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Sun Q, Cui W, Zhang X, Tian Y, Huang G, He W, Zhao Y, Zhao X, Li D, Liu X. A Systematic Review and Meta-analysis of Renin-angiotensin System Inhibitors and Angiotensin Receptor Neprilysin Inhibitors in Preventing Recurrence After Atrial Fibrillation Ablation. J Cardiovasc Pharmacol 2024; 83:220-227. [PMID: 38030133 DOI: 10.1097/fjc.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
ABSTRACT To systematically evaluate the efficacy and safety of renin-angiotensin system inhibitors (RASIs) and angiotensin receptor neprilysin inhibitors in preventing the recurrence of atrial fibrillation after atrial fibrillation ablation, we have written this meta-analysis. We systematically searched randomized controlled trials or cohort studies on RASIs and angiotensin receptor neprilysin inhibitor-sacubitril/valsartan (SV) in preventing the recurrence of atrial fibrillation. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Afterward, the meta-analysis was performed using RevMan 5.3 software. This meta-analysis results showed that the recurrence rate of atrial fibrillation after ablation in subjects using RASIs was lower than that in subjects not using them [relative risk = 0.85, 95% confidence interval (CI) (0.72-0.99), P = 0.03]; the recurrence rate in subjects using SV was lower than that in subjects using RASIs [RR= 0.50, 95% CI (0.37-0.68), P < 0.00001]. These results show that both the use of RASIs and SV can prevent the recurrence of after atrial fibrillation ablation, among which the use of SV is more effective.
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Affiliation(s)
- Qian Sun
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
| | - Wenyan Cui
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
| | - Xinhui Zhang
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
| | - Yunfei Tian
- The University of Hong Kong, Hong Kong, China
| | - Guangliang Huang
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
| | - Wenjuan He
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
| | - Yonghong Zhao
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
| | - Xiaojuan Zhao
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
| | - Dan Li
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
| | - Xiuju Liu
- Pharmacy Department, The Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China; and
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2
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Yang L, Chung MK. Lifestyle changes in atrial fibrillation management and intervention. J Cardiovasc Electrophysiol 2023; 34:2163-2178. [PMID: 36598428 PMCID: PMC10318120 DOI: 10.1111/jce.15803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias in adults, and its continued rise in the United States is complicated by the increased incidence and prevalence of several AF risk factors, such as obesity, physical inactivity, hypertension, obstructive sleep apnea, diabetes mellitus, coronary artery disease, and alcohol, tobacco, or caffeine use. Lifestyle and risk factor modification has been proposed as an additional pillar of AF therapy, added to rhythm control, rate control, and anticoagulation, to reduce AF burden and risk. Although emerging evidence largely supports the integration of lifestyle and risk factor management in clinical practice, randomized clinical trials investigating the long-term sustainability and reproducibility of these benefits remain sparse. The purpose of this review is to discuss potentially reversible risk factors on AF, share evidence for the impact on AF by modification of these risk factors, and then provide an overview of the effects of reversing or managing these risk factors on the success of various AF management strategies, such as antithrombotic, rate control, and rhythm control therapies.
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Affiliation(s)
- Lucy Yang
- The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mina K Chung
- The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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3
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Li Q, Fang Y, Peng DW, Li LA, Deng CY, Yang H, Kuang SJ, Li QQ, Zhang MZ, Zeng P, Zhang QH, Liu Y, Deng H, Wei W, Xue YM, Wu SL, Rao F. Sacubitril/valsartan reduces susceptibility to atrial fibrillation by improving atrial remodeling in spontaneously hypertensive rats. Eur J Pharmacol 2023; 952:175754. [PMID: 37182595 DOI: 10.1016/j.ejphar.2023.175754] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
AIM Sacubitril/valsartan (Sac/Val, LCZ696), the world's first angiotensin receptor-neprilysin inhibitor (ARNi), has been widely used in the treatment of heart failure. However, the use of Sac/Val in the treatment of atrial fibrillation (AF), especially AF with hypertension, has been less reported. We investigated the effect of Sac/Val on atrial remodeling and hypertension-related AF. METHODS The AF induction rate and electrophysiological characteristics of spontaneously hypertensive rats (SHRs) treated with Sac/Val or Val were detected by rapid atrial pacing and electrical mapping/optical mapping. The whole-cell patch-clamp and western blot were used to observe electrical/structural remodeling of atrial myocytes/tissue of rats and atrium-derived HL-1 cells cultured under 40 mmHg in vitro. RESULTS Sac/Val was superior to Val in reducing blood pressure, myocardial hypertrophy and susceptibility of AF in SHRs. The shorten action potentials duration (APD), decreased L type calcium channel current (ICa,L) and Cav1.2, increased ultrarapid delayed rectified potassium current (Ikur) and Kv1.5 in atrial myocytes/tissue of SHRs could be better improved by Sac/Val, as well as the levels of atrial fibrosis. While the protein expression of angiotensin-converting enzyme-1 (ACE-1), angiotensin, angiotensin II type I AT1 receptor (AT1R) and neprilysin (NEP) were increased, which could be more effective ameliorated by Sac/Val than Val. Furthermore, Val + Sacubitrilat (LBQ657) (an active NEP inhibitor) was also superior to LBQ657 or Val in improving the electrical and structural remodeling of HL-1 cells through inhibiting NEP. CONCLUSION Sac/Val can improve atrial structural and electrical remodeling induced by hypertension and reduce the AF susceptibility by inhibiting RAS and NEP. The above effects of Sac/Val were superior to Val alone.
