1
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Escribano P, Ródenas J, García M, Hornero F, Gracia-Baena JM, Alcaraz R, Rieta JJ. Novel Entropy-Based Metrics for Long-Term Atrial Fibrillation Recurrence Prediction Following Surgical Ablation: Insights from Preoperative Electrocardiographic Analysis. ENTROPY (BASEL, SWITZERLAND) 2023; 26:28. [PMID: 38248154 PMCID: PMC11154238 DOI: 10.3390/e26010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024]
Abstract
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia often treated concomitantly with other cardiac interventions through the Cox-Maze procedure. This highly invasive intervention is still linked to a long-term recurrence rate of approximately 35% in permanent AF patients. The aim of this study is to preoperatively predict long-term AF recurrence post-surgery through the analysis of atrial activity (AA) organization from non-invasive electrocardiographic (ECG) recordings. A dataset comprising ECGs from 53 patients with permanent AF who had undergone Cox-Maze concomitant surgery was analyzed. The AA was extracted from the lead V1 of these recordings and then characterized using novel predictors, such as the mean and standard deviation of the relative wavelet energy (RWEm and RWEs) across different scales, and an entropy-based metric that computes the stationary wavelet entropy variability (SWEnV). The individual predictors exhibited limited predictive capabilities to anticipate the outcome of the procedure, with the SWEnV yielding a classification accuracy (Acc) of 68.07%. However, the assessment of the RWEs for the seventh scale (RWEs7), which encompassed frequencies associated with the AA, stood out as the most promising individual predictor, with sensitivity (Se) and specificity (Sp) values of 80.83% and 67.09%, respectively, and an Acc of almost 75%. Diverse multivariate decision tree-based models were constructed for prediction, giving priority to simplicity in the interpretation of the forecasting methodology. In fact, the combination of the SWEnV and RWEs7 consistently outperformed the individual predictors and excelled in predicting post-surgery outcomes one year after the Cox-Maze procedure, with Se, Sp, and Acc values of approximately 80%, thus surpassing the results of previous studies based on anatomical predictors associated with atrial function or clinical data. These findings emphasize the crucial role of preoperative patient-specific ECG signal analysis in tailoring post-surgical care, enhancing clinical decision making, and improving long-term clinical outcomes.
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Affiliation(s)
- Pilar Escribano
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 02071 Albacete, Spain; (P.E.); (J.R.); (M.G.); (R.A.)
| | - Juan Ródenas
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 02071 Albacete, Spain; (P.E.); (J.R.); (M.G.); (R.A.)
| | - Manuel García
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 02071 Albacete, Spain; (P.E.); (J.R.); (M.G.); (R.A.)
| | - Fernando Hornero
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (F.H.); (J.M.G.-B.)
| | - Juan M. Gracia-Baena
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (F.H.); (J.M.G.-B.)
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 02071 Albacete, Spain; (P.E.); (J.R.); (M.G.); (R.A.)
| | - José J. Rieta
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain
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2
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Herrera NT, Zhang X, Ni H, Maleckar MM, Heijman J, Dobrev D, Grandi E, Morotti S. Dual effects of the small-conductance Ca 2+-activated K + current on human atrial electrophysiology and Ca 2+-driven arrhythmogenesis: an in silico study. Am J Physiol Heart Circ Physiol 2023; 325:H896-H908. [PMID: 37624096 PMCID: PMC10659325 DOI: 10.1152/ajpheart.00362.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
By sensing changes in intracellular Ca2+, small-conductance Ca2+-activated K+ (SK) channels dynamically regulate the dynamics of the cardiac action potential (AP) on a beat-to-beat basis. Given their predominance in atria versus ventricles, SK channels are considered a promising atrial-selective pharmacological target against atrial fibrillation (AF), the most common cardiac arrhythmia. However, the precise contribution of SK current (ISK) to atrial arrhythmogenesis is poorly understood, and may potentially involve different mechanisms that depend on species, heart rates, and degree of AF-induced atrial remodeling. Both reduced and enhanced ISK have been linked to AF. Similarly, both SK channel up- and downregulation have been reported in chronic AF (cAF) versus normal sinus rhythm (nSR) patient samples. Here, we use our multiscale modeling framework to obtain mechanistic insights into the contribution of ISK in human atrial cardiomyocyte electrophysiology. We simulate several protocols to quantify how ISK modulation affects the regulation of AP duration (APD), Ca2+ transient, refractoriness, and occurrence of alternans and delayed afterdepolarizations (DADs). Our simulations show that ISK activation shortens the APD and atrial effective refractory period, limits Ca2+ cycling, and slightly increases the propensity for alternans in both nSR and cAF conditions. We also show that increasing ISK counteracts DAD development by enhancing the repolarization force that opposes the Ca2+-dependent depolarization. Taken together, our results suggest that increasing ISK in human atrial cardiomyocytes could promote reentry while protecting against triggered activity. Depending on the leading arrhythmogenic mechanism, ISK inhibition may thus be a beneficial or detrimental anti-AF strategy.NEW & NOTEWORTHY Using our established framework for human atrial myocyte simulations, we investigated the role of the small-conductance Ca2+-activated K+ current (ISK) in the regulation of cell function and the development of Ca2+-driven arrhythmias. We found that ISK inhibition, a promising atrial-selective pharmacological strategy against atrial fibrillation, counteracts the reentry-promoting abbreviation of atrial refractoriness, but renders human atrial myocytes more vulnerable to delayed afterdepolarizations, thus potentially increasing the propensity for ectopic (triggered) activity.
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Affiliation(s)
- Nathaniel T Herrera
- Department of Pharmacology, University of California Davis, Davis, California, United States
| | - Xianwei Zhang
- Department of Pharmacology, University of California Davis, Davis, California, United States
| | - Haibo Ni
- Department of Pharmacology, University of California Davis, Davis, California, United States
| | - Mary M Maleckar
- Department of Computational Physiology, Simula Research Laboratory, Oslo, Norway
| | - Jordi Heijman
- Department of Cardiology, Faculty of Health, Medicine, and Life Sciences, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Dobromir Dobrev
- Faculty of Medicine, West German Heart and Vascular Center, Institute of Pharmacology, University Duisburg-Essen, Essen, Germany
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas, United States
| | - Eleonora Grandi
- Department of Pharmacology, University of California Davis, Davis, California, United States
| | - Stefano Morotti
- Department of Pharmacology, University of California Davis, Davis, California, United States
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3
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Sha R, Rong B, Zhang K, Chen T, Wang J, Han W, Liu H, Liu A, Lin M, Zhong J. The role of alcohol consumption on echocardiographic and electrophysiologic changes in atrial fibrillation. Echocardiography 2022; 39:794-802. [DOI: 10.1111/echo.15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rina Sha
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Bing Rong
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Kai Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Juntao Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
- Department of Cardiology Qilu Hospital (Qingdao) Cheeloo College of Medicine Shandong University Qingdao China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Huiyu Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Aihua Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Mingjie Lin
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
- Peking University First Hospital Beijing China
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
- Department of Cardiology Qilu Hospital (Qingdao) Cheeloo College of Medicine Shandong University Qingdao China
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4
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Sirish P, Diloretto DA, Thai PN, Chiamvimonvat N. The Critical Roles of Proteostasis and Endoplasmic Reticulum Stress in Atrial Fibrillation. Front Physiol 2022; 12:793171. [PMID: 35058801 PMCID: PMC8764384 DOI: 10.3389/fphys.2021.793171] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) remains the most common arrhythmia seen clinically. The incidence of AF is increasing due to the aging population. AF is associated with a significant increase in morbidity and mortality, yet current treatment paradigms have proven largely inadequate. Therefore, there is an urgent need to develop new effective therapeutic strategies for AF. The endoplasmic reticulum (ER) in the heart plays critical roles in the regulation of excitation-contraction coupling and cardiac function. Perturbation in the ER homeostasis due to intrinsic and extrinsic factors, such as inflammation, oxidative stress, and ischemia, leads to ER stress that has been linked to multiple conditions including diabetes mellitus, neurodegeneration, cancer, heart disease, and cardiac arrhythmias. Recent studies have documented the critical roles of ER stress in the pathophysiological basis of AF. Using an animal model of chronic pressure overload, we demonstrate a significant increase in ER stress in atrial tissues. Moreover, we demonstrate that treatment with a small molecule inhibitor to inhibit the soluble epoxide hydrolase enzyme in the arachidonic acid metabolism significantly reduces ER stress as well as atrial electrical and structural remodeling. The current review article will attempt to provide a perspective on our recent understandings and current knowledge gaps on the critical roles of proteostasis and ER stress in AF progression.
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Affiliation(s)
- Padmini Sirish
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Davis, CA, United States.,Department of Veterans Affairs, Northern California Health Care System, Mather, CA, United States
| | - Daphne A Diloretto
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Davis, CA, United States
| | - Phung N Thai
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Davis, CA, United States.,Department of Veterans Affairs, Northern California Health Care System, Mather, CA, United States
| | - Nipavan Chiamvimonvat
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Davis, CA, United States.,Department of Veterans Affairs, Northern California Health Care System, Mather, CA, United States.,Department of Pharmacology, University of California, Davis, Davis, CA, United States
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5
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Walker M, Patel P, Kwon O, Koene RJ, Duprez DA, Kwon Y. Atrial Fibrillation and Hypertension: "Quo Vadis". Curr Hypertens Rev 2022; 18:39-53. [PMID: 35023459 DOI: 10.2174/1573402118666220112122403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/29/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Abstract
Hypertension is one of the most well-established risk factors for atrial fibrillation. Long-standing untreated hypertension leads to structural remodeling and electrophysiologic alterations causing an atrial myopathy that forms a vulnerable substrate for the development and maintenance of atrial fibrillation. Hypertension-induced hemodynamic, inflammatory, hormonal, and autonomic changes all appear to be important contributing factors. Furthermore, hypertension is also associated with several atrial fibrillation-related comorbidities. As such, hypertension may represent an important target for therapy in atrial fibrillation. Clinicians should be aware of pitfalls of the blood pressure measurement in atrial fibrillation. While the auscultatory method is preferred, the use of automated devices appears to be an acceptable method in the ambulatory setting. There are pathophysiologic bases and emerging clinical evidence suggesting the benefit of renin-angiotensin system inhibition in risk reduction of atrial fibrillation development particularly in patients with left ventricular hypertrophy or left ventricular dysfunction. A better understanding of hypertension's pathophysiologic link to atrial fibrillation may lead to the development of novel therapies for the primary prevention of atrial fibrillation. Finally, future studies are needed to address optimal blood pressure goal to minimize the risk of atrial fibrillation-related complications.
