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Rotvig C, Ekholm O, Christensen AV, Berg SK. Sociodemographic inequality in children aged 0-19 years with and without parents diagnosed with heart disease: a Danish nationwide register-based study. Public Health 2024; 231:133-141. [PMID: 38688166 DOI: 10.1016/j.puhe.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES This study aimed to estimate the prevalence of children aged 0-19 years who have a parent with a history of heart disease and investigate their sociodemographic characteristics. STUDY DESIGN A national register-based study. METHODS From the Danish Fertility Register and the Danish National Patient Register information on children of parents with ischemic heart disease, arrhythmia, heart failure and heart valve disease in the period 1981-2018 were obtained. Statistical analyses including descriptive statistics, logistic and linear regression were used to illuminate associations between parental heart disease and sociodemographic characteristics. RESULTS The study population consisted of 142,480 children aged 0-19 years with at least one parent diagnosed with heart disease, corresponding to every 9th child in Denmark in 2018. The number increased from 4.5% in 2002 to 11.1% in 2018. In the study population most had a father with heart disease (57.8%) and 4.6% had two parents with heart disease. Parents with heart disease had significantly higher odds of being out of work (OR 1.68, 95% CI 1.64; 1.72), in a single-parent household (OR 1.09, 95% CI 1.07; 1.11), divorced or widowed (OR: 1.10, 95% CI 1.08; 1.12), having a lower educational level (OR 1.35, 95% CI 1.33; 1.37), and a lower family income (-42,410 DKR, 95% CI -50,306; -34,514, P < 0.0001) compared to those without heart disease. CONCLUSION Children affected by parental heart disease comprise a substantial part of the Danish population. These have significantly different sociodemographic characteristics than children in families without parental heart disease, which might affect social heritage and parental capacity.
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Affiliation(s)
- C Rotvig
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - O Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - A V Christensen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - S K Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Pan ZM, Zeng J, Li T, Hu F, Cai XY, Wang XJ, Liu GZ, Hu XH, Yang X, Lu YH, Liu MY, Gong YP, Liu M, Li N, Li CL. Age-adjusted Charlson comorbidity index is associated with the risk of osteoporosis in older fall-prone men: a retrospective cohort study. BMC Geriatr 2024; 24:413. [PMID: 38730354 PMCID: PMC11084079 DOI: 10.1186/s12877-024-05015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND There is growing evidence linking the age-adjusted Charlson comorbidity index (aCCI), an assessment tool for multimorbidity, to fragility fracture and fracture-related postoperative complications. However, the role of multimorbidity in osteoporosis has not yet been thoroughly evaluated. We aimed to investigate the association between aCCI and the risk of osteoporosis in older adults at moderate to high risk of falling. METHODS A total of 947 men were included from January 2015 to August 2022 in a hospital in Beijing, China. The aCCI was calculated by counting age and each comorbidity according to their weighted scores, and the participants were stratified into two groups by aCCI: low (aCCI < 5), and high (aCCI ≥5). The Kaplan Meier method was used to assess the cumulative incidence of osteoporosis by different levels of aCCI. The Cox proportional hazards regression model was used to estimate the association of aCCI with the risk of osteoporosis. Receiver operating characteristic (ROC) curve was adapted to assess the performance for aCCI in osteoporosis screening. RESULTS At baseline, the mean age of all patients was 75.7 years, the mean BMI was 24.8 kg/m2, and 531 (56.1%) patients had high aCCI while 416 (43.9%) were having low aCCI. During a median follow-up of 6.6 years, 296 participants developed osteoporosis. Kaplan-Meier survival curves showed that participants with high aCCI had significantly higher cumulative incidence of osteoporosis compared with those had low aCCI (log-rank test: P < 0.001). When aCCI was examined as a continuous variable, the multivariable-adjusted model showed that the osteoporosis risk increased by 12.1% (HR = 1.121, 95% CI 1.041-1.206, P = 0.002) as aCCI increased by one unit. When aCCI was changed to a categorical variable, the multivariable-adjusted hazard ratios associated with different levels of aCCI [low (reference group) and high] were 1.00 and 1.557 (95% CI 1.223-1.983) for osteoporosis (P < 0.001), respectively. The aCCI (cutoff ≥5) revealed an area under ROC curve (AUC) of 0.566 (95%CI 0.527-0.605, P = 0.001) in identifying osteoporosis in older fall-prone men, with sensitivity of 64.9% and specificity of 47.9%. CONCLUSIONS The current study indicated an association of higher aCCI with an increased risk of osteoporosis among older fall-prone men, supporting the possibility of aCCI as a marker of long-term skeletal-related adverse clinical outcomes.
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Affiliation(s)
- Zi-Mo Pan
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Graduate School of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jing Zeng
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ting Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fan Hu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Yan Cai
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xin-Jiang Wang
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Guan-Zhong Liu
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xing-He Hu
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xue Yang
- Outpatient Department, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Hui Lu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Min-Yan Liu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Ping Gong
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Miao Liu
- Department of anti-NBC medicine, Graduate School of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Nan Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Chun-Lin Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Doldi F, Geßler N, Anwar O, Kahle AK, Scherschel K, Rath B, Köbe J, Lange PS, Frommeyer G, Metzner A, Meyer C, Willems S, Kuck KH, Eckardt L. In-Hospital Pulmonary Arterial Embolism after Catheter Ablation of Over 45,000 Cardiac Arrhythmias: Individualized Case Analysis of Multicentric Data. Thromb Haemost 2024. [PMID: 38555641 DOI: 10.1055/s-0044-1785519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE AND BACKGROUND Data on incidence of in-hospital pulmonary embolisms (PE) after catheter ablation (CA) are scarce. To gain further insights, we sought to provide new findings through case-based analyses of administrative data. METHODS Incidences of PE after CA of supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter (AFlu), and ventricular tachycardias (VT) in three German tertiary centers between 2005 and 2020 were determined and coded by the G-DRG (German Diagnosis Related Groups System) and OPS (German Operation and Procedure Classification) systems. An administrative search was performed with a consecutive case-based analysis. RESULTS Overall, 47,344 ablations were analyzed (10,037 SVT; 28,048 AF; 6,252 AFlu; 3,007 VT). PE occurred in 14 (0.03%) predominantly female (n = 9; 64.3%) patients with a mean age of 55.3 ± 16.9 years, body mass index 26.2 ± 5.1 kg/m2, and left ventricular ejection fraction of 56 ± 13.6%. PE incidences were 0.05% (n = 5) for SVT, 0.02% (n = 5) for AF, and 0.13% (n = 4) for VT ablations. No patient suffered PE after AFlu ablation. Five patients (35.7%) with PE after CA had no prior indication for oral anticoagulation (OAC). Preprocedural international normalized ratio in PE patients was 1.2 ± 0.5. Most patients with PE following CA presented with symptoms the day after the procedure (n = 9) after intraprocedural heparin application of 12,943.2 ± 5,415.5 IU. PE treatment included anticoagulation with either phenprocoumon (n = 5) or non-vitamin K-dependent OAC (n = 9). Two patients with PE died after VT/AF ablation, respectively. The remaining patients were discharged without sequels. CONCLUSION Over a 15-year period, incidence of PE after ablation is low, particularly low in patients with ablation for AF/AFlu. This is most likely due to stricter anticoagulation management in these patients compared with those receiving SVT/VT ablation procedures and could argue for continuation of OAC prior to ablation. Optimizing periprocedural anticoagulation management should be subject of further prospective trials.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Nele Geßler
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Omar Anwar
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Katharina Scherschel
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Philipp Sebastian Lange
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Andreas Metzner
- Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Germany
| | - Christian Meyer
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Stephan Willems
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
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6
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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7
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Eckardt L, Doldi F, Anwar O, Gessler N, Scherschel K, Kahle AK, von Falkenhausen AS, Thaler R, Wolfes J, Metzner A, Meyer C, Willems S, Köbe J, Lange PS, Frommeyer G, Kuck KH, Kääb S, Steinbeck G, Sinner MF. Major in-hospital complications after catheter ablation of cardiac arrhythmias: individual case analysis of 43 031 procedures. Europace 2023; 26:euad361. [PMID: 38102318 PMCID: PMC10754182 DOI: 10.1093/europace/euad361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
AIMS In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of administrative data. METHODS AND RESULTS We determined the incidences of in-hospital mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German tertiary centres between 2005 and 2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all complications were individually reviewed based on patient-level source records. Overall, 43 031 ablations were analysed (30 361 AF; 9364 AFL; 3306 VT). The number of ablations/year more than doubled from 2005 (n = 1569) to 2020 (n = 3317) with 3 times and 2.5 times more AF and VT ablations in 2020 (n = 2404 and n = 301, respectively) as compared to 2005 (n = 817 and n = 120, respectively), but a rather stable number of AFL ablations (n = 554 vs. n = 612). Major peri-procedural complications occurred in 594 (1.4%) patients. Complication rates were 1.1% (n = 325) for AF, 1.0% (n = 95) for AFL, and 5.3% (n = 175) for VT. With an increase in complex AF/VT procedures, the overall complication rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; P = 0.004); but remained low over time. Following patient-adjudication, all in-hospital cardiac tamponades (0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications requiring surgical intervention occurred in 0.4% of all patients. The in-hospital mortality rate adjudicated to be ablation-related was lower than the coded mortality rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%. CONCLUSION Major adverse events are low and comparable after catheter ablation for AFL and AF (∼1.0%), whereas they are five times higher for VT ablations. In the presence of an increase in complex ablation procedures, a moderate but significant increase in overall complications from 2005-20 was observed. Individual case analysis demonstrated a lower than coded ablation-related in-hospital mortality. This highlights the importance of individual case adjudication when analysing administrative data.
