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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. J Am Coll Cardiol 2023; 82:1131-1174. [PMID: 37516946 DOI: 10.1016/j.jacc.2023.03.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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Lakkireddy D, Ahmed A, Atkins D, Bawa D, Garg J, Bush J, Charate R, Bommana S, Pothineni NVK, Kabra R, Darden D, Koreber S, Tummala R, Vasamreddy C, Park P, Mohanty S, Gopinathannair R, Seo BW, Natale A, Kennedy R. Feasibility and Safety of Intravenous Sotalol Loading in Adult Patients With Atrial Fibrillation (DASH-AF). JACC Clin Electrophysiol 2023; 9:555-564. [PMID: 37014289 DOI: 10.1016/j.jacep.2022.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Inpatient initiation of sotalol is recommended owing to its proarrhythmic effects. The DASH-AF (Feasibility and Safety of Intravenous Sotalol Administered as a Loading Dose to Initiate Oral Sotalol Therapy in Adult Patients With Atrial Fibrillation) trial evaluates the safety and feasibility of intravenous (IV) sotalol, achieving a steady state with maximum QTc prolongation within 6 hours instead of the traditional 5-dose inpatient oral (PO) titration. METHODS DASH-AF is a prospective, nonrandomized, multicenter, open-label trial consisting of patients who underwent IV sotalol loading dose to initiate rapid oral therapy for atrial arrhythmias. IV dose was calculated based on the target oral dose as indicated by baseline QTc and renal function. Patients' QTc (in sinus) was measured via electrocardiography at 15-minute intervals and after IV loading completion. Patients were discharged 4 hours after first oral dose. All patients were monitored via mobile cardiac outpatient telemetry for 72 hours. The control group was composed of patients admitted for the traditional 5 PO doses. Safety outcomes were assessed in both groups. RESULTS One hundred twenty patients from 3 centers were enrolled from 2021 to 2022 in the IV loading group (compared with type of AF- and renal function-matched patients in the conventional PO loading cohort). This study demonstrated no significant change in ΔQTc in both groups, with a significantly lower number of patients requiring dose adjustment in the IV arm compared with the PO arm (4.1% vs 16.6%; P = 0.003). This led to potential cost savings of up to $3,500.68 per admission. CONCLUSIONS The DASH-AF trial shows that rapid IV sotalol loading in atrial fibrillation/flutter patients for rhythm control is feasible and safe compared with conventional oral loading with significant cost reduction. (Feasibility and Safety of Intravenous Sotalol Administered as a Loading Dose to Initiate Oral Sotalol Therapy in Adult Patients With Atrial Fibrillation [DASH-AF]; NCT04473807).
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Tarn DM, Shih K, Tseng CH, Thomas A, Schwartz JB. Reasons for Nonadherence to the Direct Oral Anticoagulant Apixaban: A Cross-Sectional Survey of Atrial Fibrillation Patients. JACC. ADVANCES 2023; 2:100175. [PMID: 38939023 PMCID: PMC11198726 DOI: 10.1016/j.jacadv.2022.100175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/22/2022] [Indexed: 06/29/2024]
Abstract
Background Nonadherence to direct oral anticoagulants to prevent stroke occurs in up to 40% of atrial fibrillation patients. Underlying reasons are poorly understood. Objectives This study quantified patient-reported reasons for nonadherence and identified strategies to improve adherence. Methods This is a cross-sectional survey of atrial fibrillation patients in 2 academic health systems who reported apixaban nonadherence. We examined patient-reported reasons for nonadherence and level of nonadherence (assessed by a validated 3-item adherence measure) using a multivariable logistic regression model. Results Of 419 study patients, 41.5% were women. The mean age was 71.1 ± 10 years and mean CHA2DS2VASc score was 3.2 ± 1.6. About two-thirds had adherence scores ≥80 (mild nonadherence) and one-third scores <80 (poor adherence). In all groups, forgetfulness contributed to nonadherence. Attitudes/beliefs associated with adherence score <80 included: not believing apixaban was needed (odds ratio [OR]: 12.24 [95% CI: 2.25-66.47]); medication cost (OR: 3.97 [95% CI: 1.67-9.42]); and fear of severe bleeding (OR: 3.28 [95% CI: 1.20-8.96]). Strategies that patients with adherence scores <80 selected as helping "a great deal/a lot" to increase adherence included bloodwork to evaluate efficacy (56%), physician counseling about adherence (55%), and having a reversal agent (39%). Almost one-half of all patients did not disclose nonadherence to their providers. Conclusions Patients may not disclose their nonadherence to prescribers, and attitudes related to apixaban nonadherence differ among patients with mild nonadherence versus poor adherence. While all patients may benefit from strategies to address forgetfulness, concerns related to the purpose of apixaban, cost, and bleeding risk may require special attention in those with poor adherence.
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Affiliation(s)
- Derjung M. Tarn
- Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, California, USA
| | - Kevin Shih
- Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, California, USA
| | - Chi-hong Tseng
- Division of General Internal Medicine/Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, California, USA
| | - Alveena Thomas
- Division of Geriatrics, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Janice B. Schwartz
- Division of Geriatrics, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Division of Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California-San Francisco, San Francisco, California, USA
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Pujadas ER, Raisi-Estabragh Z, Szabo L, Morcillo CI, Campello VM, Martin-Isla C, Vago H, Merkely B, Harvey NC, Petersen SE, Lekadir K. Atrial fibrillation prediction by combining ECG markers and CMR radiomics. Sci Rep 2022; 12:18876. [PMID: 36344532 PMCID: PMC9640662 DOI: 10.1038/s41598-022-21663-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with a higher risk of important adverse health outcomes such as stroke and death. AF is linked to distinct electro-anatomic alterations. The main tool for AF diagnosis is the Electrocardiogram (ECG). However, an ECG recorded at a single time point may not detect individuals with paroxysmal AF. In this study, we developed machine learning models for discrimination of prevalent AF using a combination of image-derived radiomics phenotypes and ECG features. Thus, we characterize the phenotypes of prevalent AF in terms of ECG and imaging alterations. Moreover, we explore sex-differential remodelling by building sex-specific models. Our integrative model including radiomics and ECG together resulted in a better performance than ECG alone, particularly in women. ECG had a lower performance in women than men (AUC: 0.77 vs 0.88, p < 0.05) but adding radiomics features, the accuracy of the model was able to improve significantly. The sensitivity also increased considerably in women by adding the radiomics (0.68 vs 0.79, p < 0.05) having a higher detection of AF events. Our findings provide novel insights into AF-related electro-anatomic remodelling and its variations by sex. The integrative radiomics-ECG model also presents a potential novel approach for earlier detection of AF.
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Affiliation(s)
- Esmeralda Ruiz Pujadas
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain.
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Liliana Szabo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Cristian Izquierdo Morcillo
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Víctor M Campello
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Martin-Isla
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Hajnalka Vago
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
- Health Data Research UK, London, UK
- Alan Turing Institute, London, UK
| | - Karim Lekadir
- Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
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Shah SP, Sah RP, Panthi S, Shah RK, Acharya R, Neupane D, Puri R, Poudel S, Basnet LB. Atrial Fibrillation among Patients Admitted to the Department of Internal Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:756-760. [PMID: 36705122 PMCID: PMC9794939 DOI: 10.31729/jnma.7858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Atrial fibrillation is one of the commonest arrhythmias with an overall prevalence estimated to be 0.4-1% in the general population. The objective of this study was to find out the prevalence of atrial fibrillation among patients admitted to the Department of Internal Medicine in a tertiary care centre. METHODS A descriptive cross-sectional study was conducted among patients admitted to the Department of Internal Medicine of a tertiary care centre from 01 March 2021 to 01 March 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: IRC-478/2021). Convenience sampling method was used. Data were collected from the hospital records using a semi-structured study proforma including demography, clinical presentation, laboratory investigations, electrocardiogram, 2-dimension echocardiography, and CHA2DS2VASc score. Point estimate and 95% Confidence Interval were calculated. RESULTS Among 27,980 patients, atrial fibrillation was found in 185 (0.66%) (0.58-0.77, 95% Confidence Interval). Among them 66 (35.67%) were in the age group of 61-70 years and 97 (52.43%) were females. Dyspnea was present in 149 (80.54%), palpitation in 137 (74.05%) and pedal edema in 117 (63.27%). Valvular atrial fibrillation was seen in 101 (54.59%) and non-valvular atrial fibrillation was seen in 84 (45.41%) patients. CONCLUSIONS The prevalence of atrial fibrillation was found to be similar when compared to other studies conducted in similar settings.
