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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 156] [Impact Index Per Article: 156.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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2
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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3
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Karwowski J, Wrzosek K, Rekosz J, Tymoszuk K, Wiktorska A, Szmarowska K, Solecki M, Dłużniewski M. Electric Cardioversion in Older Adults. Is Sedation Using Propofol Safe in the Absence of the Direct Anesthetist's Assistance? J Cardiovasc Pharmacol Ther 2024; 29:10742484231221929. [PMID: 38291723 DOI: 10.1177/10742484231221929] [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: 02/01/2024]
Abstract
Aims: This study aimed to assess the safety of electric cardioversion in the absence of anesthetists assistance. We also evaluated the efficacy and safety of this procedure in older adults (≥80 years) compared to younger populations. Methods: We retrospectively analyzed the data of patients who underwent electric cardioversion at our cardiology department. Patients were divided into 2 groups according to age: ≥ 80 years and <80 years old. Results: The study included 218 participants, 73 were aged 80 years or more (mean age: 84.8 years), and 145 were younger than 80 years (mean age: 66.7 years). Electric cardioversion was effective in 97.3% of older patients and 96.5% of younger patients (P = 1.00). No thromboembolic complications were observed in either of the groups. Asystole >5 s occurred immediately after shock in 4.1% of older and 2.1% of younger patients (P = .405). Propofol was used as a sedative, with a mean dose of 0.83 mg/kg versus 0.93 mg/kg, in older and younger patients, respectively. Intubation, medical intervention, or other advanced resuscitation techniques were not required. During hospitalization, arrhythmia recurred in 9.6% and 12.4% of the older and younger patients, respectively (P = .537). Conclusions: Electrical cardioversion is an effective and safe procedure regardless of patient age. Sedation with propofol administered by cardiologists was safe. Adverse events were not considered serious or reversible.
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Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Karol Wrzosek
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jerzy Rekosz
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Katarzyna Tymoszuk
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Anna Wiktorska
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Mateusz Solecki
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
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Shah H, Hanna KS, Kaur H, Alazzeh MS, Thandavaram A, Channar A, Purohit A, Shrestha B, Patel D, Mohammed L. The Outcome of Electrical Cardioversion in Hyperthyroid Induced Atrial Fibrillation. Cureus 2023; 15:e37928. [PMID: 37220445 PMCID: PMC10200072 DOI: 10.7759/cureus.37928] [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: 06/26/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Hyperthyroidism is a prevalent cause of atrial fibrillation (AF). High cardiac output with low systemic vascular resistance, driven by hyperthyroidism, is associated with a rapid heartbeat, enhanced left ventricular systolic and diastolic function, and a higher incidence of supraventricular tachyarrhythmias. After returning to euthyroid status, hyperthyroidism-induced AF generally spontaneously reverts to sinus rhythm (SR), and a significant number of patients remain in chronic AF and require electrical cardioversion (ECV). After effective cardioversion, the long-term outcome of hyperthyroidism-induced persistent AF is unknown. Early ECV before the antithyroid medication should be explored for hyperthyroidism-induced AF to reduce the risk of thromboembolic consequences. The recurrence rate of AF between Hyperthyroid and Euthyroid Patients after ECV did not significantly differ. This review article compares the recurrence rate of AF as an outcome of ECV in Hyperthyroid induced atrial fibrillation.
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Affiliation(s)
- Hriday Shah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kerollos S Hanna
- General Physician, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Harkirat Kaur
- General Physician, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohammad S Alazzeh
- Orthopaedic Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abhay Thandavaram
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aneeta Channar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ansh Purohit
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bijay Shrestha
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Deepkumar Patel
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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5
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Heida A, van der Does WFB, van Schie MS, van Staveren LN, Taverne YJHJ, Bogers AJJC, de Groot NMS. Does conduction heterogeneity determine the supervulnerable period after atrial fibrillation? Med Biol Eng Comput 2023; 61:897-908. [PMID: 36223000 PMCID: PMC9988743 DOI: 10.1007/s11517-022-02679-w] [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: 01/23/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022]
Abstract
Atrial fibrillation (AF) resumes within 90 s in 27% of patients after sinus rhythm (SR) restoration. The aim of this study is to compare conduction heterogeneity during the supervulnerable period immediately after electrical cardioversion (ECV) with long-term SR in patients with AF. Epicardial mapping of both atria was performed during SR and premature atrial extrasystoles in patients in the ECV (N = 17, age: 73 ± 7 years) and control group (N = 17, age: 71 ± 6 years). Inter-electrode conduction times were used to identify areas of conduction delay (CD) (conduction times 7-11 ms) and conduction block (CB) (conduction times ≥ 12 ms). For all atrial regions, prevalences and length of longest CB and continuous CDCB lines, magnitude of conduction disorders, conduction velocity, biatrial activation time, and voltages did not differ between the ECV and control group during both SR and premature atrial extrasystoles (p ≥ 0.05). Hence, our data suggest that there may be no difference in biatrial conduction characteristics between the supervulnerable period after ECV and long-term SR in AF patients. The supervulnerable period after AF termination is not determined by conduction heterogeneity during SR and PACs. It is unknown to what extent intra-atrial conduction is impaired during the supervulnerable period immediately after ECV and whether different right and left atrial regions are equally affected. This high-resolution epicardial mapping study (upper left panel) of both atria shows that during SR the prevalences and length of longest CB and cCDCB lines (upper middle panel), magnitude of conduction disorders, CV and TAT (lower left panel), and voltages did not differ between the ECV and control group. Likewise, these parameters were comparable during PACs between the ECV and control group (lower left panel). †Non-normally distributed. cm/s = centimeters per second; mm = millimeter; ms = millisecond; AF = atrial fibrillation; AT = activation time; BB = Bachmann's bundle; cCDCB = continuous lines of conduction delay and block; CB = conduction block; CD = conduction delay; CT = conduction time; CV = conduction velocity; ECV = electrical cardioversion; LA = left atrium; LAT = local activation times; PAC = premature atrial complexes; PVA = pulmonary vein area; RA = right atrium; SR = sinus rhythm; TAT = total activation time.
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Affiliation(s)
- Annejet Heida
- Unit Translational Electrophysiology, Department of Cardiology, RG-619, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Willemijn F B van der Does
- Unit Translational Electrophysiology, Department of Cardiology, RG-619, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Mathijs S van Schie
- Unit Translational Electrophysiology, Department of Cardiology, RG-619, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Lianne N van Staveren
- Unit Translational Electrophysiology, Department of Cardiology, RG-619, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Unit Translational Electrophysiology, Department of Cardiology, RG-619, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
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6
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Um KJ, McIntyre WF, Mendoza PA, Ibrahim O, Nguyen ST, Lin SH, Duceppe E, Rochwerg B, Healey JS, Koziarz A, Lengyel AP, Bhatnagar A, Amit G, Chu VA, Whitlock RP, Belley-Côté EP. Pre-treatment with antiarrhythmic drugs for elective electrical cardioversion of atrial fibrillation: a systematic review and network meta-analysis. Europace 2022; 24:1548-1559. [PMID: 35654763 DOI: 10.1093/europace/euac063] [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: 07/29/2021] [Accepted: 04/09/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Our objective was to compare the efficacy of pre-treatment with different classes of anti-arrhythmic drugs (AADs) in patients with atrial fibrillation (AF) undergoing electrical cardioversion. METHODS AND RESULTS We performed a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing different AADs in patients with AF undergoing electrical cardioversion. We grouped AADs into five network nodes: no treatment or rate control, Class Ia, Class Ic, Class III, and amiodarone. Outcomes were (i) acute restoration and (ii) maintenance of sinus rhythm. We searched MEDLINE and EMBASE from inception until June 2020. We used Python 3.8.3 and R 3.6.2 for data analysis. We evaluated the overall certainty of evidence with the GRADE framework. We included 28 RCTs. Compared with no treatment or rate control, Class III AADs [odds ratio (OR): 2.41; 95% credible interval (CrI): 1.37 to 4.62, high certainty] and amiodarone (OR: 2.58; 95% CrI: 1.54 to 4.37, high certainty) improved restoration of sinus rhythm. Amiodarone improved long-term maintenance of sinus rhythm when compared with no treatment or rate control (OR: 5.37; 95% CrI: 4.00-7.39, high certainty), Class Ic (OR: 1.89; 95% CrI: 1.05-3.45, moderate certainty) and Class III AADs (OR: 2.19; 95% CrI: 1.39-3.26, high certainty). CONCLUSION Before electrical cardioversion of AF, treatment with Class III AADs or amiodarone improves the acute restoration of sinus rhythm. Amiodarone is most likely to improve the maintenance of sinus rhythm after electrical cardioversion, but Class Ic and Class III AADs are also effective.