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Affiliation(s)
- Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Omar Anwar
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Nele Gessler
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Katharina Scherschel
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Aenne S von Falkenhausen
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Raffael Thaler
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Julian Wolfes
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Andreas Metzner
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
- Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Germany
| | - Christian Meyer
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Stephan Willems
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Philipp Sebastian Lange
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Karl-Heinz Kuck
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stefan Kääb
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Gerhard Steinbeck
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Moritz F Sinner
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
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8
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Doldi F, Doldi PM, Plagwitz L, Westerwinter M, Wolfes J, Korthals D, Willy K, Wegner FK, Könemann H, Ellermann C, Rath B, Güner F, Reinke F, Köbe J, Lange PS, Frommeyer G, Varghese J, Eckardt L. Predictors for major in-hospital complications after catheter ablation of ventricular arrhythmias: validation and modification of the Risk in Ventricular Ablation (RIVA) Score. Clin Res Cardiol 2023; 112:1778-1789. [PMID: 37162594 DOI: 10.1007/s00392-023-02223-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE AND BACKGROUND Catheter-based treatment of patients with ventricular arrhythmias (VA) reduces VA and mortality in selected patients. With regard to potential risks of catheter ablation, a benefit-risk assessment should be carried out. This can be performed with risk scores such as the recently published "Risk in Ventricular Ablation (RIVA) Score". We sought to validate this score and to test for possible additional predictors in a large database of VT ablations. METHODS AND RESULTS We analyzed 1964 catheter ablations for VA in patients with (1069; 54.4%) and without (893, 45.6%) structural heart disease (SHD) and observed an overall major adverse event rate of 4.0% with an in-hospital mortality of 1.3% with significantly less complications occurring in patients without structural heart disease (6.5% vs. 1.1%; p ≤ 0.01). The RIVA Score demonstrated to be a valid predictive tool for major in-hospital complications (OR 1.18; 95% CI 1.12, 1.25; p ≤ 0.001). NYHA Class ≥ III (OR 2.5; 95% CI 1.5, 4.2; p < 0.001) and age (OR 1.04; 95% CI 1.02, 1.07; p ≤ 0.001) proved to be additional predictive parameters. Hence, a modified RIVA Score (mRIVA) model was analyzed with a subset of established predictors (SHD, eGFR, epicardial puncture) as well as new predictive parameters (age, NYHA Class ≥ III), that achieved a higher predictive value for major complications compared with the model based on all RIVA variables. CONCLUSION Adding age and functional heart failure status (NYHA class) as simple clinical parameters to the recently published RIVA Score increases the predictive value for ablation-associated complications in a large VT ablations registry.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany.
| | - Philipp M Doldi
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian's University Munich, Munich, Germany
| | - Lucas Plagwitz
- Institute of Medical Informatics, University of Münster, 48149, Münster, Germany
| | - Marvin Westerwinter
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Julian Wolfes
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Dennis Korthals
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Kevin Willy
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Felix K Wegner
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Hilke Könemann
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Christian Ellermann
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Fatih Güner
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Florian Reinke
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Philipp S Lange
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
| | - Julian Varghese
- Institute of Medical Informatics, University of Münster, 48149, Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, Klinik Für Kardiologie II: Rhythmologie, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Germany
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9
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Jilek C, Gleirscher L, Strzelczyk E, Sepela D, Tiemann K, Lewalter T. [Isthmus-dependent right atrial flutter : Clinical course after isthmus ablation]. Herzschrittmacherther Elektrophysiol 2023; 34:291-297. [PMID: 37847416 DOI: 10.1007/s00399-023-00966-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
Ablation of the cavotricuspid isthmus (CTI) to create bidirectional isthmus blockade is the most effective way to achieve rhythm control in typical atrial flutter. Compared with drug therapy, ablation reduces cardiovascular mortality, all-cause mortality, stroke risk, and the risk of cardiac decompensation. Concomitant arrhythmia of atrial flutter is atrial fibrillation (AF); therefore the duration of oral anticoagulation should be adapted according to the risk of stroke and bleeding. A combined procedure of CTI ablation and pulmonary vein isolation (PVI) in patients with typical atrial flutter but without evidence of AF should be evaluated individually especially in patients aged > 54 years depending on (cardiac) comorbidities. The comprehensive diagnostic view should keep in mind not only arrhythmias but also possibly underlying coronary artery disease.
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Affiliation(s)
- Clemens Jilek
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland.
| | - Lukas Gleirscher
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
| | - Elmar Strzelczyk
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
| | - Dominik Sepela
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
| | - Klaus Tiemann
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
| | - Thorsten Lewalter
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
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10
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Penela D, Chauca A, Fernández-Armenta J, Pavón R, Benito B, Acosta J, Lozano JM, Falasconi G, San Antonio R, Soto-Iglesias D, Martí-Almor J, Ordoñez A, Bellido A, Carreño JM, Matiello M, Cano L, Pedrote A, Viveros D, Alderete J, Francia P, Algarra-Cullell M, Silva E, Meca-Santamaria J, Franco P, Cappato R, Berruezo A. Outcomes of cavotricuspid isthmus-dependent flutter ablation: randomized study comparing single vs. multiple catheter procedures-the SIMPLE study. J Interv Card Electrophysiol 2023; 66:1979-1988. [PMID: 36877415 DOI: 10.1007/s10840-023-01511-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Catheter ablation is recommended as first-line therapy for patients with symptomatic typical AFl. Although the conventional multi-catheter approach is the standard of care for cavotricuspid isthmus (CTI) ablation, a single-catheter approach was recently described as a feasible alternative. The present study sought to compare safety, efficacy, and efficiency of single vs. multi-catheter approach for atrial flutter (AFl) ablation. METHODS In this randomized multi-center study, consecutive patients referred for AFl ablation (n = 253) were enrolled and randomized to multiple vs. single-catheter approach for CTI ablation. In the single-catheter arm, PR interval (PRI) on the surface ECG was used to prove CTI block. Procedural and follow-up data were collected and compared between the two arms. RESULTS 128 and 125 patients were assigned to the single-catheter and to the multi-catheter arms, respectively. In the single-catheter arm, procedure time was significantly shorter (37 ± 25 vs. 48 ± 27 minutes, p = 0.002) and required less fluoroscopy time (430 ± 461 vs. 712 ± 628 seconds, p < 0.001) and less radiofrequency time (428 ± 316 vs. 643 ± 519 seconds, p < 0.001), achieving a higher first-pass CTI block rate (55 (45%) vs. 37 (31%), p = 0.044), compared with the multi-catheter arm. After a median follow-up of 12 months, 11 (4%) patients experienced AFl recurrences (5 (4%) in the single-catheter arm and 6 (5%) in the multi-catheter arm, p = 0.99). No differences were found in arrhythmia-free survival between arms (log-rank = 0.71). CONCLUSIONS The single-catheter approach for typical AFl ablation is not inferior to the conventional multiple-catheter approach, reducing procedure, fluoroscopy, and radiofrequency time.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Ricardo Pavón
- Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Giulio Falasconi
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Rodolfo San Antonio
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Maria Matiello
- Hospital Universitario General de Cataluña, Barcelona, Spain
| | - Lucas Cano
- Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Daniel Viveros
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza, Rome, Italy
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain.
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11
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Xing Z, Xu Y, Wu Y, Fu X, Shen P, Che W, Wang J. Development and validation of a nomogram for predicting in-hospital mortality in patients with nonhip femoral fractures. Eur J Med Res 2023; 28:539. [PMID: 38001553 PMCID: PMC10668411 DOI: 10.1186/s40001-023-01515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The incidence of nonhip femoral fractures is gradually increasing, but few studies have explored the risk factors for in-hospital death in patients with nonhip femoral fractures in the ICU or developed mortality prediction models. Therefore, we chose to study this specific patient group, hoping to help clinicians improve the prognosis of patients. METHODS This is a retrospective study based on the data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Least absolute shrinkage and selection operator (LASSO) regression was used to screen risk factors. The receiver operating characteristic (ROC) curve was drawn, and the areas under the curve (AUC), net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the discrimination of the model. The consistency between the actual probability and the predicted probability was assessed by the calibration curve and Hosmer-Lemeshow goodness of fit test (HL test). Decision curve analysis (DCA) was performed, and the nomogram was compared with the scoring system commonly used in clinical practice to evaluate the clinical net benefit. RESULTS The LASSO regression analysis showed that heart rate, temperature, red blood cell distribution width, blood urea nitrogen, Glasgow Coma Scale (GCS), Simplified Acute Physiology Score II (SAPSII), Charlson comorbidity index and cerebrovascular disease were independent risk factors for in-hospital death in patients with nonhip femoral fractures. The AUC, IDI and NRI of our model in the training set and validation set were better than those of the GCS and SAPSII scoring systems. The calibration curve and HL test results showed that our model prediction results were in good agreement with the actual results (P = 0.833 for the HL test of the training set and P = 0.767 for the HL test of the validation set). DCA showed that our model had a better clinical net benefit than the GCS and SAPSII scoring systems. CONCLUSION In this study, the independent risk factors for in-hospital death in patients with nonhip femoral fractures were determined, and a prediction model was constructed. The results of this study may help to improve the clinical prognosis of patients with nonhip femoral fractures.
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Affiliation(s)
- Zhibin Xing
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiwen Xu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuxuan Wu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaochen Fu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Pengfei Shen
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenqiang Che
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jing Wang
- The First Affiliated Hospital of Jinan University, Guangzhou, China.
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12
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Manukyan H, Szegedi N, Pavlović N, Blessberger H, Fiedler L, Krieger K, Manola Š, Nagy VK, Roithinger FX, Salló Z, Steinwender C, Gellér L, Matschuck GA, Kosiuk J. Novel protocol for optimal utilization of HPSD approach for pulmonary vein isolation. J Arrhythm 2023; 39:539-545. [PMID: 37560278 PMCID: PMC10407163 DOI: 10.1002/joa3.12868] [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: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The efficiency of pulmonary vein isolation (PVI) depends on the durability of RF lesions. Recent studies documented sustained continuity of ablation lines, improvements in durability, and expected clinical outcomes through altered settings in duration and power. However, the ablation strategy has not been adapted to this new approach and different biophysics of lesion formation. PURPOSE The aim of this study was to demonstrate that by adjusting the ablation approach to the broader geometry of lesions by increasing the minimal spacing between adjacent RF, a further significant reduction of procedural time while maintaining sufficient long-term outcomes is achievable. METHODS The presented study was a prospective, observational multi-center trial. The periprocedural data were compared with data from a consecutively collected historical cohort. RESULTS In total, 196 patients were included (mean age 62 ± 11 years, male 64.3%). Procedural duration, RF time, and LA dwelling time were significantly shorter in the HPSD group compared with the standard group (73 ± 26 min vs. 98 ± 36 min, p < .001; 14 ± 7 min vs. 33 ± 12 min, p < .001; and 59 ± 21 min vs. 77 ± 32 min, p < .001, respectively). Mean AF-free survival in the first year of follow-up was 304 ± 14 days in the HPSD group versus 340 ± 10 days in the standard group (log-rank p = .403). There were no statistically significant differences in the complication rates between the groups. CONCLUSION Increasing the minimal distance between individual application points simplifies AF ablation and further reduces procedure time without negative effects on efficacy and safety. Larger studies are needed to optimally utilize this approach.