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Affiliation(s)
- Qian Li
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Yuan Fang
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - De-Wei Peng
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Lu-An Li
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Chun-Yu Deng
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Hui Yang
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Su-Juan Kuang
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Qiao-Qiao Li
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Meng-Zhen Zhang
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Peng Zeng
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Qian-Huan Zhang
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Yang Liu
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Hai Deng
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Wei Wei
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China
| | - Yu-Mei Xue
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China.
| | - Shu-Lin Wu
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China.
| | - Fang Rao
- Medical Research Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, PR China.
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Uemura T, Kondo H, Sato H, Takahashi M, Shinohara T, Mitarai K, Fukui A, Hirota K, Fukuda T, Kodama N, Miyoshi M, Ogawa N, Wada M, Yamasaki H, Iwanaga K, Uno A, Tawara K, Yonezu K, Akioka H, Teshima Y, Yufu K, Nakagawa M, Takahashi N. Predictors of outcome after catheter ablation for atrial fibrillation: Group analysis categorized by age and type of atrial fibrillation. Ann Noninvasive Electrocardiol 2023; 28:e13020. [PMID: 36527236 PMCID: PMC10023880 DOI: 10.1111/anec.13020] [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: 10/01/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The outcome of catheter ablation could probably differ among patients with atrial fibrillation (AF), depending on age and AF type. We aimed to investigate the difference in predictors of outcome after catheter ablation for AF among the patient categories divided by age and AF type. METHODS AND RESULTS A total of 396 patients with AF (mean age 65.69 ± 11.05 years, 111 women [28.0%]) who underwent catheter ablation from January 2018 to December 2019 were retrospectively analyzed. We divided the patients into four categories: patients with paroxysmal AF (PAF) or persistent AF (PeAF) who were 75 years or younger (≤75 years) or older than 75 years (>75 years). Kaplan-Meier survival analysis demonstrated that patients with PAF aged ≤75 years had the lowest AF recurrence among the four groups (log-rank test, p = .0103). In the patients with PAF aged ≤75 years (N = 186, 46.7%), significant factors associated with recurrence were female sex (p = .008) and diabetes (p = .042). In the patients with PeAF aged ≤75 years (N = 142, 35.9%), the only significant factor associated with no recurrence was medication with a renin-angiotensin system inhibitor (p = .044). In the patients with PAF aged >75 years (N = 53, 14.4%), diabetes was significantly associated with AF recurrence (p = .021). No significant parameters were found in the patients with PeAF aged >75 years (N = 15, 4.1%). CONCLUSIONS Our findings indicate that the risk factors for AF recurrence after catheter ablation differed by age and AF type.
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Affiliation(s)
- Tetsuya Uemura
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Masaki Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Kazuki Mitarai
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Kei Hirota
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Tomoko Fukuda
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Nozomi Kodama
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Miho Miyoshi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Naoko Ogawa
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Masato Wada
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Hirochika Yamasaki
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Kenzo Iwanaga
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Akihiro Uno
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Katsunori Tawara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
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5
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Middeldorp ME, Ariyaratnam JP, Kamsani SH, Albert CM, Sanders P. Hypertension and atrial fibrillation. J Hypertens 2022; 40:2337-2352. [PMID: 36204994 DOI: 10.1097/hjh.0000000000003278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertension is the most prevalent cardiovascular risk factor underlying atrial fibrillation and is present in up to 40% of patients with atrial fibrillation. Furthermore, attributable risk studies have shown that a history of hypertension contributes to up to 24% of incident atrial fibrillation. New data suggest that even early forms of hypertension (prehypertension and aortic stiffness) are associated with an increased risk of atrial fibrillation development. Hypertension and prehypertension are therefore critical mediators for the development of atrial fibrillation. Mechanisms for the association between hypertension and atrial fibrillation include diffuse electro-structural changes to the left atrium, driven by the haemodynamic and neurohormonal influences of hypertension and other, frequently coexisting, cardiovascular risk factors. Management of hypertension in atrial fibrillation should focus not only on blood pressure reduction but also on a comprehensive risk factor modification strategy. Such strategies have been shown to be associated with significant improvements in atrial fibrillation symptom burden as well as improved arrhythmia-free survival and reversal of the progression of atrial fibrillation. These strategies should focus on dietary modifications as well as prescribed exercise programmes involving a multidisciplinary team and patient-centred atrial fibrillation care. Risk factor management, supplemented by antihypertensive medications as needed, provides the optimum strategy for improving outcomes and even reversing the natural progression of atrial fibrillation in patients with hypertension.
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Affiliation(s)
- Melissa E Middeldorp
- Centre for Heart Rhythm Disorder, University of Adelaide and the Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Cardiology, Smidt Heart institute, Cedars Sinai Medical Center (CMA), Los Angeles, California, USA
| | - Jonathan P Ariyaratnam
- Centre for Heart Rhythm Disorder, University of Adelaide and the Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suraya H Kamsani
- Centre for Heart Rhythm Disorder, University of Adelaide and the Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christine M Albert
- Department of Cardiology, Smidt Heart institute, Cedars Sinai Medical Center (CMA), Los Angeles, California, USA
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorder, University of Adelaide and the Royal Adelaide Hospital, Adelaide, South Australia, Australia
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6
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Zhao J, Chen M, Zhuo C, Huang Y, Zheng L, Wang Q. The Effect of Renin-Angiotensin System Inhibitors on the Recurrence of Atrial Fibrillation After Catheter Ablation. Int Heart J 2020; 61:1174-1182. [PMID: 33191354 DOI: 10.1536/ihj.20-346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia. Renin-angiotensin system (RAS) inhibitors were reported to modify the arrhythmia substrate and reverse atrial remodeling. However, the role of RAS inhibitors on AF recurrence after catheter ablation remains much more controversial. In this study, a meta-analysis was performed to explore the effect of RAS inhibitors on AF recurrence after catheter ablation.We searched PubMed, Cochrane Library, EMBASE, and Web of Science for all articles published up to July 2019 on the effect of RAS inhibitors on AF recurrence rate after ablation. We used the random-effects model to estimate the odds ratios (ORs) and confidence intervals (CI). The I2 statistic was used to evaluate statistical heterogeneity. A two-tailed P value of <0.05 was considered statistically significant. Results were further analyzed by subgroup according to the type of study design.We included 13 studies, including 3661 patients with AF, in this analysis, of which 4 were randomized controlled trials (RCTs) and the others were cohort studies. Overall, treatment with RAS inhibitors showed a significant reduction of AF recurrence after catheter ablation (OR, 0.61; 95% CI, 0.45-0.82). Additionally, both the RCT (OR, 0.35; 95% CI, 0.24-0.49) and non-RCT (OR, 0.76; 95% CI, 0.57-1.00) groups demonstrated that RAS inhibitors could reduce the AF recurrence rate after catheter ablation in the subgroup analysis.Our meta-analysis suggests that RAS inhibitors had significant benefit in reducing the recurrence rate of AF after catheter ablation.
