1
|
Vij V, Ruf TF, Thambo JB, Vogt L, Al-Sabri SMA, Nelles D, Schrickel JW, Beiert T, Nickenig G, von Bardeleben RS, Iriart X, Sedaghat A. Contrast-free left atrial appendage occlusion in patients using the LAMBRE™ device. Int J Cardiol 2024; 405:131939. [PMID: 38458388 DOI: 10.1016/j.ijcard.2024.131939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/22/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Advances in imaging have led to procedural optimization of left atrial appendage closure (LAAC). Contrast-free approaches, guided merely by echocardiography, have been established, however data on this topic remains scarce. In this analysis, we assessed contrast-free procedural results with the LAMBRE LAAC device. METHODS The multicenter retrospective BoBoMa (Bonn/Bordeaux/Mainz)-Registry included a total of 118 patients that underwent LAAC with LAMBRE devices omitting contrast-dye. Baseline and echocardiographic characteristics as well as intra- and postprocedural complications and outcomes were assessed. RESULTS Patients were at a mean age of 77.5 ± 7.5 years with high thromboembolic and bleeding risk (CHADS-VASc-score 4.6 ± 1.4, HAS-BLED-score 3.7 ± 1.0, respectively). Renal function was impaired with a mean glomerular filtration rate (GFR) of 50 ± 22 ml/min. Mean procedural time was 47.2 ± 37.5 minutes with a mean radiation dose of 4.75 ± 5.25 Gy*cm2. Device success, defined as proper deployment in a correct position, was achieved in 97.5% (115/118) of cases with repositioning of the occluder in 7.6% (9/118) and resizing in 3.4% (4/118) of cases. No relevant peri-device leakage (>3 mm) was observed with 42% of occluders being implanted in an ostial position. Periprocedural complications occurred in 6.8% (8/118) of cases, including two cases of device embolization and one case of clinically-relevant pericardial effusion requiring surgical intervention. Other complications included pericardial effusion (2.5%, 3/118) and vascular access site complications (1.7%, 2/118). CONCLUSION Echocardiography-guided contrast-free LAAC using the LAMBRE device is safe and feasible. Further prospective studies including the direct comparison of devices as well as imaging techniques are warranted in contrast-free LAAC.
Collapse
Affiliation(s)
- Vivian Vij
- Herzzentrum Bonn, University Hospital Bonn, Germany
| | | | | | - Lara Vogt
- Herzzentrum Bonn, University Hospital Bonn, Germany
| | | | | | | | | | | | | | | | - Alexander Sedaghat
- Herzzentrum Bonn, University Hospital Bonn, Germany; RheinAhrCardio, Praxis für Kardiologie, Bad-Neuenahr Ahrweiler, Germany.
| |
Collapse
|
2
|
Pręgowski J, Pracoń R, Mioduszewska A, Skowroński J, Sondergaard L, Mintz GS, Capodanno D, Kim SW, De Baker O, Waciński P, Wojakowski W, Rdzanek A, Grygier M, Chmielecki M, Franco LN, Stokłosa P, Firek B, Marczak M, Miłosz B, Chmielak Z, Demkow M, Witkowski A. Strategy to optimize PeriproCeduraL AnticOagulation in structural transseptal interventions: Design and rationale of the STOP CLOT trial. Am Heart J 2024; 271:68-75. [PMID: 38401649 DOI: 10.1016/j.ahj.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Both transcatheter edge-to-edge repair (TEER) of mitral regurgitation or left atrial appendage closure (LAAC) require periprocedural anticoagulation with unfractionated heparin (UFH) that is administered either before or immediately after transseptal puncture (TSP). The optimal timing of UFH administration (before or after TSP) is unknown. The Strategy To Optimize PeriproCeduraL AnticOagulation in Structural Transseptal Interventions trial (STOP CLOT Trial) was designed to determine if early anticoagulation is effective in reducing ischemic complications without increasing the risk of periprocedural bleeding. METHODS The STOP CLOT trial is a multicenter, prospective, double-blind, placebo-controlled, randomized trial. A total of 410 patients scheduled for TEER or LAAC will be randomized 1:1 either early UFH administration (iv. bolus of 100 units/kg UFH or placebo, given after obtaining femoral vein access and at least 5 minutes prior to the start of the TSP) or late UFH administration (iv. bolus of 100 units/kg UFH or placebo given immediately after TSP). Prespecified preliminary statistical analysis will be performed after complete follow-up of the first 196 randomized subjects. To ensure blinding, a study nurse responsible for randomization and UFH/placebo preparation is not involved in the care of the patients enrolled into the study. The primary study endpoint is a composite of (1) major adverse cardiac and cerebrovascular events (death, stroke, TIA, myocardial infarction, or peripheral embolization) within 30 days post-procedure, (2) intraprocedural fresh thrombus formation in the right or left atrium as assessed with periprocedural transesophageal echocardiography, or (3) occurrence of new ischemic lesions (diameter ≥4 mm) on brain magnetic resonance imaging performed 2 to 5 days after the procedure. The safety endpoint is the occurrence of moderate or severe bleeding complications during the index hospitalization. CONCLUSIONS Protocols of periprocedural anticoagulation administration during structural interventions have never been tested in a randomized clinical trial. The Stop Clot trial may help reach consensus on the optimal timing of initiation of periprocedural anticoagulation. CLINICAL TRIALS REGISTRATION NUMBER The study protocol is registered at ClinicalTrials.gov, identifier NCT05305612.