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Affiliation(s)
- Kevin J Um
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - William F McIntyre
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Pablo A Mendoza
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Omar Ibrahim
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Stephanie T Nguyen
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sabrina H Lin
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Emmanuelle Duceppe
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Bram Rochwerg
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Jeff S Healey
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Alex Koziarz
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Alexandra P Lengyel
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Akash Bhatnagar
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Guy Amit
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Victor A Chu
- University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Richard P Whitlock
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Emilie P Belley-Côté
- McMaster University, David Braley Cardiac, Vascular, and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
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7
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Nuñez-Garcia JC, Sánchez-Puente A, Sampedro-Gómez J, Vicente-Palacios V, Jiménez-Navarro M, Oterino-Manzanas A, Jiménez-Candil J, Dorado-Diaz PI, Sánchez PL. Outcome Analysis in Elective Electrical Cardioversion of Atrial Fibrillation Patients: Development and Validation of a Machine Learning Prognostic Model. J Clin Med 2022; 11:jcm11092636. [PMID: 35566761 PMCID: PMC9101912 DOI: 10.3390/jcm11092636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The integrated approach to electrical cardioversion (EC) in atrial fibrillation (AF) is complex; candidates can resolve spontaneously while waiting for EC, and post-cardioversion recurrence is high. Thus, it is especially interesting to avoid the programming of EC in patients who would restore sinus rhythm (SR) spontaneously or present early recurrence. We have analyzed the whole elective EC of the AF process using machine-learning (ML) in order to enable a more realistic and detailed simulation of the patient flow for decision making purposes. Methods: The dataset consisted of electronic health records (EHRs) from 429 consecutive AF patients referred for EC. For analysis of the patient outcome, we considered five pathways according to restoring and maintaining SR: (i) spontaneous SR restoration, (ii) pharmacologic-cardioversion, (iii) direct-current cardioversion, (iv) 6-month AF recurrence, and (v) 6-month rhythm control. We applied ML classifiers for predicting outcomes at each pathway and compared them with the CHA2DS2-VASc and HATCH scores. Results: With the exception of pathway (iii), all ML models achieved improvements in comparison with CHA2DS2-VASc or HATCH scores (p < 0.01). Compared to the most competitive score, the area under the ROC curve (AUC-ROC) was: 0.80 vs. 0.66 for predicting (i); 0.71 vs. 0.55 for (ii); 0.64 vs. 0.52 for (iv); and 0.66 vs. 0.51 for (v). For a threshold considered optimal, the empirical net reclassification index was: +7.8%, +47.2%, +28.2%, and +34.3% in favor of our ML models for predicting outcomes for pathways (i), (ii), (iv), and (v), respectively. As an example tool of generalizability of ML models, we deployed our algorithms in an open-source calculator, where the model would personalize predictions. Conclusions: An ML model improves the accuracy of restoring and maintaining SR predictions over current discriminators. The proposed approach enables a detailed simulation of the patient flow through personalized predictions.
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Affiliation(s)
- Jean C. Nuñez-Garcia
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
| | - Antonio Sánchez-Puente
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Correspondence: (A.S.-P.); (P.L.S.); Tel.: +34-92-329-1100 (ext. 55738) (P.L.S.)
| | - Jesús Sampedro-Gómez
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Victor Vicente-Palacios
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- Philips Healthcare, 28050 Madrid, Spain
| | - Manuel Jiménez-Navarro
- Department of Cardiology, Hospital Virgen de la Victoria—IBIMA, 29010 Malaga, Spain;
- Facultad de Medicina, Universidad de Málaga, 29071 Malaga, Spain
| | - Armando Oterino-Manzanas
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
| | - Javier Jiménez-Candil
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Departamento de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain
| | - P. Ignacio Dorado-Diaz
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Pedro L. Sánchez
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Departamento de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain
- Correspondence: (A.S.-P.); (P.L.S.); Tel.: +34-92-329-1100 (ext. 55738) (P.L.S.)
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8
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Zigova M, Petrejèíková E, Blašèáková M, Kmec J, Bernasovská J, Boroòová I, Kmec M. Genetic targets in the management of atrial fibrillation in patients with cardiomyopathy. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_65_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Choi JH, Kwon HJ, Kim HR, Park SJ, Kim JS, On YK, Park KM. Electrocardiographic predictors of early recurrence of atrial fibrillation. Ann Noninvasive Electrocardiol 2021; 26:e12884. [PMID: 34333816 PMCID: PMC8588373 DOI: 10.1111/anec.12884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Electrical cardioversion (ECV) is an effective method for restoring sinus rhythm after atrial fibrillation (AF). However, early recurrence of AF occurs in a significant number of patients after ECV. This study aimed to identify electrocardiographic (ECG) predictors of early AF recurrence after ECV. METHODS A total of 272 patients with persistent AF undergoing successful ECV were consecutively enrolled in this study. We investigated clinical, echocardiographic, and ECG data. The 12-lead ECG parameters were measured during sinus rhythm right after ECV using a digital caliper. The early AF recurrence was defined as recurrence within 2 months. RESULTS Of the 272 patients, 165 patients (60.7%) experienced an early AF recurrence. Maximum P-wave duration (PWD) in limb leads (OR: 1.086; 95% CI: 1.019-1.157; p = .012) and P-terminal force (PTF) in V1 (OR: 1.019; 95% CI: 1.004-1.033; p = .011) were independent predictors of early AF recurrence after ECV. The optimal cutoff value of the maximum PWD in limb leads for predicting early AF recurrence was 134 ms, characterized by 90.3% sensitivity and 72.0% specificity. Likewise, the optimal cutoff value of PTF in V1 was 50 ms × mm, characterized by 80.0% sensitivity and 64.5% specificity. CONCLUSION A longer PWD (>134 ms) and a larger PTF (>50 ms × mm) were useful predictors of early recurrence of AF after successful ECV in clinical practice. A more effective rhythm control therapy such as catheter ablation or rate control strategy rather than a repeat ECV should be considered.
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Affiliation(s)
- Ji-Hoon Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee-Jin Kwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - June Soo Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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10
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Pagani S, Dede' L, Frontera A, Salvador M, Limite LR, Manzoni A, Lipartiti F, Tsitsinakis G, Hadjis A, Della Bella P, Quarteroni A. A Computational Study of the Electrophysiological Substrate in Patients Suffering From Atrial Fibrillation. Front Physiol 2021; 12:673612. [PMID: 34305637 PMCID: PMC8297688 DOI: 10.3389/fphys.2021.673612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022] Open
Abstract
In the context of cardiac electrophysiology, we propose a novel computational approach to highlight and explain the long-debated mechanisms behind atrial fibrillation (AF) and to reliably numerically predict its induction and sustainment. A key role is played, in this respect, by a new way of setting a parametrization of electrophysiological mathematical models based on conduction velocities; these latter are estimated from high-density mapping data, which provide a detailed characterization of patients' electrophysiological substrate during sinus rhythm. We integrate numerically approximated conduction velocities into a mathematical model consisting of a coupled system of partial and ordinary differential equations, formed by the monodomain equation and the Courtemanche-Ramirez-Nattel model. Our new model parametrization is then adopted to predict the formation and self-sustainment of localized reentries characterizing atrial fibrillation, by numerically simulating the onset of ectopic beats from the pulmonary veins. We investigate the paroxysmal and the persistent form of AF starting from electro-anatomical maps of two patients. The model's response to stimulation shows how substrate characteristics play a key role in inducing and sustaining these arrhythmias. Localized reentries are less frequent and less stable in case of paroxysmal AF, while they tend to anchor themselves in areas affected by severe slow conduction in case of persistent AF.
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Affiliation(s)
- S Pagani
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - L Dede'
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - A Frontera
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy
| | - M Salvador
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - L R Limite
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy
| | - A Manzoni
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - F Lipartiti
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy
| | - G Tsitsinakis
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy
| | - A Hadjis
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy
| | - P Della Bella
- Department of Arrhythmology, San Raffaele Hospital, Milan, Italy
| | - A Quarteroni
- MOX-Department of Mathematics, Politecnico di Milano, Milan, Italy.,Institute of Mathematics, EPFL, Lausanne, Switzerland
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11
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Brandes A, Crijns HJGM, Rienstra M, Kirchhof P, Grove EL, Pedersen KB, Van Gelder IC. Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure. Europace 2021; 22:1149-1161. [PMID: 32337542 PMCID: PMC7399700 DOI: 10.1093/europace/euaa057] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/25/2020] [Indexed: 12/17/2022] Open
Abstract
Cardioversion is widely used in patients with atrial fibrillation (AF) and atrial flutter when a rhythm control strategy is pursued. We sought to summarize the current evidence on this important area of clinical management of patients with AF including electrical and pharmacological cardioversion, peri-procedural anticoagulation and thromboembolic complications, success rate, and risk factors for recurrence to give practical guidance.
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Affiliation(s)
- Axel Brandes
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Corresponding author. Tel: +45 30 43 36 50. E-mail address:
| | - Harry J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Centre, Groningen, The Netherlands
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, UHB and Sandwell & West Birmingham Hospitals, NHS Trusts, Birmingham, UK
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kenneth Bruun Pedersen
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Isabelle C Van Gelder
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, University of Groningen, University Medical Centre, Groningen, The Netherlands
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12
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Chae WH, Wieneke H, Dykun I, Deuschl C, Köhrmann M, Frank B. Stroke due to Left Atrial Appendage Thrombus after Pulmonary Vein Isolation despite Novel Oral Anticoagulant: A Case Report. Case Rep Neurol 2021; 13:225-232. [PMID: 33976660 PMCID: PMC8077527 DOI: 10.1159/000515154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/04/2021] [Indexed: 11/19/2022] Open
Abstract
In patients with atrial fibrillation, catheter ablation is suggested to reduce the mortality rate and is thus frequently performed. However, peri- and postprocedural thromboembolic complications as well as high recurrence rates of atrial fibrillation limit its advantages and require concomitant anticoagulation. With the advent of novel oral anticoagulants (NOACs), fixed dosing without routine laboratory monitoring became feasible. Nevertheless, several factors are associated with either an overdose or an insufficient drug activity of NOACs. We report on a patient with atrial fibrillation undergoing catheter ablation and cardioversion suffering from ischemic stroke despite being under oral anticoagulation. It turned out that the drug activity of the NOACs used was repeatedly insufficient in spite of regular intake and adequate dosing. In sum, drug activity controls should be taken into consideration in patients with thrombotic events despite oral anticoagulation with NOACs.