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Affiliation(s)
- McCall Walker
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, USA
| | - Paras Patel
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, USA
| | - Osung Kwon
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Uslan College of Medicine, Seoul, Korea
| | - Ryan J Koene
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Daniel A Duprez
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Younghoon Kwon
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, USA
- Department of Medicine, University of Minnesota, Minneapolis, USA
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6
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Association of Nocturnal Hypoxemia and Pulse Rate Variability with Incident Atrial Fibrillation in Patients Investigated for Obstructive Sleep Apnea. Ann Am Thorac Soc 2021; 18:1043-1051. [PMID: 33433302 DOI: 10.1513/annalsats.202009-1202oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Rationale: Nocturnal hypoxemia and sympathetic/parasympathetic imbalance might contribute to the occurrence or atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA). During sleep recordings, pulse rate variability (PRV) derived from oximetry might provide an accurate estimation of heart rate variability, which reflects the autonomic cardiovascular control. Objectives: We aimed to evaluate whether indices of oxygen desaturation and PRV derived from nocturnal oximetry were associated with AF incidence in patients investigated for OSA. Methods: Data from a large multicenter cohort of AF-free patients investigated for OSA between May 15, 2007, and December 31, 2017, were linked to health administrative data to identify hospitalized and nonhospitalized patients with new-onset AF. Cox proportional hazards models were used to evaluate the association between AF incidence and oximetry-derived indices automatically generated from sleep recordings. Results: After a median (interquartile range) follow-up of 5.34 (3.3-8.0) years, 181 of 7,205 patients developed AF (130 were hospitalized for AF). After adjusting for confounders, including anthropomorphic data, alcohol intake, cardiac, metabolic and respiratory diseases, β blocker/calcium channel blocker medications, type of sleep study, study site, and positive airway pressure adherence, AF risk was associated with increasing nocturnal hypoxemia (P trend = 0.004 for quartiles of percentage of recording time with oxygen saturation <90%) and PRV (P trend < 0.0001 for quartiles of root mean square of the successive normal-normal beat interval differences), and decreasing sympathetic/parasympathetic tone (P trend = 0.0006 for quartiles of low-frequency power/high-frequency power ratio). The highest risk of AF was observed in patients with the highest quartiles of both the percentage of recording time with oxygen saturation <90% and the root mean square of the successive normal-normal beat interval differences compared with those with neither of these conditions (adjusted hazard ratio, 3.61; 95% confidence interval, 2.10-6.22). Similar associations were observed when the analyses were restricted to hospitalized AF. Conclusions: In patients investigated for OSA, nocturnal hypoxemia and PRV indices derived from single-channel pulse oximetry were independent predictors of AF incidence. Patients with both marked nocturnal hypoxemia and high PRV were at higher risk of AF. Oximetry may be used to identify patients with OSA at greatest risk of developing AF.
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7
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Benjamin EJ, Al‐Khatib SM, Desvigne‐Nickens P, Alonso A, Djoussé L, Forman DE, Gillis AM, Hendriks JML, Hills MT, Kirchhof P, Link MS, Marcus GM, Mehra R, Murray KT, Parkash R, Piña IL, Redline S, Rienstra M, Sanders P, Somers VK, Van Wagoner DR, Wang PJ, Cooper LS, Go AS. Research Priorities in the Secondary Prevention of Atrial Fibrillation: A National Heart, Lung, and Blood Institute Virtual Workshop Report. J Am Heart Assoc 2021; 10:e021566. [PMID: 34351783 PMCID: PMC8475065 DOI: 10.1161/jaha.121.021566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Abstract
There has been sustained focus on the secondary prevention of coronary heart disease and heart failure; yet, apart from stroke prevention, the evidence base for the secondary prevention of atrial fibrillation (AF) recurrence, AF progression, and AF-related complications is modest. Although there are multiple observational studies, there are few large, robust, randomized trials providing definitive effective approaches for the secondary prevention of AF. Given the increasing incidence and prevalence of AF nationally and internationally, the AF field needs transformative research and a commitment to evidenced-based secondary prevention strategies. We report on a National Heart, Lung, and Blood Institute virtual workshop directed at identifying knowledge gaps and research opportunities in the secondary prevention of AF. Once AF has been detected, lifestyle changes and novel models of care delivery may contribute to the prevention of AF recurrence, AF progression, and AF-related complications. Although benefits seen in small subgroups, cohort studies, and selected randomized trials are impressive, the widespread effectiveness of AF secondary prevention strategies remains unknown, calling for development of scalable interventions suitable for diverse populations and for identification of subpopulations who may particularly benefit from intensive management. We identified critical research questions for 6 topics relevant to the secondary prevention of AF: (1) weight loss; (2) alcohol intake, smoking cessation, and diet; (3) cardiac rehabilitation; (4) approaches to sleep disorders; (5) integrated, team-based care; and (6) nonanticoagulant pharmacotherapy. Our goal is to stimulate innovative research that will accelerate the generation of the evidence to effectively pursue the secondary prevention of AF.
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Affiliation(s)
- Emelia J. Benjamin
- Cardiovascular MedicineDepartment of MedicineBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public HealthBostonMA
| | - Sana M. Al‐Khatib
- Division of Cardiology and Duke Clinical Research InstituteDuke University Medical CenterDurhamNC
| | - Patrice Desvigne‐Nickens
- Division of Cardiovascular SciencesNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Luc Djoussé
- Division of AgingDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMA
| | - Daniel E. Forman
- Divisions of Geriatrics and CardiologyUniversity of Pittsburgh Medical CenterAging InstituteUniversity of PittsburghVA Pittsburgh Healthcare SystemPittsburghPA
| | - Anne M. Gillis
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Jeroen M. L. Hendriks
- Centre for Heart Rhythm DisordersUniversity of Adelaide, and Royal Adelaide HospitalAdelaideAustralia
- Caring Futures InstituteCollege of Nursing and Health SciencesFlinders UniversityAdelaideAustralia
| | | | - Paulus Kirchhof
- Department of CardiologyUniversity Heart and Vascular Center UKE HamburgHamburgGermany
- Institute of Cardiovascular ScienceUniversity of BirminghamUnited Kingdom
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/LübeckBerlinGermany
- AFNETMünsterGermany
| | - Mark S. Link
- Division of CardiologyDepartment of MedicineUT Southwestern Medical CenterDallasTX
| | - Gregory M. Marcus
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCA
| | - Reena Mehra
- Sleep Disorders CenterNeurologic InstituteRespiratory InstituteHeart and Vascular Institute, and Molecular Cardiology Department of the Lerner Research InstituteCleveland ClinicClevelandOH
| | | | - Ratika Parkash
- Division of CardiologyQEII Health Sciences Center/Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Ileana L. Piña
- Wayne State UniversityDetroitMI
- Central Michigan UniversityMt PleasantMI
- FDAOPEQCenter for Devices and Radiological HealthSilver SpringMD
| | - Susan Redline
- Department of MedicineBrigham and Women’s HospitalBostonMA
| | - Michiel Rienstra
- Department of CardiologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Prashanthan Sanders
- Centre for Heart Rhythm DisordersUniversity of Adelaide, and Royal Adelaide HospitalAdelaideAustralia
| | | | | | - Paul J. Wang
- Stanford University School of MedicinePalo AltoCA
| | - Lawton S. Cooper
- Division of Cardiovascular SciencesNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
| | - Alan S. Go
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
- Department of Health System ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCA
- Departments of Epidemiology, Biostatistics and MedicineUniversity of California, San FranciscoSan FranciscoCA
- Departments of MedicineHealth Research and PolicyStanford UniversityStanfordCA
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8
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Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, Dagres N, Di Toro D, Eckhardt LL, Ellenbogen K, Hardy C, Ikeda T, Jaswal A, Kaufman E, Krahn A, Kusano K, Kutyifa V, Lim HS, Lip GYH, Nava-Townsend S, Pak HN, Rodríguez Diez G, Sauer W, Saxena A, Svendsen JH, Vanegas D, Vaseghi M, Wilde A, Bunch TJ, Buxton AE, Calvimontes G, Chao TF, Eckardt L, Estner H, Gillis AM, Isa R, Kautzner J, Maury P, Moss JD, Nam GB, Olshansky B, Pava Molano LF, Pimentel M, Prabhu M, Tzou WS, Sommer P, Swampillai J, Vidal A, Deneke T, Hindricks G, Leclercq C. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. Europace 2021; 22:1147-1148. [PMID: 32538434 PMCID: PMC7400488 DOI: 10.1093/europace/euaa065] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
| | - Alberto Alfie
- Division of Electrophysiology, Instituto Cardiovascular Adventista, Clinica Bazterrica, Buenos Aires, Argentina
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
| | - Dario Di Toro
- Department of Cardiology, Division of Electrophysiology, Argerich Hospital and CEMIC, Buenos Aires, Argentina
| | - Lee L Eckhardt
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Carina Hardy
- Arrhythmia Unit, Heart Institute, University of São, Paulo Medical School, Instituto do Coração -InCor- Faculdade de Medicina de São Paulo-São Paulo, Brazil
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Faculty of Medicine, Toho University, Japan
| | - Aparna Jaswal
- Department of Cardiac Electrophysiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Elizabeth Kaufman
- The Heart and Vascular Research Center, Metrohealth Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Andrew Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Valentina Kutyifa
- University of Rochester, Medical Center, Rochester, USA.,Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - 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
| | - Santiago Nava-Townsend
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Gerardo Rodríguez Diez
- Department of Electrophysiology and Hemodynamic, Arrhytmias Unity, CMN 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - William Sauer
- Cardiovascular Division, Brigham and Women s Hospital and Harvard Medical School, Boston, USA
| | - Anil Saxena
- Department of Cardiac Electrophysiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Diego Vanegas