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Affiliation(s)
- Jianqiang Zhao
- Department of Cardiology and Atrial fibrillation Center, The First Affiliated Hospital of Zhejiang University
| | - Miao Chen
- Department of Cardiology and Atrial fibrillation Center, The First Affiliated Hospital of Zhejiang University
| | - Chengui Zhuo
- Department of Cardiology and Atrial fibrillation Center, The First Affiliated Hospital of Zhejiang University
| | - Yuan Huang
- Department of Cardiology and Atrial fibrillation Center, The First Affiliated Hospital of Zhejiang University
| | - Liangrong Zheng
- Department of Cardiology and Atrial fibrillation Center, The First Affiliated Hospital of Zhejiang University
| | - Qiqi Wang
- Department of Cardiology and Atrial fibrillation Center, The First Affiliated Hospital of Zhejiang University
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7
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Peng L, Li Z, Luo Y, Tang X, Shui X, Xie X, Zheng Z, Dong R, Liu J, Zhu J, Li S. Renin-Angiotensin System Inhibitors for the Prevention of Atrial Fibrillation Recurrence After Ablation - A Meta-Analysis. Circ J 2020; 84:1709-1717. [PMID: 32879151 DOI: 10.1253/circj.cj-20-0402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) recurrence remains a tricky problem in patients undergoing ablation. This meta-analysis aimed to summarize the current literature to clarify whether renin-angiotensin system inhibitors (RASIs) prevent AF recurrence after ablation.Methods and Results:Relevant studies were searched on Pubmed and EMBASE through December 2019. Pooled relative risk (RR) of AF recurrence was calculated. Subgroup analyses according to study design, race, and follow-up duration were further performed. A total of 15 studies examining 4,300 patients were included, with 3 randomized controlled trials and 12 cohort studies. Overall analysis showed that RASIs significantly reduced AF recurrence after ablation (RR=0.83; 95% confidence interval (CI) 0.70-0.98, P=0.028; I2=68.9%). Subgroup analysis further indicated that positive results were found in randomized controlled trials (RR=0.51, 95% CI 0.37-0.70, P<0.001; I2=4%), studies conducted in Asia (RR=0.59, 95% CI 0.46-0.76, P<0.001; I2=30.7%), and studies with follow-up duration ≥1 year (RR=0.82, 95% CI 0.70-0.95, P=0.01; I2=59.1%); negative results were found in cohort studies, studies conducted in Europe or the USA, and studies with follow-up duration <1 year. CONCLUSIONS RASIs can potentially prevent AF recurrence after ablation under selected conditions. However, more studies are required to confirm this finding due to the variation in current evidence.
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Affiliation(s)
- Long Peng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University.,Cardiac Electrophysiology Center, The Third Affiliated Hospital, Sun Yat-sen University
| | - Zexiong Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University
| | - Yanting Luo
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University.,Cardiac Electrophysiology Center, The Third Affiliated Hospital, Sun Yat-sen University
| | - Xixiang Tang
- VIP Medical Service Center, The Third Affiliated Hospital, Sun Yat-sen University
| | - Xing Shui
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University
| | - Xujing Xie
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University.,Cardiac Electrophysiology Center, The Third Affiliated Hospital, Sun Yat-sen University
| | - Zhenda Zheng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University.,Cardiac Electrophysiology Center, The Third Affiliated Hospital, Sun Yat-sen University
| | - Ruimin Dong
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University.,Cardiac Electrophysiology Center, The Third Affiliated Hospital, Sun Yat-sen University
| | - Jinlai Liu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University.,Cardiac Electrophysiology Center, The Third Affiliated Hospital, Sun Yat-sen University
| | - Jieming Zhu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University.,Cardiac Electrophysiology Center, The Third Affiliated Hospital, Sun Yat-sen University
| | - Suhua Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University.,Cardiac Electrophysiology Center, The Third Affiliated Hospital, Sun Yat-sen University
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8
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Park HS, Jeong DS, Yu HT, Pak HN, Shim J, Kim JY, Kim J, Lee JM, Kim KH, Roh SY, Cho YJ, Kim YH, Yoon NS. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part I. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Şerban RC, Scridon A. Data Linking Diabetes Mellitus and Atrial Fibrillation-How Strong Is the Evidence? From Epidemiology and Pathophysiology to Therapeutic Implications. Can J Cardiol 2018; 34:1492-1502. [PMID: 30404752 DOI: 10.1016/j.cjca.2018.08.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023] Open
Abstract
According to estimates, around 5% of the world population has hazel eyes. And there are about as many people with diabetes mellitus (DM). Red hair occurs naturally in up to 2% of the human population. And about as many people are estimated to have atrial fibrillation (AF). If a hazel eyed person with red hair does not surprise us, should a diabetic patient with AF? Accumulating epidemiologic data suggest, however, that the DM-AF association may be more than a simple coincidence. But, how strong is this evidence? Experimental studies bring evidence for a DM-induced atrial proarrhythmic remodelling. But how relevant are these data for the clinical setting? In this review, we aim to provide a critical analysis of the existing clinical and experimental, epidemiologic, and mechanistic data that bridge DM and AF, we emphasize a number of questions that remain to be answered, and we identify hotspots for future research. The therapeutic implications of the DM-AF coexistence are also discussed, with a focus on rhythm control and on conventional and DM-specific upstream therapies for AF management.