Collapse
Affiliation(s)
| | | | | | | | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY
| | - Davide Capodanno
- Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | | | - Ole De Baker
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Piotr Waciński
- Samodzielny Publiczny Szpital Kliniczny 4 w Lublinie, Lublin, Poland
| | - Wojciech Wojakowski
- Górnośląskie Centrum Medyczne im prof. L. Gieca Śląskiego Uniwersytetu Medycznego, Katowice, Poland
| | - Adam Rdzanek
- Uniwersyteckie Centrum Medyczne Warszawskiego Uniwersytetu Medycznego, Warsaw, Poland
| | - Marek Grygier
- Uniwersytecki Szpital Kliniczny w Poznaniu, Poznań, Poland
| | - Michał Chmielecki
- Kliniczne Centrum Kardiologii, Uniwersyteckie, Centrum Kliniczne, Gdański, Poland
| | | | | | - Bohdan Firek
- National Institute of Cardiology, Warsaw, Poland
| | | | | | | | | | | |
Collapse
|
3
|
Wang K, Xu M, Wang Z, Wang Z, Li M, Liu H, Chen H, Ju W, Chen M. Anticoagulation Intensity during Appendage Occlusion: Lessons from Silent Cerebral Embolism. Cardiology 2024; 149:349-356. [PMID: 38354708 PMCID: PMC11309060 DOI: 10.1159/000537708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Endovascular left atrial appendage occlusion (LAAO) is associated with a high incidence of peri-procedure silent cerebral embolism (SCE), while the recommended activated clotting time (ACT) level by the expert consensus is lower than that in atrial fibrillation (AF) ablation. The aim of our study was to investigate whether raising the targeted ACT level during LAAO to the same level as AF ablation could decrease the incidence of SCE. METHODS It was a prospective observational cohort study. Consecutive AF patients receiving LAAO between January 2021 and December 2022 were included and categorized into two groups based on the time of enrollment. Patients enrolled in 2021 (group 250) maintained a target ACT level of ≥250 s during LAAO procedure, while patients enrolled in 2022 (group 300) maintained the peri-procedure ACT ≥300 s. All patients underwent cerebral magnetic resonance imaging before and after the procedure. RESULTS A total of 81 patients were included (38 in the group 250 and 43 in the group 300). After inverse probability of treatment weighting (IPTW), patients in the group 250 showed a significantly lower incidence of SCE than group 300 (IPTW p = 0.038). Only a stable high ACT pattern could decrease the risk of SCE. No significant differences were found between other ACT change patterns on the SCE incidence. CONCLUSION Raising the peri-procedure ACT level to a stable 300 s could decrease the risk of the SCE without increasing the major bleeding events.
Collapse
Affiliation(s)
- Kexin Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingjia Xu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhe Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zidun Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Streb W, Lasek-Bal A, Mitręga K, Kowalczyk J, Podolecki T, Kowalska W, Olma A, Sobczyk A, Kalarus Z. Rationale and design of a randomized clinical trial evaluating the efficacy of mechanical neuroprotection in reducing the risk of silent brain infarcts associated with percutaneous left atrial appendage closure: study protocol for a LAAC-SBI trial. Trials 2023; 24:749. [PMID: 37996955 PMCID: PMC10666419 DOI: 10.1186/s13063-023-07766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Left atrial appendage closure (LAAC) procedures prevent cardioembolic stroke in patients with atrial fibrillation who have contraindications to oral anticoagulant medications. However, these procedures carry certain risks of peri-procedural complications. One such complication is silent brain infarcts (SBI), which can lead to cognitive impairment and mood disturbances. The implementation of mechanical neuroprotection systems during LAAC procedures may reduce the risk of SBI and associated cognitive and mood disorders. METHODS The LAAC-SBI trial is a prospective, multicenter, randomized, and double-blind interventional study. The study aims to enroll a total of 240 patients, with 120 patients allocated to each group. The study group will evaluate the use of the Sentinel CPS during LAAC, while the control group will undergo LAAC procedures without the Sentinel CPS. The primary endpoint of the study is the number of new SBIs or stroke foci detected by diffusion-weighted magnetic resonance imaging (DW MRI). Secondary endpoints include deterioration of cognitive function, development of dementia syndrome, and occurrence of depressive disorders. These endpoints will be assessed using questionnaire tools such as the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Controlled Oral Word Association Test (COWAT), and Hospital Anxiety and Depression Scale (HADS). The observational period for patients in the study is 2 years. DISCUSSION If the study demonstrates a favorable outcome with reduced incidence of SBI and improved cognitive and mood outcomes in patients receiving cerebral protection devices during LAAC, it will have significant implications for clinical management standards. This would support the use of neuroprotection devices not only for LAAC but also in procedures such as atrial fibrillation ablation or transcatheter mitral valve interventions, where the risk of embolic events and subsequent brain injury may also be present. TRIAL REGISTRATION ClinicalTrials.gov NCT05369195. Registration on 11.05.2022.