- Hospital Militar Central, Fundarritmia, Bogotá, Colombia
| | - Marmar Vaseghi
- Los Angeles UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine, at UCLA, USA
| | - Arthur Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T Jared Bunch
- Department of Medicine, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, USA
| | | | - Alfred E Buxton
- Department of Medicine, The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lars Eckardt
- Department for Cardiology, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Heidi Estner
- Department of Medicine, I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Anne M Gillis
- University of Calgary - Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Joshua D Moss
- Department of Cardiac Electrophysiology, University of California San Francisco, San Francisco, USA
| | - Gi-Byung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Brian Olshansky
- University of Iowa Carver College of Medicine, Iowa City, USA
| | | | - Mauricio Pimentel
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mukund Prabhu
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Wendy S Tzou
- Department of Cardiology/Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum, Clinic for Electrophysiology, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Alejandro Vidal
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Thomas Deneke
- Clinic for Cardiology II (Interventional Electrophysiology), Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
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9
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Rooney MR, Norby FL, Maheshwari A, Lutsey PL, Dudley SC, Soliman EZ, Loehr LR, Mosley TH, Coresh J, Alonso A, Chen LY. Frequent Premature Atrial Contractions Are Associated With Poorer Cognitive Function in the Atherosclerosis Risk in Communities (ARIC) Study. Mayo Clin Proc 2021; 96:1147-1156. [PMID: 33840519 PMCID: PMC8106627 DOI: 10.1016/j.mayocp.2021.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/07/2020] [Accepted: 01/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the association of premature atrial contraction (PAC) frequency with cognitive test scores and prevalence of dementia or mild cognitive impairment (MCI). MATERIALS AND METHODS We conducted a cross-sectional analysis using Atherosclerosis Risk in Communities study visit 6 (January 1, 2016, through December 31, 2017) data. We included 2163 participants without atrial fibrillation (AF) (age mean ± SD, 79±4 years; 1273 (58.9%) female; and 604 (27.97.0% Black) who underwent cognitive testing and wore a leadless, ambulatory electrocardiogram monitor for 14 days. We categorized PAC frequency based on the percent of beats: less than 1%, minimal; 1% to <5%, occasional; greater than or equal to 5%, frequent. We derived cognitive domain-specific factor scores (memory, executive function, language, and global z-score). Dementia and MCI were adjudicated. RESULTS During a mean analyzable time of 12.6±2.6 days, 339 (15.7%) had occasional PACs and 107 (4.9%) had frequent PACs. Individuals with frequent PACs (vs minimal) had lower executive function factor scores by 0.30 (95% CI, -0.46 to -0.14) and lower global factor scores by 0.20 (95% CI, -0.33 to -0.07) after multivariable adjustment. Individuals with frequent PACs (vs minimal) had higher odds of prevalent dementia or MCI after multivariable adjustment (odds ratio, 1.74; 95% CI, 1.09 to 2.79). These associations were unchanged with additional adjustment for stroke. CONCLUSION In community-dwelling older adults without AF, frequent PACs were cross-sectionally associated with lower executive and global cognitive function and greater prevalence of dementia or MCI, independently of stroke. Our findings lend support to the notion that atrial cardiomyopathy may be a driver of AF-related outcomes. Further research to confirm these associations prospectively and to elucidate underlying mechanisms is warranted.
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Affiliation(s)
- Mary R Rooney
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
| | - Faye L Norby
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Ankit Maheshwari
- Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Samuel C Dudley
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest University, Winston-Salem, NC
| | - Laura R Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Thomas H Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson, MS
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Alvaro Alonso
- Department of Epidemiology, Emory University, Atlanta, GA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN
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10
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Atrial fibrillation and stroke: how much atrial fibrillation is enough to cause a stroke? Curr Opin Neurol 2021; 33:17-23. [PMID: 31809335 DOI: 10.1097/wco.0000000000000780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW The association between atrial fibrillation and stroke is firmly established, and anticoagulation reduces stroke risk in patients with atrial fibrillation. However, the role of anticoagulation in very brief durations of atrial fibrillation (subclinical atrial fibrillation) is an area of controversy. RECENT FINDINGS Stroke risk increases alongside burden of atrial fibrillation. Ongoing trials will clarify if 24 h or less of atrial fibrillation on extended monitoring necessitates lifelong anticoagulation. Trials examining empiric anticoagulation for individuals with ESUS did not demonstrate benefit over antiplatelet agents. However, hypothesis-generating sub-analyses suggest that certain at-risk groups may benefit. Atrial cardiopathy is associated with subclinical atrial fibrillation and research examining anticoagulation after ESUS in this population is underway. SUMMARY Stroke risk increases alongside burden of ectopic atrial activity. However, this risk may in part be because of prothrombotic dysfunction associated with atrial cardiopathy in addition to the arrhythmia itself. The minimal amount of subclinical atrial fibrillation to warrant anticoagulation for stroke prevention, and how this may be modified by the total duration of monitoring, will be clarified by the results of ongoing clinical trials. Currently research will also help identify whether a select group of ESUS patients who have structural and electrophysiological markers of atrial cardiopathy warrant anticoagulation for secondary prevention.
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11
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Younis A, Berkovitch A, Segev S, Kivity S, Klempfner R, Abu-Much A, Goldenberg I, Maor E. High fitness might be associated with the development of new-onset atrial fibrillation in obese non-athletic adults. Int J Clin Pract 2020; 74:e13638. [PMID: 32750733 DOI: 10.1111/ijcp.13638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/28/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Data on the association between AF and fitness are conflicting. OBJECTIVES The aim of this analysis was to investigate the association between fitness, obesity and incidence of atrial fibrillation (AF) among apparently healthy non-athlete adults. METHODS We investigated 20 410 self-referred subjects who were annually screened in a tertiary medical centre. All subjects were free of AF and completed maximal exercise stress test according to the Bruce protocol at baseline. Fitness was categorised into age- and sex-specific quintiles (Q) according to the treadmill time. Subjects were categorised to low (Q1-Q2) and high fitness (Q3-5) groups. The primary end point was new-onset AF during follow-up. RESULTS Mean age was 48 ± 10 years and 72% were men. A total of 463 (2.3%) events occurred during an average follow-up of 8 ± 5 years corresponding to an AF event rate of 0.3% per person year. Univariate and multivariate models showed that AF risk was similar in both fitness groups. However, AF event rate was 0.55% per person year among high fitness obese subjects, compared with 0.31% for low fitness obese subjects (P < .01). Subgroup interaction analysis showed that AF risk is obesity-dependent, such that in the obese group (≥30 kg/m2 ) high fitness was independently associated with a significant 79% increased AF risk (95% CI 1.15-2.78; P = .01), whereas among non-obese subjects the rate of events was similar between both fitness groups (P for interaction = (.02)). CONCLUSIONS Our findings suggest that high fitness might be associated with increased AF risk among obese subjects.
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Affiliation(s)
- Arwa Younis
- University of Rochester Medical Center, Rochester, NY, USA
| | - Anat Berkovitch
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Shlomo Segev
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Shaye Kivity
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Robert Klempfner
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Arsalan Abu-Much
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | | | - Elad Maor
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
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12
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Iroegbu CD, Chen W, Wu X, Cheng L, Zhang H, Wu M, Zhao Y, Liu LM, Yang J. Evaluating the cost-effectiveness of catheter ablation of atrial fibrillation. Cardiovasc Diagn Ther 2020; 10:1200-1215. [PMID: 33224744 DOI: 10.21037/cdt-20-574] [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: 11/06/2022]
Abstract
Background The pursuit of a clearer understanding of the pathogenesis of atrial fibrillation (AFib) and the development of new technology has resulted in a surge of interest in the surgical ablation for AFib. Here, we report our 8-year experience in the surgical treatment and management of AFib alongside, evaluating the cost-effectiveness in southern Mainland China over a 1-year follow-up. Methods Data of 3,068 patients from March 2011 through June 2019 was retrospectively extracted from The Provincial National Cardiac Database of Xiangya Second Hospital. The activities considered (and costs calculated) were outpatient consultations, hospital admissions, and drug treatment. Quality of life (QoL) questionnaires were also carried out to assess whether concomitant AFib correction procedures increase risk in patients, or improve patient's QoL. Results A total of 3,068 patients completed the questionnaires at a minimum of one time-point during the follow-up. The total cost was combined to obtain incremental costs per quality-adjusted life-years (QALYs). The total costs of the AFib catheter ablation group were remarkably higher compared to surgery as usual group. The incremental cost-effectiveness ratio was $76,513,227 (¥542,287,667) per QALY, with an acceptability line graph for cost at 43%. Conclusions AFib is an extraordinarily costly and worrisome public health problem. Precision medicine is vital as it provides a platform for the clinical translation of targeted interventions that are designed to help treat and prevent AFib. Thus, to improve the QoL expectancy outcome(s), both therapeutic and surgical interventions should be aimed at addressing the underlying heart disease rather than restoring sinus rhythm.