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Affiliation(s)
| | - Nandor Szegedi
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Nikola Pavlović
- Department of CardiologyUniversity Hospital DubravaZagrebCroatia
| | | | | | - Konstantin Krieger
- Department of Internal Medicine and CardiologyUnfallkrankenhaus BerlinBerlinGermany
- Department of ElectrophysiologyAsklepios Klinikum HarburgHamburgGermany
| | - Šime Manola
- Department of CardiologyUniversity Hospital DubravaZagrebCroatia
| | - Vivien K. Nagy
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | | | - Zoltán Salló
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Clemens Steinwender
- Department of CardiologyKepler University HospitalLinzAustria
- Clinic of Internal Medicine II, Department of CardiologyParacelsus Medical University of SalzburgSalzburgAustria
| | - László Gellér
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | | | - Jedrzej Kosiuk
- Department of RhythmologyHelios Clinic KoethenKoethenGermany
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13
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Dai Q, Li P, Bose A, Cai P, Jin L, Pan S, Dixon RAF, Laidlaw D, Liu Q. Association of atrial fibrillation burden with in-hospital outcomes in patients with Takotsubo cardiomyopathy. Am J Med Sci 2023; 365:345-352. [PMID: 35793734 DOI: 10.1016/j.amjms.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/15/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND The effects of atrial fibrillation (AF) and its burden on in-hospital mortality in patients with Takotsubo cardiomyopathy (TCM) are unclear. Here, we examined the effect of AF and paroxysmal AF on in-hospital outcomes in patients with TCM. METHODS We used ICD-10 codes to retrospectively identify patients with a primary diagnosis of TCM in the National Inpatient Sample database 2016-2018. We compared in-hospital outcomes in TCM patients with and without AF before and after propensity score matching. The effect of AF burden on outcomes was assessed in patients with paroxysmal AF and no AF. RESULTS Of the 4,733 patients with a primary diagnosis of TCM, 650 (13.7%) had AF, and 4,083 (86.3%) did not. Of TCM patients with AF, 368 (56.6%) had paroxysmal AF. In-hospital mortality was higher in patients with AF before (3.4% vs 1.2%, P < 0.001) and after propensity matching (3.4% vs 1.7%, P = 0.021) but did not differ between the paroxysmal AF and the no AF groups (P = 0.205). In the matched cohorts, both AF and paroxysmal AF groups were associated with a higher rate of cardiogenic shock (AF, P < 0.001; paroxysmal AF, P < 0.001), ventricular arrhythmia (AF, P = 0.002; paroxysmal AF, P = 0.02), acute kidney injury (AF, P = 0.007; paroxysmal AF, P = 0.008), and acute respiratory failure (AF, P < 0.001; paroxysmal AF, P < 0.001) compared with the no AF group. CONCLUSIONS Although AF was associated with increased in-hospital mortality, paroxysmal AF did not affect in-hospital mortality, suggesting a higher AF burden is associated with worse clinical outcome in patients with TCM.
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Affiliation(s)
- Qiying Dai
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, USA.
| | - Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Abhishek Bose
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Ling Jin
- Department of Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - Su Pan
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
| | - Richard A F Dixon
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
| | - Douglas Laidlaw
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Qi Liu
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
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14
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Hernández-Romero I, Molero R, Fambuena-Santos C, Herrero-Martín C, Climent AM, Guillem MS. Electrocardiographic imaging in the atria. Med Biol Eng Comput 2023; 61:879-896. [PMID: 36370321 PMCID: PMC9988819 DOI: 10.1007/s11517-022-02709-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
The inverse problem of electrocardiography or electrocardiographic imaging (ECGI) is a technique for reconstructing electrical information about cardiac surfaces from noninvasive or non-contact recordings. ECGI has been used to characterize atrial and ventricular arrhythmias. Although it is a technology with years of progress, its development to characterize atrial arrhythmias is challenging. Complications can arise when trying to describe the atrial mechanisms that lead to abnormal propagation patterns, premature or tachycardic beats, and reentrant arrhythmias. This review addresses the various ECGI methodologies, regularization methods, and post-processing techniques used in the atria, as well as the context in which they are used. The current advantages and limitations of ECGI in the fields of research and clinical diagnosis of atrial arrhythmias are outlined. In addition, areas where ECGI efforts should be concentrated to address the associated unsatisfied needs from the atrial perspective are discussed.
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Affiliation(s)
| | - Rubén Molero
- ITACA, Universitat Politècnica de València, Valencia, Spain
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15
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Pauly V, Vlcek J, Zhang Z, Hesse N, Xia R, Bauer J, Loy S, Schneider S, Renner S, Wolf E, Kääb S, Schüttler D, Tomsits P, Clauss S. Effects of Sex on the Susceptibility for Atrial Fibrillation in Pigs with Ischemic Heart Failure. Cells 2023; 12:cells12070973. [PMID: 37048048 PMCID: PMC10093477 DOI: 10.3390/cells12070973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent arrhythmia, often caused by myocardial ischemia/infarction (MI). Men have a 1.5× higher prevalence of AF, whereas women show a higher risk for new onset AF after MI. However, the underlying mechanisms of how sex affects AF pathophysiology are largely unknown. In 72 pigs with/without ischemic heart failure (IHF) we investigated the impact of sex on ischemia-induced proarrhythmic atrial remodeling and the susceptibility for AF. Electrocardiogram (ECG) and electrophysiological studies were conducted to assess electrical remodeling; histological analyses were performed to assess atrial fibrosis in male and female pigs. IHF pigs of both sexes showed a significantly increased vulnerability for AF, but in male pigs more and longer episodes were observed. Unchanged conduction properties but enhanced left atrial fibrosis indicated structural rather than electrical remodeling underlying AF susceptibility. Sex differences were only observed in controls with female pigs showing an increased intrinsic heart rate, a prolonged QRS interval and a prolonged sinus node recovery time. In sum, susceptibility for AF is significantly increased both in male and female pigs with ischemic heart failure. Differences between males and females are moderate, including more and longer AF episodes in male pigs and sinus node dysfunction in female pigs.
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Affiliation(s)
- Valerie Pauly
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Julia Vlcek
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Zhihao Zhang
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Nora Hesse
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Ruibing Xia
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Julia Bauer
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Simone Loy
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Sarah Schneider
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Simone Renner
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Feodor-Lynen-Strasse 25, D-81377 Munich, Germany
- Center for Innovative Medical Models (CiMM), Department of Veterinary Sciences, LMU Munich, Hackerstrasse 27, D-85764 Oberschleissheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany
| | - Eckhard Wolf
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Feodor-Lynen-Strasse 25, D-81377 Munich, Germany
- Center for Innovative Medical Models (CiMM), Department of Veterinary Sciences, LMU Munich, Hackerstrasse 27, D-85764 Oberschleissheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany
- Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, Grosshadern Campus, LMU Munich, Feodor-Lynen-Stasse 25, D-81377 Munich, Germany
| | - Stefan Kääb
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
| | - Dominik Schüttler
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Philipp Tomsits
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Sebastian Clauss
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
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16
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Doldi F, Geßler N, Anwar O, Kahle AK, Scherschel K, Rath B, Köbe J, Lange PS, Frommeyer G, Metzner A, Meyer C, Willems S, Kuck KH, Eckardt L. In-hospital mortality and major complications related to radiofrequency catheter ablations of over 10 000 supraventricular arrhythmias from 2005 to 2020: individualized case analysis of multicentric administrative data. Europace 2023; 25:130-136. [PMID: 36006798 PMCID: PMC10103566 DOI: 10.1093/europace/euac146] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/11/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS The incidence of in-hospital post-interventional complications and mortality after ablation of supraventricular tachycardia (SVT) vary among the type of procedure and most likely the experience of the centre. As ablation therapy of SVT is progressively being established as first-line therapy, further assessment of post-procedural complication rates is crucial for health care quality. METHODS AND RESULTS We aimed at determining the incidence of in-hospital mortality and bleeding complications from SVT ablations in German high-volume electrophysiological centres between 2005 and 2020. All cases were registered by the German Diagnosis Related Groups-and the German Operation and Procedure Classification (OPS) system. A uniform search for SVT ablations from 2005 to 2020 with the same OPS codes defining the type of ablation/arrhythmia as well as the presence of a vascular complication, cardiac tamponade, and/or in-hospital death was performed. An overall of 47 610 ablations with 10 037 SVT ablations were registered from 2005 to 2020 among three high-volume centres. An overall complication rate of 0.5% (n = 38) was found [median age, 64; ±15 years; female n = 26 (68%)]. All-cause mortality was 0.02% (n = 2) and both patients had major prior co-morbidities precipitating a lethal outcome irrespective of the ablation procedure. Vascular complications occurred in 10 patients (0.1%), and cardiac tamponade was detected in 26 cases (0.3%). CONCLUSION The present case-based analysis shows an overall low incidence of in-hospital complications after SVT ablation highlighting the overall very good safety profile of SVT ablations in high-volume centres. Further prospective analysis is still warranted to guarantee continuous quality control and optimal patient care.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Nele Geßler
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Omar Anwar
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Katharina Scherschel
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Philipp Sebastian Lange
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Andreas Metzner
- Universitäres Herz- und Gefäßzentrum UKE Hamburg, Klinik und Poliklinik für Kardiologie, Hamburg, Germany
| | - Christian Meyer
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Stephan Willems
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
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17
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Liu D, Chen H, Fu Y, Yao Y, He S, Wang Y, Cao Z, Wang X, Yang M, Zhao Q. KCa3.1 Promotes Proinflammatory Exosome Secretion by Activating AKT/Rab27a in Atrial Myocytes during Rapid Pacing. Cardiovasc Ther 2023; 2023:3939360. [PMID: 37035755 PMCID: PMC10079387 DOI: 10.1155/2023/3939360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose The aim of this study was to investigate the role of the medium-conductance calcium-activated potassium channel (KCNN4, KCa3.1) in the secretion of proinflammatory exosomes by atrial myocytes. Methods Eighteen beagles were randomly divided into the sham group (n = 6), pacing group (n = 6), and pacing+TRAM-34 group (n = 6). Electrophysiological data, such as the effective refractory period, atrial fibrillation (AF) induction, and AF duration, were collected by programmed stimulation. Atrial tissues were subjected to hematoxylin and eosin, Masson's trichrome, and immunofluorescence staining. The expression of KCa3.1 and Rab27a was assessed by immunohistochemistry and western blotting. The downstream signaling pathways involved in KCa3.1 were examined by rapid pacing or overexpressing KCNN4 in HL-1 cells. Results Atrial rapid pacing significantly induced electrical remodeling, inflammation, fibrosis, and exosome secretion in the canine atrium, while TRAM-34 (KCa3.1 blocker) inhibited these changes. Compared with those in control HL-1 cells, the levels of exosome markers and inflammatory factors were increased in pacing HL-1 cells. Furthermore, the levels of CD68 and iNOS in macrophages incubated with exosomes derived from HL-1 cells were higher in the pacing-exo group than in the control group. More importantly, KCa3.1 regulated exosome secretion through the AKT/Rab27a signaling pathway. Similarly, inhibiting the downstream signaling pathway of KCa3.1 significantly inhibited exosome secretion. Conclusions KCa3.1 promotes proinflammatory exosome secretion through the AKT/Rab27a signaling pathway. Inhibiting the KCa3.1/AKT/Rab27a signaling pathway reduces myocardial tissue structural remodeling in AF.