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Affiliation(s)
- Woon Hyung Chae
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Heinrich Wieneke
- Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
| | - Iryna Dykun
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Benedikt Frank
- Department of Neurology, University Hospital Essen, Essen, Germany
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13
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Um KJ, McIntyre WF, Healey JS, Mendoza PA, Koziarz A, Amit G, Chu VA, Whitlock RP, Belley-Côté EP. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: a systematic review and meta-analysis. Europace 2019; 21:856-863. [PMID: 30875422 DOI: 10.1093/europace/euy310] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/03/2018] [Indexed: 09/07/2023] Open
Abstract
AIMS Clinicians frequently pre-treat patients with amiodarone to increase the efficacy of electrical cardioversion for atrial fibrillation (AF). Our objective was to determine the precise effects of amiodarone pre- and post-treatment on conversion efficacy and sinus rhythm maintenance. METHODS AND RESULTS We conducted a systematic review and meta-analysis of trials comparing pre- and post-treatment for electrical cardioversion with amiodarone vs. no therapy on (i) acute restoration and (ii) maintenance of sinus rhythm after 1 year. We searched MEDLINE and EMBASE from inception to July 2018 for randomized controlled trials. We evaluated the risk of bias for individual studies with the Cochrane tool and overall quality of evidence with the GRADE framework. We identified eight eligible studies (n = 1012). Five studies were deemed to have unclear or high risk of selection bias. We found the evidence to be of high quality based on GRADE. Treatment with amiodarone (200-800 mg daily for 1-6 weeks pre-cardioversion; 0-200 mg daily post-cardioversion) was associated with higher rates of acute restoration [relative risk (RR) 1.22, 95% confidence interval (CI) 1.07-1.39, P = 0.004, n = 1012, I2 = 65%] and maintenance of sinus rhythm over 13 months (RR 4.39, 95% CI 2.99-6.45, P < 0.001, n = 695, I2 = 0%). The effects of amiodarone for acute restoration were maintained when considering only studies at low risk of bias (RR 1.22, 95% CI 1.10-1.36, P < 0.001, n = 572, I2 = 0%). Adverse effects were typically non-serious, occurring in 3.4% (6/174) of subjects receiving amiodarone. CONCLUSION High-quality evidence demonstrated that treatment with amiodarone improved the restoration and maintenance of sinus rhythm after electrical cardioversion of AF. Short-term amiodarone was well-tolerated.
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Affiliation(s)
- Kevin J Um
- McMaster University, Hamilton, ON, Canada
| | - William F McIntyre
- McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Jeff S Healey
- McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | - Guy Amit
- McMaster University, Hamilton, ON, Canada
| | | | - Richard P Whitlock
- McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Emilie P Belley-Côté
- McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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14
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Giubertoni A, Boggio E, Ubertini E, Zanaboni J, Calcaterra E, Degiovanni A, Bellacosa I, Marino PN. Atrial conduit function quantitation precardioversion predicts early arrhythmia recurrence in persistent atrial fibrillation patients. J Cardiovasc Med (Hagerstown) 2019; 20:169-179. [DOI: 10.2459/jcm.0000000000000756] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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15
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Zhou Y, Chen J, Hu B, Cao S, Zhou Q, Guo R. The predictive value of intra-left atrial mechanical delay for 1-year recurrence of atrial fibrillation after catheter ablation: A clinical follow-up study using dual Doppler echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:519-526. [PMID: 30229917 DOI: 10.1002/jcu.22629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/17/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The availability of dual Doppler echocardiography (DDE), which facilitates the simultaneous recording of Doppler waveforms at two different sites, has enhanced ability to assess single-beat atrial mechanical delay. We sought to investigate the predictive value of intra-left atrial mechanical delay for atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) with DDE. METHODS Eighty-six patients with paroxysmal AF scheduled to undergo RFCA were prospectively enrolled. Intra-atrial and interatrial mechanical delays were evaluated by DDE and traditional tissue Doppler imaging (tTDI), respectively. The time of whole analysis process with each method was recorded. After RFCA, patients were followed for 1 year. RESULTS Thirty (34.88%) patients had AF recurrence, and 56 (65.12%) patients maintained sinus rhythm. Cut-off values of 39.38 ms for intra-left atrial mechanical delay obtained by DDE and 32.70 ms by tTDI predicted AF recurrence. Areas under curves were comparable in receiver operator characteristic analysis (P > .05). The whole analysis time of DDE was less than tTDI. Parameters obtained by DDE had better reproducibility. CONCLUSION Intra-left atrial mechanical delay best predicted 1-year AF recurrence after RFCA. Compared with tTDI, DDE can noninvasively assess single-beat atrial mechanical delay with high predictive power, less analysis time, and better reproducibility.
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Affiliation(s)
- Yanxiang Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Jinling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Bo Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Ruiqiang Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
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16
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Fujimoto Y, Yodogawa K, Maru YJ, Oka E, Hayashi H, Yamamoto T, Iwasaki YK, Hayashi M, Shimizu W. Advanced interatrial block is an electrocardiographic marker for recurrence of atrial fibrillation after electrical cardioversion. Int J Cardiol 2018; 272:113-117. [PMID: 30072150 DOI: 10.1016/j.ijcard.2018.07.135] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/15/2018] [Accepted: 07/27/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Early recurrence of atrial fibrillation (AF) is common following a successful electrical cardioversion (ECV). The purpose of this study was to investigate the hypothesis that AF recurrence is related to atrial electrical inhomogeneity, which may influence the P wave characteristics. METHODS Two hundred ninety-one consecutive persistent AF patients who underwent ECV were enrolled, and evaluated for AF recurrences one month after the ECV. Patients with open-heart surgery, a history of catheter ablation, and an unsuccessful ECV were excluded. The P wave duration, dispersion and P wave morphology were evaluated by 12‑lead ECGs 30 min after the ECV. RESULTS In total, 141 patients were investigated. One month after the ECV, 60 (43%) patients maintained sinus rhythm. The advanced interatrial block (aIAB; P wave duration >120 ms and biphasic P waves in the inferior leads) (Hazard ratio [HR], 4.51; 95% confidence interval [CI] 1.45-14.01, P = 0.009), P wave dispersion (HR, 1.06; 95%CI 1.02-1.09, P = 0.001), and duration of AF per month (HR, 1.03; 95%CI 1.01-1.04, P = 0.004) were independent predictors of AF recurrence. An aIAB was not associated with structural parameters such as the left atrial volume index or right atrial area. There were no differences in the serum BNP level and frequency of administering anti-arrhythmic drugs between the patients with and without recurrence. CONCLUSIONS The risk of AF recurrence after the ECV can be predicted by the P wave characteristics. A longer P wave dispersion and the duration of AF also had a tendency for recurrence.
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Affiliation(s)
- Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu-Jin Maru
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Eiichiro Oka
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Meiso Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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17
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Risk Factors for Failure of Direct Current Cardioversion in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5936180. [PMID: 29721508 PMCID: PMC5867679 DOI: 10.1155/2018/5936180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 12/03/2017] [Accepted: 02/08/2018] [Indexed: 01/31/2023]
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is a well-recognised risk factor for cardiovascular disease and the prevalence of atrial fibrillation (AF) is higher among patients with T2DM. Direct current cardioversion (DCCV) is an important management option in persistent AF. We sought to determine independent risk factors for immediate and short-term outcomes of DCCV for treatment of AF in patients with T2DM. Methods Retrospective outcome analysis of DCCV for persistent AF in 102 T2DM patients compared with 102 controls. Results DCCV was successful in 68 (66.6%) people with T2DM compared to 86 (84.3%) in the control group (P = 0.003). After initial successful cardioversion, only 38 (37.2%) T2DM patients remained in sinus rhythm compared to 63 (61.8%) in the control group (P = 0.007) at a median follow-up of 74.5 days (IQR 69.4-77.4). Multiple logistic regression analysis showed that the presence of T2DM (P = 0.014), digoxin use (P = 0.01), statin use (P = 0.005), left-atrial size (P = 0.01), and LV ejection fraction (P = 0.008) were independent risk factors for immediate DCCV failure. T2DM (P = 0.034) was an independent risk factor for AF relapse. Among patients with T2DM, previous DCCV (P = 0.033), digoxin use (P = 0.035), left-atrial size (P = 0.01), LV ejection fraction (P = 0.036), and HbA1c (P = 0.011) predicted immediate failure of DCCV whilst digoxin use (P = 0.026) was an independent risk factor for relapse of AF. Conclusion T2DM, higher HbA1c, digoxin treatment, and structural and functional cardiac abnormalities are independent risk factors for immediate DCCV failure and AF relapse.
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18
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Lipidomic profiling reveals free fatty acid alterations in plasma from patients with atrial fibrillation. PLoS One 2018; 13:e0196709. [PMID: 29723222 PMCID: PMC5933795 DOI: 10.1371/journal.pone.0196709] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/18/2018] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its incidence is increasing worldwide. One method used to restore sinus rhythm is direct current cardioversion (DCCV). Despite the high success rate of DCCV, AF typically recurs within the first 2 weeks. However, our understanding of the pathophysiology of AF recurrence, incidence, and progression are highly limited. Lipidomic profiling was applied to identify altered lipids in plasma from patients with AF using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry coupled with multivariate statistical analysis. Partial least-squares discriminant analysis revealed a clear separation between AF patients and healthy controls. The levels of several lipid species, including fatty acids and phospholipids, were different between AF patients and healthy controls, indicating that oxidative stress and inflammation are associated with the pathogenesis of AF. Similar patterns were also detected between recurrent and non-recurrent AF patients. These results suggest that the elevated saturated fatty acid and reduced polyunsaturated fatty acid levels in AF patients may be associated with enhanced inflammation and that free fatty acid levels may play a crucial role in the development and progression of AF.