Collapse
Affiliation(s)
- Witold Streb
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
- Silesian Centre for Heart Diseases in Zabrze, Curie-Skłodowskiej 9, Zabrze, 41‒800, Poland.
| | - Anetta Lasek-Bal
- Department of Neurology, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Mitręga
- Silesian Centre for Heart Diseases in Zabrze, Curie-Skłodowskiej 9, Zabrze, 41‒800, Poland
| | - Jacek Kowalczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Centre for Heart Diseases in Zabrze, Curie-Skłodowskiej 9, Zabrze, 41‒800, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Centre for Heart Diseases in Zabrze, Curie-Skłodowskiej 9, Zabrze, 41‒800, Poland
| | - Wiktoria Kowalska
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Centre for Heart Diseases in Zabrze, Curie-Skłodowskiej 9, Zabrze, 41‒800, Poland
| | - Anna Olma
- Silesian Centre for Heart Diseases in Zabrze, Curie-Skłodowskiej 9, Zabrze, 41‒800, Poland
| | - Agata Sobczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Centre for Heart Diseases in Zabrze, Curie-Skłodowskiej 9, Zabrze, 41‒800, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Centre for Heart Diseases in Zabrze, Curie-Skłodowskiej 9, Zabrze, 41‒800, Poland
| |
Collapse
|
5
|
Garot P, Bergmann MW. Limitations in Contemporary Pharmacological Stroke Prevention Therapies in Atrial Fibrillation: A Descriptive Literature Review. J Clin Med 2023; 12:6594. [PMID: 37892737 PMCID: PMC10607152 DOI: 10.3390/jcm12206594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The most common arrhythmia, atrial fibrillation (AF), increases with age and is associated with a 5-fold increased risk of stroke. Although lifelong oral anticoagulation (OAC) is strongly recommended for stroke prevention in patients with AF and CHA2DS2-VASc ≥ 2 only 50-60% of patients in Western countries belonging to this group are treated with oral anticoagulants, and less than half of these adhere to therapy over time. Before 2010, the numerous limitations associated with vitamin K antagonists (VKAs) were considered to be the reason behind OAC underuse; however, the approval of direct oral anticoagulants (DOACs) that require once- or twice-daily intake, no regular blood tests and fewer drug-food interactions has resulted in only modest improvements in OAC use and adherence.
Collapse
Affiliation(s)
- Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay-Santé, 91300 Massy, France
| | | |
Collapse
|
6
|
Jimenez Diaz VA, Kapadia SR, Linke A, Mylotte D, Lansky AJ, Grube E, Settergren M, Puri R. Cerebral embolic protection during transcatheter heart interventions. EUROINTERVENTION 2023; 19:549-570. [PMID: 37720969 PMCID: PMC10495748 DOI: 10.4244/eij-d-23-00166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
Stroke remains a devastating complication of transcatheter aortic valve replacement (TAVR), with the incidence of clinically apparent stroke seemingly fixed at around 3% despite TAVR's significant evolution during the past decade. Embolic showers of debris (calcium, atheroma, valve material, foreign material) are captured in the majority of patients who have TAVR using a filter-based cerebral embolic protection device (CEPD). Additionally, in systematic brain imaging studies, the majority of patients receiving TAVR exhibit new cerebral lesions. Mechanistic studies have shown reductions in the volume of new cerebral lesions using CEPDs, yet the first randomised trial powered for periprocedural stroke within 72 hours of a transfemoral TAVR failed to meet its primary endpoint of showing superiority of the SENTINEL CEPD. The present review summarises the clinicopathological rationale for the development of CEPDs, the evidence behind these devices to date and the emerging recognition of cerebral embolisation in many non-TAVR transcatheter procedures. Given the uniqueness of each of the various CEPDs under development, specific trials tailored to their designs will need to be undertaken to broaden the CEPD field, in addition to evaluating the role of CEPD in non-TAVR transcatheter heart interventions. Importantly, the cost-effectiveness of these devices will require assessment to broaden the adoption of CEPDs globally.
Collapse
Affiliation(s)
- Victor Alfonso Jimenez Diaz
- Cardiology Department, Hospital Álvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IISGS), SERGAS-UVIGO, Vigo, Spain
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden University Hospital, Dresden, Germany and Technische Universität Dresden, Dresden, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland and University of Galway, Galway, Ireland
| | | | - Eberhard Grube
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Magnus Settergren
- Heart and Vascular Unit, Karolinska University Hospital, Stockholm, Sweden and Karolinska Institutet, Stockholm, Sweden
| | - Rishi Puri
- Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
7
|
Kany S, Brachmann J, Lewalter T, Akin I, Sievert H, Zeymer U, Ledwoch J, Ince H, Thomas D, Hochadel M, Senges J, Kirchhof P, Rillig A. Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry. Clin Res Cardiol 2021; 111:511-521. [PMID: 34043052 PMCID: PMC9054864 DOI: 10.1007/s00392-021-01874-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. METHODS Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). RESULTS A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02-2.72, p = 0.041). CONCLUSION Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality.