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Affiliation(s)
- Dishiwen Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Huiyu Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Yuntao Fu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Yajun Yao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Shanqing He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Youcheng Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Zhen Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Xuewen Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Mei Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
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Jackson I, Etuk A, Jackson N. Arrhythmia prevalence, predictors, and impact on hospital-associated outcomes among patients with diffuse large B-cell lymphoma. Am J Med Sci 2023; 365:56-62. [PMID: 36030898 DOI: 10.1016/j.amjms.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/23/2022] [Accepted: 08/19/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) patients have been reported to have cardiac manifestations, however, arrhythmias have not been characterized in this population. We examined the predictors of arrhythmias and assessed the impact of arrhythmias on inpatient outcomes among DLBCL patients. METHODS Retrospective cohort analysis was performed using the National Inpatient Sample data collected between 2016 and 2018. Multivariable logistic and linear regression models were used to examine the predictors of arrhythmias and inpatient outcomes among DLBCL patients. RESULTS 11% of DLBCL patients had a diagnosis of arrhythmias. Patients aged 70 years or older had 2.6 times higher odds (95% CI: 2.37-2.78) of having arrhythmias compared to patients younger than 70 years. Females were 23% (AOR: 0.77; 95% CI: 0.71-0.83) less likely to have a diagnosis of arrhythmias relative to their male counterparts. Compared to non-Hispanic whites, patients who were non-Hispanic blacks (AOR: 0.69; 95% CI: 0.60-0.81), Hispanics (AOR: 0.60; 95% CI: 0.52-0.69) or in the non-Hispanic other category (AOR: 0.80; 95% CI: 0.70-0.91) were significantly less likely to be diagnosed with arrhythmias. Other factors that predicted arrhythmias were patient disposition and comorbidity index. Additionally, arrhythmias were associated with higher inpatient mortality, length of stay and hospital costs. CONCLUSIONS Older male patients were more likely to be diagnosed with arrhythmias while non-Hispanic blacks and Hispanics were less likely to have arrhythmias. These findings highlight the need for surveillance to enable early detection of arrhythmias in this population.
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Affiliation(s)
- Inimfon Jackson
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.
| | - Aniekeme Etuk
- Department of Internal Medicine, Thomas Hospital Infirmary Health, Fairhope, AL, USA
| | - Nsikak Jackson
- Department of Management, Policy and Community Health, University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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19
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Evaluation of the Impact of Catheter Ablation Procedure on Outcomes and Economic Burden in Patients with Atrial Fibrillation: Real-World Data from Italian Administrative Databases. Healthcare (Basel) 2022; 10:healthcare10122561. [PMID: 36554084 PMCID: PMC9778702 DOI: 10.3390/healthcare10122561] [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: 11/10/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
A real-world analysis among the Italian population has been carried out to estimate the number of atrial fibrillation (AF) patients undergoing catheter ablation and to evaluate their clinical outcome and economic burden. A retrospective analysis on administrative Italian databases has been performed. Between January 2011 and December 2019, all patients diagnosed with AF were considered and those undergoing catheter ablation were identified. Overall, 3084 (3.54%) of AF patients with at least one catheter ablation were included (mean age 63.2, 67.3% males). A significant decrease in the use of AF-related medications and in hospitalizations, mainly related to AF and heart failure, was observed during the 3-year post-ablation period. The average total cost per patient during the 1-year before ablation period was significantly higher compared to the 1-year post-ablation cost (EUR 5248 vs. 4008, respectively; p < 0.001). After propensity score matching, the overall mortality of patients who underwent ablation was significantly lower compared to that assessed in patients not treated with the procedure (9.386/1000 vs. 23.032/1000 person-year, respectively; p < 0.001). Moreover, the mean total costs were significantly higher in patients who did not undergo ablation compared to those who received ablation (EUR 5516 vs. 4008, respectively; p < 0.001). This real-world data analysis shows that in Italy, although catheter ablation is performed in a minority of AF patients, it is associated with significantly better post-procedure clinical outcomes and a significant reduction in healthcare-related costs.
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20
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Althoff TF, Mont L. Catheter ablation of supraventricular tachycardias-a success story. Europace 2022; 25:4-5. [PMID: 36305555 PMCID: PMC9907505 DOI: 10.1093/europace/euac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lluís Mont
- Corresponding author. E-mail addresses: ;
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21
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Leiner J, Pellissier V, König S, Hohenstein S, Ueberham L, Nachtigall I, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. Machine learning-derived prediction of in-hospital mortality in patients with severe acute respiratory infection: analysis of claims data from the German-wide Helios hospital network. Respir Res 2022; 23:264. [PMID: 36151525 PMCID: PMC9502925 DOI: 10.1186/s12931-022-02180-w] [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: 03/28/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe acute respiratory infections (SARI) are the most common infectious causes of death. Previous work regarding mortality prediction models for SARI using machine learning (ML) algorithms that can be useful for both individual risk stratification and quality of care assessment is scarce. We aimed to develop reliable models for mortality prediction in SARI patients utilizing ML algorithms and compare its performances with a classic regression analysis approach. METHODS Administrative data (dataset randomly split 75%/25% for model training/testing) from years 2016-2019 of 86 German Helios hospitals was retrospectively analyzed. Inpatient SARI cases were defined by ICD-codes J09-J22. Three ML algorithms were evaluated and its performance compared to generalized linear models (GLM) by computing receiver operating characteristic area under the curve (AUC) and area under the precision-recall curve (AUPRC). RESULTS The dataset contained 241,988 inpatient SARI cases (75 years or older: 49%; male 56.2%). In-hospital mortality was 11.6%. AUC and AUPRC in the testing dataset were 0.83 and 0.372 for GLM, 0.831 and 0.384 for random forest (RF), 0.834 and 0.382 for single layer neural network (NNET) and 0.834 and 0.389 for extreme gradient boosting (XGBoost). Statistical comparison of ROC AUCs revealed a better performance of NNET and XGBoost as compared to GLM. CONCLUSION ML algorithms for predicting in-hospital mortality were trained and tested on a large real-world administrative dataset of SARI patients and showed good discriminatory performances. Broad application of our models in clinical routine practice can contribute to patients' risk assessment and quality management.
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Affiliation(s)
- Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. .,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany.
| | - Vincent Pellissier
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Laura Ueberham
- Clinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, Helios Hospital Emil-von-Behring, Berlin, Germany.,Institute of Hygiene and Environmental Medicine, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
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22
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König S, Richter S, Bollmann A, Hindricks G. Safety and feasibility of same-day discharge following catheter ablation of atrial fibrillation: what is known and what needs to be explored? Herz 2022; 47:123-128. [PMID: 35257191 DOI: 10.1007/s00059-022-05102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
Catheter ablation of atrial fibrillation (AF) is the most effective rhythm control strategy and its role in the treatment of AF patients has been strengthened by recent guidelines. An increasing AF prevalence and the resulting demands on interventional electrophysiology call for improved resource allocation through both technical innovations and streamlined workflows and patient pathways. Same-day discharge is already established in the context of other electrophysiological interventions; however, its broad implementation in the practice of AF ablation is pending for several reasons, despite the fact that the body of evidence is growing and the majority of reports propagate early discharge to be feasible and safe under certain conditions. This review article is intended to provide an overview of the existing data, classify these into the specific study context, and to show limitations and open questions.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
- Leipzig Heart Institute, Leipzig, Germany.
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
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23
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Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias. Sci Rep 2021; 11:18111. [PMID: 34518592 PMCID: PMC8438063 DOI: 10.1038/s41598-021-97335-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF) is associated with various major adverse cardiac events such as ischemic stroke, heart failure, and increased overall mortality. However, its association with lethal ventricular arrhythmias such as ventricular tachycardia (VT), ventricular flutter (VFL), and ventricular fibrillation (VF) is controversial. We conducted this study to determine whether AF can increase the risk of VT, VFL, and VF. We utilized the Korean National Health Insurance Service database for this nationwide population-based study. This study enrolled people who underwent a nationwide health screen in 2009 for whom clinical follow-up data were available until December 2018. Primary outcome endpoint was the occurrence of VT, VFL, or VF in people who were and were not diagnosed with new-onset AF in 2009. We analyzed a total of 9,751,705 people. In 2009, 12,689 people were diagnosed with new-onset AF (AF group). The incidence (events per 1000 person-years of follow-up) of VT, VFL, and VF was 2.472 and 0.282 in the AF and non-AF groups, respectively. After adjustment for covariates, new-onset AF was associated with 4.6-fold increased risk (p < 0.001) of VT, VFL, and VF over 10 years of follow-up. The risk of VT, VFL, and VF was even higher if identification of AF was based on intensified criteria (≥ 2 outpatient records or ≥ 1 inpatient record; hazard ratio = 5.221; p < 0.001). In conclusion, the incidence of VT, VFL, and VF was significantly increased in people with new-onset AF. The potential risk of suffering lethal ventricular arrhythmia in people with AF should be considered in clinical practice.
