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Kotlyarov S, Lyubavin A. Early Detection of Atrial Fibrillation in Chronic Obstructive Pulmonary Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:352. [PMID: 38541078 PMCID: PMC10972327 DOI: 10.3390/medicina60030352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 09/13/2024]
Abstract
Atrial fibrillation (AF) is an important medical problem, as it significantly affects patients' quality of life and prognosis. AF often complicates the course of chronic obstructive pulmonary disease (COPD), a widespread disease with heavy economic and social burdens. A growing body of evidence suggests multiple links between COPD and AF. This review considers the common pathogenetic mechanisms (chronic hypoxia, persistent inflammation, endothelial dysfunction, and myocardial remodeling) of these diseases and describes the main risk factors for the development of AF in patients with COPD. The most effective models based on clinical, laboratory, and functional indices are also described, which enable the identification of patients suffering from COPD with a high risk of AF development. Thus, AF in COPD patients is a frequent problem, and the search for new tools to identify patients at a high risk of AF among COPD patients remains an urgent medical problem.
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Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia
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2
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Guan F, Saguner AM, Breitenstein A, Wang M, Molitor N, Brunckhorst C, Wolber T, Duru F. The effect of first step right atrial mapping (FRAM) on ablation duration and fluoroscopy exposure during cavotricuspid isthmus ablation of atrial flutter. Front Cardiovasc Med 2023; 10:1205966. [PMID: 37346289 PMCID: PMC10279846 DOI: 10.3389/fcvm.2023.1205966] [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: 04/14/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Aim To investigate the clinical significance of right atrial mapping prior to cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL). Methods Clinical and ablation parameters were retrospectively assessed and compared in patients undergoing CTI ablation with or without a first-step right atrial mapping (FRAM) by using the CARTO 3D mapping system. Results CTI block by radiofrequency ablation (RFA) was achieved in all 143 patients. In the FRAM group there was a shorter ablation duration and fluoroscopy exposure compared with the non-FRAM group. CHA2DS2-VASc score was associated with higher ablation durations, more ablation applications and increased fluoroscopy exposure. Body mass index (BMI) was associated with longer ablation duration and more ablation applications. Furthermore, patients with reduced left ventricular ejection fraction (LVEF) had longer ablation durations and more fluoroscopy exposure. One patient in the non-FRAM group developed cardiac effusion after ablation. None of the patients had recurrence after 6 months of follow-up. Conclusions Patients with high BMI, high CHA2DS2-VASc score and reduced LVEF may benefit from the FRAM approach by reducing ablation duration, number of ablation applications and fluoroscopy exposure.
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Affiliation(s)
- Fu Guan
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M. Saguner
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Schlieren, Switzerland
| | - Alexander Breitenstein
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Mia Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Nadine Molitor
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Corinna Brunckhorst
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Wolber
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Firat Duru
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Schlieren, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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3
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Parikh RR, Norby FL, Wang W, Thenappan T, Prins KW, Van't Hof JR, Lutsey PL, Solomon SD, Shah AM, Chen LY. Association of Right Ventricular Afterload With Atrial Fibrillation Risk in Older Adults: The Atherosclerosis Risk in Communities Study. Chest 2022; 162:884-893. [PMID: 35562059 PMCID: PMC9659616 DOI: 10.1016/j.chest.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is widely perceived to originate from the left atrium (LA). Whether increases in right ventricular (RV) afterload in older adults play an etiological role in AF genesis independent of LA and left ventricular (LV) remodeling is unknown. RESEARCH QUESTION Is higher RV afterload associated with greater AF risk independent of LA and LV remodeling? STUDY DESIGN AND METHODS In this observational prospective study, we included 2,246 community-dwelling older adults (mean age, 75 years) without known cardiovascular disease, with LV ejection fraction > 50%, LA volume index < 34 mL/m2, and E/e' ratio < 14 and a measurable functional tricuspid regurgitation jet velocity. From 2D-echocardiograms, we estimated pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR). We ascertained incident AF (through 2018) from hospital discharge codes and death certificates. We estimated hazard ratios (HR) by Cox regression. RESULTS During follow-up (median, 6.3 years; interquartile interval, 5.5-6.9 years), 215 participants developed AF. AF risk was significantly higher in the third (vs first) tertile of PASP (HR, 1.65; 95% CI, 1.08-2.54) and PVR (HR, 1.38; 95% CI, 1.00-2.08) independent of LA and LV structure and function, heart rate, BMI, prevalent sleep apnea, systemic BP, antihypertensive medications, and lung, kidney, and thyroid function. These associations persisted after further exclusion of participants with tricuspid regurgitation jet velocity > 2.8 m/s and lateral and septal mitral annular velocity above age- and sex-specific reference limits. INTERPRETATION In older adults, higher RV afterload is associated with greater AF risk independent of LA and LV remodeling. Future research should focus on confirming this novel association and elucidate underlying mechanisms.