Collapse
Affiliation(s)
- Shinwan Kany
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Johannes Brachmann
- Department of Cardiology, Angiology and Pneumology, Coburg Hospital, Coburg, Germany
| | - Thorsten Lewalter
- Department of Medicine-Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Ibrahim Akin
- Department of Cardiology, University Hospital Mannheim, Mannheim, Germany
| | - Horst Sievert
- Cardio Vascular Centre, Frankfurt, Frankfurt/Main, Germany
| | - Uwe Zeymer
- Department of Cardiology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Jakob Ledwoch
- Department of Cardiology, Hospital Neuperlach, Munich, Germany
| | - Hüseyin Ince
- Department of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Dierk Thomas
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jochen Senges
- Stiftung Für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| |
Collapse
|
8
|
Mohanty S, Mohanty P, Trivedi C, Assadourian J, Mayedo AQ, MacDonald B, Della Rocca DG, Gianni C, Horton R, Al-Ahmad A, Bassiouny M, Burkhardt JD, Di Biase L, Gurol ME, Natale A. Impact of Oral Anticoagulation Therapy Versus Left Atrial Appendage Occlusion on Cognitive Function and Quality of Life in Patients With Atrial Fibrillation. J Am Heart Assoc 2021; 10:e019664. [PMID: 33870705 PMCID: PMC8200746 DOI: 10.1161/jaha.120.019664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background We compared the cognitive status and quality of life in patients with atrial fibrillation undergoing left atrial appendage occlusion (LAAO) or remaining on oral anticoagulation (OAC) after atrial fibrillation ablation. Methods and Results Cognition was assessed by the Montreal Cognitive Assessment (MoCA) survey at baseline and follow‐up. Consecutive patients receiving LAAO or OAC after atrial fibrillation ablation were screened, and patients with a score of ≤17 were excluded from the study. Quality of life was measured at baseline and 1 year using the Atrial Fibrillation Effect on Quality of Life survey. A total of 50 patients (CHA2DS2‐VASc [congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65–74 years, sex category] score: 3.30±1.43) in the LAAO group and 48 (CHA2DS2‐VASc score 2.73±1.25) in the OAC group were included in this prospective study. Mean baseline MoCA score was 26.18 and 26.08 in the LAAO and OAC groups, respectively (P=0.846). At 1 year, scores were 26.94 and 23.38 in the respective groups. MoCA score decreased by an estimated −2.74 (95% CI, −3.61 to −1.87; P<0.0001) points in the OAC group, whereas the change in the LAAO group was nonsignificant (0.79; (95% CI, −0.06 to 1.64; P=0.07). After adjusting for baseline clinical characteristics, remaining on OAC was an independent predictor of MoCA change at 1 year (regression coefficient, −3.38; 95% CI, −4.75 to −2.02; P<0.0001). Change in Atrial Fibrillation Effect on Quality of Life score did not differ significantly in achieving a clinically important difference between groups. Conclusions In this series, a significant difference in the postprocedure MoCA score was observed in postablation patients with atrial fibrillation receiving LAAO versus remaining on OAC with a substantial decline in the score in the OAC group. However, quality of life improved similarly across groups. Registration https://www.ClinicalTrials.gov. Unique identifier: NCT01816308
Collapse
Affiliation(s)
| | - Prasant Mohanty
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX
| | | | | | - Bryan MacDonald
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX
| | | | - Carola Gianni
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX
| | - Rodney Horton
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX
| | - John D Burkhardt
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX.,Albert Einstein College of Medicine at Montefiore Hospital New York NY
| | - M Edip Gurol
- Massachusetts General HospitalHarvard Medical School Boston MA
| | - Andrea Natale
- Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX.,Interventional Electrophysiology Scripps Clinic San Diego CA.,Metro Health Medical CenterCase Western Reserve University School of Medicine Cleveland OH
| |
Collapse
|
9
|
Brockmeyer M, Wolff G, Krieger T, Lin Y, Karathanos A, Afzal S, Zeus T, Westenfeld R, Polzin A, Heinen Y, Perings S, Kelm M, Schulze V. Kidney function stratified outcomes of percutaneous left atrial appendage occlusion in patients with atrial fibrillation and high bleeding risk. Acta Cardiol 2020; 75:312-320. [PMID: 30983505 DOI: 10.1080/00015385.2019.1585643] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Patients with chronic kidney disease (CKD) and atrial fibrillation have increased risks for stroke and bleeding under oral anticoagulation (OAC). We investigated an alternative therapy of percutaneous left atrial appendage occlusion (LAAO) in CKD patients in this study.Methods: Consecutive patients undergoing LAAO were included in a retrospective analysis and stratified for kidney function into CKD/Non-CKD groups (cutoff eGFR 60 ml/min). Procedural characteristics, in-hospital and follow-up events were analysed and compared between groups.Results: LAAO was performed in 146 patients (81 CKD; 65 Non-CKD), mean follow-up was 391 days. Groups differed in eGFR (40.1 (CKD) vs. 75.1 (Non-CKD) ml/min) and CHA2DS2VASc scores (4.65 ± 1.3 (CKD) vs. 4.06 ± 1.4 (Non-CKD)). Procedural success was 98.6%, contrast-induced acute kidney injury was significantly more frequent in CKD patients (11.1% vs. 0%; p = .004). Follow-up mortality was higher in CKD (10.5/100 PY vs. 4.2/100 PY; p = .156). Follow-up stroke rates were 2.3/100 (CKD) patient-years (PY) and 1.4/100 PY (Non-CKD) (p = 1.000), corresponding to a relative risk reduction (RRR) of 60% (all), 68% (CKD) and 71% (Non-CKD) compared to expected stroke rates. Follow-up major bleeding rates were 3.5/100 PY (CKD) and 4.2/100 PY (Non-CKD), corresponding to RRR of 57% (all), 61% (CKD) and 53% (Non-CKD) compared to OAC.Conclusions: Left atrial appendage occlusion shows comparable efficacy for stroke and bleeding prevention in CKD and Non-CKD patients. CKD patients experience more adverse events during follow-up and a significantly increased risk for periprocedural contrast-induced acute kidney injury.
