate the bleeding risk? Acta Cardiol 2021; 76:461-463. [PMID: 33435835 DOI: 10.1080/00015385.2020.1870194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Atrial fibrillation and diabetes: time to reconsider duration of the disease to evaluate the bleeding risk? Impact of diabetes status in patients suffering of non-valvular atrial fibrillation requiring anticoagulation have been analysed previously and risk/benefit balance of NOACs have been confirmed in these patients. The implication of that pathology in the evaluation of the thrombotic risk is discussed but more importantly bleeding risk in this growing population is analysed, perhaps neglected until now.
Collapse
Affiliation(s)
- Olivier Gach
- Université de Liège. Service de Cardiologie, CHC MontLégia, Liège, Belgium
| | - Luc A. Pierard
- Faculté de Médecine. Département des sciences cliniques, Université de Liège, Liège, Belgium
| |
Collapse
|
239
|
Conduction Disorders during Sinus Rhythm in Relation to Atrial Fibrillation Persistence. J Clin Med 2021; 10:jcm10132846. [PMID: 34199081 PMCID: PMC8269325 DOI: 10.3390/jcm10132846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/25/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
Classification of atrial fibrillation (AF) is currently based on clinical characteristics. However, classifying AF using an objective electrophysiological parameter would be more desirable. The aim of this study was to quantify parameters of atrial conduction during sinus rhythm (SR) using an intra-operative high-resolution epicardial mapping approach and to relate these parameters to clinical classifications of AF. Patients were divided according to the standard clinical classification and spontaneous termination of AF episodes. The HATCH score, a score predictive of AF progression, was calculated, and surface ECGs were evaluated for signs of interatrial block. Conduction disorders mainly differed at Bachmann’s bundle (BB). Activation time (AT) at BB was longer in persistent AF patients (AT-BB: 75 (53–92) ms vs. 55 (40–76) ms, p = 0.017), patients without spontaneous termination of AF episodes (AT-BB: 53.5 (39.6–75.8) ms vs. 72.0 (49.6–80.8) ms, p = 0.009) and in patients with a P-wave duration ≥ 120 ms (64.3 (52.3–93.0) ms vs. 50.5 (39.6–56.6) ms, p = 0.014). HATCH scores also correlated positively to AT-BB (rho 0.326, p = 0.029). However, discriminatory values of electrophysiological parameters, as calculated using ROC-curves, were limited. These results may reflect shortcomings of clinical classifications and further research is needed to establish an objective substrate-based classification of AF.
Collapse
|
240
|
van Marion DMS, Ramos KS, Lanters EAH, Bulte LBT, Bogers AJJC, de Groot NMS, Brundel BJJM. Atrial heat shock protein levels are associated with early postoperative and persistence of atrial fibrillation. Heart Rhythm 2021; 18:1790-1798. [PMID: 34186247 DOI: 10.1016/j.hrthm.2021.06.1194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early detection and staging of atrial fibrillation (AF) is of importance for clinical management. Serum (bio)markers, such as heat shock proteins (HSP), may enable AF staging and identify patients at risk for AF recurrence and postoperative AF (PoAF). OBJECTIVE This study evaluates the relation between serum and atrial tissue HSP levels, stages of AF, AF recurrence after treatment, and PoAF from patients undergoing cardiothoracic surgery. METHODS Patients without (control) and with paroxysmal, persistent (PerAF), or longstanding persistent (LSPerAF) AF were included. HSPB1, HSPA1, HSPB7, and HSPD1 levels were measured in serum obtained prior to and post intervention. HSPB1, HSPA1, HSPA5, HSPD1, HSPB5, and pHSF1 levels were measured in left and/or right atrial appendages (respectively, LAA and RAA). RESULTS In RAA, HSPA5 levels were significantly lower in LSPerAF and HSPD1 levels significantly higher in PerAF patients compared to controls. In RAA of controls who developed PoAF, HSPA1 and HSPA5 levels were significantly higher compared to those without PoAF. Also, HSPB1 RAA levels were lower and HSPA5 LAA levels higher in patients undergoing arrhythmia surgery who developed AF recurrence within 1 week after surgery compared to patients who did not. CONCLUSION HSPA5 RAA and HSPD1 RAA and LAA levels are altered in persistent stages of AF. RAA HSPA1 and HSPA5 levels associate with development of PoAF. Additionally, HSPB1 RAA and HSPA5 LAA levels can predict AF recurrence in patients who underwent arrhythmia surgery. Nevertheless, HSP levels in serum cannot discriminate AF stages from controls, nor predict PoAF or AF recurrence after treatment.
