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Dittrich S, Kece F, Scheurlen C, van den Bruck JH, Filipovic K, Wörmann J, Erlhöfer S, Pavel F, Schipper JH, Sultan A, Lüker J, Steven D. Implementation and first outcomes of a novel standard operating procedure for preprocedural transoesophageal echocardiography screening in course of atrial arrhythmia ablation. Europace 2023; 25:euad279. [PMID: 37713241 PMCID: PMC10516708 DOI: 10.1093/europace/euad279] [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: 07/17/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS Preprocedural transoesophageal echocardiography (TEE) screening for left atrial (LA) thrombi is the standard of care in many centres performing atrial fibrillation (AF) ablation. However, TEE imposes procedural risks for patients and is often challenging to implement in daily practice, besides causing patient discomfort. At our centre, a novel standard operating procedure (SOP) was implemented, aiming to identify patients that can be exempt from TEE screening. We aimed to assess whether this screening approach may reduce preprocedural TEEs without imposing patients of higher risks for cerebrovascular events (CVEs). METHODS AND RESULTS Data of 1874 consecutive patients treated by catheter ablation of LA arrhythmias between 2018 and 2022 were retrospectively analysed. A cohort of 937 patients, where decision to perform TEE screening was based on a new SOP (considering rhythm at admission, CHA2DS2-VASc score, and sufficient anticoagulation), was compared to a matched cohort receiving TEE before every procedure. Number of performed TEEs and incidences of CVEs were compared. Implementation of the new SOP led to a 67% reduction in TEEs performed (old SOP: 933 vs. new SOP: 305). No significant differences between the groups were detected regarding transitory ischaemic attack (old SOP: 5 vs. new SOP: 3; P = 0.48) and stroke (no events). No solid thrombi were detected during TEE screening. CONCLUSION The number of preprocedural screening TEEs before AF ablation procedures can be safely reduced by applying risk stratification based on rhythm at admission and CHA2DS2-VASc score, if anticoagulation was performed properly.
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Affiliation(s)
- Sebastian Dittrich
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Fehmi Kece
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Cornelia Scheurlen
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Karlo Filipovic
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jonas Wörmann
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Susanne Erlhöfer
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Friederike Pavel
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Gawałko M, Budnik M, Uziębło-Życzkowska B, Krzesiński P, Scisło P, Kochanowski J, Jurek A, Kiliszek M, Gielerak G, Filipiak KJ, Opolski G, Kapłon-Cieślicka A. Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation. Int J Clin Pract 2020; 74:e13609. [PMID: 32654352 DOI: 10.1111/ijcp.13609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Decreased left atrial appendage emptying velocity (LAAV) is a known predictor of LAA thrombus in atrial fibrillation (AF). The aim of our study was to identify which of the clinical risk factors for LAA thrombus are associated with decreased LAAV. METHODS The study included 1476 consecutive AF patients who underwent transesophageal echocardiography (TEE) before AF direct current cardioversion or ablation in two high-reference cardiology departments. Patients were divided into two groups: 71 (4.8%) patients with LAAV < 20 cm/s and 1405 patients (95%) with LAAV ≥ 20 cm/s. RESULTS Compared with patients with LAAV ≥ 20 cm/s, those with decreased LAAV were older, more often had non-paroxysmal AF, were burdened with more concomitant diseases (including hypertension, diabetes, vascular disease, and heart failure [HF]) with higher median CHA2 DS2 -VASc score (3 [2-4] vs 2 [1-3], P < .0001), and had lower glomerular filtration rate (GFR). Prevalence of LAA thrombus was higher in patients with decreased LAAV compared with those with LAAV ≥ 20cm/s (20% vs 4.6%, P < .0001). In patients with decreased LAAV, there was no difference in the frequency of LAA thrombus between those treated with VKA and those receiving NOAC, while in patients with LAAV ≥ 20 cm/s a trend was observed towards a benefit with NOAC. In multivariate logistic regression, non-paroxysmal AF, HF and age ≥ 65 years predicted both LAAV < 20 cm/s and LAA thrombus, while GFR < 60 mL/min/1.73 m2 predicted only the presence of LAA thrombus. CONCLUSION One in five AF patients with decreased LAAV had LAA thrombus, regardless of the type of OAC. Non-paroxysmal AF, HF and age ≥ 65 years might increase LAA thrombus risk via reduced LAAV.