Collapse
Affiliation(s)
- Maximilian Brockmeyer
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Georg Wolff
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Torben Krieger
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Yingfeng Lin
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Athanasios Karathanos
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shazia Afzal
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tobias Zeus
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ralf Westenfeld
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Amin Polzin
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Yvonne Heinen
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stefan Perings
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
- Medical Faculty, CARID – Cardiovascular Research Institute Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Volker Schulze
- Medical Faculty, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| |
Collapse
|
10
|
Haussig S, Linke A, Mangner N. Cerebral Protection Devices during Transcatheter Interventions: Indications, Benefits, and Limitations. Curr Cardiol Rep 2020; 22:96. [PMID: 32651654 PMCID: PMC7351861 DOI: 10.1007/s11886-020-01335-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose of Review Stroke remains a devastating complication of cardiovascular interventions. This review is going to discuss stroke rates and outcomes in different cardiovascular procedures with a highlight on the current evidence for the use of cerebral protection devices (CPD). Recent Findings Depending on the quality of neurological assessment, stroke occurs in up to 9.1% after TAVI, 3.9% after mitral clipping, 3.1% in LAAO patients, 0.4% after PCIs, and 1.8% after catheter ablation. CPDs are available for routine use. They are easy to use in most anatomies, feasible, and safe. Data on clinical impact and stroke reduction from RCTs are still missing. Summary Most evidence for the routine use of CPDs exists in TAVI patients, who are at the highest risk. The PROTECTED TAVI RCT will shed more light on the clinical impact of CPD-use in TAVI patients. In other cardiovascular procedures like mitral clipping, PCIs, and ablation, the current data do not support the routine use of CPDs in these patients.
Collapse
Affiliation(s)
- Stephan Haussig
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany.
| | - Axel Linke
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany
| | - Norman Mangner
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany
| |
Collapse
|
11
|
Häusler KG, Endres M, Landmesser U. [Left atrial appendage occlusion in patients with nonvalvular atrial fibrillation : Present evidence, ongoing studies, open questions]. Med Klin Intensivmed Notfmed 2020; 115:107-113. [PMID: 30483820 DOI: 10.1007/s00063-018-0500-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/18/2018] [Accepted: 07/29/2018] [Indexed: 01/14/2023]
Abstract
About every fifth ischemic stroke is caused by atrial fibrillation. Oral anticoagulation is highly effective in secondary stroke prevention, but a relevant portion of patients with atrial fibrillation is not (permanently) anticoagulated for a variety of reasons. Based on present evidence, no general recommendation can be given for left atrial appendage occlusion in patients with nonvalvular atrial fibrillation. However, left atrial appendage occlusion is a treatment option after severe anticoagulation-related bleeding, if the cause of bleeding is not treatable. Left atrial appendage occlusion is critical in patients with a relative contraindication for oral anticoagulation or lack of adherence to given medication. It seems to be important that further randomized studies confirm a benefit of left atrial appendage occlusion in selected patients with nonvalvular atrial fibrillation. In addition, it is vital to clarify whether discontinuation of antiplatelets is feasible after catheter-based left atrial appendage occlusion, as antiplatelets are associated with a risk of bleeding. Within this review article, we discuss present evidence, gaps of knowledge and provide an overview on ongoing clinical studies. In addition, we summarize the design of the CLOSURE-AF study. This randomized multicenter study will start recruitment soon and is funded by the German Center for Cardiovascular Research e. V.
Collapse
Affiliation(s)
- K G Häusler
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland.
- Kompetenznetz Vorhofflimmern e. V., Münster, Deutschland.
