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Okazaki RA, Flashner LC, Kinlay S, Peralta AO, Hoffmeister PS, Yarmohammadi H, Joseph J, Yuyun MF. Catheter Ablation for Atrial Fibrillation in Patients with Significant Mitral Regurgitation: A Systematic Review and Meta-Analysis. Heart Rhythm 2024:S1547-5271(24)03087-X. [PMID: 39094723 DOI: 10.1016/j.hrthm.2024.07.110] [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: 06/11/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is commonly associated with cardiac structural abnormalities including mitral regurgitation (MR). Contemporary guidelines recommend consideration of early rhythm control strategies including catheter ablation (CA) for AF. However, the long-term efficacy of CA is highly variable across studies and patient populations, and the effect of coexisting MR on AF recurrence remains unclear. OBJECTIVES Determine the impact of significant MR defined as ≥ moderate on AF recurrence rate following CA, and whether CA for AF is associated with significant changes in the severity of MR. METHODS A systematic search of PubMed, EMBASE, Web of Science, and Cochrane databases for all English-language studies published till December 31, 2023 was performed. RESULTS A total of 17 studies (N= 2624 patients) were retained for meta-analysis. The pooled recurrence proportion of AF post-CA in patients with baseline significant MR was 36% (95% CI 27 %-46%), compared to 27% (14%-41%) in patients without. The pooled hazard ratio (95% CI) for AF recurrence after CA in the presence of significant MR was 2.47 (1.52 - 4.01), p <0.001, Egger's test p-value =0.0583. The pooled proportion of patients who witnessed MR improvement to non-significant (i.e. CONCLUSIONS Baseline significant MR was independently predictive of AF recurrence rate post-CA. Despite the increased AF recurrence rates post-CA associated with significant MR, CA with maintenance of sinus rhythm appeared to improve the severity of MR suggesting a possible induction of reverse positive atrial and mitral valvular remodeling.
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Affiliation(s)
- Ross A Okazaki
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Lillian C Flashner
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Scott Kinlay
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA; VA Boston Healthcare System, Boston, USA; Harvard Medical School, Boston, USA; Brigham and Women's Hospital, Boston, USA
| | - Adelqui O Peralta
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA; VA Boston Healthcare System, Boston, USA; Harvard Medical School, Boston, USA
| | - Peter S Hoffmeister
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA; VA Boston Healthcare System, Boston, USA; Harvard Medical School, Boston, USA
| | | | - Jacob Joseph
- Brown University, Providence, Rhode Island, USA; VA Providence Healthcare System, Providence, Rhode Island, USA
| | - Matthew F Yuyun
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA; VA Boston Healthcare System, Boston, USA; Harvard Medical School, Boston, USA.
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2
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Bshennaty A, Vogl BJ, Bavo AM, Sularz A, Kramer AD, Jia Y, De Beule M, Nielsen-Kudsk JE, De Backer O, Alkhouli M, Hatoum H. Understanding the role of the left atrial appendage on the flow in the atrium. Catheter Cardiovasc Interv 2024. [PMID: 39033333 DOI: 10.1002/ccd.31153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The exclusion/occlusion of the left atrial appendage (LAA) is a treatment option for atrial fibrillation (AF) patients who are at high risk of stroke and high risk of bleeding. As the role of the LAA is not well understood or explored, this study aims to assess its role on flow dynamics in the left atrium. METHODS Computational fluid dynamics (CFD) simulations were carried out for nine AF patients before and after LAA exclusion. The flow parameters investigated included the LA velocities, Time Averaged Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI), Relative Residence Time (RRT), and Pressure in the LA. RESULTS This study shows that, on average, a decrease in TAWSS (1.82 ± 1.85 Pa to 1.27 ± 0.96 Pa, p < 0.05) and a slight increase in OSI (0.16 ± 0.10 to 0.17 ± 0.10, p < 0.05), RRT (1.87 ± 1.84 Pa-1 to 2.11 ± 1.78 Pa-1, p < 0.05), and pressure (-19.2 ± 6.8 mmHg to -15.3 ± 8.3 mmHg, p < 0.05) were observed in the LA after the exclusion of the LAA, with a decrease in low-magnitude velocities. CONCLUSION The exclusion of the LAA seems to be associated with changes in LA flow dynamics. Further studies are needed to elucidate the clinical implications of these changes.
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Affiliation(s)
- Ahmad Bshennaty
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
| | - Brennan J Vogl
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
| | | | - Agata Sularz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Yuheng Jia
- Department of Cardiology, Copenhagen University Hospital, Denmark
| | | | | | - Ole De Backer
- Department of Cardiology, Copenhagen University Hospital, Denmark
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
- Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybersystems, Michigan Technological University, Houghton, Michigan, USA
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3
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Zhu N, Li T, Bai Y, Sun J, Guo J, Yuan H, Shan Z. Targeting myocardial inflammation: investigating the therapeutic potential of atrial natriuretic peptide in atrial fibrosis. Mol Biol Rep 2024; 51:506. [PMID: 38622341 PMCID: PMC11018689 DOI: 10.1007/s11033-024-09393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Atrial Fibrillation (AF), a prevalent arrhythmic condition, is intricately associated with atrial fibrosis, a major pathological contributor. Central to the development of atrial fibrosis is myocardial inflammation. This study focuses on Atrial Natriuretic Peptide (ANP) and its role in mitigating atrial fibrosis, aiming to elucidate the specific mechanisms by which ANP exerts its effects, with an emphasis on fibroblast dynamics. METHODS AND RESULTS The study involved forty Sprague-Dawley rats, divided into four groups: control, Angiotensin II (Ang II), Ang II + ANP, and ANP only. The administration of 1 µg/kg/min Ang II was given to Ang II and Ang II + ANP groups, while both Ang II + ANP and ANP groups received 0.1 µg/kg/min ANP intravenously for a duration of 14 days. Cardiac fibroblasts were used for in vitro validation of the proposed mechanisms. The study observed that rats in the Ang II and Ang II + ANP groups showed an increase in blood pressure and a decrease in body weight, more pronounced in the Ang II group. Diastolic dysfunction, a characteristic of the Ang II group, was alleviated by ANP. Additionally, ANP significantly reduced Ang II-induced atrial fibrosis, myofibroblast proliferation, collagen overexpression, macrophage infiltration, and the elevated expression of Interleukin 6 (IL-6) and Tenascin-C (TN-C). Transcriptomic sequencing indicated enhanced PI3K/Akt signaling in the Ang II group. Furthermore, in vitro studies showed that ANP, along with the PI3K inhibitor LY294002, effectively reduced PI3K/Akt pathway activation and the expression of TN-C, collagen-I, and collagen-III, which were induced by Ang II. CONCLUSIONS The study demonstrates ANP's potential in inhibiting myocardial inflammation and reducing atrial fibrosis. Notably, ANP's effect in countering atrial fibrosis seems to be mediated through the suppression of the Ang II-induced PI3K/Akt-Tenascin-C signaling pathway. These insights enhance our understanding of AF pathogenesis and position ANP as a potential therapeutic agent for treating atrial fibrosis.
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Affiliation(s)
- Nana Zhu
- Graduate School, Medical School of Chinese PLA, Beijing, China
| | - Tianlun Li
- Graduate School, Medical School of Chinese PLA, Beijing, China
| | - Yili Bai
- Southern Medical Branch, Chinese PLA General Hospital, Beijing, China
| | - Jiao Sun
- Graduate School, Medical School of Chinese PLA, Beijing, China
| | - Jianping Guo
- Department of Cardiovascular Medicine, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Hongtao Yuan
- Department of Cardiovascular Medicine, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhaoliang Shan
- Department of Cardiovascular Medicine, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China.