Collapse
Affiliation(s)
- Denise M S van Marion
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kennedy S Ramos
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Luciënne Baks-Te Bulte
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Bianca J J M Brundel
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands.
| |
Collapse
|
241
|
Himmelreich JCL, Veelers L, Lucassen WAM, Schnabel RB, Rienstra M, van Weert HCPM, Harskamp RE. Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis. Europace 2021; 22:684-694. [PMID: 32011689 PMCID: PMC7526764 DOI: 10.1093/europace/euaa005] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/06/2020] [Indexed: 01/06/2023] Open
Abstract
Aims Atrial fibrillation (AF) is a common arrhythmia associated with an increased stroke risk. The use of multivariable prediction models could result in more efficient primary AF screening by selecting at-risk individuals. We aimed to determine which model may be best suitable for increasing efficiency of future primary AF screening efforts. Methods and results We performed a systematic review on multivariable models derived, validated, and/or augmented for AF prediction in community cohorts using Pubmed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) through 1 August 2019. We performed meta-analysis of model discrimination with the summary C-statistic as the primary expression of associations using a random effects model. In case of high heterogeneity, we calculated a 95% prediction interval. We used the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist for risk of bias assessment. We included 27 studies with a total of 2 978 659 unique participants among 20 cohorts with mean age ranging from 42 to 76 years. We identified 21 risk models used for incident AF risk in community cohorts. Three models showed significant summary discrimination despite high heterogeneity: CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) [summary C-statistic 0.71; 95% confidence interval (95% CI) 0.66–0.76], FHS-AF (Framingham Heart Study risk score for AF) (summary C-statistic 0.70; 95% CI 0.64–0.76), and CHA2DS2-VASc (summary C-statistic 0.69; 95% CI 0.64–0.74). Of these, CHARGE-AF and FHS-AF had originally been derived for AF incidence prediction. Only CHARGE-AF, which comprises easily obtainable measurements and medical history elements, showed significant summary discrimination among cohorts that had applied a uniform (5-year) risk prediction window. Conclusion CHARGE-AF appeared most suitable for primary screening purposes in terms of performance and applicability in older community cohorts of predominantly European descent.
Collapse
Affiliation(s)
- Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Lieke Veelers
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg/German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Martinistrasse 52, 20246 Hamburg, Germany
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| |
Collapse
|
242
|
Zink MD, Chua W, Zeemering S, di Biase L, Antoni BDL, David C, Hindricks G, Haeusler KG, Al-Khalidi HR, Piccini JP, Mont L, Nielsen JC, Escobar LA, de Bono J, Van Gelder IC, de Potter T, Scherr D, Themistoclakis S, Todd D, Kirchhof P, Schotten U. Predictors of recurrence of atrial fibrillation within the first 3 months after ablation. Europace 2021; 22:1337-1344. [PMID: 32725107 PMCID: PMC7478316 DOI: 10.1093/europace/euaa132] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/19/2020] [Indexed: 11/23/2022] Open
Abstract
Aims Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50–70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. Methods and results We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA–AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93–2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20–2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26–2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00–1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). Conclusion Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF. Trial registration Clinicaltrials.gov identifier NCT02227550
Collapse
Affiliation(s)
- Matthias Daniel Zink
- Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Universiteitsingel 50, 6229 ER Maastricht, Netherlands
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Stef Zeemering
