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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024; 67:921-1072. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [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] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Rivera SI, Bernal CP, Martínez-Peláez R, Robledo-Nolasco R, De León-Larios G, Félix VG, Ostos R, Maestre GE, Melgarejo JD, Mena LJ. Computer Simulation of Catheter Cryoablation for Pulmonary Vein Isolation. Healthcare (Basel) 2024; 12:1508. [PMID: 39120212 PMCID: PMC11312416 DOI: 10.3390/healthcare12151508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Cryoablation is a well-established medical procedure for surgically treating atrial fibrillation. Cryothermal catheter therapy induces cellular necrosis by freezing the insides of pulmonary veins, with the goal of disrupting abnormal electrical heart signals. Nevertheless, tissue damage induced by cold temperatures may also lead to other complications after cardiac surgery. In this sense, the simulation of catheter ablation can provide safer environments for training and the performance of cryotherapy interventions. Therefore, in this paper, we propose a novel approach to help better understand how temperature rates can affect this procedure by using computer tools to develop a simulation framework to predict lesion size and determine optimal temperature conditions for reducing the risk of major complications. The results showed that a temperature profile of around -40 °C caused less penetration, reduced necrotic damage, and smaller lesion size in the tissue. Instead, cryotherapy close to -60 °C achieved a greater depth of temperature flow inside the tissue and a larger cross-section area of the lesion. With further development and validation, the framework could represent a cost-effective strategy for providing personalized modeling, better planning of cryocatheter-based treatment, and preventing surgical complications.
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Affiliation(s)
- Solange I. Rivera
- Department of Chemical, Electronic and Biomedical Engineering, Science and Engineering Division, Universidad de Guanajuato, Guanajuato 36250, Mexico;
| | - Clara P. Bernal
- Faculty of Engineering and Technologies, Universidad La Salle Bajío, Leon 36700, Mexico;
| | - Rafael Martínez-Peláez
- Department of Systems and Computer Engineering, Faculty of Engineering and Geological Sciences, Universidad Católica del Norte, Antofagasta 1270709, Chile;
- Computer Academic Unit, School of Information Technologies, Universidad Politécnica de Sinaloa, Mazatlan 82199, Mexico; (V.G.F.); (R.O.)
| | - Rogelio Robledo-Nolasco
- Department of Interventional Cardiology and Electrophysiology, Centro Médico Nacional 20 de Noviembre ISSSTE, Mexico City 03100, Mexico; (R.R.-N.); (G.D.L.-L.)
| | - Gerardo De León-Larios
- Department of Interventional Cardiology and Electrophysiology, Centro Médico Nacional 20 de Noviembre ISSSTE, Mexico City 03100, Mexico; (R.R.-N.); (G.D.L.-L.)
| | - Vanessa G. Félix
- Computer Academic Unit, School of Information Technologies, Universidad Politécnica de Sinaloa, Mazatlan 82199, Mexico; (V.G.F.); (R.O.)
| | - Rodolfo Ostos
- Computer Academic Unit, School of Information Technologies, Universidad Politécnica de Sinaloa, Mazatlan 82199, Mexico; (V.G.F.); (R.O.)
| | - Gladys E. Maestre
- Institute of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX 78550, USA; (G.E.M.); (J.D.M.)
| | - Jesús D. Melgarejo
- Institute of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX 78550, USA; (G.E.M.); (J.D.M.)
| | - Luis J. Mena
- Computer Academic Unit, School of Information Technologies, Universidad Politécnica de Sinaloa, Mazatlan 82199, Mexico; (V.G.F.); (R.O.)
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Gupta D, Calvert P. PolarX vs Arctic Front Advance Cryoballoon: Young Pretender or Worthy Successor? JACC Clin Electrophysiol 2024; 10:1377-1379. [PMID: 38878015 DOI: 10.1016/j.jacep.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 07/26/2024]
Affiliation(s)
- Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom.
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Linz D, Chaldoupi SM. Early Rhythm Management in Patients With Atrial Fibrillation: From Symptom Control to Adverse Outcome Reduction. JACC Clin Electrophysiol 2024; 10:1406-1408. [PMID: 39048249 DOI: 10.1016/j.jacep.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Hein R, Riis-Vestergaard LD, Tønnesen J, Zörner CR, Rasmussen PV, Ruwald MH, Johannessen A, Worck RH, Hansen J, Middelfart C, Gislason GH, Hansen ML. Effect of early cryoballoon ablation on atrial fibrillation recurrence-A Danish nationwide register study. J Cardiovasc Electrophysiol 2024; 35:1429-1439. [PMID: 38757241 DOI: 10.1111/jce.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/16/2024] [Accepted: 04/28/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Cryoballoon ablation is a safe and efficient rhythm control strategy in atrial fibrillation (AF) patients. The impact of time from diagnosis to ablation is unclear. The aim of this study was to examine the impact of timing of first-time cryoballoon ablation on AF recurrence in a nationwide cohort of AF patients. METHODS AND RESULTS From nationwide registers, all AF patients ≥18 years of age who underwent first-time AF cryoballoon ablation in Denmark from 2012 to 2018 were included. The AF patients were stratified by ablation timing: Early group (≤1 year after AF diagnosis), intermediate group (1-3 years after AF diagnosis), and late group (≥3 years after AF diagnosis). By adjusted Cox regression models, the effect of timing on AF recurrence was examined. This study included 1064 AF patients with a median age of 63 years. Most patients were male (66%) and had paroxysmal AF (67%). The 1-year risk of AF recurrence increased from 31% in the early group to 41% and 44% in the intermediate and late group. The hazard ratios (95% confidence intervals) were 1.28 (0.95, 1.74) in the intermediate group and 1.42 (1.09, 1.86) in the late group when compared to the early group. Continuous diagnosis-to-ablation time seemed to have the greatest impact on AF recurrence within the first 2 years. CONCLUSION In AF patients undergoing cryoballoon ablation, late timing of ablation was associated with a significantly higher AF recurrence rate when compared to early timing of ablation. These findings support early cryoballoon ablation to improve the outcomes after ablation.
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Affiliation(s)
- Regitze Hein
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Lise Da Riis-Vestergaard
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Jacob Tønnesen
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Christopher Ryan Zörner
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Peter Vibe Rasmussen
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
- The Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Martin Huth Ruwald
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Arne Johannessen
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - René Husted Worck
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Jim Hansen
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Charlotte Middelfart
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Gunnar Hilmar Gislason
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Lock Hansen
- Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Erkapic D, Roussopoulos K, Aleksic M, Sözener K, Kostev K, Rosenbauer J, Sossalla S, Gündüz D, Labenz J, Tanislav C, Weipert KF. Cryoballoon-Assisted Pulmonary Vein Isolation and Left Atrial Roof Ablation Using a Simplified Sedation Strategy without Esophageal Temperature Monitoring: No Notable Thermal Esophageal Lesions and Low Arrhythmia Recurrence Rates after 2 Years. Diagnostics (Basel) 2024; 14:1370. [PMID: 39001260 PMCID: PMC11241260 DOI: 10.3390/diagnostics14131370] [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: 06/02/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) ablation is increasingly effective for managing heart rhythm but poses risks like esophageal fistulas. Minimizing esophageal thermal lesions while simplifying procedures is crucial. METHODS This prospective study involved 100 consecutive AF patients undergoing cryoballoon ablation with simplified sedation, without esophageal temperature monitoring. Patients with paroxysmal AF (Group A) received pulmonary vein isolation only, while those with persistent AF (Group B) also had left atrial roof ablation. Gastroesophageal endoscopy was performed post-procedure to detect lesions, and cardiological follow-ups were conducted at 3, 12, and 24 months. RESULTS The cohort included 69% men, with a median age of 65.5 years. Post-ablation endoscopy was performed in 92 patients; esophageal lesions were found in 1.1% of Group A and none of Group B. GERD was diagnosed in 14% of patients, evenly distributed between groups and not linked to lesion occurrence. Gastric hypomotility was observed in 16% of patients, with no significant difference between groups. At 24 months, arrhythmia-free survival was 88% in Group A and 74% in Group B. CONCLUSION Cryoballoon-assisted pulmonary vein isolation, with or without additional left atrial roof ablation and without esophageal temperature monitoring during a simplified sedation strategy, shows low risk of esophageal thermal injury and effective ablation outcomes.
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Affiliation(s)
- Damir Erkapic
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
- Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, 35392 Giessen, Germany;
| | - Konstantinos Roussopoulos
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
| | - Marko Aleksic
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
| | - Korkut Sözener
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
| | - Karel Kostev
- Department of Epidemiology, Philipps-University Marburg, 35037 Marburg, Germany;
| | - Josef Rosenbauer
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
| | - Samuel Sossalla
- Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, 35392 Giessen, Germany;
| | - Dursun Gündüz
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
- Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, 35392 Giessen, Germany;
| | - Joachim Labenz
- Department of Gastroenterology, Medical Clinic I, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany;
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany;
| | - Kay Felix Weipert
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
- Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, 35392 Giessen, Germany;
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Lu J, Zhang N, Yang F, Gao Y, Ren Y, Ma D. A bibliometric analysis from 2013 to 2024 reveals research hotspots and trends in the connection between atrial fibrillation and cryoballoon: An observational study. Medicine (Baltimore) 2024; 103:e38435. [PMID: 38875388 PMCID: PMC11175869 DOI: 10.1097/md.0000000000038435] [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: 04/07/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/16/2024] Open
Abstract
Using bibliometric analysis, this study attempted to provide an overview of the current state of research and key findings regarding the relationship between atrial fibrillation (AF) and cryoballoons in general. We gathered the literature from the Web of Science (WOS) database covering the last 11 years (2013-2024) pertaining to AF and cryoballoons, and we used Citespace to evaluate the mapping of knowledge. The findings demonstrated that there were 1986 articles concerning AF and cryoballoons, with a faster growth after 2018. The United States, Vrije Universiteit Brussel, and Chierchia, Gian-Battista are the nation, organization, and writer with the highest number of publications. Kuck KH (2016) is the most frequently mentioned reference as well (488). We know that Vrije Universiteit Brusse in the Belgium has emerged as 1 of this discipline's leading research forces based on a 10-year bibliometric investigation. Prominent universities and developed nations form the finest alliances for research on cryoballoons and AF.