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4
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Impact of Atrial Fibrillation Ablation on Activity Minutes in Patients With Cardiac Implantable Electronic Devices. Heart Rhythm 2022; 19:1405-1411. [PMID: 35716857 DOI: 10.1016/j.hrthm.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/02/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Impaired quality of life due to atrial fibrillation (AF), which often includes decreased activity level, is an indication for ablation. However, the impact of ablation for AF on activity is poorly understood. OBJECTIVE To assess the impact of ablation on activity minutes per day using continuous accelerometer data from cardiac implantable electronic devices (CIED). METHODS Using the Optum® Health Record dataset (2007-2019) linked with the Medtronic CareLink® database, we identified patients who had a CIED with AF detection and accelerometer capabilities. Patients with a device that transmitted heart rhythm and activity data ≥ 3 months prior to- and ≥ 12 months following ablation were included in analysis. The associations between ablation and activity minutes were assessed in each CIED type. RESULTS Of 4297 eligible patients who underwent AF ablation, 409 (9.5%) (65% Male, 67.3±9.8 years, 64% paroxysmal AF) were included in analysis. The average AF burden and activity minutes per day pre-ablation were 30.9±37.4% and 175±99 minutes, respectively. Following ablation, relative AF burden decreased by 75.1±53.2% (p<0.001). There was no change in activity minutes per day following ablation in the entire cohort (average change: -0.10±36.2 min, p=0.96). There were also no clinically significant changes in activity minutes post-ablation in subgroups based on CIED, season of ablation, quartile of AF burden change, and quartile of age at the time of ablation. CONCLUSION There were no clinically significant changes in activity minutes per day in patients with CIEDs following ablation for AF.
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5
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Effect of catheter ablation on the hemodynamics of the left atrium. J Interv Card Electrophysiol 2022; 65:83-96. [DOI: 10.1007/s10840-022-01191-3] [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: 12/27/2021] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
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6
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Li S, Li Q, Jiang C, Chen X, Lai Y, He L, Cui F, Wu J, Hu R, Jia C, Feng L, Sang C, Tang R, Long D, Du X, Dong J, Ma C. Factors associated with depression and anxiety among caregivers of patients with atrial fibrillation. J Clin Nurs 2021; 31:3263-3271. [PMID: 34866264 DOI: 10.1111/jocn.16165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To assess the prevalence and associated factors of depression and anxiety among caregivers of patients with atrial fibrillation. BACKGROUND Depression and anxiety are common in caregivers of patients with cardiovascular diseases, including heart failure and coronary artery disease. However, studies about depression and anxiety among caregivers of patients with atrial fibrillation are limited. DESIGN Cross-sectional study. METHODS We enrolled 465 dyads of patients with atrial fibrillation and their primary family caregivers from Beijing Anzhen Hospital between September 2020 and March 2021. The patient-caregiver dyads were excluded if primary family caregivers had previous mental disorders before the patient diagnosis of atrial fibrillation. Depression and anxiety of patients and caregivers were measured by Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scale. Multivariate logistic regression analysis was used to assess factors associated with depression and anxiety of caregivers. STROBE guidelines were followed to report this study. RESULTS The prevalence of caregiver depression (Patient Health Questionnaire-9 score ≥5) and anxiety (Generalized Anxiety Disorder-7 score ≥5) was 14.0% and 13.5% respectively. Caregiver number of comorbidities ≥2 and patient depression were significantly associated with caregiver depression. Caregiver age ≥65 years, caregiver female sex and patient anxiety were predictors of caregiver anxiety. CONCLUSIONS Depression and anxiety are common in caregivers of patients with AF. Better management of caregiver mental problems and associated factors may benefit both patients and caregivers. RELEVANCE TO CLINICAL PRACTICE Clinicians and nurses should pay more attention to depression and anxiety in caregivers of patients with atrial fibrillation, and provide support to caregivers in most need.
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Affiliation(s)
- Sitong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Qifan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xuan Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Feihuan Cui
- Department of Psychology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiahui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Rong Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changqi Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Li Feng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- 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.,Heart Health Research Center, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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7
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Essebag V, Azizi Z, Alipour P, Khaykin Y, Leong-Sit P, Sarrazin JF, Sturmer M, Morillo C, Terricabras M, Amit G, Roux JF, Patterson S, Verma A. Relationship between quality of life and burden of recurrent atrial fibrillation following ablation: CAPCOST multicentre cohort study. Europace 2021; 22:1017-1025. [PMID: 32531030 DOI: 10.1093/europace/euaa066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/13/2020] [Indexed: 01/12/2023] Open
Abstract
AIMS Atrial fibrillation (AF) significantly impairs patients' quality of life (QOL). We performed this study to investigate the effect of AF-ablation success and atrial fibrillation burden (AFB) on QOL measures. METHODS AND RESULTS Overall, 230 patients with paroxysmal AF refractory to antiarrhythmic drugs were enrolled and underwent ablation in a multicentre, prospective cohort. Electrocardiogram, 48-h Holter, Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF), short form-12 (SF-12), and Atrial Fibrillation Effect on Quality of life (AFEQT) scales were used to assess patients. Atrial fibrillation burden was defined as total duration of AF during the month prior to each visit (h/month). The change in AFB was calculated as the difference between the month prior to the 12-month post-ablation and the baseline pre-ablation. The Minimal Clinically Important Difference (MCID) was considered as a 19-point change for AFEQT and 3-5-point change for SF-12 scores. There was significant rise in the AFEQT and SF12 and decrease in CCS-SAF score post-AF ablation; however, the magnitude of these changes was greater in patients without AF recurrence (P < 0.05). The QOL score that best differentiated patients with and without recurrence was AFEQT, while, CCS-SAF was the most specific score. Patients with AFB decrease >19 h/month had significantly greater change in QOL scores. Atrial fibrillation burden < 24 h/month at 12-months post-ablation was associated with significant changes in QOL and CCS-SAF when adjusting for baseline scores and other covariates. These changes were consistent with the MCID of these measures. CONCLUSION Patients experience significant improvements in QOL post-ablation, which correlate with a decrease in AFB despite ongoing brief recurrences of AF. CLINICAL TRIAL REGISTRATION NCT01562912. https://www.clinicaltrials.gov/ct2/show/NCT01562912? term=capcost&rank=1.
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Affiliation(s)
- Vidal Essebag
- McGill University Health Centre, Montreal, QC, Canada.,Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Zahra Azizi
- Southlake Regional Health Centre, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada.,Faculty of Health, York University, ON, Canada
| | - Pouria Alipour
- Southlake Regional Health Centre, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada.,Faculty of Health, York University, ON, Canada
| | - Yaariv Khaykin
- Southlake Regional Health Centre, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada
| | | | | | | | - Carlos Morillo
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Maria Terricabras
- Southlake Regional Health Centre, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada
| | - Guy Amit
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jean Francois Roux
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Sherri Patterson
- Southlake Regional Health Centre, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada
| | - Atul Verma
- Southlake Regional Health Centre, 602-581 Davis Drive, Newmarket, ON L3Y 2P6, Canada
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Abstract
AF and heart failure (HF) commonly coexist. Left atrial ablation is an effective treatment to maintain sinus rhythm (SR) in patients with AF. Recent evidence suggests that the use of ablation for AF in patients with HF is associated with an improved left ventricular ejection fraction and lower death and HF hospitalisation rates. We performed a systematic search of world literature to analyse the association in more detail and to assess the utility of AF ablation as a non-pharmacological tool in the treatment of patients with concomitant HF.
