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Agarwal PP, Nasr LA, Ghoshhajra BB, Brown RKJ, Collier P, De Cecco CN, Fuss C, Goldstein JN, Kallianos K, Malik SB, Maroules CD, Meyersohn NM, Nazarian S, Scherer MD, Singh S, Tailor TD, Tong MS, Koweek LM. ACR Appropriateness Criteria® Preprocedural Planning for Left Atrial Procedures in Atrial Fibrillation. J Am Coll Radiol 2024; 21:S237-S248. [PMID: 38823947 DOI: 10.1016/j.jacr.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
This document summarizes the relevant literature for the selection of preprocedural imaging in three clinical scenarios in patients needing endovascular treatment or cardioversion of atrial fibrillation. These clinical scenarios include preprocedural imaging prior to radiofrequency ablation; prior to left atrial appendage occlusion; and prior to cardioversion. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Layla A Nasr
- Research Author, Allegheny Health Network Imaging Institute, Pittsburgh, Pennsylvania
| | | | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Cristina Fuss
- Oregon Health & Science University, Portland, Oregon
| | - Jennifer N Goldstein
- ChristianaCare Health System, Newark, Delaware; Society of General Internal Medicine
| | | | - Sachin B Malik
- VA Palo Alto Health Care System, Palo Alto, California; Stanford University, Stanford, California
| | | | | | - Saman Nazarian
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Heart Rhythm Society
| | - Markus D Scherer
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; Society of Cardiovascular Computed Tomography
| | - Simranjit Singh
- Indiana University School of Medicine, Indianapolis, Indiana; American College of Physicians
| | - Tina D Tailor
- Duke University Medical Center, Durham, North Carolina
| | - Matthew S Tong
- Ohio State University, Columbus, Ohio; Society for Cardiovascular Magnetic Resonance
| | - Lynne M Koweek
- Specialty Chair, Duke University Medical Center, Durham, North Carolina
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2
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Nomura T, Maeda M, Kumazawa D, Mizuno Y, Onodera K, Toyoda S, Yamashita K. The effect of ablation settings on lesion characteristics with DiamondTemp ablation system: An ex vivo experiment. J Arrhythm 2024; 40:109-117. [PMID: 38333399 PMCID: PMC10848608 DOI: 10.1002/joa3.12970] [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: 07/18/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Creating large lesion in ablations using the DiamondTemp (DTA) ablation system may reduce the frequency of arrhythmia recurrence and allow the treatment of ventricular arrhythmias. Therefore, this study aimed to investigate whether power, application time, contact force (CF), and contact angle affect lesion formation in the ventricles. Methods Ablations were delivered to porcine myocardial preps to evaluate the lesion characteristics. Ablations were conducted with a maximum power of 50 W, target temperature of 58°C, CF of 10, 20, or 30 g, and contact angle between the catheter tip and tissue. The ablation durations were 15, 30, 60 s, 15 s × 2, or 30 s × 2. Results Steam pops occurred only in cases with perpendicular contact. The lesion depth was larger in all settings in the perpendicular orientation than in the parallel orientation. The temperatures were lower in all settings in the perpendicular orientation than in the parallel orientation. The lesions became larger as CF increased with perpendicular contact and duration of ≥30 s. The longer application time resulted in larger surface area, depth, and volume of the lesion. Lesion depth was greater with single application of 30 and 60 s than with 15 s × 2 and 30 s × 2, respectively. Conclusion It is important to perform a single prolonged application as much as possible to create deeper lesions. Parallel contact with the tissue should be maintained to take advantage of the temperature sensor's capabilities to avoid pop phenomenon.
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Affiliation(s)
- Takehiro Nomura
- Heart Rhythm Center, Department of Cardiovascular MedicineSendai Kosei HospitalSendai‐shiMiyagiJapan
| | - Manabu Maeda
- Heart Rhythm Center, Department of Cardiovascular MedicineSendai Kosei HospitalSendai‐shiMiyagiJapan
| | - Daiki Kumazawa
- Heart Rhythm Center, Department of Cardiovascular MedicineSendai Kosei HospitalSendai‐shiMiyagiJapan
| | - Yosuke Mizuno
- Heart Rhythm Center, Department of Cardiovascular MedicineSendai Kosei HospitalSendai‐shiMiyagiJapan
| | - Kosuke Onodera
- Heart Rhythm Center, Department of Cardiovascular MedicineSendai Kosei HospitalSendai‐shiMiyagiJapan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of MedicineDokkyo Medical UniversityMibuTochigiJapan
| | - Kennosuke Yamashita
- Heart Rhythm Center, Department of Cardiovascular MedicineSendai Kosei HospitalSendai‐shiMiyagiJapan
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3
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Suzuki S, Kitai T, Skoularigis J, Spiliopoulos K, Xanthopoulos A. Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure: Current Evidence and Future Opportunities. J Pers Med 2023; 13:1394. [PMID: 37763161 PMCID: PMC10532515 DOI: 10.3390/jpm13091394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Atrial fibrillation (AF) and heart failure (HF) are highly prevalent cardiac disorders worldwide, and both are associated with poor prognosis. The incidence of AF and HF has been increasing substantially in recent years, mainly due to the progressive aging of the population. These disorders often coexist, and may have a causal relationship, with one contributing to the development or progression of the other. AF is a significant risk factor for adverse outcomes in HF patients, including mortality, hospitalization, and stroke. Although the optimal treatment for AF with HF remains unclear, catheter ablation (CA) has emerged as a promising treatment option. This review provides a comprehensive overview of the current scientific evidence regarding the efficacy of CA for managing AF in HF patients. In addition, the potential benefits and risks associated with CA are also discussed. We will also explore the factors that may influence treatment outcomes and highlight the remaining gaps in knowledge in this field.
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Affiliation(s)
- Sho Suzuki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
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Bisson A, Fawzy AM, El-Bouri W, Angoulvant D, Lip GYH, Fauchier L, Clementy N. Clinical Phenotypes and Atrial Fibrillation Recurrences after Catheter Ablation: An Unsupervised Cluster Analysis. Curr Probl Cardiol 2023; 48:101732. [PMID: 37003451 DOI: 10.1016/j.cpcardiol.2023.101732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Catheter ablation (CA) is a well-established treatment of atrial fibrillation (AF). Data-driven cluster analysis is able to better distinguish prognostically-relevant phenotype clusters among patients with AF. We performed a hierarchical cluster analysis in a cohort of AF patients undergoing a first CA and evaluate associations between identified clusters and recurrences of arrhythmia following ablation. The study included 209 AF patients treated with CA. 3 clusters with distinct characteristics were identified. Recurrences at one year occurred in 27.2% in Cluster 1, 43.2% in Cluster 2 and 60.9% in Cluster 3 (p<0.0001). Cluster classification was independently associated with arrhythmia recurrences (HR 1.58, 95% CI 1.01-2.49, p=0.046) after adjustment for age, CHA2DS2-VASc score, left atrial volume, type of atrial fibrillation and ejection fraction. To concluded, cluster analysis identified three statistically-driven groups among AF patients treated with CA with different risks for arrhythmia recurrences.