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Affiliation(s)
- Surendra Prasad Shah
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal,Correspondence: Dr Surendra Prasad Shah, Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal. , Phone: +977-9860101376
| | - Ram Pratap Sah
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Sagar Panthi
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Rakesh Kumar Shah
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Rochana Acharya
- B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Durga Neupane
- B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Reecha Puri
- Manmohan Memorial Institute of Health Sciences, Maharajgunj, Kathmandu, Nepal
| | - Sulaksha Poudel
- Curative Service Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Lila Bahadur Basnet
- Curative Service Division, Department of Health Services, Teku, Kathmandu, Nepal
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 596] [Impact Index Per Article: 298.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Kraft M, Büscher A, Wiedmann F, L’hoste Y, Haefeli WE, Frey N, Katus HA, Schmidt C. Current Drug Treatment Strategies for Atrial Fibrillation and TASK-1 Inhibition as an Emerging Novel Therapy Option. Front Pharmacol 2021; 12:638445. [PMID: 33897427 PMCID: PMC8058608 DOI: 10.3389/fphar.2021.638445] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia with a prevalence of up to 4% and an upwards trend due to demographic changes. It is associated with an increase in mortality and stroke incidences. While stroke risk can be significantly reduced through anticoagulant therapy, adequate treatment of other AF related symptoms remains an unmet medical need in many cases. Two main treatment strategies are available: rate control that modulates ventricular heart rate and prevents tachymyopathy as well as rhythm control that aims to restore and sustain sinus rhythm. Rate control can be achieved through drugs or ablation of the atrioventricular node, rendering the patient pacemaker-dependent. For rhythm control electrical cardioversion and pharmacological cardioversion can be used. While electrical cardioversion requires fasting and sedation of the patient, antiarrhythmic drugs have other limitations. Most antiarrhythmic drugs carry a risk for pro-arrhythmic effects and are contraindicated in patients with structural heart diseases. Furthermore, catheter ablation of pulmonary veins can be performed with its risk of intraprocedural complications and varying success. In recent years TASK-1 has been introduced as a new target for AF therapy. Upregulation of TASK-1 in AF patients contributes to prolongation of the action potential duration. In a porcine model of AF, TASK-1 inhibition by gene therapy or pharmacological compounds induced cardioversion to sinus rhythm. The DOxapram Conversion TO Sinus rhythm (DOCTOS)-Trial will reveal whether doxapram, a potent TASK-1 inhibitor, can be used for acute cardioversion of persistent and paroxysmal AF in patients, potentially leading to a new treatment option for AF.
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Affiliation(s)
- Manuel Kraft
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Antonius Büscher
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Felix Wiedmann
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Yannick L’hoste
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Constanze Schmidt
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
- HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
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Cortisol on Circadian Rhythm and Its Effect on Cardiovascular System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020676. [PMID: 33466883 PMCID: PMC7830980 DOI: 10.3390/ijerph18020676] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 01/09/2023]
Abstract
The synthesis and secretion of cortisol are controlled by the hypothalamic–pituitary–adrenal axis. Cortisol exhibits a proper 24-h circadian rhythm that affects the brain, the autonomic nervous system, the heart, and the vasculature that prepares the cardiovascular system for optimal function during these anticipated behavioral cycles. A literature search was conducted using databases such as Google Scholar, PubMed, and Scopus. Relevant search terms included “circadian rhythm and cardiovascular”, “cortisol”, “cortisol and acute coronary syndrome”, “cortisol and arrhythmias”, “cortisol and sudden cardiac death”, “cortisol and stroke”, and “cardioprotective agents”. A total of 120 articles were obtained on the basis of the above search. Lower levels of cortisol were seen at the beginning of sleep, while there was a rise towards the end of sleep, with the highest level reached at the moment the individual wakes up. In the present review, we discuss the role of 11β-hydroxysteroid dehydrogenase (11β-HSD1), which is a novel molecular target of interest for treating metabolic syndrome and type-2 diabetes mellitus. 11β-HSD1 is the major determinant of cortisol excess, and its inhibition alleviates metabolic abnormalities. The present review highlights the role of cortisol, which controls the circadian rhythm, and describes its effect on the cardiovascular system. The review provides a platform for future potential cardioprotective therapeutic agents.
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A new risk model of assessing left atrial appendage thrombus in patients with atrial fibrillation - Using multiple clinical and transesophageal echocardiography parameters. Int J Cardiol 2020; 314:60-63. [PMID: 32305560 DOI: 10.1016/j.ijcard.2020.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/05/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUNDS Predicting left atrial appendage thrombus (LAAT) in non-valvular atrial fibrillation (NVAF) patients need more precisely quantified risk models. In this study, we attempted to review the risk markers for LAAT and develop a simple and reliable model for LAAT prediction. METHODS The study included 307 patients with NVAF who were scheduled for transesophageal echocardiography (TEE) to exclude LAA thrombus before synchronized electrical cardioversion or radiofrequency ablation for atrial fibrillation (AF). We analyzed the relationship between echo, clinical parameters and the presence or absence of LAAT. RESULTS A total of 33 patients were found having LAAT (10.7%, 33/307). The age, left atrial appendage emptying velocity (LAAEV), left atrial or left atrial appendage spontaneous echocardiographic contrast (SEC), less than moderate to severe mitral regurgitation (≤mild MR), and left atrial enlargement showed association with LAAT. The multivariate logistic regression analysis revealed that LAAEV, SEC and ≤mild MR were independent risk factors of the LAAT. We used LAAEV ≤ 21.5 cm/s, SEC and ≤mild MR to construct a combined predictive model for LAAT in NVAF patients (the area under receiver operator characteristic curve: 0.88; 95% confidence interval: 0.82-0.95, P < 0.0001). CONCLUSION Comprehensive evaluation of LAAEV, SEC, and MR with associated LAAT may help risk stratifying the NVAF patients, especially if the LAA imaging quality was suboptimal for identifying thrombus. These parameters may facilitate the decision-making process at the time of TEE.
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Choi H, Lee W, Lee HS, Kong SG, Kim DJ, Lee S, Oh H, Kim YN, Ock S, Kim T, Park MJ, Song W, Rim JH, Lee JH, Jeong S. The risk factors associated with treatment-related mortality in 16,073 kidney transplantation-A nationwide cohort study. PLoS One 2020; 15:e0236274. [PMID: 32722695 PMCID: PMC7386583 DOI: 10.1371/journal.pone.0236274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023] Open
Abstract
Mortality at an early stage after kidney transplantation is a catastrophic event. Treatment-related mortality (TRM) within 1 or 3 months after kidney transplantation has been seldom reported. We designed a retrospective observational cohort study using a national population-based database, which included information about all kidney recipients between 2003 and 2016. A total of 16,073 patients who underwent kidney transplantation were included. The mortality rates 1 month (early TRM) and 3 months (TRM) after transplantation were 0.5% (n = 74) and 1.0% (n = 160), respectively. Based on a multivariate analysis, older age (hazard ratio [HR] = 1.06; P < 0.001), coronary artery disease (HR = 3.02; P = 0.002), and hemodialysis compared with pre-emptive kidney transplantation (HR = 2.53; P = 0.046) were the risk factors for early TRM. Older age (HR = 1.07; P < 0.001), coronary artery disease (HR = 2.88; P < 0.001), and hemodialysis (HR = 2.35; P = 0.004) were the common independent risk factors for TRM. In contrast, cardiac arrhythmia (HR = 1.98; P = 0.027) was associated only with early TRM, and fungal infection (HR = 2.61; P < 0.001), and epoch of transplantation (HR = 0.34; P < 0.001) were the factors associated with only TRM. The identified risk factors should be considered in patient counselling, selection, and management to prevent TRM.
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Affiliation(s)
- Hyunji Choi
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Woonhyoung Lee
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sup Lee
- Department of Hematology-Oncology, Kosin University College of Medicine, Busan, South Korea
| | - Seom Gim Kong
- Department of Pediatrics, Kosin University College of Medicine, Busan, South Korea
| | - Da Jung Kim
- Department of Hematology-Oncology, Kosin University College of Medicine, Busan, South Korea
| | - Sangjin Lee
- Graduate School, Department of Statistics, Pusan National University, Busan, South Korea
| | - Haeun Oh
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Ye Na Kim
- Department of Nephrology, Kosin University College of Medicine, Busan, South Korea
| | - Soyoung Ock
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Taeyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
| | - John Hoon Rim
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Medicine, Physician-Scientist Program, Yonsei University Graduate School of Medicine, Seoul, South Korea
| | - Jong-Han Lee
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seri Jeong
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
- * E-mail:
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Verlato R, Pieragnoli P, Iacopino S, Rauhe W, Molon G, Stabile G, Rebellato L, Allocca G, Arena G, Rovaris G, Sacchi R, Catanzariti D, Pepi P, Tondo C. Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:687-697. [PMID: 32510595 DOI: 10.1111/pace.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long-term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re-ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF-then-CB group or (b) RF repeat ablation following a failed CB ablation, CB-then-RF group. METHODS Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. RESULTS We studied 474 patients, 349 in RF-then-CB and 125 in CB-then-RF group. Less women (21% vs 30%; P = .041), more persistent AF (33% vs 22%; P = .015), longer duration of AF (60 vs 31 months; P < .001), and more hypertension (50% vs 36%; P = .007) were observed in the RF-then-CB cohort as compared with the CB-then-RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF-then-CB and CB-then-RF group, respectively (P < .001). During the follow-up, significantly less AF recurrence occurred in the CB-then-RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24-0.92; P = .025). Cohort designation was the only independent predictor of AF recurrence. CONCLUSION Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long-term follow-up as compared with those originally treated by RF ablation receiving a CB repeat ablation.