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Affiliation(s)
| | - Magdi Saba
- St George's, University of London, London, UK
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9
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Yanagisawa S, Inden Y, Fujii A, Sakamoto Y, Tomomatsu T, Mamiya K, Okamoto H, Murohara T, Shibata R. Early improvement of daily physical activity after catheter ablation for atrial fibrillation in an accelerometer assessment: A prospective pilot study. Ann Noninvasive Electrocardiol 2020; 26:e12807. [PMID: 32949223 PMCID: PMC7816803 DOI: 10.1111/anec.12807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Catheter ablation improves physical activity in patients with atrial fibrillation (AF). However, continuous daily evaluation and time course of improvement in physical activity after ablation have not been fully assessed. This prospective study was conducted to evaluate the daily physical activities and changes in the physical performance in patients undergoing catheter ablation for AF by continuous monitoring of a portable accelerometer. Methods Ten patients scheduled for catheter ablation for AF were fitted with a uniaxial accelerometer prior to and 6 months after the procedure. This study evaluated changes in daily steps, activity intensity, and activity duration. We also evaluated changes in activity intensity using a short version of the International Physical Activity Questionnaire (IPAQ). Results The maximum daily steps significantly increased from baseline to postablation (baseline, 9,232 [6,716–11,485]; after 1–3 months, 11,605 [8,285–14,802]; and after 4–6 months, 11,412 [8,939–13,808], p = .020). Similarly, Δ maximum‐mean daily steps increased significantly (baseline, 2,431 [1,199–6,181]; after 1–3 months, 4,674 [4,164–6,474]; and after 4–6 months, 4,871 [3,657–6,117], p = .014). These improvements were more pronounced in patients with paroxysmal and symptomatic AF. The total IPAQ score significantly improved from baseline to after 6 months ablation (from 1,170 [693–3,930] to 4,312 [1,865–6,569], p = .037). All patients were recurrence‐free from AF after ablation. Conclusions The physical activity improved significantly even in the early phase following catheter ablation. The effect of suppressing AF on activity levels was apparent soon after the procedure.
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Affiliation(s)
- Satoshi Yanagisawa
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aya Fujii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiro Tomomatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Mamiya
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroya Okamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Zhuo C, Ji F, Lin X, Jiang D, Wang L, Tian H, Xu Y, Liu S, Chen C. Depression and recurrence of atrial fibrillation after catheter ablation: a meta-analysis of cohort studies. J Affect Disord 2020; 271:27-32. [PMID: 32312694 DOI: 10.1016/j.jad.2020.03.118] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/05/2020] [Accepted: 03/29/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The influence of depression on the recurrence of atrial fibrillation (AF) after catheter ablation remains unclear. We performed a meta-analysis to evaluate the association between depression and AF recurrence after catheter ablation. METHODS Cohort studies that evaluated depression at baseline and correlated depression with AF recurrence after catheter ablation were identified by searching the PubMed and Embase databases. Heterogeneity was determined using the Cochrane's Q test and calculating the I2 statistic. A random-effect model was applied to incorporate the potential influence of heterogeneity. RESULTS Our analysis included seven cohort studies with 1,070 AF patients who underwent catheter ablation by circumferential pulmonary vein isolation. No significant heterogeneity was detected among the included studies (p for Cochrane's Q test = 0.20, I2 = 29%). Pooled results showed that depression before procedure was independently associated with increased risk of AF recurrence after catheter ablation (adjusted relative risk [RR]: 2.24, 95% confidence interval [CI]: 1.75 - 2.88, p < 0.001). Sensitivity analyses, conducted by omitting one study at a time, retrieved similar results (RR: 2.06 - 2.53, p all < 0.05). Predefined subgroup analyses showed that the association between depression and AF recurrence after catheter ablation was consistent regardless of the study characteristics, including study location, study design, patient number, type of AF, follow-up duration, adjustment of left atrial dimension, and quality score. LIMITATIONS This analysis included a limited number of studies and various instruments applied to measure depression. CONCLUSIONS Depression is an independent risk factor of AF recurrence after catheter ablation.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, 272100, Shandong Province, China; Department of Psychiatric-Neuroimaging-Genetics Laboratory (PNG_Lab), Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province, 325000, China; Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab) Tianjin Mental Health Canter, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin,300222, China; Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China.
| | - Feng Ji
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, 272100, Shandong Province, China
| | - Xiaodong Lin
- Department of Psychiatric-Neuroimaging-Genetics Laboratory (PNG_Lab), Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province, 325000, China
| | - Deguo Jiang
- Department of Psychiatric-Neuroimaging-Genetics Laboratory (PNG_Lab), Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province, 325000, China
| | - Lina Wang
- Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab) Tianjin Mental Health Canter, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin,300222, China
| | - Hongjun Tian
- Department of Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab) Tianjin Mental Health Canter, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin,300222, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Ce Chen
- Department of Psychiatric-Neuroimaging-Genetics Laboratory (PNG_Lab), Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province, 325000, China
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11
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Impacts of sinus rhythm maintenance with catheter ablation on exercise tolerance in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 61:105-113. [PMID: 32488748 DOI: 10.1007/s10840-020-00786-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND It has been recently reported that sinus rhythm (SR) maintenance with catheter ablation therapy improves exercise tolerance (ET) in patients with persistent atrial fibrillation (AF). However, it remains to be elucidated whether this is also the case for patients with paroxysmal AF (PAF). METHODS We enrolled consecutive 54 patients with PAF (age; 63 ± 10 [SD] years old, male/female 46/8) and 26 patients with persistent AF (non-PAF) (age; 57 ± 12 [SD] years old, male/female 23/3) who underwent AF ablation without recurrence. ET and cardiac function were evaluated by cardio-pulmonary exercise test and ultrasound echocardiography before and 6 months after ablation. RESULTS The parameters of cardiopulmonary exercise test were comparable between the 2 groups. When PAF group was divided into 2 groups according to the time since diagnosis, peak oxygen uptake (peak VO2) before ablation was significantly lower in patients with PAF duration of more than 1 year (n = 26), compared with those with less than 1 year (n = 28) (18.1 ± 3.7 vs 21.3 ± 5.8 ml/kg/min, P = 0.022). At 6 months after SR maintenance without AF burden, peak VO2 significantly improved in both PAF (19.8 ± 5.1 to 22.0 ± 4.8 ml/kg/min, P = 0.0001) and non-PAF (20.6 ± 3.9 to 23.4 ± 5.0 ml/kg/min, P < 0.01). Furthermore, the improvement rate of peak VO2 after successful ablation had a highly significant inverse relationship with peak VO2 at baseline in patients with PAF (r = - 0.48, P = 0.0003). CONCLUSIONS These results indicate that SR maintenance with ablation improves ET in patients with PAF, especially in those with reduced ET.
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12
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Cost Effectiveness Analysis and Payment Policy Recommendation-Population-Based Survey with Big Data Methodology for Readmission Prevention of Patients with Paroxysmal Supraventricular Tachycardia treated with Radiofrequency Catheter Ablation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072334. [PMID: 32235633 PMCID: PMC7178252 DOI: 10.3390/ijerph17072334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/22/2022]
Abstract
Recurrence of paroxysmal supraventricular tachycardia (PSVT) has been reported to be lower in patients treated with radiofrequency catheter ablation (RFCA) than in those who are not. Few population-based surveys have stated the cost-effectiveness related to this treatment. We, therefore, performed a nationwide retrospective study using National Health Insurance Research Database (NHIRD) data from 2001–2012 in Taiwan. The incidence of PSVT-related admissions was computed from patients’ first admission for a primary PSVT diagnosis. There were 21,086 patients hospitalized due to first-time PSVT, of whom 13,075 underwent RFCA, with 374 recurrences (2.86%). In contrast, 1751 (21.86%) of the remaining 8011 patients who did not receive RFCA, most of whom had financial concerns, experienced PSVT recurrence. The relative PSVT recurrence risk in those who did not receive RFCA was 7.6 times (95% CI: 6.67–8.33) that of those who did undergo RFCA. In conclusion, the PSVT recurrence rate was much higher in patients who did not receive RFCA at their first admission. Furthermore, RFCA proved cost-effective, with the ratio of the incremental cost-effectiveness ratio (ICER) and gross domestic product (GDP) being only 1.15. To prevent readmission and avoid incremental cost, the authority could provide a financial supplement for every patient so that the procedure is performed, reducing the PSVT-recurrence life-years (disease-specific DALY).