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Affiliation(s)
- Jing Lu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Nan Zhang
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Fan Yang
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yu Gao
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yan Ren
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Dengfeng Ma
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Benezet-Mazuecos J, Lozano Á, Miracle Á, Crosa J. Integrated dilator-needle transseptal crossing device in atrial fibrillation cryoballoon ablation procedures. J Cardiovasc Electrophysiol 2024; 35:1095-1100. [PMID: 38511484 DOI: 10.1111/jce.16256] [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: 02/10/2024] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION In cryoballoon ablation (CBA) procedures, transseptal access (TSA) is generally achieved using a standard sheath and needle system that is exchanged for the cryoballoon delivery sheath and dilator over a long wire. Sheath exchange has been related with air embolic events. Recently, an integrated dilator-needle system assembled to the cryoballoon sheath was introduced. We aimed to evaluate the efficacy and safety of an integrated TSA tool compared with the traditional approach in atrial fibrillation CBA procedures. METHODS Patients scheduled for CBA procedures were randomized 1:1 to traditional TSA (t-TSA) or integrated TSA (i-TSA). TSA time was defined as time from superior vena cava to LA insertion of the cryoballoon delivery sheath, after sheath exchange (t-TSA) or directly (i-TSA). RESULTS Ninety-seven patients (76 males, mean age 59 ± 10 years) were randomized, 48 patients underwent t-TSA, and 49 i-TSA. Mean TSA time was 5 min 59 s ± 5 min 36 s in the t-TSA group and 2 min 59 s ± 2 min 14 s in the i-TSA group (p < .001). Total fluoroscopy time, skin-to-skin procedure time, and LA dwell time were respectively 15 ± 6, 69 ± 16, and 44 ± 12 min in the t-TSA group and 13 ± 6, 65 ± 15, and 43 ± 11 min in the i-TSA group (p = ns). No clinically significant acute complications related to TSA were noted in both cohorts. CONCLUSION This is the first randomized study comparing both TSA approaches. TSA in CBA procedures using this integrated tool enables a safe and efficient workflow, reducing TSA time and avoiding sheath exchange.
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Affiliation(s)
- Juan Benezet-Mazuecos
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Luz, Madrid, Spain
| | - Álvaro Lozano
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Luz, Madrid, Spain
| | - Ángel Miracle
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Luz, Madrid, Spain
| | - Julián Crosa
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Luz, Madrid, Spain
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9
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Marine JE, Vasquez N. Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: Caveat Ablator. JACC. ADVANCES 2024; 3:100900. [PMID: 38939643 PMCID: PMC11198182 DOI: 10.1016/j.jacadv.2024.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Joseph E. Marine
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nestor Vasquez
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Tokavanich N, Techasatian W, Prasitlumkum N, Cheungpasitporn W, Navaravong L, Jongarangsin K, Chokesuwattanaskul R. The efficacy and safety of cryoballoon atrial fibrillation ablation in patients with heart failure: A systematic review and meta-analysis. Indian Pacing Electrophysiol J 2024; 24:123-129. [PMID: 38218450 PMCID: PMC11143725 DOI: 10.1016/j.ipej.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/23/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION While atrial fibrillation (AF) ablation has proven beneficial for heart failure (HF) patients, most reports were performed with radiofrequency ablation. We aimed to evaluate the efficacy and safety of cryoballoon AF ablation in patients with HFrEF. METHOD We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to December 2022. Studies that reported the outcomes of freedom from atrial arrhythmia, complications, NYHA functional class (NYHA FC), and left ventricular ejection fraction (LVEF) after Cryoballoon AF ablation in HF patients were included. Data from each study were combined with a random-effects model. RESULT A total of 9 studies observational studies with 1414 HF patients were included. Five studies had only HF with reduced ejection fraction (HFrEF), 1 study with HF with preserved ejection fraction (HFpEF), and others with mixed HF types. Freedom from AA in HFrEF at 12 months was 64% (95% CI 56-71%, I2 58%). There was a significant improvement of LVEF in these patients with a standard mean difference of 13% (95% CI 8.6-17.5%, I2 99% P < 0.001. The complication rate in HFrEF group was 6% (95% CI 4-10%, I2 0%). The risk of recurrence of atrial arrhythmia was not significantly different between HF and no HF patients (RR 1.34, 95% CI 0.8-2.23, I2 76%). CONCLUSION Cryoballoon AF ablation is effective in HFrEF patients comparable to radiofrequency ablation. The complication rate was low.
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Affiliation(s)
- Nithi Tokavanich
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, MI, USA
| | - Witina Techasatian
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, CA, USA
| | | | | | - Krit Jongarangsin
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, MI, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
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11
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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12
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Tønnesen J, Ruwald MH, Pallisgaard J, Rasmussen PV, Johannessen A, Hansen J, Worck RH, Zörner CR, Riis‐Vestergaard L, Middelfart C, Sørensen SK, Sattler S, Gislason G, Hansen ML. Lower Recurrence Rates of Atrial Fibrillation and MACE Events After Early Compared to Late Ablation: A Danish Nationwide Register Study. J Am Heart Assoc 2024; 13:e032722. [PMID: 38533962 PMCID: PMC11179760 DOI: 10.1161/jaha.123.032722] [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: 11/15/2023] [Accepted: 02/02/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Guidelines recommend prioritizing treatment with antiarrhythmic drugs before referral of patients with atrial fibrillation to ablation, delaying a potential subsequent ablation. However, delaying ablation may affect ablation outcomes. We sought to investigate the impact of duration from diagnosis to ablation on the risk of atrial fibrillation recurrence and adverse events. METHODS AND RESULTS Using Danish nationwide registries, all patients with first-time ablation for atrial fibrillation were identified and included from 2010 to 2018. Patients were divided into 4 groups by diagnosis-to-ablation time: <1.0 year (early ablation), 1.0 to 1.9 years, 2.0 to 2.9 years, and >2.9 years (late ablation). The primary end point was atrial fibrillation recurrence after the 90-day blanking period, defined by admission for atrial fibrillation, cardioversions, use of antiarrhythmic drugs, or repeat atrial fibrillation ablations. The secondary end point was a composite end point of heart failure, ischemic stroke, or death, and each event individually. The study cohort consisted of 7705 patients. The 5-year cumulative incidence of atrial fibrillation recurrence in the 4 groups was 42.9%, 54.8%, 55.9%, and 58.4%, respectively. Hazard ratios were 1.20 (95% CI, 1.07-1.35), 1.29 (95% CI, 1.13-1.47), and 1.40 (95% CI, 1.28-1.53), respectively, with the early ablation group as reference. The hazard ratio for the combined secondary end point was 1.22 (95% CI, 1.04-1.44) in the late ablation group compared with the early ablation group. CONCLUSIONS In patients undergoing ablation for atrial fibrillation, early ablation was associated with a significantly lower risk of atrial fibrillation recurrence. Furthermore, the associated risk of heart failure, ischemic stroke, or death was significantly lower in early-compared with late-ablation patients.
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Affiliation(s)
- Jacob Tønnesen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Martin H. Ruwald
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Jannik Pallisgaard
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Peter Vibe Rasmussen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
- Bispebjerg and Frederiksberg HospitalCopenhagenDenmark
| | - Arne Johannessen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Jim Hansen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Rene H. Worck
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Christopher R. Zörner
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Lise Riis‐Vestergaard
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Charlotte Middelfart
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Samuel K. Sørensen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Stefan Sattler
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Gunnar Gislason
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenDenmark
- The Danish Heart FoundationCopenhagenDenmark
| | - Morten Lock Hansen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenDenmark
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13
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Magnani S, Cappato R. Efficacy of cryoablation in atrial fibrillation: comparison with antiarrhythmic therapy. Eur Heart J Suppl 2024; 26:i35-i38. [PMID: 38867872 PMCID: PMC11167975 DOI: 10.1093/eurheartjsupp/suae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Atrial fibrillation (AF) represents the most common arrhythmia in clinical practice, characterized by irregular atrial electrical activity originating mainly in and around the pulmonary veins. This condition can manifest itself symptomatically or silently but still dangerously. Complications associated with AF include stroke, heart failure, worst clinical outcome in patients with underlying conditions, increased emergency room visits, hospitalizations, and cardiovascular mortality. Currently, according to the main international guidelines, antiarrhythmic therapy is considered the first choice for rhythm control in patients with AF despite modest efficacy and non-negligible side effects. In recent decades, radiofrequency catheter ablation has emerged as an alternative to antiarrhythmic drugs for rhythm control. Cryoablation was developed with the aim of reducing procedural times and reducing complications related to the ablative procedure with radiofrequency without losing efficacy. Recent studies conducted with rigour and scientific solidity have demonstrated on the one hand that the results of this technique are not inferior compare with radiofrequency. This study aims to compare data on the safety and efficacy of cryoablation with those obtained from antiarrhythmic drugs through a review of the most recent scientific evidence.
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Affiliation(s)
- Silvia Magnani
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica, Milan
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica, Milan
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14
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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15
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Schemoul E, Tovmassian L, Mancini J, Koutbi L, Biermé C, Deharo JC, Franceschi F, Maille B. Diaphragm movement sensor for phrenic nerve monitoring during cryoballoon procedures: the first clinical evaluation. Front Cardiovasc Med 2024; 11:1361761. [PMID: 38572304 PMCID: PMC10987823 DOI: 10.3389/fcvm.2024.1361761] [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: 12/26/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Background and aims Right phrenic nerve palsy is the most frequent complication of cryoballoon procedures. The SMARTFREEZE™ console (Boston Scientific, St. Paul, MN, USA) has integrated a new tool for diaphragm monitoring-the Diaphragm Movement Sensor; however, it has not been evaluated in clinical practice. We aimed to assess the diagnostic performance of the Diaphragm Movement Sensor based on compound motor action potential data recorded simultaneously. Methods Thirty consecutive patients (mean age 63.2 ± 10.2 years) were included. We simultaneously recorded the compound motor action potential and the Diaphragm Movement Sensor during cryoapplications in the right pulmonary veins. The right phrenic nerve was paced at 60 per minute, 12 V and 2.9 ms. Compound motor action potential monitoring with a 30% decrease cutoff for the diagnosis of phrenic nerve threatening was considered the gold standard. The Diaphragm Movement Sensor decrease threshold was also set at 30%. Results Considering compound motor action potential monitoring, phrenic nerve threatening occurred 11 times (in seven patients) among 84 cryoapplications (13.1%) at the right pulmonary veins. The sensitivity and specificity of the Diaphragm Movement Sensor were, respectively, 33% (95% CI: 7%-70%) and 49% (95% CI: 38%-61%; P < 0.001). The predictive positive and negative values for the Diaphragm Movement Sensor were, respectively, 7% (95% CI: 2%-20%) and 86% (95% CI: 72%-95%). The Diaphragm Movement Sensor gave an erroneous diagnosis in 44/84 cryoapplications (52.4%). Conclusions The diagnostic performance of the Diaphragm Movement Sensor is low, and the relevance of its use in clinical practice may be debated.
