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Zeng D, Chang S, Zhang X, Zhong Y, Cai Y, Huang T, Wu J. Development and validation of a predictive model for atrial fibrillation recurrence post-catheter ablation in non-valvular atrial fibrillation patients based on hemodynamic parameters. Heart Rhythm 2024:S1547-5271(24)03284-3. [PMID: 39236992 DOI: 10.1016/j.hrthm.2024.08.058] [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: 04/10/2024] [Revised: 08/17/2024] [Accepted: 08/27/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The influence of hemodynamic parameters on the recurrence of atrial fibrillation (AF) following catheter ablation is not well known, and it remains unclear whether a nomogram combining risk factors and hemodynamic parameters improves prediction accuracy. OBJECTIVE This study aimed to develop a nomogram based on echocardiographic hemodynamic parameters for predicting AF recurrence following catheter ablation in non-valvular atrial fibrillation (NVAF). METHODS A total of 380 consecutive NVAF patients undergoing AF catheter ablation treatment were prospectively collected. Patients were divided into training and validation cohorts at a 7:3 ratio. The follow-up duration averaged 9 months with a median of 12 months, during which 132 patients (34.7%) experienced a recurrence of AF. RESULTS LASSO regression and Cox regression analyses identified four significant predictors of AF recurrence: persistent AF (HR=1.63, 95% CI=1.02∼2.61, P=0.041), the systolic/diastolic (S/D) ratio (HR=0.50, 95% CI=0.30∼0.84, P=0.009), left atrial acceleration factor α (HR=1.31, 95% CI=1.02∼1.68, P=0.032), and left atrial appendage peak emptying flow velocity (HR=0.98, 95% CI=0.97∼0.99, P=0.004). Based on these four variables, a predictive nomogram was constructed. The nomogram demonstrated C-indexes of 0.664 and 0.728 for predicting 1-year and 2-year AF recurrence, respectively, in the validation cohort. The Kaplan-Meier survival analysis indicated that a Nomo-score greater than 128 was associated with a higher risk of AF recurrence. CONCLUSION Hemodynamic parameters may offer valuable insight in predicting AF recurrence following catheter ablation. Our study successfully developed a reliable nomogram based on echocardiographic hemodynamic parameters to estimate the risk of AF recurrence after catheter ablation in NVAF patients.
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Affiliation(s)
- Decai Zeng
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University
| | - Shuai Chang
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University
| | - Xiaofeng Zhang
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University
| | - Yanfen Zhong
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University
| | - Yongzhi Cai
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University
| | - Tongtong Huang
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University
| | - Ji Wu
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University.
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Barilli M, Mandoli GE, Sisti N, Dokollari A, Ghionzoli N, Soliman-Aboumarie H, D’Ascenzi F, Focardi M, Cavigli L, Pastore MC, Cameli M. Potential Role of Left Atrial Strain to Predict Atrial Fibrillation Recurrence after Catheter Ablation Therapy: A Clinical and Systematic Review. J Cardiovasc Dev Dis 2024; 11:203. [PMID: 39057623 PMCID: PMC11277505 DOI: 10.3390/jcdd11070203] [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: 03/15/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Pulmonary vein isolation (PVI) with catheter ablation (CA) represents an effective therapy for atrial fibrillation (AF). Unfortunately, it is still not exempt from severe complications. The balance of risks and benefits should be assessed, and a patient-tailored approach is desirable. So far, several clinical and cardiac imaging parameters have been evaluated to investigate pre- and post-procedural features that could help clinicians in the selection of patients at high risk of a poor outcome after CA. This clinical and systematic review analyses the potential role of new LA parameters, such as LA reservoir strain, to predict AF recurrence after CA therapy. Notably, LA reservoir strain gains substantial clinical importance in patients with paroxysmal AF and when a low CHADS2-VASc score is retrieved. LA reservoir strain provides data concerning the risk of AF recurrence after PVI and, thus, in the management of long-term medical therapy in this patient's group.