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19
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Weijs B, Limantoro I, Delhaas T, de Vos CB, Blaauw Y, Houben RPM, Verheule S, Pisters R, Crijns HJGM. Cardioversion of persistent atrial fibrillation is associated with a 24-hour relapse gap: Observations from prolonged postcardioversion rhythm monitoring. Clin Cardiol 2018; 41:366-371. [PMID: 29569353 DOI: 10.1002/clc.22877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/12/2017] [Accepted: 12/19/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Many recurrences occur after electrical cardioversion (ECV) of atrial fibrillation (AF). Assessment of extent of remodeling and continuous prolonged rhythm monitoring might reveal actionable recurrence mechanisms. HYPOTHESIS After ECV of AF specific patterns of arrhythmia recurrence can be distinguished. METHODS All patients who underwent successful ECV due to persistent AF were included. Tissue velocity echocardiography during AF was performed before ECV to study atrial fibrillatory cycle length and fibrillatory velocity. After ECV, the heart rhythm of all patients was monitored 3 times daily during 4 weeks, and timing of recurrence was noted. RESULTS In total, 50 patients (68% male) were included; mean age was 68 ± 9 years. Median duration of the current AF episode was 102 (range, 74-152) days. Twenty-one (42%) patients showed recurrence of persistent AF. No recurrences occurred during the first 24 hours. There were no differences in clinical characteristics between patients with or without recurrence of AF. However, patients with early recurrence of AF had significantly higher precardioversion wall-motion velocity compared with patients who remained in sinus rhythm (2.8 [1.6-3.6] vs 1.4 [0.9-3.3] cm/s; P = 0.017), whereas atrial fibrillatory cycle length did not differ. CONCLUSIONS In this study on 50 patients successfully cardioverted for persistent AF, there was a relapse gap of ≥24 hours. This phenomenon has not been well appreciated before and offers an AF-free window of opportunity for electrocardiographically triggered cardiac imaging or complex electrophysiological procedures. Echocardiographic tissue velocity imaging may visualize atrial remodeling relevant to AF recurrence.
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Affiliation(s)
- Bob Weijs
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Ione Limantoro
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Tammo Delhaas
- Department of Physiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Cees B de Vos
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard P M Houben
- Medtronic Bakken Research Center Maastricht, Maastricht, the Netherlands
| | - Sander Verheule
- Department of Physiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Ronny Pisters
- Department of Cardiology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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20
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Erne P, Resink TJ, Mueller A, Coslovsky M, Kobza R, Conen D, Bauer P, Arand P. Use of acoustic cardiography immediately following electrical cardioversion to predict relapse of atrial fibrillation. J Atr Fibrillation 2017; 10:1527. [PMID: 29250219 DOI: 10.4022/jafib.1527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/19/2017] [Accepted: 05/14/2017] [Indexed: 11/10/2022]
Abstract
Predicting atrial fibrillation (AF) recurrence after successful electrical cardioversion (ECV) is difficult. The main aim of this study was to investigate whether acoustic cardiography (AUDICOR® 200) immediately post-ECV might provide indices for AF relapse following cardioversion. Acoustic cardiography parameters included Electromechanical Activation Time (EMAT), Left Ventricular Systolic Time (LVST), QRS duration, heart rate and third heart sound intensity (S3 Strength). We analysed data from 140 patients who underwent successful cardioversion and in whom AUDICOR results and echocardiographic measurements immediately after (baseline) ECV were available. Patients were prospectively followed-up at 4-6 weeks, 3 and 12 months post-ECV, and sinus rhythm maintenance was evaluated using acoustic cardiography and Holter electrocardiography. The effect of each baseline AUDICOR parameter on the hazard of AF relapse was investigated using Cox proportional hazards (PH) models. Fifty patients (35.7%) had AF relapse. Of all the AUDICOR parameters, only S3 Strength exhibited consistent predictive value. Increasing S3 Strength increased the hazard of relapse in a univariable Cox PH model (HR=2.52, p=0.003), and in two multivariable Cox PH model constructions (Model 1 excluded heart rate and Model II excluded EMAT/RR, LVST and LVST/RR) both of which included the parameters as continuous variables (Model I: HR=1.15, p=0.042; Model II: HR=1.14, p=0.045) or the parameters dichotomized according to suggested cut-points (Model I: HR=2.5, p=0.007; Model II: HR=2.09, p=0.031). In conclusion, this study suggests that acoustic cardiography may be a simple inexpensive and quantitative bedside method to assist in prediction of AF recurrence after ECV.
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Affiliation(s)
- Paul Erne
- Laboratory of Signal Transduction, Department of Biomedicine, Basel University Hospital and Basel University, Basel, Switzerland
| | - Therese J Resink
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Andrea Mueller
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - David Conen
- Department of Cardiology, Basel University Hospital, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Peter Bauer
- Inovise Medical, Inc., Beaverton, Oregon, USA
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Abstract
Patients with atrial fibrillation and flutter routinely require transesophageal echocardiography with cardioversion. It is not uncommon to encounter patients with reduced ejection fractions, coronary artery disease, prior cardiac surgery, or obstructive sleep apnea. The anesthesiologist must carefully evaluate the patient and any available laboratory and study findings to assess for potential complications after anesthesia. Appropriate anesthetics must be chosen based on the preoperative evaluation. Additionally, because most of these cases are done without a secured airway, emergency medications and airway equipment must be readily available.
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Affiliation(s)
- Ronak Shah
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Elizabeth Zhou
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Degiovanni A, Boggio E, Prenna E, Sartori C, De Vecchi F, Marino PN. Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion. Clin Res Cardiol 2017; 107:329-337. [PMID: 29181725 PMCID: PMC5869942 DOI: 10.1007/s00392-017-1188-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/23/2017] [Indexed: 01/08/2023]
Abstract
Background Diastolic dysfunction promotes atrial fibrillation (AF) inducing left atrial (LA) remodeling, with chamber dilation and fibrosis. Predominance of LA phasic conduit (LAC) function should reflect not only chamber alterations but also underlying left ventricular (LV) filling impairment. Thus, LAC was tested as possible predictor of early AF relapse after electrical cardioversion (EC). Methods 96 consecutive patients, who underwent EC for persistent non-valvular AF, were prospectively enrolled. Immediately after successful EC (3 h ± 15 min), an echocardiographic apical four-chamber view was acquired with transmitral velocities, annular tissue Doppler and simultaneous LV and LA three-dimensional full-volume datasets. Then, from LA–LV volumetric curves we computed LAC as: [(LV maximum − LV minimum) − (LA maximum − LA minimum) volume], expressed as % LV stroke volume. LA pump, immediately post-EC, was assumed and verified as being negligible. Sinus rhythm persistence at 1 month was checked with ECG-Holter monitoring. Results At 1 month 62 patients were in sinus rhythm and 34 in AF. AF patients presented pre-EC higher E/é values (p = 0.012), no major LA volume differences (p = NS), but a stiffer LV cavity (p = 0.012) for a comparable LV capacitance (p = 0.461). Conduit contributed more (p < 0.001) to LV stroke volume in AF subpopulation. Multiple regression revealed LAC as the most significant AF predictor (p = 0.013), even after correction for biometric characteristics and pharmacotherapy (p = 0.008). Conclusion Our data suggest that LAC larger contribution to LV filling soon after EC reflects LA–LV stiffening, which skews atrioventricular interaction leading to AF perpetuation and makes conduit dominance a powerful predictor of early AF recurrence. Electronic supplementary material The online version of this article (10.1007/s00392-017-1188-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Degiovanni
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Enrico Boggio
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Eleonora Prenna
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Chiara Sartori
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Federica De Vecchi
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Paolo N Marino
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy.
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Boriani G, Tukkie R, Biffi M, Mont L, Ricci R, Pürerfellner H, Botto GL, Manolis AS, Landolina M, Gulizia M, Hudnall JH, Mangoni L, Grammatico A, Padeletti L. Atrial antitachycardia pacing and atrial remodeling: A substudy of the international, randomized MINERVA trial. Heart Rhythm 2017; 14:1476-1484. [DOI: 10.1016/j.hrthm.2017.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Indexed: 11/30/2022]
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Kim N, Jung Y, Nam M, Sun Kang M, Lee MK, Cho Y, Choi EK, Hwang GS, Soo Kim H. Angiotensin II affects inflammation mechanisms via AMPK-related signalling pathways in HL-1 atrial myocytes. Sci Rep 2017; 7:10328. [PMID: 28871102 PMCID: PMC5583339 DOI: 10.1038/s41598-017-09675-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/27/2017] [Indexed: 11/30/2022] Open
Abstract
Inflammation is a common cause of cardiac arrhythmia. Angiotensin ІІ (Ang ІІ) is a major contributing factor in the pathogenesis of cardiac inflammation; however, its underlying molecular mechanism remains unclear. Here, we explored the effect of Ang ІІ on inflammatory mechanisms and oxidative stress using HL-1 atrial myocytes. We showed that Ang ІІ activated c-Jun N-terminal kinase (JNK) phosphorylation and other inflammatory markers, such as transforming growth factor-β1 (TGF-β1) and tumor necrosis factor-α (TNF-α). Ang ІІ decreased oxygen consumption rate, which resulted in reactive oxygen species (ROS) generation and inhibition of ROS blocked Ang II-mediated JNK phosphorylation and TGF-β1 induction. Ang ІІ induced the expression of its specific receptor, AT1R. Ang II-induced intracellular calcium production associated with Ang ІІ-mediated signalling pathways. In addition, the generated ROS and calcium stimulated AMPK phosphorylation. Inhibiting AMPK blocked Ang II-mediated JNK and TGF-β signalling pathways. Ang ІІ concentration, along with TGF-β1 and tumor necrosis factor-α levels, was slightly increased in plasma of patients with atrial fibrillation. Taken together, these results suggest that Ang ІІ induces inflammation mechanisms through an AMPK-related signalling pathway. Our results provide new molecular targets for the development of therapeutics for inflammation-related conditions, such as atrial fibrillation.