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24
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Fabritz L, Crijns HJGM, Guasch E, Goette A, Häusler KG, Kotecha D, Lewalter T, Meyer C, Potpara TS, Rienstra M, Schnabel RB, Willems S, Breithardt G, Camm AJ, Chan A, Chua W, de Melis M, Dimopoulou C, Dobrev D, Easter C, Eckardt L, Haase D, Hatem S, Healey JS, Heijman J, Hohnloser SH, Huebner T, Ilyas BS, Isaacs A, Kutschka I, Leclercq C, Lip GYH, Marinelli EA, Merino JL, Mont L, Nabauer M, Oldgren J, Pürerfellner H, Ravens U, Savelieva I, Sinner MF, Sitch A, Smolnik R, Steffel J, Stein K, Stoll M, Svennberg E, Thomas D, Van Gelder IC, Vardar B, Wakili R, Wieloch M, Zeemering S, Ziegler PD, Heidbuchel H, Hindricks G, Schotten U, Kirchhof P. Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference. Europace 2021; 23:329-344. [PMID: 33555020 DOI: 10.1093/europace/euaa279] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/28/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS The risk of developing atrial fibrillation (AF) and its complications continues to increase, despite good progress in preventing AF-related strokes. METHODS AND RESULTS This article summarizes the outcomes of the 7th Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA) held in Lisbon in March 2019. Sixty-five international AF specialists met to present new data and find consensus on pressing issues in AF prevention, management and future research to improve care for patients with AF and prevent AF-related complications. This article is the main outcome of an interactive, iterative discussion between breakout specialist groups and the meeting plenary. AF patients have dynamic risk profiles requiring repeated assessment and risk-based therapy stratification to optimize quality of care. Interrogation of deeply phenotyped datasets with outcomes will lead to a better understanding of the cardiac and systemic effects of AF, interacting with comorbidities and predisposing factors, enabling stratified therapy. New proposals include an algorithm for the acute management of patients with AF and heart failure, a call for a refined, data-driven assessment of stroke risk, suggestions for anticoagulation use in special populations, and a call for rhythm control therapy selection based on risk of AF recurrence. CONCLUSION The remaining morbidity and mortality in patients with AF needs better characterization. Likely drivers of the remaining AF-related problems are AF burden, potentially treatable by rhythm control therapy, and concomitant conditions, potentially treatable by treating these conditions. Identifying the drivers of AF-related complications holds promise for stratified therapy.
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Affiliation(s)
- Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, UK.,Department of Cardiology, University Hospital Birmingham, UK
| | - Harry J G M Crijns
- School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands
| | - Eduard Guasch
- Hospital Clinic, IDIBAPS, CIBERCV, University of Barcelona, Spain
| | - Andreas Goette
- Medical Clinic II, St. Vincenz Krankenhaus, Paderborn, Germany.,Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | | | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Thorsten Lewalter
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Internistisches Klinikum München Süd, Germany
| | - Christian Meyer
- University Heart Center, University Hospital Hamburg-Eppendorf, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Clinical Centre of Serbia, Serbia
| | | | - Renate B Schnabel
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,University Heart Center, University Hospital Hamburg-Eppendorf, Germany
| | - Stephan Willems
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Guenter Breithardt
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Cardiovascular Medicine, University Hospital Münster, Germany
| | - A John Camm
- St George's Hospital Medical School, University of London, UK
| | | | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | | | | | - Dobromir Dobrev
- Department of Cardiology, University Hospital Essen, Germany
| | - Christina Easter
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Lars Eckardt
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiovascular Medicine, University Hospital Münster, Germany
| | - Doreen Haase
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - Stephane Hatem
- Department of Cardiology, Sorbonne Universités, Faculté de médecine UPMC, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeff S Healey
- Population Health Research Institute Hamilton, Canada
| | - Jordi Heijman
- Department of Cardiology, University Hospital Birmingham, UK
| | | | | | | | - Aaron Isaacs
- School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands
| | - Ingo Kutschka
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Klinik für Thorax-, Herz- und Gefäßchirurgie, University Hospital Göttingen, Germany
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, UK
| | | | - Jose L Merino
- Arrhythmia & Robotic EP Unit, La Paz University Hospital, Spain
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Michael Nabauer
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Medizinische Klinik und Poliklinik I, University Hospital Munich, Germany
| | - Jonas Oldgren
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Helmut Pürerfellner
- Department für Rhythmologie und Elektrophysiologie, Ordensklinikum Linz, Austria
| | - Ursula Ravens
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Institut für Experimentelle Kardiovaskuläre Medizin, Universitätsherzzentrum Freiburg, Bad Krozingen, Germany
| | | | - Moritz F Sinner
- Medizinische Klinik und Poliklinik I, University Hospital Munich, Germany
| | - Alice Sitch
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | | | | | | | - Monika Stoll
- School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands
| | - Emma Svennberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd's Hospital Stockholm, Sweden
| | - Dierk Thomas
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Internal Medicine III-Cardiology, Angiology and Pneumonology, Medical University Hospital Heidelberg, Germany
| | - Isabelle C Van Gelder
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - Reza Wakili
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiology, University Hospital Essen, Germany
| | | | - Stef Zeemering
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - Hein Heidbuchel
- Department of Cardiology, Antwerp University, University Hospital, Belgium
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany
| | - Ulrich Schotten
- School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands.,Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, UK.,Atrial Fibrillation NETwork (AFNET), Münster, Germany.,University Heart Center, University Hospital Hamburg-Eppendorf, Germany
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25
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Bollmann A, Pellissier V, Hohenstein S, König S, Ueberham L, Meier-Hellmann A, Kuhlen R, Thiele H, Hindricks G. Cumulative hospitalization deficit for cardiovascular disorders in Germany during the COVID-19 pandemic: insights from the German-wide Helios hospital network. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:e5-e6. [PMID: 32857835 PMCID: PMC7499594 DOI: 10.1093/ehjqcco/qcaa071] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Andreas Bollmann
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Vincent Pellissier
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Sven Hohenstein
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Sebastian König
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Laura Ueberham
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
| | | | - Ralf Kuhlen
- Helios Health, Friedrichstraße 136, 10117 Berlin, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
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26
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König S, Svetlosak M, Grabowski M, Duncker D, Nagy VK, Bogdan S, Vanduynhoven P, Sohaib SMA, Malaczynska-Raipold K, Lane DA, Lenarczyk R, Bollmann A, Hindricks G, Potpara TS, Kosiuk J. Utilization and perception of same-day discharge in electrophysiological procedures and device implantations: an EHRA survey. Europace 2021; 23:149-156. [PMID: 33503658 DOI: 10.1093/europace/euaa301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
The aim of this European Heart Rhythm Association (EHRA) survey was to assess the utilization of same-day discharge (SDD) in electrophysiology (EP). An online-based questionnaire was shared with the EHRA community between 12 and 30 June 2020 and recorded institutional information, complication assessment, recent experiences, and opinions regarding possible advantages or concerns with SDD. In total, 218 responses from 49 countries provided information on current SDD management. Overall, SDD was implemented in 77.5%, whereas this proportion was significantly higher in tertiary and high-volume centres (83.8% and 85.3%, both P < 0.01). The concept of SDD was most commonly used following implantations of cardiac event recorders (97%), diagnostic EP procedures (72.2%), and implantations of pacemakers with one or two intracardiac leads (50%), while the lowest SDD utilization was observed after catheter ablations of left atrial or ventricular arrhythmias. Within SDD-experienced centres, ∼90% respondents stated that this discharge concept is recommendable or highly recommendable and reported that rates of increased rehospitalization and complication rates were low. Most respondents assumed a better utilization of hospital resources (78.2%), better cost effectiveness (77.3%), and an improved patients' comfort but were concerned about possible impairment of detection (72.5%) and management (78.7%) of late complications. In conclusion, >75% of respondents already implement SDD following EP interventions with a large heterogeneity with regard to specific procedures. Further research is needed to confirm or disprove existing and expected benefits and obstacles.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Martin Svetlosak
- Department for Arrhythmias and Cardiostimulation, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Marcin Grabowski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Hannover Heart Rhythm Center, Hannover, Germany
| | - Vivien K Nagy
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Stefan Bogdan
- Clinical Emergency Hospital of Bucharest, Clinical Electrophysiology and Pacing Laboratory, Bucharest, Romania
| | | | | | | | - Deirdre A Lane
- University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Radoslaw Lenarczyk
- Department of Cardiology Congenital Heart Disease and Electrotherapy, Silesian Medical University, Zabrze, Poland
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Jedrzej Kosiuk
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,Department of Cardiology, Helios Hospital Köthen, Köthen, Germany
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27
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Schmidt B, Brugada J, Arbelo E, Laroche C, Bayramova S, Bertini M, Letsas KP, Pison L, Romanov A, Scherr D, Tilz RR, Maggioni A, Adragao P, Lund J, Haman L, Oliveira MM, Dagres N. Ablation strategies for different types of atrial fibrillation in Europe: results of the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term registry. Europace 2021; 22:558-566. [PMID: 31821488 DOI: 10.1093/europace/euz318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS The ESC EORP EHRA Atrial Fibrillation (AF) Ablation Long-Term registry was designed to assess management and outcomes of AF catheter ablation procedures in Europe. To investigate the current ablation approaches and their outcomes for patients with paroxymal AF (PAF) and non-PAF in Europe. METHODS AND RESULTS Data from index ablations were collected in 27 European countries at 104 centres in a prospective fashion. Pre-procedural, procedural, and 1-year follow-up data were captured on a web-based electronic case record form. Data on the ablation procedure were available for 3446 patients. Of these, 2513 patients and 933 patients underwent pulmonary vein isolation (PVI) or PVI plus (PVIplus) additional ablation, respectively. The ablation strategy was limited to PVI in 81% and 56% of patients in the PAF and non-PAF group, respectively (P < 0.001). In the non-PAF group, left atrial linear ablation and ablation of complex fragmented atrial electrograms were more commonly performed. Arrhythmias recurrence after PVI was 29% and 39% in the PAF and non-PAF group, respectively (P < 0.001) and 42% after PVIplus in both groups. Atrial fibrillation related hospital admissions were more common in the PVIplus group (20% vs. 14%). A very low procedural complication rate was observed. No relevant differences were observed with regard to repeat ablation (PVI 9% and PVIplus 11%). CONCLUSION In patients with PAF and non-PAF, the ablation strategies of PVI and PVIplus led to similar arrhythmia-free survival rates after 1 year. A considerable hospital readmission rate was noted.