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Affiliation(s)
- Maria Barilli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Nicolò Sisti
- Cardiology Unit, Electrophysiology Section, Gualdo Tadino Hospital, 06024 Gubbio, Italy
| | - Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Nicolò Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Hatem Soliman-Aboumarie
- Department of Anaesthetics and Cardiothoracic Critical Care, Harefield Hospital, Hill End Road, Uxbridge UB9 6JH, UK;
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
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Levent F, Kanat S, Tutuncu A. Predictive Value of C2HEST Score for Atrial Fibrillation Recurrence Following Successful Cryoballoon Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation. Angiology 2023; 74:273-281. [PMID: 35583221 DOI: 10.1177/00033197221102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The C2HEST score ((coronary artery disease (CAD) or chronic obstructive pulmonary disease (COPD) [C2, 1 point each]; hypertension [H, 1 point]; elderly [E, age ≥75 years, 2 points]; systolic heart failure [S, 2 points]; thyroid disease [T, hyperthyroidism, 1 point]) has been validated for predicting incidental atrial fibrillation (AF) in both the general population and patients with ischemic stroke. The present study evaluated the performance of this score in predicting AF recurrence in 252 patients following cryoballoon ablation (CRYO) for paroxysmal AF. The AF recurrence rate in 3-12 months following CRYO was 20,2%. The predictive value of the C2HEST score was significantly better than that of the CHA2DS2-VASc score ((congestive heart failure, hypertension, age (>65 = 1 point, >75 = 2 points), diabetes, previous stroke/transient ischemic attack (2 points), vascular disease, age 65-74 years, and sex category)) (area under curve [AUC]: .881 vs .741; P = .0017). C2HEST score of ≥2, increased atrial diameter, and E/e' ratio as well as, the presence of COPD and systolic heart failure (SHF) were independent predictors for AF recurrence (P < .05). In patients undergoing CRYO for paroxysmal AF, the C2HEST, a simple clinical score, could be useful to assess the risk of AF recurrence.
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Affiliation(s)
- Fatih Levent
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
| | - Selçuk Kanat
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
| | - Ahmet Tutuncu
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
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Lin Y, Fu S, Yao Y, Li Y, Zhao Y, Luo L. Heart failure with preserved ejection fraction based on aging and comorbidities. J Transl Med 2021; 19:291. [PMID: 34229717 PMCID: PMC8259336 DOI: 10.1186/s12967-021-02935-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/10/2021] [Indexed: 12/25/2022] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause of hospitalizations and mortality when diagnosed at the age of ≥ 65 years. HFpEF represents multifactorial and multisystemic syndrome and has different pathophysiology and phenotypes. Its diagnosis is difficult to be established based on left ventricular ejection fraction and may benefit from individually tailored approaches, underlying age-related changes and frequent comorbidities. Compared with the rapid development in the treatment of heart failure with reduced ejection fraction, HFpEF presents a great challenge and needs to be addressed considering the failure of HF drugs to improve its outcomes. Further extensive studies on the relationships between HFpEF, aging, and comorbidities in carefully phenotyped HFpEF subgroups may help understand the biology, diagnosis, and treatment of HFpEF. The current review summarized the diagnostic and therapeutic development of HFpEF based on the complex relationships between aging, comorbidities, and HFpEF.
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Affiliation(s)
- Ying Lin
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, 572013, China
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, 572013, China.