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Affiliation(s)
- Nami Kim
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul, 120-140, Republic of Korea
| | - Youngae Jung
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul, 120-140, Republic of Korea
| | - Miso Nam
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul, 120-140, Republic of Korea
| | - Mi Sun Kang
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul, 120-140, Republic of Korea
| | - Min Kyung Lee
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul, 120-140, Republic of Korea
| | - Youngjin Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Geum-Sook Hwang
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul, 120-140, Republic of Korea. .,Chemistry & Nanoscience, Ewha Womans University, Seoul, Republic of Korea.
| | - Hyeon Soo Kim
- Department of Anatomy, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
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Varounis C, Maounis T, Cokkinos DV. Peak Early Diastolic Transmitral Velocity As A Surrogate Marker Of Short-Term Atrial Fibrillation Recurrence After Electrical Cardioversion. J Atr Fibrillation 2016; 8:1251. [PMID: 27957223 DOI: 10.4022/jafib.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The aim of this study was to assess if peak early diastolic transmitral velocity (E-wave) can be used as a surrogate marker of short-term atrial fibrillation (AF) recurrence. METHODS We prospectively studied 57 consecutive patients who underwent electrical cardioversion (ECV) for AF and successfully converted to sinus rhythm. N-terminal brain natriuretic peptide levels (BNP) before and after ECV was measured in all patients. The follow-up included physical examination and a 12-lead electrocardiogram 14 days and one month after the ECV. RESULTS In 42.1% patients AF recurred during one-month follow-up period. Gender, presence of mitral regurgitation, treatment with angiotensin II receptor blocker and left atrium diameter independently influenced E-wave velocity before ECV. E-wave velocity fell immediately after successful ECV (94.0±27 cm/s vs 79.7±23 cm/s, P<0.0001). E-wave velocity before ECV>94 cm/s and E-wave velocity after ECV >80 cm/s were predictors of one-month AF recurrence [(Hazard Ratio) HR=3.62 with 95% CI=1.49-8.78 and HR=3.76 with 95% CI=1.40-10.10, respectively]. E-wave velocity before and E-wave velocity after ECV remained predictors of AF recurrence but only in non-hypertensive patients (HR=1.01 with 95% C.I=1.01-1.03 and HR=1.03 with 95% C.I=1.01-1.06, respectively). Similarly, BNP levels before and after ECV were associated with an increased the risk of AF recurrence (HR=1.14 with 95% C.I 1.01-1.28 and HR= 1.16 with 95% C.I 1.03- 1.31, respectively). The addition of BNP levels to E-wave velocity before ECV appeared to have incremental value on short-term AF recurrence but at a marginally statistical significance (LR chi2=3.28, p=0.07). CONCLUSIONS E-wave velocity before and after ECV appears to be a marker of short-term recurrence of AF.
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Affiliation(s)
- Christos Varounis
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece; Cardiology Department, Attikon University hospital, University of Athens, Greece
| | | | - Dennis V Cokkinos
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece; Biomedical Research Foundation Academy of Athens, Greece
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Evaluación de la fibrilación auricular mediante electrocardiograma y Holter. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gasparova I, Kubatka P, Opatrilova R, Caprnda M, Filipova S, Rodrigo L, Malan L, Mozos I, Rabajdova M, Nosal V, Kobyliak N, Valentova V, Petrovic D, Adamek M, Kruzliak P. Perspectives and challenges of antioxidant therapy for atrial fibrillation. Naunyn Schmiedebergs Arch Pharmacol 2016; 390:1-14. [PMID: 27900409 DOI: 10.1007/s00210-016-1320-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/18/2016] [Indexed: 12/26/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia associated with significant morbidity and mortality. The mechanisms underlying the pathogenesis of AF are poorly understood, although electrophysiological remodeling has been described as an important initiating step. There is growing evidence that oxidative stress is involved in the pathogenesis of AF. Many known triggers of oxidative stress, such as age, diabetes, smoking, and inflammation, are linked with an increased risk of arrhythmia. Numerous preclinical studies and clinical trials reported the importance of antioxidant therapy in the prevention of AF, using vitamins C and E, polyunsaturated fatty acids, statins, or nitric oxide donors. The aim of our work is to give a current overview and analysis of opportunities, challenges, and benefits of antioxidant therapy in AF.
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Affiliation(s)
- Iveta Gasparova
- Institute of Biology, Genetics and Medical Genetics, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic, Slovakia
| | - Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovak Republic, Slovakia
| | - Radka Opatrilova
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Martin Caprnda
- 2nd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Slavomira Filipova
- Department of Cardiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Luis Rodrigo
- Faculty of Medicine, University of Oviedo, Central University of Asturias (HUCA), Oviedo, Spain
| | - Leone Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Ioana Mozos
- Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Miroslava Rabajdova
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Vladimir Nosal
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University and University Hospital in Martin, Martin, Slovak Republic
| | - Nazarii Kobyliak
- Department of Endocrinology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Vanda Valentova
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovak Republic, Slovakia
| | - Daniel Petrovic
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljublana, Ljublana, Slovenia
| | - Mariusz Adamek
- Department of Thoracic Surgery, Medical University of Silesia, Zabrze, Poland
| | - Peter Kruzliak
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic. .,2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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28
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Rago A, Russo V, Papa AA, Ciardiello C, Pannone B, Mayer MC, Cimmino G, Nigro G. The role of the atrial electromechanical delay in predicting atrial fibrillation in beta-thalassemia major patients. J Interv Card Electrophysiol 2016; 48:147-157. [PMID: 27878421 DOI: 10.1007/s10840-016-0201-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paroxysmal atrial tachyarrhythmias frequently occur in beta-thalassemia major (β-TM) patients. The aim of the current study was to evaluate the atrial electromechanical delay (AEMD) in a large β-TM population with normal cardiac function and its relationship to atrial fibrillation (AF) onset. METHODS Eighty β-TM patients (44 men, 36 women), with a mean age of 36.2 ± 11.1 years, and 80 healthy subjects used as controls, matched for age and gender, were studied for the occurrence of AF during a 5-year follow-up, through 30-day external loop recorder (ELR) monitoring performed every 6 months. Intra-AEMD and inter-AEMD of both atria were measured through tissue Doppler echocardiography. P-wave dispersion (PD) was carefully measured using 12-lead electrocardiogram (ECG). RESULTS Compared to the healthy control group, the β-TM patients showed a statistically significant increase in inter-AEMD, intra-left AEMD, maximum P-wave duration, and PD. Dividing the β-TM group into two subgroups (patients with or without AF), the inter-AEMD, intra-left AEMD, maximum P-wave duration, and PD were significantly higher in the subgroup with AF compared to the subgroup without AF. There were significant good correlations of intra-left AEMD and inter-AEMD with PD. A cut-off value of 40.1 ms for intra-left AEMD had a sensitivity of 76.2% and a specificity of 97.5% in identifying β-TM patients with AF risk. A cut-off value of 44.8 ms for inter-AEMD had a sensitivity of 81.2% and a specificity of 98.7% in identifying this category of patients. CONCLUSIONS Our results showed that the echocardiographic atrial electromechanical delay indices (intra-left and inter-AEMD) and the PD were significantly increased in β-TM subjects with normal cardiac function. PD and AEMD represent non-invasive, inexpensive, useful, and simple parameters to assess the AF risk in β-TM patients.
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Affiliation(s)
- Anna Rago
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
| | - Vincenzo Russo
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Andrea Antonio Papa
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | | | - Bruno Pannone
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | | | - Giovanni Cimmino
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
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Osmanagic A, Möller S, Osmanagic A, Sheta HM, Vinther KH, Egstrup K. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion: An Echocardiographic Study. Clin Cardiol 2016; 39:406-12. [PMID: 27163514 DOI: 10.1002/clc.22545] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/12/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial sphericity index (LASI) acquired by 2-dimensional transthoracic echocardiography (TTE) could be used as a predictor of AF recurrence after successful DCC. HYPOTHESIS A baselline LASI assessed by 2D TTE can predict AF recurrence after successful DCC in patients with persistent AF. METHODS A total of 124 consecutive patients with persistent AF lasting <120 days underwent successful DCC. Other than β-blockers, no other antiarrhythmic treatment was administered. Prior to DCC, all patients underwent thorough TTE, and LASI was calculated as the fraction of the left atrial width/length of the largest possible left atrial volume in a 4-chamber view. The primary outcome was a TTE-estimated baseline LASI as a predictor of AF recurrence after successful DCC for persistent AF. RESULTS Anatomically, a more spherical shape of the left atrium (LASI >0.9) proved to be a strong and independent predictor of AF recurrence, with an odds ratio between 4.1 (95% confidence interval: 1.6-11.9, P = 0.005) and 7.6 (95% confidence interval: 3.3-19.7; P = 7.2 × 10(-6) ). The receiver operating characteristic curve indicated good power for distinguishing between recurring and nonrecurring AF, and we chose a cutoff of 0.9 because high specificity was a priority for clinical reasons. CONCLUSIONS In conclusion, baseline LASI >0.9 was associated with significantly greater AF recurrence throughout the 12-month follow-up period.
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Affiliation(s)
- Armin Osmanagic
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Sören Möller
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Azra Osmanagic
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Hussam M Sheta
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Kristina H Vinther
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Kenneth Egstrup
- Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
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Lankveld T, de Vos CB, Limantoro I, Zeemering S, Dudink E, Crijns HJ, Schotten U. Systematic analysis of ECG predictors of sinus rhythm maintenance after electrical cardioversion for persistent atrial fibrillation. Heart Rhythm 2016; 13:1020-1027. [DOI: 10.1016/j.hrthm.2016.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Indexed: 11/16/2022]
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Yang S, Xu W, Dong Z, Zhou M, Lin C, Jin H, Su Y, Li Q, Wang X, Chang H, Han W. TPEN prevents rapid pacing-induced calcium overload and nitration stress in HL-1 myocytes. Cardiovasc Ther 2016; 33:200-8. [PMID: 25973665 DOI: 10.1111/1755-5922.12134] [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] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia. However, the current drug interference of antiarrhythmia has limited efficacy and off-target effects. Accumulating evidence has implicated a potential role of nitration stress in the pathogenesis of AF. The aim of the study was to determine whether TPEN provided antinitration effects on atrial myocytes during AF, especially under circumstances of nitration stress. METHODS We utilized a rapid paced HL-1 cells model for AF. The changes of electrophysiological characteristics and structure of paced HL-1 cells were determined by a patch clamp and a TEM method. The effects of TPEN on pacing and ONOO(-) pretreated HL-1 cells were examined using MTT assay, TUNEL technique, confocal microscope experiment, and Western blot analysis. RESULTS The results revealed that ONOO(-) reduced the viability of HL-1 cells in a dose-dependent manner, and 1 μmol/L TPEN significantly ameliorated the damage caused by 50 μmol/L ONOO(-) (P < 0.05). Pacing and/or ONOO(-) -induced marked shortening of APD, myolysis, and nuclear condensation. TPEN inhibited the Ca(2+) overload induced by rapid pacing (P < 0.05) and ONOO(-) stimulation (P < 0.05). The application of TPEN significantly prevented the protein nitration caused by pacing or pacing plus ONOO(-) (P < 0.05). Additionally, pacing in combination with ONOO(-) treatment led to increase in apoptosis in HL-1 cells (P < 0.01), which could be reduced by pretreatment with TPEN (P < 0.05). CONCLUSIONS TPEN prevents Ca(2+) overload and nitration stress in HL-1 atrial myocytes during rapid pacing and circumstances of nitration stress.