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Affiliation(s)
- Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, Tours, France; Service de Cardiologie, Centre Hospitalier Régional Universitaire d'Orléans, Orléans, France; EA4245, Transplantation Immunité Inflammation, Université de Tours, Tours, France; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | - Ameenathul M Fawzy
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Wahbi El-Bouri
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, Tours, France; EA4245, Transplantation Immunité Inflammation, Université de Tours, Tours, France
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Clinique du Millénaire, Montpellier, France
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Yue J, Li M, Wu Q, Li P, Liang C, Chen J, Li P, Guo J, Dou W, Guo C, Gao J. Is it feasible to measure pulmonary vein data using volume rendering images? Acta Radiol 2023; 64:1018-1027. [PMID: 35722668 DOI: 10.1177/02841851221106591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary vein (PV) data are commonly measured on multiplanar image reformation (MPR) images and volume rendering (VR) images. PURPOSE To compared and analyze the advantages and disadvantages of PV data based on VR images and MPR images. MATERIAL AND METHODS A total of 94 patients with atrial fibrillation (AF) with imaging data were included in the study. The respective image postprocessing time and the three surgical interventionists' preferences for the two images were recorded. A paired t-test or chi-square test was used to compare their difference, and P < 0.05 was considered statistically significant. RESULTS There was no statistically significant difference between the data values including the maximal and minimal ostial diameters of the left superior PV (LSPV), the left inferior PV (LIPV), the right superior PV (RSPV), and the right inferior PV (RIPV) obtained by VR and MPR images (P > 0.05). Yet, the mean postprocessing time of VR images (15.10 ± 3.05 min) was shorter compared to MPR images (16.54 ± 2.60 min) (t = 22.84, P < 0.05). All three surgical interventionists preferred VR images (accounted for 85.1%, 86.2%, and 84.0%, respectively), and there was no statistical difference in the degree of image preference among the three (chi-square = 0.596, P = 0.963). CONCLUSION PV data measurement could be performed on both VR and MRP images; however, the data on VR images were more intuitive and more accessible for interventional surgeons.
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Affiliation(s)
- Junyan Yue
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
- Department of Radiology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
- Heart Center, 159367The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Meixia Li
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Qingwu Wu
- Department of Radiology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Peicheng Li
- Electrophysiology Laboratory, 159367The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Changhua Liang
- Department of Radiology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Jie Chen
- Department of Radiology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Peiheng Li
- Department of Radiology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Junxia Guo
- Internal Medicine-Cardiovascular Department, 159367The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Wenguang Dou
- Department of Radiology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Changlei Guo
- Internal Medicine-Cardiovascular Department, 159367The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, PR China
| | - Jianbo Gao
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
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Fujisawa T, Kawakami H, Nagai T, Miyazaki S, Akazawa Y, Miyoshi T, Higaki A, Seike F, Higashi H, Nishimura K, Inoue K, Ikeda S, Yamaguchi O. Premature atrial contraction immediately after catheter ablation was associated with late recurrence of atrial fibrillation. Pacing Clin Electrophysiol 2023; 46:152-160. [PMID: 36524673 DOI: 10.1111/pace.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although premature atrial contractions (PACs) just after catheter ablation (CA) for atrial fibrillation (AF) are common, their clinical significance is uncertain. This study aimed to evaluate whether the PAC burden after an initial CA for AF was associated with late recurrence. METHODS We enrolled 346 patients with AF (median age, 65 years; 30% female; 57% with paroxysmal AF) who underwent an initial radiofrequency CA and a 24-h Holter monitoring the day after the procedure. PAC was defined as supraventricular complexes occurring ≥30% earlier than expected compared with a previous RR interval, and the number of PAC/24 h during post-procedural Holter monitoring was analyzed. RESULTS AF recurred in 106 patients (31%) during a median follow-up of 19 months. These patients had significantly more PAC/24 h than those without (median [interquartile range], 891 [316-4351] beats vs. 409 [162-1,303] beats; p < 0.01). The number of PACs was independently associated with AF recurrence after adjustment for clinical parameters and left atrial (LA) enlargement. Receiver operating characteristic (ROC) curve analysis revealed that 1431 PAC/24 h was the optimal cut-off value for predicting AF recurrence. Adding the PAC/24 h to the prediction model with LA diameter appeared to correctly reclassify patients who were thought to be at high risk for AF recurrence into the low-risk group and vice versa. CONCLUSIONS The number of PACs was an independent risk factor for AF recurrence. A 24-h Holter recording the day after an initial CA is a simple and beneficial tool for the risk stratification of AF recurrence.
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Affiliation(s)
- Tomoki Fujisawa
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiroshi Kawakami
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takayuki Nagai
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shigehiro Miyazaki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yusuke Akazawa
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Toru Miyoshi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Akinori Higaki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Fumiyasu Seike
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Haruhiko Higashi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuhisa Nishimura
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Katsuji Inoue
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shuntaro Ikeda
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Osamu Yamaguchi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
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Beltrami M, Dei LL, Milli M. The Role of the Left Atrium: From Multimodality Imaging to Clinical Practice: A Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081191. [PMID: 36013370 PMCID: PMC9410416 DOI: 10.3390/life12081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
In recent years, new interest is growing in the left atrium (LA). LA functional analysis and measurement have an essential role in cardiac function evaluation. Left atrial size and function are key elements during the noninvasive analysis of diastolic function in several heart diseases. The LA represents a “neuroendocrine organ” with high sensitivity to the nervous, endocrine, and immune systems. New insights highlight the importance of left atrial structural, contractile, and/or electrophysiological changes, introducing the concept of “atrial cardiomyopathy”, which is closely linked to underlying heart disease, arrhythmias, and conditions such as aging. The diagnostic algorithm for atrial cardiomyopathy should follow a stepwise approach, combining risk factors, clinical characteristics, and imaging. Constant advances in imaging techniques offer superb opportunities for a comprehensive evaluation of LA function, underlying specific mechanisms, and patterns of progression. In this literature review, we aim to suggest a practical, stepwise algorithm with integrative multimodality imaging and a clinical approach for LA geometry and functional analysis. This integrates diastolic flow analysis with LA remodelling by the application of traditional and new diagnostic imaging techniques in several clinical settings such as heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), and mitral regurgitation (MR).