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Affiliation(s)
- Romil R Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Thenappan Thenappan
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Kurt W Prins
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Jeremy R Van't Hof
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
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4
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Compagnucci P, Casella M, Bagliani G, Capestro A, Volpato G, Valeri Y, Cipolletta L, Parisi Q, Molini S, Misiani A, Russo AD. Atrial Flutter in Particular Patient Populations. Card Electrophysiol Clin 2022; 14:517-532. [PMID: 36153131 DOI: 10.1016/j.ccep.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
"Despite being one of the best understood cardiac arrhythmias, the clinical meaning of atrial flutter varies according to the specific context, and its optimal treatment may be limited by both the suboptimal response to rate/rhythm control drugs and by the complexity of the underlying substrate. In this article, we present a state-of-the-art overview of mechanisms, prognostic impact, and medical/interventional management options for atrial flutter in several specific patient populations, including heart failure, cardiomyopathies, muscular dystrophies, posttransplant patients, patients with respiratory disorders, athletes, and subjects with preexcitation, aiming to stimulate further research in this challenging field and facilitate appropriate patient care."
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Alessandro Capestro
- Department of Pediatric and Congenital Cardiology and Cardiac Surgery, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Quintino Parisi
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Silvano Molini
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Agostino Misiani
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
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5
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Lang RM, Cameli M, Sade LE, Faletra FF, Fortuni F, Rossi A, Soulat-Dufour L. Imaging assessment of the right atrium: anatomy and function. Eur Heart J Cardiovasc Imaging 2022; 23:867-884. [PMID: 35079782 DOI: 10.1093/ehjci/jeac011] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.
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Affiliation(s)
- Roberto M Lang
- Heart and Vascular Center, University of Chicago, 5758 S Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Leila E Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Cardiology, University of Baskent, Ankara, Turkey
| | | | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexia Rossi
- Department of Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Zurich, Switzerland
| | - Laurie Soulat-Dufour
- Saint Antoine and Tenon Hospital, AP-HP, Pr Ariel Cohen, Sorbonne Université, INSERM, Unité de recherche sur les maladies cardiovasculaires, le métabolisme et la nutrition, ICAN, Paris F-75013, France
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6
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Chen K, Tanner M, Thomason JD. ECG of the Month. J Am Vet Med Assoc 2022; 260:1641-1643. [PMID: 35560127 DOI: 10.2460/javma.21.04.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kaiwen Chen
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Matthew Tanner
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Justin D. Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
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7
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Moving Beyond 'Fib/Flutter'. Am J Med 2022; 135:191-193. [PMID: 34508705 DOI: 10.1016/j.amjmed.2021.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/17/2021] [Accepted: 07/30/2021] [Indexed: 11/20/2022]
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8
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Simons SO, Elliott A, Sastry M, Hendriks JM, Arzt M, Rienstra M, Kalman JM, Heidbuchel H, Nattel S, Wesseling G, Schotten U, van Gelder IC, Franssen FME, Sanders P, Crijns HJGM, Linz D. Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective. Eur Heart J 2021; 42:532-540. [PMID: 33206945 DOI: 10.1093/eurheartj/ehaa822] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/12/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is highly prevalent among patients with atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of COPD in AF patients is high and is estimated to be ∼25%. Diagnosis and treatment of COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and fatigue. Routine evaluation of lung function and determination of natriuretic peptides and echocardiography may be reasonable to detect COPD and heart failure as contributing causes of dyspnoea. Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy. However, it remains unclear whether treatment of COPD improves AF outcomes and which metric should be used to determine COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, the benefits of treatment of either COPD or AF in this population, and to clarify the need and cost-effectiveness of routine COPD screening.