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Universiteitsingel 50, 6229 ER Maastricht, Netherlands
| | - Luigi di Biase
- Department of Medicine (Cardiology), Albert Einstein College of Medicine at Montefiore Hospital, Montefiore-Einstein Center for Heart & Vascular Care New York, NY, USA
| | - Bayes de Luna Antoni
- Autonomous University of Barcelona and Institut Català Ciències Cardiovasculars (ICCC)-St. Pau Hospital, Barcelona, Spain
| | - Callans David
- Cardiology Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Hussein R Al-Khalidi
- Department of Cardiac Electrophysiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Jonathan P Piccini
- Department of Cardiac Electrophysiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Lluís Mont
- Arrhythmia Section, Universitat de Barcelona, Hospital Clinic, Barcelona, Catalonia, Spain
| | | | - Luis Alberto Escobar
- Autonomous University of Barcelona and Institut Català Ciències Cardiovasculars (ICCC)-St. Pau Hospital, Barcelona, Spain
| | - Joseph de Bono
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Isabelle C Van Gelder
- Department of Cardiology and Thorax Surgery, UMCG Thorax Center, University of Groningen, Groningen, The Netherlands
| | - Tom de Potter
- Department of Cardiology, Electrophysiology section, Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | - Daniel Scherr
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Universiteitsingel 50, 6229 ER Maastricht, Netherlands.,Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Sakis Themistoclakis
- Unit of Electrophysiology and Cardiac Pacing, Dell'Angelo Hospital, Mestre-Venice, Italy
| | - Derick Todd
- Department of EP, Devices and ICC, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Universiteitsingel 50, 6229 ER Maastricht, Netherlands
| |
Collapse
|
243
|
Lillo-Castellano JM, González-Ferrer JJ, Marina-Breysse M, Martínez-Ferrer JB, Pérez-Álvarez L, Alzueta J, Martínez JG, Rodríguez A, Rodríguez-Pérez JC, Anguera I, Viñolas X, García-Alberola A, Quintanilla JG, Alfonso-Almazán JM, García J, Borrego L, Cañadas-Godoy V, Pérez-Castellano N, Pérez-Villacastín J, Jiménez-Díaz J, Jalife J, Filgueiras-Rama D. Personalized monitoring of electrical remodelling during atrial fibrillation progression via remote transmissions from implantable devices. Europace 2021; 22:704-715. [PMID: 31840163 PMCID: PMC7203636 DOI: 10.1093/europace/euz331] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022] Open
Abstract
Aims Atrial electrical remodelling (AER) is a transitional period associated with the progression and long-term maintenance of atrial fibrillation (AF). We aimed to study the progression of AER in individual patients with implantable devices and AF episodes. Methods and results Observational multicentre study (51 centres) including 4618 patients with implantable cardioverter-defibrillator +/−resynchronization therapy (ICD/CRT-D) and 352 patients (2 centres) with pacemakers (median follow-up: 3.4 years). Atrial activation rate (AAR) was quantified as the frequency of the dominant peak in the signal spectrum of AF episodes with atrial bipolar electrograms. Patients with complete progression of AER, from paroxysmal AF episodes to electrically remodelled persistent AF, were used to depict patient-specific AER slopes. A total of 34 712 AF tracings from 830 patients (87 with pacemakers) were suitable for the study. Complete progression of AER was documented in 216 patients (16 with pacemakers). Patients with persistent AF after completion of AER showed ∼30% faster AAR than patients with paroxysmal AF. The slope of AAR changes during AF progression revealed patient-specific patterns that correlated with the time-to-completion of AER (R2 = 0.85). Pacemaker patients were older than patients with ICD/CRT-Ds (78.3 vs. 67.2 year olds, respectively, P < 0.001) and had a shorter median time-to-completion of AER (24.9 vs. 93.5 days, respectively, P = 0.016). Remote transmissions in patients with ICD/CRT-D devices enabled the estimation of the time-to-completion of AER using the predicted slope of AAR changes from initiation to completion of electrical remodelling (R2 = 0.45). Conclusion The AF progression shows patient-specific patterns of AER, which can be estimated using available remote-monitoring technology.