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
- Correspondence: ; Tel.: +39-339-541-8158
| | - Lorenzo-Lupo Dei
- Cardiology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
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Chou CY, Chung FP, Chang HY, Lin YJ, Lo LW, Hu YF, Chao TF, Liao JN, Tuan TC, Lin CY, Chang TY, Liu CM, Wu CI, Huang SH, Chen CC, Cheng WH, Liu SH, Lugtu IC, Jain A, Feng AN, Chang SL, Chen SA. Prediction of Recurrent Atrial Tachyarrhythmia After Receiving Atrial Flutter Ablation in Patients With Prior Cardiac Surgery for Valvular Heart Disease. Front Cardiovasc Med 2021; 8:741377. [PMID: 34631838 PMCID: PMC8495322 DOI: 10.3389/fcvm.2021.741377] [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: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical scars cause an intra-atrial conduction delay and anatomical obstacles that facilitate the perpetuation of atrial flutter (AFL). This study aimed to investigate the outcome and predictor of recurrent atrial tachyarrhythmia after catheter ablation in patients with prior cardiac surgery for valvular heart disease (VHD) who presented with AFL. Methods: Seventy-two patients with prior cardiac surgery for VHD who underwent AFL ablation were included. The patients were categorized into a typical AFL group (n = 45) and an atypical AFL group (n = 27). The endpoint was the recurrence of atrial tachyarrhythmia during follow-up. A multivariate analysis was performed to determine the predictor of recurrence. Results: No significant difference was found in the recurrence rate of atrial tachyarrhythmia between the two groups. Patients with concomitant atrial fibrillation (AF) had a higher recurrence of typical AFL compared with those without AF (13 vs. 0%, P = 0.012). In subgroup analysis, typical AFL patients with concomitant AF had a higher incidence of recurrent atrial tachyarrhythmia than those without it (53 vs. 14%, P = 0.006). Regarding patients without AF, the typical AFL group had a lower recurrence rate of atrial tachyarrhythmia than the atypical AFL group (14 vs. 40%, P = 0.043). Multivariate analysis showed that chronic kidney disease (CKD) and left atrial diameter (LAD) were independent predictors of recurrence. Conclusions: In our study cohort, concomitant AF was associated with recurrence of atrial tachyarrhythmia. CKD and LAD independently predicted recurrence after AFL ablation in patients who have undergone cardiac surgery for VHD.
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Affiliation(s)
- Ching-Yao Chou
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Medical Center, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yu Chang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-I Wu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sung-Hao Huang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Chun-Chao Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Isaiah Carlos Lugtu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Heart Institute, Chinese General Hospital and Medical Center, Manila, Philippines
| | - Ankit Jain
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - An-Ning Feng
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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9
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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.
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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
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10
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Sangsriwong M, Cismaru G, Puiu M, Simu G, Istratoaie S, Muresan L, Gusetu G, Cismaru A, Pop D, Zdrenghea D, Rosu R. Formula to estimate left atrial volume using antero-posterior diameter in patients with catheter ablation of atrial fibrillation. Medicine (Baltimore) 2021; 100:e26513. [PMID: 34398006 PMCID: PMC8294916 DOI: 10.1097/md.0000000000026513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/13/2020] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT In patients undergoing atrial fibrillation (AF) ablation, an enlarged left atrium (LA) is a predictor of procedural failure as well as AF recurrence on long term. The most used method to assess LA size is echocardiography-measured diameter, but the most accurate remains computed tomography (CT).The aim of our study was to determine whether there is an association between left atrial diameters measured in echocardiography and the left atrial volume determined by CT in patients who underwent AF ablation.The study included 93 patients, of whom 60 (64.5%) were men and 64 (68.8%) had paroxysmal AF, who underwent AF catheter ablation between January 2018 and June 2019. Left atrial diameters in echocardiography were measured from the long axis parasternal view and the LA volume in CT was measured on reconstructed three-dimensional images.The LA in echocardiography had an antero-posterior (AP) diameter of 45.0 ± 6 mm (median 45; Inter Quartile Range [IQR] 41-49, range 25-73 mm), longitudinal diameter of 67.5 ± 9.4 (median 66; IQR 56-88, range 52-100 mm), and transversal diameter of 42 ± 8.9 mm (IQR 30-59, range 23-64.5 mm). The volume in CT was 123 ± 29.4 mL (median 118; IQR 103-160; range 86-194 mL). We found a significant correlation (r = 0.702; P < .05) between the AP diameter and the LA volume. The formula according to which the AP diameter of the LA can predict the volume was: LA volume = AP diam3 + 45 mL.There is a clear association between the left atrial AP diameter measured on echocardiography and the volume measured on CT. The AP diameter might be sufficient to determine the increase in the volume of the atrium and predict cardiovascular outcomes.
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Affiliation(s)
- Muktapha Sangsriwong
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Puiu
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gelu Simu
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sabina Istratoaie
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucian Muresan
- Department of Cardiology, Centre Hospitalier Emile Muller, Mulhouse, France
| | - Gabriel Gusetu
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, The “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Functional Sciences, Immunology and Allergology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Pop
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dumitru Zdrenghea
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Rosu
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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No impact of sub-clinical coronary artery disease identified by cardiac CT scan on the recurrence of atrial fibrillation after a single ablation procedure. J Interv Card Electrophysiol 2021; 64:393-400. [PMID: 34240293 DOI: 10.1007/s10840-021-01018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Performing a cardiac CT scan before ablation provides a better understanding of the anatomical variations of the left atrium and pulmonary veins, as well as an analysis of coronary anatomy and the calcium score. The aim of the present study was to determine whether the CT characteristics of patients with unknown CAD have an impact on recurrence of AF. METHODS This monocentric retrospective study included patients with AF who had undergone cardiac CT prior to a single ablation. RESULTS Among the 229 patients included in the study, 70 (30.5%) presented AF recurrence between 3 and 12 months after a single ablation. The prevalence of CAD confirmed by CT coronary angiogram and the coronary calcium score were similar in the two groups. Patients with recurrent atrial fibrillation had a significantly higher LAVI evaluated by CT scan than patients without recurrence. The ROC curve determined an optimal LAVI threshold of 49 mL/m2. In multivariate analysis, the LAVI measured by CT scan was independently associated with the risk of AF recurrence. CONCLUSIONS Our study confirms that CAD is not a predictor of AF recurrence after a single ablation, unlike the LAVI. Further studies are necessary to re-evaluate the long-term conclusions of this work.