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Affiliation(s)
- Shusen Yang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenjing Xu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zengxiang Dong
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mo Zhou
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chaolan Lin
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongbo Jin
- Laboratory of Physiology, Harbin Medical University, Harbin, China
| | - Yafen Su
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qingyu Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xu Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huiying Chang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Han
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Russo V, Di Meo F, Rago A, Mosella M, Molino A, Russo MG, Nigro G. Impact of Continuous Positive Airway Pressure Therapy on Atrial Electromechanical Delay in Obesity-Hypoventilation Syndrome Patients. J Cardiovasc Electrophysiol 2015; 27:327-34. [PMID: 26552735 DOI: 10.1111/jce.12879] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 10/05/2015] [Accepted: 10/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity-hypoventilation syndrome (OHS) is defined as daytime hypercapnia and hypoxemia in obese patients with sleep-disordered breathing. We evaluated the electrocardiographic P-wave duration and dispersion (PD) and echocardiographic noninvasive indicators of atrial conduction heterogeneity in OHS patients and the impact of CPAP on atrial conduction and atrial fibrillation incidence. METHODS AND RESULTS We enrolled 50 OHS patients and 50 sex- and age-matched obese subjects as control. Study population underwent cardiologic evaluation and polysomnography before enrollment, at 1- and 6-month follow-ups after CPAP therapy. The OHS group showed a significant increase in inter-atrial (35.2 ± 8 milliseconds vs. 20.1 ± 2.7 milliseconds, P < 0.0001), intra-left (30.5 ± 7.2 milliseconds vs. 16.5 ± 2 milliseconds, P < 0.0001), and intra-right atrial electromechanical delays (AEMD)(24.8 ± 10 milliseconds vs. 15 ± 2.6 milliseconds, P < 0.0001) as well as in Pmax (130 ± 7.4 milliseconds vs. 97 ± 7.2 milliseconds, P = 0.002) and PD (56.5 ± 8.5 milliseconds vs. 31 ± 7.2 milliseconds, P = 0.002) compared to the control group. Significant improvement was noted after 6 months of CPAP therapy in inter-atrial (35.2 ± 8 milliseconds vs. 24.5 ± 6.3 milliseconds, P < 0.0001), intra-left (30.5 ± 7.2 milliseconds vs. 20.6 ± 5 milliseconds, P = 0.003), and intra-right AEMD (24.8 ± 10 milliseconds vs. 17 ± 7.5 milliseconds, P < 0.0001), as well as in Pmax (130 ± 7.4 milliseconds vs. 95 ± 10 milliseconds, P < 0.0001) and in PD (56.5 ± 8.5 milliseconds vs. 32.5 ± 6 milliseconds, P < 0.0001) in the OHS group. External loop recorder monitoring detected paroxysmal AF in 19 OHS patients (38%) with significant reduction in paroxysmal AF episodes (12 ± 6 vs. 47 ± 12, P < 0.0001) after 6-month CPAP therapy. CONCLUSION Our findings showed a significant increase of electrocardiographic and echocardiographic indexes of atrial conduction heterogeneity in OHS patients. The CPAP therapy, having a positive impact on atrial conduction time, seems to reduce AF incidence in OHS patients.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Federica Di Meo
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Marco Mosella
- Division of Pneumology, Department of Respiratory Diseases, University of Naples Federico II, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Antonio Molino
- Division of Pneumology, Department of Respiratory Diseases, University of Naples Federico II, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy
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Müssigbrodt A, John S, Kosiuk J, Richter S, Hindricks G, Bollmann A. Vernakalant-facilitated electrical cardioversion: comparison of intravenous vernakalant and amiodarone for drug-enhanced electrical cardioversion of atrial fibrillation after failed electrical cardioversion. Europace 2015; 18:51-6. [PMID: 26056189 PMCID: PMC7108474 DOI: 10.1093/europace/euv194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/07/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Electrical cardioversion is one cornerstone for the rhythm control strategy of atrial fibrillation (AF), which is, however, hampered by immediate AF recurrence (IRAF) or failed electrical cardioversion (FECV). We aimed to investigate the potential role of vernakalant for facilitated electrical cardioversion in cardioversion-resistant AF. METHODS AND RESULTS The subjects of this study were 63 patients referred to the Heart Centre Leipzig between November 2011 and May 2014 for transthoracic electrical cardioversion of AF. All patients experienced after antiarrhythmic-naïve electrical cardioversion either IRAF (n = 44; 70%) or FECV (n = 19; 30%). After drug infusion, electrical cardioversion was successful in 66.7% of vernakalant-treated as opposed to 46.7% of amiodarone-treated patients (P = 0.109). Multivariate analysis revealed treatment with vernakalant (OR 0.057, 95% CI 0.006-0.540, P = 0.013), treatment with ACEI or ARB (OR 0.101, 95% CI 0.015-0.691 P = 0.019), and IRAF after initial CV (OR 0.047, 95% CI 0.004-0.498, P = 0.011) as predictors for successful, drug-facilitated electrical cardioversion. Subgroup analysis of 18 patients with previous AF ablation revealed a significantly higher success rate of electrical cardioversion after infusion of vernakalant than after infusion of amiodarone (66.7 vs. 11.1%, P = 0.016). CONCLUSION Vernakalant may therefore be considered as a useful agent for facilitated electrical cardioversion in cardioversion-resistant AF.
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Affiliation(s)
- Andreas Müssigbrodt
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Silke John
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Jedrzej Kosiuk
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Sergio Richter
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
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Russo V, Rago A, Di Meo F, Papa AA, Ciardiello C, Cristiano A, Calabrò R, Russo MG, Nigro G. Atrial Septal Aneurysms and Supraventricular Arrhythmias: The Role of Atrial Electromechanical Delay. Echocardiography 2015; 32:1504-14. [PMID: 25735318 DOI: 10.1111/echo.12908] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Paroxysmal supraventricular arrhythmias (SVAs) frequently occur in patients with atrial septal aneurysm (ASA). The aim of the current study was to evaluate the electrocardiographic (P-wave duration and dispersion) and echocardiographic (atrial electromechanical delay, AEMD) noninvasive indicators of atrial conduction heterogeneity in healthy ASA subjects without interatrial shunt and to assess the AEMD role in predicting the SVAs onset in this population. MATERIALS AND METHODS One hundered ASA patients (41 males, mean age of 32.5 ± 8 years) and 100 healthy subjects used as controls, matched for age and gender, were studied for the occurrence of SVAs during a 4-year follow-up, through 30-day external loop recorder (ELR) monitoring performed every 3 months. ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurismal base of ≥15 mm and an excursion of ≥10 mm. Intra-AEMD and inter-AEMD of both atria were measured through tissue Doppler echocardiography. P-wave dispersion (PD) was carefully measured using 12-lead electrocardiogram (ECG). RESULTS Compared to the healthy control group, the ASA group showed a statistically significant increase in inter-AEMD, intra-left AEMD, maximum P-wave duration, and PD. Dividing the ASA group into 2 subgroups (patients with or without SVAs), the inter-AEMD, intra-left AEMD, P max, and PD were significantly higher in the subgroup with SVAs compared to the subgroup without SVAs. There were significant good correlations of intra-left AEMD and inter-AEMD with PD. A cutoff value of 40.1 msec for intra-left AEMD had a sensitivity of 82% and a specificity of 83% in identifying ASA patients at risk for SVA. CONCLUSION Our results showed that the echocardiographic AEMD indices (intra-left and inter-AEMD) and the PD were significantly increased in healthy ASA subjects without interatrial shunt. PD and AEMD represent noninvasive, inexpensive, useful, and simple parameters to assess the SVAs' risk in ASA patients.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Federica Di Meo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | | | | | - Anna Cristiano
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | | | | | - Gerardo Nigro
- Chair of Cardiology, Second University of Naples, Naples, Italy
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De Ferrari GM, Maier LS, Mont L, Schwartz PJ, Simonis G, Leschke M, Gronda E, Boriani G, Darius H, Guillamón Torán L, Savelieva I, Dusi V, Marchionni N, Quintana Rendón M, Schumacher K, Tonini G, Melani L, Giannelli S, Alberto Maggi C, Camm AJ. Ranolazine in the treatment of atrial fibrillation: Results of the dose-ranging RAFFAELLO (Ranolazine in Atrial Fibrillation Following An ELectricaL CardiOversion) study. Heart Rhythm 2015; 12:872-8. [PMID: 25602175 DOI: 10.1016/j.hrthm.2015.01.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Currently available antiarrhythmic agents for the treatment of atrial fibrillation (AF) have important limitations, leaving an unmet need for safe and effective therapy. Ranolazine is an approved antianginal agent with a favorable safety profile and electrophysiologic properties suggesting a potential role in the treatment of AF. OBJECTIVE The purpose of this study was to assess the safety and efficacy of ranolazine in the prevention of AF recurrence after successful electrical cardioversion and to ascertain the most appropriate dose of this agent. METHODS This prospective, multicenter, randomized, double-blind, placebo-control parallel group phase II dose-ranging trial randomized patients with persistent AF (7 days to 6 months) 2 hours after successful electrical cardioversion to placebo, or ranolazine 375 mg, 500 mg, or 750 mg bid. Patients were monitored daily by transtelephonic ECG. The primary end-point was the time to first AF recurrence. RESULTS Of 241 patients randomized, 238 took at least 1 drug dose. Ranolazine proved to be safe and tolerable. No dose of the drug significantly prolonged time to AF recurrence. AF recurred in 56.4%, 56.9%, 41.7%, and 39.7% of patients in the placebo, ranolazine 375 mg, ranolazine 500 mg, and ranolazine 750 mg groups, respectively. The reduction in overall AF recurrence in the combined 500-mg and 750-mg groups was of borderline significance compared to the placebo group (P = .053) and significant compared to 375-mg group (P = .035). CONCLUSION No dose of ranolazine significantly prolonged time to AF recurrence. However, the 500-mg and 750 mg-groups combined reduced AF recurrences, suggesting a possible role for this agent in the treatment of AF.