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Affiliation(s)
- Răzvan C Şerban
- Physiology Department, University of Medicine and Pharmacy of Târgu Mureş, Târgu Mureş, Romania; Laboratory of Cardiac Catheterization, Angiography and Electrophysiology, Emergency Institute for Cardiovascular Diseases and Transplantation, Târgu Mureş, Romania
| | - Alina Scridon
- Physiology Department, University of Medicine and Pharmacy of Târgu Mureş, Târgu Mureş, Romania.
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10
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Lorenzo N, Mendez I, Taibo M, Martinis G, Badia S, Reyes G, Aguilar R. Mid-Term Results of Surgical Treatment of Atrial Fibrillation in Valvular Heart Disease Assesed by Speckle Tracking Echocardiography. Arq Bras Cardiol 2018; 110:312-320. [PMID: 29561964 PMCID: PMC5941952 DOI: 10.5935/abc.20180040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/10/2017] [Indexed: 11/29/2022] Open
Abstract
Background Atrial fibrillation frequently affects patients with valvular heart disease.
Ablation of atrial fibrillation during valvular surgery is an alternative
for restoring sinus rhythm. Objectives This study aimed to evaluate mid-term results of successful atrial
fibrillation surgical ablation during valvular heart disease surgery, to
explore left atrium post-ablation mechanics and to identify predictors of
recurrence. Methods Fifty-three consecutive candidates were included. Eligibility criteria for
ablation included persistent atrial fibrillation <10 years and left
atrium diameter < 6.0 cm. Three months after surgery, echocardiogram,
24-hour Holter monitoring and electrocardiograms were performed in all
candidates who maintained sinus rhythm (44 patients). Echo-study included
left atrial deformation parameters (strain and strain rate), using
2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy
individuals (controls) were analyzed with the same protocol for left atrial
performance. Significance was considered with a P value of < 0.05. Results After a mean follow up of 17 ± 2 months, 13 new post-operative cases
of recurrent atrial fibrillation were identified. A total of 1,245 left
atrial segments were analysed. Left atrium was severely dilated in the
post-surgery group and, mechanical properties of left atrium did not recover
after surgery when compared with normal values. Left atrial volume (≥
64 mL/m2) was the only independent predictor of atrial
fibrillation recurrence (p = 0.03). Conclusions Left atrial volume was larger in patients with atrial fibrillation recurrence
and emerges as the main predictor of recurrences, thereby improving the
selection of candidates for this therapy; however, no differences were found
regarding myocardial deformation parameters. Despite electrical maintenance
of sinus rhythm, left atrium mechanics did not recover after atrial
fibrillation ablation performed during valvular heart disease surgery.
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Affiliation(s)
- Natalia Lorenzo
- Hospital Universitario Infanta Cristina, Parla, Madrid - Spain
| | - Irene Mendez
- Hospital Universitario de La Princesa, Madrid - Spain
| | - Mikel Taibo
- Hospital Universitario de La Princesa, Madrid - Spain
| | | | - Sara Badia
- Hospital Universitario de La Princesa, Madrid - Spain
| | | | - Rio Aguilar
- Hospital Universitario de La Princesa, Madrid - Spain
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11
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 708] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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12
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1370] [Impact Index Per Article: 195.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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14
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O'Neill L, Harrison J, O'Neill M, Williams SE. Clinical, electrophysiological and imaging predictors of atrial fibrillation ablation outcome. Expert Rev Cardiovasc Ther 2017; 15:289-305. [PMID: 28267401 DOI: 10.1080/14779072.2017.1303378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Significant technological advances for catheter ablation of atrial fibrillation (AF) have occurred over the last decade, with a consequent increase in numbers of patients referred for AF ablation worldwide. Despite this, long-term success rates, particularly in those with persistent AF, remain modest. The patient population presenting for AF ablation are heterogeneous with regard to age, type of AF and presence of associated cardiovascular disease. Improved understanding of factors predicting response to AF ablation may therefore help to improve patient selection for ablation procedures. Areas covered: This review outlines the clinical, electrophysiological and imaging predictors of response to radiofrequency ablation for AF in contemporary practice. Recently developed scoring systems incorporating these parameters are examined, as are factors identified thus far which may predict the outcome of cryoballoon ablation. Expert commentary: Traditional clinical factors associated with ablation outcomes serve as surrogates rather than direct measures of the underlying arrhythmia substrate. An improved understanding of this substrate could improve the prediction of response to radiofrequency ablation. Continued development of methods for characterising the arrhythmia substrate, including atrial cardiac magnetic resonance imaging and invasive voltage mapping, may inform patient risk assessment and help guide selection for catheter ablation on an increasingly individualistic basis.