Collapse
Affiliation(s)
- José María Lillo-Castellano
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Manuel Marina-Breysse
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Agencia Española de Protección de la Salud en el Deporte (AEPSAD), Madrid. Spain
| | | | - Luisa Pérez-Álvarez
- Department of Cardiology, Hospital Hospital Universitario de A Coruña, La Coruña, Spain
| | - Javier Alzueta
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan Gabriel Martínez
- Department of Cardiology, Hospital General Universitario de Alicante, ISABIAL-FISABIO, Alicante, Spain
| | - Aníbal Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Ignasi Anguera
- Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Xavier Viñolas
- Department of Cardiology, Hospital Santa Creu i san Pau, Barcelona, Spain
| | | | - Jorge G Quintanilla
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Manuel Alfonso-Almazán
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Javier García
- Department of Cardiology, Hospital Universitario de Getafe, Madrid, Spain
| | - Luis Borrego
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain
| | - Victoria Cañadas-Godoy
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Jiménez-Díaz
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - José Jalife
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiac Arrhythmia Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - David Filgueiras-Rama
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| |
Collapse
|
244
|
Schmidt B, Brugada J, Arbelo E, Laroche C, Bayramova S, Bertini M, Letsas KP, Pison L, Romanov A, Scherr D, Tilz RR, Maggioni A, Adragao P, Lund J, Haman L, Oliveira MM, Dagres N. Ablation strategies for different types of atrial fibrillation in Europe: results of the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term registry. Europace 2021; 22:558-566. [PMID: 31821488 DOI: 10.1093/europace/euz318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS The ESC EORP EHRA Atrial Fibrillation (AF) Ablation Long-Term registry was designed to assess management and outcomes of AF catheter ablation procedures in Europe. To investigate the current ablation approaches and their outcomes for patients with paroxymal AF (PAF) and non-PAF in Europe. METHODS AND RESULTS Data from index ablations were collected in 27 European countries at 104 centres in a prospective fashion. Pre-procedural, procedural, and 1-year follow-up data were captured on a web-based electronic case record form. Data on the ablation procedure were available for 3446 patients. Of these, 2513 patients and 933 patients underwent pulmonary vein isolation (PVI) or PVI plus (PVIplus) additional ablation, respectively. The ablation strategy was limited to PVI in 81% and 56% of patients in the PAF and non-PAF group, respectively (P < 0.001). In the non-PAF group, left atrial linear ablation and ablation of complex fragmented atrial electrograms were more commonly performed. Arrhythmias recurrence after PVI was 29% and 39% in the PAF and non-PAF group, respectively (P < 0.001) and 42% after PVIplus in both groups. Atrial fibrillation related hospital admissions were more common in the PVIplus group (20% vs. 14%). A very low procedural complication rate was observed. No relevant differences were observed with regard to repeat ablation (PVI 9% and PVIplus 11%). CONCLUSION In patients with PAF and non-PAF, the ablation strategies of PVI and PVIplus led to similar arrhythmia-free survival rates after 1 year. A considerable hospital readmission rate was noted.