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12
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Badoz M, Serzian G, Favoulet B, Sellal JM, De Chillou C, Hammache N, Laurent G, Mebazaa A, Ecarnot F, Bardonnet K, Seronde MF, Schiele F, Meneveau N. Impact of Midregional N-Terminal Pro-Atrial Natriuretic Peptide and Soluble Suppression of Tumorigenicity 2 Levels on Heart Rhythm in Patients Treated With Catheter Ablation for Atrial Fibrillation: The Biorhythm Study. J Am Heart Assoc 2021; 10:e020917. [PMID: 34187182 PMCID: PMC8403329 DOI: 10.1161/jaha.121.020917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background We assessed the impact of preprocedural plasma levels of MRproANP (midregional N‐terminal pro–atrial natriuretic peptide) and sST2 (soluble suppression of tumorigenicity 2) on recurrence of atrial fibrillation (AF) at 1 year after catheter ablation of AF. Methods and Results This was a prospective, multicenter, observational study including patients undergoing catheter ablation of AF. MRproANP and sST2 were measured in a peripheral venous blood preprocedure, and MRproANP was assessed in the right and left atrial blood during ablation. The primary end point was recurrent AF between 3 and 12 months postablation, defined as a documented (>30 seconds) episode of AF, flutter, or atrial tachycardia. We included 106 patients from December 2017 to March 2019; 105 had complete follow‐up, and the mean age was 63 years with 74.2% males. Overall, 34 patients (32.1%) had recurrent AF. In peripheral venous blood, MRproANP was significantly higher in patients with recurrent AF (median, 192.2; [quartile 1–quartile 3, 155.9–263.9] versus 97.1 [60.9–150.7] pmol/L; P<0.0001), as was sST2 (median, 30.3 [quartile 1–quartile 3, 23.3–39.3] versus 23.4 [95% CI, 17.4–33.0] ng/mL; P=0.0033). In the atria, MRproANP was significantly higher than in peripheral blood and was higher during AF than during sinus rhythm. Receiver operating characteristic curve analysis identified a threshold of MRproANP>107.9 pmol/L to predict AF recurrence at 1 year and a threshold of >26.7 ng/mL for sST2. By multivariate analysis, MRproANP>107.9 pmol/L was the only independent predictor of recurrent AF (OR, 24.27; 95% CI, 4.23–139.18). MRproANP<107.9 pmol/L identified subjects at very low risk of recurrence (negative predictive value >95%). Conclusions Elevated MRproANP level independently predicts recurrent AF, whereas sST2 levels do not appear to have any prognostic value in assessing the risk of recurrence of AF up to 1 year after catheter ablation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03351816.
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Affiliation(s)
- Marc Badoz
- Department of CardiologyUniversity Hospital Besançon Besançon France.,EA3920University of Burgundy Franche-Comté Besançon France
| | - Guillaume Serzian
- Department of CardiologyUniversity Hospital Besançon Besançon France
| | - Baptiste Favoulet
- Department of CardiologyUniversity Hospital Besançon Besançon France
| | - Jean-Marc Sellal
- Department of Cardiology Centre Hospitalier Régional Universitaire de NancyUniversité de Lorraine Nancy France.,IADIINSERM U1254Université de Lorraine Nancy France
| | - Christian De Chillou
- Department of Cardiology Centre Hospitalier Régional Universitaire de NancyUniversité de Lorraine Nancy France
| | - Néfissa Hammache
- Department of Cardiology Centre Hospitalier Régional Universitaire de NancyUniversité de Lorraine Nancy France.,IADIINSERM U1254Université de Lorraine Nancy France
| | - Gabriel Laurent
- Department of Cardiology University Hospital François Mitterand Dijon France
| | - Alexandre Mebazaa
- INSERM UMR-S 942 Paris France.,Department of Anesthesiology and Critical Care Medicine Assistance Publique - Hôpitaux de ParisSaint Louis Lariboisière University Hospitals Paris France
| | - Fiona Ecarnot
- Department of CardiologyUniversity Hospital Besançon Besançon France.,EA3920University of Burgundy Franche-Comté Besançon France
| | - Karine Bardonnet
- Department of BiochemistryUniversity Hospital Besançon Besançon France
| | - Marie-France Seronde
- Department of CardiologyUniversity Hospital Besançon Besançon France.,EA3920University of Burgundy Franche-Comté Besançon France
| | - François Schiele
- Department of CardiologyUniversity Hospital Besançon Besançon France.,EA3920University of Burgundy Franche-Comté Besançon France
| | - Nicolas Meneveau
- Department of CardiologyUniversity Hospital Besançon Besançon France.,EA3920University of Burgundy Franche-Comté Besançon France
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [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]
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Kotalczyk A, Ding WY, Gupta D, Wright DJ, Lip GYH. Clinical outcomes following rhythm control for atrial fibrillation: is early better? Expert Rev Cardiovasc Ther 2021; 19:277-287. [PMID: 33715565 DOI: 10.1080/14779072.2021.1902307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction: An integral aspect of atrial fibrillation (AF) management involves better symptom control, incorporating a rate control, rhythm control, or a combination strategy. The 2020 ESC Guidelines suggest that rhythm control strategy should be recommended for symptomatic patients, to mitigate their symptoms and improve the quality of life. However, adequately powered randomized control trials and prospective 'real-world' registries are needed to fully assess the impact of early rhythm control strategies on clinical outcomes in patients with AF.Objective: In this narrative review, we discuss clinical outcomes following rhythm management approach among patients with AF, considering the effectiveness of an early intervention strategy.Expert opinion: Patients involvement and shared decision-making are crucial when deciding the optimal management strategy among patients with AF. For those with newly diagnosed symptomatic AF, an early invasive approach such as catheter ablation may have a role in preventing AF progression and subsequent pathophysiological changes.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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15
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5307] [Impact Index Per Article: 1769.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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16
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Motoc A, Roosens B, Scheirlynck E, Tanaka K, Luchian ML, Magne J, Mandoli GE, Hinojar R, Cameli M, Zamorano JL, Droogmans S, Cosyns B. Feasibility and Reproducibility of Left Atrium Measurements Using Different Three-Dimensional Echocardiographic Modalities. Diagnostics (Basel) 2020; 10:diagnostics10121043. [PMID: 33287239 PMCID: PMC7761745 DOI: 10.3390/diagnostics10121043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
Left atrium (LA) volume is a biomarker of cardiovascular outcomes. Three-dimensional echocardiography (3DE) provides an accurate LA evaluation, but data regarding the optimal 3DE method is scarce. We assessed the feasibility and reproducibility of LA measurements using different 3DE methods. One hundred and ninety-four patients were prospectively analyzed. Conventional 3DE and two semi-automatic 3DE algorithms (Tomtec™ and Dynamic Heart Model (DHM)) were used in 110 patients. Intra- and interobserver reproducibility and intervendor comparison were performed in additional patients' subsets. Forty patients underwent cardiac magnetic resonance (CMR). Feasibility was 100% for Tomtec, 98.2% for DHM, and 72.8% for conventional 3DE. Tomtec volumes were higher than 3DE and DHM (p < 0.001). Reproducibility was better for DHM (intraobserver LA maximum volume (LAmax) ICC 0.99 (95% CI 1.0-0.99), LA minimum volume (LAmin) 0.98 (95% CI 0.95-0.99), LApreA 0.96 (95% CI 0.91-0.98); interobserver LAmax ICC 0.98 (95% CI 0.96-0.99), LAmin 0.99 (95% CI 0.99-1.00), and LApreA 0.97 (95% CI 0.94-0.99)). Intervendor comparison showed differences between left ventricle (LV) software adapted for LA (p < 0.001). Tomtec underestimated the least LA volumes compared to CMR. These findings emphasize that dedicated software should be used for LA assessment, for consistent clinical longitudinal follow-up and research.