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Affiliation(s)
- Elsa Schemoul
- Department of Cardiology, CHU Timone, Aix-Marseille University, Marseille, France
| | - Lilith Tovmassian
- Department of Cardiology, CHU Timone, Aix-Marseille University, Marseille, France
| | - Julien Mancini
- Department of Cardiology, CHU Timone, Aix-Marseille University, Marseille, France
- Biostatistics Department, Aix-Marseille University, INSERM, IRD, ISSPAM, APHM, SESSTIM, Hôpital de la Timone, Marseille, France
| | - Linda Koutbi
- Department of Cardiology, CHU Timone, Aix-Marseille University, Marseille, France
| | - Cédric Biermé
- Department of Cardiology, CHU Timone, Aix-Marseille University, Marseille, France
| | - Jean-Claude Deharo
- Department of Cardiology, CHU Timone, Aix-Marseille University, Marseille, France
- Center for CardioVascular and Nutrition Research (C2VN), INSERM, INRA, Marseille, France
| | - Frédéric Franceschi
- Department of Cardiology, CHU Timone, Aix-Marseille University, Marseille, France
- Center for CardioVascular and Nutrition Research (C2VN), INSERM, INRA, Marseille, France
| | - Baptiste Maille
- Department of Cardiology, CHU Timone, Aix-Marseille University, Marseille, France
- Center for CardioVascular and Nutrition Research (C2VN), INSERM, INRA, Marseille, France
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16
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Carneiro HA, Knight B. Does asymptomatic atrial fibrillation exist? J Cardiovasc Electrophysiol 2024; 35:522-529. [PMID: 37870151 DOI: 10.1111/jce.16108] [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: 07/30/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
Atrial fibrillation (AF) is currently defined as symptomatic by asking patients if they are aware of when they are in AF and if they feel better in sinus rhythm. However, this approach of defining AF as symptomatic and asymptomatic fails to adequately consider the adverse effects of AF in patients who are unaware of their rhythm including progression from paroxysmal to persistent AF, and the development of dementia, stroke, sinus node dysfunction, valvular regurgitation, ventricular dysfunction, and heart failure. Labeling these patients as asymptomatic falsely suggests that their AF requires less intense therapy and puts into question the notion of truly asymptomatic AF. Because focusing on patient awareness ignores other important consequences of AF, clinical endpoints that are independent of symptoms are being developed. The concept of AF burden has more recently been used as a clinical endpoint in clinical trials as a more clinically relevant endpoint compared to AF-related symptoms or time to first recurrence, but its correlation with symptoms and other clinical outcomes remains unclear. This review will explore the impact of AF on apparently asymptomatic patients, the use of AF burden as an endpoint for AF management, and potential refinements to the AF burden metric. The review is based on a presentation by the senior author during the 2023 16th annual European Cardiac Arrhythmia Society (ECAS) congress in Paris, France.
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Affiliation(s)
- Herman A Carneiro
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Bradley Knight
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois, USA
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17
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Andrade JG, Deyell MW, Khairy P, Champagne J, Leong-Sit P, Novak P, Sterns L, Roux JF, Sapp J, Bennett R, Bennett M, Hawkins N, Sanders P, Macle L. Atrial fibrillation progression after cryoablation vs. radiofrequency ablation: the CIRCA-DOSE trial. Eur Heart J 2024; 45:510-518. [PMID: 37624879 DOI: 10.1093/eurheartj/ehad572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIMS Atrial fibrillation (AF) is a chronic progressive disorder. Persistent forms of AF are associated with increased rates of thromboembolism, heart failure, and death. Catheter ablation modifies the pathogenic mechanism of AF progression. No randomized studies have evaluated the impact of the ablation energy on progression to persistent atrial tachyarrhythmia. METHODS Three hundred forty-six patients with drug-refractory paroxysmal AF were enrolled and randomly assigned to contact-force-guided RF ablation (CF-RF ablation, 115), 4 min cryoballoon ablation (CRYO-4, 115), or 2 min cryoballoon ablation (CRYO-2, 116). Implantable cardiac monitors placed at study entry were used for follow-up. The main outcome was the first episode of persistent atrial tachyarrhythmia. Secondary outcomes included atrial tachyarrhythmia recurrence and arrhythmia burden on the implantable monitor. RESULTS At a median of 944.0 (interquartile range [IQR], 612.5-1104) days, 0 of 115 patients (0.0%) randomly assigned to CF-RF, 8 of 115 patients (7.0%) assigned to CRYO-4, and 5 of 116 patients (4.3%) assigned to CRYO-2 experienced an episode of persistent atrial tachyarrhythmia (P = .03). A documented recurrence of any atrial tachyarrhythmia ≥30 s occurred in 56.5%, 53.9%, and 62.9% of those randomized to CF-RF, CRYO-4, and CRYO-2, respectively; P = .65. Compared with that of the pre-ablation monitoring period, AF burden was reduced by a median of 99.5% (IQR 94.0%, 100.0%) with CF-RF, 99.9% (IQR 93.3%-100.0%) with CRYO-4, and 99.1%% (IQR 87.0%-100.0%) with CRYO-2 (P = .38). CONCLUSIONS Catheter ablation of paroxysmal AF using radiofrequency energy was associated with fewer patients developing persistent AF on follow-up.
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Affiliation(s)
- Jason G Andrade
- Department of Medicine, University of British Columbia, 2775 Laurel St 10th Floor, Vancouver, BC V5Z 1M9, Canada
- Center for Cardiovascular Innovation, 2775 Laurel St 9th Floor, Vancouver, BC V5Z 1M9, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Marc W Deyell
- Center for Cardiovascular Innovation, 2775 Laurel St 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Paul Khairy
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Jean Champagne
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
| | - Peter Leong-Sit
- Department of Medicine, University of Western Ontario, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Paul Novak
- Department of Medicine, Royal Jubilee Hospital, 1952 Bay St, Victoria, BC V8R 1J8, Canada
| | - Lawrence Sterns
- Department of Medicine, Royal Jubilee Hospital, 1952 Bay St, Victoria, BC V8R 1J8, Canada
| | - Jean-Francois Roux
- Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, 580 Rue Bowen S, Sherbrooke, QC J1G 2E8, Canada
| | - John Sapp
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Richard Bennett
- Center for Cardiovascular Innovation, 2775 Laurel St 9th Floor, Vancouver, BC V5Z 1M9, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Matthew Bennett
- Center for Cardiovascular Innovation, 2775 Laurel St 9th Floor, Vancouver, BC V5Z 1M9, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Nathaniel Hawkins
- Center for Cardiovascular Innovation, 2775 Laurel St 9th Floor, Vancouver, BC V5Z 1M9, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia
- Centre for Heart Rhythm Disorders, The University of Adelaide, Cardiology 4G751-769, Port Rd, Adelaide, SA 5000, Australia
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
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Paisey J, Moss J, Andrade J, Kuniss M, Wazni O, Chierchia GB, Mealing S, Ismyrloglou E, Sale A, Souter M, Kaplon R, Bromilow T, Lane E, Lewis D, Todd D. Economic evaluation of first-line cryoballoon ablation versus antiarrhythmic drug therapy for the treatment of paroxysmal atrial fibrillation from an English National Health Service perspective. Open Heart 2024; 11:e002423. [PMID: 38238026 PMCID: PMC10806544 DOI: 10.1136/openhrt-2023-002423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Three recent randomised controlled trials have demonstrated that pulmonary vein isolation as an initial rhythm control strategy with cryoablation reduces atrial arrhythmia recurrence in patients with symptomatic paroxysmal atrial fibrillation (PAF) compared with antiarrhythmic drug (AAD) therapy. The aim of this study was to evaluate the cost-effectiveness of first-line cryoablation compared with first-line AADs for treating symptomatic PAF in an English National Health Service (NHS) setting. METHODS Individual patient-level data from 703 participants with PAF enrolled into Cryo-FIRST (Catheter Cryoablation Versus Antiarrhythmic Drug as First-Line Therapy of Paroxysmal Atrial Fibrillation), STOP AF First (Cryoballoon Catheter Ablation in an Antiarrhythmic Drug Naive Paroxysmal Atrial Fibrillation) and EARLY-AF (Early Aggressive Invasive Intervention for Atrial Fibrillation) were used to derive the parameters applied in the cost-effectiveness model (CEM). The CEM comprised a hybrid decision tree and Markov structure. The decision tree had a 1-year time horizon and was used to inform the initial health state allocation in the first cycle of the Markov model (40-year time horizon; 3-month cycle length). Health benefits were expressed in quality-adjusted life years (QALYs). Costs and benefits were discounted at 3.5% per year. Model outcomes were generated using probabilistic sensitivity analysis. RESULTS The results estimated that cryoablation would yield more QALYs (+0.17) and higher costs (+£641) per patient over a lifetime than AADs. This produced an incremental cost-effectiveness ratio of £3783 per QALY gained. Independent of initial treatment, individuals were expected to receive ~1.2 ablations over a lifetime. There was a 45% relative reduction in time spent in AF health states for those initially treated with cryoablation. DISCUSSION AF rhythm control with first-line cryoablation is cost effective compared with first-line AADs in an English NHS setting.