Collapse
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Josep Brugada
- Pediatric Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Cécile Laroche
- EURObservational Research Programme, EORP, European Society of Cardiology, Sophia-Antipolis, France
| | - Sevda Bayramova
- E. Meshalkin National Medical Research Center» of the Ministry of Health of the Russian Federation, Rechkunovskaya, Novosibirsk, Russia
| | | | | | - Laurent Pison
- Cardiology, Ziekenhuis Oost Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Alexander Romanov
- E. Meshalkin National Medical Research Center» of the Ministry of Health of the Russian Federation, Rechkunovskaya, Novosibirsk, Russia
| | | | - Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Luebeck, Germany.,Department II. Med. Kardiologie, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Aldo Maggioni
- EURObservational Research Programme, EORP, European Society of Cardiology, Sophia-Antipolis, France.,ANMCO Research Center, Florence, Italy
| | | | - Juha Lund
- Turku University Hospital, Turku, Finland
| | - Ludek Haman
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | |
Collapse
|
245
|
Atar D, Berge E, Le Heuzey JY, Virdone S, Camm AJ, Steffel J, Gibbs H, Goldhaber SZ, Goto S, Kayani G, Misselwitz F, Stepinska J, Turpie AGG, Bassand JP, Kakkar AK. The association between patterns of atrial fibrillation, anticoagulation, and cardiovascular events. Europace 2021; 22:195-204. [PMID: 31747004 PMCID: PMC7005596 DOI: 10.1093/europace/euz292] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/07/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS Guidelines do not recommend to take pattern of atrial fibrillation (AF) into account for the indication of anticoagulation (AC). We assessed AF pattern and the risk of cardiovascular events during 2-years of follow-up. METHODS AND RESULTS We categorized AF as paroxysmal, persistent, or permanent in 29 181 patients enrolled (2010-15) in the Global Anticoagulant Registry In the FIELD of AF (GARFIELD-AF). We used multivariable Cox regression to assess the risks of stroke/systemic embolism (SE) and death across patterns of AF, and whether this changed with AC on outcomes. Atrial fibrillation pattern was paroxysmal in 14 344 (49.2%), persistent in 8064 (27.6%), and permanent 6773 (23.2%) patients. Median CHA2DS2-VASc, GARFIELD-AF, and HAS-BLED scores assessing the risk of stroke/SE and/or bleeding were similar across AF patterns, but the risk of death, as assessed by the GARFIELD-AF risk calculator, was higher in non-paroxysmal than in paroxysmal AF patterns. During 2-year follow-up, after adjustment, non-paroxysmal AF patterns were associated with significantly higher rates of all-cause death, stroke/SE, and new/worsening congestive heart failure (CHF) than paroxysmal AF in non-anticoagulated patients only. In anticoagulated patients, a significantly higher risk of death but not of stroke/SE and new/worsening CHF persisted in non-paroxysmal compared with paroxysmal AF patterns. CONCLUSION In non-anticoagulated patients, non-paroxysmal AF patterns were associated with higher risks of stroke/SE, new/worsening HF and death than paroxysmal AF. In anticoagulated patients, the risk of stroke/SE and new/worsening HF was similar across all AF patterns. Thus AF pattern is no longer prognostic for stroke/SE when patients are treated with anticoagulants. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
Collapse
Affiliation(s)
- Dan Atar
- Department of Cardiology, Oslo University Hospital, Kirkeveien 166, NO-0407 Oslo, Norway
- Department of Cardiology, Institute of Clinical Sciences, University of Oslo, Oslo, Norway
- Corresponding author. Tel: +47 22119100. E-mail address:
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital, Kirkeveien 166, NO-0407 Oslo, Norway
| | - Jean-Yves Le Heuzey
- Department of Cardiology, Georges Pompidou Hospital, René Descartes University, Paris, France
| | - Saverio Virdone
- Department of Clinical Research, Thrombosis Research Institute, London, UK
| | - A John Camm
- Department of Clinical Cardiology, St. George’s University of London, London, UK
| | - Jan Steffel
- Department of Cardiology, University Hospital, Zurich, CH, Switzerland
| | - Harry Gibbs
- Vascular Laboratory, The Alfred Hospital, Melbourne, Australia
| | - Samuel Z Goldhaber
- Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Shinya Goto
- Department of Medicine (Cardiology), Tokai University, Kanagawa, Japan
| | - Gloria Kayani
- Department of Clinical Research, Thrombosis Research Institute, London, UK
| | - Frank Misselwitz
- Therapeutic areas Thrombosis & Hematology, Bayer AG, Berlin, Germany
| | - Janina Stepinska
- Department of Intensive Cardiac Therapy, Institute of Cardiology, Warsaw, Poland