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Affiliation(s)
- Louisa O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - James Harrison
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Mark O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Steven E Williams
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
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15
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Fluvastatin combined with benazepril may contribute to the favorable prognosis of patients with atrial fibrillation. Biomed Pharmacother 2016; 83:687-692. [PMID: 27470569 DOI: 10.1016/j.biopha.2016.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/01/2016] [Accepted: 07/18/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to observe the clinical efficacy of fluvastatin combined with benazepril in the treatment of patients with atrial fibrillation (AF). A total of 92 patients with AF were randomly assigned to the case group (n=46), in which the patients were treated with fluvastatin (80mg) plus benazepril (10mg), or to the control group (n=46), in which the patients were treated with fluvastatin (80mg). The conversion rate of sinus rhythm was higher in the case group than in the control group (P<0.05). The case group had more treatment-effective patients than the control group, with fewer treatment-ineffective patients (P<0.05). The LVEDd, LVESd, LAD, and LVEF indexes in the case group were lower than in the control group after 6 months of treatment (all P<0.05). Levels of hs-CRP were also lower in patients in the case group than in patients in the control group after 1 month of treatment (P<0.05). After 12 months, renin and Ang II concentrations were lower in patients in the case group than in the control group (both P<0.05). Significant differences in IL-6 and TNF-α expression were found between the two groups after 1 month, 6 months, and 12 months of treatment (all P<0.05). Compared to patients in the control group, the levels of total cholesterol (TC), triglycerides, and LDL-C in the case group were lower after 6 and 12 months of treatment (all P<0.05), while the HDL level was higher (P<0.05). Treatment with fluvastatin combined with benazepril further increased the conversion rate of sinus rhythm and significantly improved the quality of life and prognosis of AF patients.
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16
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Mohanty S, Mohanty P, Trivedi C, Gianni C, Bai R, Burkhardt JD, Gallinghouse JG, Horton R, Sanchez JE, Hranitzky PM, Al-Ahmad A, Bailey S, Di Biase L, Natale A. Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction. Heart Rhythm 2015; 12:1963-71. [DOI: 10.1016/j.hrthm.2015.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 01/12/2023]
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17
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Tadic M, Cuspidi C. Type 2 diabetes mellitus and atrial fibrillation: From mechanisms to clinical practice. Arch Cardiovasc Dis 2015; 108:269-76. [DOI: 10.1016/j.acvd.2015.01.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 01/15/2023]
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18
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Cui Y, Ma C, Long D, Wang L, Cao X, Zhang G. Effect of valsartan on atrial fibrillation recurrence following pulmonary vein isolation in patients. Exp Ther Med 2014; 9:631-635. [PMID: 25574246 PMCID: PMC4280931 DOI: 10.3892/etm.2014.2143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 12/04/2014] [Indexed: 01/13/2023] Open
Abstract
Pulmonary venous isolation has emerged as an effective therapy for atrial fibrillation (AF); however, AF recurrence is common. The aim of the present study was to investigate the effect of angiotensin receptor blockers (ARBs) on the recurrence rate of AF following ablation therapy. In total, 120 patients, who were scheduled for ablation, were randomly selected. The patients were randomly divided into three groups, which received treatment with a placebo (n=40), 80 mg valsartan daily (n=40) or with 160 mg valsartan daily (n=40). The demographic characteristics, comorbidities, AF type and information regarding treatment with ARBs were recorded and analyzed. Following a mean follow-up period of 13.8±8.6 months, 66.7% of patients were found to be free of AF. Kaplan-Meier analysis of the time until the first recurrence during the follow-up period revealed that patients treated with 160 mg/day valsartan presented a higher probability of remaining free of AF (88%, vs. 47% for the control and 65% for the 80 mg/day valsartan groups). In addition, multivariate analysis demonstrated that treatment with ARB was associated with lower AF recurrence rates (hazard ratio, 0.46; 95% confidence interval, 0.20–0.93] P=0.01). In conclusion, treatment with 160 mg/day valsartan markedly reduced the risk of recurrence of AF in a dose-dependent manner in AF patients following ablation.
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Affiliation(s)
- Yingkai Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Chao Yang, Beijing 100029, P.R. China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Chao Yang, Beijing 100029, P.R. China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Chao Yang, Beijing 100029, P.R. China
| | - Liping Wang
- Department of Cardiology, Geriatric Cardiovascular Disease Center of Chinese PLA, No. 252 Hospital of PLA, Baoding, Hebei 071000, P.R. China
| | - Xuebin Cao
- Department of Cardiology, Geriatric Cardiovascular Disease Center of Chinese PLA, No. 252 Hospital of PLA, Baoding, Hebei 071000, P.R. China
| | - Ghang Zhang
- Department of Cardiology, Geriatric Cardiovascular Disease Center of Chinese PLA, No. 252 Hospital of PLA, Baoding, Hebei 071000, P.R. China
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19
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Ullah W, McLean A, Hunter RJ, Baker V, Richmond L, Cantor EJ, Dhinoja MB, Sporton S, Earley MJ, Schilling RJ. Randomized trial comparing robotic to manual ablation for atrial fibrillation. Heart Rhythm 2014; 11:1862-9. [DOI: 10.1016/j.hrthm.2014.06.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Indexed: 11/30/2022]
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20
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Oliveira MM. How To Follow Atrial Fibrillation Ablation Patients? J Atr Fibrillation 2014; 7:1087. [PMID: 27957113 DOI: 10.4022/jafib.1087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 08/25/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022]
Abstract
Catheter ablation is an established treatment option for symptomatic atrial fibrillation (AF), with circumferential pulmonary vein isolation being considered the cornerstone of the procedure. However, this is a complex intervention with potential major complications and with common arrhythmia recurrences. There is consensus among experts that all patients should be seen in follow-up regularly after AF ablation. To date there are limited data regarding the best methodology for routine clinical follow-up of this population. This review summarizes a contemporary insight into management of late complications following AF ablation, post-procedural anticoagulation and arrhythmia monitoring strategies, in order to prevent thromboembolic events, detect and treat arrhythmia recurrences, and discuss the use of upstream therapies after AF ablation.