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Affiliation(s)
- John Paisey
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Joe Moss
- York Health Economics Consortium, York, UK
| | - Jason Andrade
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | - Emily Lane
- York Health Economics Consortium, York, UK
| | | | - Derick Todd
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
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19
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Ashar T, Ashar A, Golding B. Ablation as first-line treatment for asymptomatic atrial fibrillation in the context of conduction disturbances: Case report. HeartRhythm Case Rep 2024; 10:53-57. [PMID: 38264107 PMCID: PMC10800999 DOI: 10.1016/j.hrcr.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Tom Ashar
- Emergency Medicine, UCHealth University of Colorado Hospital, Denver, Colorado
| | - Asaf Ashar
- University of New Orleans, New Orleans, Louisiana
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20
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Wubulikasimu S, Wang L, Yang S, Sang W, Han Y, Wang L, Wang F, Zhou X, Zhang J, Xing Q, Tuerhong Z, Xiaokereti J, Guo Y, Tang B, Li Y. Feasibility study of cryoballoon ablation for atrial fibrillation with KODEX-EPD: a single center experience. Sci Rep 2023; 13:22945. [PMID: 38135733 PMCID: PMC10746707 DOI: 10.1038/s41598-023-49475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
To evaluate the feasibility of cryoballoon (CB) ablation of atrial fibrillation (AF) under the guidance of a new three-dimensional (3D) mapping system KODEX-EPD. 40 patients scheduled for CB ablation of AF in the first affiliated Hospital of Xinjiang Medical University from August 2021 to July 2022 were randomly divided into two groups: KODEX-EPD 3D mapping system guidance group (KODEX group, n = 20) and conventional two-dimensional perspective group (standard group, n = 20). The ablation time, operation time, fluoroscopy time, fluoroscopy dose, contrast agent dosage and follow-up data were compared between the two groups. Besides, the feasibility and accuracy of the dielectric sensing system in evaluating pulmonary vein (PV) occlusion in patients with AF during CB ablation were verified. All pulmonary veins were being isolated. The ablation time (36.40 ± 6.72 min vs 35.15 ± 6.29 min, P > 0.05) and the operation time (64.20 ± 11.82 min vs 66.00 ± 13.18 min, P > 0.05) were not statistically different in the two groups. The standard group has longer fluoroscopy time, dose and contrast medium dosage. There were significant differences in fluoroscopy time (532.30 ± 72.83 s vs 676.25 ± 269.33 s, P < 0.05), fluoroscopy dose (110.00 ± 28.64 mGy vs 144.68 ± 66.66 mGy, P < 0.05), and contrast medium dosage (71.90 ± 5.97 ml vs 76.05 ± 5.93 ml, P < 0.05) between the two groups. The learning curves of the first 5 patients and the last 15 patients in the KODEX group were compared. There was no statistical difference in the ablation time (36.80 ± 8.56 min vs 36.27 ± 6.34 min, P > 0.05) or the operation time (69.00 ± 5.00 min vs 62.60 ± 13.10 min, P > 0.05); however, compared to the first 5 patients, fluoroscopy time (587.40 ± 38.34 s vs 513.93 ± 73.02 s, P < 0.05), fluoroscopy dose (147.85 ± 35.19 mGy vs 97.39 ± 8.80 mGy, P < 0.05) and contrast medium dosage (79.60 ± 1.14 ml vs 69.33 ± 4.45 ml, P < 0.05) were significantly decreased. Using pulmonary venography as the gold standard, the sensitivity, specificity of the completely occlusion in KODEX group was 93.6% (95% CI 85-97.6%) and 69.6% (95% CI 54-81.8%); and the sensitivity, specificity of the small leak in KODEX group was 93.1% (95% CI 82.4-97.8%) and 82.0% (95% CI 65.9-91.9%). During an average follow-up of (9.90 ± 1.06) months, there was no statistical difference in arrhythmia recurrence and antiarrhythmic drugs taking after CB ablation between the two groups (P > 0.05). Using the KODEX-EPD system, the CB ablation procedure can correctly evaluate the PV occlusion, and significantly reduce fluoroscopy exposure and contrast medium without significantly increasing the operation time.
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Affiliation(s)
- Subinuer Wubulikasimu
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Liang Wang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Suxia Yang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Wanyue Sang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Yafan Han
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Lu Wang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Feifei Wang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Xianhui Zhou
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Jianghua Zhang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Qiang Xing
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Zukela Tuerhong
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Jiasuoer Xiaokereti
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Yankai Guo
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Baopeng Tang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China
| | - Yaodong Li
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Department of Pacing and Electrophysiology, Department of Cardiac Electrophysiology and Remodeling, Urumqi, China.
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Sidhu GDS, Wissner E. Pulmonary vein isolation using the cryoballoon: is "real-time" really important? J Interv Card Electrophysiol 2023; 66:1967-1968. [PMID: 37338612 DOI: 10.1007/s10840-023-01592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Affiliation(s)
| | - Erik Wissner
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL, USA.
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22
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Ayinde H, Markson F, Ogbenna UK, Jackson L. Addressing racial differences in the management of atrial fibrillation: Focus on black patients. J Natl Med Assoc 2023:S0027-9684(23)00142-6. [PMID: 38114334 DOI: 10.1016/j.jnma.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.
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Affiliation(s)
- Hakeem Ayinde
- Cardiology Associates of Fredericksburg, Fredericksburg, VA, USA.
| | - Favour Markson
- Department of Medicine, Lincoln Medical Center, Bronx, NY, USA
| | - Ugonna Kevin Ogbenna
- Department of Medicine, Michigan State University College of Osteopathic Medicine, Lansing, MI, USA
| | - Larry Jackson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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23
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Huang J, Wu B, Qin P, Cheng Y, Zhang Z, Chen Y. Research on atrial fibrillation mechanisms and prediction of therapeutic prospects: focus on the autonomic nervous system upstream pathways. Front Cardiovasc Med 2023; 10:1270452. [PMID: 38028487 PMCID: PMC10663310 DOI: 10.3389/fcvm.2023.1270452] [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: 07/31/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Atrial fibrillation (AF) is the most common clinical arrhythmia disorder. It can easily lead to complications such as thromboembolism, palpitations, dizziness, angina, heart failure, and stroke. The disability and mortality rates associated with AF are extremely high, significantly affecting the quality of life and work of patients. With the deepening of research into the brain-heart connection, the link between AF and stroke has become increasingly evident. AF is now categorized as either Known Atrial Fibrillation (KAF) or Atrial Fibrillation Detected After Stroke (AFDAS), with stroke as the baseline. This article, through a literature review, briefly summarizes the current pathogenesis of KAF and AFDAS, as well as the status of their clinical pharmacological and non-pharmacological treatments. It has been found that the existing treatments for KAF and AFDAS have limited efficacy and are often associated with significant adverse reactions and a risk of recurrence. Moreover, most drugs and treatment methods tend to focus on a single mechanism pathway. For example, drugs targeting ion channels primarily modulate ion channels and have relatively limited impact on other pathways. This limitation underscores the need to break away from the "one disease, one target, one drug/measurement" dogma for the development of innovative treatments, promoting both drug and non-drug therapies and significantly improving the quality of clinical treatment. With the increasing refinement of the overall mechanisms of KAF and AFDAS, a deeper exploration of physiological pathology, and comprehensive research on the brain-heart relationship, it is imperative to shift from long-term symptom management to more precise and optimized treatment methods that are effective for almost all patients. We anticipate that drugs or non-drug therapies targeting the central nervous system and upstream pathways can guide the simultaneous treatment of multiple downstream pathways in AF, thereby becoming a new breakthrough in AF treatment research.
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Affiliation(s)
- Jingjie Huang
- Postgraduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bangqi Wu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Peng Qin
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yupei Cheng
- Postgraduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ziyi Zhang
- Postgraduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yameng Chen
- Postgraduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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24
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Gencher JA, Andrade JG. First-line cryoballoon ablation for AF: the real world is a great mirror. J Interv Card Electrophysiol 2023; 66:1305-1306. [PMID: 36652081 DOI: 10.1007/s10840-023-01476-1] [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] [Received: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Jason A Gencher
- Vancouver, General Hospital, Vancouver, Canada
- Center for Cardiovascular Innovation, Vancouver, Canada
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Jason G Andrade
- Vancouver, General Hospital, Vancouver, Canada.
- Center for Cardiovascular Innovation, Vancouver, Canada.
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
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25
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Khan Z. Cardiac Tamponade During Catheter Atrial Fibrillation Ablation: A Life-Threatening Complication. Cureus 2023; 15:e44989. [PMID: 37829980 PMCID: PMC10566643 DOI: 10.7759/cureus.44989] [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] [Accepted: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
Catheter ablation has become an important treatment strategy for the management of atrial fibrillation (AF) in symptomatic patients. Pulmonary vein isolation (PVI) is increasingly used to restore rhythm in patients with AF and flutter. The serious procedural complication rate has significantly reduced over time and most patients undergo PVI without any adverse events. We present the case of a 70-year-old man with symptomatic AF who underwent elective PVI that was complicated by large pericardial effusion from left atrial appendage (LAA) perforation resulting in cardiac tamponade requiring emergency pericardiocentesis followed by sternotomy to suture the LAA. The perforated LAA was sutured and the LAA was closed surgically through sternotomy by using AtriClip and a large amount of blood was evacuated achieving good cardiac output and hemodynamic stability. A surgical PVI was performed twice restoring normal sinus rhythm. The patient was discharged home, however, he returned to the hospital a few days later with atrial flutter with a rapid ventricular response. He underwent direct current cardioversion (DCCV) and remained in sinus rhythm during the rest of his admission. His bisoprolol was switched to Sotalol to maintain normal sinus rhythm and he was discharged home with outpatient follow-up.
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Affiliation(s)
- Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR
- Cardiology, Bart's Heart Center, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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26
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Tomaselli M, Badano LP, Cannone V, Radu N, Curti E, Perelli F, Heilbron F, Gavazzoni M, Rella V, Oliverio G, Caravita S, Baratto C, Perego GB, Parati G, Brasca F, Muraru D. Incremental Value of Right Atrial Strain Analysis to Predict Atrial Fibrillation Recurrence After Electrical Cardioversion. J Am Soc Echocardiogr 2023; 36:945-955. [PMID: 37302440 DOI: 10.1016/j.echo.2023.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although the assessment of left atrial (LA) mechanics has been reported to refine atrial fibrillation (AF) risk prediction, it doesn't completely predict AF recurrence. The potential added role of right atrial (RA) function in this setting is unknown. Accordingly, this study sought to evaluate the added value of RA longitudinal reservoir strain (RASr) for the prediction of AF recurrence after electrical cardioversion (ECV). METHODS We retrospectively studied 132 consecutive patients with persistent AF who underwent elective ECV. Complete two-dimensional and speckle-tracking echocardiography analyses of LA and RA size and function were obtained in all patients before ECV. The end point was AF recurrence. RESULTS During a 12-month follow-up, 63 patients (48%) showed AF recurrence. Both LASr and RASr were significantly lower in patients experiencing AF recurrence than in patients with persistent sinus rhythm (LASr, 10% ± 6% vs 13% ± 7%; RASr, 14% ± 10% vs 20% ± 9%, respectively; P < .001 for both). Right atrial longitudinal reservoir strain (area under the curve = 0.77; 95% CI, 0.69-0.84; P < .0001) was more strongly associated with the recurrence of AF after ECV than LASr (area under the curve = 0.69; 95% CI, 0.60-0.77; P < .0001). Kaplan-Meier curves showed that patients with both LASr ≤ 10% and RASr ≤ 15% had a significantly increased risk for AF recurrence (log-rank, P < .001). However, at multivariable Cox regression, RASr (hazard ratio, 3.26; 95% CI, 1.73-6.13; P < .001) was the only parameter independently associated with AF recurrence. Right atrial longitudinal reservoir strain was more strongly associated with the occurrence of AF relapse after ECV than LASr, and LA and RA volumes. CONCLUSION Right atrial longitudinal reservoir strain was independently and more strongly associated than LASr with AF recurrence after elective ECV. This study highlights the importance of assessing the functional remodeling of both the RA and LA in patients with persistent AF.