| | | | - Jean-Pierre Bassand
- Department of Clinical Research, Thrombosis Research Institute, London, UK
- Department of Cardiology, University of Besançon, France
| | - Ajay K Kakkar
- Department of Clinical Research, Thrombosis Research Institute, London, UK
- Department of Surgery, University College London, London, UK
| | | |
Collapse
|
246
|
Wu J, Alsaeed ES, Barrett J, Hall M, Cowan C, Gale CP. Prescription of oral anticoagulants and antiplatelets for stroke prophylaxis in atrial fibrillation: nationwide time series ecological analysis. Europace 2021; 22:1311-1319. [PMID: 32778878 DOI: 10.1093/europace/euaa126] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/27/2020] [Indexed: 02/05/2023] Open
Abstract
AIMS To investigate trends in the prescription of oral anticoagulants (OACs) and antiplatelet agents for atrial fibrillation (AF). METHODS AND RESULTS Prescription data for 450 518 patients with AF from 3352 General Practices in England, was obtained from the GRASP-AF registry, 2009-2018. Annualized temporal trends for OAC and antiplatelet prescription were reported according to eligibility based on stroke risk (CHADS2 or CHA2DS2-VASc scores ≥1 or >2, respectively). From 2009 to 2018, the prevalence of AF increased from 1.6% [95% confidence interval (CI) 1.5-1.7%] to 2.4% (2.3-2.5%), and for those with AF the proportion prescribed OAC increased from 47.6% to 75.0% (P-trend < 0.001; relative risk 1.57, 95% CI 1.55-1.60) and for antiplatelet decreased from 37.4% to 9.2% (P-trend < 0.001). In early-years (2009-2013), eligible patients aged ≥80 years were less likely to be prescribed OAC than patients aged <80 years [odds ratio (OR) 0.55, 95% CI 0.51-0.59 for CHADS2≥1 in 2009] (all P-trends < 0.001). This 'OAC prescription gap' reduced over the study period (OR 0.93, 0.90-0.96 in 2018). Whilst the prescription of direct oral anticoagulant (DOAC) as a proportion of all OAC increased from 0.1% (95% CI 0.0-0.2%) in 2011 to 58.8% (58.4-59.2%) in 2018, it was inversely associated with patient age (P-trend < 0.001) and their risk of stroke. CONCLUSION Between 2009 and 2018, in England, the use of OAC for stroke prophylaxis in AF increased, with DOAC accounting for over half of OAC uptake in 2018. Despite a reduction in the OAC-prescription gap, a new paradox exists relating to DOAC prescription for the elderly and those at higher risk of stroke.
Collapse
Affiliation(s)
- Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Eman S Alsaeed
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds LS2 9JT, UK
| | - James Barrett
- PRIMIS, Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Marlous Hall
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds LS2 9JT, UK
| | - Campbell Cowan
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds LS2 9JT, UK.,Department of Cardiology, Leeds General Infirmary, Leeds, UK
| |
Collapse
|
247
|
Atterman A, Friberg L, Asplund K, Engdahl J. Net benefit of oral anticoagulants in patients with atrial fibrillation and active cancer: a nationwide cohort study. Europace 2021; 22:58-65. [PMID: 31750897 DOI: 10.1093/europace/euz306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/08/2019] [Indexed: 12/24/2022] Open
Abstract
AIMS To estimate the net cerebrovascular benefit of prophylactic treatment with oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and active cancer. METHODS AND RESULTS We included all Swedish patients who had been diagnosed with AF in a hospital or in a hospital-associated outpatient unit between 1 July 2005 and 1 October 2017. Patients with active cancer (n = 22 596) and without cancer (n = 440 848) were propensity score matched for the likelihood of receiving OACs at baseline. At baseline, 38.3% of cancer patients with AF and high stroke risk according to CHA2DS2-VASc score received OACs. There was a net benefit of OACs, assessed by the composite outcome of ischaemic stroke, extracranial arterial thromboembolism, all major bleedings, and death, both among patients with active cancer [hazard ratio (HR): 0.81, confidence interval (CI): 0.78-0.85] and among patients without cancer (HR: 0.81, CI: 0.80-0.82). When limiting follow-up to 1 year to minimize the effects of possible treatment cross-over and additionally accounting for death as a competing risk in cancer patients, a net cerebrovascular benefit regarding ischaemic stroke or intracranial bleeding was observed for OACs [subhazard ratio (sHR): 0.67, CI: 0.55-0.83]. A net cerebrovascular benefit was also seen for non-vitamin K antagonist OACs over warfarin after competing risk analyses in cancer patients (sHR: 0.65, CI: 0.48-0.88). CONCLUSION Patients with AF and active cancer benefit from OAC treatment.