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Affiliation(s)
- Sami O Simons
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Division of Respiratory & Age-related Health, Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - Adrian Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia
| | - Manuel Sastry
- Academic Sleep Centre CIRO, Hornerheide 1, 6085 NM Horn, the Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia.,Institute of Health, Medicine and Caring Sciences, Linköping University, Campus US, SE 581 83 Linköping, Sweden.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, SA 5001 Adelaide, Australia
| | - Michael Arzt
- Department of Internal Medicine II, Centre of Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Grattan St Parkville, 3050 Melbourne, Australia
| | - Hein Heidbuchel
- University of Antwerp and Antwerp University Hospital, Drie Eikenstraat 655, 2650 Antwerp, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, 5000 Rue Bélanger, QC H1T 1C8, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, 3649 Promenade Sir-William-Osler, QC H3A 1A3, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Geertjan Wesseling
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Ulrich Schotten
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Division of Respiratory & Age-related Health, Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.,Academic Sleep Centre CIRO, Hornerheide 1, 6085 NM Horn, the Netherlands
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia
| | - Harry J G M Crijns
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia.,University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Denmark
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9
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Ebner B, Grant J, Vincent L, Maning J, Olorunfemi O, Olarte N, Colombo R, Lambrakos L, Mendoza I. Comparison of in-hospital outcomes of patients undergoing catheter ablation for typical versus atypical atrial flutter. J Interv Card Electrophysiol 2021; 63:295-302. [PMID: 33770337 DOI: 10.1007/s10840-021-00982-4] [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: 01/17/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Catheter ablation (CA) is indicated as definitive therapy for patients with either typical or atypical atrial flutter (TAFlutter and AAFlutter, respectively) which is unresponsive to medical therapy. There is a paucity of data regarding in-hospital outcomes of patients undergoing CA. METHODS Retrospective study using the NIS to identify patients ≥18 years who underwent CA between 2015 and 2017. Individuals were identified using ICD-10-CM/PCS for TAFlutter, AAFlutter, and CA. RESULTS A total of 17,390 patients underwent CA for Aflutter (33% AAFlutter and 67% TAFlutter). The TAFlutter group was younger (mean 65.9 years vs. 67.2 years), with less females (30% vs. 43%, p ≤ 0.001 for both) compared to the AAFlutter group. The TAFlutter group had a higher rate of diabetes, tobacco use, obesity, and chronic obstructive pulmonary disease (p ≤ 0.001 for all). The AAFlutter cohort had increased prior strokes and atrial fibrillation (p ≤ 0.001 for both). The mean CHA2DS2-VASc score was found to be 2.3 in AAFlutter compared to 2.1 in TAFlutter (p ≤ 0.001). There were significantly higher proportions of thromboembolic events, transfusions, and longer length of stay in the TAFlutter group (p ≤ 0.001 for all) with the AAFlutter group having significantly higher rates of cardioversion, implantation of cardiac devices, and increased hospital charges (p ≤ 0.001 for all); no significant difference was found in mortality after controlling for comorbidities. CONCLUSIONS We found higher complication rates in CA for patients with TAFlutter, but no difference in in-hospital all-cause mortality. Variation in CA depending upon the mechanism of AFlutter may underlie these differences, and warrant further study.
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Affiliation(s)
- Bertrand Ebner
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA.
| | - Jelani Grant
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Louis Vincent
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Jennifer Maning
- Department of Internal Medicine, University of Miami Hospital Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Odunayo Olorunfemi
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neal Olarte
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rosario Colombo
- Cardiovascular Division, Jackson Memorial Hospital, Miami, FL, USA
| | - Litsa Lambrakos
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivan Mendoza
- Cardiovascular Division, Jackson Memorial Hospital, Miami, FL, USA
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10
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Influence of Chronic Obstructive Pulmonary Disease on Atrial Mechanics by Speckle Tracking Echocardiography in Patients With Atrial Fibrillation. Am J Cardiol 2021; 143:60-66. [PMID: 33359195 DOI: 10.1016/j.amjcard.2020.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023]
Abstract
The present study aimed to examine differences in left- and right atrial characteristics between atrial fibrillation (AF) patients with and without chronic obstructive pulmonary disease (COPD). For this, 420 patients (mean age 68 ± 10 years, 73% female) with first diagnosis of AF and baseline echocardiography were included. Of these, 143 COPD patients were compared with 277 patients without COPD matched by age, gender and body surface area. Additionally 38 healthy controls without cardiovascular risk factors, matched for age, were included. For all 3 groups, left atrial (LA) volumes and diameter, LA reservoir strain (LASr), left ventricular ejection fraction (LVEF), right atrial (RA) area and diameter, RA reservoir strain (RASr) and tricuspid annular plane systolic excursion were evaluated on transthoracic echocardiography. Baseline characteristics were similar in patients with and without COPD except for smoking and a history of heart failure (42% vs 11%, p < 0.001 and 48% vs 37%, p = 0.036 for COPD and non-COPD patients, respectively). Also, COPD patients less often used β-blockers (63% vs 75%, p = 0.017). There were no significant differences in LVEF, LA volume and RA area between COPD and non-COPD patients. Compared to the controls, AF patients had impaired LVEF, LASr and RASr. Only RASr was significantly worse in COPD patients as compared to non-COPD patients (15.3% [9.0 to 25.1] vs 19.6% [11.8 to 28.5], p = 0.013). Additionally, a trend towards worse RASr was observed with increasing COPD severity. In conclusion, AF patients with concomitant COPD have more impaired RA function compared to patients without COPD but with similar atrial size and LA function.