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Affiliation(s)
- Roberto Verlato
- AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | | | | | | | | | - Giuseppe Stabile
- Casa di Cura Montevergine, Mercogliano, Italy.,Clinica San Michele, Maddaloni, Italy
| | - Luca Rebellato
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giuseppe Allocca
- Santa Maria dei Battuti, Presidio Ospedaliero, Conegliano, Italy
| | | | | | | | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS Milan, Milan, Italy
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12
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Inaba O, Metzner A, Rottner L, Mathew S, Lemes C, Maurer T, Heeger C, John A, Hashiguchi N, Wohlmuth P, Ouyang F, Kuck K, Rillig A, Reissmann B. Radiofrequency or cryoballoon ablation for index pulmonary vein isolation: What is the impact on long‐term clinical outcomes after repeat ablation? J Cardiovasc Electrophysiol 2020; 31:1068-1074. [DOI: 10.1111/jce.14432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/20/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Osamu Inaba
- Department of CardiologySaitama Red Cross Hospital Saitama Japan
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Andreas Metzner
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- Department of CardiologyUniversity Heart Center Hamburg Hamburg Germany
| | - Laura Rottner
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- Department of CardiologyUniversity Heart Center Hamburg Hamburg Germany
| | - Shibu Mathew
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Christine Lemes
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Tilman Maurer
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Christian Heeger
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- University Heart Centre Lübeck Germany
| | - Alexander John
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | | | | | - Feifan Ouyang
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Karl‐Heinz Kuck
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Andreas Rillig
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- Department of CardiologyUniversity Heart Center Hamburg Hamburg Germany
| | - Bruno Reissmann
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- Department of CardiologyUniversity Heart Center Hamburg Hamburg Germany
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13
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Gunawardene MA, Eickholt C, Akbulak RÖ, Jularic M, Klatt N, Hartmann J, Schlüter M, Meyer C, Willems S, Schaeffer B. Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current. J Cardiovasc Electrophysiol 2020; 31:1051-1061. [DOI: 10.1111/jce.14413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie A. Gunawardene
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Christian Eickholt
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Ruken Ö. Akbulak
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| | - Mario Jularic
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Niklas Klatt
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| | - Jens Hartmann
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | | | - Christian Meyer
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LübeckBerlin Germany
| | - Stephan Willems
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Benjamin Schaeffer
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
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14
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The impact of the dominant frequency of body surface electrocardiography in patients with persistent atrial fibrillation. Heart Vessels 2020; 35:967-976. [PMID: 32016538 DOI: 10.1007/s00380-020-01563-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
The dominant frequency (DF) of atrial fibrillation (AF) reflects atrial electrical activity. However, the relationship between DF measured using surface electrocardiography (ECG) and AF ablation success remains unclear. This study aimed to clarify whether the DF of surface ECG in patients with persistent AF could predict arrhythmia recurrence after catheter ablation. We investigated 125 patients with persistent AF who underwent catheter ablation between January 2009 and December 2016. Thirty-four patients (27%) had arrhythmia recurrence after catheter ablation. These patients showed a significantly high DF value in leads aVL (7.2 ± 0.7 Hz vs 6.6 ± 0.9 Hz, p < 0.001) and V1 (7.4 ± 0.8 Hz vs 6.7 ± 0.7 Hz, p < 0.001). We set the cutoff value of DF as 6.9 Hz in lead aVL (sensitivity, 80%; specificity, 63%) and as 7.1 Hz in lead V1 (sensitivity, 72%; specificity, 67%). Patients with DF < 6.9 Hz in lead aVL showed a significantly higher recurrence-free rate than those with DF ≥ 6.9 Hz (88% vs 45%; p < 0.001). Patients with DF of < 7.1 Hz in lead V1 showed a significantly higher recurrence-free rate than those with DF of ≥ 7.1 (87% vs 47%; p < 0.001). Patients with a high DF in leads aVL and V1 showed a lower success rate of persistent AF ablation. The DF measured from surface ECG can be a useful marker to predict ablation success.
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15
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Forkmann M, Schwab C, Edler D, Vevecka A, Butz S, Haller B, Brachmann J, Busch S. Characteristics of early recurrences detected by continuous cardiac monitoring influencing the long-term outcome after atrial fibrillation ablation. J Cardiovasc Electrophysiol 2019; 30:1886-1893. [PMID: 31397518 DOI: 10.1111/jce.14109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 01/23/2023]
Abstract
AIMS Early recurrences (ER) of atrial arrhythmias are common after catheter ablation of atrial fibrillation (AF). The significance of these ER is controversial. Based on data of continuous cardiac monitoring, we sought to investigate the characteristics of ER and their impact on late recurrences (LR) during follow-up. METHODS One hundred twenty-six patients with paroxysmal (49%) or persistent (51%) AF underwent an AF ablation with subsequent implantation of implantable loop recorder. Follow up was 12 months using remote monitoring. All atrial arrhythmia (AF or atrial tachycardia-AT-) episodes >30 seconds. within the 3-month blanking period were considered and the AF burden evaluated every 3 months. RESULTS Within the 3-months blanking period, 72 patients (57%) experienced an AF/AT recurrence. Survival free from any arrhythmia recurrence during follow-up was 40% in patients with ER vs 69% in those without ER. AF burden during the blanking period and timing of ER correlated significantly with LR at 12 months (area under curve = 0.74, P < .0001 and .831, P < .0001). An AF burden ≥0.5% and ER after 74 days predicted LR (sensitivity 60%, specificity 84.4%; sensitivity 75.6%, specificity 90.3%). In cox regression analysis, AF burden ≥0.5% and ER after 74 days were independently associated with LR. CONCLUSION Continuous cardiac monitoring after AF ablation provides important information regarding early recurrence episodes and their prognostic impact. A cut-off of 74 days for the blanking period seems to better differentiate patients with a good or a poor long-term outcome. An AF burden ≥0.5% during the 3 months postablation is predictive for late arrhythmia recurrences.
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Affiliation(s)
| | | | - Daniela Edler
- II, Medizinische Klinik, Klinikum Coburg, Coburg, Germany
| | - Aneida Vevecka
- II, Medizinische Klinik, Klinikum Coburg, Coburg, Germany
| | - Steffi Butz
- II, Medizinische Klinik, Klinikum Coburg, Coburg, Germany
| | - Bernhard Haller
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum rechts der Isar der TU München, München, Germany
| | | | - Sonia Busch
- II, Medizinische Klinik, Klinikum Coburg, Coburg, Germany
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16
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Bonfanti L, Lippi G, Donelli V, Pigna F, Saccenti C, Cervellin G. Is anticoagulant therapy always indicated in "medium-risk" patients with first diagnosed atrial fibrillation? Insights from a real world, 10-year observational study. Int J Cardiol 2019; 288:76-81. [PMID: 31047700 DOI: 10.1016/j.ijcard.2019.04.057] [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: 03/11/2019] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The choice of antithrombotic prophylaxis in the so-called "medium-risk" patients (i.e., CHA2DS2-VASc score = 1 in males or 2 in females) is one of the major enigmatic issues in clinical management of atrial fibrillation (AF). METHODS We retrospectively evaluated 30-day and 1-year thromboembolic events in all consecutive medium-risk patients visited for first diagnosed AF in the local Emergency Department during a 10-year period. The main aim was to establish whether anticoagulant or antiplatelet therapy was effective to lower the thromboembolic risk in patients receiving these drugs. Bleeding events, related to anticoagulant or antiplatelet therapy, was defined as secondary end point. RESULTS The final study population consisted of 6389 (3640 males and 2749 females) patients for whom a complete dataset regarding targeted follow-up was available. Patients were then subdivided into two subgroups, according to performance of cardioversion and spontaneous sinus rhythm restoring. In both genders, no significant difference in thromboembolic or bleeding events was noted between patients who underwent cardioversion and were discharged with oral anticoagulant therapy or antiplatelet treatment versus those who were not treated with antithrombotic drugs. Moreover, no difference was also observed in thromboembolic or hemorrhagic event rate between low risk and "medium-risk" patients. CONCLUSIONS The results of this study suggest that anticoagulant or antiplatelet therapy would not produce clinical benefits in "medium-risk" AF patients.