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Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Josep Brugada
- Pediatric Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Cécile Laroche
- EURObservational Research Programme, EORP, European Society of Cardiology, Sophia-Antipolis, France
| | - Sevda Bayramova
- E. Meshalkin National Medical Research Center» of the Ministry of Health of the Russian Federation, Rechkunovskaya, Novosibirsk, Russia
| | | | | | - Laurent Pison
- Cardiology, Ziekenhuis Oost Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Alexander Romanov
- E. Meshalkin National Medical Research Center» of the Ministry of Health of the Russian Federation, Rechkunovskaya, Novosibirsk, Russia
| | | | - Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Luebeck, Germany.,Department II. Med. Kardiologie, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Aldo Maggioni
- EURObservational Research Programme, EORP, European Society of Cardiology, Sophia-Antipolis, France.,ANMCO Research Center, Florence, Italy
| | | | - Juha Lund
- Turku University Hospital, Turku, Finland
| | - Ludek Haman
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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28
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König S, Pellissier V, Hohenstein S, Bernal A, Ueberham L, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. Machine learning algorithms for claims data-based prediction of in-hospital mortality in patients with heart failure. ESC Heart Fail 2021; 8:3026-3036. [PMID: 34085775 PMCID: PMC8318394 DOI: 10.1002/ehf2.13398] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022] Open
Abstract
Aims Models predicting mortality in heart failure (HF) patients are often limited with regard to performance and applicability. The aim of this study was to develop a reliable algorithm to compute expected in‐hospital mortality rates in HF cohorts on a population level based on administrative data comparing regression analysis with different machine learning (ML) models. Methods and results Inpatient cases with primary International Statistical Classification of Diseases and Related Health Problems (ICD‐10) encoded discharge diagnosis of HF non‐electively admitted to 86 German Helios hospitals between 1 January 2016 and 31 December 2018 were identified. The dataset was randomly split 75%/25% for model development and testing. Highly unbalanced variables were removed. Four ML algorithms were applied, and all algorithms were tuned using a grid search with multiple repetitions. Model performance was evaluated by computing receiver operating characteristic areas under the curve. In total, 59 125 cases (69.8% aged 75 years or older, 51.9% female) were investigated, and in‐hospital mortality was 6.20%. Areas under the curve of all ML algorithms outperformed regression analysis in the testing dataset with values of 0.829 [95% confidence interval (CI) 0.814–0.843] for logistic regression, 0.875 (95% CI 0.863–0.886) for random forest, 0.882 (95% CI 0.871–0.893) for gradient boosting machine, 0.866 (95% CI 0.854–0.878) for single‐layer neural networks, and 0.882 (95% CI 0.872–0.893) for extreme gradient boosting. Brier scores demonstrated a good calibration especially of the latter three models. Conclusions We introduced reliable models to calculate expected in‐hospital mortality based only on administrative routine data using ML algorithms. A broad application could supplement quality measurement programs and therefore improve future HF patient care.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, 04289, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, 04289, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, 04289, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, 04289, Germany.,Leipzig Heart Institute, Leipzig, Germany
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 508] [Impact Index Per Article: 169.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Ueberham L, König S, Pellissier V, Hohenstein S, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. Admission rates and care pathways in patients with atrial fibrillation during the COVID-19 pandemic-insights from the German-wide Helios hospital network. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:257-264. [PMID: 33729489 PMCID: PMC7989580 DOI: 10.1093/ehjqcco/qcab011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022]
Abstract
Introduction Several reports indicate lower rates of emergency admissions in the cardiovascular sector and reduced admissions of patients with chronic diseases during the COVID-19 pandemic. The aim of this study was therefore to evaluate numbers of admissions in incident and prevalent atrial fibrillation and flutter (AF) and to analyze care pathways in comparison to 2019. Methods A retrospective analysis of claims data of 74 German Helios hospitals was performed to identify consecutive patients hospitalized with a main discharge diagnosis of AF. A study period including the start of the German national protection phase (13th March 2020 to 16th July 2020) was compared to a previous year control cohort (15th March 2019 to 18th July 2019), with further sub-division into early and late phase. Incidence rate ratios (IRR) were calculated. Numbers of admission per day (A/day) for incident and prevalent AF and care pathways including readmissions, numbers of transesophageal echocardiogram (TEE), electrical cardioversion (CV) and catheter ablation (CA) were analyzed. Results During the COVID-19 pandemic, there was a significant decrease of total AF admissions both in the early (44.4 vs. 77.5 A/day, IRR 0.57 [95% CI 0.54–0.61], p < 0.01) and late phase (59.1 vs. 63.5 A/day, IRR 0.93 [95% CI 0.90–0.96], p < 0.01), length of stay was significantly shorter (3.3 ± 3.1 nigths vs. 3.5 ± 3.6 nigths, p < 0.01), admissions were more frequently in high volume centers (77.0% vs. 75.4%, p = 0.02) and frequency of readmissions was reduced (21.7% vs. 23.6%, p < 0.01) compared to the previous year. Incident AF admission rates were significantly lower both in the early (21.9 admission per day vs. 41.1 A/day, IRR 0.53 [95% CI 0.48 − 0.58]) and late phase (35.5 vs. 39.3 A/day, IRR 0.90 [95% CI 0.86 − 0.95]), whereas prevalent admissions were only lower in the early phase (22.5 vs 36.4 A/day IRR 0.62 [95% CI 0.56 − 0.68]), but not in the late phase (23.6 vs. 24.2 A/day IRR 0.97 [95% CI 0.92 − 1.03]). Analysis of care pathways showed reduced numbers of TEE during the early phase (34.7% vs. 41.4%, OR 0.74 [95% CI 0.64 − 0.86], p < 0.01), but not during the late phase (39.9% vs. 40.2%, OR 0.96 [95% CI 0.88 − 1.03], p = 0.26). Numbers of CV were comparable during early (40.6% vs. 39.7%, OR 1.08 [95% CI 0.94 − 1.25], p = 0.27) and late phase (38.6% vs. 37.5%, OR 1.06 [95% CI 0.98 − 1.14], p = 0.17), compared to the previous year, respectively. Numbers of CA were comparable during the early phase (21.6% vs. 21.1%, OR 0.98 [95% CI 0.82 − 1.17], p = 0.82) with a distinct increase during the late phase (22.9% vs. 21.5%, OR 1.05 [95% CI 0.96–1.16], p = 0.28). Conclusion During the COVID-19 pandemic, AF admission rates declined significantly, with a more pronounced reduction in incident than in prevalent AF. Overall AF care was maintained during early and late pandemic phase with only minor changes, namely less frequent use of TEE. Confirmation of these findings in other study populations as well as identification of underlying causes are required to ensure optimal therapy in patients with AF during the COVID-19 pandemic.
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Affiliation(s)
- Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig 04289, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig 04289, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig 04289, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig 04289, Germany.,Leipzig Heart Institute, Leipzig, Germany
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bollmann A, Hohenstein S, Pellissier V, Stengler K, Reichardt P, Ritz JP, Thiele H, Borger MA, Hindricks G, Meier-Hellmann A, Kuhlen R. Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network. PLoS One 2021; 16:e0249251. [PMID: 33765096 PMCID: PMC7993839 DOI: 10.1371/journal.pone.0249251] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/02/2021] [Indexed: 12/27/2022] Open
Abstract
Background During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting. Methods and findings Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the “protection” stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06–1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01–1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00–1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78–1.31], P<0.95). Conclusions There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies.
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Affiliation(s)
- Andreas Bollmann
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
- * E-mail:
| | - Sven Hohenstein
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Vincent Pellissier
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Katharina Stengler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Helios Park Hospital, Leipzig, Germany
| | - Peter Reichardt
- Oncology Center Berlin-Buch, Helios Hospital Berlin-Buch and Berlin Cancer Institute, Berlin, Germany
| | - Jörg-Peter Ritz
- Department of Surgery, Helios Hospital Schwerin, Schwerin, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Michael A. Borger
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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Lundqvist CB, Pürerfellner H, White A, Schilling R. Redefining the Standard for Atrial Fibrillation: A Patient-centric Report. Eur Cardiol 2021; 16. [PMID: 33859732 PMCID: PMC8034477 DOI: 10.15420/ecr.2021.16.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A roundtable discussion with three European clinical experts in AF and one expert patient diagnosed and treated for AF was conducted in London in October 2019. The panel discussed the implications of AF for patients, current patient pathways, what treatment outcomes were relevant for patients and how the recommendations for the management of AF may change in the future, based on the outcomes of recently published and on-going clinical trials. This article summarises the discussion, and draws upon wider sources to detail best practice and optimal patient treatment pathways.
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5092] [Impact Index Per Article: 1697.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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König S, Ueberham L, Pellissier V, Hohenstein S, Meier-Hellmann A, Thiele H, Ahmadli V, Borger MA, Kuhlen R, Hindricks G, Bollmann A. Hospitalization deficit of in- and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID-19 pandemic: Insights from the German-wide helios hospital network. Clin Cardiol 2021; 44:392-400. [PMID: 33497509 PMCID: PMC7943897 DOI: 10.1002/clc.23549] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background Treatment numbers of various cardiovascular diseases were reduced throughout the early phase of the ongoing COVID‐19 pandemic. Aim of this study was to (a) expand previous study periods to examine the long‐term course of hospital admission numbers, (b) provide data for in‐ and outpatient care pathways, and (c) illustrate changes of numbers of cardiovascular procedures. Methods and Results Administrative data of patients with ICD‐10‐encoded primary diagnoses of cardiovascular diseases (heart failure, cardiac arrhythmias, ischemic heart disease, valvular heart disease, hypertension, peripheral vascular disease) and in‐ or outpatient treatment between March, 13th 2020 and September, 10th 2020 were analyzed and compared with 2019 data. Numbers of cardiovascular procedures were calculated using OPS‐codes. The cumulative hospital admission deficit (CumAD) was computed as the difference between expected and observed admissions for every week in 2020. In total, 80 hospitals contributed 294 361 patient cases to the database without relevant differences in baseline characteristics between the studied periods. There was a CumAD of −10% to −16% at the end of the study interval in 2020 for all disease groups driven to varying degrees by both reductions of in‐ and outpatient case numbers. The number of performed interventions was significantly reduced for all examined procedures (catheter ablations: −10%; cardiac electronic device implantations: −7%; percutaneous cardiovascular interventions: −9%; cardiovascular surgery: −15%). Conclusions This study provides data on the long‐term development of cardiovascular patient care during the COVID‐19 pandemic demonstrating a significant CumAD for several cardiovascular diseases and a concomitant performance deficit of cardiovascular interventions.