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Affiliation(s)
- Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Wangping Chen
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xun Wu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Luo Cheng
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hao Zhang
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming Wu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Zhao
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Li Ming Liu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
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13
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Lv W, Zhang L, Cheng X, Wang H, Qin W, Zhou X, Tang B. Apelin Inhibits Angiotensin II-Induced Atrial Fibrosis and Atrial Fibrillation via TGF-β1/Smad2/α-SMA Pathway. Front Physiol 2020; 11:583570. [PMID: 33329030 PMCID: PMC7711167 DOI: 10.3389/fphys.2020.583570] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Angiotensin II (Ang II) could promote the development of atrial fibrosis in atrial fibrillation (AF). Apelin can inhibit the occurrence of myocardial fibrosis. However, the effect of apelin on Ang II-induced atrial fibrosis and subsequent AF still remains unknown. OBJECTIVE In the present study, we examined the effect of apelin on the suppression of atrial fibrosis and subsequent AF, and investigated its underlying mechanisms. METHODS Sprague-Dawley rats were treated for 2 weeks with Ang II (1080 μg/kg/24 h) and apelin-13 (140 μg/kg/24 h) using implantable mini-pumps. The incidence of AF induced by atrial pacing was determined. Atrial electrophysiological mapping was recorded by a 32-electrode microelectrode array. Blood was collected to measure the levels of Ang II and apelin. Atrial tissue samples were preserved to assess the pathohistological changes, DDR2 and α-SMA co-staining were performed, and the protein expression of Smad2 phosphorylation was evaluated. RESULTS Apelin significantly inhibited Ang II-induced atrial fibrosis (HE:1.45 ± 0.11 vs 6.12 ± 0.16, P < 0.001; Masson:1.49 ± 0.25 vs 8.15 ± 0.23, P < 0.001; Picrosirius Red:1.98 ± 0.64 vs 9.59 ± 0.56, P < 0.001, respectively) and decreased the vulnerability of AF (inducibility of AF: z = -4.40, P < 0.001; total AF duration: z = -4.349, P < 0.001). Left atrial epicardial mapping studies demonstrated preservation of atrial conduction homogeneity by apelin. The protective effects of apelin from fibrotic remodeling were mediated by suppression of Smad2-dependent fibrosis. CONCLUSION Apelin potently inhibited Ang II-induced atrial fibrosis and subsequent vulnerability to AF induction via suppression TGF-β/Smad2/α-SMA pathway. Our results indicated that apelin might be an effective up-stream therapy for atrial fibrosis and AF.
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Affiliation(s)
- Wenkui Lv
- Heart Failure Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ling Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiological, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xinchun Cheng
- Geriatrics Center, The People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hongli Wang
- Department of Pacing and Electrophysiological, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wen Qin
- Department of Histology and Embryology, School of Basic Medical Science, Xinjiang Medical University, Urumqi, China
| | - Xianhui Zhou
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiological, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Baopeng Tang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiological, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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14
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El Masri I, Kayali SM, Manolukas T, Levine YC. Role of Catheter Ablation as a First-Line Treatment for Atrial Fibrillation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Alonso A, Almuwaqqat Z, Chamberlain A. Mortality in atrial fibrillation. Is it changing? Trends Cardiovasc Med 2020; 31:469-473. [PMID: 33127438 DOI: 10.1016/j.tcm.2020.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
Patients with atrial fibrillation experience higher mortality rates than those without this condition. Recent studies have explored whether mortality rates in atrial fibrillation patients and the overall impact of atrial fibrillation on mortality has changed. Overall, mortality in atrial fibrillation has decreased over the last few decades, with no strong differences between men and women. These improvements could be caused by advances in preventing thromboembolic complications of atrial fibrillation or better management of comorbidities in these patients. Understanding the mechanisms for these changes and developing novel approaches to improve survival in AF patients are areas deserving of future research.
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Affiliation(s)
- Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, CNR 3051, Atlanta, GA 30322, United States.
| | - Zakaria Almuwaqqat
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Alanna Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
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16
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A Deep Learning Approach for Featureless Robust Quality Assessment of Intermittent Atrial Fibrillation Recordings from Portable and Wearable Devices. ENTROPY 2020; 22:e22070733. [PMID: 33286505 PMCID: PMC7517279 DOI: 10.3390/e22070733] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 01/03/2023]
Abstract
Atrial fibrillation (AF) is the most common heart rhythm disturbance in clinical practice. It often starts with asymptomatic and very short episodes, which are extremely difficult to detect without long-term monitoring of the patient’s electrocardiogram (ECG). Although recent portable and wearable devices may become very useful in this context, they often record ECG signals strongly corrupted with noise and artifacts. This impairs automatized ulterior analyses that could only be conducted reliably through a previous stage of automatic identification of high-quality ECG intervals. So far, a variety of techniques for ECG quality assessment have been proposed, but poor performances have been reported on recordings from patients with AF. This work introduces a novel deep learning-based algorithm to robustly identify high-quality ECG segments within the challenging environment of single-lead recordings alternating sinus rhythm, AF episodes and other rhythms. The method is based on the high learning capability of a convolutional neural network, which has been trained with 2-D images obtained when turning ECG signals into wavelet scalograms. For its validation, almost 100,000 ECG segments from three different databases have been analyzed during 500 learning-testing iterations, thus involving more than 320,000 ECGs analyzed in total. The obtained results have revealed a discriminant ability to detect high-quality and discard low-quality ECG excerpts of about 93%, only misclassifying around 5% of clean AF segments as noisy ones. In addition, the method has also been able to deal with raw ECG recordings, without requiring signal preprocessing or feature extraction as previous stages. Consequently, it is particularly suitable for portable and wearable devices embedding, facilitating early detection of AF as well as other automatized diagnostic facilities by reliably providing high-quality ECG excerpts to further processing stages.
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17
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Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, Dagres N, Di Toro D, Eckhardt LL, Ellenbogen K, Hardy C, Ikeda T, Jaswal A, Kaufman E, Krahn A, Kusano K, Kutyifa V, Lim HS, Lip GYH, Nava-Townsend S, Pak HN, Diez GR, Sauer W, Saxena A, Svendsen JH, Vanegas D, Vaseghi M, Wilde A, Bunch TJ, Buxton AE, Calvimontes G, Chao TF, Eckardt L, Estner H, Gillis AM, Isa R, Kautzner J, Maury P, Moss JD, Nam GB, Olshansky B, Pava Molano LF, Pimentel M, Prabhu M, Tzou WS, Sommer P, Swampillai J, Vidal A, Deneke T, Hindricks G, Leclercq C. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. Heart Rhythm 2020; 17:e269-e316. [PMID: 32553607 DOI: 10.1016/j.hrthm.2020.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
| | - Alberto Alfie
- Division of Electrophysiology, Instituto Cardiovascular Adventista, Clinica Bazterrica, Buenos Aires, Argentina
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
| | - Dario Di Toro
- Department of Cardiology, Division of Electrophysiology, Argerich Hospital and CEMIC, Buenos Aires, Argentina
| | - Lee L Eckhardt
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kenneth Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Carina Hardy
- Arrhythmia Unit, Heart Institute, University of São Paulo Medical School, Instituto do Coração -InCor- Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Aparna Jaswal
- Department of Cardiac Electrophysiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Elizabeth Kaufman
- The Heart and Vascular Research Center, Metrohealth Campus of Case Western Reserve University, Cleveland, Ohio, USA
| | - Andrew Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Valentina Kutyifa
- University of Rochester, Medical Center, Rochester, New York, USA; Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - 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
| | - Santiago Nava-Townsend
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Gerardo Rodríguez Diez
- Department of Electrophysiology and Hemodynamic, Arrhytmias Unity, CMN 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - William Sauer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Anil Saxena
- Department of Cardiac Electrophysiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Diego Vanegas
- Hospital Militar Central, Fundarritmia, Bogotá, Colombia
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Arthur Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | - T Jared Bunch
- Department of Medicine, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | | | - Alfred E Buxton
- Department of Medicine, The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lars Eckardt
- Department for Cardiology, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Heidi Estner
- Department of Medicine, I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Anne M Gillis
- University of Calgary - Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Joshua D Moss
- Department of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Gi-Byung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Brian Olshansky
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Mauricio Pimentel
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mukund Prabhu
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Wendy S Tzou
- Department of Cardiology/Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum, Clinic for Electrophysiology, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Alejandro Vidal
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Thomas Deneke
- Clinic for Cardiology II (Interventional Electrophysiology), Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
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18
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Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, Dagres N, Di Toro D, Eckhardt LL, Ellenbogen K, Hardy C, Ikeda T, Jaswal A, Kaufman E, Krahn A, Kusano K, Kutyifa V, S Lim H, Lip GYH, Nava-Townsend S, Pak HN, Rodríguez Diez G, Sauer W, Saxena A, Svendsen JH, Vanegas D, Vaseghi M, Wilde A, Bunch TJ, Buxton AE, Calvimontes G, Chao TF, Eckardt L, Estner H, Gillis AM, Isa R, Kautzner J, Maury P, Moss JD, Nam GB, Olshansky B, Molano LFP, Pimentel M, Prabhu M, Tzou WS, Sommer P, Swampillai J, Vidal A, Deneke T, Hindricks G, Leclercq C. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. J Arrhythm 2020; 36:553-607. [PMID: 32782627 PMCID: PMC7411224 DOI: 10.1002/joa3.12338] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Yenn-Jiang Lin
- Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
| | | | - Alireza Sepehri Shamloo
- Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany
| | - Alberto Alfie
- Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina
| | - Serge Boveda
- Department of Cardiology Clinique Pasteur Toulouse France
| | - Nikolaos Dagres
- Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany
| | - Dario Di Toro
- Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina
| | - Lee L Eckhardt
- Department of Medicine University of Wisconsin-Madison Madison WI USA
| | - Kenneth Ellenbogen
- Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA
| | - Carina Hardy
- Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil
| | - Takanori Ikeda
- Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan
| | - Aparna Jaswal
- Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India
| | - Elizabeth Kaufman
- The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA
| | - Andrew Krahn
- Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada
| | - Kengo Kusano
- Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Valentina Kutyifa
- University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary
| | - Han S Lim
- Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia
| | - 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
| | - Santiago Nava-Townsend
- Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico
| | - Hui-Nam Pak
- Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea
| | - Gerardo Rodríguez Diez
- Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico
| | - William Sauer
- Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA
| | - Anil Saxena
- Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands
| | | | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA
| | - Arthur Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - T Jared Bunch
- Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Alfred E Buxton
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Gonzalo Calvimontes
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Tze-Fan Chao
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Lars Eckardt
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Heidi Estner
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Anne M Gillis
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Rodrigo Isa
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Josef Kautzner
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Philippe Maury
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Joshua D Moss
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Gi-Byung Nam
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Brian Olshansky
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Luis Fernando Pava Molano
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Mauricio Pimentel
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Mukund Prabhu
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Wendy S Tzou
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Philipp Sommer
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Janice Swampillai
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Alejandro Vidal
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Thomas Deneke
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Gerhard Hindricks
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Christophe Leclercq
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,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.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
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19
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Chung MK, Eckhardt LL, Chen LY, Ahmed HM, Gopinathannair R, Joglar JA, Noseworthy PA, Pack QR, Sanders P, Trulock KM. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e750-e772. [DOI: 10.1161/cir.0000000000000748] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity, mortality, and healthcare use. Great strides have been made in stroke prevention and rhythm control strategies, yet reducing the incidence of AF has been slowed by the increasing incidence and prevalence of AF risk factors, including obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, and other modifiable lifestyle-related factors. Fortunately, many of these AF drivers are potentially reversible, and emerging evidence supports that addressing these modifiable risks may be effective for primary and secondary AF prevention. A structured, protocol-driven multidisciplinary approach to integrate lifestyle and risk factor management as an integral part of AF management may help in the prevention and treatment of AF. However, this aspect of AF management is currently underrecognized, underused, and understudied. The purpose of this American Heart Association scientific statement is to review the association of modifiable risk factors with AF and the effects of risk factor intervention. Implementation strategies, care pathways, and educational links for achieving impactful weight reduction, increased physical activity, and risk factor modification are included. Implications for clinical practice, gaps in knowledge, and future directions for the research community are highlighted.