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11
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Bai Y, Zhao Y, Li J, Zhang Y, Bai R, Du X, Dong JZ, He YH, Ma CS. Association of peak atrial longitudinal strain with atrial fibrillation recurrence in patients with chronic lung diseases following radiofrequency ablation. Intern Med J 2018; 48:851-859. [PMID: 29460463 DOI: 10.1111/imj.13768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Strain was shown associated with atrial fibrillation (AF) recurrence after radiofrequency ablation (RFA), but data on AF patients complicated with chronic lung diseases (CLD) were rare. AIM This study was designed to evaluate the relationship of baseline atrial function with AF recurrence in these patients using speckle-tracking echocardiography. METHODS Average strain values (median: 2 days before RFA) were calculated for 87 AF patients (Mean age: 61.91 years, male: 71.26%) with CLD undergoing RFA from 2013 to 2014. Of these patients, 25 (28.74%) experienced AF recurrence during a mean follow up of 10.3 months. RESULTS Peak right atrial longitudinal strain (R-PALS) was associated with peak left atrial longitudinal strain (L-PALS, Standardised β = 0.45, P < 0.001) in multivariate linear regression. Multivariate Cox regression analysis showed R-PALS was associated with AF recurrence (hazard ratio, 0.86; 95% confidence interval (CI), 0.78-0.96, P = 0.005) in CLD. Patients with R-PALS ≥14.69% had higher AF free rate compared with R-PALS<14.69% using Kaplan-Meier analysis (log-rank, P < 0.001). R-PALS had similar C-index compared to L-PALS (difference: 0.03, 95%CI: -0.06-0.12, P = 0.53) and combined R-PALS and L-PALS (difference: 0.005, 95%CI: -0.04-0.05, P = 0.84) associated with AF recurrence in CLD. CONCLUSION R-PALS, L-PALS and combined R-PALS and L-PALS are important factors associated with AF recurrence following RFA in patients with CLD.
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Affiliation(s)
- Ying Bai
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Zhao
- Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Li
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yi-Hua He
- Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chang-Sheng Ma
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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12
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Corlateanu A, Covantev S, Mathioudakis AG, Botnaru V, Cazzola M, Siafakas N. Chronic Obstructive Pulmonary Disease and Stroke. COPD 2018; 15:405-413. [PMID: 29746193 DOI: 10.1080/15412555.2018.1464551] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world and its incidence and prevalence is on the rise. It is evident that COPD is linked to cardiovascular disease. In the last years, several studies demonstrated that COPD may also be a risk factor for stroke, another major cause of death worldwide. Taking in consideration that COPD has multiple comorbidities it is hard to say whether COPD is an independent risk factor for stroke or it is due to confounding effect. This review is aimed to discuss current data on COPD and stroke, potential links, therapy, and prevention. Current data suggest that COPD may increase the risk of hemorrhagic stroke. The incidence of other stroke subtypes may also be increased in COPD or may be due to confounding effect. However, COPD patients who have stroke are at risk for pulmonary and extrapulmonary complications. We conclude that more studies are needed to further clarify the links between COPD and stroke. The management of COPD as well as the use of prevention therapy is essential to decrease the risk for stroke and should be at special attention in pulmonary medicine and neurology.