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Affiliation(s)
- Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi P Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Vincenzo Cannone
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Noela Radu
- Carol Davila University of Medicine and Pharmacy, Prof. Dr. C. C. Iliescu Institute, Bucharest, Romania
| | - Emanuele Curti
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Perelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Valeria Rella
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giorgio Oliverio
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni B Perego
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Brasca
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Chahine Y, Afroze T, Bifulco SF, Macheret F, Abdulsalam N, Boyle PM, Akoum N. Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence. J Interv Card Electrophysiol 2023; 66:1367-1373. [PMID: 36418664 PMCID: PMC10205917 DOI: 10.1007/s10840-022-01429-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) is an established approach for rhythm management of atrial fibrillation (AF). We sought to assess balloon temperature (BT) parameters as predictors of pulmonary vein (PV) reconnection within the index procedure and AF recurrence following CBA. METHODS BT was monitored in 119 AF patients undergoing CBA. PVs were assessed for reconnection during the procedure and patients were followed for arrhythmia recurrence. RESULTS PV reconnection was identified in 39 (8.3%) of 471 PVs. BT was significantly colder in the absence of PV reconnection (30 s: - 33.5 °C [- 36; - 30] vs - 29.5 °C [- 35; - 25.5], p = 0.001; 60 s: - 41 °C [- 44; - 37] vs - 36.5 °C [- 42; - 33.5], p < 0.001; nadir: - 47 °C [- 52; - 43] vs - 41.5 °C [- 47; - 38], p < 0.001). PV reconnection was associated with significantly longer time to reach - 15 °C and - 40 °C (14.5 s [11.5-18.5] vs 12 s [10-15.5], p = 0.023; and 75 s [40-95.5] vs 46 s [37-66.75], p = 0.005) and shorter rewarming time (5.75 s [4.75-8.5] vs 7 s [6-9], p = 0.012). ROC analysis of these procedural parameters had an AUC = 0.71 in predicting PV reconnection. AF recurrence occurred in 51 (42.8%) patients. Kaplan-Meier analysis showed better arrhythmia-free survival for patients in whom BT decreased below - 40 °C in all PVs and patients who had no early PV reconnections, compared to patients in whom BT below - 40 °C was not achieved in at least one PV (log rank = 6.3, p = 0.012) and patients who had PV reconnections (log rank = 4.1, p = 0.043). CONCLUSIONS Slower BT decline, warmer BT nadir, and faster rewarming time predict early PV reconnection. Absence of early PV reconnections and BT dropping below - 40 °C in all PVs during CBA are associated with lower rates of AF recurrence.
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Affiliation(s)
- Yaacoub Chahine
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Tanzina Afroze
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Savannah F Bifulco
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Fima Macheret
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | | | - Patrick M Boyle
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
| | - Nazem Akoum
- Division of Cardiology, University of Washington, Seattle, WA, USA.
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
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Rodríguez Muñoz D, Marco del Castillo Á, Rajjoub Al-Mahdi EA, Lázaro Rivera C, Guisasola Cienfuegos M, Ramos Jiménez J, Borrego Bernabé L, Arribas Ynsaurriaga F, Salguero-Bodes R. Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during cryoballoon ablation of atrial fibrillation: the SWEET-Cryo strategy. Europace 2023; 25:euad231. [PMID: 37497862 PMCID: PMC10443437 DOI: 10.1093/europace/euad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS Cryoballoon pulmonary vein isolation (CB-PVI) offers similar efficacy to point-by-point radiofrequency PVI for patients with atrial fibrillation (AF), but generally with higher X-ray exposure. Strategies aimed at reducing fluoroscopy mostly rely on other costly imaging techniques, limiting their applicability. We designed a Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during CB-PVI (SWEET-Cryo) strategy and analysed its impact on fluoroscopy use and acute procedural and clinical outcomes. METHODS AND RESULTS We enrolled 100 patients with paroxysmal or persistent AF undergoing CB-PVI by two operators with different levels of expertise. Patients treated with the SWEET-Cryo strategy (prospective cohort; n = 50) or conventional fluoroscopy (retrospective control cohort; n = 50) were compared. When applied by the senior operator, the SWEET-Cryo strategy significantly reduced the mean fluoroscopy time (FT) (2.6 ± 1.25 vs. 20.3 ± 10.8 min) and mean dose area product (DAP) (5.1 ± 3.8 vs. 35.3 ± 22.3 Gy cm2) compared with those of the control group, respectively (P < 0.001). Significant reductions in FT (6.4 ± 2.5 min vs. 32.5 ± 10.05) and DAP (13.9 ± 7.7 vs. 92.3 ± 63.8) were also achieved by the less experienced operator (P < 0.001). No difference was observed in acute and long-term complications or freedom from AF between fluoroscopy strategies during a 33-month median follow-up. Mean FT was maintained below 3 min in randomly selected cases performed during the follow-up period. CONCLUSION In contrast to conventional protocols and regardless of the operator's experience, the optimized SWEET-Cryo strategy dramatically reduced fluoroscopy exposure during CB-PVI. The efficacy, safety, or added costs of the ablation procedure were not compromised.
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Affiliation(s)
- Daniel Rodríguez Muñoz
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Álvaro Marco del Castillo
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Ez Alddin Rajjoub Al-Mahdi
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Carla Lázaro Rivera
- Cardiology Department, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - María Guisasola Cienfuegos
- Cardiology Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Javier Ramos Jiménez
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Luis Borrego Bernabé
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
- Department of Medicine, Universidad Complutense, Av. Séneca, 2, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
- Department of Medicine, Universidad Complutense, Av. Séneca, 2, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
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Deyell MW, Andrade JG. Same-Day Discharge for Atrial Fibrillation Ablation: Time to Push Further? JACC Clin Electrophysiol 2023; 9:1527-1529. [PMID: 37245151 DOI: 10.1016/j.jacep.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Marc W Deyell
- Centre for Cardiovascular Innovation and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Centre for Cardiovascular Innovation and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Pilichowska-Paszkiet E, Sikorska A, Kowalik I, Smarż K, Sikora-Frąc M, Baran J, Piotrowski R, Kryński T, Kułakowski P, Zaborska B. Subclinical Dysfunction of Left Atrial Compliance after Cryoballoon versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. J Clin Med 2023; 12:4974. [PMID: 37568376 PMCID: PMC10420106 DOI: 10.3390/jcm12154974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
It has been suggested that cryoballoon (CB) ablation for paroxysmal atrial fibrillation (PAF) may lead to more extensive left atrial (LA) injury than radiofrequency (RF) ablation; however, results are conflicting. We sought to address this issue using modern echocardiographic techniques estimating the LA function after successful CB and RF ablation for PAF. A total of 90 patients (66% males, mean age 57 ± 10 years) successfully treated (no AF recurrences confirmed in serial 4-7 day ECG Holter monitoring) with RF (51%) or CB (49%) ablation for PAF were retrospectively studied. Echocardiography with speckle tracking (STE) was performed before and 12 months after the procedure. The peak longitudinal LA strain (LAS) and strain rate (LASR) during the reservoir (r), conduit (cd), and contraction (ct) phases were measured in sinus rhythm. Analysis of covariance was applied to compare changes in the echocardiographic parameters over time with the baseline measurements as covariance and the type of ablation as the factor. The parallelism of the slopes of the covariance was tested. The LA diameter decreased (38.3 ± 4.1 mm vs. 36.8 ± 3.6 mm, p < 0.001) in the whole study group at 12 months after ablation. The LASRr and LASRcd increased (1.1 ± 0.3 s-¹ vs. 1.3 ± 0.3 s-¹, p < 0.001 and 1.1 ± 0.3 s-¹ vs. 1.2 ± 0.3 s-¹, p < 0.001, respectively) whereas other LA strain parameters remained unchanged in the whole study group at 12 months after ablation. In the analysis of LA function at 12 months after the procedure regarding the mode of ablation, the worsening of parameters reflecting LA compliance was observed in patients with better pre-served baseline values in the CB ablation subgroup. For baseline LAScd >28%, the difference ΔCB - ΔRF was -7.6 (11.7; -3.4), p < 0.001, and for baseline LAScd >16%, ΔCB - ΔRF was -1.8 (-3.2; -0.4), p = 0.014. The traditional Doppler-derived parameter e' showed the same trend-for baseline e' ≥12 cm/s, ΔCB - ΔRF was -1.7 (-2.8; -0.6), p = 0.003. We conclude that worsening of parameters reflecting LA compliance was observed 12 months after CB ablation compared to RF ablation for PAF in patients who underwent a successful procedure and had better-preserved baseline LA function. This might suggest subclinical dysfunction of LA after the CB ablation procedure. The clinical significance of these findings warrants further investigations.
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Affiliation(s)
- Ewa Pilichowska-Paszkiet
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
| | - Agnieszka Sikorska
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
| | - Ilona Kowalik
- Clinical Research Support Center, National Institute of Cardiology, 04-073 Warsaw, Poland;
| | - Krzysztof Smarż
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
| | - Małgorzata Sikora-Frąc
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
| | - Jakub Baran
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
| | - Roman Piotrowski
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
| | - Tomasz Kryński
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
| | - Piotr Kułakowski
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
| | - Beata Zaborska
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland; (A.S.); (M.S.-F.); (J.B.); (R.P.); (T.K.); (P.K.); (B.Z.)
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31
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Andrade JG. Ablation as First-line Therapy for Atrial Fibrillation. Eur Cardiol 2023; 18:e46. [PMID: 37546183 PMCID: PMC10398511 DOI: 10.15420/ecr.2023.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/08/2023] [Indexed: 08/08/2023] Open
Abstract
AF is a chronic and progressive heart rhythm disorder characterised by exacerbations and remissions. Contemporary guidelines recommend antiarrhythmic drugs (AADs) as the initial therapy for the maintenance of sinus rhythm. However, these medications have modest efficacy and are associated with significant adverse effects. Several recent trials have evaluated catheter ablation as an initial therapy for AF, demonstrating that cryoballoon catheter ablation significantly improves arrhythmia outcomes (e.g. atrial tachyarrhythmia recurrence and arrhythmia burden), produces clinically meaningful improvements in patient-reported outcomes (e.g. symptoms and quality of life), and significantly decreases healthcare resource usage (e.g. hospitalisation), without increasing the risk of serious adverse events. Moreover, in contrast to antiarrhythmic drugs, catheter ablation appears to be disease-modifying, significantly reducing the progression of disease. These findings are relevant to patients, providers, and healthcare systems, helping inform the initial choice of rhythm-control therapy in patients with treatment-naïve AF.