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Affiliation(s)
- Andreea Motoc
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; (B.R.); (E.S.); (M.L.L.); (S.D.); (B.C.)
- Correspondence: ; Tel.: +32-477-23-06-11
| | - Bram Roosens
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; (B.R.); (E.S.); (M.L.L.); (S.D.); (B.C.)
| | - Esther Scheirlynck
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; (B.R.); (E.S.); (M.L.L.); (S.D.); (B.C.)
| | - Kaoru Tanaka
- Radiology Department, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium;
| | - Maria Luiza Luchian
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; (B.R.); (E.S.); (M.L.L.); (S.D.); (B.C.)
| | - Julien Magne
- Department of Cardiology, Centre Hospitalier Universitaire de Limoges, Hopital Dupuytren, Rue Marcland, 87000 Limoges, France;
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, AOUS Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy; (G.E.M.); (M.C.)
| | - Rocio Hinojar
- Cardiology Department, University Hospital Ramon y Cajal, Ctra. Colmenar Viejo 100, 28034 Madrid, Spain; (R.H.); (J.L.Z.)
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, AOUS Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy; (G.E.M.); (M.C.)
| | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramon y Cajal, Ctra. Colmenar Viejo 100, 28034 Madrid, Spain; (R.H.); (J.L.Z.)
| | - Steven Droogmans
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; (B.R.); (E.S.); (M.L.L.); (S.D.); (B.C.)
| | - Bernard Cosyns
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; (B.R.); (E.S.); (M.L.L.); (S.D.); (B.C.)
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Mulder MJ, Götte MJ, Allaart CP. Left atrial appendage morphology in atrial fibrillation: Do we prefer chicken wing or cauliflower? J Cardiovasc Comput Tomogr 2020; 14:201-202. [DOI: 10.1016/j.jcct.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
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Abstract
From the bedside of patients contributing samples to large genome-wide association studies for atrial fibrillation (AF), over 100 AF risk loci have been identified. The top locus is near a gene implicated in pulmonary vein formation; the ostia of the pulmonary veins harbor initiating triggers of AF, and isolation of these areas is the cornerstone of ablation therapies for AF. Transcriptomic studies suggest that AF is associated with impaired or overwhelmed responses to cell stress. A dual risk model proposes that in genetically-susceptible individuals, inadequate transcriptional responses to stress predispose to AF in later life. Drugs targeting metabolic, oxidative, or protein handling stress may be novel upstream agents to bring back to the bedside for study in the prevention of AF.
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19
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Ballo P, Nistri S, Cameli M, Zuppiroli A, Mondillo S. Reply to "Comparison of Accuracy of Left Atrial Area and Volume by Two-Dimensional Transthoracic Echocardiography Versus Computed Tomography". Am J Cardiol 2019; 124:461-463. [PMID: 31182212 DOI: 10.1016/j.amjcard.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy.
| | - Stefano Nistri
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | - Matteo Cameli
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | | - Sergio Mondillo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
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Denham NC, Pearman CM, Caldwell JL, Madders GWP, Eisner DA, Trafford AW, Dibb KM. Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure. Front Physiol 2018; 9:1380. [PMID: 30337881 PMCID: PMC6180171 DOI: 10.3389/fphys.2018.01380] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
Atrial fibrillation (AF) is commonly associated with heart failure. A bidirectional relationship exists between the two-AF exacerbates heart failure causing a significant increase in heart failure symptoms, admissions to hospital and cardiovascular death, while pathological remodeling of the atria as a result of heart failure increases the risk of AF. A comprehensive understanding of the pathophysiology of AF is essential if we are to break this vicious circle. In this review, the latest evidence will be presented showing a fundamental role for calcium in both the induction and maintenance of AF. After outlining atrial electrophysiology and calcium handling, the role of calcium-dependent afterdepolarizations and atrial repolarization alternans in triggering AF will be considered. The atrial response to rapid stimulation will be discussed, including the short-term protection from calcium overload in the form of calcium signaling silencing and the eventual progression to diastolic calcium leak causing afterdepolarizations and the development of an electrical substrate that perpetuates AF. The role of calcium in the bidirectional relationship between heart failure and AF will then be covered. The effects of heart failure on atrial calcium handling that promote AF will be reviewed, including effects on both atrial myocytes and the pulmonary veins, before the aspects of AF which exacerbate heart failure are discussed. Finally, the limitations of human and animal studies will be explored allowing contextualization of what are sometimes discordant results.