| | - M Endres
- Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
- Centrum für Schlaganfallforschung Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, Berlin, Deutschland
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Berlin, Berlin, Deutschland
- Excellence Cluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Berliner Institut für Gesundheitsforschung, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - U Landmesser
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, Berlin, Deutschland
- Berliner Institut für Gesundheitsforschung, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Medizinische Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| |
Collapse
|
12
|
Ali M, Rigopoulos AG, Mammadov M, Torky A, Auer A, Matiakis M, Abate E, Bakogiannis C, Tzikas S, Bigalke B, Sedding D, Noutsias M. Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord 2020; 20:78. [PMID: 32050904 PMCID: PMC7017553 DOI: 10.1186/s12872-020-01349-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Percutaneous closure (LAAC) of the left atrial appendage (LAA) is an efficacious preventive procedure for patients with non-valvular atrial fibrillation (NVAF) and considerable bleeding risk. We sought to systematically review the available LAAC data on the novel occluder device LAmbre™. METHODS For this systematic review, a search of the literature was conducted by 3 independent reviewers, reporting the safety and therapeutic success of LAAC in patients being treated with a LAmbre™. Publications reporting the safety and therapeutic success of LAAC using LAmbre™ in n > 5 patients were included. RESULTS The literature search retrieved n = 10 publications, encompassing n = 403 NVAF patients treated with a LAmbre™ LAAC, with relevant data regarding safety and therapeutic success of the procedure. The mean CHA2DS2-VASc Score was 4.0 + 0.9, and the mean HAS-BLED score was 3.4 + 0.5. The implantation success was 99.7%, with a mean procedure time of 45.4 ± 18.7 min, and a fluoroscopy time of 9.6 ± 5.9 min, and a contrast agent volume of 96.7 ± 0.7 ml. The anticoagulation regimen was switched to DAPT post procedure in the majority of the patients (96.8%). Partial and full recapture were done in 45.5% and in 25.6%, respectively. Major complications were reported in 2.9%, with 0.3% mortality, 1.7% pericardial tamponade, 0.3% stroke, and 0.6% major bleeding complications; no device embolization was observed. During follow up at 6 or 12 months, major adverse cardiovascular events were reported in 3.3%: Stroke or TIA in 1.7%, thrombus formation on the device in 0.7%, and residual flow > 5 mm in 1.0%. In some publications, the favorable implantion properties of the LAmbre™ for difficult anatomies such as shallow or multilobular LAA anatomies were described. CONCLUSIONS This systematic review on the LAmbre™ LAA-occluder including n = 403 NVAF patients demonstrates an excellent implantion success rate, promising follow-up clinical data, and favorable properties for also challenging LAA anatomies,. While its design seems to be helpful in preventing device embolization, pericardial tamponade may not be substantially reduced by the LAmbre™ as compared with other established LAAC devices. Further larger prospective multicenter registries and randomized trials are needed to scrutinize the value of the LAmbre™ compared with established LAAC devices.
Collapse
Affiliation(s)
- Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Mammad Mammadov
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Abdelrahman Torky
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Andrea Auer
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Marios Matiakis
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Elena Abate
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Constantinos Bakogiannis
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Boris Bigalke
- Department of Cardiology, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany.
| |
Collapse
|
13
|
Abstract
Atrial fibrillation is the most frequent cardiac arrhythmia worldwide, causing approximately 20% of all ischemic strokes. Therefore, oral anticoagulation is recommended in patients with atrial fibrillation with at least a moderate risk of stroke; however, there is a significant proportion of patients who cannot undergo long-term oral anticoagulation. As the left atrial appendage is of major relevance for atrial fibrillation-induced thrombus formation, catheter-based or surgical closure of the left atrial appendage appears to be a promising therapeutic option. Large registry studies including patients with catheter-based left atrial appendage closure have proven its effectiveness and a decreasing procedure-related complication rate. This review article summarizes the current knowledge and introduces major ongoing randomized studies, which will investigate the impact of left atrial appendage closure on stroke prevention. The authors hope that the results of the randomized CLOSURE AF trial, which is funded by the German Center for Cardiovascular Research e. V. and is now recruiting patients in Germany, will help to solve many of the currently prevalent clinical questions.
Collapse
Affiliation(s)
- K G Häusler
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland.
| | - U Landmesser
- Medizinische Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
- Berliner Institut für Gesundheitsforschung, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland
| |
Collapse
|
14
|
Rosman L, Burg MM, Lampert R. Catheter Ablation and Cognitive Impairment in Atrial Fibrillation: Another Hit or a Silver Bullet? Circ Arrhythm Electrophysiol 2019; 12:e007521. [PMID: 31442073 DOI: 10.1161/circep.119.007521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lindsey Rosman
- Section of Cardiovascular Medicine, Department of Internal Medicine (L.R., M.M.B., R.L.), Yale School of Medicine, New Haven, CT
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Department of Internal Medicine (L.R., M.M.B., R.L.), Yale School of Medicine, New Haven, CT.,Department of Anesthesiology (M.M.B.), Yale School of Medicine, New Haven, CT
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Department of Internal Medicine (L.R., M.M.B., R.L.), Yale School of Medicine, New Haven, CT
| |
Collapse
|
15
|
Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Europace 2019; 20:1399-1421. [PMID: 29562326 DOI: 10.1093/europace/euy046] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023] Open
Abstract
Abstract
Collapse
Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Tze-Fan Chao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute, Memorial Health, Hollywood, FL, USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health, Framingham Heart Study, Boston, MA, USA
| | | | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Université François Rabelais, Tours, France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography, Instituto Nacional De Cardiologia, Mexico City, Mexico
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | | | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Atul Verma
- Southlake Regional Health Centre, Ontario, Canada
| | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, People's Republic of China
| | | | | |
Collapse
|
16
|
Glassy MS, Sharma G, Singh GD, Smith TWR, Fan D, Rogers JH. Usable implantation depth for watchman left atrial appendage occlusion is greater with appendage angiography than transesophageal echocardiography. Catheter Cardiovasc Interv 2019; 93:E311-E317. [PMID: 30311343 DOI: 10.1002/ccd.27916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/09/2018] [Accepted: 09/09/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare left atrial appendage (LAA) angiography to transesophageal echocardiography (TEE) for assessing usable LAA depth. BACKGROUND TEE is typically employed for procedural measurement of LAA ostial diameter and depth. Since angiography enhances distal LAA anatomy, we sought to compare angiography to TEE for determining usable LAA depth. METHODS Seventy five Watchman device cases were retrospectively evaluated. Two independent cardiologists measured intraoperative LAA ostial diameter and depth at standard 0°, 45°, 90°, and 135° TEE omniplane views and in the right anterior oblique (RAO) 30°, caudal (CAUD) 30° angiographic view. RESULTS The average age and CHA2 DS2 VASc score were 74 (±7.2) years and 4.6 (±1.3), respectively. The average ostial diameter and depth (mm) by TEE were 0°: 19.6 and 26.5; 45°: 17.5 and 26.6; 90°: 18.3 and 25.1; 135°: 19.5 and 23.3. The ostial diameter and depth (mm) by RAO 30° CAUD 30° angiography were 21.1 and 29.7. This angiographic view corresponds to a TEE view between 90° and 135°. In comparison to angiography, TEE 90° underestimated the LAA ostial diameter by 2.9 ± 3.7 mm (P < 0.001) and by 1.9 ± 4.0 mm at TEE 135° (P < 0.01); Pearson's r 0.53 angiography/TEE 90° and 0.50 angiography/TEE 135°. More importantly, TEE 90° underestimated the true usable LAA depth by 5.4 ± 5.8 mm (P < 0.001) and by 7.3 ± 6.1 mm at TEE 135° (P < 0.001); Pearson's r 0.39 angiography/TEE 90° and 0.30 angiography/TEE 135°. CONCLUSIONS Compared to TEE, LAA angiography provides additional depth information and may be particularly valuable when patients have insufficient depth for Watchman by TEE measures.