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20
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Fredriksson T, Gudmundsdottir KK, Frykman V, Friberg L, Al-Khalili F, Engdahl J, Svennberg E. Brief episodes of rapid irregular atrial activity (micro-AF) are a risk marker for atrial fibrillation: a prospective cohort study. BMC Cardiovasc Disord 2020; 20:167. [PMID: 32276611 PMCID: PMC7149874 DOI: 10.1186/s12872-020-01453-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/29/2020] [Indexed: 01/15/2023] Open
Abstract
Background Short supraventricular tachycardias with atrial fibrillation (AF) characteristics are associated with an increased risk of developing AF over time. The aim of this study is to determine if presence of very short-lasting episodes of AF-like activity (micro-AF) can also be used as a marker of undiagnosed silent atrial fibrillation. Methods In the STROKESTOP II study, a Swedish mass screening study for AF among 75- and 76-year-olds, participants with NT-proBNP ≥125 ng/L performed intermittent ECG recordings 30 s, four times daily for 2 weeks. Participants with micro-AF (sudden onset of irregular tachycardia with episodes of ≥5 consecutive supraventricular beats and total absence of p-waves, lasting less than 30 s) were invited to undergo extended AF screening using continuous event recording for 2 weeks. A control group of individuals without micro-AF was examined using the same ECG modalities. Results Out of 3763 participants in STROKESTOP II who had elevated NT-proBNP levels and were free of AF, n = 221 (6%) had micro-AF. The majority of participants with micro-AF (n = 196) accepted further investigation with continuous ECG monitoring which showed presence of AF in 26 of them. In the control group (n = 250), continuous monitoring detected 7 new AF cases. Thus, AF was significantly more common in the micro AF group (13%) compared to the control group (3%), p < 0.001. Conclusions Presence of short-lasting episodes of AF-like activity (micro-AF) indicates increased likelihood for undetected AF. Continuous screening therefore seems recommendable if a finding of AF would change clinical management. Trail registration ClinicalTrials.gov, identifier: NCT02743416, registered April 19, 2016.
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Affiliation(s)
- Tove Fredriksson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden.
| | - Katrin Kemp Gudmundsdottir
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Viveka Frykman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Leif Friberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Faris Al-Khalili
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Johan Engdahl
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
| | - Emma Svennberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88, Stockholm, Sweden
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21
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The Pathogenic Role of Very Low Density Lipoprotein on Atrial Remodeling in the Metabolic Syndrome. Int J Mol Sci 2020; 21:ijms21030891. [PMID: 32019138 PMCID: PMC7037013 DOI: 10.3390/ijms21030891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 12/16/2022] Open
Abstract
Atrial fibrillation (AF) is the most common persistent arrhythmia, and can lead to systemic thromboembolism and heart failure. Aging and metabolic syndrome (MetS) are major risks for AF. One of the most important manifestations of MetS is dyslipidemia, but its correlation with AF is ambiguous in clinical observational studies. Although there is a paradoxical relationship between fasting cholesterol and AF incidence, the benefit from lipid lowering therapy in reduction of AF is significant. Here, we reviewed the health burden from AF and MetS, the association between two disease entities, and the metabolism of triglyceride, which is elevated in MetS. We also reviewed scientific evidence for the mechanistic links between very low density lipoproteins (VLDL), which primarily carry circulatory triglyceride, to atrial cardiomyopathy and development of AF. The effects of VLDL to atria suggesting pathogenic to atrial cardiomyopathy and AF include excess lipid accumulation, direct cytotoxicity, abbreviated action potentials, disturbed calcium regulation, delayed conduction velocities, modulated gap junctions, and sarcomere protein derangements. The electrical remodeling and structural changes in concert promote development of atrial cardiomyopathy in MetS and ultimately lead to vulnerability to AF. As VLDL plays a major role in lipid metabolism after meals (rather than fasting state), further human studies that focus on the effects/correlation of postprandial lipids to atrial remodeling are required to determine whether VLDL-targeted therapy can reduce MetS-related AF. On the basis of our scientific evidence, we propose a pivotal role of VLDL in MetS-related atrial cardiomyopathy and vulnerability to AF.
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22
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Mehra R, Marcus GM. Novel Insights Into Sleep Disorder and Atrial Fibrillation Risk: More Than Sleep Apnea. Chest 2019; 156:421-423. [PMID: 31511147 DOI: 10.1016/j.chest.2019.04.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Reena Mehra
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, San Francisco, CA
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23
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Martínez-Iniesta M, Ródenas J, Rieta JJ, Alcaraz R. The stationary wavelet transform as an efficient reductor of powerline interference for atrial bipolar electrograms in cardiac electrophysiology. Physiol Meas 2019; 40:075003. [PMID: 31239416 DOI: 10.1088/1361-6579/ab2cb8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The most relevant source of signal contamination in the cardiac electrophysiology (EP) laboratory is the ubiquitous powerline interference (PLI). To reduce this perturbation, algorithms including common fixed-bandwidth and adaptive-notch filters have been proposed. Although such methods have proven to add artificial fractionation to intra-atrial electrograms (EGMs), they are still frequently used. However, such morphological alteration can conceal the accurate interpretation of EGMs, specially to evaluate the mechanisms supporting atrial fibrillation (AF), which is the most common cardiac arrhythmia. Given the clinical relevance of AF, a novel algorithm aimed at reducing PLI on highly contaminated bipolar EGMs and, simultaneously, preserving their morphology is proposed. APPROACH The method is based on the wavelet shrinkage and has been validated through customized indices on a set of synthesized EGMs to accurately quantify the achieved level of PLI reduction and signal morphology alteration. Visual validation of the algorithm's performance has also been included for some real EGM excerpts. MAIN RESULTS The method has outperformed common filtering-based and wavelet-based strategies in the analyzed scenario. Moreover, it possesses advantages such as insensitivity to amplitude and frequency variations in the PLI, and the capability of joint removal of several interferences. SIGNIFICANCE The use of this algorithm in routine cardiac EP studies may enable improved and truthful evaluation of AF mechanisms.