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Affiliation(s)
- Laura Bonfanti
- Emergency Department, University Hospital of Parma, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Valentina Donelli
- Postgraduate Emergency Medicine School, University of Parma, Parma, Italy
| | - Federica Pigna
- Emergency Department, University Hospital of Parma, Italy
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17
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Nagase T, Asano S, Yukino M, Mori H, Goto K, Ikeda Y, Iwanaga S, Muramatsu T, Mukaida H, Kato R, Matsumoto K. Influence of various energy settings and overlap ratios on size and continuity of lesions in a laser balloon ablation in vitro model. J Cardiovasc Electrophysiol 2019; 30:1330-1338. [DOI: 10.1111/jce.14040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/04/2019] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Takahiko Nagase
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - So Asano
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - Midori Yukino
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - Hitoshi Mori
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - Koji Goto
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - Yoshifumi Ikeda
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - Shiro Iwanaga
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - Toshihiro Muramatsu
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - Hisamitsu Mukaida
- Physics, Department of Liberal ArtsSaitama Medical University Saitama Japan
| | - Ritsushi Kato
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
| | - Kazuo Matsumoto
- Department of CardiologySaitama Medical University International Medical Center Saitama Japan
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18
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Pandozi C, Lavalle C, Ficili S, Russo M, Galeazzi M, Rio T, Centurion Aznaran C, Malacrida M, Colivicchi F. Reasons for successful clinical outcome following pulmonary vein isolation despite lack of persistent LA‐PV conduction block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1056-1062. [DOI: 10.1111/pace.13732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/23/2019] [Accepted: 05/16/2019] [Indexed: 12/01/2022]
Affiliation(s)
| | - Carlo Lavalle
- Division of CardiologySan Filippo Neri Hospital Rome Italy
| | - Sabina Ficili
- Division of CardiologySan Filippo Neri Hospital Rome Italy
| | - Maurizio Russo
- Division of CardiologySan Filippo Neri Hospital Rome Italy
| | - Marco Galeazzi
- Division of CardiologySan Filippo Neri Hospital Rome Italy
| | - Teresa Rio
- Division of CardiologySan Filippo Neri Hospital Rome Italy
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19
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Siontis KC, Noseworthy PA. Down but not out-addressing the scourge of late pulmonary vein reconnection. J Cardiovasc Electrophysiol 2019; 30:824-826. [PMID: 30887591 DOI: 10.1111/jce.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, College of Medicine, Rochester, Minnesota
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, College of Medicine, Rochester, Minnesota.,Division of Health Care Policy and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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20
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Zeng LJ, Shi L, Tian Y, Wang YJ, Yin XD, Liu XQ, Yang XC, Liu XP. Pace capture and adenosine triphosphate provocation are complementary rather than mutually exclusive methods to ensure durable pulmonary vein isolation. J Cardiovasc Electrophysiol 2019; 30:815-823. [PMID: 30891845 DOI: 10.1111/jce.13901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Adenosine triphosphate (ATP)-provoked dormant conduction (DC) and pacing for unexcitability are used to identify conduction gaps along the ablation lines after circumferential pulmonary vein isolation (CPVI). We aim to determine whether ATP provocation and pacing are interchangeable as endpoints for ablation of paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS A total of 107 patients with PAF were randomly divided into two groups after completion of CPVI. In group I (A-P group, n = 53), ATP was administered first. If DC was uncovered, additional ablation was performed until ATP tests were negative. Bipolar pacing along the ablation line was performed subsequently. In group II (P-A group, n = 54), the same protocol was used, but the pacing and the ATP tests were performed in the opposite sequence. The 12-month ablation outcomes of all patients were compared with those of a historical control group of 107 patients with PAF in whom only ATP test was performed. Regardless of which test was performed first, the other modality still identified conduction gaps. In group I, pacing maneuvers identified gaps in 49% (n = 26) of patients who had negative ATP tests. In group II, ATP tests uncovered DC in 18.5% (n = 10) of patients in whom pacing identified no gaps. After 12 months, a higher proportion of patients (91.6%) were free from atrial tachyarrhythmias compared with the historical control group (81.3%; P = 0.031). CONCLUSION Pacing along the ablation lines and ATP provocation are complementary tests for evaluating the durability of CPVI and can lead to better long-term outcomes when used in combination.
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Affiliation(s)
- Li-Jun Zeng
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Liang Shi
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan-Jiang Wang
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xian-Dong Yin
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Qing Liu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xing-Peng Liu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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21
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Mackin C, DeWitt ES, Black KJ, Tang X, Polizzotti BD, van den Bosch SJ, Alexander ME, Kheir JN. Intravenous Amiodarone and Sotalol Impair Contractility and Cardiac Output, but Procainamide Does Not: A Langendorff Study. J Cardiovasc Pharmacol Ther 2018; 24:288-297. [PMID: 30497293 DOI: 10.1177/1074248418810811] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Direct comparison of the effects of antiarrhythmic agents on myocardial performance may be useful in choosing between medications in critically ill patients. Studies directly comparing multiple antiarrhythmic medications are lacking. The use of an experimental heart preparation permits examination of myocardial performance under constant loading conditions. METHODS Hearts of Sprague Dawley rats (n = 35, 402-507 g) were explanted and cannulated in working heart model with fixed preload and afterload. Each heart was then exposed to a 3-hour infusion of procainamide (20 µg/kg/min), esmolol (100 or 200 µg/kg/min), amiodarone (10 or 20 mg/kg/d), sotalol (80 mg/m2/d), or placebo infusions (n = 5 per dose). Cardiac output, contractility (dP/dTmax), diastolic performance (dP/dTmin), and heart rate were compared between groups over time by linear mixed modeling. RESULTS Compared with placebo, sotalol decreased contractility by an average of 24% ( P < .001) over the infusion period, as did amiodarone (low dose by 13%, P = .029; high dose by 14%, P = .013). Compared with placebo, mean cardiac output was significantly lower in animals treated with sotalol (by 22%, P = .016) and esmolol 200 μg/kg/min (by 23%, P = .012). Over time, amiodarone decreased cardiac output (20 mg/kg/d, β = -89 [-144, -33] μL/min2 decrease, P = .002) and also worsened diastolic function, decreasing dP/dTmin by ∼18% and 22% ( P = .032 and P = .011, low and high doses, respectively). Procainamide did not have a significant effect on any measures of systolic or diastolic performance. CONCLUSIONS In isolated hearts, amiodarone and sotalol depressed myocardial contractility, cardiac output, and diastolic function. However, procainamide did not negatively affect myocardial performance and represents a favorable agent in settings of therapeutic equivalence.
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Affiliation(s)
- Charles Mackin
- 1 Department of Cardiology at Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Charles Mackin and Elisabeth S. DeWitt contributed equally as first authors
| | - Elizabeth S DeWitt
- 1 Department of Cardiology at Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Charles Mackin and Elisabeth S. DeWitt contributed equally as first authors
| | - Katherine J Black
- 1 Department of Cardiology at Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Xiaoqi Tang
- 1 Department of Cardiology at Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Brian D Polizzotti
- 1 Department of Cardiology at Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah J van den Bosch
- 1 Department of Cardiology at Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mark E Alexander
- 1 Department of Cardiology at Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - John N Kheir
- 1 Department of Cardiology at Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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22
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Prystowsky EN. A bridge to the future: Maintenance of sinus rhythm in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2018; 29:1604-1606. [PMID: 30375058 DOI: 10.1111/jce.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 11/29/2022]
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23
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Nanbu T, Yotsukura A, Sano F, Suzuki G, Ishidoya Y, Yoshida I, Sakurai M. A relation between ablation area and outcome of ablation using 28‐mm cryoballon ablation: Importance of carina region. J Cardiovasc Electrophysiol 2018; 29:1221-1229. [DOI: 10.1111/jce.13648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Tadafumi Nanbu
- Department of Cardiovascular MedicineHokko Memorial Hospital Hokkaido Japan
| | - Akihiko Yotsukura
- Department of Cardiovascular MedicineHokko Memorial Hospital Hokkaido Japan
| | - Fumihiko Sano
- Department of Cardiovascular MedicineHokko Memorial Hospital Hokkaido Japan
| | - George Suzuki
- Department of Cardiovascular MedicineHokko Memorial Hospital Hokkaido Japan
| | - Yuki Ishidoya
- Department of Cardiovascular MedicineHokko Memorial Hospital Hokkaido Japan
| | - Izumi Yoshida
- Department of Cardiovascular MedicineHokko Memorial Hospital Hokkaido Japan
| | - Masayuki Sakurai
- Department of Cardiovascular MedicineHokko Memorial Hospital Hokkaido Japan
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24
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Linhart M, Werner JT, Stöckigt F, Kohlmann AT, Lodde PC, Linneborn LPT, Beiert T, Hammerstingl C, Borràs R, Nickenig G, Andrié RP, Schrickel JW. High rate of persistent iatrogenic atrial septal defect after single transseptal puncture for cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol 2018; 52:141-148. [DOI: 10.1007/s10840-018-0352-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
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25
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Pyo WK, Kim HJ, Kim JB. Recurrent Mediastinal Sarcoma in the Aortic Arch. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:463-466. [PMID: 29234616 PMCID: PMC5716652 DOI: 10.5090/kjtcs.2017.50.6.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/04/2017] [Accepted: 04/07/2017] [Indexed: 11/16/2022]
Abstract
As mediastinal sarcomas commonly present as large tumors invading adjacent vital structures, complete resection is frequently challenging. For such tumors, aggressive surgical strategies, such as the resection and reconstruction of the invaded vital structures under cardiopulmonary bypass, may be required to achieve complete resection and to improve survival. Herein, we report a case of recurrent mediastinal sarcoma invading the aortic arch and arch vessels that was successfully removed by total arch replacement.