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Affiliation(s)
- Alexandru Corlateanu
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | - Serghei Covantev
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | | | - Victor Botnaru
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | - Mario Cazzola
- c Department of Systems Medicine , Università degli Studi di Roma "Tor Vergata," Rome , Italy
| | - Nikolaos Siafakas
- d University General Hospital , Department of Thoracic Medicine, Stavrakia , Heraklion , Greece
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Chen X, Lin M, Wang W. The progression in atrial fibrillation patients with COPD: a systematic review and meta-analysis. Oncotarget 2017; 8:102420-102427. [PMID: 29254257 PMCID: PMC5731967 DOI: 10.18632/oncotarget.22092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/22/2017] [Indexed: 02/05/2023] Open
Abstract
AIM Chronic Obstructive Pulmonary Disease (COPD) and atrial fibrillation (AF) share pathophysiological links, as supported by the high prevalence of AF within COPD patients. AF progression and recurrence can increase the risks of mortality, morbidity and adverse cardiovascular events. The present systematic review and meta-analysis aims to assess the risk for AF progression and recurrence for COPD patients, to further demonstrate the risk of COPD in AF patients. METHODS AND RESULTS A systematic review was conducted in MEDLINE / PubMed and Cochrane Library and Embase, Web of science. Prospective studies including AF patients with COPD were screened and included if matching inclusion and exclusion criteria. 7 studies were included, adding up to 10761 AF patients (1556 with AF and COPD, 9205 without COPD). Mean age from each study ranged from 51 to 81 years, and 57.2% were male. Hypertension accounted for 75.5% of the population, and 20.7% had the comorbidity of diabetes mellitus. The pool analysis showed that COPD could promote AF progression (OR = 1.90; 95% CI, 1.34-2.68, I2 = 77%, p = 0.0003). For subgroup analysis, we found that COPD could increase the risk of AF recurrence (OR = 2.35; 95% CI, 1.86-2.97, I2 = 0%, p = 0.39). Besides, in the younger group, at the median age of 64, COPD was still a risk factor for AF progression (OR = 2.22; 95% CI, 1.80-2.74, I2 = 0%, p = 0.69). CONCLUSIONS COPD is an independent risk for AF progression and recurrence, COPD patients with AF carry a worse prognosis than those in sinus rhythm (SR).
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Affiliation(s)
- Xiaoying Chen
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong, 515000, China
| | - Meiling Lin
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong, 515000, China
- Department of Cardiology, The First Affiliate Hospital of Shantou University Medical College, Guangdong, 515000, China
| | - Wei Wang
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong, 515000, China
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14
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Chen DY, Lin CH, Chen YM, Chen HH. Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study. PLoS One 2016; 11:e0165601. [PMID: 27798703 PMCID: PMC5087888 DOI: 10.1371/journal.pone.0165601] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/15/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the risk of atrial fibrillation or atrial flutter in patients with periodontitis (PD) in comparison with individuals without PD. METHODS We used the 1999-2010 Taiwanese National Health Insurance Research Database to identify cases of PD in the year 2000 matching (1:1) with persons without PD during 1999-2000 according to sex and individual age as the control group. Using Cox proportional regression analysis adjusting for potential confounders, including age, sex, and comorbidities at baseline, and average annual number of ambulatory visits and dental scaling frequency during the follow-up period, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to examine the risk of atrial fibrillation or flutter in PD patients in comparison with the control group. Subgroup analyses according to age, gender, or comorbidities were conducted to study the robustness of the association and investigate possible interaction effects. RESULTS We enrolled 393,745 patients with PD and 393,745 non-PD individuals. The incidence rates of atrial fibrillation or flutter were 200 per 105 years among the PD group and 181 per 105 years in the non-PD group (incidence rate ratio, 1.10; 95% CI, 1.06-1.14). After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% CI, 1.25-1.36). The greater risk of atrial fibrillation or flutter in the PD group remained significant across all disease subgroups except hyperthyroidism and sleep apnea. CONCLUSION The present study results indicate an increased risk of atrial fibrillation or flutter in patients with PD. Lack of individual information about alcohol consumption, obesity, and tobacco use was a major limitation.
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Affiliation(s)
- Der-Yuan Chen
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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15
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Hayashi T, Fukamizu S, Mitsuhashi T, Kitamura T, Aoyama Y, Hojo R, Sugawara Y, Sakurada H, Hiraoka M, Fujita H, Momomura SI. Peri-Mitral Atrial Tachycardia Using the Marshall Bundle Epicardial Connections. JACC Clin Electrophysiol 2016; 2:27-35. [DOI: 10.1016/j.jacep.2015.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
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16
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Goudis CA, Konstantinidis AK, Ntalas IV, Korantzopoulos P. Electrocardiographic abnormalities and cardiac arrhythmias in chronic obstructive pulmonary disease. Int J Cardiol 2015. [DOI: 10.1016/j.ijcard.2015.06.096] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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17
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Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for approaching the therapeutic options of the COPD patient afflicted by comorbidity.
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Affiliation(s)
- Georgios Hillas
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | - Fotis Perlikos
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | - Ioanna Tsiligianni
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
- Department of General Practice, University Medical Centre of Groningen, Groningen, The Netherlands
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
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18
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Huang B, Yang Y. Radiofrequency catheter ablation of atrial fibrillation in patients with chronic obstructive pulmonary disease: opportunity and challenge: response to Dr. Kumar's comment. J Am Med Dir Assoc 2014; 16:83-4. [PMID: 25444574 DOI: 10.1016/j.jamda.2014.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/23/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Bi Huang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yanmin Yang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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