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Affiliation(s)
- Miguel Martínez-Iniesta
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, Albacete, Spain
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24
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Hamada R, Muto S. Simple risk model and score for predicting of incident atrial fibrillation in Japanese. J Cardiol 2019; 73:65-72. [DOI: 10.1016/j.jjcc.2018.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/22/2018] [Accepted: 06/28/2018] [Indexed: 01/14/2023]
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25
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Magnani JW, Norby FL, Agarwal SK, Soliman EZ, Chen LY, Loehr LR, Alonso A. Racial Differences in Atrial Fibrillation-Related Cardiovascular Disease and Mortality: The Atherosclerosis Risk in Communities (ARIC) Study. JAMA Cardiol 2018; 1:433-41. [PMID: 27438320 DOI: 10.1001/jamacardio.2016.1025] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The adverse outcomes associated with atrial fibrillation (AF) have been studied in predominantly white cohorts. Racial differences in outcomes associated with AF merit continued investigation. OBJECTIVE To evaluate the race-specific associations of AF with stroke, heart failure, coronary heart disease (CHD), and all-cause mortality in a community-based cohort. DESIGN, SETTING, AND PARTICIPANTS The Atherosclerosis Risk in Communities (ARIC) Study is a prospective, observational cohort. From 1987 through 1989, the ARIC Study enrolled 15 792 men and women and conducted 4 follow-up examinations (2011-2013) with active surveillance for vital status and hospitalizations. Race was determined by self-report and categorized as white, black, or other. MAIN OUTCOMES AND MEASURES Atrial fibrillation (adjudicated using electrocardiograms, hospital discharge codes, and death certificates), stroke, heart failure, CHD, and mortality. RESULTS After exclusions, 15 080 participants (mean [SD] age, 54.2 [5.8] years; 8290 women [55.5%]; 3831 black individuals [25.4%]) were included in this analysis. During a mean (SD) follow-up of 20.6 (6.2) years, there were 2348 cases of incident AF. The incident rates of AF per 1000 person-years were 8.1 (95% CI, 7.7-8.5) in white individuals and 5.8 (95% CI, 5.2-6.3) in black individuals. The rates of stroke, heart failure, CHD, and mortality were higher in black individuals with AF than white individuals with AF. The association of AF with these outcomes, estimated with rate differences (rate of the end point in those with AF minus the rate in those without AF per 1000 person-years), also differed by race. The rate difference for stroke in individuals with AF was 10.2 (95% CI, 6.6-13.9) in white individuals and 21.4 (95% CI, 10.2-32.6) in black individuals. For heart failure and CHD, the rate differences were 1.5- to 2.0-fold higher in black individuals than white individuals. White individuals with AF had a rate difference of 55.9 (95% CI, 48.1-63.7) for mortality compared with black individuals, who had a rate difference of 106.0 (95% CI, 86.0-125.9). CONCLUSIONS AND RELEVANCE In the prospective ARIC Study, the outcome of AF on the rates of stroke, heart failure, CHD, and mortality was considerably larger in black individuals than white individuals. These results indicate the vulnerability and increased risk in black individuals with AF. Continued investigation of racial differences in AF and its related adverse outcomes are essential to identify and mitigate racial disparities in the treatment of AF.
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Affiliation(s)
- Jared W Magnani
- Cardiology Section, Whitaker Cardiovascular Institute, Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts2currently with the Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center Hea
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Sunil K Agarwal
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Laura R Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
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26
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Larsen TB, Lip GYH, Løchen ML, Marín F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Marques-Vidal PM, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace 2018; 19:190-225. [PMID: 28175283 DOI: 10.1093/europace/euw242] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- University of Birmingham, Birmingham, UK.,Aalborg University Hospital, Aalborg, Denmark
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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27
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Alzahrani Z, Ornelas-Loredo A, Darbar SD, Farooqui A, Mol D, Chalazan B, Villagrana NE, McCauley M, Lazar S, Wissner E, Bhan A, Konda S, Darbar D. Association Between Family History and Early-Onset Atrial Fibrillation Across Racial and Ethnic Groups. JAMA Netw Open 2018; 1:e182497. [PMID: 30646169 PMCID: PMC6324458 DOI: 10.1001/jamanetworkopen.2018.2497] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/08/2018] [Indexed: 12/19/2022] Open
Abstract
Importance There is a genetic predisposition to early-onset atrial fibrillation (EOAF) in European American individuals. However, the role of family history in the pathogenesis of EOAF in racial and ethnic minorities remains unclear. Objective To determine whether probands with EOAF across racial and ethnic groups have a higher rate of AF in first-degree family members than racially and ethnically matched control patients with non-early-onset AF (non-EOAF). Design, Setting, and Participants In this cohort study, patients prospectively enrolled in a clinical and genetic biorepository were administered baseline questionnaires that included questions about family history of AF. Early-onset AF was defined as AF occurring in probands aged 60 years or younger in the absence of structural heart disease. All other forms were categorized as non-EOAF. Recruitment took place from July 2015 to December 2017. Analysis was performed in January 2018. Main Outcomes and Measures Primary analysis of reported family history of AF in first-degree relatives with sensitivity analysis restricted to those in whom a family history was confirmed by medical record review and electrocardiogram. Results Of 664 patients enrolled (mean [SD] age, 62 [12] years; 407 [61%] male), 267 (40%) were European American; 258 (39%), African American; and 139 (21%), Hispanic/Latino. There was a family history of AF in 36 probands with EOAF (49%) compared with 128 patients with non-EOAF (22%) (difference, 27%; 95% CI, 14%-40%; P < .001). On multivariable analysis, the adjusted odds of a proband with EOAF who was of African descent (odds ratio [OR], 2.69; 95% CI, 1.06-6.91; P < .001) or Hispanic descent (OR, 9.25; 95% CI, 2.37-36.23; P = .002) having a first-degree relative with AF were greater than those of European descent (OR, 2.51; 95% CI, 1.29-4.87; P = .006). Overall, probands with EOAF were more likely to have a first-degree relative with AF compared with patients with non-EOAF (adjusted OR, 3.02; 95% CI, 1.82-4.95; P < .001) across the 3 racial and ethnic groups. Atrial fibrillation in a first-degree family member was confirmed in 32% of probands with EOAF vs 11% of those with non-EOAF (difference, 21%; 95% CI, 11%-33%; P < .001). Furthermore, African American (28% vs 5%; difference, 23%; 95% CI, 4%-43%; P = .001), European American (35% vs 20%; difference, 15%; 95% CI, 1%-30%; P = .03), and Hispanic/Latino (30% vs 5%; difference, 25%; 95% CI, 4%-54%; P = .02) probands with EOAF were more likely to have a first-degree relative with confirmed AF vs racially and ethnically matched control patients with non-EOAF. The positive and negative predictive values for a family history of confirmed AF were both 89%. Conclusions and Relevance Probands of African or Hispanic/Latino descent with EOAF were more likely to have a first-degree relative with AF when compared with European American individuals. These findings support genetic predisposition to EOAF across all 3 races.
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Affiliation(s)
- Zain Alzahrani
- Department of Medicine, University of Illinois at Chicago
| | | | - Sara D. Darbar
- Department of Medicine, University of Illinois at Chicago
| | | | - Denise Mol
- Department of Medicine, University of Illinois at Chicago
| | | | | | - Mark McCauley
- Department of Medicine, University of Illinois at Chicago
- Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Sorin Lazar
- Department of Medicine, University of Illinois at Chicago
| | - Erik Wissner
- Department of Medicine, University of Illinois at Chicago
| | - Adarsh Bhan
- Department of Medicine, University of Illinois at Chicago
| | - Sreenivas Konda
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago
| | - Dawood Darbar
- Department of Medicine, University of Illinois at Chicago
- Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
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28
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Lutsey PL, Chen LY, Eaton A, Jaeb M, Rudser KD, Neaton JD, Alonso A. A Pilot Randomized Trial of Oral Magnesium Supplementation on Supraventricular Arrhythmias. Nutrients 2018; 10:nu10070884. [PMID: 29996476 PMCID: PMC6073799 DOI: 10.3390/nu10070884] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 02/07/2023] Open
Abstract
Low magnesium may increase the risk of atrial fibrillation. We conducted a double-blind pilot randomized trial to assess adherence to oral magnesium supplementation (400 mg of magnesium oxide daily) and a matching placebo, estimate the effect on circulating magnesium concentrations, and evaluate the feasibility of using an ambulatory heart rhythm monitoring device (ZioPatch) for assessing premature atrial contractions. A total of 59 participants were randomized; 73% were women, and the mean age was 62 years. A total of 98% of the participants completed the follow-up. In the magnesium supplement group, 75% of pills were taken, and in the placebo group, 83% were taken. The change in magnesium concentrations was significantly greater for those given the magnesium supplements than for those given the placebo (0.07; 95% confidence interval: 0.03, 0.12 mEq/L; p = 0.002). The ZioPatch wear time was approximately 13 of the requested 14 days at baseline and follow-up. There was no difference by intervention assignment in the change in log premature atrial contractions burden, glucose, or blood pressure. Gastrointestinal changes were more common among the participants assigned magnesium (50%) than among those assigned the placebo (7%), but only one person discontinued participation. In sum, compliance with the oral magnesium supplementation was very good, and acceptance of the ZioPatch monitoring was excellent. These findings support the feasibility of a larger trial for atrial fibrillation (AF) prevention with oral magnesium supplementation.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA.
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Anne Eaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Melanie Jaeb
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA.
| | - Kyle D Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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29
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Johnson LS, Persson AP, Wollmer P, Juul-Möller S, Juhlin T, Engström G. Irregularity and lack of p waves in short tachycardia episodes predict atrial fibrillation and ischemic stroke. Heart Rhythm 2018; 15:805-811. [DOI: 10.1016/j.hrthm.2018.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 12/24/2022]
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30
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Deng F, Raza A, Guo J. Treating obstructive sleep apnea with continuous positive airway pressure reduces risk of recurrent atrial fibrillation after catheter ablation: a meta-analysis. Sleep Med 2018; 46:5-11. [DOI: 10.1016/j.sleep.2018.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 10/18/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022]
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31
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McCabe PJ, Darbar D. Is Achieving the American Heart Association's Life Simple 7 Goals Sufficient to Reduce the Burden of Atrial Fibrillation? No Simple Answers. J Am Heart Assoc 2018; 7:JAHA.118.009127. [PMID: 29650713 PMCID: PMC6015403 DOI: 10.1161/jaha.118.009127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | - Dawood Darbar
- Department of Medicine and Pharmacology, University of Illinois at Chicago, IL
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32
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Influence of abdominal obesity and habitual behaviors on incident atrial fibrillation in Japanese. J Cardiol 2018; 71:118-124. [DOI: 10.1016/j.jjcc.2017.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022]
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33
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Zhao E, Chen S, Du Y, Zhang Y. Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A Meta-Analysis of Cohort Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5215868. [PMID: 29581977 PMCID: PMC5822830 DOI: 10.1155/2018/5215868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/04/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022]
Abstract
Numerous reports have been done to seek the relationship between sleep apnea hypopnea syndrome (SAHS) and the risk of atrial fibrillation (AF). However, definite conclusion has not yet been fully established. We examined whether SAHS increases AF incidence in common population and summarized all existing studies in a meta-analysis. We summarized the current studies by searching related database for potential papers of the association between SAHS and the risk of AF. Studies that reported original data or relative risks (RRs) with 95% confidence intervals (CIs) for the associations were included. Sensitivity analyses were performed by omitting each study iteratively and publication bias was detected by Begg's tests. Eight eligible studies met the inclusion criteria. Fixed effects meta-analysis showed that SAHS increased AF risk in the common population (RR = 1.70, 95% CI: 1.53-1.89, P = 0.002, I2 = 69.2%). There was a significant association between mild SAHS and the risk of AF (RR = 1.52, 95% CI: 1.28-1.79, P = 0.01, I2 = 78.4%), moderate SAHS (RR = 1.88, 95% CI: 1.55-2.27, P = 0.017, I2 = 75.6%), and severe SAHS (RR = 2.16, 95% CI: 1.78-2.62, P < 0.001, I2 = 91.0%). The results suggest that sleep apnea hypopnea syndrome could increase the risk of AF, and the higher the severity of SAHS, the higher risk of atrial fibrillation.