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Affiliation(s)
- Nathan C. Denham
- Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | | | | | | | | | | | - Katharine M. Dibb
- Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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21
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Seewöster T, Büttner P, Nedios S, Sommer P, Dagres N, Schumacher K, Bollmann A, Hilbert S, Jahnke C, Paetsch I, Hindricks G, Kornej J. Association Between Cardiovascular Magnetic Resonance-Derived Left Atrial Dimensions, Electroanatomical Substrate and NT-proANP Levels in Atrial Fibrillation. J Am Heart Assoc 2018; 7:e009427. [PMID: 30371296 PMCID: PMC6404891 DOI: 10.1161/jaha.118.009427] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022]
Abstract
Background Enlargement of left atrial ( LA ) size indicates advanced disease stage in patients with atrial fibrillation ( AF ) and is associated with poor success of different AF therapies. Two dimensional echocardiographic LA measurements do not reliably reflect the true size of LA anatomy. The aim of the current study was: 1) to analyze cardiovascular magnetic resonance ( CMR )-derived LA dimensions and their association with low voltage areas ( LVA ); and 2) to investigate the association between these parameters and NT -pro ANP (N-terminal proatrial natriuretic peptide) levels. Methods and Results Patients undergoing first AF catheter ablation were included. All patients underwent CMR imaging (Ingenia 1.5T Philips) before intervention. CMR data ( LA volume, superior-inferior, transversal and anterior-posterior LA diameters) were measured in all patients. LVA were determined using high-density maps and a low voltage threshold <0.5 mV. Blood plasma samples from femoral vein were collected before catheter ablation. NT -pro ANP levels were studied using commercially available assays. There were 216 patients (65±11 years, 59% males, 56% persistent AF , 26% LVA ) included into analyses. NT -pro ANP levels in patients with LVA were significantly higher than in those without (median/interquartile range 22 [13-29] versus 15 [9-22] pg/mL, P=0.004). All CMR derived LA diameters correlated significantly with persistent AF ( r²=0.291-0.468, all P<0.001), LVA ( r²=0.187-0.306, all P<0.001), and NT -pro ANP levels ( r²=0.258-0.352, P<0.01). On logistic regression multivariable analysis, age (odds ratio=1.090, 95% confidence interval: 1.030-1.153, P=0.003), females (odds ratio=2.686, 95% confidence interval: 1.047-6.891, P=0.040), and LA volume (odds ratio=1.022, 95% confidence interval: 1.009-1.035, P=0.001) remained significant predictors for LVA . Conclusions Left atrial CMR parameters are associated with persistent AF , low voltage areas and NT -pro ANP levels. LA volume is the most significant predictor for LVA .
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Affiliation(s)
- Timm Seewöster
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Petra Büttner
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Sotirios Nedios
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Philipp Sommer
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Nikolaos Dagres
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Katja Schumacher
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Andreas Bollmann
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Sebastian Hilbert
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Cosima Jahnke
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Ingo Paetsch
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Gerhard Hindricks
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Jelena Kornej
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Institute for Medical Informatics, Statistics, and EpidemiologyUniversity of LeipzigLeipzigGermany
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22
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Motoc A, Abugattas JP, Roosens B, Scheirlynck E, Heyndrickx B, de Asmundis C, Chierchia GB, Droogmans S, Cosyns B. Left atrium remodeling predicts late recurrence of paroxysmal atrial fibrillation after second generation cryoballoon ablation. Cardiovasc Ultrasound 2018; 16:19. [PMID: 30249263 PMCID: PMC6154403 DOI: 10.1186/s12947-018-0137-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia worldwide. Nowadays, AF ablation is a valuable treatment option. It has been shown that the left atrium (LA) diameter is a predictor of AF recurrence after cryoballoon ablation (CBA). Since it does not reflect the true LA size, we compared the role of different LA anatomical parameters using echocardiography for the prediction of AF recurrence after CBA. Methods We retrospectively included 209 patients (mean age 56.1 ± 13.6 years, male 62%) with paroxysmal AF undergoing CBA. A transthoracic echocardiography was performed in all patients. Results At a mean follow-up of 16.9 ± 6.3 months, AF recurred in 25.4% of the patients. LA anterior - posterior diameter (LAD), LA minimum volume (LAmin) and early AF recurrence were independent predictors of recurrence. Based on receiver operating characteristics, cut – off values for LAD and, LAmin were 41 mm, 23.69 mL, respectively. The negative predictive values for recurrence were 73% and 87.3% respectively. In patients with AF recurrence, a significant proportion (30.2%) showed LA longitudinal remodeling (LA superior – inferior diameter) even though classically measured LAD was normal. Conclusions Longitudinal LA remodeling plays an additional role for predicting AF recurrence after CBA, in patients without LAD dilation. Moreover, LAmin had a high negative predictive value and was an independent predictor of AF recurrence. Therefore, a more complete LA anatomical assessment allows a better prediction of AF recurrences after CBA.
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Affiliation(s)
- Andreea Motoc
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Juan-Pablo Abugattas
- Heart Rhythm Management Centre, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bram Roosens
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Esther Scheirlynck
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Benedicte Heyndrickx
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | - Steven Droogmans
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bernard Cosyns
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Szilágyi J, Walters TE, Marcus GM, Vedantham V, Moss JD, Badhwar N, Lee B, Lee R, Tseng ZH, Gerstenfeld EP. Surface ECG and intracardiac spectral measures predict atrial fibrillation recurrence after catheter ablation. J Cardiovasc Electrophysiol 2018; 29:1371-1378. [PMID: 30016007 DOI: 10.1111/jce.13699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/22/2018] [Accepted: 07/06/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Outcome of patients undergoing catheter ablation of atrial fibrillation (AF) varies widely. We sought to investigate whether parameters derived from the spectral analysis of surface ECG and intracardiac AF electrograms can predict outcome in patients referred for pulmonary vein isolation (PVI). METHODS We performed spectral analysis on the surface ECG and intracardiac electrograms from patients referred for AF ablation. After filtering and QRST subtraction, we measured the dominant frequency (DF), regularity index (RI) and the organizational index (OI) of fibrillatory electrograms and determined their value for predicting AF recurrence after ablation. A subjective, blinded prediction based on the surface ECG was also performed. RESULTS We analyzed data from 153 PVI procedures in 140 patients (67.1% with persistent or longstanding AF). In a multivariable model, DF in the right atrium (RA) and distal coronary sinus (CSd)-to-RA DF gradient predicted AF recurrence (OR, 3.52, P = 0.023 and OR, 0.2, P = 0.034, respectively). DF in RA and CSd to RA DF gradient had a good predictive value for PVI outcome (area under the curve [AUC] of 0.73, P = 0.007 and 0.74, P = 0.007, respectively). These performed better than the subjective predictions of experienced electrophysiologists ( P = 0.2). CONCLUSIONS Higher RA DF, lower CSd to RA DF gradient predicted recurrence after AF ablation. These spectral measures suggest a more remodeled atrial substrate and may provide simple tools for risk stratification or predict the need for additional substrate modification in patients referred for AF ablation.