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Affiliation(s)
- Gaetano M De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy.
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lluís Mont
- Department of Cardiology, Thorax Institute Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Matthias Leschke
- Klinikum Esslingen GmbH, Abteilung Kardiologie, Esslingen, Germany
| | | | - Giuseppe Boriani
- Ospedale S. Orsola-Malpighi, Dipartimento di Cardiologia, Bologna, Italy
| | | | | | | | - Veronica Dusi
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia and University of Pavia, Italy
| | - Niccolò Marchionni
- Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Miguel Quintana Rendón
- The Karolinska Institute at Hospital de Torrevieja, Servicio de Cardiología, Alicante, Spain
| | - Kai Schumacher
- Menarini Research & Business Service GmbH, Berlin, Germany
| | | | - Lorenzo Melani
- Menarini Industrie Farmaceutiche Riunite s.r.l, Florence, Italy
| | | | | | - A John Camm
- St. George's University, London, United Kingdom
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Besli F, Basar C, Kecebas M, Turker Y. Improvement of the myocardial performance index in atrial fibrilation patients treated with amiodarone after cardioversion. J Interv Card Electrophysiol 2015; 42:107-15. [PMID: 25591725 DOI: 10.1007/s10840-014-9965-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/10/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE This study evaluated the response to electrical cardioversion (EC) and the effect on the myocardial performance index (MPI) in patients with persistent and long-standing persistent atrial fibrillation (AF). METHODS We enrolled 103 patients (mean age 69.6 ± 8.9 years, 40.7% males) with a diagnosis of persistent and long-standing persistent AF. EC was applied to all patients after one g of amiodarone administration. Echocardiographic findings before EC were compared in patients with successful versus unsuccessful cardioversions and in patients with maintained sinus rhythm (SR) versus those with AF recurrence at the end of the first month. We also compared echocardiographic data before EC versus at the end of the first month in the same patients with maintained SR. RESULTS SR was achieved in 72.8% of patients and was continued at the end of the first month in 69.3% of the patients. The MPI value of all patients was found to be 0.73 ± 0.21. The size of the left atrium was determined to be an independent predictor of the maintenance of SR at 1 month. In subgroup analyses, when we compared echocardiographic findings before EC and at the end of the first month in patients with maintained SR, the MPI (0.66 ± 0.14 vs 0.56 ± 0.09, p < 0.001) values were significantly decreased. CONCLUSIONS Our study is the first to show impairment of the MPI, which is an indicator of systolic and diastolic function, in patients with persistent and long-standing persistent AF and improvement of the MPI after successful EC.
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Affiliation(s)
- Feyzullah Besli
- Department of Cardiology, Duzce Ataturk State Hospital, Duzce, Turkey,
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Efficacy of dronedarone versus propafenone in the maintenance of sinus rhythm in patients with atrial fibrillation after electrical cardioversion. Clin Ther 2014; 36:1169-75. [PMID: 25134972 DOI: 10.1016/j.clinthera.2014.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE Our objective was to compare the efficacy of dronedarone and propafenone in maintaining sinus rhythm in patients with atrial fibrillation (AF) after electrical cardioversion. METHODS In this single-center, open-label, randomized trial, we randomly assigned patients with AF after electrical cardioversion to receive dronedarone 400 mg BID or propafenone 150 mg TID. Follow-up clinical evaluations were conducted at 1, 2, 3, and 6 months of treatment. The primary end point was the time to the first recurrence of AF. FINDINGS A total of 98 patients were enrolled (79 men; mean age, 59.2 years; n = 49 per group). The median times to first recurrence of AF were 31 days in the dronedarone group and 32 days in the propafenone group (P = 0.715). The median (interquartile range) ventricular rates at first recurrence of AF were 76.5 (67.3-86.5) beats/min in the dronedarone group and 83.0 (71.0-96.0) beats/min in the propafenone group (P = 0.059). IMPLICATIONS Dronedarone and propafenone had similar efficacies in maintaining sinus rhythm in patients with AF after electrical cardioversion. The ventricular rate at the first recurrence of AF was numerically but not statistically significantly lower in the dronedarone group than in the propafenone group. ClinicalTrials.gov identifier: NCT01991119.
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Gonna H, Gallagher MM. The efficacy and tolerability of commonly used agents to prevent recurrence of atrial fibrillation after successful cardioversion. Am J Cardiovasc Drugs 2014; 14:241-51. [PMID: 24604773 DOI: 10.1007/s40256-014-0064-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A number of therapeutic strategies exist for the restoration and maintenance of sinus rhythm in patients presenting with atrial fibrillation. The acute success rate with electrical cardioversion is high. However, many patients relapse into atrial fibrillation. A major challenge faced by those who care for patients with atrial fibrillation is the long-term maintenance of sinus rhythm whilst avoiding treatment-related adverse effects. This review examines the efficacy and tolerability of conventional anti-arrhythmic drugs for the secondary prevention of atrial fibrillation in the post-cardioversion period.
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Affiliation(s)
- Hanney Gonna
- Department of Cardiology, St. George's Hospital, Blackshaw Rd, SW17 0QT, London, UK
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Zamani P, Verdino RJ. Management of Atrial Fibrillation. J Intensive Care Med 2014; 30:484-98. [PMID: 24828991 DOI: 10.1177/0885066614534603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 03/03/2014] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation remains the most prevalent cardiac arrhythmia, and its incidence is increasing as the population ages. Common conditions associated with an increased incidence include advanced age, hypertension, heart failure, and valvular heart disease. Patients with atrial fibrillation may complain of palpitations, fatigue, and decreased exercise tolerance or may be completely asymptomatic. Options for treating patients who experience atrial fibrillation include rate-controlling drugs such as digoxin, β-blockers, and calcium channel blockers or a rhythm-controlling strategy with agents such as sodium channel blockers and potassium channel blockers. Atrial fibrillation increases the risk of stroke due to atrial thrombus formation and embolization. Anticoagulation with the vitamin K antagonist, warfarin, remains the most widely prescribed treatment option to decrease stroke risk. Several other antithrombotic agents have recently become available and offer excellent alternatives to warfarin. Catheter ablation can be undertaken as a nonpharmacologic rhythm control option with varying degrees of success depending on duration of atrial fibrillation and follow-up time from the procedure. This review article further describes the management options for patients presenting with atrial fibrillation.
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Affiliation(s)
- Payman Zamani
- Division of Cardiovascular Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ralph J Verdino
- Division of Cardiovascular Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Abu-El-Haija B, Giudici MC. Predictors of long-term maintenance of normal sinus rhythm after successful electrical cardioversion. Clin Cardiol 2014; 37:381-5. [PMID: 24700327 DOI: 10.1002/clc.22276] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/25/2014] [Indexed: 11/05/2022] Open
Abstract
Electrical cardioversion (EC) for atrial fibrillation (AF) is a common procedure performed in an attempt to restore normal sinus rhythm (NSR). Many factors predict long-term maintenance of NSR and the risk of AF recurrence. The duration of AF, cardiac size and function, rheumatic heart disease, significant mitral valve disease, left atrial enlargement, and older age are among the most common recognized factors. A number of interventions can potentially decrease the AF recurrence rate. Identifying and treating reversible causes and the use of antiarrhythmic medications in certain situations can help decrease the risk of AF recurrence. The role of the newer anticoagulants is expanding, and wider application is expected in the near future. We hope that this summary will serve as a guide to physicians and healthcare providers to address the question of who should undergo cardioversion, as there are patients who are most likely to benefit from this procedure and others that will revert back into AF within a short period. To identify who would benefit most from EC and have a reasonable chance of long-term maintenance of NSR, a thorough evaluation of each individual patient should be performed to tailor the best therapy to each individual.
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Affiliation(s)
- Basil Abu-El-Haija
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Doruchowska A, Wita K, Bochenek T, Szydło K, Filipecki A, Staroń A, Wróbel W, Krzych Ł, Trusz-Gluza M. Role of left atrial speckle tracking echocardiography in predicting persistent atrial fibrillation electrical cardioversion success and sinus rhythm maintenance at 6 months. Adv Med Sci 2014; 59:120-5. [PMID: 24797987 DOI: 10.1016/j.advms.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 10/02/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE We assessed the value of left atrium speckle tracking imaging (STI) indices, and clinical and other echocardiographic parameters in persistent atrial fibrillation (AF) patients to predict the efficacy of electrical cardioversion (EC) and sinus rhythm (SR) maintenance at 6 months. MATERIAL/METHODS Eighty persistent AF patients planned to receive EC, underwent echocardiography including STI. After 24h, patients with successful EC were examined to predict SR maintenance. After 6 months patients with no AF recurrence in electrocardiogram (ECG) underwent 7-day ECG to exclude silent AF. Every AF>1 min was a recurrence. RESULTS SR restored in 61 patients, 19 unsuccessful. Prior use of statins (68.8% vs. 42.1%, p=0.03) was the only factor, determined later by univariate analysis to be a significant EC success predictor (OR=1.09, CL ± 95% 1.001-1.019, p<0.03). Both groups received similar antiarrhythmics and had similar echocardiographic parameters. After 6 months, SR was maintained in 19 patients (31.1%, Group I); AF recurrences were registered in 42 patients (68.8%, Group II). In Group I, only the mitral valve deceleration time (MVDT) 224.18 ± 88.13 vs. 181.6 ± 60.6 in Group II, p=0.04) and the dispersion of time to peak longitudinal strain (dTPLS) (86.0 ± 68.3 vs. 151.8 ± 89.6, p=0.03) differed significantly. The univariate analysis revealed dTPLS as a significant predictor of SR maintenance. CONCLUSION High EC efficacy and frequent AF recurrences were observed. The dispersion of time to the maximal longitudinal strain (LS) of left atrial segments facilitated prediction of SR maintenance. The value of 7-day ECG monitoring for detection of arrhythmia after 6 months was limited.