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Affiliation(s)
- Enfa Zhao
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shimin Chen
- Department of Gastroenterology, The First Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Yajuan Du
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yushun Zhang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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34
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Ellinwood N, Dobrev D, Morotti S, Grandi E. In Silico Assessment of Efficacy and Safety of I Kur Inhibitors in Chronic Atrial Fibrillation: Role of Kinetics and State-Dependence of Drug Binding. Front Pharmacol 2017; 8:799. [PMID: 29163179 PMCID: PMC5681918 DOI: 10.3389/fphar.2017.00799] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022] Open
Abstract
Current pharmacological therapy against atrial fibrillation (AF), the most common cardiac arrhythmia, is limited by moderate efficacy and adverse side effects including ventricular proarrhythmia and organ toxicity. One way to circumvent the former is to target ion channels that are predominantly expressed in atria vs. ventricles, such as KV1.5, carrying the ultra-rapid delayed-rectifier K+ current (IKur). Recently, we used an in silico strategy to define optimal KV1.5-targeting drug characteristics, including kinetics and state-dependent binding, that maximize AF-selectivity in human atrial cardiomyocytes in normal sinus rhythm (nSR). However, because of evidence for IKur being strongly diminished in long-standing persistent (chronic) AF (cAF), the therapeutic potential of drugs targeting IKur may be limited in cAF patients. Here, we sought to simulate the efficacy (and safety) of IKur inhibitors in cAF conditions. To this end, we utilized sensitivity analysis of our human atrial cardiomyocyte model to assess the importance of IKur for atrial cardiomyocyte electrophysiological properties, simulated hundreds of theoretical drugs to reveal those exhibiting anti-AF selectivity, and compared the results obtained in cAF with those in nSR. We found that despite being downregulated, IKur contributes more prominently to action potential (AP) and effective refractory period (ERP) duration in cAF vs. nSR, with ideal drugs improving atrial electrophysiology (e.g., ERP prolongation) more in cAF than in nSR. Notably, the trajectory of the AP during cAF is such that more IKur is available during the more depolarized plateau potential. Furthermore, IKur block in cAF has less cardiotoxic effects (e.g., AP duration not exceeding nSR values) and can increase Ca2+ transient amplitude thereby enhancing atrial contractility. We propose that in silico strategies such as that presented here should be combined with in vitro and in vivo assays to validate model predictions and facilitate the ongoing search for novel agents against AF.
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Affiliation(s)
- Nicholas Ellinwood
- Department of Pharmacology, University of California, Davis, Davis, CA, United States
| | - Dobromir Dobrev
- West German Heart and Vascular Center, Institute of Pharmacology, University Duisburg-Essen, Essen, Germany
| | - Stefano Morotti
- Department of Pharmacology, University of California, Davis, Davis, CA, United States
| | - Eleonora Grandi
- Department of Pharmacology, University of California, Davis, Davis, CA, United States
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35
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Gore-Panter SR, Rennison JH, Van Wagoner DR. Genetic-Genomic Insights Into the Metabolic Determinants of Spontaneous Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005636. [PMID: 28784606 DOI: 10.1161/circep.117.005636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | - Julie H Rennison
- From the Department of Molecular Cardiology, Cleveland Clinic, OH
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36
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Chatterjee NA, Shah RV, Murthy VL, Praestgaard A, Shah SJ, Ventetuolo CE, Barr RG, Kronmal R, Lima JAC, Bluemke DA, Jerosch-Herold M, Alonso A, Kawut SM. Right Ventricular Structure and Function Are Associated With Incident Atrial Fibrillation: MESA-RV Study (Multi-Ethnic Study of Atherosclerosis-Right Ventricle). Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004738. [PMID: 28082528 DOI: 10.1161/circep.116.004738] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 11/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right ventricular (RV) morphology has been associated with drivers of atrial fibrillation (AF) risk, including left ventricular and pulmonary pathology, systemic inflammation, and neurohormonal activation. The aim of this study was to investigate the association between RV morphology and risk of incident AF. METHODS AND RESULTS We interpreted cardiac magnetic resonance imaging in 4204 participants free of clinical cardiovascular disease in the MESA (Multi-Ethnic Study of Atherosclerosis). Incident AF was determined using hospital discharge records, study electrocardiograms, and Medicare claims data. The study sample (n=3819) was 61±10 years old and 47% male with 47.2% current/former smokers. After adjustment for demographics and clinical factors, including incident heart failure, higher RV ejection fraction (hazard ratio, 1.16 per SD; 95% confidence interval, 1.03-1.32; P=0.02) and greater RV mass (hazard ratio, 1.25 per SD; 95% confidence interval, 1.08-1.44; P=0.002) were significantly associated with incident AF. After additional adjustment for the respective left ventricular parameter, higher RV ejection fraction remained significantly associated with incident AF (hazard ratio, 1.15 per SD; 95% confidence interval, 1.01-1.32; P=0.04), whereas the association was attenuated for RV mass (hazard ratio, 1.16 per SD; 95% confidence interval, 0.99-1.35; P=0.07). In a subset of patients with available spirometry (n=2540), higher RV ejection fraction and mass remained significantly associated with incident AF after additional adjustment for lung function (P=0.02 for both). CONCLUSIONS Higher RV ejection fraction and greater RV mass were associated with an increased risk of AF in a multiethnic population free of clinical cardiovascular disease at baseline.
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Affiliation(s)
| | - Ravi V Shah
- For the author affiliations, please see the Appendix
| | | | | | - Sanjiv J Shah
- For the author affiliations, please see the Appendix
| | | | - R Graham Barr
- For the author affiliations, please see the Appendix
| | | | - Joao A C Lima
- For the author affiliations, please see the Appendix
| | | | | | - Alvaro Alonso
- For the author affiliations, please see the Appendix
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Pokorney SD, Piccini JP. Chocolate and prevention of atrial fibrillation: what is bad for the pancreas might be good for the atria? Heart 2017; 103:1141-1142. [DOI: 10.1136/heartjnl-2016-311026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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38
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Long MT, Yin X, Larson MG, Ellinor PT, Lubitz SA, McManus DD, Magnani JW, Staerk L, Ko D, Helm RH, Hoffmann U, Chung RT, Benjamin EJ. Relations of Liver Fat With Prevalent and Incident Atrial Fibrillation in the Framingham Heart Study. J Am Heart Assoc 2017; 6:JAHA.116.005227. [PMID: 28465298 PMCID: PMC5524082 DOI: 10.1161/jaha.116.005227] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Obesity is an important risk factor for nonalcoholic fatty liver disease and atrial fibrillation (AF). Less is known about the relations between nonalcoholic fatty liver disease and AF. We sought to evaluate the association between fatty liver and prevalent and incident AF in the community. Methods and Results We examined Framingham Heart Study participants who underwent a study‐directed computed tomography scan, had hepatic steatosis (HS) evaluated, and did not report heavy alcohol use between 2002 and 2005. We evaluated cross‐sectional associations between liver fat and prevalent AF with logistic regression models. We assessed the relations between liver fat and incident AF during 12‐year follow‐up with Cox proportional hazards models. Of 2122 participants (53% women; mean age, 59.0±9.6 years), 20% had HS. AF prevalence (n=62) among individuals with HS was 4% compared to 3% among those without HS. There was no significant association between HS (measured as continuous or dichotomous variables) and prevalent AF in age‐ and sex‐adjusted or multivariable‐adjusted models. Incidence of AF (n=153) among participants with and without HS was 8.7 cases and 7.8 cases per 1000 person‐years, respectively. In age‐ and sex‐adjusted and multivariable‐adjusted models, there were no significant associations between continuous or dichotomous measures of HS and incident AF. Conclusions In our community‐based, longitudinal cohort study, liver fat by computed tomography scan was not significantly associated with increased prevalence or incidence of AF over 12 years of follow‐up.