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Yao Yao
- Centre for the Study of Ageing and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, 27708, USA
- Centre for Healthy Ageing and Development Studies, National School of Development, Peking University, Beijing, 100871, China
| | - Yulong Li
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, 572013, China.
| | - Leiming Luo
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
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Akima T, Sekine K, Yamaoka K, Seki Y, Nakajima K, Munakata M, Kanki H, Akaishi M, Koyama T. Left Ventricular Diastolic Dysfunction Is Associated With the Prevalence of Paroxysmal Atrial Fibrillation Determined on the Latest Echocardiographic Criteria. Circ Rep 2020; 2:657-664. [PMID: 33693192 PMCID: PMC7937499 DOI: 10.1253/circrep.cr-20-0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background:
The relationship between left ventricular diastolic dysfunction (LVDD) and paroxysmal atrial fibrillation (PAF) remains unclear because of a lack of standard measures to evaluate LVDD. Accordingly, we examined the association between the prevalence of PAF and each LVDD grade determined according to the latest American Society of Echocardiography guidelines. Methods and Results:
In all, 2,063 patients without persistent AF who underwent echocardiography at Saitama Municipal Hospital from July 2016 to June 2017 were included in the study. Patients were divided into LVDD 6 categories: No-LVDD (n=1,107), Borderline (n=392), Grade 1 (n=204), Indeterminate (n=62), Grade 2 (n=254), and Grade 3 (n=44). PAF was documented in 111 (10.0%), 81 (20.7%), 28 (13.7%), 6 (9.7%), 52 (20.5%), and 24 (54.5%) patients in the No-LVDD, Borderline, Grade 1, Indeterminate, Grade 2, and Grade 3 categories, respectively. PAF prevalence was higher in patients with Grade 3 LVDD across the whole study population. Subgroup analyses showed that the prevalence of PAF increased with increased LVDD grade in patients with reduced left ventricular ejection fraction. This relationship was significant in multivariate analysis including various patient characteristics. Conclusions:
LVDD severity determined on the basis of the latest echocardiographic criteria was associated with the prevalence of PAF. The present findings shed light on the development of new therapeutic markers for PAF.
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Affiliation(s)
- Takashi Akima
- Department of Cardiology, Saitama-Municipal Hospital
| | | | - Koki Yamaoka
- Department of Cardiology, Saitama-Municipal Hospital
| | - Yuta Seki
- Department of Cardiology, Saitama-Municipal Hospital
| | | | | | - Hideaki Kanki
- Department of Cardiology, Saitama-Municipal Hospital
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Lu L, Che J, Xie W, Cheng W, Yang Z, Dong R, Huang J, Lu J. Adjusted preoperative variables to predict perioperative red blood cell transfusion in coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2020; 68:1377-1387. [PMID: 32418192 DOI: 10.1007/s11748-020-01386-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The variables for predicting blood transfusion perioperatively are not completely clear in coronary artery bypass grafting (CABG) patients. OBJECTIVES To construct a comprehensive model to predict perioperative RBC transfusion in patients undergoing isolated CABG using adjusted preoperative variables. METHODS Perioperative data of 1253 patients who underwent isolated CABG by the same surgical team were collected from April 2018 to March 2019. Logistic regression analyses were used to establish equations to construct two models for predicting intraoperative and postoperative RBC transfusions, respectively. All significant variables included in the two models were combined to form a comprehensive model to predict perioperative RBC transfusion. Area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discriminatory power of the models. RESULTS The total RBC transfusion rate for CABG patients during hospitalization was 29.05%. The rate of intraoperative and postoperative RBC transfusions was 6.9% and 26.7%, respectively. Eight variables in a total of 30 risk factors constituted the intraoperative prediction model, 12 variables constituted the postoperative prediction model, and 13 variables for the combined model. The AUC of the three models were 0.87, 0.82, and 0.83, respectively, demonstrating moderate discriminatory power for RBC transfusion during the intraoperative, postoperative, and perioperative periods. CONCLUSION The comprehensive model combined with all variables of predicting intraoperative and postoperative RBC transfusion is feasible for predicting perioperative RBC transfusion.