Collapse
Affiliation(s)
- Adriano Atterman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Mörbygårdsvägen, SE Stockholm, Sweden
| | | | - Kjell Asplund
- Department of Public Health and Clinical Medicine, Umeå University, SE Umeå, Sweden
| | - Johan Engdahl
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Mörbygårdsvägen, SE Stockholm, Sweden
| |
Collapse
|
248
|
Phillips KP, Romanov A, Artemenko S, Folkeringa RJ, Szili-Torok T, Senatore G, Stein KM, Razali O, Gordon N, Boersma LVA. Combining left atrial appendage closure and catheter ablation for atrial fibrillation: 2-year outcomes from a multinational registry. Europace 2021; 22:225-231. [PMID: 31665276 DOI: 10.1093/europace/euz286] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS Clinical practice guidelines do not recommend discontinuation of long-term oral anticoagulation in patients with a high stroke risk after catheter ablation for atrial fibrillation (AF). Left atrial appendage closure (LAAC) with Watchman has emerged as an alternative to long-term anticoagulation for patients accepting of the procedural risks. We report on the long-term outcomes of combining catheter ablation procedures for AF and LAAC from multicentre registries. METHODS AND RESULTS Data were pooled from two prospective, real-world Watchman LAAC registries running in parallel in Europe/Middle-East/Russia (EWOLUTION) and Asia/Australia (WASP) between 2013 and 2015. Of the 1140 patients, 142 subjects at 11 centres underwent a concomitant AF ablation and LAAC procedure. The mean CHA2DS2-VASc score was 3.4 ± 1.4 and HAS-BLED score 1.5 ± 0.9. Successful LAAC was achieved in 99.3% of patients. The 30-day device and/or procedure-related serious adverse event rate was 2.1%. After a mean follow-up time of 726 ± 91 days, 92% of patients remained off oral anticoagulation. The rates of the composite endpoint of ischaemic stroke/transient ischaemic attack/systemic thromboembolism were 1.09 per 100 patient-years (100-PY); and for non-procedural major bleeding were 1.09 per 100-PY. These represent relative reductions of 84% and 70% vs. expected rates per risk scores. CONCLUSION The long-term outcomes from these international, multicentre registries show efficacy for all-cause stroke prevention and a significant reduction in late bleeding events in a population of high stroke risk post-ablation patients who have been withdrawn from oral anticoagulation.