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Chen Y, Nagendran M, Gomes M, Wharton PV, Raine R, Lambiase PD. Gaps in patient-reported outcome measures in randomized clinical trials of cardiac catheter ablation: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:234-242. [DOI: 10.1093/ehjqcco/qcaa022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/14/2022]
Abstract
Abstract
The aim of this systematic review was to evaluate randomized clinical trials (RCTs) of cardiac catheter ablation (CCA) and to assess the prevalence, characteristics and reporting standards of clinically relevant patient-reported outcome measures (PROMs). Electronic database searches of Medline, Embase, CENTRAL, and the WHO Trial Registry were conducted in March 2019. The study protocol was registered on PROSPERO (CRD42019133086). Of 7125 records identified, 237 RCTs were included for analysis, representing 35 427 patients with a mean age of 59 years. Only 43 RCTs (18%) reported PROMs of which 27 included a generic PROM that measured health-related quality of life (HRQL) necessary to conduct comparative effectiveness research. There was notable under-representation of certain patient groups—only 31% were women and only 8% were of non-Caucasian ethnicity, in trials which reported such data. The reporting standard of PROMs was highly variable with 8–62% adherence against CONSORT PRO-specific items. In summary, PROMs play a crucial role in determining the clinical and cost-effectiveness of treatments which primarily offer symptomatic improvement, such as CCA. Their underuse significantly limits evaluation of the comparative effectiveness of treatments. Using CCA as an exemplar, there are additional issues of infrequent assessment, poor reporting and under-representation of many population groups. Greater use of PROMs, and specifically validated HRQL questionnaires, is paramount in giving patients a voice in studies, generating more meaningful comparisons between treatments and driving better patient-centred clinical and policy-level decision-making.
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Affiliation(s)
- Yang Chen
- Institute of Cardiovascular Science, University College London, 62 Huntley Street, London WC1E 6DD, UK
| | - Myura Nagendran
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Manuel Gomes
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
| | - Peter V Wharton
- Cardiac Patient and Patient Member of the Arrhythmia Alliance, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, 62 Huntley Street, London WC1E 6DD, UK
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14
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Proietti R, Birnie D, Ziegler PD, Wells GA, Verma A. Postablation Atrial Fibrillation Burden and Patient Activity Level: Insights From the DISCERN AF Study. J Am Heart Assoc 2019; 7:e010256. [PMID: 30486704 PMCID: PMC6405544 DOI: 10.1161/jaha.118.010256] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Recent evidence shows an association between the level of physical activity and cardiovascular mortality and morbidity in patients with atrial fibrillation ( AF ). We sought to assess the impact of AF daily burden on the activity level of the patient who underwent pulmonary vein isolation. Methods and Results Patients enrolled in the DISCERN AF (Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation) study all had insertable cardiac monitors, which provided the daily burden of atrial tachycardia and atrial fibrillation ( AT / AF ) and a corresponding activity level. A total of 44 341 daily AT / AF burden points were collected from 50 patients with an average of 887 observations for every patient, with <5 minutes of AT / AF reported on 82.6% of days. The daily burden of AT / AF after ablation ranged between 0 and 1440 minutes. The minimum and maximum daily activity was 0 and 600 minutes per day, respectively. A significant inverse association was detected between activity levels and AF burden ( P<0.001; 95% confidence interval, 0.01-0.04). The daily activity starts progressively decreasing after 500 minutes of AF and considerably drops after 1000 minutes. The association between activity level and burden of AT / AF was still statistically significant after adjustment for clinical variables ( P =0.02; 95% confidence interval, -003 to 0.04). Conclusions Daily activity level correlates with daily AT / AF burden in patients who underwent AF ablation. The daily activity started decreasing after a daily burden of 500 minutes of AF and greatly drops after 1000 minutes. Therefore, the amount of AT / AF burden that may impact the activity level seems to be related to hours and not minutes of arrhythmias. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 00745706.
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Affiliation(s)
- Riccardo Proietti
- 1 Department of Cardiac, Thoracic, and Vascular Sciences University of Padua Italy
| | - David Birnie
- 2 Cardiovascular Research Methods Centre University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Paul D Ziegler
- 3 Medtronic Diagnostics and Monitoring Research Mounds View MN
| | - George A Wells
- 2 Cardiovascular Research Methods Centre University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Atul Verma
- 4 Southlake Regional Health Centre Heart Rhythm Program Newmarket Ontario Canada
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15
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Katsumata Y, Tamura Y, Kimura T, Kohsaka S, Sadahiro T, Nishiyama T, Aizawa Y, Azuma K, Fukuda K, Takatsuki S. A high BNP level predicts an improvement in exercise tolerance after a successful catheter ablation of persistent atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:2283-2290. [PMID: 31471993 DOI: 10.1111/jce.14149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Restoration of sinus rhythm (SR) by catheter ablation (CA) of atrial fibrillation (AF) improves exercise tolerance. However, it is still unclear what characteristics of patients are contributing to an improvement in exercise tolerance after CA of AF without heart failure. METHODS AND RESULTS This study consisted of 51 consecutive patients with persistent or long-standing persistent AF without heart failure who were restored to SR for over 6 months by a successful CA. Exercise tolerance was evaluated by cardiopulmonary exercise testing before and 3 and 6 months after CA. The clinical characteristics contributing to an improvement in exercise tolerance was elucidated. The peak oxygen uptake (VO2 )% significantly increased from 101.4 ± 20.3% to 110.9 ± 19.9% 3 months after the CA (P < .001). The improvement rate in the peak VO2 % exhibited a positive correlation to the baseline brain natriuretic peptide (BNP; ρ = 0.39, P < .01), but not to the age, AF duration, left ventricular ejection fraction, or left atrial size. The linear regression analysis revealed that the baseline BNP was an independent predictor of an improvement in the peak VO2 % (coefficients = 0.32; 95% confidence interval = 0.08, 0.54; P = .01). The peak VO2 % improved significantly in the patients whose baseline BNP level was greater than 100 pg/mL, compared to the others (P < .01). These favorable findings were also observed 6 months after the CA. CONCLUSION Elimination of persistent AF by CA was associated with an improvement in exercise tolerance. This was particularly true in patients with high BNP values at baseline.
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Affiliation(s)
| | - Yuichi Tamura
- Department of Cardiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taketaro Sadahiro
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takahiko Nishiyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Koichiro Azuma
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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16
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Asad ZUA, Yousif A, Khan MS, Al-Khatib SM, Stavrakis S. Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circ Arrhythm Electrophysiol 2019; 12:e007414. [PMID: 31431051 DOI: 10.1161/circep.119.007414] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite the publication of several randomized clinical trials comparing catheter ablation (CA) with medical therapy (MT) in patients with atrial fibrillation (AF), the superiority of one strategy over another is still questioned by many. In this meta-analysis of randomized controlled trials, we compared the efficacy and safety of CA with MT for AF. METHODS We systematically searched MEDLINE, EMBASE, and other online sources for randomized controlled trials of AF patients that compared CA with MT. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular hospitalizations and recurrence of atrial arrhythmia. Subgroup analyses stratified by the presence of heart failure with reduced ejection fraction, type of AF, age, and sex were performed. Risk ratios (RRs) with 95% CIs were calculated using a random effects model, and Mantel-Haenszel method was used to pool RR. RESULTS Eighteen randomized controlled trials comprising 4464 patients (CA, n=2286; MT, n=2178) were included. CA resulted in a significant reduction in all-cause mortality (RR, 0.69; 95% CI, 0.54-0.88; P=0.003) that was driven by patients with AF and heart failure with reduced ejection fraction (RR, 0.52; 95% CI, 0.35-0.76; P=0.0009). CA resulted in significantly fewer cardiovascular hospitalizations (hazard ratio, 0.56; 95% CI, 0.39-0.81; P=0.002) and fewer recurrences of atrial arrhythmias (RR, 0.42; 95% CI, 0.33-0.53; P<0.00001). Subgroup analyses suggested that younger patients (age, <65 years) and men derived more benefit from CA compared with MT. CONCLUSIONS CA is associated with all-cause mortality benefit, that is driven by patients with AF and heart failure with reduced ejection fraction. CA reduces cardiovascular hospitalizations and recurrences of atrial arrhythmia for patients with AF. Younger patients and men appear to derive more benefit from CA.