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Affiliation(s)
- Liangyuan Lu
- Department of Anesthesiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 An Zhen Road, Chaoyang District, Beijing, 100029, Beijing, China
- Department of Anesthesiology, Aerospace Center Hospital, Beijing, China
| | - Ji Che
- Department of Transfusion, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Weiping Cheng
- Department of Anesthesiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 An Zhen Road, Chaoyang District, Beijing, 100029, Beijing, China
| | - Zhanmin Yang
- Department of Anesthesiology, Aerospace Center Hospital, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, 530 South Jackson Street, Louisville, KY, 40202, USA.
| | - Jiakai Lu
- Department of Anesthesiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 An Zhen Road, Chaoyang District, Beijing, 100029, Beijing, China.
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Packer M. Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment. Eur J Heart Fail 2019; 22:214-227. [PMID: 31849132 DOI: 10.1002/ejhf.1646] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk-to-benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post-ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.,Imperial College London, London, UK
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Chen F, Sun Q, Li H, Qu S, Yu W, Jiang S, Tian J. Value of dual Doppler echocardiography for prediction of atrial fibrillation recurrence after radiofrequency catheter ablation. BMC Cardiovasc Disord 2019; 19:257. [PMID: 31729953 PMCID: PMC6858698 DOI: 10.1186/s12872-019-1233-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/23/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Increasing evidence has been presented which suggests that left ventricular (LV) diastolic dysfunction may play an important role in the development of atrial fibrillation (AF). However, the potential for LV diastolic dysfunction to serve as a predictor of AF recurrence after radiofrequency catheter ablation remains unresolved. METHODS Dual Doppler and M-PW mode echocardiography were performed in 67 patients with AF before ablation and 47 patients with sinus rhythm. The parameters measured within identical cardiac cycles included, the time interval between the onset of early transmitral flow peak velocity (E) and that of early diastolic mitral annular velocity (e') (TE-e'), the ratio of E to color M-mode Doppler flow propagation velocity (Vp)(E/Vp), the Tei index, the ratio of E and mitral annular septal (S) peak velocity in early diastolic E/e'(S) and the ratio of E and mitral annular lateral (L) peak velocity E/e'(L). A follow-up examination was performed 1 year after ablation and patients were divided into two groups based on the presence or absence of AF recurrence. Risk estimations for AF recurrence were performed using univariate and multivariate logistic regression. RESULTS TE-e', E/Vp, the Tei index, E/e'(S) and E/e'(L) were all increased in AF patients as compared with the control group (p < 0.05). At the one-year follow-up examination, a recurrence of AF was observed in 21/67 (31.34%) patients. TE-e' and the Tei index within the recurrence group were significantly increased as compared to the group without recurrence (p < 0.001). Results from multivariate analysis revealed that TE-e' can provide an independent predictor for AF recurrence (p = 0.001). CONCLUSIONS Dual Doppler echocardiography can provide an effective and accurate technique for evaluating LV diastolic function within AF patients. The TE-e' obtained within identical cardiac cycles can serve as an independent predictor for the recurrence of AF as determined at 1 year after ablation.
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Affiliation(s)
- Fengjiao Chen
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Qinliang Sun
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Hairu Li
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Shaohui Qu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Weidong Yu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Shuangquan Jiang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Jiawei Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China.
