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Campbell KB, Eickman SD, Truong T, Black-Maier E, Barnett AS, Wang A, Green CL, Daubert JP, Lewis RK, Atwater BD, Al-Khatib SM, Bahnson TD, Thomas KL, Jackson KP, Jackson LR, Pokorney S, Frazier-Mills C, Piccini JP. Colchicine for the Prevention of Recurrent Arrhythmia After Catheter Ablation of Atrial Fibrillation: Results of a Single-Center, Retrospective Study. Am J Cardiovasc Drugs 2023; 23:709-719. [PMID: 37801260 DOI: 10.1007/s40256-023-00612-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND There is evidence to suggest that colchicine reduces the risk of recurrent atrial fibrillation (AF) after catheter ablation; however, the tolerability and safety of colchicine in routine practice is unknown. METHODS Patients undergoing catheter ablation for AF who received colchicine after ablation were matched 1:1 to patients who did not by age, sex, and renal function. Recurrent AF was compared between groups categorically at 12 months and via propensity weighted Cox proportional hazards models with and without a 3-month blanking period. RESULTS Overall, 180 patients (n = 90 colchicine and n = 90 matched controls) were followed for a median (Q1, Q3) of 10.3 (7.0, 12.0) months. Mean age was 65.3 ± 9.1 years, 33.9% were women, mean CHA2DS2-VASc score was 2.9 ± 1.5, and 51.1% had persistent AF. Most patients (70%) received colchicine 0.6 mg daily for a median of 30 days. In the colchicine group, 55 patients (61.1%) were receiving at least one known interacting medication with colchicine. After ablation, one patient required colchicine dose reduction and four patients required discontinuation. After adjusting for covariate imbalance using propensity weighting, no significant association between colchicine use and AF recurrence was identified (adjusted hazard ratio 0.94, 95% confidence interval [CI] 0.48-1.85; p = 0.853). No significant association was found between colchicine use and all-cause hospitalizations (adjusted odds ratio 0.74, 95% CI 0.28-1.96; p = 0.548). CONCLUSION Despite the frequent presence of drug-drug interactions, a 30-day course of colchicine is well-tolerated after AF ablation; however, we did not observe any association between colchicine and lower rates of AF recurrence or hospitalization.
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Affiliation(s)
- Kristen Bova Campbell
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA.
| | | | - Tracy Truong
- Duke Clinical Research Institute, Durham, NC, USA
- Duke Biostatistics, Epidemiology, and Research Design (BERD) Methods Core, Duke University Medical Center, Durham, NC, USA
| | - Eric Black-Maier
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Adam S Barnett
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Allen Wang
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Cynthia L Green
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - James P Daubert
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Robert K Lewis
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | | | - Sana M Al-Khatib
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Tristram D Bahnson
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Kevin L Thomas
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kevin P Jackson
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Larry R Jackson
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Sean Pokorney
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Camille Frazier-Mills
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Jonathan P Piccini
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
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2
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Bergonti M, Ascione C, Marcon L, Pambrun T, Della Rocca DG, Ferrero TG, Pannone L, Kühne M, Compagnucci P, Bonomi A, Gevaert AB, Anselmino M, Casella M, Krisai P, Tondo C, Rodríguez-Mañero M, Derval N, Chierchia GB, de Asmundis C, Heidbuchel H, Jaïs P, Sarkozy A. Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure: a prediction model. Eur Heart J 2023; 44:3327-3335. [PMID: 37387689 DOI: 10.1093/eurheartj/ehad428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/27/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
AIMS Management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains complex. The Antwerp score, based on four parameters [QRS >120 ms (2 points), known aetiology (2 points), paroxysmal AF (1 point), severe atrial dilation (1 point)] adequately estimated the probability of left ventricular ejection fraction (LVEF) recovery after AF ablation in a single-centre cohort. The present study aims to externally validate this prediction model in a large European multi-centre cohort. METHODS AND RESULTS A total of 605 patients (61.1 ± 9.4 years, 23.8% females, 79.8% with persistent AF) with HF and impaired LVEF (<50%) undergoing AF ablation in 8 European centres were retrospectively identified. According to the LVEF changes at 12-month echocardiography, 427 (70%) patients fulfilled the '2021 Universal Definition of HF' criteria for LVEF recovery and were defined as 'responders'. External validation of the score yielded good discrimination and calibration {area under the curve 0.86 [95% confidence interval (CI) 0.82-0.89], P < .001; Hosmer-Lemeshow P = .29}. Patients with a score < 2 had a 93% probability of LVEF recovery as opposed to only 24% in patients with a score > 3. Responders experienced more often positive ventricular remodelling [odds ratio (OR) 8.91, 95% CI 4.45-17.84, P < .001], fewer HF hospitalizations (OR 0.09, 95% CI 0.05-0.18, P < .001) and lower mortality (OR 0.11, 95% CI 0.04-0.31, P < .001). CONCLUSION In this multi-centre study, a simple four-parameter score predicted LVEF recovery after AF ablation in patients with HF and discriminated clinical outcomes. These findings support the use of the Antwerp score to standardize shared decision-making regarding AF ablation referral in future clinical studies.