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Affiliation(s)
- Mário M Oliveira
- Pacing and Electrophysiology Department, Cardiology, Santa Marta HospitalLisbon, Portugal
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21
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Stabile G, Iuliano A, Agresta A, La Rocca V, D'Ascia S, De Simone A. Antiarrhythmic therapy following ablation of atrial fibrillation. Expert Rev Cardiovasc Ther 2014; 11:837-42. [PMID: 23895027 DOI: 10.1586/14779072.2013.811982] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antiarrhythmic drugs (AADs) are often used after ablation for atrial fibrillation (AF); the drugs employed vary, but most common are the drugs that were unsuccessful prior to ablation since it seems that the efficacy of AADs might substantially increase after catheter ablation of AF. AADs reduce early recurrences of atrial tachyarrhythmias after AF catheter ablation, whereas they did not prevent arrhythmia recurrences occurring later. Several upstream therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, corticosteroids and colchicine) have been tested with conflicting results. To date, there is no sufficient evidence to support the use of any upstream therapy after AF catheter ablation. Larger registries and controlled clinical trials in well-defined patient groups and with well-defined outcome parameters are required to further elucidate the role of AADs after AF ablation.
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Affiliation(s)
- Giuseppe Stabile
- Laboratorio di Elettrofisiologia, Clinica Mediterranea, Napoli, Italy.
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22
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Inoue K, Murakawa Y, Nogami A, Shoda M, Naito S, Kumagai K, Miyauchi Y, Yamane T, Morita N, Okumura K, on behalf of the Japanese Heart Rhythm Society Members. Current Status of Catheter Ablation for Atrial Fibrillation. Circ J 2014; 78:1112-20. [DOI: 10.1253/circj.cj-13-1179] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Mizonokuchi Hospital
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Morio Shoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | | | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine
| | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Ken Okumura
- Division of Cardiology, Hirosaki University Graduate School of Medicine
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23
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Rosen BD, Akoum N, Burgon N, Vergara G, Marrouche N, Bader F. Renin Angiotenin Blocker Pre-treatment and Recurrence After Pulmonary Vein Isolation in Patients with Paroxysmal and Persistent Atrial Fibrillation. J Atr Fibrillation 2013; 6:898. [PMID: 28496891 DOI: 10.4022/jafib.898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 09/02/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022]
Abstract
Introduction: Pulmonary venous isolation has emerged as an effective method for preventing atrial fibrillation (AF) recurrence. Yet, recurrence is common. Angiotensin-receptor-blockers (ARBs) and angiotensin-converting-enzyme-inhibitors (ACEI) are effective in reducing the extent of myocardial remodeling and fibrosis. Our aim was to study whether pretreatment with ARBs and ACEI was effective in decreasing recurrence after pulmonary vein isolation for patients with AF. Methods: Three hundred and twelve consecutive patients who underwent ablation from 12/2006 until 7/2010 were followed for at least one year. All patients underwent MRI before ablation to assess atrial fibrosis. Data include demographic characteristics, comorbidities, AF type and information regarding treatment with ACEI or ARBs. Results: Most patients were men (62%), mean age was 64. Hypertension (HTN) was present in 60%. Their mean ejection fraction was 60%. There were 104 patients (33.3%) treated with ACEI, and 13.5 % were treated with ARBs prior to ablation. Ninety seven patients (31.1%) had AF recurrence. AF type was a significant predictor for recurrence (recurrence with paroxysmal, persistent and long-standing persistent: 23.75, 37.3 and 60%, respectively, p=0.005). The most important factor predicting recurrence was increased pre-ablation atrial fibrosis (p<0.0001). Recurrence was more frequent in patients treated with ACEI (40.4% vs 26.4% untreated patients, p=0.012). In the ARB treated group, 38.1% vs 30.0% untreated experienced recurrence (p=0.3). After multivariable adjustment for demographics, risk factors and atrial fibrosis, treatment with ACEI was associated with increased rate of recurrence in patients with persistent AF (hazard ratio: 2.6, p=0.003). There was no significant relation between ACEI pretreatment and recurrence in patients with paroxysmal AF (HR- 0.83, p=0.7), or between ARB pre-treatment and recurrence in patients with paroxysmal as well as persistent AF (p=0.2 and 0.53, respectively). Conclusions: Pretreatment with ACEI or ARBs is not associated with reduced recurrence rate in patients with paroxysmal or persistent AF undergoing ablation.
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Affiliation(s)
- Boaz D Rosen
- Department of Medicine, Cardiology Division, University of Utah, Salt Lake City, UT.,Department of Medicine, Harbor Hospital, Baltimore, MD
| | - Nazem Akoum
- Department of Medicine, Cardiology Division, University of Utah, Salt Lake City, UT
| | - Nathan Burgon
- Department of Medicine, Cardiology Division, University of Utah, Salt Lake City, UT
| | - Gaston Vergara
- Department of Medicine, Cardiology Division, University of Utah, Salt Lake City, UT
| | - Nassir Marrouche
- Department of Medicine, Cardiology Division, University of Utah, Salt Lake City, UT
| | - Feras Bader
- Department of Medicine, Cardiology Division, University of Utah, Salt Lake City, UT
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Asghar O, Alam U, Hayat SA, Aghamohammadzadeh R, Heagerty AM, Malik RA. Diabetes, Obesity and Atrial Fibrillation: Epidemiology, Mechanisms and Interventions. J Atr Fibrillation 2013; 6:869. [PMID: 28496876 DOI: 10.4022/jafib.869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/21/2013] [Accepted: 05/26/2013] [Indexed: 01/19/2023]
Abstract
Body mass index (BMI) is a powerful predictor of death, type 2 diabetes (T2DM) and cardiovascular (CV) morbidity and mortality. Over the last few decades, we have witnessed a global rise in adult obesity of epidemic proportions. Similarly, there has been a parallel increase in the incidence of atrial fibrillation (AF), itself a significant cause of cardiovascular morbidity and mortality. This may be partly attributable to advances in the treatment of coronary heart disease (CHD) and heart failure (HF) improving life expectancy, however, epidemiological studies have demonstrated an independent association between obesity, diabetes and AF, suggesting possible common pathophysiological mechanisms and risk factors. Indeed, cardiac remodeling, haemodynamic alterations, autonomic dysfunction, and diastolic dysfunction have been reported in obese and diabetic cohorts. Moreover, diabetic cardiomyopathy is characterized by an adverse structural and functional cardiac phenotype, which may predispose to the development of AF. In this review, we discuss the pathophysiological and mechanistic relationships between obesity, diabetes and AF, and some of the challenges posed in the management of this high-risk group of individuals.