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Affiliation(s)
- Jason G Andrade
- University of British Columbia Vancouver, Canada
- Centre for Cardiovascular Innovation Vancouver, Canada
- Montreal Heart Institute, Université de Montréal Montreal, Canada
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32
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Chung HG, Park J, Park JK, Kang KW, Shim J, Kim JB, Kim J, Choi EK, Park HW, Lee YS, Joung B. Rhythm Control and Cardiovascular or Cerebrovascular Outcomes in Patients with Atrial Fibrillation: A Study of the CODE-AF Registry. J Clin Med 2023; 12:4579. [PMID: 37510693 PMCID: PMC10380641 DOI: 10.3390/jcm12144579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND It is not clear whether the data regarding rhythm control during atrial fibrillation (AF) contained in AF registries is prognostically significant. Thus, this study investigated the relationship between rhythm control and cardiovascular outcomes in patients in contemporary AF registries. METHODS This study was conducted using data from 6670 patients with AF receiving oral anticoagulation in the CODE-AF registry. We used propensity overlap weighting to account for differences in baseline characteristics between the rhythm control and rate control groups. The primary outcome was a composite of the rate of death due to cardiovascular causes, stroke, acute coronary syndrome, and heart failure. The secondary outcomes were individual components of the primary outcome. RESULTS In the CODE-AF registry, 5407 (81.1%) patients were enrolled three months after AF diagnosis. During a median follow-up period of 973 days (interquartile range: 755-1089 days), a primary outcome event occurred in 72 patients in the rhythm control group (1.4 events per 100 person-years) and in 211 patients in the rate control group (1.8 events per 100 person-years). However, after overlap weighting, the incidence rates were 1.4 and 1.5 events per 100 person-years, respectively. No significant difference was found in either the primary outcome (weighted HR: 0.87; 95% CI: 0.66-1.17; p = 0.363) or secondary outcomes between the rhythm control and rate control groups. CONCLUSION In a prospective AF registry in which most of the population was enrolled at least three months after AF diagnosis, no difference in the risk of cardiovascular or cerebrovascular outcomes was found between the rhythm control and rate control groups, suggesting the early rhythm control should be considered to improve the outcome of patients.
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Affiliation(s)
- Ho-Gi Chung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Jin-Kyu Park
- Department of Cardiology, Hanyang University Seoul Hospital, Seoul 04763, Republic of Korea
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon 35233, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul 02841, Republic of Korea
| | - Jin-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea
| | - Jun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyung Wook Park
- Department of Cardiology, School of Medicine, Chonnam National University, Gwangju 61469, Republic of Korea
| | - Young Soo Lee
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu 42472, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Republic of Korea
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Benali K, Khairy P, Hammache N, Petzl A, Da Costa A, Verma A, Andrade JG, Macle L. Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation. J Am Coll Cardiol 2023; 81:2089-2099. [PMID: 37225362 DOI: 10.1016/j.jacc.2023.03.418] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Catheter ablation of atrial fibrillation (AF) is a commonly performed procedure. However, it is associated with potentially significant complications. Reported procedure-related complication rates are highly variable, depending in part on study design. OBJECTIVES The purpose of this systematic review and pooled analysis was to determine the rate of procedure-related complications associated with catheter ablation of AF using data from randomized control trials and to assess temporal trends. METHODS MEDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure of AF using either radiofrequency or cryoballoon (PROSPERO, CRD42022370273). RESULTS A total of 1,468 references were retrieved, of which 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis. Overall and severe procedure-related complication rates were 4.51% (95% CI: 3.76%-5.32%) and 2.44% (95% CI: 1.98%-2.93%), respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%; P = 0.043). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%; P = 0.892). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. CONCLUSIONS Procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.
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Affiliation(s)
- Karim Benali
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Saint-Etienne University, Saint-Etienne, France; INSERM-LTSI, U1099, Rennes, France. https://twitter.com/KarimBenali42
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Adrian Petzl
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Atul Verma
- McGill University Health Centre, Montreal, Quebec, Canada. https://twitter.com/atulverma_md
| | - Jason G Andrade
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada. https://twitter.com/DrJasonAndrade
| | - Laurent Macle
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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Leon-Acuna IG, Suzuki T. Progression of Atrial Fibrillation after Cryoablation. N Engl J Med 2023; 388:1340-1341. [PMID: 37018501 DOI: 10.1056/nejmc2301604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
| | - Takeki Suzuki
- Indiana University School of Medicine, Indianapolis, IN
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35
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Pharmacological mechanism of natural drugs and their active ingredients in the treatment of arrhythmia via calcium channel regulation. Biomed Pharmacother 2023; 160:114413. [PMID: 36805187 DOI: 10.1016/j.biopha.2023.114413] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Arrhythmia is characterized by abnormal heartbeat rhythms and frequencies caused by heart pacing and conduction dysfunction. Arrhythmia is the leading cause of death in patients with cardiovascular disease, with high morbidity and mortality rates, posing a serious risk to human health. Natural drugs and their active ingredients, such as matrine(MAT), tetrandrine(TET), dehydroevodiamine, tanshinone IIA, and ginsenosides, have been widely used for the treatment of atrial fibrillation, ventricular ectopic beats, sick sinus syndrome, and other arrhythmia-like diseases owing to their unique advantages. This review summarizes the mechanism of action of natural drugs and their active ingredients in the treatment of arrhythmia via the regulation of Ca2+, such as alkaloids, quinones, saponins, terpenoids, flavonoids, polyphenols, and lignan compounds, to provide ideas for the innovative development of natural drugs with potential antiarrhythmic efficacy.
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36
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Reynolds MR, Ahmad J. The NCDR AFib Ablation Registry: Better Late Than Never? J Am Coll Cardiol 2023; 81:879-881. [PMID: 36858708 DOI: 10.1016/j.jacc.2022.12.017] [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: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 03/02/2023]
Affiliation(s)
- Matthew R Reynolds
- Division of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA.
| | - Javaria Ahmad
- Division of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
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37
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Nelson DW, Dhorepatil A, Kreidieh O, Mekhael M, Noujaim C, Assaf A, Feng H, Marrouche N. Differences in postablation cardiac MRI scar between radiofrequency and cryoballoon ablation: A DECAAF II subanalysis. J Cardiovasc Electrophysiol 2023; 34:810-822. [PMID: 36871178 DOI: 10.1111/jce.15879] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/11/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) using radiofrequency (RF) and cryoballoon (Cryo) ablation are standard approaches for rhythm control in patients with symptomatic atrial fibrillation. Both strategies create scars in the left atrium (LA). There have been few studies investigating the difference in scar formation between patients undergoing RF and Cryo using cardiac magnetic resonance (CMR) imaging. METHODS The current study is a subanalysis of the control arm of the Delayed-Enhancement MRI Determinant of Successful Catheter Ablation of Atrial Fibrillation study (DECAAF II). The study was a multicenter, randomized, controlled, single-blinded trial that evaluated atrial arrhythmia recurrence (AAR) between PVI alone and PVI plus CMR atrial fibrosis-guided ablation. Preablation CMR and 3- to 6-month postablation CMR were obtained to assess baseline LA fibrosis and scar formation, respectively. RESULTS Of the 843 patients randomized in the DECAAF II trial, we analyzed the 408 patients in the primary analysis control arm that received standard PVI. Five patients received combined RF and Cryo ablations, so they were excluded from this subanalysis. Of the 403 patients analyzed, 345 underwent RF and 58 Cryo. The average procedure duration was 146 min for RF and 103 min for Cryo (p = .001). The rate of AAR at ~15 months occurred in 151 (43.8%) patients in the RF group and 28 (48.3%) patients in the Cryo group (p = .62). On 3-month post-CMR, the RF arm had significantly more scar (8.8% vs. 6.4%, p = .001) compared to Cryo. Patients with ≥6.5% LA scar (p < .001) and ≥2.3% LA scar around the PV antra (p = .01) on 3-month post-CMR had less AAR independent of the ablation technique. Cryo caused a greater percentage of right and left pulmonary vein (PV) antral scar (p = .04, p = .02) and less non-PV antral scar (p = .009) compared to RF. On Cox regression, Cryo patients free of AAR had a greater percentage of left PV antral scar (p = .01) and less non-PV antral scar (p = .004) compared to RF free of AAR. CONCLUSION In this subanalysis of the control arm of the DECAAF II trial, we observed that Cryo formed a more significant percentage of PV antral scar and less non-PV antral scar compared to RF. Post ablation LA scar ≥6.5% predicted freedom from AAR, independent of ablation technique. These findings may have prognostic implications in ablation technique selection and freedom from AAR.
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Affiliation(s)
- Daniel Wetherbee Nelson
- Division of Cardiovascular, Tulane University, New Orleans, Louisiana, USA.,TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Aneesh Dhorepatil
- Division of Cardiovascular, Tulane University, New Orleans, Louisiana, USA.,TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Omar Kreidieh
- Division of Cardiovascular, Tulane University, New Orleans, Louisiana, USA.,TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Mario Mekhael
- TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Charbel Noujaim
- TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Ala Assaf
- TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Han Feng
- TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Nassir Marrouche
- Division of Cardiovascular, Tulane University, New Orleans, Louisiana, USA.,TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
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Blomström-Lundqvist C, Naccarelli GV, McKindley DS, Bigot G, Wieloch M, Hohnloser SH. Effect of dronedarone vs. placebo on atrial fibrillation progression: a post hoc analysis from ATHENA trial. Europace 2023; 25:845-854. [PMID: 36758013 PMCID: PMC10062319 DOI: 10.1093/europace/euad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
AIMS This post hoc analysis of the ATHENA trial (NCT00174785) assessed the effect of dronedarone on the estimated burden of atrial fibrillation (AF)/atrial flutter (AFL) progression to presumed permanent AF/AFL, and regression to sinus rhythm (SR), compared with placebo. METHODS AND RESULTS The burden of AF/AFL was estimated by a modified Rosendaal method using available electrocardiograms (ECG). Cumulative incidence of permanent AF/AFL (defined as ≥6 months of AF/AFL until end of study) or permanent SR (defined as ≥6 months of SR until end of study) were calculated using Kaplan-Meier estimates. A log-rank test was used to assess statistical significance. Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were estimated using a Cox model, adjusted for treatment group. Of the 4439 patients included in this analysis, 2208 received dronedarone, and 2231 placebo. Baseline and clinical characteristics were well balanced between groups. Overall, 304 (13.8%) dronedarone-treated patients progressed to permanent AF/AFL compared with 455 (20.4%) treated with placebo (P < 0.0001). Compared with those receiving placebo, patients receiving dronedarone had a lower cumulative incidence of permanent AF/AFL (log-rank P < 0.001; HR: 0.65; 95% CI: 0.56-0.75), a higher cumulative incidence of permanent SR (log-rank P < 0.001; HR: 1.19; 95% CI: 1.09-1.29), and a lower estimated AF/AFL burden over time (P < 0.01 from Day 14 to Month 21). CONCLUSION These results suggest that dronedarone could be a useful antiarrhythmic drug for early rhythm control due to less AF/AFL progression and more regression to SR vs. placebo, potentially reflecting reverse remodeling. CLINICAL TRIAL REGISTRATION NCT00174785.