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Affiliation(s)
- Sebastian König
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Laura Ueberham
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Holger Thiele
- Leipzig Heart Institute, Leipzig, Germany.,Heart Center Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Vusal Ahmadli
- Leipzig Heart Institute, Leipzig, Germany.,Heart Center Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Michael A Borger
- Leipzig Heart Institute, Leipzig, Germany.,Heart Center Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | | | - Gerhard Hindricks
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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König S, Hohenstein S, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network. Eur J Heart Fail 2020; 22:2190-2201. [PMID: 33135851 DOI: 10.1002/ejhf.2044] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/09/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in-hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study. METHODS AND RESULTS Administrative data provided by 67 German Helios hospitals were examined for patients with a main discharge diagnosis of HF using ICD codes. Urgent hospital admissions per day were compared for a study period (13 March-21 May 2020) with control intervals in 2020 (1 January-12 March) and 2019 (13 March-21 May), resulting in a total of 13 484 patients excluding all patients with laboratory-proven COVID-19 infection. Incidence rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in-hospital mortality. The number of admissions per day was lower in the study period compared to the same year [IRR 0.69, 95% confidence interval (CI) 0.67-0.73, P < 0.01] and the previous year control group (IRR 0.73, 95% CI 0.70-0.76, P < 0.01). Age was similar throughout the intervals, but case severity increased in terms of distribution within New York Heart Association (NYHA) classes and comorbidities. Within the study period, 30-day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In-hospital mortality was 7.3% in the study period, 6.1% in the same year (P = 0.03) and 6.0% in the previous year control group (P = 0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during the study period was not independently associated with mortality. CONCLUSION Our data showed a significant reduction of urgent hospital admissions for HF with increased case severity and concomitant in-hospital mortality during the COVID-19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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Cheng X, Hu Q, Gao L, Liu J, Qin S, Zhang D. Sex-related differences in catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Europace 2020; 21:1509-1518. [PMID: 31281922 DOI: 10.1093/europace/euz179] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/05/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS The sex-related differences in the clinical outcomes of rhythm and safety after catheter ablation remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for atrial fibrillation (AF) in women and men. METHODS AND RESULTS The Medline and EMBASE databases were searched for published articles up to December 2018. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, stroke/transient ischaemic attack (TIA), and all-cause mortality. After literature search and detailed assessment, 19 observational studies (151 370 patients; 34% women) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was lower in women than men at the 2.4-year follow-up [odds ratio (OR): 0.75, 95% confidence interval (CI) 0.69-0.81; P < 0.0001]. Moreover, women had an increased risk of stroke/TIA (OR: 1.42, 95% CI 1.21-1.67; P < 0.0001) and all-cause mortality (OR: 1.53, 95% CI 1.02-2.28; P = 0.04). Nevertheless, for the endpoint of all-cause mortality, there was no significant difference between the two genders in the subgroup of prospective studies (OR: 1.19, 95% CI 0.69-2.05; P = 0.53). Additionally, women were more likely to experience major complications compared with men (pericardial effusion/tamponade, major bleeding requiring transfusion, and pacemaker implantation). CONCLUSIONS Women who underwent catheter ablation of AF might experience lower efficacy and a higher risk of stroke/TIA and major complications than men. The reasons for these sex-related differences need to be further studied.
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Affiliation(s)
- Xiaocheng Cheng
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| | - Qiongwen Hu
- Department of Clinical Laboratory, Chongqing General Hospital, Chongqing, China
| | - Lei Gao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| | - Jian Liu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
| | - Dongying Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, China
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Bollmann A, Hohenstein S, König S, Meier-Hellmann A, Kuhlen R, Hindricks G. In-hospital mortality in heart failure in Germany during the Covid-19 pandemic. ESC Heart Fail 2020; 7:4416-4419. [PMID: 32915516 PMCID: PMC7754920 DOI: 10.1002/ehf2.13011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 01/16/2023] Open
Abstract
Aims The Covid‐19 pandemic affects care for cardiovascular conditions, but data on heart failure (HF) are scarce. This study aims to analyse HF care and in‐hospital outcomes during the pandemic in Germany. Methods and results A total of 9452 HF admissions were studied using claims data of 65 Helios hospitals; 1979 in the study period (13 March 30 April 2020) and 4691 and 2782 in two control periods (13 March to 30 April 2019 and 1 January to 12 March 2020). HF admissions declined compared with both control periods by 29–38%. Cardiac resynchronization therapy was implanted in 0.55% during the study period, 0.32% [odds ratio (OR) 1.66, 95% confidence interval (CI) 0.68–4.04, P = 0.27] in the previous year and 0.43% (OR 1.35, 95% CI 0.64–2.84, P = 0.43) in the same year control. Intensive care treatment was 6.22% during the study period, 4.49% in the previous year (OR 1.46, 95% CI 1.13–1.89, P < 0.01), and 5.27% in the same year control (OR 1.19, 95% CI 0.96–1.49, P = 0.12). Length of hospital stay was 7.0 ± 5.0 days in the study and 7.8 ± 5.6 (P < 0.01) and 7.3 ± 5.1 days (P = 0.07) in the control periods. In‐hospital mortality was 7.0% in the study and 5.5% in both control periods (P < 0.05). Conclusions During the early phase of the Covid‐19 pandemic in Germany, HF treatment pathways seem not to be affected, but hospital stay shortened and in‐hospital mortality increased. As the pandemic continues, this early signal demands close monitoring and further investigation of potential causes.
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Affiliation(s)
- Andreas Bollmann
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, Leipzig, 04289, Germany
| | - Sven Hohenstein
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, Leipzig, 04289, Germany
| | - Sebastian König
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, Leipzig, 04289, Germany
| | | | | | - Gerhard Hindricks
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, Leipzig, 04289, Germany
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Bollmann A, Hohenstein S, Meier-Hellmann A, Kuhlen R, Hindricks G. Emergency hospital admissions and interventional treatments for heart failure and cardiac arrhythmias in Germany during the Covid-19 outbreak: insights from the German-wide Helios hospital network. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:221-222. [PMID: 32502261 PMCID: PMC7314091 DOI: 10.1093/ehjqcco/qcaa049] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Andreas Bollmann
- Heart Center Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Sven Hohenstein
- Heart Center Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
| | | | - Ralf Kuhlen
- Helios Health, Friedrichstraße 136, 10117 Berlin, Germany
| | - Gerhard Hindricks
- Heart Center Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289 Leipzig, Germany
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40
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Goldstein K, Hansen C, Lüthje L, Vollmann D. [Safety and efficiency of interventional electrophysiology utilizing the German "Belegarztsystem"]. Herzschrittmacherther Elektrophysiol 2020; 31:210-218. [PMID: 32372229 DOI: 10.1007/s00399-020-00687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/10/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Electrophysiology study (EPS) and catheter ablation (abl.), in particular for atrial fibrillation, are increasingly performed in Germany. Therefore, measures and steps to ensure quality assurance are indicated. Most of the procedures are performed by physicians employed by hospitals; however, some are also carried out by attending cardiologists on contract in private practice, applying the so-called Belegarztsystem. The aim of this study was to determine the safety and efficiency of an interventional electrophysiology performed in a German Belegarztsystem. METHODS Based on a prospective registry, we analyzed procedure-related data from 1400 consecutive EPS/abl. performed at our center between 2014 and 2018. One-year follow-up data (arrhythmia recurrences, complications, deaths) were collected for all procedures carried out during the first 2 years. RESULTS In the total study cohort, no periprocedural death occurred, and there was a low cumulative incidence of groin complications (0.9%). The most common procedure (n = 772) was complex ablation for atrial fibrillation/flutter (55%). In this group, the success rate was 98% (acute) and 65% (1 year), and the cumulative rate of complications was 5.0% (transient ischemic attack/stroke 0.1%, pericardial tamponade 0.4%, relevant pericarditis/pericardial effusion 1.1%, groin complication 1.5%, other 1.9%). For the other procedures, rates for success and complications were comparable, and procedure times and x‑ray doses tended to be lower in our analysis as compared to prior reports. CONCLUSION Interventional electrophysiology, carried out by experienced operators and qualified staff, can be performed safely and effectively by attending physicians in a Belegarztsystem.
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Affiliation(s)
- Kathi Goldstein
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Claudius Hansen
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Lars Lüthje
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Dirk Vollmann
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland.
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Cheng EP, Yeo I, Kim LK, Lerman BB, Cheung JW. Reply: Early Mortality Following Catheter Ablation of Atrial Fibrillation. J Am Coll Cardiol 2020; 75:1245-1247. [PMID: 32164905 DOI: 10.1016/j.jacc.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 11/27/2022]
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Hadjamu N, Azizy O, Wakili R. [Approaches to atrial fibrillation with tachycardia transition]. Herzschrittmacherther Elektrophysiol 2020; 31:20-25. [PMID: 32055925 DOI: 10.1007/s00399-020-00670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
Atrial fibrillation, the most common cardiac arrhythmia in the daily clinical routine, is a challenge in in-hospital and prehospital emergency medicine and is associated with increased morbidity and mortality if left untreated. Especially tachyarrhythmia, caused by atrial fibrillation, leads to various unspecified symptoms and in some cases to severely impaired circulation. Thus, an individualized therapeutic regimen is required. A fundamental distinction between rhythm control and rate control strategies must be made. In symptomatic but hemodynamically stable patients rate control is the method of choice. This applies in particular to patients with no pre-existing anticoagulation, especially if left atrial thrombi are not excluded. In hemodynamically unstable patients, considering the potential complications of sedation, electrical cardioversion is preferred. Pharmacological therapy of atrial fibrillation has to be divided into AV conduction modulating drugs-like short- or long-acting β‑blockers, calcium antagonists or cardiac glycosides-and the heterogeneous group of antiarrhythmic drugs aiming for rhythm control. Pulmonary vein ablation is the current long-term treatment of choice for symptomatic drug-refractory atrial fibrillation.