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Packer M. Heightened risk of intensive rate control in patients with atrial fibrillation who are obese or have type 2 diabetes: A critical review and re-evaluation. J Cardiovasc Electrophysiol 2019; 30:3020-3024. [PMID: 31626365 DOI: 10.1111/jce.14236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/19/2019] [Accepted: 10/09/2019] [Indexed: 01/03/2023]
Abstract
Atrial fibrillation (AF) is common in patients with obesity and diabetes; the arrhythmia (if long-standing) is typically managed by rate control and anticoagulation. However, the coexistence of these two metabolic disorders complicates therapeutic options for rate control. The likely pathogenesis of AF in these patients is an expansion of epicardial adipose tissue whose inflammation is transmitted to the left atrium causing electromechanical remodeling. However, this same process is also transmitted to the left ventricle (LV), impairing its distensibility and its ability to tolerate volume, leading to heart failure with preserved ejection fraction. Unfortunately, the latter diagnosis (although commonly present in patients with AF and a coexistent metabolic disorder) is often ignored. To achieve rate control, physicians prescribe intensive treatment with atrioventricular (AV) nodal-blocking drugs, often at doses that are titrated to blunt exercise as well as resting heart rate responses. However, strict rate control (target rate, <80/min) is associated with somewhat worse outcomes than lenient rate control (target rate, <110/min). Furthermore, any rate slowing that facilitates diastolic filling may aggravate filling pressures that are already disproportionately increased because the LV is stiff and overfilled as a result of cardiac inflammation. Rate slowing in AF with beta blockers may not achieve the benefit expected from the blockade of adrenergically mediated cardiotoxicity, and some AV nodal-blocking drugs (digoxin and dronedarone) can increase the risk of death in patients with AF. Finally, cardiac fibrosis in obesity and diabetes may affect the conduction system, which can predispose to serious bradyarrhythmias if patients are prescribed AV nodal-blocking drugs.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.,Imperial College London, London, United Kingdom
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10
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Arques S. Clinical Relevance of the Spectral Tissue Doppler E/e' Ratio in the Management of Patients with Atrial Fibrillation: a Comprehensive Review of the Literature. J Atr Fibrillation 2018; 11:2038. [PMID: 30505378 DOI: 10.4022/jafib.2038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/19/2018] [Accepted: 07/24/2018] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation is the most common cardiac rhythm disorder observed in clinical practice. It carries high morbidity and mortality rates, primarily related to heart failure, stroke and death. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is relevant in this clinical setting. The spectral tissue Dopplerderived E/e' ratio is a simple and reproducible index, which has been validated in noninvasive assessment of left ventricular diastolic pressures, regardless of rhythm. Septal E/e' >11 is a good predictor of invasively determined left ventricular diastolic pressure >15 mmHg in patients with atrial fibrillation. Several studies have validated the clinical relevance of abnormal values for E/e' at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. Increased E/e' value is associated with adverse outcome (death, left atrial appendage thrombus, stroke and heart failure) in patients with atrial fibrillation and predicts arrhythmia recurrence after cardioversion and catheter ablation. In conclusion, E/e' by spectral tissue Doppler is clinically relevant in the clinical management of any patients with atrial fibrillation referred for transthoracic Doppler echocardiography.
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Affiliation(s)
- Stephane Arques
- Department of Cardiology, Centre hospitalier Edmond Garcin, Aubagne, France
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11
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Liżewska-Springer A, Dąbrowska-Kugacka A, Lewicka E, Drelich Ł, Królak T, Raczak G. Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review. Cardiol J 2018; 27:848-856. [PMID: 29924375 PMCID: PMC8079104 DOI: 10.5603/cj.a2018.0067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/10/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Catheter ablation (CA) is a well-known treatment option for patients with symptomatic drug-resistant atrial fibrillation (AF). Multiple factors have been identified to determine AF recurrence after CA, however their predictive value is rather small. Identification of novel predictors of CA outcome is therefore of primary importance to reduce health costs and improve long-term results of intervention. The recurrence of AF following CA is related to severity of left ventricular (LV) dysfunction, extent of atrial dilatation and fibrosis. The aim of this paper was to present and discuss the latest studies on the utility of echocardiographic parameters in terms of CA effectiveness in patients with paroxysmal and persistent AF. METHODS PubMed, Google Scholar, EBSCO databases were searched for studies reporting echocardiographic preprocedural predictors of AF recurrence after CA. LV systolic and diastolic function, as well as atrial size, strain and dyssynchrony were taken into consideration. RESULTS Twenty one full-text articles were analyzed, including three meta-analyses. Several echocardiographic parameters have been reported to determine a risk of AF recurrence after CA. There are conventional methods that measure left atrial size and volume, LV ejection fraction, parameters assessing LV diastolic dysfunction, and methods using more innovative technologies based on speckle tracking echocardiography to determine left atrial synchrony and strain. Each of these parameters has its own predictive value. CONCLUSIONS Regarding CA effectiveness, every patient has to be evaluated individually to estimate the risk of AF recurrence, optimally using a combination of several echocardiographic parameters.