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Affiliation(s)
- Zain Ul Abideen Asad
- Cardiovascular Disease Section, University of Oklahoma Health Sciences Center (Z.U.A.A., A.Y., S.S.)
| | - Ali Yousif
- Cardiovascular Disease Section, University of Oklahoma Health Sciences Center (Z.U.A.A., A.Y., S.S.)
| | - Muhammad Shahzeb Khan
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (M.S.K.)
| | | | - Stavros Stavrakis
- Cardiovascular Disease Section, University of Oklahoma Health Sciences Center (Z.U.A.A., A.Y., S.S.)
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Osmancik P, Budera P, Talavera D, Herman D, Vesela J, Prochazkova R, Rizov V, Kacer P. Improvement in the quality of life of patients with persistent or long-standing persistent atrial fibrillation after hybrid ablation. J Interv Card Electrophysiol 2019; 57:435-442. [DOI: 10.1007/s10840-019-00546-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/26/2019] [Indexed: 12/15/2022]
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18
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Fiala M, Bulková V, Šknouril L, Nevralová R, Toman O, Januška J, Špinar J, Wichterle D. Functional improvement after successful catheter ablation for long-standing persistent atrial fibrillation. Europace 2018; 19:1781-1789. [PMID: 27707782 DOI: 10.1093/europace/euw282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/13/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Identifying patients who benefit from restored sinus rhythm (SR) would optimize the selection of candidates for ablation of long-standing persistent atrial fibrillation (LSPAF). This prospective study sought to identify the hitherto unknown factors associated with global functional improvement after successful radiofrequency catheter ablation of LSPAF. Methods and results In 171 LSPAF patients (84% of the total consecutive 203 patients) who were examined in SR 12 months after ablation, the individual per cent change from baseline value in maximum oxygen consumption at exercise test (VO2 max), left ventricular ejection fraction (LVEF), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and five-dimensional descriptive system (EQ-5D) of quality-of-life questionnaire were classified in quartiles by 0 (worse) to 3 (best) grades. The individual grades were summed into a composite score (SCORE, 0 … 12) reflecting global functional improvement. Significant improvement in VO2 max (3.4 ± 4.7 mL/kg/min), LVEF (7.5 ± 9.1%), NT-proBNP (-861 ± 809 pg/mL), and EQ-5D (0.7 ± 0.12) was observed (all P < 0.0001). On multivariable analysis, younger age (P = 0.001), male gender (P = 0.02), timely post-ablation left atrial appendage (LAA) outflow (P = 0.005) with improvement in outflow velocity (P = 0.0002), and withdrawal of Class I/III antiarrhythmic drugs (P < 0.05) were positively and independently correlated with the SCORE. Conclusions Younger male patients benefited most from catheter ablation of LSPAF. Delayed or non-improved LAA outflow and inability to discontinue Class I/III antiarrhythmic medication reduced the post-ablation functional improvement.
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Affiliation(s)
- Martin Fiala
- Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic.,Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic
| | - Veronika Bulková
- Department of Cardiology and Angiology, St. Anne's University Hospital and International, Clinical Research Centre, Brno, Czech Republic
| | - Libor Šknouril
- Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic
| | - Renáta Nevralová
- Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic
| | - Ondrej Toman
- Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic
| | - Jaroslav Januška
- Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic
| | - Jindrich Špinar
- Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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19
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Fiala M. Catheter Ablation for Persistent and Long-Standing Persistent Atrial Fibrillation. J Atr Fibrillation 2017; 9:1473. [PMID: 28496934 DOI: 10.4022/jafib.1473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/20/2016] [Accepted: 10/20/2016] [Indexed: 11/10/2022]
Abstract
Persistent and long-standing persistent atrial fibrillation evolves from complex arrhythmogenic substrate and sources. Multiple studies have shown improved freedom from arrhythmia recurrences if sinus rhythm had been restored during the index ablation; however, such harder procedural endpoint requires laborious stepwise approach almost invariably pursuing non-pulmonary-vein sources. Longer-term conversion of persistent atrial fibrillation into sinus rhythm is associated with significant improvement in major indices of hemodynamic and functional status; these indices also represent major predictors of cardiovascular mortality. Optimal ablation techniques and strategies preserving most of the individual potential for functional improvement need to be established.
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Affiliation(s)
- Martin Fiala
- Department of Cardiology, Center of Cardiovascular Care, Brno, Czech Republic. Department of Internal Medicine and Cardiology, University Hospital, Brno, Czech Republic
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20
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Rencz F, Gulácsi L, Drummond M, Golicki D, Prevolnik Rupel V, Simon J, Stolk EA, Brodszky V, Baji P, Závada J, Petrova G, Rotar A, Péntek M. EQ-5D in Central and Eastern Europe: 2000-2015. Qual Life Res 2016; 25:2693-2710. [PMID: 27472992 DOI: 10.1007/s11136-016-1375-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. METHODS An electronic database search was performed up to 1 July 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. RESULTS We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n = 11), Bulgaria (n = 6), Czech Republic (n = 18), Hungary (n = 47), Poland (n = 51), Romania (n = 2), Slovakia (n = 3) and Slovenia (n = 14). Cardiovascular (21 %), neurologic (17 %), musculoskeletal (15 %) and endocrine, nutritional and metabolic diseases (13 %) were the most frequently studied clinical areas. Overall, 112 (78 %) of the studies reported EQ VAS results and 86 (60 %) EQ-5D index scores, of which 27 (31 %) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. CONCLUSIONS Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened.
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Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary.,Semmelweis University Doctoral School of Clinical Medicine, Üllői út 26., Budapest, H-1085, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary.