Collapse
Affiliation(s)
- Matthew S Glassy
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Gaurav Sharma
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Thomas W R Smith
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Dali Fan
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| |
Collapse
|
17
|
Contrast-free, echocardiography-guided left atrial appendage occlusion (LAAo): a propensity-matched comparison with conventional LAAo using the AMPLATZER™ Amulet™ device. Clin Res Cardiol 2018; 108:333-340. [DOI: 10.1007/s00392-018-1401-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/30/2018] [Indexed: 10/27/2022]
|
18
|
Schellinger PD, Tsivgoulis G, Steiner T, Köhrmann M. Percutaneous Left Atrial Appendage Occlusion for the Prevention of Stroke in Patients with Atrial Fibrillation: Review and Critical Appraisal. J Stroke 2018; 20:281-291. [PMID: 30309224 PMCID: PMC6186917 DOI: 10.5853/jos.2018.02537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 09/12/2018] [Indexed: 12/27/2022] Open
Abstract
The authors review the current status of percutaneous left atrial appendage (LAA) occlusion therapy in patients with atrial fibrillation with the goal to prevent ischemic stroke and systemic embolism and to reduce oral anticoagulation associated bleeding. While we cover the historical and also surgical background, and all tested devices, the main focus rests on the single currently U.S. Food and Drug Administration (FDA) approved LAA occluder, the WATCHMAN device, and its approval process. The authors also give a critical appraisal beyond the review of mere facts, trying to put the current data into perspective.
Collapse
Affiliation(s)
- Peter D Schellinger
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Clinic RUB, Minden, Germany
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Thorsten Steiner
- Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt, Germany.,Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Köhrmann
- Department of Neurology, Essen University Hospital, Essen, Germany
| |
Collapse
|
19
|
Wisst T, Meincke F, Spangenberg T, Wienemann H, Reinholz C, Kreidel F, Kuck KH, Ghanem A. Safety and feasibility of interventional left atrial appendage closure without contrast agent. ASIAINTERVENTION 2018; 4:126-133. [PMID: 36484002 PMCID: PMC9706726 DOI: 10.4244/aij-d-17-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/09/2018] [Indexed: 06/17/2023]
Abstract
AIMS Interventional left atrial appendage closure (LAAC) is routinely performed under both echocardiographic and angiographic guiding. However, adverse outcomes, e.g., kidney injury and cerebral embolism, might be associated with injections of contrast agent into the LAA. Therefore, this prospective registry investigated the safety and feasibility of LAAC without the support of angiographic images as the default approach. METHODS AND RESULTS This single-centre registry included a total of 46 non-selected, consecutive patients. In the first 25 patients (54%), LAAC with the Amulet device was performed routinely with LAA angiography prior to implantation and after release of the device. The following 21 patients (46%) were treated without the use of contrast agent. The combination of successful implantation and lack of procedural complications was regarded as the primary endpoint. Procedure time, number of recapture manoeuvres, change of device size, compression, leakage, dose area product and late thrombosis on the device were investigated as secondary endpoints. Besides the longer fluoroscopy time and duration of the procedure in the group using angiography, no significant differences could be found. Major complications occurred equally often in both cohorts. CONCLUSIONS Interventional LAAC with the Amulet device can be performed safely without the use of contrast agent. This approach might help to enhance the use of LAAC in patients at high risk of contrast-induced nephropathy and procedural stroke.