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Affiliation(s)
- Won Kyung Pyo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Rhythm and rate control of atrial fibrillation in the emergency department – A large community-based observational study. CAN J EMERG MED 2017; 20:834-840. [DOI: 10.1017/cem.2017.421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveAtrial fibrillation (AF) is the most common arrhythmia presentation to the emergency department (ED) and frequently results in admission to the hospital. Although rarely life-threatening and not usually an emergent condition, AF places a large burden on our health-care system. The objective of this study was to describe the practices of ED physicians in the management of AF in a large urban Canadian city.MethodsFrom January 1, 2010 to December 31, 2010, patients with a primary diagnosis of AF were identified across 10 EDs in Toronto, Canada (N=2,609). Fifty patients were selected at random from each hospital for a detailed chart review (n=500).ResultsTwo hundred thirty-two patients (46%) received rate control, and 129 (26%) received rhythm control with the remainder (28%) receiving neither therapy. Sixty-seven percent of patients were discharged home. Most patients (79%) were symptomatic on arrival; however, only a minority of these (31%) received rhythm control. Factors that were associated with rhythm control included younger age, duration of palpitations ≤ 48 hours, a lower CHADS2 score, and the absence of left ventricular dysfunction.ConclusionOur data suggest a wide range of practice amongst ED physicians treating patients presenting to the ED with a primary diagnosis of AF. A randomized trial is needed to better understand the optimal management strategy in this patient population and setting.
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Ammentorp B, Darius H, De Caterina R, Schilling R, Schmitt J, Zamorano JL, Kirchhof P, Le Heuzey JY. Differences among western European countries in anticoagulation management of atrial fibrillation. Thromb Haemost 2017; 111:833-41. [DOI: 10.1160/th13-12-1007] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/20/2014] [Indexed: 11/05/2022]
Abstract
SummaryDue to improved implementation of guidelines, new scoring approaches to improve risk categorisation, and introduction of novel oral anticoagulants, medical management of patients with atrial fibrillation (AF) is continuously improving. The PREFER in AF registry enrolled 7,243 consecutive patients with ECG-confirmed AF in seven European countries in 2012–2013 (mean age: 71.5 ± 10.7 years; 60.1% males; mean CHA2DS 2 -VASc score: 3.4). While patient characteristics were generally homogeneous across countries, anticoagulation management showed important differences: the proportion of patients taking vitamin K antagonists (VKAs) varied between 86.0% (in France) and 71.4% (in Italy). Warfarin was used predominantly in the UK and Italy (74.9% and 62.0%, respectively), phenprocoumon in Germany (74.1%), acenocoumarol in Spain (67.3%), and fluindione in France (61.8 %). The major sites for international normalised ratio (INR) measurements were biology laboratories in France anticoagulation clinics in Italy, Spain, and the UK, and physicians’ offices or self-measurement in Germany. Temporary VKA discontinuation and bridging with other anticoagulants was frequent (at least once in the previous 12 months for 22.9% of the patients, on average; ranging from 29.7% in Germany to 14.9% in the UK). Time in therapeutic range (TTR), defined as at least two of the last three available INR values between 2.0–3.0 prior to enrolment, ranged from 70.3% in Spain to 81.4% in Germany. TTR was constantly overestimated by physicians. While the type and half-lives of VKA as well as the mode of INR surveillance differed, overall quality of anticoagulation management by TTR was relatively homogenous in AF patients across countries.
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Galli F, Borghi L, Carugo S, Cavicchioli M, Faioni EM, Negroni MS, Vegni E. Atrial fibrillation and psychological factors: a systematic review. PeerJ 2017; 5:e3537. [PMID: 28828233 PMCID: PMC5555290 DOI: 10.7717/peerj.3537] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/12/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Psychological factors have been suggested to have an influence in Atrial Fibrillation (AF) onset, progression, severity and outcomes, but their role is unclear and mainly focused on anxiety and depression. METHODS A systematic electronic search had been conducted to identify studies exploring different psychological factors in AF. The search retrieved 832 articles that were reviewed according to inclusion criteria: observational study with a control/comparison group; use of standardized and validated instruments for psychological assessment. Results were summarized qualitatively and quantitatively by effect size measure (Cohen's d and its 95% confidence interval). Cochrane Collaboration guidelines and the PRISMA Statement were adopted. RESULTS Eight studies were included in the systematic review. Depression was the most studied construct/ but only one study showed a clear link with AF. The remaining studies showed small and non-significant (95% CI [-0.25-1.00]) differences between AF and controls, no differences in frequency of depression history (95% CI [-0.14-0.22]) or in case frequency (95% CI [-0.50-0.04]). Miscellaneous results were found as far as anxiety: AF patients showed higher levels when compared to healthy subjects (95% CI [2.05-2.95]), but findings were inconsistent when compared to other heart diseases. Considering personality and life-events preceding AF, we respectively found a large (95% CI [1.87-2.49]) and a moderate to large effect (95% CI [0.48-0.98]). DISCUSSION The small number of studies does not allow to draw clear-cut conclusions on the involvement of psychological factors in AF. Promising lines of research are related to personality and adverse life-events, and to the increase of longitudinal design studies. Some methodological problems could be overcome by including clinical psychologists in the implementation of research protocols.
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Affiliation(s)
- Federica Galli
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Lidia Borghi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Carugo
- Department of Health Sciences, University of Milan, Milan, Italy
- Cardiology Unit and UTIC, UOC Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Elena Maria Faioni
- Department of Health Sciences, University of Milan, Milan, Italy
- SIMT, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Silvia Negroni
- Cardiology Unit and UTIC, UOC Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
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Andersen RS, Poulsen ES, Puthusserypady S. A novel approach for automatic detection of Atrial Fibrillation based on Inter Beat Intervals and Support Vector Machine. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2039-2042. [PMID: 29060297 DOI: 10.1109/embc.2017.8037253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with a major economic burden for the society. Automatic detection of AF in long term recordings can efficiently assist in early diagnosis and management of comorbidities associated with AF. This study presents a novel approach for AF detection based on Inter Beat Intervals (IBI) extracted from long term electrocardiogram (ECG) recordings. Five time-domain features are extracted from the IBIs and a Support Vector Machine (SVM) is used for classification. The results are compared to a state of the art algorithm based on raw ECG. Both algorithms are evaluated on the MIT-BIH Atrial Fibrillation database resulting in equally high classification performance (Sensitivity ≥ 95%). The proposed approach requires detection of R-peaks in the ECG signal but allows for significantly reduced computation time without loss of performance.
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Di Biase L, Burkhardt JD, Reddy V, Romero J, Neuzil P, Petru J, Sadiva L, Skoda J, Ventura M, Carbucicchio C, Dello Russo A, Csanadi Z, Casella M, Fassini GM, Tondo C, Sacher F, Theran M, Dukkipati S, Koruth J, Jais P, Natale A. Initial international multicenter human experience with a novel epicardial access needle embedded with a real-time pressure/frequency monitoring to facilitate epicardial access: Feasibility and safety. Heart Rhythm 2017; 14:981-988. [DOI: 10.1016/j.hrthm.2017.02.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Indexed: 10/20/2022]
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Ogawa E, Kurotsu M, Arai T. Irradiance dependence of the conduction block of an in vitro cardiomyocyte wire. Photodiagnosis Photodyn Ther 2017; 19:93-97. [PMID: 28502877 DOI: 10.1016/j.pdpdt.2017.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/25/2017] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND To obtain therapeutic condition precisely by in vitro experiment, we studied the irradiance dependence of the electrical conduction blockage caused by a photodynamic reaction using a high extracellular concentration of talaporfin sodium on a novel in vitro cardiomyocyte electrical conduction wire. METHODS The cardiomyocyte wires were constructed on patterned cultivation cover glass, which had cultivation areas 60μm in width, and a maximum length of 10mm. The talaporfin sodium concentration was set to 20μg/mL. The photodynamic reaction with a high extracellular photosensitizer concentration was performed with a short time interval (approximately 15min) between photosensitizer exposure and irradiation. A 663-nm laser was applied to the cardiomyocyte wire, and the irradiance was varied between 3 and 120mW/cm2. The cardiomyocyte electrical conduction was evaluated using the cross-correlation function of intracellular Ca2+ probe fluorescence brightness from an upper and lower section outside the laser irradiation area of a wire every 10s, which lasted up to 600s. RESULTS The onset of electrical conduction blockage was defined by an 85% decrease in the cross-correlation function, compared with its initial value. The time for the electrical conduction blockage decreased from 600 to 300s as the irradiance was increased. Also, the probability of electrical conduction blockage was found to increase with increasing irradiance. CONCLUSIONS We found a strong dependence on the irradiance for the time and probability of electrical conduction blockage.