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Affiliation(s)
- Marco Bergonti
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Ciro Ascione
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Lorenzo Marcon
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France
| | - Domenico G Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Teba Gonzalez Ferrero
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Michael Kühne
- Cardiology Division, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti Umberto I-Lancisi-Salesi', Ancona, Italy
| | - Alice Bonomi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Andreas B Gevaert
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Matteo Anselmino
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti Umberto I-Lancisi-Salesi', Ancona, Italy
| | - Philipp Krisai
- Cardiology Division, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Claudio Tondo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Moises Rodríguez-Mañero
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
- L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
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Bergonti M, Spera F, Tijskens M, Bonomi A, Saenen J, Huybrechts W, Miljoen H, Wittock A, Casella M, Tondo C, Heidbuchel H, Sarkozy A. A new prediction model for left ventricular systolic function recovery after catheter ablation of atrial fibrillation in patients with heart failure. Int J Cardiol 2022; 358:45-50. [DOI: 10.1016/j.ijcard.2022.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/26/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
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Steinberg BA, Zhang M, Bensch J, Lyons A, Bunch TJ, Piccini JP, Siu A, Spertus JA, Stehlik J, Wohlfahrt P, Greene T, Hess R, Fang JC. Quantifying the Impact of Atrial Fibrillation on Heart Failure-Related Patient-Reported Outcomes in the Utah mEVAL Program. J Card Fail 2022; 28:13-20. [PMID: 34324927 PMCID: PMC8748275 DOI: 10.1016/j.cardfail.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) frequently complicates heart failure (HF), and each is associated with lower overall health-related quality of life. We aimed to quantify the incremental burden of AF on the health-related quality of life of patients with HF in clinical practice. METHODS AND RESULTS We used data from the Utah mEVAL program to analyze patient-reported outcomes (PROs) among patients with HF with and without AF. The primary outcome was the HF-specific Kansas City Cardiomyopathy Questionnaire, with generic PROs as secondary outcomes. Among 1707 patients with HF, 36% had AF (n = 616). Those with HF and AF were older (mean age 69 years vs 58 years, P < .001), more likely to have prior stroke (29% vs 17%, P < .001) and ischemic cardiomyopathy (28% vs 23%, P = .01), but had similar ejection fractions (mean 44% each, P = .6). After adjustment, and compared with HF alone, HF with AF was associated with worse Kansas City Cardiomyopathy Questionnaire scores (adjusted mean difference -3.45, 95% confidence interval [CI] -6.24 to -0.65), and worse Patient-Reported Outcomes Measurement Information System physical function scores (adjusted mean difference -1.63, 95% CI -2.59 to -0.67). The difference in visual analog scale general health was borderline (adjusted mean difference -2.01, 95% CI -4.51 to 0.49), and Patient-Reported Outcomes Measurement Information System depression scores were similar (adjusted mean difference 0.54, 95% CI -0.48 to 1.57). CONCLUSIONS AF complicates nearly one-third of HF cases, and patients with HF and AF are substantially older and sicker. After adjustment, AF was independently associated with worse disease-specific and overall health-related quality of life than HF alone. Whether maintaining sinus rhythm can improve the HF-related health status of patients with HF in clinical practice should be explored further.
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Affiliation(s)
| | - Mingyuan Zhang
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jason Bensch
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Ann Lyons
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - T Jared Bunch
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Alfonso Siu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/UMKC, Kansas City MO
| | - Josef Stehlik
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Peter Wohlfahrt
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Tom Greene
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Rachel Hess
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - James C Fang
- University of Utah Health Sciences Center, Salt Lake City, Utah
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5
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Chiocchini A, Terricabras M, Verma A. Atrial fibrillation ablation in heart failure: What do we know? What can we do? Europace 2021; 23:353-361. [PMID: 33083820 DOI: 10.1093/europace/euaa217] [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: 05/09/2020] [Accepted: 10/14/2020] [Indexed: 11/14/2022] Open
Abstract
Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) are two conditions that frequently impact reciprocally on each other. Patients with HFrEF have an increased risk of stroke, hospitalization and mortality after they develop AF and vice versa, AF causing deterioration of the ejection fraction is also associated to increased mortality. Catheter ablation has emerged as an effective alternative to antiarrhythmic drug treatment to maintain sinus rhythm and some randomized trials have shown a potential benefit in terms of mortality and hospitalization. This review discusses the available evidence regarding catheter ablation treatment in this specific patient group.
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Affiliation(s)
- Andrea Chiocchini
- Southlake Regional Health Centre, University of Toronto, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada
| | - Maria Terricabras
- Southlake Regional Health Centre, University of Toronto, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada
| | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada
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Ardashev AV, Belenkov YN, Matsiukevich MC, Snezhitskiy VA. [Atrial Fibrillation and Mortality: Prognostic Factors and Direction of Prevention]. ACTA ACUST UNITED AC 2021; 61:91-98. [PMID: 33715615 DOI: 10.18087/cardio.2021.2.n1348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022]
Abstract
This review focuses on major causes and risk factors for death of patients with atrial fibrillation (AF). The authors analyzed current therapeutic strategies for managing patients with AF with respect of their effects on prediction and mortality. Special attention is paid to the strategy of rhythm control and the clinical significance of catheter ablation in the treatment of patients with AF and heart failure.
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Affiliation(s)
| | | | | | - V A Snezhitskiy
- State Healthcare Institution "Grodno City Policlinic #1", Grodno
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7
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Bazoukis G, Naka KK. Editorial to "effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology". J Arrhythm 2020; 36:93-94. [PMID: 32071626 PMCID: PMC7011804 DOI: 10.1002/joa3.12295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- George Bazoukis
- Department of CardiologyElectrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Katerina K. Naka
- Second Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of IoanninaIoanninaGreece
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