Collapse
Affiliation(s)
- Karen P Phillips
- Department of Cardiology, GenesisCare, Greenslopes Private Hospital, Suite 212 Ramsay Specialist Centre, Newdegate Street, Greenslopes, Brisbane 4120, Australia
| | - Aleksandr Romanov
- Department of Cardiology, E. Meshalkin National Medical Research Center of the Ministry of Health, Novosibirsk, Russian Federation
| | - Sergey Artemenko
- Department of Cardiology, E. Meshalkin National Medical Research Center of the Ministry of Health, Novosibirsk, Russian Federation
| | | | | | | | | | - Omar Razali
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | | | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| |
Collapse
|
249
|
Loring Z, Mehrotra S, Piccini JP, Camm J, Carlson D, Fonarow GC, Fox KAA, Peterson ED, Pieper K, Kakkar AK. Machine learning does not improve upon traditional regression in predicting outcomes in atrial fibrillation: an analysis of the ORBIT-AF and GARFIELD-AF registries. Europace 2021; 22:1635-1644. [PMID: 32879969 DOI: 10.1093/europace/euaa172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/26/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Prediction models for outcomes in atrial fibrillation (AF) are used to guide treatment. While regression models have been the analytic standard for prediction modelling, machine learning (ML) has been promoted as a potentially superior methodology. We compared the performance of ML and regression models in predicting outcomes in AF patients. METHODS AND RESULTS The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) and Global Anticoagulant Registry in the FIELD (GARFIELD-AF) are population-based registries that include 74 792 AF patients. Models were generated from potential predictors using stepwise logistic regression (STEP), random forests (RF), gradient boosting (GB), and two neural networks (NNs). Discriminatory power was highest for death [STEP area under the curve (AUC) = 0.80 in ORBIT-AF, 0.75 in GARFIELD-AF] and lowest for stroke in all models (STEP AUC = 0.67 in ORBIT-AF, 0.66 in GARFIELD-AF). The discriminatory power of the ML models was similar or lower than the STEP models for most outcomes. The GB model had a higher AUC than STEP for death in GARFIELD-AF (0.76 vs. 0.75), but only nominally, and both performed similarly in ORBIT-AF. The multilayer NN had the lowest discriminatory power for all outcomes. The calibration of the STEP modelswere more aligned with the observed events for all outcomes. In the cross-registry models, the discriminatory power of the ML models was similar or lower than the STEP for most cases. CONCLUSION When developed from two large, community-based AF registries, ML techniques did not improve prediction modelling of death, major bleeding, or stroke.
Collapse
Affiliation(s)
- Zak Loring
- Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Department of Medicine, Duke University Medical Center, 2301 Erwin Rd, DUMC 3845, Durham, NC 27710, USA
| | - Suchit Mehrotra
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Department of Medicine, Duke University Medical Center, 2301 Erwin Rd, DUMC 3845, Durham, NC 27710, USA
| | - John Camm
- Cardiology Clinical Academic Group, St. George's University of London, London, UK
| | | | - Gregg C Fonarow
- Department of Medicine, UCLA Division of Cardiology, Los Angeles, CA, USA
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Eric D Peterson
- Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Department of Medicine, Duke University Medical Center, 2301 Erwin Rd, DUMC 3845, Durham, NC 27710, USA
| | - Karen Pieper
- Duke Clinical Research Institute, Durham, NC, USA
| | - Ajay K Kakkar
- Thrombosis Research Institute, London, UK.,University College London, London, UK
| |
Collapse
|
250
|
Undas A. Altered fibrin clot properties and fibrinolysis in patients with atrial fibrillation: practical implications. Europace 2021; 22:185-194. [PMID: 31625555 DOI: 10.1093/europace/euz271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
Compelling evidence indicates that a hypercoagulable state occurs in patients with atrial fibrillation (AF) including those in sinus rhythm following paroxysmal and persistent AF. Activation of blood coagulation in AF reflects heightened thrombin generation with the subsequent increased formation of fibrin as evidenced by elevated soluble fibrin monomers and D-dimer. Formation of denser fibrin meshworks, relatively resistant to plasmin-mediated lysis has been demonstrated in patients with AF. The presence of stroke risk factors in AF, such as diabetes, heart failure, hypertension, previous myocardial infarction, or stroke, advanced age have been shown to be linked to the prothrombotic clot characteristics, including reduced clot permeability and lysability. Importantly, biomarkers, including cardiac troponins and N-terminal pro-brain natriuretic peptide, are associated with thrombin generation and fibrin-related markers in AF patients. Recently, increased fibrin clot density (low clot permeability measured in plasma-based assays) and impaired fibrinolysis measured off anticoagulation have been demonstrated to predict ischaemic cerebrovascular events in patients with AF receiving vitamin K antagonists and those on rivaroxaban. The current review summarizes evidence for a role of altered fibrin clot properties and hypofibrinolysis in AF and their prognostic value in terms of adverse events.
Collapse
Affiliation(s)
- Anetta Undas
- Institute of Cardiology, Jagiellonian University School of Medicine and John Paul II Hospital, 80 Prądnicka Str., 31-202 Cracow, Poland
| |
Collapse
|