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Affiliation(s)
- Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Budnik
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Scisło
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochanowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | | | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Lin Y, Wu HK, Wang TH, Chen TH, Lin YS. Trend and risk factors of recurrence and complications after arrhythmias radiofrequency catheter ablation: a nation-wide observational study in Taiwan. BMJ Open 2019; 9:e023487. [PMID: 31152025 PMCID: PMC6549656 DOI: 10.1136/bmjopen-2018-023487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 03/22/2019] [Accepted: 05/08/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study determined the recurrence and complication rates after radiofrequency catheter ablation (RFCA) for those with paroxysmal supraventricular tachycardia (PSVT), Wolff-Parkinson-White syndrome (WPW), atrial flutter (AFL), atrial fibrillation (AF) and ventricular tachycardia (VT). STUDY DESIGN AND SETTING This retrospective study included RFCAs for 2001-2010 in the Taiwan National Health Insurance Research Database. Primary outcomes included perioperative complications (pericardial effusion and new-onset stroke), RFCA recurrence and long-term outcomes (high-grade atrioventricular block (AVB) and pacemaker implantation). RESULTS Of 19,475 patients who underwent RFCA, prevalence rates were 56.7% for PSVT, 13.5% for WPW, 9.5% for AFL, 5.1% for AF and 2.7% for VT. Prevalence rates increased in AF, AFL and VT over the study years. During an average follow-up period of 4.3 years (SD: 2.8 years), recurrence rates for PSVT, WPW, VT, AFL and AF were 2.0%, 4.9%, 5.7%, 5.8% and 16.1%, respectively. Compared with the PSVT group, the WPW and AF groups had significantly higher risk of pericardial effusion during admission (adjusted OR (aOR) 2.98, 95% CI (CI) 1.24 to 7.15; aOR 4.09, 95% CI 1.90 to 8.79, respectively); the AFL group had a higher risk of new-onset stroke during admission (aOR 4.07, 95% CI 1.39 to 11.91); the WPW group had a lower risk of high-grade AVB during follow-up (adjusted HR (aHR) 0.37, 95% CI 0.19 to 0.71) while the AFL group had a greater risk (aHR 1.74, 95% CI 1.17 to 2.60); and the AFL group had a higher risk of permanent pacemaker (aHR 2.14, 95% CI 1.27 to 3.62). CONCLUSIONS The RFCA rate increased rapidly during 2001-2010 for AF, AFL and VT. Recurrence was associated with congenital heart disease in PSVT and WPW, and with age in AF and AFL. AFL had a higher risk of permanent pacemaker implantation and new stroke. AF had a higher risk of life-threatening pericardial effusion.
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Affiliation(s)
- Yuan Lin
- Emergency Medicine Department, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - Hsin-Kuan Wu
- Emergency Medicine Department, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - Te-Hsiung Wang
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
- Biostatistical Consultation Center, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi, Taiwan
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Lip GY, Banerjee A, Boriani G, Chiang CE, Fargo R, Freedman B, Lane DA, Ruff CT, Turakhia M, Werring D, Patel S, Moores L. Antithrombotic Therapy for Atrial Fibrillation. Chest 2018; 154:1121-1201. [DOI: 10.1016/j.chest.2018.07.040] [Citation(s) in RCA: 481] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 02/08/2023] Open
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Vadmann H, Nielsen PB, Hjortshøj SP, Riahi S, Rasmussen LH, Lip GYH, Larsen TB. Atrial flutter and thromboembolic risk: a systematic review. Heart 2015; 101:1446-55. [DOI: 10.1136/heartjnl-2015-307550] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/13/2015] [Indexed: 11/04/2022] Open
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Fung E, Järvelin MR, Doshi RN, Shinbane JS, Carlson SK, Grazette LP, Chang PM, Sangha RS, Huikuri HV, Peters NS. Electrocardiographic patch devices and contemporary wireless cardiac monitoring. Front Physiol 2015; 6:149. [PMID: 26074823 PMCID: PMC4444741 DOI: 10.3389/fphys.2015.00149] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/27/2015] [Indexed: 01/19/2023] Open
Abstract
Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG), Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable “on-body” ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks) is indicated, these cardiac devices and related digital mobile health technologies are reshaping the clinician-patient interface with important implications for future healthcare delivery.