| | - Michael Drummond
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland, ul. Banacha 1b, 02-097, Warsaw, Poland
| | | | - Judit Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Elly A Stolk
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary
| | - Jakub Závada
- Institute of Rheumatology, 1st Faculty of Medicine, Charles University, Na Slupi 4, 128 00, Prague, Czech Republic
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Alexandru Rotar
- Department of Social Medicine, University of Amsterdam, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, H-1093, Hungary
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21
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van Breugel HNAM, Parise O, Nieman FHM, Accord RE, Lucà F, Lozekoot P, Kumar N, van Mastrigt GAPG, Nijs JFMA, Vrakking R, Maessen JG, La Meir M, Gelsomino S. Does sinus rhythm conversion after cardiac surgery affect postoperative health- related quality of life? J Cardiothorac Surg 2016; 11:75. [PMID: 27142813 PMCID: PMC4855340 DOI: 10.1186/s13019-016-0459-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background We investigated the impact and the predictive value of sinus rhythm at 12 months (SR12) on subscales of three different HrQoL questionnaires: SF-36., EuroQoL and MFI 20. Methods Data of 125 cardiac surgery patients with pre-operative AF from our previous randomized trial were used. Based on their rhythm outcome patients were divided in two groups: SR12 or AF at 12 months follow up (non-SR12). All questionnaires were self-administered pre-operatively and at 3 months, 6 months and 12 months after surgery. Results Synus rhytm at 12 months was predictive of improvement of SF36- mental score (MS, p = 0.021), Euro-QoL-MS (p = 0.009), VAS (p = 0.006), and MFI 20-MS (p = 0.009). We failed to find any significant interactions between SR12 and any of the other significant risk factors: age <65 years, paroxysmal type of AF and preoperative AF duration <12 months. In contrast, SR12 was not significant in predicting physical score (PS) subscales of any of the questionnaires (all, p > 0.05) which were predicted by age <65 years (SF36-PS, p = 0.029) by paroxysmal type of AF and age <65 years (Euro-QoL-PS, p = 0.017 and p = 0.04, respectively) and by AF duration <12 months, paroxysmal type of AF and age < 65 years (MFI 20-PS, p = 0.019, p = 0.020 and p = 0.015, respectively). Conclusions Specific mental-related HrQoL scales are much more sensitive to sinus rhythm conversion. Sinus rithm mantainance shows significant effects on mental scores independently of other cofactors. Successful conversion to sinus rhythm after surgical ablation during cardiac surgery does not significantly affect phisical health related quality of life during 1 year follow up.
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Affiliation(s)
- Henrica N A M van Breugel
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Orlando Parise
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Fred H M Nieman
- Department of Clinical Epidemiology & Medical Technology Assessment, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Ryan E Accord
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Fabiana Lucà
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Pieter Lozekoot
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Narendra Kumar
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Ghislaine A P G van Mastrigt
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Jan F M A Nijs
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Ries Vrakking
- Department of Cardiothoracic Surgery, Amphia Hospital Breda, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Mark La Meir
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands
| | - Sandro Gelsomino
- Department of Cardiology and Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands. .,Experimental Surgery Unit, Careggi Hospital, Viale Morgagni 85, 50134, Florence, Italy.
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22
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Zhang Y, Chen A, Song L, Li M, Chen Y, He B. Association Between Baseline Natriuretic Peptides and Atrial Fibrillation Recurrence After Catheter Ablation. Int Heart J 2016; 57:183-9. [DOI: 10.1536/ihj.15-355] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yunhe Zhang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Ao Chen
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Lei Song
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Min Li
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Yingmin Chen
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Ben He
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
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23
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YANAGISAWA SATOSHI, INDEN YASUYA, KATO HIROYUKI, FUJII AYA, MIZUTANI YOSHIAKI, ITO TADAHIRO, KAMIKUBO YOSUKE, KANZAKI YASUNORI, HIRAI MAKOTO, MUROHARA TOYOAKI. Decrease in B-Type Natriuretic Peptide Levels and Successful Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:225-34. [DOI: 10.1111/pace.12788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- SATOSHI YANAGISAWA
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - YASUYA INDEN
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - HIROYUKI KATO
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - AYA FUJII
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - YOSHIAKI MIZUTANI
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - TADAHIRO ITO
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - YOSUKE KAMIKUBO
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - YASUNORI KANZAKI
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - MAKOTO HIRAI
- Department of Cardiology; Nagoya University Graduate School of Health Science; Nagoya Japan
| | - TOYOAKI MUROHARA
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
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24
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KOCHHÄUSER SIMON, JOZA JACQUELINE, ESSEBAG VIDAL, PROIETTI RICCARDO, KOEHLER JODI, TSANG BERNICE, WULFFHART ZAEV, PANTANO ALFREDO, KHAYKIN YAARIV, ZIEGLER PAULD, VERMA ATUL. The Impact of Duration of Atrial Fibrillation Recurrences on Measures of Health-Related Quality of Life and Symptoms. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:166-72. [DOI: 10.1111/pace.12772] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/11/2015] [Accepted: 10/14/2015] [Indexed: 12/20/2022]
Affiliation(s)
| | - JACQUELINE JOZA
- McGill University Health Center; McGill University; Montreal Canada
| | - VIDAL ESSEBAG
- McGill University Health Center; McGill University; Montreal Canada
| | | | - JODI KOEHLER
- Medtronic Cardiac Rhythm Heart Failure Division; Mounds View Minnesota
| | | | | | | | | | - PAUL D. ZIEGLER
- Medtronic Cardiac Rhythm Heart Failure Division; Mounds View Minnesota
| | - ATUL VERMA
- Southlake Regional Health Centre; Newmarket Canada
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25
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Anselmino M, Matta M, D'ascenzo F, Pappone C, Santinelli V, Bunch TJ, Neumann T, Schilling RJ, Hunter RJ, Noelker G, Fiala M, Frontera A, Thomas G, Katritsis D, Jais P, Weerasooriya R, Kalman JM, Gaita F. Catheter ablation of atrial fibrillation in patients with diabetes mellitus: a systematic review and meta-analysis. Europace 2015; 17:1518-25. [DOI: 10.1093/europace/euv214] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Raine D, Langley P, Shepherd E, Lord S, Murray S, Murray A, Bourke JP. Effect of catheter ablation on quality of life in patients with atrial fibrillation and its correlation with arrhythmia outcome. Open Heart 2015; 2:e000302. [PMID: 26380100 PMCID: PMC4567786 DOI: 10.1136/openhrt-2015-000302] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/08/2015] [Indexed: 11/07/2022] Open
Abstract
Objective To assess the effect of catheter ablation on atrial fibrillation (AF) symptoms and quality of life (QoL). Methods Patients with AF scheduled for ablation were recruited. Pulmonary vein isolation (PVI) was performed and complex fractionated atrial electrogram (CFAE)±linear ablation undertaken in patients in AF despite PVI. QoL and AF symptoms were assessed using SF-36 V2 and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaires before and 3 months after ablation. Change in QoL scores after ablation was correlated with clinical parameters and the extent of ablation. Magnitude of QoL change was compared between AFEQT and SF-36 physical component summary (PCS) and mental component summary (MCS) scores and correlated with arrhythmia outcome. Results 80 patients were studied. Summative and individual health scores for both AFEQT (51.5±22.0 vs 81.3±18.2; p<0.01) and SF-36 (PCS 43.3±10.5 vs 47.9±11.3; p<0.01 and MCS 45.0±11.5 vs 51.5±9.4; p<0.01) improved significantly in patients who maintained sinus rhythm after ablation, but not in those with recurrent AF. Improvement in AFEQT (25.4±19) was significantly greater than change in PCS (6.8±6.4; p<0.01) and MCS (8.5±7.9; p<0.01) scores and correlated more closely with arrhythmia outcome (AFEQT r=0.55; PCS r=0.26; MCS r=0.30). Conclusions Patients who maintained sinus rhythm after ablation had a significant improvement in AF symptoms and QoL; however, no improvement was observed in patients with recurrent AF. QoL change after ablation did not correlate with baseline clinical parameters or ablation strategy. AF specific QoL scales are more responsive to change and correlate better with ablation outcome.