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Affiliation(s)
- O Asghar
- Division of Cardiovascular Sciences, The University of Manchester, UK
| | - U Alam
- Division of Cardiovascular Sciences, The University of Manchester, UK
| | - S A Hayat
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - A M Heagerty
- Division of Cardiovascular Sciences, The University of Manchester, UK
| | - R A Malik
- Division of Cardiovascular Sciences, The University of Manchester, UK
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Hogarth AJ, Dobson LE, Tayebjee MH. During ablation for atrial fibrillation, is simultaneous renal artery ablation appropriate? J Hum Hypertens 2013; 27:707-14. [PMID: 23945464 DOI: 10.1038/jhh.2013.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 01/12/2023]
Abstract
Over the past few decades, the mainstay of hypertension management has been pharmacological therapy; however, there is now a growing body of evidence that drug-resistant hypertension can be managed effectively by renal artery ablation. Several studies have documented the feasibility and safety of this treatment, although data regarding long-term outcomes are still emerging. Atrial fibrillation (AF) and hypertension commonly coexist, and recent work has demonstrated improved outcomes from catheter ablation of AF with concomitant renal artery denervation at little extra cost in terms of time and resource. The aim of this review is to explore the link between hypertension and AF, the synergistic effect of renal artery ablation on AF ablation, explain how this may work and address unanswered questions.
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Affiliation(s)
- A J Hogarth
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
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Asghar O, Alam U, Hayat SA, Aghamohammadzadeh R, Heagerty AM, Malik RA. Obesity, diabetes and atrial fibrillation; epidemiology, mechanisms and interventions. Curr Cardiol Rev 2013; 8:253-64. [PMID: 22920475 PMCID: PMC3492809 DOI: 10.2174/157340312803760749] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 04/28/2012] [Accepted: 05/11/2012] [Indexed: 02/08/2023] Open
Abstract
The last few decades have witnessed a global rise in adult obesity of epidemic proportions. The potential impact of this is emphasized when one considers that body mass index (BMI) is a powerful predictor of death, type 2 diabetes (T2DM) and cardiovascular (CV) morbidity and mortality [1, 2]. Similarly we have witnessed a parallel rise in the incidence of atrial fibrillation (AF), the commonest sustained cardiac arrhythmia, which is also a significant cause of cardiovascular morbidity and mortality. Part of this increase is attributable to advances in the treatment of coronary heart disease (CHD) and heart failure (HF) improving life expectancy and consequently the prevalence of AF. However, epidemiological studies have demonstrated an independent association between obesity and AF, possibly reflecting common pathophysiology and risk factors for both conditions. Indeed, weight gain and obesity are associated with structural and functional changes of the cardiovascular system including left atrial and ventricular remodeling, haemodynamic alterations, autonomic dysfunction, and diastolic dysfunction. Moreover, diabetic cardiomyopathy is characterized by an adverse structural and functional cardiac phenotype which may predispose to the development of AF [3]. In this review, we discuss the pathophysiological and mechanistic relationships between obesity, diabetes and AF, and the challenges posed in the management of this high-risk group of individuals.
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Affiliation(s)
- O Asghar
- Division of Cardiovascular Sciences, The University of Manchester, UK
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27
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Skála T. Follow-up of patients after catheter ablation of atrial fibrillation and their clinical management. COR ET VASA 2012. [DOI: 10.1016/j.crvasa.2012.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zhang XL, Wu LQ, Liu X, Yang YQ, Tan HW, Wang XH, Zhou L, Jiang WF, Li Z. Association of angiotensin-converting enzyme gene I/D and CYP11B2 gene -344T/C polymorphisms with lone atrial fibrillation and its recurrence after catheter ablation. Exp Ther Med 2012; 4:741-747. [PMID: 23170137 PMCID: PMC3501435 DOI: 10.3892/etm.2012.650] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 07/12/2012] [Indexed: 11/07/2022] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) plays a key role in atrial structural and electrical remodeling. The aim of this study was to investigate the potential associations of angiotensin-converting enzyme (ACE) gene insertion/ deletion (I/D) and aldosterone synthase (CYP11B2) gene −344T/C polymorphisms with the risk and recurrence of lone atrial fibrillation (AF). One hundred and ninety-three patients who underwent successful catheter ablation for lone AF were recruited. Two hundred and ninety-seven sinus rhythm subjects without a history of arrhythmia served as controls. The subjects were genotyped for ACE gene I/D and CYP11B2 gene −344T/C polymorphisms. Results showed that the ACE gene DD genotype and D allele were associated with a greater prevalence of lone AF (both P<0.01). In addition, the ACE gene DD genotype had a significantly larger left atrial dimension (LAD; 41.6±5.7 mm vs. 39.6±5.2 mm; P=0.043) and higher risk of AF recurrence [44.7% vs. 23.2%; odds ratio (OR), 2.68; 95% confidence interval (CI), 1.28–5.61; P=0.008] compared with the II+ID genotype in lone AF patients. After adjustment for a variety of risk factors, the ACE gene DD genotype had a 1.97-fold increased risk for lone AF (OR, 1.97; 95% CI, 1.15–3.37; P= 0.013) and 2.35-fold increased risk for AF recurrence (RR, 2.35; 95% CI, 1.10–5.04; P=0.028) compared with the ACE gene II+ID genotype. However, no correlation between the CYP11B2 gene −344T/C polymorphism and lone AF or its recurrence was observed in this cohort. In conclusion, the ACE gene DD genotype was associated with an increased incidence of lone AF and its recurrence following ablation, which was partly mediated by LAD.