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Affiliation(s)
- Emiyu Ogawa
- School of Fundamental Science and Technology, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan.
| | - Mariko Kurotsu
- School of Fundamental Science and Technology, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan
| | - Tsunenori Arai
- School of Fundamental Science and Technology, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan; School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan
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Outcomes for Emergency Department Patients With Recent-Onset Atrial Fibrillation and Flutter Treated in Canadian Hospitals. Ann Emerg Med 2017; 69:562-571.e2. [DOI: 10.1016/j.annemergmed.2016.10.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 11/22/2022]
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Hassan Virk HU, Qureshi WT, Makkar N, Bastawrose J, Souvaliotis N, Aziz J, Aziz E. Short- and long-term clinical predictors of pharmacological cardioversion of persistent atrial fibrillation by dofetilide: A retrospective cohort study of 160 patients. Clin Cardiol 2017; 40:474-479. [PMID: 28295387 DOI: 10.1002/clc.22680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Dofetilide is a class III antiarrhythmic prescribed to cardiovert persistent atrial fibrillation (AF) to sinus rhythm (SR). HYPOTHESIS To determine the clinical predictors of cardioversion and readmission in persistent AF patients on dofetilide. METHODS We analyzed 160 patients with persistent AF who were started on dofetilide and followed for 1 year. We examined age, sex, race, hypertension, diabetes, smoking, dyslipidemia, CAD, left ventricular ejection fraction (LVEF), creatinine, BMI and concomitant use of calcium channel blockers (CCB), β-blockers in a multivariable logistic regression model. We also examined the same predictors in Cox regression model for AF-related readmission within 1 year of follow-up. RESULTS 13.5% individuals did not convert to SR on dofetilide. 55.6% converted on the first dose and 83.1% converted by the fourth dose. In multivariable logistic models, dyslipidemia (OR: 2.4, CI: 1.12-5.16) and LVEF (OR: 3.83,CI: 1.37-10.8) were associated with failure to convert with the first dose. Female sex and LVEF also were associated with increased risk of failure to convert at all. Concomitant use of CCB associated with decreased risk of failure to convert to SR. In Cox proportional model, female sex, age <63 years and CAD were associated with increased AF readmission within 1 year. CONCLUSIONS Dyslipidemia and LVEF <40% were associated with failure to cardiovert after first dose, and female sex and LVEF 40% were related to failure to convert at all on dofetilide in persistent AF patients. After 1-year follow-up, female sex, known CAD, and age <63 years were associated with increased AF readmissions.
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Affiliation(s)
- Hafeez Ul Hassan Virk
- ACAP Cardiac Research Program, Al-Sabah Arrhythmia Institute, Division of Cardiology, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York
| | - Waqas T Qureshi
- Department of Cardiology, Wake Forest University, Winston-Salem, North Carolina
| | - Nayani Makkar
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Joseph Bastawrose
- ACAP Cardiac Research Program, Al-Sabah Arrhythmia Institute, Division of Cardiology, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York
| | - Nektarios Souvaliotis
- ACAP Cardiac Research Program, Al-Sabah Arrhythmia Institute, Division of Cardiology, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York
| | - Joshua Aziz
- ACAP Cardiac Research Program, Al-Sabah Arrhythmia Institute, Division of Cardiology, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York
| | - Emad Aziz
- ACAP Cardiac Research Program, Al-Sabah Arrhythmia Institute, Division of Cardiology, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York
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Lenis G, Pilia N, Oesterlein T, Luik A, Schmitt C, Dössel O. P wave detection and delineation in the ECG based on the phase free stationary wavelet transform and using intracardiac atrial electrograms as reference. ACTA ACUST UNITED AC 2017; 61:37-56. [PMID: 26136298 DOI: 10.1515/bmt-2014-0161] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 06/01/2015] [Indexed: 11/15/2022]
Abstract
Robust and exact automatic P wave detection and delineation in the electrocardiogram (ECG) is still an interesting but challenging research topic. The early prognosis of cardiac afflictions such as atrial fibrillation and the response of a patient to a given treatment is believed to improve if the P wave is carefully analyzed during sinus rhythm. Manual annotation of the signals is a tedious and subjective task. Its correctness depends on the experience of the annotator, quality of the signal, and ECG lead. In this work, we present a wavelet-based algorithm to detect and delineate P waves in individual ECG leads. We evaluated a large group of commonly used wavelets and frequency bands (wavelet levels) and introduced a special phase free wavelet transformation. The local extrema of the transformed signals are directly related to the delineating points of the P wave. First, the algorithm was studied using synthetic signals. Then, the optimal parameter configuration was found using intracardiac electrograms and surface ECGs measured simultaneously. The reverse biorthogonal wavelet 3.3 was found to be optimal for this application. In the end, the method was validated using the QT database from PhysioNet. We showed that the algorithm works more accurately and more robustly than other methods presented in literature. The validation study delivered an average delineation error of the P wave onset of -0.32±12.41 ms when compared to manual annotations. In conclusion, the algorithm is suitable for handling varying P wave shapes and low signal-to-noise ratios.
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Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Endocr J 2016; 63:1025-1064. [PMID: 27746415 DOI: 10.1507/endocrj.ej16-0336] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thyroid storm is an endocrine emergency which is characterized by multiple organ failure due to severe thyrotoxicosis, often associated with triggering illnesses. Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. We, the Japan Thyroid Association and Japan Endocrine Society taskforce committee, previously developed new diagnostic criteria and conducted nationwide surveys for thyroid storm in Japan. Detailed analyses of clinical data from 356 patients revealed that the mortality in Japan was still high (∼11%) and that multiple organ failure and acute heart failure were common causes of death. In addition, multimodal treatment with antithyroid drugs, inorganic iodide, corticosteroids and beta-adrenergic antagonists has been suggested to improve mortality of these patients. Based on the evidence obtained by nationwide surveys and additional literature searches, we herein established clinical guidelines for the management of thyroid storm. The present guideline includes 15 recommendations for the treatment of thyrotoxicosis and organ failure in the central nervous system, cardiovascular system, and hepato-gastrointestinal tract, admission criteria for the intensive care unit, and prognostic evaluation. We also proposed preventive approaches to thyroid storm, roles of definitive therapy, and future prospective trial plans for the treatment of thyroid storm. We hope that this guideline will be useful for many physicians all over the world as well as in Japan in the management of thyroid storm and the improvement of its outcome.
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Affiliation(s)
- Tetsurou Satoh
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan
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Baker WL, White CM. Cardiology: Post-Cardiothoracic Surgery Atrial Fibrillation: A Review of Preventive Strategies. Ann Pharmacother 2016; 41:587-98. [PMID: 17374620 DOI: 10.1345/aph.1h594] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To review the available literature addressing preventive strategies of post-cardiothoracic surgery atrial fibrillation (post-CTS atrial fibrillation). Data Sources: Pertinent articles related to the etiology, risk factors, and preventive strategies were identified through a MEDLINE search (1966–March 2007) using the MeSH terms atrial fibrillation, cardiothoracic surgery, cardiac surgery, etiology, neurohormonal, sympathetic, volume, fluid, inflammation, risk factors, operative, pacing, β-adrenergic blockers, amiodarone, sotalol, calcium-channel blockers, magnesium, HMG-CoA reductase inhibitors, statins, fatty acids, PUFA, steroids, and nonsteroidal antiinflammatory drugs. Study Selection and Data Extraction: Articles evaluated were limited to human studies, published in the English language, with a Jadad score greater than 3. References of identified articles were reviewed for additional pertinent articles. Data Synthesis: Post-CTS atrial fibrillation most commonly occurs on the second or third postoperative day, with an incidence of 20–50%. Etiology theories include neurohormonal activation, volume overload, and inflammation. Studies examining nonpharmacologic therapies have shown that maintenance of the anterior epicardial fat pad is not a viable prophylactic strategy. Biatrial cardiac pacing, especially in combination with amiodarone, is a viable preventive option. Withdrawal of preoperative β-blockers places patients at higher risk for atrial fibrillation; these drugs should be continued postoperatively. Evidence exists supporting the use of amiodarone, sotalol, and magnesium in addition to β-blockers. Since most of these strategies work by attenuating neurohormonal activation, adverse events, including hypotension and bradycardia, are of concern. Adding agents with antiinflammatory properties, including hydroxymethylglutaryl coenzyme A reductase inhibitors or corticosteroids, may prove to be of benefit. Additional studies using novel therapies are needed in addition to established preventive strategies. Conclusions: Available evidence supports the continuation of preoperative β-blockers, as well as prophylactic amiodarone, sotalol, and magnesium. Other novel therapies, mostly targeting inflammation, are under investigation and may provide additional strategies.
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Affiliation(s)
- William L Baker
- School of Pharmacy, University of Connecticut, Hartford, CT, USA
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Evaluación de la fibrilación auricular mediante electrocardiograma y Holter. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Coleman CI, Makanji S, Kluger J, White CM. Effect of Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers on the Frequency of Post-Cardiothoracic Surgery Atrial Fibrillation. Ann Pharmacother 2016; 41:433-7. [PMID: 17341525 DOI: 10.1345/aph.1h583] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: A recent meta-analysis demonstrated that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce the incidence of new-onset atrial fibrillation by nearly 50%. However, the ability of ACE inhibitors or ARBs to prevent post-cardiothoracic surgery (CTS) atrial fibrillation, when used postoperatively, has yet to be evaluated. Objective: To evaluate the impact of postoperative ACE inhibitor or ARB use on the incidence of post-CTS atrial fibrillation. Methods: We performed a retrospective cohort study of propensity score matched patients who underwent CTS at a single institution from January 2004 through December 2005. Patients who received either an ACE inhibitor or an ARB within 24 hours of surgery were propensity score matched for common predictors of post-CTS atrial fibrillation (age >70 y, preoperative digoxin use, postoperative β-blocker or amiodarone use, β-blockor intolerance, valve surgery, male sex, and history of diabetes mellitus, smoking, chronic obstructive pulmonary disease, prior cardiothoracic surgery) in a 1:1 ratio with patients who did not receive an ACE inhibitor or an ARB. Multivariate logistic regression was used to generate adjusted odds ratios to minimize the impact of baseline confounders. Results: A total of 1469 patients underwent CTS during the study evaluation period. Postoperatively, 188 received an ACE inhibitor or an ARB and were matched to 188 control patients. Mean ± SD age of matched patients was 68.1 ± 11.8 years, 66% were men, 42% underwent valve surgery, and 69% and 35% received postoperative β-blockade and amiodarone, respectively. Patients who received an ACE inhibitor or an ARB did not experience a significant reduction in post-CTS atrial fibrillation compared with control patients (adjusted OR 0.95; 95% CI 0.57 to 1.56; p = 0.83). Conclusions: In this evaluation, postoperative ACE inhibitor or ARB use was not associated with a reduction in post-CTS atrial fibrillation. A study of preoperative, longer-term ACE inhibitor and/or ARB therapy is needed to determine the benefits of that strategy.