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Affiliation(s)
- Carina Blomström-Lundqvist
- Department of Medical Science, Uppsala University, Uppsala, 751 85, Sweden.,Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE-701 82, Sweden
| | - Gerald V Naccarelli
- Penn State University College of Medicine, Penn State Hershey Heart and Vascular Institute, 500 University Drive, Hershey, PA 17033, USA
| | | | - Gregory Bigot
- IVIDATA Life Sciences, 79 Rue Baudin, Paris, 92300 Levallois-Perret, France
| | - Mattias Wieloch
- Sanofi, Rue la Boetie 54-56, Paris 75008, France.,Department of Coagulation Disorders, Lund University, Jan Waldenströms gata 14, Lund 20502, Sweden
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Theodor-Stern-Kai 7, Frankfurt D 60590, Germany
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39
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Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures. J Cardiovasc Dev Dis 2023; 10:jcdd10020055. [PMID: 36826551 PMCID: PMC9967334 DOI: 10.3390/jcdd10020055] [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: 12/31/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Nowadays, the cryoballoon (CB) constitutes an established alternative to radio frequency (RF) ablation for pulmonary vein isolation (PVI), which offers the possibility to isolate the PVs with a single application. Since the introduction of the second-generation CB, we prospectively collected our data to optimize the procedure on >1000 consecutive patients who underwent CB PVI performed in our center. It is expected that subsequent guidelines will suggest first-line PVI through CB in patients with paroxysmal AF with a class I indication. Indeed, in the long-term follow-up (36 months) of the EARLY-AF trial, CB had a lower incidence of persistent atrial fibrillation episodes compared to the anti-arrhythmic drugs group. We now review the current best practices in an effort to drive consistent outcomes and minimize complications. PV isolation through CB is the most studied single-shot technique for atrial fibrillation ablation, having shown the potential to alter the natural history of the arrhythmia. Several procedural tips and tricks can improve procedural flow and effectiveness. In the present article we provided not only technical details but measurable biophysical parameters that can reliably guide the operator into achieving the best outcome for his patients.
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40
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Andrade JG, Deyell MW, Macle L, Wells GA, Bennett M, Essebag V, Champagne J, Roux JF, Yung D, Skanes A, Khaykin Y, Morillo C, Jolly U, Novak P, Lockwood E, Amit G, Angaran P, Sapp J, Wardell S, Lauck S, Cadrin-Tourigny J, Kochhäuser S, Verma A. Progression of Atrial Fibrillation after Cryoablation or Drug Therapy. N Engl J Med 2023; 388:105-116. [PMID: 36342178 DOI: 10.1056/nejmoa2212540] [Citation(s) in RCA: 117] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial fibrillation is a chronic, progressive disorder, and persistent forms of atrial fibrillation are associated with increased risks of thromboembolism and heart failure. Catheter ablation as initial therapy may modify the pathogenic mechanism of atrial fibrillation and alter progression to persistent atrial fibrillation. METHODS We report the 3-year follow-up of patients with paroxysmal, untreated atrial fibrillation who were enrolled in a trial in which they had been randomly assigned to undergo initial rhythm-control therapy with cryoballoon ablation or to receive antiarrhythmic drug therapy. All the patients had implantable loop recorders placed at the time of trial entry, and evaluation was conducted by means of downloaded daily recordings and in-person visits every 6 months. Data regarding the first episode of persistent atrial fibrillation (lasting ≥7 days or lasting 48 hours to 7 days but requiring cardioversion for termination), recurrent atrial tachyarrhythmia (defined as atrial fibrillation, flutter, or tachycardia lasting ≥30 seconds), the burden of atrial fibrillation (percentage of time in atrial fibrillation), quality-of-life metrics, health care utilization, and safety were collected. RESULTS A total of 303 patients were enrolled, with 154 patients assigned to undergo initial rhythm-control therapy with cryoballoon ablation and 149 assigned to receive antiarrhythmic drug therapy. Over 36 months of follow-up, 3 patients (1.9%) in the ablation group had an episode of persistent atrial fibrillation, as compared with 11 patients (7.4%) in the antiarrhythmic drug group (hazard ratio, 0.25; 95% confidence interval [CI], 0.09 to 0.70). Recurrent atrial tachyarrhythmia occurred in 87 patients in the ablation group (56.5%) and in 115 in the antiarrhythmic drug group (77.2%) (hazard ratio, 0.51; 95% CI, 0.38 to 0.67). The median percentage of time in atrial fibrillation was 0.00% (interquartile range, 0.00 to 0.12) in the ablation group and 0.24% (interquartile range, 0.01 to 0.94) in the antiarrhythmic drug group. At 3 years, 8 patients (5.2%) in the ablation group and 25 (16.8%) in the antiarrhythmic drug group had been hospitalized (relative risk, 0.31; 95% CI, 0.14 to 0.66). Serious adverse events occurred in 7 patients (4.5%) in the ablation group and in 15 (10.1%) in the antiarrhythmic drug group. CONCLUSIONS Initial treatment of paroxysmal atrial fibrillation with catheter cryoballoon ablation was associated with a lower incidence of persistent atrial fibrillation or recurrent atrial tachyarrhythmia over 3 years of follow-up than initial use of antiarrhythmic drugs. (Funded by the Cardiac Arrhythmia Network of Canada and others; EARLY-AF ClinicalTrials.gov number, NCT02825979.).
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Affiliation(s)
- Jason G Andrade
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Marc W Deyell
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Laurent Macle
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - George A Wells
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Matthew Bennett
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Vidal Essebag
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Jean Champagne
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Jean-Francois Roux
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Derek Yung
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Allan Skanes
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Yaariv Khaykin
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Carlos Morillo
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Umjeet Jolly
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Paul Novak
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Evan Lockwood
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Guy Amit
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Paul Angaran
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - John Sapp
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Stephan Wardell
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Sandra Lauck
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Julia Cadrin-Tourigny
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Simon Kochhäuser
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
| | - Atul Verma
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary's Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael's Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) - all in Canada; and Marienhospital Osnabrück, Niedersachsen, Germany (S.K.)
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Shizuta S. Balloon Technologies for Atrial Fibrillation Ablation - It Really Is a Hot Topic Now! Circ J 2022; 87:74-75. [PMID: 36310049 DOI: 10.1253/circj.cj-22-0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Nakamaru R, Ikemura N, Spertus JA, Kimura T, Katsumata Y, Fujisawa T, Ueno K, Inoue S, Ueda I, Fukuda K, Takatsuki S, Kohsaka S. Rate versus rhythm control in patients with newly diagnosed atrial fibrillation: Effects of the treatment timing on health status outcomes. Am Heart J 2022; 254:156-165. [PMID: 36099976 DOI: 10.1016/j.ahj.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/05/2022] [Accepted: 09/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Recent randomized clinical trials have demonstrated that applying rhythm control during the early stage of atrial fibrillation (AF) may lead to improved clinical outcomes. However, the effects of this modality on health-related quality of life (HRQoL) have not been fully investigated. We aimed to assess the association between the AF stage, determined by the time between AF diagnosis and referral to the cardiology clinic, and HRQoL outcomes. METHODS Using an outpatients-based multicenter AF registry (n = 3,313), we analyzed 2,070 patients with AF diagnosed within 5 years. The patients were divided into 2 groups according to AF stage: early and late AF (AF duration ≤1 and >1 year, respectively). All patients had HRQoL information collected at baseline and 1 year after their initial treatment (assessed via the Atrial Fibrillation Effect on Quality-of-Life-overall summary [AFEQT-OS] score, with higher scores reflecting better HRQoL). The change in AFEQT-OS was adjusted for patient characteristics using a generalized linear mixed model. RESULTS The early AF group (n = 1,644) was older (early, 68.5 ± 11.1, late, 64.4 ± 10.6 years, P < .001) and had more heart failure (early, 19.9%, late, 12.7%, P < .001) than the late AF group (n = 426). At 1 year after treatment, the adjusted changes in AFEQT-OS were similar in patients with rhythm (adjusted difference [SE], early, 8.4 [1.2], late, 7.2 [1.4], P = .15) or rate (early, 4.0 [0.7], late, 2.3 [1.4], P = .16) control, regardless of AF stage. Furthermore, the improvement in HRQoL was similar between early and late AF in patients undergoing catheter ablation (early, 10.2 [2.1], late, 9.8 [2.4], P = .78), whereas a significant difference was observed in those receiving antiarrhythmic drug therapy alone (early, 10.2 [1.4], late, 3.5 [2.2], P < .001). CONCLUSIONS Rhythm control therapy provided clinically meaningful improvements in HRQoL, regardless of AF stage. For patients with impaired HRQoL, AF duration should not be a deterrent to treatment, especially catheter ablation.
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Affiliation(s)
- Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Cardiovascular Research, Department of Biomedical and Health Informatics, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO
| | - John A Spertus
- Cardiovascular Research, Department of Biomedical and Health Informatics, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Koji Ueno
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Soushin Inoue
- Department of Cardiology, Hino Municipal Hospital, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
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Gomez SE, Fazal M, Nunes JC, Shah S, Perino AC, Narayan SM, Tamirisa KP, Han JK, Rodriguez F, Baykaner T. Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01383-x. [PMID: 36224481 PMCID: PMC10097842 DOI: 10.1007/s10840-022-01383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups. METHODS This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials. RESULTS Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection. CONCLUSION Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.
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Affiliation(s)
- Sofia E Gomez
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Muhammad Fazal
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Julio C Nunes
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA.,Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Shayena Shah
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Alexander C Perino
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Sanjiv M Narayan
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | | | - Janet K Han
- Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Tina Baykaner
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA.
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The right modality for the right pulmonary vein shape in ablation for atrial fibrillation. J Interv Card Electrophysiol 2022; 66:827-828. [PMID: 36214806 DOI: 10.1007/s10840-022-01390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 10/17/2022]
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45
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Andrade JG, Deyell MW, Dubuc M, Macle L. Cryoablation as a first-line therapy for atrial fibrillation: current status and future prospects. Expert Rev Med Devices 2022; 19:623-631. [PMID: 36168922 DOI: 10.1080/17434440.2022.2129008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is a common chronic and progressive heart rhythm disorder. For those in whom sinus rhythm is desired, contemporary clinical practice guidelines recommend antiarrhythmic drugs (AADs) as the initial therapy. However, these medications have modest efficacy and are associated with significant adverse effects. AREAS COVERED The current article reviews the evidence surrounding first line catheter ablation, particularly the emerging evidence surrounding the use of cryoballoon ablation as a first-line therapy. The focus of the review is on the outcomes of arrhythmia freedom, quality of life, healthcare utilisation and safety. In addition, the article will review novel cryoablation systems. EXPERT OPINION : Recent evidence suggests that cryoballoon ablation significantly improves arrhythmia outcomes (e.g., freedom from any atrial tachyarrhythmia or symptomatic atrial tachyarrhythmia, reduction in arrhythmia burden), patient-reported outcomes (e.g., symptoms and quality of life), and healthcare resource utilization (e.g., hospitalization), without increasing the risk of adverse events. These findings are relevant to patients, providers, and healthcare systems, as it helps inform the decision-making regarding the initial choice of rhythm-control therapy in patients with treatment-naïve AF.