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Affiliation(s)
- Xian-Ling Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine; ; Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University
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2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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Takigawa M, Yamada T, Yoshida Y, Ando M, Ishikawa K, Aoyama Y, Yamamoto T, Inoue N, Tatematsu Y, Nanasato M, Kato K, Tsuboi N, Hirayama H. Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium. J Renin Angiotensin Aldosterone Syst 2012; 13:487-95. [DOI: 10.1177/1470320312446212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, USA
| | - Yukihiko Yoshida
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Japan
| | - Monami Ando
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Japan
| | | | - Yutaka Aoyama
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Japan
| | - Natsuo Inoue
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Japan
| | | | - Mamoru Nanasato
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Japan
| | - Kazuo Kato
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Japan
| | - Naoya Tsuboi
- Cardiovascular Internal Medicine, Social Insurance Chukyo Hospital, Nagoya, Japan
| | - Haruo Hirayama
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Japan
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14:528-606. [PMID: 22389422 DOI: 10.1093/europace/eus027] [Citation(s) in RCA: 1144] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 2012; 9:632-696.e21. [PMID: 22386883 DOI: 10.1016/j.hrthm.2011.12.016] [Citation(s) in RCA: 1299] [Impact Index Per Article: 108.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Indexed: 12/20/2022]
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Goette A. Neutral effects of statins to prevent atrial fibrillation recurrences after catheter ablation of atrial fibrillation: Should we bury upstream therapy for secondary prevention of atrial fibrillation? Heart Rhythm 2012; 9:179-80. [DOI: 10.1016/j.hrthm.2011.09.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Indexed: 11/30/2022]
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Disertori M, Quintarelli S. Renin-Angiotensin System and AtrialFibrillation:Understanding the Connection. J Atr Fibrillation 2011; 4:398. [PMID: 28496706 DOI: 10.4022/jafib.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 09/19/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) arises as a result of a complex interaction of triggers, perpetuators and the substrate. The recurrence of AF may be partially related to a biologic phenomenon known as remodeling, in which the electrical, mechanical, and structural properties of the atrial tissue and cardiac cells are progressively altered,creating a more favorable substrate. Atrial remodeling is in part a consequence of arrhythmia itself. Therefore,to prevent and to treat AF, much attention has been directed to upstream therapies to alter the arrhythmia substrate and to reduce atrial remodeling. The renin-angiotensin-aldosterone system (RAAS) plays a keyrole in these strategies. In this review we analyze the experimental and clinical evidence regarding the efficacy of RAAS inhibitors in AF treatment. In the primary prevention of AF, meta-analyses have shown that risk of new-onset AF in patients with congestive heart failure and left ventricular dysfunction is reduced by RAAS inhibitors, whereas in hypertensive and post-myocardial infarction patients, the results are less evident. In the secondary prevention of AF, some large, prospective, randomized, placebo-controlled studieswith angiotensin II-receptor blockers returned negative results. Unfortunately, the approach of using RAASinhibitors as antiarrhythmic drugs to prevent both new-onset and recurrent AF is in decline because negativetrial results are accumulating, with the exception of the results in patients with congestive heart failure.
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Savelieva I, Kakouros N, Kourliouros A, Camm AJ. Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines. Part II: secondary prevention. Europace 2011; 13:610-25. [PMID: 21515595 DOI: 10.1093/europace/eur023] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fundamental research into molecular mechanisms of atrial fibrillation (AF) and improved understanding of processes involved in the initiation and maintenance of AF have transformed the traditional approach to its management by targeting only the electrical aspects, usually with antiarrhythmic drugs and, recently, by ablation. The antiarrhythmic potential of upstream therapies, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers (ARBs), statins, and n-3 (ω-3) polyunsaturated fatty acids, extends beyond the benefit of treating underlying heart disease to modifying the atrial substrate and intervening in specific mechanisms of AF. The key target is structural remodelling of the atria, particularly inflammation and fibrosis, although there is evidence to suggest the direct involvement at the ion channel level. Positive clinical reports supported by robust experimental data have suggested that upstream therapies can be valuable strategies for primary prevention of AF in selected patients and have resulted in several class IIA recommendations in the new European guidelines on AF. However, these results have not been consistently replicated in the secondary prevention setting, and several recent randomized controlled studies failed to demonstrate any effect of upstream therapies on AF burden or on major cardiovascular outcomes. Part II of the review summarizes the evidence base for the use of upstream therapies for secondary prevention of AF.
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Affiliation(s)
- Irene Savelieva
- Division of Cardiac and Vascular Sciences, St George's University of London, London SW17 0RE, UK.
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KHAYKIN YAARIV, OOSTHUIZEN RICHARD, ZARNETT LAUREN, ESSEBAG VIDAL, PARKASH RATIKA, SEABROOK CATHERINE, BEARDSALL MARIANNE, TSANG BERNICE, WULFFHART ZAEV, VERMA ATUL. Clinical Predictors of Arrhythmia Recurrences Following Pulmonary Vein Antrum Isolation for Atrial Fibrillation: Predicting Arrhythmia Recurrence Post-PVAI. J Cardiovasc Electrophysiol 2011; 22:1206-14. [DOI: 10.1111/j.1540-8167.2011.02108.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Savelieva I, Camm AJ. Upstream therapies after pulmonary vein ablation: five negative studies--what's next? Europace 2010; 12:1509-13. [DOI: 10.1093/europace/euq402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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