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Affiliation(s)
- Judit Szilágyi
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California.,Second Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Tomos E Walters
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
| | - Gregory M Marcus
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
| | - Vasanth Vedantham
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
| | - Joshua D Moss
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
| | - Nitish Badhwar
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
| | - Byron Lee
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
| | - Randall Lee
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
| | - Zian H Tseng
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
| | - Edward P Gerstenfeld
- Department of Medicine, The UCSF Section of Cardiac Electrophysiology, University of California, San Francisco, California
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Celik AI, Kanadasi M, Demir M, Deniz A, Akilli RE, Deveci OS, Cagliyan CE, Ozmen C, Ikikardes F, Karaaslan MB. Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio. Indian Pacing Electrophysiol J 2018; 19:9-14. [PMID: 30712532 PMCID: PMC6354203 DOI: 10.1016/j.ipej.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/02/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
Background Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. Methods 50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). Results In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ± 18.13 ml and 53.24 ± 22.11 ml vs 48.85 ± 12.89 ml and 42.08 ± 13.85 (p = 0.037). LAVi were 20.9 ± 8.91 ml/m2 and 26.85 ± 11.28 ml/m2 vs 25.36 ± 6.21 and 21.87 ± 6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ± 4.09 ng/ml and 6.02 ± 2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ± 1.07 103/μl and 1.98 ± 0.66 103/μl (p = 0.674). Conclusion LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.
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Affiliation(s)
- Aziz Inan Celik
- Bayburt State Hospital, Department of Cardiology, Bayburt, Turkey.
| | - Mehmet Kanadasi
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Mesut Demir
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Ali Deniz
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Rabia Eker Akilli
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Onur Sinan Deveci
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Caglar Emre Cagliyan
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Caglar Ozmen
- Pazarcık State Hospital, Department of Cardiology, Kahramanmaras, Turkey.
| | - Firat Ikikardes
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
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Nedios S, Koutalas E, Sommer P, Arya A, Rolf S, Husser D, Bollmann A, Hindricks G, Breithardt OA. Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes. Europace 2018; 19:1463-1469. [PMID: 27738076 DOI: 10.1093/europace/euw225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/27/2016] [Indexed: 11/12/2022] Open
Abstract
Aims The association between anatomical left atrial (LA) remodelling and ventricular diastolic dysfunction (DD) in atrial fibrillation (AF) patients is not well studied. We aimed to examine the effect of DD on anatomic LA remodelling and their relation with ablation outcomes. Methods and results In 104 patients (58 ± 10 years, 69% male) referred for AF ablation, LA volume (LAV) was determined by computed tomography. A cutting plane, between the pulmonary vein (PV) ostia and the appendage and parallel to the posterior wall, divided LAV into anterior- (LA-A) and posterior-LA parts. The ratio of LA-A and LAV was defined as the LA asymmetry index (ASI). According to the current guidelines, the presence of DD was evaluated by echocardiography. Regression analysis was used to identify predictors of asymmetry changes and long-term success. Univariate linear regression revealed that ASI is associated with LAV, the presence of DD, and mitral regurgitation. Asymmetry index was higher in patients with DD (n = 35, 62 ± 5 vs. 59 ± 6%, P = 0.013) or mitral regurgitation (n = 67, 61 ± 6 vs. 58 ± 5%, P = 0.025). Multiple linear regression analysis showed that DD (B = 2.6, β = 0.207, 95% confidence interval, CI: 0.167-5.011, P = 0.036) and LAV (B = 0.037, β = 0.211, 95% CI: 0.003-0.071, P = 0.033) were the only factors independently associated with ASI (adjusted r2 = 0.92, F = 6.2, P = 0.003). Regression analysis showed that AF recurrence (33% after 24 months) is associated with asymmetric LA changes, while DD is not. Conclusions Left atrial symmetry changes are associated with DD and dilatation. Since DD could cause LA remodelling, appropriate early treatment should be considered for AF patients with DD, before geometrical changes occur.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Emmanuel Koutalas
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Daniela Husser
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Ole-Alexander Breithardt
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
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Odozynski G, Forno ARJD, Lewandowski A, Nascimento HG, d'Avila A. Paroxysmal Atrial Fibrillation in Females: Understanding gender diferences. Arq Bras Cardiol 2018; 110:449-454. [PMID: 29723328 PMCID: PMC5967139 DOI: 10.5935/abc.20180069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/22/2017] [Indexed: 12/02/2022] Open
Abstract
Background The catheter ablation of atrial fibrillation (AF) is performed less
frequently in women. In addition, there is divergent information in the
literature regarding the effectiveness and safety for the ablative procedure
to females. Objectives The objective of this study was to compare the clinical characteristics and
outcomes in men and women undergoing paroxysmal atrial fibrillation (PAF)
ablation. Methods Cohort study of patients undergoing first-ever PAF catheter ablation
procedure refractory to antiarrhythmic drugs. The information was taken from
patients’ records by means of a digital collection instrument and indexed to
an online database (Syscardio®). Clinical characteristics and
procedures were compared between each gender (M x F), adopting a level of
statistical significance of 5%. The primary endpoint associated with
efficacy was freedom from atrial arrhythmia over the follow-up time. Results 225 patients were included in the study, 64 (29%) women and 161 (71%) men.
Women presented more symptoms due to AF according to the CCS-SAF score (1.8
± 0.8M x 2.3 ± 0.8F p = 0.02) and higher CHADS2 score compared
to men (0.9 ± 0.8M x 1.2 ± 1F). Post-ablation recurrence
occurred in 20% of the patients, with no difference based on gender (21% M x
20% F p = 0.52). The rate of complications was less than 3% for both groups
(p = 0.98). Conclusion Women undergoing the first-ever PAF catheter ablation procedure present
similar complication rate and clinical outcome compared to men. These
findings suggest that the current underutilization of AF catheter ablation
in women may represent a discrepancy in care.