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Affiliation(s)
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland.
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Łukasz Drelich
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
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Arques S, Roux E. [Usefulness of spectral tissue Doppler (E/e' ratio) in the management of patients with atrial fibrillation]. Ann Cardiol Angeiol (Paris) 2017; 66:303-308. [PMID: 29025686 DOI: 10.1016/j.ancard.2017.09.011] [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: 05/22/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Atrial fibrillation is the most common cardiac rhythm disorder encountered in daily clinical practice. It carries high morbidity and mortality rates, mainly related to sudden death, heart failure and stroke. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is therefore attractive in this clinical setting. The spectral tissue Doppler-derived E/e' ratio is a simple and user-friendly index which has been validated in the assessment of left ventricular diastolic pressures, regardless of rhythm. A septal E/e' >11 is associated with invasive left ventricular diastolic pressures >15mmHg in patients with atrial fibrillation. Several studies have reported the clinical relevance of abnormal values of E/e' at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. There is now convincing evidence that increased E/e' is associated with adverse outcome in patients with atrial fibrillation and predicts the recurrence of arrhythmia after cardioversion or catheter ablation. In conclusion, we recommend the measurement of E/e' in each patient with atrial fibrillation referred for clinically indicated transthoracic Doppler echocardiography.
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Affiliation(s)
- S Arques
- Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France.
| | - E Roux
- Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France
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13
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Bossard M, Knecht S, Aeschbacher S, Buechel RR, Hochgruber T, Zimmermann AJ, Kessel-Schaefer A, Stephan FP, Völlmin G, Pradella M, Sticherling C, Osswald S, Kaufmann BA, Conen D, Kühne M. Conventional versus 3-D Echocardiography to Predict Arrhythmia Recurrence After Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol 2017; 28:651-658. [PMID: 28301685 DOI: 10.1111/jce.13202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Arrhythmia recurrence after atrial fibrillation (AF) ablation remains high and requires repeat interventions in a substantial number of patients. We assessed the value of conventional and 3-D echocardiography to predict AF recurrence. METHODS AND RESULTS Consecutive patients undergoing AF ablation by means of pulmonary vein isolation were included in a prospective registry. Echocardiograms were obtained prior to the ablation procedure, and analyzed offline in a standardized manner, including 3-D left atrial (LA) volumetry and determination of LA function and sphericity. The primary endpoint, AF recurrence (>30 seconds) between 3 to 12 months after AF ablation, was independently adjudicated. We included 276 patients (73% male, mean age 59.9 ± 9.9 years). Paroxysmal and persistent AF were present in 178 (64%) and 98 (36%) patients, respectively. Mean left ventricular ejection fraction and indexed LA volume in 3-D (LAVI) were 52 ± 12% and 42 ± 13 mL/m2 , respectively. AF recurrence was observed in 110 (40%) patients after a single procedure. Median (interquartile range) time to AF recurrence was 123 (92; 236) days. In multivariable Cox regression models, the only predictors for AF recurrence were the minimal, maximal, and indexed 3-D LA volumes, P = 0.024, P = 0.016, and P = 0.014, respectively. Quartile specific analysis of 3-D LAVI showed an HR of 1.885 (95%CI 1.066-3.334; P for trend = 0.015) for the highest compared to the lowest quartile. CONCLUSION Our results show the important role of LA volume for the long-term freedom from arrhythmia after AF ablation. These data also highlight the potential of 3-D echocardiography in this context and may facilitate patient selection for AF ablation.