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Bernard-Brunet A, Saint Etienne C, Piver E, Zannad N, Pagés JC, Fauchier L, Babuty D. Incomplete recovery of mechanical and endocrine left atrial functions one month after electrical cardioversion for persistent atrial fibrillation: a pilot study. J Transl Med 2014; 12:51. [PMID: 24559296 PMCID: PMC3941800 DOI: 10.1186/1479-5876-12-51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 02/18/2014] [Indexed: 11/14/2022] Open
Abstract
Background Restoration of the mechanical and endocrine functions of the left atrium remains controversial after electrical cardioversion treatment for persistent atrial fibrillation. The objective of the prospective study was to describe the recovery of the endocrine and mechanical functions of the left atrium. Methods Evaluation of left atrium recovery after electrical cardioversion by the new speckle-tracking echocardiography technique and proANP measurement. Results Twenty patients suffering from persistent atrial fibrillation with no alteration of left ventricular ejection fraction were prospectively evaluated at baseline and then one month later by echocardiography, measuring left atrial volume and left atrial deformation (MPALS), as well as the proANP and BNP concentrations. One month after cardioversion 10 patients remained in sinus rhythm and 10 showed recurrent atrial fibrillation. No significant differences between the two groups in terms of clinical, echocardiographic and endocrine parameters were observed at baseline evaluation. We observed a significant reduction of left atrial volume only in the sinus group, whereas restoration of the left atrial deformation was only partial (18%) in that group. By contrast, we registered no significant changes in ANP concentration at one month in either the sinus or the atrial fibrillation groups. Conclusion These results suggest that restoration of left atrium mechanical function is only partial one month after treatment of persistent atrial fibrillation by electrical cardioversion, whereas a significant reduction of left atrial volume was noted, explaining the remaining high level of ANP in the sinus group.
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Affiliation(s)
| | | | | | | | | | | | - Dominique Babuty
- Cardiology Department, François Rabelais University, 37020 Tours, France.
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Atrial fibrillation: A progressive atrial myopathy or a distinct disease? Int J Cardiol 2014; 171:126-33. [DOI: 10.1016/j.ijcard.2013.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/09/2013] [Accepted: 12/10/2013] [Indexed: 02/06/2023]
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Obel O, Joglar JA. Unveiling the remodeled atrium: lessons from the early recurrence of atrial fibrillation. J Cardiovasc Electrophysiol 2013; 25:168-70. [PMID: 24237906 DOI: 10.1111/jce.12323] [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: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Owen Obel
- Division of Cardiology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Rajagopalan B, Curtis AB. Contemporary approach to electrical and pharmacological cardioversion of atrial fibrillation. Postgrad Med 2013; 124:26-35. [PMID: 23322136 DOI: 10.3810/pgm.2012.11.2610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In patients with atrial fibrillation (AF), a rhythm-control strategy may be adopted when there are unacceptable symptoms from AF, failure of rate control, and/or the presence of comorbidities, such as heart failure, that may improve with restoration of sinus rhythm. When a rhythm-control strategy is chosen and the patient is in persistent AF, cardioversion will be necessary to convert the rhythm to sinus. Patients with AF present for > 48 hours must be effectively anticoagulated both prior to and after cardioversion. With newer oral anticoagulants, achieving effective anticoagulation is faster and more reliable, with no requirement for blood test monitoring. Cardioversion can be accomplished either electrically or pharmacologically, and in some cases, electrical cardioversion may be facilitated pharmacologically. Electrical cardioversion has a higher success rate compared with pharmacological cardioversion in the short-term. Pharmacological cardioversion is usually accomplished with intravenous ibutilide, oral flecainide or propafenone, or intravenous amiodarone. Oral amiodarone and dofetilide also result in chemical cardioversion in some patients over a longer period of time. Long-term success in the maintenance of sinus rhythm post-cardioversion can be increased with the use of antiarrhythmic drugs. Alternatively, when AF is recurrent and symptomatic despite the use of antiarrhythmic drugs, catheter ablation is a reasonable option for many patients. Cardioversion may be incorporated into the management approach of persistent AF when the primary therapeutic option chosen is catheter ablation.
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Seeck A, Rademacher W, Fischer C, Haueisen J, Surber R, Voss A. Prediction of atrial fibrillation recurrence after cardioversion—Interaction analysis of cardiac autonomic regulation. Med Eng Phys 2013; 35:376-82. [DOI: 10.1016/j.medengphy.2012.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 05/21/2012] [Accepted: 06/03/2012] [Indexed: 11/27/2022]
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Smit MD, Moes ML, Van Gelder IC. Antiarrhythmic drug treatment after cardioversion of atrial fibrillation. Lancet 2012; 380:1467; author reply 1468. [PMID: 23101705 DOI: 10.1016/s0140-6736(12)61831-5] [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] [Indexed: 11/26/2022]
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Alcaraz R, Rieta JJ. Central tendency measure and wavelet transform combined in the non-invasive analysis of atrial fibrillation recordings. Biomed Eng Online 2012; 11:46. [PMID: 22877316 PMCID: PMC3444389 DOI: 10.1186/1475-925x-11-46] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/30/2012] [Indexed: 11/26/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common supraventricular arrhythmia in the clinical practice, being the subject of intensive research. Methods The present work introduces two different Wavelet Transform (WT) applications to electrocardiogram (ECG) recordings of patients in AF. The first one predicts spontaneous termination of paroxysmal AF (PAF), whereas the second one deals with the prediction of electrical cardioversion (ECV) outcome in persistent AF patients. In both cases, the central tendency measure (CTM) from the first differences scatter plot was applied to the AF wavelet decomposition. In this way, the wavelet coefficients vector CTM associated to the AF frequency scale was used to assess how atrial fibrillatory (f) waves variability can be related to AF events. Results Structural changes into the f waves can be assessed by combining WT and CTM to reflect atrial activity organization variation. This fact can be used to predict organization-related events in AF. To this respect, results in the prediction of PAF termination regarding sensitivity, specificity and accuracy were 100%, 91.67% and 96%, respectively. On the other hand, for ECV outcome prediction, 82.93% sensitivity, 90.91% specificity and 85.71% accuracy were obtained. Hence, CTM has reached the highest diagnostic ability as a single predictor published to date. Conclusions Results suggest that CTM can be considered as a promising tool to characterize non-invasive AF signals. In this sense, therapeutic interventions for the treatment of paroxysmal and persistent AF patients could be improved, thus, avoiding useless procedures and minimizing risks.
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Affiliation(s)
- Raúl Alcaraz
- Innovation in Bioengineering Research Group, University of Castilla-La Mancha, Cuenca, Spain.
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Degiovanni A, Bortnik M, Dell'Era G, Bolzani V, Occhetta E, Bellomo G, Marino P. Analysis of electrical and mechanical left atrial properties in patients with persistent atrial fibrillation. Int J Cardiovasc Imaging 2012; 29:71-8. [PMID: 22543570 DOI: 10.1007/s10554-012-0053-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/05/2012] [Indexed: 11/24/2022]
Abstract
The study of left atrial (LA) mechanical function during atrial fibrillation (AFib) can provide valuable information, particularly if such profiling is related to the cavity electrical substrate and conveys prognostic information. To assess if there is any relation between LA mechanical and electrical asynchrony and if such evaluation can be of interest in stratifying AFib patients. 50 patients with persistent AFib who underwent electrical cardioversion (CV) were evaluated with pre-CV atrial electrograms (AEGs). Electrical asynchrony was classified according to Wells' patterns of AEGs, ranging from most organized (I) to most dispersed (III) one. LA mechanical asynchrony was addressed by transthoracic 2D-speckle-tracking echo and quantified according to time-to-peak standard deviation (TP-SD) of wall strains and their peak values (PS) before CV, after 24 h, at 1 month. Pre-CV a linear, inverse relation between TP-SD and PS (p < 0.001) and a direct linear relation between TP-SD and Wells' classes (p = 0.04) were observed. With sinus rhythm TP-SD decreased (p = 0.023) and PS increased (p < 0.001), suggesting improved LA mechanical milieu. A multivariate analysis, testing the effects of baseline variables in predicting post-CV recurrence of AFib, revealed that amount of TP-SD variation pre/24 h post-CV was the only independent predictor at 6 months (p = 0.046). Speckle tracking-derived LA parameters can describe LA wall forces during AFib, categorizing the asynchronous mechanistic profile of AFib that correlates with the degree of the dispersed LA electrical activity. The amount of changes in LA mechanical asynchrony pre/post-CV seems to have prognostic relevance in predicting SR maintenance.
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Affiliation(s)
- Anna Degiovanni
- Department of Cardiology, Clinical Cardiology, Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
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Multidimensional ECG-based analysis of cardiac autonomic regulation predicts early AF recurrence after electrical cardioversion. J Electrocardiol 2012; 45:116-22. [DOI: 10.1016/j.jelectrocard.2011.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Indexed: 11/21/2022]
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