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Affiliation(s)
- Erik Fung
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA ; Department of Medicine, Geisel School of Medicine, Dartmouth College Hanover, NH, USA ; Department of Epidemiology and Biostatistics, Medical Research Council Health Protection Agency Centre for Environment and Health, School of Public Health, Imperial College London London, UK ; Digital Health Kitchen, Institute for Digital Health London, UK
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, Medical Research Council Health Protection Agency Centre for Environment and Health, School of Public Health, Imperial College London London, UK ; Faculty of Medicine, Center for Life Course Epidemiology, University of Oulu Oulu, Finland ; Biocenter Oulu, University of Oulu Oulu, Finland ; Unit of Primary Care, Oulu University Hospital Oulu, Finland
| | - Rahul N Doshi
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA
| | - Jerold S Shinbane
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA
| | - Steven K Carlson
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA
| | - Luanda P Grazette
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA
| | - Philip M Chang
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA ; Division of Cardiology, Children's Hospital Los Angeles Los Angeles, CA, USA
| | - Rajbir S Sangha
- Department of Medicine, Geisel School of Medicine, Dartmouth College Hanover, NH, USA ; Section of Cardiology, Dartmouth-Hitchcock Medical Center Lebanon, NH, USA
| | - Heikki V Huikuri
- Medical Research Center Oulu, Institute of Clinical Medicine, Oulu University Hospital and University of Oulu Oulu, Finland
| | - Nicholas S Peters
- Digital Health Kitchen, Institute for Digital Health London, UK ; National Heart and Lung Institute, Imperial College London, St Mary's and Hammersmith Hospitals London, UK
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Cresti A, García-Fernández MA, De Sensi F, Miracapillo G, Picchi A, Scalese M, Severi S. Prevalence of auricular thrombosis before atrial flutter cardioversion: a 17-year transoesophageal echocardiographic study. Europace 2015; 18:450-6. [PMID: 26017468 DOI: 10.1093/europace/euv128] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/13/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Prevalence of left appendage thrombosis ranges from 6 to 18% in persistent atrial fibrillation (AF). Few and low sample size studies have assessed left and right atrial thrombosis in persistent atrial flutter (AFL) and a wide variety of frequencies, from 1 to 21%, has been reported. The aim of this study was to evaluate the prevalence of atrial appendage thrombosis in a large population of patients undergoing transoesophageal echocardiography (TEE)-guided cardioversion (CV) for recent AFL onset and compare it with AF. METHODS AND RESULTS From 1999 to September 2014, we collected data of 1081 patients to CV: 877 affected by AF (81.1%) and 204 by AFL (18.9%). The presence of auricular thrombosis was evaluated by TEE in AF or AFL persisting for more than 48 h. The presence of appendage thrombosis, Doppler emptying velocities, and severe spontaneous echo contrast (SEC) was studied. The overall prevalence of atrial thrombosis was 9.62% (104/1081). Frequency of atrial thrombosis in AFL patients was 6.4% (13/204) vs. 10.5% among AF (92/877), P = 0.074. Comparing the two appendages, frequency of left atrial appendage thrombosis was in AFL 5.9% (12/204) vs. 9.9% (87/877) in the AF group, P = 0.07. Right atrial appendage thrombosis was present in 0.5% (1/204) in the AFL group vs. 0.8% (7/877) in the AF group, P = 0.64. Moderate to severe SEC (3+/4+) was present in 28% of AFL patients (57/204) vs. 35% of AF patients (307/877), P = 0.05. CONCLUSION Auricular thrombosis is not an infrequent finding in AFL before CV. Our study suggests the use of TEE screening in AFL, as well as in AF, when patients arrive to clinical attention after more than 48 h from arrhythmia onset.
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Affiliation(s)
- Alberto Cresti
- Cardiological Department, Misericordia Hospital, via Senese, Grosseto 58100, Italy
| | - Miguel Angel García-Fernández
- Department of Medicine, San Carlos University Hospital, Universidad Complutense, Facultad de Medicina, Madrid, Spain
| | - Francesco De Sensi
- Cardiological Department, Misericordia Hospital, via Senese, Grosseto 58100, Italy
| | - Gennaro Miracapillo
- Cardiological Department, Misericordia Hospital, via Senese, Grosseto 58100, Italy
| | - Andrea Picchi
- Cardiological Department, Misericordia Hospital, via Senese, Grosseto 58100, Italy
| | - Marco Scalese
- Department of Epidemiology and Health Research, Institute of Clinical Physiology, National Council of Research, F. G. Monasterio, Pisa, Italy
| | - Silva Severi
- Cardiological Department, Misericordia Hospital, via Senese, Grosseto 58100, Italy
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Malik R, Alyeshmerni DM, Wang Z, Goldstein SA, Torguson R, Lindsay J, Waksman R, Ben-Dor I. Prevalence and predictors of left atrial thrombus in patients with atrial fibrillation: is transesophageal echocardiography necessary before cardioversion? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:12-4. [DOI: 10.1016/j.carrev.2014.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022]
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