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Affiliation(s)
- Matthias Bossard
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.,Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
| | - Sven Knecht
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Hochgruber
- Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Andreas J Zimmermann
- Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Arnheid Kessel-Schaefer
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Frank-Peter Stephan
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Gian Völlmin
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Maurice Pradella
- Department of Radiology and Nuclear Medicine, University Hospital Basel, University Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Beat A Kaufmann
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - David Conen
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.,Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland
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O'Neill L, Harrison J, O'Neill M, Williams SE. Clinical, electrophysiological and imaging predictors of atrial fibrillation ablation outcome. Expert Rev Cardiovasc Ther 2017; 15:289-305. [PMID: 28267401 DOI: 10.1080/14779072.2017.1303378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Significant technological advances for catheter ablation of atrial fibrillation (AF) have occurred over the last decade, with a consequent increase in numbers of patients referred for AF ablation worldwide. Despite this, long-term success rates, particularly in those with persistent AF, remain modest. The patient population presenting for AF ablation are heterogeneous with regard to age, type of AF and presence of associated cardiovascular disease. Improved understanding of factors predicting response to AF ablation may therefore help to improve patient selection for ablation procedures. Areas covered: This review outlines the clinical, electrophysiological and imaging predictors of response to radiofrequency ablation for AF in contemporary practice. Recently developed scoring systems incorporating these parameters are examined, as are factors identified thus far which may predict the outcome of cryoballoon ablation. Expert commentary: Traditional clinical factors associated with ablation outcomes serve as surrogates rather than direct measures of the underlying arrhythmia substrate. An improved understanding of this substrate could improve the prediction of response to radiofrequency ablation. Continued development of methods for characterising the arrhythmia substrate, including atrial cardiac magnetic resonance imaging and invasive voltage mapping, may inform patient risk assessment and help guide selection for catheter ablation on an increasingly individualistic basis.
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Affiliation(s)
- Louisa O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - James Harrison
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Mark O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Steven E Williams
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
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15
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Relationship between exercise induced elevation of left ventricular filling pressure and exercise intolerance in patients with atrial fibrillation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:546-51. [PMID: 27582773 PMCID: PMC4987427 DOI: 10.11909/j.issn.1671-5411.2016.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Elevated left ventricular filling pressure (LVFP) is an important cause of exercise intolerance in patients with atrial fibrillation (AF). Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. Methods This study included 145 consecutive patients (81 men and 64 women; mean age 65.5 ± 8.0 years) with persistent non-valvular AF and normal left ventricular systolic function (left ventricular ejection fraction ≥ 50%). All patients underwent a symptom-limited cardiopulmonary exercise test (CPET). Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity (E) and early diastolic mitral annular velocity (e') were taken and averaged. E/e' ratio was calculated. Elevated LVFP was defined as E/e' > 9, and patients with elevated LVFP at rest were excluded. Results Patients were classified into two groups according to LVFP estimated by E/e' ratio after exercise: 39 (26.9%) with elevated LVFP after exercise and 106 (73.1%) with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake (VO2 peak) (21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P < 0.001), lower anaerobic threshold (19.9 ± 2.5 vs. 26.0 ± 4.0 mL/min per kilogram, P < 0.001), and shorter exercise time duration (6.2 ± 0.8 vs. 7.0 ± 1.3 min, P < 0.001). Multivariate analysis showed that age, gender and E/e' after exercise were significantly correlated with VO2 peak. Conclusion Elevated LVFP estimated by E/e' ratio after exercise is independently associated with reduced exercise capacity in AF patients.
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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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Evranos B, Kocyigit D, Gurses KM, Yalcin MU, Sahiner ML, Kaya EB, Ozer N, Aytemir K. Increased left atrial pressure predicts recurrence following successful cryoablation for atrial fibrillation with second-generation cryoballoon. J Interv Card Electrophysiol 2016; 46:145-51. [DOI: 10.1007/s10840-016-0107-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/18/2016] [Indexed: 11/27/2022]
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