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Affiliation(s)
- Daniel Raine
- Department of Cardiology , Freeman Hospital , Newcastle upon Tyne , UK
| | | | - Ewen Shepherd
- Department of Cardiology , Freeman Hospital , Newcastle upon Tyne , UK
| | - Stephen Lord
- Department of Cardiology , Freeman Hospital , Newcastle upon Tyne , UK
| | - Stephen Murray
- Department of Cardiology , Freeman Hospital , Newcastle upon Tyne , UK
| | - Alan Murray
- Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne , UK
| | - John P Bourke
- Department of Cardiology , Freeman Hospital , Newcastle upon Tyne , UK
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27
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Fiala M, Bulková V, Škňouřil L, Nevřalová R, Toman O, Januška J, Špinar J, Wichterle D. Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: a prospective study. Heart Rhythm 2015; 12:687-98. [PMID: 25576779 DOI: 10.1016/j.hrthm.2015.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of restoring sinus rhythm (SR) by initial ablation in patients with long-standing persistent atrial fibrillation (LSPAF) is not fully established. OBJECTIVE The purpose of this study was to investigate the prognostic value of SR restoration at the initial procedure and arrhythmia noninducibility at the final repeat procedure for long-term outcome. METHODS A total of 203 patients (22% female; age 59 ± 9 years) underwent stepwise catheter ablation for LSPAF. RESULTS The procedural end-point of SR restoration was achieved in 50% of patients. During follow-up (median 48 months) and after 1.7 procedures per patient, 72% of patients were free from arrhythmia off antiarrhythmic drugs. Failure to restore SR was independently predicted by left atrial (LA) long-axis diameter ≥68 mm (relative risk [RR] 1.55, P = .03], proportion of high-voltage LA sites <20% (RR 1.62, P = .02), and left atrial appendage (LAA) atrial fibrillation cycle length (AFCL) <155 ms (RR 1.5, P = .05). Arrhythmia recurrence after the initial procedure was predicted by SR nonrestoration (RR 2.99, P <.000001) and LAA AFCL ≥155 ms (RR 1.90, P = .0002). Arrhythmia recurrence after the final procedure was predicted by SR nonrestoration at the initial procedure (RR 2.83, P = .0007), persistent AF duration ≥24 months (RR 2.74, P = .002), LAA outflow velocity <40 cm/s (RR 2.21, P = .006), and LAA AFCL ≥155 ms (RR 1.92, P = .02). In 115 patients with repeat procedure(s), failure to achieve arrhythmia noninducibility at the final procedure (19% of patients) was associated with arrhythmia recurrence (RR 8.9, P < .000001). CONCLUSION SR restoration at the initial procedure and arrhythmia noninducibility at the last repeat procedure were major predictors of arrhythmia-free outcome after ablation for LSPAF.
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Affiliation(s)
- Martin Fiala
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czech Republic; Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic.
| | - Veronika Bulková
- Department of Cardiology and Angiology, St. Anne's University Hospital and International, Clinical Research Center, Brno, Czech Republic
| | - Libor Škňouřil
- Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic
| | - Renáta Nevřalová
- Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic
| | - Ondřej Toman
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czech Republic
| | - Jaroslav Januška
- Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic
| | - Jindřich Špinar
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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28
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Anselmino M, Matta M, D’Ascenzo F, Bunch TJ, Schilling RJ, Hunter RJ, Pappone C, Neumann T, Noelker G, Fiala M, Bertaglia E, Frontera A, Duncan E, Nalliah C, Jais P, Weerasooriya R, Kalman JM, Gaita F. Catheter Ablation of Atrial Fibrillation in Patients With Left Ventricular Systolic Dysfunction. Circ Arrhythm Electrophysiol 2014; 7:1011-8. [DOI: 10.1161/circep.114.001938] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Catheter ablation of atrial fibrillation (AFCA) is an established therapeutic option for rhythm control in symptomatic patients. Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small populations, and data concerning long-term outcome are limited. We performed this meta-analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction, to evaluate predictors of recurrence and impact on left ventricular function.
Methods and Results—
A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with left ventricular systolic dysfunction undergoing AFCA were included. Twenty-six studies were selected, including 1838 patients. Mean follow-up was 23 (95% confidence interval, 18–40) months. Overall complication rate was 4.2% (3.6%–4.8%). Efficacy in maintaining sinus rhythm at follow-up end was 60% (54%–67%). Meta-regression analysis revealed that time since first atrial fibrillation (
P
=0.030) and heart failure (
P
=0.045) diagnosis related to higher, whereas absence of known structural heart disease (
P
=0.003) to lower incidence of atrial fibrillation recurrences. Left ventricular ejection fraction improved significantly during follow-up by 13% (
P
<0.001), with a significant reduction of patients presenting an ejection fraction <35% (
P
<0.001). N-terminal pro-brain natriuretic peptide blood levels decreased by 620 pg/mL (
P
<0.001).
Conclusions—
AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation and heart failure. AFCA provides long-term benefits on left ventricular function, significantly reducing the number of patients with severely impaired systolic function.
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Affiliation(s)
- Matteo Anselmino
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Mario Matta
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Fabrizio D’Ascenzo
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - T. Jared Bunch
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Richard J. Schilling
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Ross J. Hunter
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Carlo Pappone
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Thomas Neumann
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Georg Noelker
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Martin Fiala
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Emanuele Bertaglia
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Antonio Frontera
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Edward Duncan
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Chrishan Nalliah
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Pierre Jais
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Rukshen Weerasooriya
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Jon M. Kalman
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
| | - Fiorenzo Gaita
- From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff
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29
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Bulková V, Fiala M, Havránek Š, Šimek J, Škňouřil L, Januška J, Špinar J, Wichterle D. Improvement in quality of life after catheter ablation for paroxysmal versus long-standing persistent atrial fibrillation: a prospective study with 3-year follow-up. J Am Heart Assoc 2014; 3:e000881. [PMID: 25037195 PMCID: PMC4310368 DOI: 10.1161/jaha.114.000881] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/24/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Changes in quality of life (QoL) after catheter ablation for long-standing persistent atrial fibrillation (LSPAF) are not well described. We sought to compare QoL improvement after catheter ablation of paroxysmal atrial fibrillation (PAF) versus that after LSPAF. METHODS AND RESULTS A total of 261 PAF and 126 LSPAF ablation recipients were prospectively followed for arrhythmia recurrence, QoL, hospital stay, and sick leave. In PAF versus LSPAF groups, 1.3±0.6 versus 1.6±0.7 procedures were performed per patient (P<0.00001) during a 3-year follow-up. Good arrhythmia control was achieved in 86% versus 87% of patients (P=0.69) and in 69% versus 69% of patients not receiving antiarrhythmic drugs (P=0.99). The baseline QoL was better in the PAF than in the LSPAF group (European Quality of Life Group instrument self-report questionnaire visual analog scale: 66.4±14.2 versus 61.0±14.2, P=0.0005; European Quality of Life Group 3-level, 5-dimensional descriptive system: 71.4±9.2 versus 67.7±13.8, P=0.002). Postablation 3-year increase in QoL was significant in both groups (all P<0.00001) and significantly lower in PAF versus LSPAF patients (visual analog scale: +5.0±14.5 versus +10.2±12.8, P=0.001; descriptive system: +5.9±14.3 versus +9.3±13.9, P=0.03). In multivariate analysis, LSPAF, less advanced age, shorter history of AF and good arrhythmia control were consistently associated with postablation 3-year improvement in QoL. Days of hospital stay for cardiovascular reasons and days on sick leave per patient/year were significantly reduced in both groups. CONCLUSIONS Patients with LSPAF had worse baseline QoL. The magnitude of QoL improvement after ablation of LSPAF was significantly greater compared with after ablation of PAF, particularly when good arrhythmia control was achieved without the use of antiarrhythmic drugs.
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Affiliation(s)
- Veronika Bulková
- Department of Cardiology and Angiology, St. Anne's University Hospital and International Clinical Research Center, Brno, Czech Republic (V.B.)
- Department of Cardiology and Angiology, First Faculty of Medicine, Charles University, Prague, Czech Republic (V.B., H., J., D.W.)
| | - Martin Fiala
- Department of Internal Medicine and Cardiology, University Hospital, Masaryk University, Brno, Czech Republic (M.F., J.)
- Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic (M.F., L., J.J.)
| | - Štěpán Havránek
- Department of Cardiology and Angiology, First Faculty of Medicine, Charles University, Prague, Czech Republic (V.B., H., J., D.W.)
| | - Jan Šimek
- Department of Cardiology and Angiology, First Faculty of Medicine, Charles University, Prague, Czech Republic (V.B., H., J., D.W.)
| | - Libor Škňouřil
- Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic (M.F., L., J.J.)
| | - Jaroslav Januška
- Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic (M.F., L., J.J.)
| | - Jindřich Špinar
- Department of Internal Medicine and Cardiology, University Hospital, Masaryk University, Brno, Czech Republic (M.F., J.)
| | - Dan Wichterle
- Department of Cardiology and Angiology, First Faculty of Medicine, Charles University, Prague, Czech Republic (V.B., H., J., D.W.)
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30
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MOHANTY SANGHAMITRA, SANTANGELI PASQUALE, MOHANTY PRASANT, BIASE LUIGIDI, HOLCOMB SHAWNA, TRIVEDI CHINTAN, BAI RONG, BURKHARDT DAVID, HONGO RICHARD, HAO STEVEN, BEHEIRY SALWA, SANTORO FRANCESCO, FORLEO GIOVANNI, GALLINGHOUSE JOSEPHG, HORTON RODNEY, SANCHEZ JAVIERE, BAILEY SHANE, HRANITZKY PATRICKM, ZAGRODZKY JASON, NATALE ANDREA. Catheter Ablation of Asymptomatic Longstanding Persistent Atrial Fibrillation: Impact on Quality of Life, Exercise Performance, Arrhythmia Perception, and Arrhythmia-Free Survival. J Cardiovasc Electrophysiol 2014; 25:1057-64. [DOI: 10.1111/jce.12467] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/06/2014] [Accepted: 05/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- SANGHAMITRA MOHANTY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
- College of Natural Sciences; University of Texas at Austin; Texas USA
| | - PASQUALE SANTANGELI
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - PRASANT MOHANTY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - LUIGI DI BIASE
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
- Department of Biomedical Engineering; University of Texas at Austin; Texas USA
- Department of Cardiology; University of Foggia; Foggia Italy
- Albert Einstein College of Medicine at Montefiore Hospital; New York USA
| | - SHAWNA HOLCOMB
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - CHINTAN TRIVEDI
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - RONG BAI
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
- Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - DAVID BURKHARDT
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | | | - STEVEN HAO
- California Pacific Medical Center; California USA
| | | | | | | | | | - RODNEY HORTON
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - JAVIER E. SANCHEZ
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - SHANE BAILEY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - PATRICK M. HRANITZKY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - JASON ZAGRODZKY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
| | - ANDREA NATALE
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center, Austin; Texas USA
- Department of Biomedical Engineering; University of Texas at Austin; Texas USA
- California Pacific Medical Center; California USA
- Division of Cardiology; Stanford University; Palo Alto California USA
- Interventional Electrophysiology; Scripps Clinic; San Diego California USA. Case Western Reserve University; Cleveland Ohio USA. St. Luke's Hospital; New York USA
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Effects of radiofrequency catheter ablation on left ventricular structure and function in patients with atrial fibrillation: a meta-analysis. J Interv Card Electrophysiol 2014; 40:137-45. [PMID: 24966021 DOI: 10.1007/s10840-014-9903-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/11/2014] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Radiofrequency catheter ablation (RFCA) is an effective therapy for atrial fibrillation (AF). This study was designed to investigate the effects of RFCA on left ventricular (LV) structure and function in AF patients. METHODS AND RESULTS A systematic literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was performed to identify trials involving changes of LV structure and function in AF patients undergoing RFCA. Effect size was expressed as weighted mean difference (WMD) with 95% confidence interval (CI). LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were estimated. A total of 21 trials including 1,135 participants were qualified for this meta-analysis. Compared to the baseline values, there were significant decreases in LVEDV (WMD, -6.39 ml; 95%CI, -12.46 to -0.33) and LVESV (WMD, -6.39 ml; 95%CI, -11.35 to -1.42) and a significant improvement in LVEF (WMD, 6.23%; 95%CI, 3.70 to 8.75), but no significant changes were observed in LVEDD (WMD, -0.64 mm; 95%CI, -2.40 to 1.13) and LVESD (WMD, -0.38 mm; 95%CI, -1.32 to 0.56) after RFCA. Subgroup analysis demonstrated that patients with low LVEF (WMD, 11.90%; 95%CI, 9.16 to 14.64) gained more benefits than those with normal LVEF (WMD, 1.56%; 95%CI, 0.38 to 2.74). Besides, patients with chronic AF (WMD, 10.96%; 95%CI, 4.92 to 17.01) improved more than those with paroxysmal AF (WMD, 1.93%; 95%CI, -0.27 to 4.12). CONCLUSIONS RFCA in AF patients could reverse LV structural remodeling and improve LV systolic function, especially in patients with low LVEF and chronic AF.
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Gonzalez J, Macle L, Deyell MW, Bennett MT, Dubuc M, Dyrda K, Guerra PG, Khairy P, Mondesert B, Rivard L, Roy D, Talajic M, Thibault B, Andrade JG. Effect Of Catheter Ablation On Quality Of Life In Atrial Fibrillation. J Atr Fibrillation 2014; 6:1063. [PMID: 27957067 DOI: 10.4022/jafib.1063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia seen in clinical practice, affecting approximately 1% of the overall population. While rarely life-threatening, AF is almost universally associated with increased morbidity and mortality, predominantly through an increased risk of thromboembolic events, left ventricular dysfunction, as well as significant impairments in functional capacity and health-related quality of life (HRQOL).[1-8] Improvement in HRQOL, with a secondary reduction of disability and health-care resource utilization, is one of the major therapeutic goals in the management of AF.
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Affiliation(s)
- Jorge Gonzalez
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Laurent Macle
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Marc W Deyell
- The Department of Medicine, The University of British Columbia, British Columbia, Canada
| | - Matthew T Bennett
- The Department of Medicine, The University of British Columbia, British Columbia, Canada
| | - Marc Dubuc
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Katia Dyrda
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Peter G Guerra
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Blandine Mondesert
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Léna Rivard
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Denis Roy
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Mario Talajic
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Bernard Thibault
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada
| | - Jason G Andrade
- The Electrophysiology Service at the Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montreal, Canada; The Department of Medicine, The University of British Columbia, British Columbia, Canada
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Aliot E, Botto GL, Crijns HJ, Kirchhof P. Quality of life in patients with atrial fibrillation: how to assess it and how to improve it. Europace 2014; 16:787-96. [PMID: 24469433 DOI: 10.1093/europace/eut369] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Atrial fibrillation (AF) is the most frequent cardiac rhythm disorder and presents a considerable public health burden that is likely to increase in the next decades due to the ageing population. Current management strategies focus on the heart rate and rhythm control, thromboembolism prevention, and treatment of underlying diseases. The concept of quality of life (QoL) has gained significant importance in recent years as an outcome measure in AF studies evaluating therapeutic interventions and as a relevant component of a comprehensive treatment plan. Quality of life is impaired in the majority of patients with AF, and both rate and rhythm control strategies show significant improvement in QoL measures in highly symptomatic patients. This article reviews generic and specialized instruments for measuring QoL in the context of AF, discusses their applications and limitations to integration in clinical practice, and addresses the potential of early therapy for improving QoL outcomes. The development and validation of new QoL assessment tools will have a central role in the advancement of therapies and treatment guidelines for AF.
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Affiliation(s)
- Etienne Aliot
- Cardiology Department, Institut Lorrain du Coeur et des Vaisseaux, CHU de Nancy, 54500 Vandoeuvre-lès-Nancy Cedex, France
| | | | - Harry J Crijns
- Department of Cardiology and CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paulus Kirchhof
- University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, Institute for Biomedical Research, Birmingham B15 2TT, UK Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
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