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Affiliation(s)
- Michelle T Long
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Xiaoyan Yin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA.,Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Martin G Larson
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA.,Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
| | - Steven A Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
| | - David D McManus
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Jared W Magnani
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center Heart & Vascular Institute University of Pittsburgh, Pittsburgh, PA
| | - Laila Staerk
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA
| | - Darae Ko
- Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Robert H Helm
- Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Udo Hoffmann
- Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Raymond T Chung
- Gastrointestinal Division, Department of Medicine, Liver Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA.,Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA
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Zakeri R, Van Wagoner DR, Calkins H, Wong T, Ross HM, Heist EK, Meyer TE, Kowey PR, Mentz RJ, Cleland JG, Pitt B, Zannad F, Linde C. The burden of proof: The current state of atrial fibrillation prevention and treatment trials. Heart Rhythm 2017; 14:763-782. [PMID: 28161513 PMCID: PMC5403606 DOI: 10.1016/j.hrthm.2017.01.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is an age-related arrhythmia of enormous socioeconomic significance. In recent years, our understanding of the basic mechanisms that initiate and perpetuate AF has evolved rapidly, catheter ablation of AF has progressed from concept to reality, and recent studies suggest lifestyle modification may help prevent AF recurrence. Emerging developments in genetics, imaging, and informatics also present new opportunities for personalized care. However, considerable challenges remain. These include a paucity of studies examining AF prevention, modest efficacy of existing antiarrhythmic therapies, diverse ablation technologies and practice, and limited evidence to guide management of high-risk patients with multiple comorbidities. Studies examining the long-term effects of AF catheter ablation on morbidity and mortality outcomes are not yet completed. In many ways, further progress in the field is heavily contingent on the feasibility, capacity, and efficiency of clinical trials to incorporate the rapidly evolving knowledge base and to provide substantive evidence for novel AF therapeutic strategies. This review outlines the current state of AF prevention and treatment trials, including the foreseeable challenges, as discussed by a unique forum of clinical trialists, scientists, and regulatory representatives in a session endorsed by the Heart Rhythm Society at the 12th Global CardioVascular Clinical Trialists Forum in Washington, DC, December 3-5, 2015.
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Affiliation(s)
- Rosita Zakeri
- Royal Brompton & Harefield NHS Trust, London, United Kingdom.
| | | | | | - Tom Wong
- Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | | | - E Kevin Heist
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Peter R Kowey
- Lankenau Heart Institute and Jefferson Medical College, Wynnewood, Pennsylvania
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina
| | - John G Cleland
- Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | | | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, France
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40
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Raman D, Kaffashi F, Lui LY, Sauer WH, Redline S, Stone P, Cawthon PM, Stone KL, Ensrud KE, Ancoli-Israel S, Loparo K, Mehra R. Polysomnographic Heart Rate Variability Indices and Atrial Ectopy Associated with Incident Atrial Fibrillation Risk in Older Community-dwelling Men. JACC Clin Electrophysiol 2017; 3:451-460. [PMID: 28534047 PMCID: PMC5437978 DOI: 10.1016/j.jacep.2016.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autonomic dysfunction contributes to atrial fibrillation (AF). OBJECTIVE We hypothesized that polysomnogram (PSG)-based heart rate variability (HRV) autonomic function biomarkers are associated with incident AF and these associations are modified by measures of sleep disordered breathing (SDB). METHODS 2350 participants of a multi-center prospective study (Outcomes of Sleep Disorders in Older Men Study) without baseline AF underwent sleep studies with incident adjudicated AF follow up (8.0 ± 2.6 years). Cox proportional hazard models were used to analyze sleep study-ECG spectral HRV indices [low and high frequency power (LF, HF), LF/HF] and time domain indices [mean of normal to normal beats (MNN), short and long term variability (STV, LTV) and STV/LTV] and premature atrial contractions (PACs) and incident AF (HR and 95% CI). Statistical interactions between HRV and SDB were examined. Models were adjusted for age, race, body mass index, waist circumference, cardiac medications, co-morbid diseases, alcohol use and study site. RESULTS Lower LF/HF and lower LF were associated with higher AF incidence (LF/HF Q1 vs. Q4: 1.46, 1.02-2.08, LF Q1 vs. Q4: 1.46, 1.02-2.10). Higher STV/LTV was associated with an increased risk of AF (p-trend= 0.028). The highest PAC quartile had a 3-fold increased AF risk (2.99, 1.94-4.62) compared to the lowest quartile. A significant interaction of obstructive apnea was observed in the LF-AF relationship (0.045). CONCLUSIONS Sleep-related reduced sympathovagal balance (LF/HF) and increased atrial ectopy are independently associated with future AF; a relationship modified by obstructive apnea.
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Affiliation(s)
- Dileep Raman
- Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Farhad Kaffashi
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, USA
| | - Li-Yung Lui
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | | | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Stone
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peggy M. Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Kristine E. Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California – San Diego, La Jolla, CA, USA
| | - Kenneth Loparo
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, USA
| | - Reena Mehra
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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41
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Piccini JP, Steinberg BA. Preventing heart failure in atrial fibrillation: In the middle of difficulty lies opportunity. Heart Rhythm 2017; 14:799-800. [PMID: 28254414 DOI: 10.1016/j.hrthm.2017.02.025] [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: 02/11/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan P Piccini
- Duke Center for Atrial Fibrillation, Electrophysiology Section, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Bjerregaard Larsen T, Lip GYH, Løchen ML, Marin F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Manuel Marques-Vidal P, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Eur J Prev Cardiol 2017; 24:4-40. [PMID: 27815538 PMCID: PMC5427484 DOI: 10.1177/2047487316676037] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- UiT The Arctic University of Norway, Tromso, Norway
- Mary MacKillop Institute for Health Research, Centre for Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Melbourne, Australia
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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43
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Healy C, Bonhomme CE. Can a pacemaker improve our ability to manage sleep apnea? Heart Rhythm 2016; 14:365-366. [PMID: 27989688 DOI: 10.1016/j.hrthm.2016.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Chris Healy
- Community Heart and Vascular, Indianapolis, Indiana.
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44
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Huang HD, Darbar D. Genetic Risk Scores for Atrial Fibrillation: Do They Improve Risk Estimation? Can J Cardiol 2016; 33:422-424. [PMID: 28129965 DOI: 10.1016/j.cjca.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/11/2016] [Accepted: 12/11/2016] [Indexed: 01/10/2023] Open
Affiliation(s)
- Henry D Huang
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Dawood Darbar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
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Eckhardt LL, Makielski JC. Complexity of AF genetic susceptibility begets complexity of interpretation. Heart Rhythm 2016; 14:292-293. [PMID: 27825974 DOI: 10.1016/j.hrthm.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Lee L Eckhardt
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jonathan C Makielski
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
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46
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37:2893-2962. [PMID: 27567408 DOI: 10.1093/eurheartj/ehw210] [Citation(s) in RCA: 4703] [Impact Index Per Article: 587.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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47
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The Role of Pharmacogenetics in Atrial Fibrillation Therapeutics: Is Personalized Therapy in Sight? J Cardiovasc Pharmacol 2016; 67:9-18. [PMID: 25970841 DOI: 10.1097/fjc.0000000000000280] [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] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide requiring therapy. Despite recent advances in catheter-based and surgical therapy, antiarrhythmic drugs (AADs) remain the mainstay of treatment for symptomatic AF. However, response in individual patients is highly variable with over half the patients treated with rhythm control therapy experiencing recurrence of AF within a year. Contemporary AADs used to suppress AF are incompletely and unpredictably effective and associated with significant risks of proarrhythmia and noncardiac toxicities. Furthermore, this "one-size" fits all strategy for selecting antiarrhythmics is based largely on minimizing risk of adverse effects rather than on the likelihood of suppressing AF. The limited success of rhythm control therapy is in part due to heterogeneity of the underlying substrate, interindividual differences in disease mechanisms, and our inability to predict response to AADs in individual patients. Genetic studies of AF over the past decade have revealed that susceptibility to and response to therapy for AF is modulated by the underlying genetic substrate. However, the bedside application of these new discoveries to the management of AF patients has thus far been disappointing. This may in part be related to our limited understanding about genetic predictors of drug response in general, the challenges associated with determining efficacy of response to AADs, and lack of randomized genotype-directed clinical trials. Nonetheless, recent studies have shown that common AF susceptibility risk alleles at the chromosome 4q25 locus modulated response to AADs, electrical cardioversion, and ablation therapy. This monograph discusses how genetic approaches to AF have not only provided important insights into underlying mechanisms but also identified AF subtypes that can be better targeted with more mechanism-based "personalized" therapy.
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48
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016; 50:e1-e88. [DOI: 10.1093/ejcts/ezw313] [Citation(s) in RCA: 602] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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49
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Abstract
Atrial fibrillation (AF) is an important cause of stroke and risk factor for heart failure and death. Current pharmacologic treatments for AF have limited efficacy, and treatments that more directly target the underlying causes of AF are needed. Oxidant stress and inflammatory activation are interrelated pathways that promote atrial electrical and structural remodeling, leading to atrial ectopy, interstitial fibrosis, and increased stroke risk. This review evaluates the impact of common stressors on atrial oxidant stress and inflammatory activation and the contribution of these pathways to atrial remodeling. Recent studies suggest that integrated efforts to target the underlying risk factors, rather than the AF per se, may have a greater impact on health and outcomes than isolated efforts focused on the electrical abnormalities.
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50
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016; 18:1609-1678. [PMID: 27567465 DOI: 10.1093/europace/euw295] [Citation(s) in RCA: 1318] [Impact Index Per Article: 164.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Stefan Agewall
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - John Camm
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gonzalo Baron Esquivias
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Werner Budts
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Scipione Carerj
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Filip Casselman
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Antonio Coca
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Raffaele De Caterina
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Spiridon Deftereos
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Dobromir Dobrev
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - José M Ferro
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gerasimos Filippatos
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Donna Fitzsimons
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Bulent Gorenek
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Maxine Guenoun
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Stefan H Hohnloser
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Philippe Kolh
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gregory Y H Lip
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Athanasios Manolis
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - John McMurray
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Piotr Ponikowski
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Raphael Rosenhek
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Frank Ruschitzka
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Irina Savelieva
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Sanjay Sharma
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Piotr Suwalski
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Juan Luis Tamargo
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Clare J Taylor
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Isabelle C Van Gelder
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Adriaan A Voors
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Stephan Windecker
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Jose Luis Zamorano
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Katja Zeppenfeld
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
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