Collapse
Affiliation(s)
- Theresa Wisst
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Felix Meincke
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Hendrik Wienemann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Claudia Reinholz
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Felix Kreidel
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Ghanem
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
20
|
Bellmann B, Rillig A, Skurk C, Leistner DM, Haeusler KG, Lin T, Geran R, Koehler L, Guttmann S, Tscholl V, Roser M, Lenz K, Villringer K, Wun Park J, Fiebach JB, Landmesser U. Long-term follow up of 3 T MRI-detected brain lesions after percutaneous catheter-based left atrial appendage closure. Catheter Cardiovasc Interv 2018; 92:327-333. [PMID: 29737618 DOI: 10.1002/ccd.27611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/05/2018] [Accepted: 03/02/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) for stroke prevention is an increasingly performed intervention. AIMS This prospective study aims to evaluate the incidence of long-term magnetic resonance imaging (MRI)-detected brain lesions as well as potential changes of neurocognitive function after percutaneous LAAC. METHODS Brain MRI at 3 T was performed within 24 hr before and after LAAC. A follow-up MRI was carried out after three months. Neuro-cognitive examination using the National Institutes of Health Stroke Scale (NIHSS) score and the Montreal Cognitive Assessment (MoCA) Test was performed. RESULTS Successful device implantation was achieved in all 25 patients (age 74.6 ± 10.2 years, male = 17) using the Amulet (n = 20), Occlutech (n = 3), or a Lambre (n = 2) device. In 12/25 (48%) patients, acute brain lesions (ABL) were detected after LAAC. A three-month follow-up MRI was performed in seven patients, and no new ABLs were seen. In 5/7 (71%) patients, there were no residual changes from the ABLs detectable. However, the FLAIR sequence was still positive in two patients. After LAAC, there were no significant differences in the MoCA-test (mean 24.3 ± 4.5 vs. 23.5 ± 4.5; P = 0.1) and the NIHSS-score (mean 0.9 ± 1.6 vs. 1.2 ± 1.8; P = 0.1). This was the same at the three-month follow-up (MoCA-test 23.5 ± 4.5 vs. 23.8 ± 2.7; P = 0.3; NIHSS-score 1.2 ± 1.8 vs. 1.0 ± 0.8; P = 0.4). CONCLUSION While new MRI-detected brain lesions are commonly observed after percutaneous LAAC, ABLs were no longer detectable in 71% of the patients at the three-month follow-up. There were no significant changes in neurocognitive function after LAAC and at the three-month follow-up.
Collapse
Affiliation(s)
- Barbara Bellmann
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - Andreas Rillig
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - David Manuel Leistner
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - Karl Georg Haeusler
- Charité - Universitätsmedizin Berlin, University Hospital, Center for Stroke Research Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - Tina Lin
- HeartCare Victoria, Melbourne, Australia
| | - Rohat Geran
- Charité - Universitätsmedizin Berlin, University Hospital, Center for Stroke Research Berlin, Berlin, Germany
| | - Luzie Koehler
- Charité - Universitätsmedizin Berlin, University Hospital, Center for Stroke Research Berlin, Berlin, Germany
| | - Selma Guttmann
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - Verena Tscholl
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - Mattias Roser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - Klaus Lenz
- Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kersten Villringer
- Charité - Universitätsmedizin Berlin, University Hospital, Center for Stroke Research Berlin, Berlin, Germany
| | - Jai- Wun Park
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| | - Jochen B Fiebach
- Charité - Universitätsmedizin Berlin, University Hospital, Center for Stroke Research Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, University Hospital, Berlin, Germany
| |
Collapse
|
21
|
Ahmad TA, Gilchrist I. Subclinical brain lesions after left atrial appendage occlusion: Does silence mean reassurance? Catheter Cardiovasc Interv 2018; 92:334-335. [DOI: 10.1002/ccd.27774] [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: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Tariq Ali Ahmad
- Penn State University, College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center; Hershey Pennsylvania 17033
| | - IanC. Gilchrist
- Penn State University, College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center; Hershey Pennsylvania 17033
| |
Collapse
|
22
|
Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK, Bautista-Vargas WF, Chiang CE, Cuesta A, Dan GA, Frankel DS, Guo Y, Hatala R, Lee YS, Murakawa Y, Pellegrini CN, Pinho C, Milan DJ, Morin DP, Nadalin E, Ntaios G, Prabhu MA, Proietti M, Rivard L, Valentino M, Shantsila A. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice? J Arrhythm 2018; 34:99-123. [PMID: 29657586 PMCID: PMC5891416 DOI: 10.1002/joa3.12050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany
| | | | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute Memorial Health Hollywood FL USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA
| | | | - Lin Yee Chen
- Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
| | - Laurent Fauchier
- Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany
| | - Jonathan Kalman
- Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia
| | | | | | - Deirdre A Lane
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico
| | - Tatjana Potpara
- School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK
| | | | - Hung-Fat Tse
- Department of Medicine The University of Hong Kong Hong Kong China
| | - Atul Verma
- Southlake Regional Health Centre Newmarket ON Canada
| | - Shu Zhang
- Beijing Fuwai Hospital Beijing China
| | | | - William-Fernando Bautista-Vargas
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Chern-En Chiang
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alejandro Cuesta
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Gheorghe-Andrei Dan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David S Frankel
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yutao Guo
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Robert Hatala
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Young Soo Lee
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yuji Murakawa
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Cara N Pellegrini
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Claudio Pinho
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David J Milan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Daniel P Morin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Elenir Nadalin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - George Ntaios
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mukund A Prabhu
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Marco Proietti
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Lena Rivard
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mariana Valentino
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alena Shantsila
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| |
Collapse
|
23
|
European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Heart Rhythm 2018; 15:e37-e60. [PMID: 29563045 DOI: 10.1016/j.hrthm.2018.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 12/18/2022]
|