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Affiliation(s)
- Craig I Coleman
- School of Pharmacy, University of Connecticut, Storrs, CT, USA
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Kurzendorfer T, Mewes PW, Maier A, Strobel N, Brost A. Cryo-Balloon Catheter Localization Based on a Support-Vector-Machine Approach. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:1892-1902. [PMID: 26978663 DOI: 10.1109/tmi.2016.2537052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cryo-balloon catheters have attracted an increasing amount of interest in the medical community as they can reduce patient risk during left atrial pulmonary vein ablation procedures. As cryo-balloon catheters are not equipped with electrodes, they cannot be localized automatically by electro-anatomical mapping systems. As a consequence, X-ray fluoroscopy has remained an important means for guidance during the procedure. Most recently, image guidance methods for fluoroscopy-based procedures have been proposed, but they provide only limited support for cryo-balloon catheters and require significant user interaction. To improve this situation, we propose a novel method for automatic cryo-balloon catheter detection in fluoroscopic images by detecting the cryo-balloon catheter's built-in X-ray marker. Our approach is based on a blob detection algorithm to find possible X-ray marker candidates. Several of these candidates are then excluded using prior knowledge. For the remaining candidates, several catheter specific features are introduced. They are processed using a machine learning approach to arrive at the final X-ray marker position. Our method was evaluated on 75 biplane fluoroscopy images from 40 patients, from two sites, acquired with a biplane angiography system. The method yielded a success rate of 99.0% in plane A and 90.6% in plane B, respectively. The detection achieved an accuracy of 1.00 mm±0.82 mm in plane A and 1.13 mm±0.24 mm in plane B. The localization in 3-D was associated with an average error of 0.36 mm±0.86 mm.
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Abstract
BACKGROUND Atrial fibrillation (AF), the most common arrhythmia in clinical practice, is a leading cause of morbidity and mortality. Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy before the onset of symptoms. However, for screening to be an effective intervention, it must improve the detection of AF and provide benefit for those detected earlier as a result of screening. OBJECTIVES This review aims to answer the following questions.Does systematic screening increase the detection of AF compared with routine practice? Which combination of screening population, strategy and test is most effective for detecting AF compared with routine practice? What safety issues and adverse events may be associated with individual screening programmes? How acceptable is the intervention to the target population? What costs are associated with systematic screening for AF? SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) up to 11 November 2015. We searched other relevant research databases, trials registries and websites up to December 2015. We also searched reference lists of identified studies for potentially relevant studies, and we contacted corresponding authors for information about additional published or unpublished studies that may be relevant. We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials comparing screening for AF with routine practice in people 40 years of age and older were eligible. Two review authors (PM and CT) independently selected trials for inclusion. DATA COLLECTION AND ANALYSIS Two review authors (PM and CT) independently assessed risk of bias and extracted data. We used odds ratios (ORs) and 95% confidence intervals (CIs) to present results for the primary outcome, which is a dichotomous variable. As we identified only one study for inclusion, we performed no meta-analysis. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) method to assess the quality of the evidence and GRADEPro to create a 'Summary of findings' table. MAIN RESULTS One cluster-randomised controlled trial met the inclusion criteria for this review. This study compared systematic screening (by invitation to have an electrocardiogram (ECG)) and opportunistic screening (pulse palpation during a general practitioner (GP) consultation for any reason, followed by an ECG if pulse was irregular) versus routine practice (normal case finding on the basis of clinical presentation) in people 65 years of age or older.Results show that both systematic screening and opportunistic screening of people over 65 years of age are more effective than routine practice (OR 1.57, 95% CI 1.08 to 2.26; and OR 1.58, 95% CI 1.10 to 2.29, respectively; both moderate-quality evidence). We found no difference in the effectiveness of systematic screening and opportunistic screening (OR 0.99, 95% CI 0.72 to 1.37; low-quality evidence). A subgroup analysis found that systematic screening and opportunistic screening were more effective in men (OR 2.68, 95% CI 1.51 to 4.76; and OR 2.33, 95% CI 1.29 to 4.19, respectively) than in women (OR 0.98, 95% CI 0.59 to 1.62; and OR 1.2, 95% CI 0.74 to 1.93, respectively). No adverse events associated with screening were reported.The incremental cost per additional case detected by opportunistic screening was GBP 337, compared with GBP 1514 for systematic screening. All cost estimates were based on data from the single included trial, which was conducted in the UK between 2001 and 2003. AUTHORS' CONCLUSIONS Evidence suggests that systematic screening and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice. Although these approaches have comparable effects on the overall AF diagnosis rate, the cost of systematic screening is significantly greater than the cost of opportunistic screening from the perspective of the health service provider. Few studies have investigated effects of screening in other health systems and in younger age groups; therefore, caution needs to be exercised in relation to transferability of these results beyond the setting and population in which the included study was conducted.Additional research is needed to examine the effectiveness of alternative screening strategies and to investigate the effects of the intervention on risk of stroke for screened versus non-screened populations.
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Affiliation(s)
- Patrick S Moran
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Smithfield, Dublin, Dublin, Ireland, D7
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Association of Body Mass Index With Care and Outcomes in Patients With Atrial Fibrillation. JACC Clin Electrophysiol 2016; 2:355-363. [DOI: 10.1016/j.jacep.2015.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/07/2015] [Accepted: 12/01/2015] [Indexed: 11/23/2022]
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Sardu C, Santamaria M, Paolisso G, Marfella R. microRNA expression changes after atrial fibrillation catheter ablation. Pharmacogenomics 2015; 16:1863-77. [PMID: 26554530 DOI: 10.2217/pgs.15.117] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Atrial fibrillation (AF) is most common arrhythmia in general population, with increasing trend in mortality and morbidity. Electrophysiological and structural abnormalities, promoting abnormal impulse formation and propagation, lead to this disease. AF catheter ablation is related to a not small percentage of nonresponder patients. microRNAs (miRs) have been used as AF fibrotic and electrical alterations biomarkers. miRs may differentiate responders patients to ablative approach. Selective miR target therapy, as upregulation by adenovirus transfection and/or miR downregulation by antagomiR, may be used to treat AF patients. Catheter ablation of triggering electrical pulmonary veins activity or fibrotic areas defragmentation may be upgraded by miR therapy to prevent cardiac electrical and fibrotic remodeling after AF ablation.
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Affiliation(s)
- Celestino Sardu
- Medical, Surgical, Neurological, Metabolic & Aging Sciences Department, Second University study of Naples, Naples, Italy.,Cardiovascular & Arrhythmias Department, Giovanni Paolo II Research & Care Foundation, Campobasso, Italy
| | - Matteo Santamaria
- Cardiovascular & Arrhythmias Department, Giovanni Paolo II Research & Care Foundation, Campobasso, Italy
| | - Giuseppe Paolisso
- Medical, Surgical, Neurological, Metabolic & Aging Sciences Department, Second University study of Naples, Naples, Italy
| | - Raffaele Marfella
- Medical, Surgical, Neurological, Metabolic & Aging Sciences Department, Second University study of Naples, Naples, Italy
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Dai H, Sodhro AH, Li Y. Decomposing atrial activity signal by combining ICA and WABS. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:5849-52. [PMID: 24111069 DOI: 10.1109/embc.2013.6610882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this paper we proposed a novel technique for Atrial Activity (AA) decomposition in Electrocardiogram (ECG) of Atrial Fibrillation (AF). The main purpose of our proposed technique is to decompose AA signal by combining two statistical methods, Independent Component Analysis (ICA)-existing and Weighted Average Beat Subtraction (WABS)-new, for AF with multiple stable sources, respectively. We found the limits of BSS algorithms which are mostly used to extract AA signal, while beauty of our proposed algorithm is that it decomposes multi-lead AA signals from surface ECG with AF. Our proposed technique is verified with clinical data and the results demonstrate that our proposed method is feasible.