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Affiliation(s)
- Gabriel Odozynski
- Universidade Federal de Santa Catarina - Florianópolis, SC - Brazil.,Serviço de Arritmia e Marcapasso - Hospital SOS Cardio - Florianópolis, SC - Brazil
| | | | - Andrei Lewandowski
- Serviço de Arritmia e Marcapasso - Hospital SOS Cardio - Florianópolis, SC - Brazil
| | | | - André d'Avila
- Serviço de Arritmia e Marcapasso - Hospital SOS Cardio - Florianópolis, SC - Brazil
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Beltrami M, Palazzuoli A, Padeletti L, Cerbai E, Coiro S, Emdin M, Marcucci R, Morrone D, Cameli M, Savino K, Pedrinelli R, Ambrosio G. The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction. Int J Clin Pract 2018; 72. [PMID: 29283475 DOI: 10.1111/ijcp.13050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/29/2017] [Indexed: 12/28/2022] Open
Abstract
AIM Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools. METHODS The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed. RESULTS In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk. CONCLUSION Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies.
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Affiliation(s)
- Matteo Beltrami
- Cardio-Thoracic and Vascular Department, University of Florence, Florence, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Palazzuoli
- Department of Internal Medicine, Cardiovascular Diseases Unit, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | | | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Florence, Italy
| | - Stefano Coiro
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic diseases, University of Florence, Florence, Italy
| | - Doralisa Morrone
- Surgery, medicine, molecular and critical area Department, Cardiovascular disease Section 2, Pisa, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Ketty Savino
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Roberto Pedrinelli
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
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Fayad E, Boucebci S, Vesselle G, Zourdani H, Herpe G, Hamya I, Ingrand P, Christiaens L, Tasu J. Left atrial volume assessed by ECG-gated computed tomography: Variations according to age, gender and time during the cardiac cycle. Diagn Interv Imaging 2018; 99:105-109. [DOI: 10.1016/j.diii.2017.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/07/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
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Njoku A, Kannabhiran M, Arora R, Reddy P, Gopinathannair R, Lakkireddy D, Dominic P. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace 2017; 20:33-42. [DOI: 10.1093/europace/eux013] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/21/2017] [Indexed: 11/13/2022] Open
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Singh SM, D'Avila A, Aryana A, Kim YH, Mangrum JM, Michaud GF, Dukkipati SR, Heist EK, Barrett CD, Thorpe KE, Reddy VY. Persistent Atrial Fibrillation Ablation in Females: Insight from the MAGIC-AF Trial. J Cardiovasc Electrophysiol 2016; 27:1259-1263. [PMID: 27461576 DOI: 10.1111/jce.13051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is less frequently performed in women when compared to men. There are conflicting data on the safety and efficacy of AF ablation in women. The objective of this study was to compare the clinical characteristics and outcomes in a contemporary cohort of men and women undergoing persistent AF ablation procedures. METHODS AND RESULTS A total of 182 men and 53 women undergoing a first-ever persistent AF catheter ablation procedure in The Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF) trial were evaluated. Clinical and procedural characteristics were compared between each gender. The primary efficacy endpoint was the 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs. Women undergoing catheter ablation procedures were older than men (P < 0.001). The duration of AF and associated co-morbidities were similar between both genders. Single procedure drug-free atrial arrhythmia recurrence occurred in 53% of the cohort with no difference based on gender (men = 54%, women = 53%; P = 1.0). Procedural (P = 0.04), fluoroscopic (P = 0.02), and ablation times (P = 0.003) were shorter in women compared to men. Periprocedural complications and postablation improvement in quality of life were similar between men and women. CONCLUSION Women undergoing a first-ever persistent AF ablation procedure were older but had similar clinical outcomes and complications when compared with men.
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Affiliation(s)
- Sheldon M Singh
- Schulich Heart Program, Sunnybrook Health Science Center, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Andre D'Avila
- Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Instituto de Pesquisa em Arritmia Cardiaca - Hospital Cardiologico, Florianopolis, SC, Brazil
| | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart & Vascular Institute, Sacramento, California, USA
| | - Young-Hoon Kim
- Cardiovascular Division, Korea University Medical Center, Seoul, Korea
| | - J Michael Mangrum
- Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Srinivas R Dukkipati
- Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - E Kevin Heist
- Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Conor D Barrett
- Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital University of Toronto, Toronto, Canada
| | - Vivek Y Reddy
- Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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31
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Osmanagic A, Möller S, Osmanagic A, Sheta HM, Vinther KH, Egstrup K. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion: An Echocardiographic Study. Clin Cardiol 2016; 39:406-12. [PMID: 27163514 DOI: 10.1002/clc.22545] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/12/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial sphericity index (LASI) acquired by 2-dimensional transthoracic echocardiography (TTE) could be used as a predictor of AF recurrence after successful DCC. HYPOTHESIS A baselline LASI assessed by 2D TTE can predict AF recurrence after successful DCC in patients with persistent AF. METHODS A total of 124 consecutive patients with persistent AF lasting <120 days underwent successful DCC. Other than β-blockers, no other antiarrhythmic treatment was administered. Prior to DCC, all patients underwent thorough TTE, and LASI was calculated as the fraction of the left atrial width/length of the largest possible left atrial volume in a 4-chamber view. The primary outcome was a TTE-estimated baseline LASI as a predictor of AF recurrence after successful DCC for persistent AF. RESULTS Anatomically, a more spherical shape of the left atrium (LASI >0.9) proved to be a strong and independent predictor of AF recurrence, with an odds ratio between 4.1 (95% confidence interval: 1.6-11.9, P = 0.005) and 7.6 (95% confidence interval: 3.3-19.7; P = 7.2 × 10(-6) ). The receiver operating characteristic curve indicated good power for distinguishing between recurring and nonrecurring AF, and we chose a cutoff of 0.9 because high specificity was a priority for clinical reasons. CONCLUSIONS In conclusion, baseline LASI >0.9 was associated with significantly greater AF recurrence throughout the 12-month follow-up period.
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Affiliation(s)
- Armin Osmanagic
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Sören Möller
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Azra Osmanagic
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Hussam M Sheta
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Kristina H Vinther
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Kenneth Egstrup
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
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32
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Nedios S, Seewöster T, Lip GHY, Husser D, Hindricks G, Bollmann A, Kornej J. Association between peripheral plasma markers and left atrial anatomy in patients with atrial fibrillation. Int J Cardiol 2016; 203:621-3. [PMID: 26580343 DOI: 10.1016/j.ijcard.2015.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sotirios Nedios
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany.
| | - Timm Seewöster
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Gregory H Y Lip
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Daniela Husser
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Gerhard Hindricks
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Andreas Bollmann
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Jelena Kornej
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany; University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
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