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Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada.,Department of Medicine, University of British Columbia, Canada.,Center for Cardiovascular Innovation, Vancouver, Canada
| | - Marc W Deyell
- Department of Medicine, University of British Columbia, Canada.,Center for Cardiovascular Innovation, Vancouver, Canada
| | - Marc Dubuc
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada
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Deyell MW, Hoskin K, Forman J, Laksman ZW, Hawkins NM, Bennett MT, Yeung-Lai-Wah JA, Chakrabarti S, Krahn AD, Andrade JG. Same-day discharge for atrial fibrillation ablation: outcomes and impact of ablation modality. Europace 2022; 25:400-407. [PMID: 36164922 PMCID: PMC9935052 DOI: 10.1093/europace/euac170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Same-day discharge is increasingly common after catheter ablation for atrial fibrillation (AF). However, the impact of same-day discharge on healthcare utilization after ablation and whether this differs by ablation modality remains uncertain. We examined the safety, efficacy, and subsequent healthcare utilization of a same-day discharge protocol for AF ablation, including radiofrequency (RF) and cryoballoon ablation, in a contemporary cohort. METHODS AND RESULTS All consecutive patients for whom full healthcare utilization data were available at two centres and who underwent AF ablation from 2018 to 2019 were included. Same-day discharge was the default strategy for all patients. The efficacy and safety outcomes were proportions of same-day discharge and readmission/emergency room (ER) visits, and post-discharge complications, respectively. Of the 421 patients who underwent AF ablation (mean 63.3 ± 10.2 years, 33% female), 90.5% (381/421) achieved same-day discharge with no difference between RF and cryoballoon ablation (89.8 vs. 95.1%, adjusted P = 0.327). Readmission ≤30 days occurred in 4.8%, with ER visits ≤30 days seen in 26.1% with no difference between ablation modalities (P = 0.634). Patients admitted overnight were more likely to present to the ER (40.0 vs. 24.7% with same-day discharge, P = 0.036). The overall post-discharge complication rate was low at 4/421 (1.0%), with no difference between ablation modality (P = 0.324) and admission/same-day discharge (P = 0.485). CONCLUSION Same-day discharge can be achieved in a majority of patients undergoing RF or cryoballoon ablation for AF. Healthcare utilization, particularly ER visits, remains high after AF ablation, regardless of ablation modality or same-day discharge.
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Affiliation(s)
- Marc W Deyell
- Corresponding author. Tel: +1 605 806 8256. E-mail address:
| | - Kurt Hoskin
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Jacqueline Forman
- St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Zachary W Laksman
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Nathaniel M Hawkins
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Matthew T Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - John A Yeung-Lai-Wah
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Santabhanu Chakrabarti
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Jason G Andrade
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
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Kim JY, Park HS, Park HW, Choi EK, Park JK, Kim JB, Kang KW, Shim J, Joung B, Park KM. Clinical Outcomes of Rhythm Control Strategies for Asymptomatic Atrial Fibrillation According to the Quality-of-Life Score: The CODE-AF (Comparison Study of Drugs for Symptom Control and Complication Prevention of Atrial Fibrillation) Registry. J Am Heart Assoc 2022; 11:e025956. [PMID: 36073646 PMCID: PMC9683675 DOI: 10.1161/jaha.122.025956] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Atrial fibrillation (AF) is associated with an increased risk of poor cardiovascular outcomes; appropriate rhythm control can reduce the incidence of these adverse events. Therefore, catheter ablation is recommended in symptomatic patients with AF. The aims of this study were to compare AF-related outcomes according to a baseline symptom scale score and to determine the best treatment strategy for asymptomatic patients with AF. Methods and Results This study enrolled all patients who completed a baseline Atrial Fibrillation Effect on Quality-of-Life (AFEQT) survey in a prospective observational registry. The patients were divided into 2 groups according to AFEQT score at baseline; scores ≤80 were defined as symptomatic, whereas scores >80 represented asymptomatic patients. The primary outcome was defined as a composite of hospitalization for heart failure, ischemic stroke, or cardiac death. This study included 1515 patients (mean age: 65.7±10.5 years; 998 [65.9%] men). The survival curve showed a poorer outcome in the symptomatic group compared with the asymptomatic group (log-rank P=0.04). Rhythm control led to a significantly lower risk of a composite outcome in asymptomatic patients (hazard ratio [HR], 0.47 [95% CI, 0.27-0.84], P=0.01). Rhythm control was associated with more favorable composite outcomes in the asymptomatic group with paroxysmal AF, left atrium diameter ≤50 mm, and CHA2DS2-VASc score ≥3. Conclusions Symptomatic patients with AF experienced more adverse outcomes compared with asymptomatic patients. In asymptomatic patients with AF, a strategy of rhythm control improved the outcomes, especially with paroxysmal AF, smaller left atrium size, or higher stroke risk. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02786095.
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Affiliation(s)
- Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hyoung-Seob Park
- Department of Cardiology Keimyung University Dongsan Hospital Daegu Republic of Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine Chonnam National University Medical School Gwangju Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Jin-Kyu Park
- Division of Cardiology Hanyang University Medical College Seoul Republic of Korea
| | - Jin-Bae Kim
- Division of Cardiology Kyung Hee University Medical College Seoul Republic of Korea
| | - Ki-Woon Kang
- Division of Cardiology Chung-Ang University Hospital Seoul Republic of Korea
| | - Jaemin Shim
- Division of Cardiology Korea University Anam Hospital Seoul Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine Severance Cardiovascular Hospital, Yonsei University College of Medicine Seoul Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Incidence of Long-Term Pulmonary Vein Reconnection after a 2-Minute Cryoballoon Freeze for Pulmonary Vein Isolation—Invasive Insights of TTI-Dependent Cryoenergy Titration. J Cardiovasc Dev Dis 2022; 9:jcdd9090284. [PMID: 36135429 PMCID: PMC9505807 DOI: 10.3390/jcdd9090284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: The optimal freeze duration in cryoballoon pulmonary vein isolation (PVI) is unknown. TTI-based titration of cryoenergy allows individualized freeze duration and has emerged as a favorable ablation strategy in PV cryoablation. In a recent study, we demonstrated that omission of a bonus freeze and reduction in freeze duration to a minimum of 2 min in the case of short TTI led to comparable arrhythmia recurrence rates. Whereas clinical outcome seems to be comparable to fixed freeze duration, evidence of long-term PV reconnection rates in patients undergoing TTI-based cryoballoon ablation is sparse. Aim of the study: To evaluate the procedural efficacy of a single 2-min freeze for PVI, we assessed PV conduction recovery after cryoballoon PVI with a TTI-guided titration of freeze duration compared to a fixed ablation protocol. Methods and Results: We included consecutive patients with atrial fibrillation (AF) recurrence undergoing a second ablation procedure after the initial cryoballoon procedure. The second AF ablation procedure was performed by the 3D-mapping system and radiofrequency ablation technique. A total of 219 patients (age: 66.2 ± 10.8 years, 53% female, paroxysmal AF: 53%) treated with the TTI-guided protocol (174 patients, 685 PV) or fixed protocol (45 patients, 179 PV) showed comparable total reconnection rates (TTI: 36.9% vs. fixed: 31.8%, p = 0.21). The PV reconnection rate was not statistically different for PVs treated with a 2-min freeze in case of short TTI, compared to longer freeze duration. Interestingly, the PV reconnection rate was lower in LIPVs treated with the fixed protocol (13% vs. 31%, p = 0.029). In the TTI group, 17 out of 127 patients (15%) had durable isolation of all PVs, whereas in 8 out of 40 patients (20%) in the fixed group, all PVs were still isolated (p = 0.31). Conclusions: overall reconnection rate was not different using a TTI-guided ablation protocol compared to a fixed ablation protocol, whereas the LIPV reconnection rate was significantly lower in patients treated with a fixed ablation protocol.
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Use of a novel integrated dilator-needle system in cryoballoon procedures: a zero-exchange approach. J Interv Card Electrophysiol 2022; 65:527-534. [PMID: 35799029 DOI: 10.1007/s10840-022-01294-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recently, a novel integrated dilator-needle system (AcQCross Qx, Acutus Medical) was introduced to reduce the number of exchanges for a transseptal access. This system can be used in combination with large bore sheaths. In this pilot study, we evaluated the safety and efficacy of a zero-exchange approach with the AcQCross system in cryoballoon procedures. METHODS In this retrospective single-center study, we included 40 patients (AcQCross: n = 20; control group: n = 20) who underwent a cryoballoon procedure for the treatment of atrial fibrillation. In the AcQCross and control group, patients underwent ablation with POLARx (Boston Scientific) and Arctic Front Advance Pro (AFA-Pro, Medtronic) in equal numbers (n = 10). In the AcQCross group, the AcQGuide Max sheath (Acutus Medical) was used in all POLARx cases. RESULTS The baseline characteristics of the study population were comparable between groups. In the AcQCross group, there was a reduction in procedure time (49.7 ± 9.0 min vs. 59.6 ± 8.1 min, P < 0.001) and time from puncture until balloon delivery (15.5 ± 6.8 min vs. 21.5 ± 7.4 min, P = 0.01) in comparison with the control group. The balloon in body time, fluoroscopy time, number of cryoapplications, and biophysical parameters were similar between groups. There was one temporary phrenic nerve injury in the AcQCross group. Importantly, no signs of air embolism were noted with the AcQGuide Max sheath. CONCLUSIONS The use of the novel AcQCross system improves procedural efficacy in cryoballoon procedures by reducing the number of exchanges.
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Andrade JG, Macle L. Mortality Risk Associated with Atrial Fibrillation Ablation: No Harm No Foul. Can J Cardiol 2022; 38:1619-1620. [PMID: 35777683 DOI: 10.1016/j.cjca.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Jason G Andrade
- University of British Columbia, Vancouver, Canada; Center for Cardiovascular Innovation, Vancouver, Canada; Montreal Heart Institute, Université de Montréal, Montréal, Canada
| | - Laurent Macle
- Montreal Heart Institute, Université de Montréal, Montréal, Canada.
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