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Rosychuk RJ, Mariathas HH, Graham MM, Holroyd BR, Rowe BH. Geographic clustering of emergency department presentations for atrial fibrillation and flutter in Alberta, Canada. Acad Emerg Med 2015. [PMID: 26205400 DOI: 10.1111/acem.12731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Atrial fibrillation and flutter (AFF) are the most common arrhythmias seen in the outpatient setting, and they affect more than 300,000 adult Canadians. The aims of this study were to examine temporal and geographic trends in emergency department (ED) presentations made by adults (age ≥ 35 years) for AFF in Alberta, Canada, from 1999 to 2011. Statistical disease cluster detection techniques were used to identify geographic areas with higher numbers of individuals presenting with AFF and higher numbers of ED presentations for AFF than expected by chance alone. Geographic clusters of individuals with stroke or heart failure follow-up within 365 days of ED presentations for AFF were also identified. METHODS All ED presentations for AFF made by individuals aged ≥35 years were extracted from Alberta's Ambulatory Care Classification System. The Alberta Health Care Insurance Plan provided population counts and demographics for the patients presenting (age, sex, year, geographic unit). The Physician Claims File provided non-ED physician claims data after a patient's ED presentation. Statistical analyses included numerical and graphical summaries, directly standardized rates, and statistical disease cluster detection tests. RESULTS During 12 years, there were 63,395 ED presentations for AFF made by 32,101 individuals. Standardized rates remained relatively stable over time, at about two per 1,000 for individuals presenting to the ED for AFF and about three per 1,000 for ED presentations for AFF. The northern and southeastern parts of the province were identified as clusters of individuals presenting for AFF, and ED presentations for AFF, and several of the areas demonstrated clusters in multiple years. Further, several of the geographic clusters were also identified as potential clusters for stroke or heart failure within 365 days after the ED presentations for AFF. CONCLUSIONS This population-based study spanned 12 fiscal years and showed variations in the number of people presenting to EDs for AFF and the number of ED presentations for AFF over geography. The potential clusters identified may represent geographic areas with higher disease severity or a lower availability of non-ED health services. The clusters are not all likely to have occurred by chance, and further investigation and intervention could occur to reduce ED presentations for AFF.
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Affiliation(s)
- Rhonda J. Rosychuk
- The Department of Pediatrics; University of Alberta; Edmonton Alberta
- Women & Children's Health Research Institute; Edmonton Alberta
| | - Hensley H. Mariathas
- The Department of Mathematics and Statistics; Memorial University of Newfoundland; St. John's Newfoundland Canada
| | | | - Brian R. Holroyd
- The Department of Emergency Medicine; University of Alberta; Edmonton Alberta
- Alberta Health Services; Edmonton Alberta Canada
| | - Brian H. Rowe
- The Department of Emergency Medicine; University of Alberta; Edmonton Alberta
- The School of Public Health; University of Alberta; Edmonton Alberta
- Alberta Health Services; Edmonton Alberta Canada
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Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. CAN J EMERG MED 2015; 12:181-91. [DOI: 10.1017/s1481803500012227] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:There is no consensus on the optimal management of recent-onset episodes of atrial fibrillation or flutter. The approach to these conditions is particularly relevant in the current era of emergency department (ED) overcrowding. We sought to examine the effectiveness and safety of the Ottawa Aggressive Protocol to perform rapid cardioversion and discharge patients with these arrhythmias.Methods:This cohort study enrolled consecutive patient visits to an adult university hospital ED for recent-onset atrial fibrillation or flutter managed with the Ottawa Aggressive Protocol. The protocol includes intravenous chemical cardioversion, electrical cardioversion if necessary and discharge home from the ED.Results:A total of 660 patient visits were included, 95.2% involving atrial fibrillation and 4.9% involving atrial flutter. The mean age of patients enrolled was 64.5 years. In total, 96.8% were discharged home and, of those, 93.3% were in sinus rhythm. All patients were initially administered intravenous procaïnamide, with a 58.3% conversion rate. A total of 243 patients underwent subsequent electrical cardioversion with a 91.7% success rate. Adverse events occurred in 7.6% of cases: hypotension 6.7%, bradycardia 0.3% and 7-day relapse 8.6%. There were no cases of torsades de pointes, stroke or death. The median lengths of stay in the ED were as follows: 4.9 hours overall, 3.9 hours for those undergoing conversion with procaïnamide and 6.5 hours for those requiring electrical conversion.Conclusion:This is the largest study to date to evaluate the Ottawa Aggressive Protocol, a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. Our data demonstrate that the Ottawa Aggressive Protocol is effective, safe and rapid, and has the potential to significantly reduce hospital admissions and expedite ED care.
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Sanak D, Hutyra M, Kral M, Bartkova A, Zapletalova J, Fedorco M, Veverka T, Vindis D, Dornak T, Skala T, Skoloudik D, Taborsky M, Kanovsky P. Paroxysmal atrial fibrillation in young cryptogenic ischemic stroke: A 3-week ECG Holter monitoring study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:283-7. [PMID: 25916280 DOI: 10.5507/bp.2015.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/14/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atrial fibrillation is known very frequent cause of ischemic stroke. Undetected paroxysmal atrial fibrillation (PAF) is thus often considered a possible cause of cryptogenic ischemic stroke (CIS). The aim of this prospective study was to detect PAF using ECG Holter monitoring and determinate whether prolongation of the Holter monitoring to 3 weeks would increase the detection rates of PAF in young CIS patients ≤ 50 years. METHODS The study set consisted of IS patients ≤ 50 years enrolled in the HISTORY (Heart and Ischemic STrOke Relationship studY) study (NCT01541163). CIS was defined according to the TOAST criteria including the absence of ultrasonographic or angiographic signs of atherosclerosis, vasculitis or dissection. Admission ECG, serum levels of high sensitive Troponin T (hs TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP), markers of thrombophilia, transoesophageal echocardiography (TEE) and 24-hour ECG-Holter monitoring were performed in all patients. In case of negative 24-h ECG Holter, an additional 3-weeks monitoring was done. RESULTS Of the 105 enrolled patients ≤ 50 years, 95 (90%) were identified as cryptogenic (49 males, mean age 39.1 ± 8.2 years). All CIS patients had normal admission ECG. In total, PAF was detected in 9 (9.5%, 95% CI: 3.5% - 17.8%) patients; in two during 24-h ECG Holter and in seven during 3-weeks Holter monitoring. Patients with PAF had more frequently elevated admission hs TnT and NT-proBNP levels (P - 0.0001). CONCLUSIONS PAF was detected in 9.5% of young CIS patients and 3-weeks ECG Holter monitoring increased the detection rate.
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Affiliation(s)
- Daniel Sanak
- Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Cardiology, University Hospital Olomouc
| | - Michal Kral
- Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - Andrea Bartkova
- Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc
| | | | - Tomas Veverka
- Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - David Vindis
- Department of Cardiology, University Hospital Olomouc
| | - Tomas Dornak
- Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - Tomas Skala
- Department of Cardiology, University Hospital Olomouc
| | - David Skoloudik
- Department of Nursing, Faculty of Health Sciences, Palacky University Olomouc
| | | | - Petr Kanovsky
- Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
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Malik R, Alyeshmerni DM, Wang Z, Goldstein SA, Torguson R, Lindsay J, Waksman R, Ben-Dor I. Prevalence and predictors of left atrial thrombus in patients with atrial fibrillation: is transesophageal echocardiography necessary before cardioversion? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:12-4. [DOI: 10.1016/j.carrev.2014.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022]
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January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.03.021] [Citation(s) in RCA: 508] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bai L, Liu Z, Bakeyi M, Lu W, He P, Yang Y, Wulasihan M. Association of PS gene polymorphism and soluble P-selectin levels in atrial fibrillation thromboembolism population in Xinjiang. Biochem Biophys Res Commun 2014; 452:303-7. [PMID: 25089002 DOI: 10.1016/j.bbrc.2014.07.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 07/24/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED To investigate the association between the polymorphism of P choose element (p. selectin, PS) and soluble P-selectin levels in atrial fibrillation (AF) thromboembolism in Han and Uigur population of Xinjiang. METHOD Using ELISA method determination of plasma level of sPs. The frequency distributions of SNP sP-selectin gene promoter (-2123C/G) and SNP in exon region (Thr715Pro) were investigated by polymerase chain reaction (PCR)-restriction fragment length polymorphism and direct DNA sequence analysis among 302 Xinjiang Uigur and 340 age- and sex-matched Han people. RESULTS Cases sPs exist significant difference serum level and the control group. The frequencies of the -2123C/G allele among the Uigur population had no significant differences from those of the Han population. Thr715Pro did not show any polymorphism in the two populations. CONCLUSIONS The sP-selectin gene polymorphisms are associated with serum sP-selectin levels or thromboembolic events, suggesting that the patients with nonvalvular AF and thromboembolic events may have genetic susceptibility.
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Affiliation(s)
- Ling Bai
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, 137 Liyushan Road, Urumqi 830054, PR China
| | - Zhiqiang Liu
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, 137 Liyushan Road, Urumqi 830054, PR China
| | - Maerjiaen Bakeyi
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, 137 Liyushan Road, Urumqi 830054, PR China
| | - Wuhong Lu
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, 137 Liyushan Road, Urumqi 830054, PR China
| | - Pengyi He
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, 137 Liyushan Road, Urumqi 830054, PR China
| | - Yuchun Yang
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, 137 Liyushan Road, Urumqi 830054, PR China
| | - Muhuyati Wulasihan
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, 137 Liyushan Road, Urumqi 830054, PR China.
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