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Affiliation(s)
- Nino Hadjamu
- Klinik für Kardiologie und Angiologie, Westdeutsches Herzzentrum des Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland
| | - Obayda Azizy
- Klinik für Kardiologie und Angiologie, Westdeutsches Herzzentrum des Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland
| | - Reza Wakili
- Klinik für Kardiologie und Angiologie, Westdeutsches Herzzentrum des Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
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Bollmann A, König S, Basedow F, Hindricks G, Walker J. Early Mortality After Catheter Ablation of Atrial Fibrillation. J Am Coll Cardiol 2020; 75:1243-1244. [DOI: 10.1016/j.jacc.2019.11.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 10/24/2022]
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König S, Ueberham L, Müller-Röthing R, Wiedemann M, Ulbrich M, Sause A, Tebbenjohanns J, Schade A, Shin DI, Staudt A, Andrié R, Neuser H, Kuhlen R, Arya A, Hindricks G, Bollmann A. Catheter ablation of ventricular arrhythmias and in-hospital mortality: insights from the German-wide Helios hospital network of 5052 cases. Europace 2020; 22:100-108. [PMID: 31638643 DOI: 10.1093/europace/euz260] [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: 08/01/2019] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Catheter ablation (CA) of ventricular arrhythmias is one of the most challenging electrophysiological interventions with an increasing use over the last years. Several benefits must be weighed against the risk of potentially life-threatening complications which necessitates a steady reevaluation of safety endpoints. Therefore, the aims of this study were (i) to investigate overall in-hospital mortality in patients undergoing such procedures and (ii) to identify variables associated with in-hospital mortality in a German-wide hospital network. METHODS AND RESULTS Between January 2010 and September 2018, administrative data provided by 85 Helios hospitals were screened for patients with main or secondary discharge diagnosis of ventricular tachycardia (VT) or premature ventricular contractions (PVCs) in combination with an arrhythmia-related CA using ICD- and OPS codes. In 5052 cases (mean age 60.9 ± 14.3 years, 30.1% female) of 30 different hospitals, in-hospital mortality was 1.27% with a higher mortality in patients ablated for VT (1.99%, n = 2, 955) compared to PVC (0.24%, n = 2, 097, P < 0.01). Mortality rates were 2.06% in patients with ischaemic heart disease (IHD, n = 2, 137), 1.47% in patients with non-ischaemic structural heart disease (NIHD, n = 1, 224), and 0.12% in patients without structural heart disease (NSHD, n = 1, 691). Considering different types of hospital admission, mortality rates were 0.35% after elective (n = 2, 825), 1.60% after emergency admission/hospital transfer <24 h (n = 1, 314) and 3.72% following delayed hospital transfer >24 h after initial admission (n = 861, P < 0.01 vs. elective admission and emergency admission/hospital transfer <24 h). In multivariable analysis, a delayed hospital transfer >24 h [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.59-3.28, P < 0.01], the occurrence of procedure-related major adverse events (OR 6.81, 95% CI 2.90-16.0, P < 0.01), Charlson Comorbidity Index (CCI, OR 2.39, 95% CI 1.56-3.66, P < 0.01) and its components congestive heart failure (OR 8.04, 95% CI 1.71-37.8, P < 0.01), and diabetes mellitus (OR 1.59, 95% CI 1.13-2.22, P < 0.01) were significantly associated with in-hospital death. CONCLUSIONS We reported in-hospital mortality rates after CA of ventricular arrhythmias in the largest multicentre, administrative dataset in Germany which can be implemented in quality management programs. Aside from comorbidities, a delayed hospital transfer to a CA performing centre is associated with an increased in-hospital mortality. This deserves further studies to determine the optimal management strategy.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | - Michael Wiedemann
- Department of Cardiology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Michael Ulbrich
- Department of Internal Medicine I, Helios Hospital München West, München, Germany
| | - Armin Sause
- Department of Cardiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Anja Schade
- Department of Cardiology, Helios Hospital Erfurt, Erfurt, Germany
| | - Dong-In Shin
- Department of Cardiology, Helios Hospital Krefeld, Krefeld, Germany
| | - Alexander Staudt
- Department of Cardiology and Angiology, Helios Hospital Schwerin, Schwerin, Germany
| | - René Andrié
- Department of Cardiology, Helios Hospital Siegburg, Siegburg, Germany
| | - Hans Neuser
- Department of Internal Medicine II, Helios Hospital Plauen, Plauen, Germany
| | | | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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Ueberham L, König S, Hohenstein S, Mueller-Roething R, Wiedemann M, Schade A, Seyfarth M, Sause A, Neuser H, Staudt A, Zacharzowsky U, Reithmann C, Shin DI, Andrie R, Wetzel U, Tebbenjohanns J, Wunderlich C, Kuhlen R, Hindricks G, Bollmann A. Sex differences of resource utilisation and outcomes in patients with atrial arrhythmias and heart failure. Heart 2019; 106:527-533. [DOI: 10.1136/heartjnl-2019-315566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/16/2019] [Accepted: 11/25/2019] [Indexed: 12/14/2022] Open
Abstract
ObjectiveAtrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study.MethodsUsing International Statistical Classification of Diseases and Related Health Problems and Operations and Procedures codes, administrative data of 75 hospitals from 2010 to 2018 were analysed to identify cases with AF and HF. Sex differences were compared for baseline characteristics, right and left atrial CA use, procedure-related adverse outcomes and in-hospital mortality.ResultsOf 54 645 analysed cases with AF and HF, 46.2% were women. Women were significantly older (75.4±9.5 vs 68.7±11.1 years, p<0.001), had different comorbidities (more frequently: cerebrovascular disease (2.4% vs 1.8%, p<0.001), dementia (5.3% vs 2.2%, p<0.001), rheumatic disease (2.1% vs 0.8%, p<0.001), diabetes with chronic complications (9.7% vs 9.1%, p=0.033), hemiplegia or paraplegia (1.7% vs 1.2%, p<0.001) and chronic kidney disease (43.7% vs 33.5%, p<0.001); less frequently: myocardial infarction (5.4% vs 10.5%, p<0.001), peripheral vascular disease (6.9% vs 11.3%, p<0.001), mild liver disease (2.0% vs 2.3%, p=0.003) or any malignancy (1.0% vs 1.3%, p<0.001), underwent less often CA (12.0% vs 20.7%, p<0.001), had longer hospitalisations (6.6±5.8 vs 5.2±5.2 days, p<0.001) and higher in-hospital mortality (1.6% vs 0.9%, p<0.001). However, in the multivariable generalised linear mixed model for in-hospital mortality, sex did not remain an independent predictor (OR 0.96, 95% CI 0.82 to 1.12, p=0.579) when adjusted for age and comorbidities. Vascular access complications requiring interventions (4.8% vs 4.2%, p=0.001) and cardiac tamponade (0.3% vs 0.1%, p<0.001) occurred more frequently in women, whereas stroke (0.6% vs 0.5%, p=0.179) and death (0.3% vs 0.1%, p=0.101) showed no sex difference in patients undergoing CA.ConclusionsThere are sex differences in patients with AF and HF with respect to demographics, resource utilisation and in-hospital outcomes. This needs to be considered when treating women with AF and HF, especially for a sufficient patient informed decision making in clinical practice.
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Lüscher TF. Between Scylla and Charybdis: combining anticoagulants with platelet inhibitors and outcome. Eur Heart J 2019; 40:3737-3740. [DOI: 10.1093/eurheartj/ehz877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals, London, UK
- Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland
- Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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Lüscher TF. Risks and management of cardioversion and catheter ablation in atrial fibrillation. Eur Heart J 2019; 40:2999-3002. [PMID: 31541553 DOI: 10.1093/eurheartj/ehz643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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Gibbs C, Thalamus J, Kristoffersen DT, Svendsen MV, Holla ØL, Heldal K, Haugaa KH, Hysing J. QT prolongation predicts short-term mortality independent of comorbidity. Europace 2019; 21:1254-1260. [PMID: 31220237 PMCID: PMC6680365 DOI: 10.1093/europace/euz058] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/11/2019] [Indexed: 01/24/2023] Open
Abstract
AIMS A prolonged corrected QT interval (QTc) ≥500 ms is associated with high all-cause mortality in hospitalized patients. We aimed to explore any difference in short- and long-term mortality in patients with QTc ≥500 ms compared with patients with QTc <500 ms after adjustment for comorbidity and main diagnosis. METHODS AND RESULTS Patients with QTc ≥500 ms who were hospitalized at Telemark Hospital Trust, Norway between January 2007 and April 2014 were identified. Thirty-day and 3-year all-cause mortality in 980 patients with QTc ≥500 ms were compared with 980 patients with QTc <500 ms, matched for age and sex and adjusting for Charlson comorbidity index (CCI), previous admissions, and main diagnoses. QTc ≥500 ms was associated with increased 30-day all-cause mortality [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.38-2.62; P < 0.001]. There was no significant difference in mortality between patients with QTc ≥500 ms and patients with QTc <500 ms who died between 30 days and 3 years; 32% vs. 29%, P = 0.20. Graded CCI was associated with increased 3-year all-cause mortality (CCI 1-2: HR 1.62, 95% CI 1.34-1.96; P < 0.001; CCI 3-4: HR 2.50, 95% CI 1.95-3.21; P < 0.001; CCI ≥5: HR 3.76, 95% CI 2.85-4.96; P < 0.001) but was not associated with 30-day all-cause mortality. CONCLUSION QTc ≥500 ms is a powerful predictor of short-term mortality overruling comorbidities. QTc ≥500 ms also predicted long-term mortality, but this effect was mainly caused by the increased short-term mortality. For long-term mortality, comorbidity was more important.
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Affiliation(s)
- Charlotte Gibbs
- Department of Internal Medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jacob Thalamus
- Department of Internal Medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway
| | - Doris Tove Kristoffersen
- Norwegian Institute of Public Health, Cluster for Health Services Research, Skøyen, N Oslo, Norway
| | - Martin Veel Svendsen
- Department of Occupational and Environmental medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway
| | - Øystein L Holla
- Department of Medical Genetics, Telemark Hospital Trust, Kjørbekk, Skien, Norway
| | - Kristian Heldal
- Department of Internal Medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina H Haugaa
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan Hysing
- Department of Internal Medicine, Telemark Hospital Trust, Kjørbekk, Skien, Norway
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Mascheroni J, Mont L, Stockburger M, Patwala A, Retzlaff H, Gallagher AG, Alonso C, Binner L, Bongiorni MG, Diaz Infante E, Gadler F, Gras D, Margitfalvi P, Moreno J, Paratsii O, Rao A, Schäfer H, van Kraaij D. International expert consensus on a scientific approach to training novice cardiac resynchronization therapy implanters using performance quality metrics. Int J Cardiol 2019; 289:63-69. [DOI: 10.1016/j.ijcard.2019.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/12/2019] [Accepted: 04/10/2019] [Indexed: 01/22/2023]
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50
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Katritsis DG. What Cannot be Missed: Must-read Papers, 2018. Arrhythm Electrophysiol Rev 2019; 8:81-82. [DOI: 10.15420/aer.2019.8.2.fo1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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