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Mahmoud M, Haloot J, El Kortbi K, Rodriguez Fuenmayor V, Cheema M, Badin A. Supraventricular Tachycardia Ablation and Its Effects on Anxiety Medications. Cureus 2022; 14:e24609. [PMID: 35664386 PMCID: PMC9148719 DOI: 10.7759/cureus.24609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with true paroxysmal supraventricular tachycardia (PSVT) are frequently misdiagnosed with panic or anxiety disorders due to similar symptoms of palpitations, light-headedness, dyspnea, or chest discomfort. Unrecognized PSVT can lead to unnecessary management with anxiety medications. Treatment of PSVT with catheter ablation may lead to a reduction in anxiety medications. Methods: A total of 175 patients underwent successful PSVT ablation between January 1, 2010 and December 31, 2020. We examined symptoms at presentation, psychiatric medications prior to PSVT ablation, comorbidities, and psychiatric medications at three months post-ablation. Results: Fifteen percent of patients who underwent successful PSVT ablation were being treated with psychiatric medications and included in the final study population. The most common symptoms were palpitations (80.77%), followed by dizziness (42.31%), and shortness of breath (34.62%). The average number of medications prior to ablation was 1.42 and decreased to 1.08 at three months post-ablation (p = 0.04). The average number of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other anxiolytics also decreased but was not statistically significant. CONCLUSION In patients with anxiety and PSVT, catheter ablation reduced the average number of psychiatric medications.
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Affiliation(s)
- Mohamed Mahmoud
- Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Justin Haloot
- Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Khadija El Kortbi
- General Practice, Hassan II University, Faculty of Medicine, Casablanca, MAR
| | | | - Mubeen Cheema
- Cardiovascular Disease, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Auroa Badin
- Cardiac Electrophysiology, Riverside Methodist Hospital, Columbus, USA
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Stempfel S, Aeschbacher S, Blum S, Meyre P, Gugganig R, Beer JH, Kobza R, Kühne M, Moschovitis G, Menghini G, Novak J, Osswald S, Rodondi N, Moutzouri E, Schwenkglenks M, Witassek F, Conen D, Sticherling C. Symptoms and quality of life in patients with coexistent atrial fibrillation and atrial flutter. IJC HEART & VASCULATURE 2020; 29:100556. [PMID: 32577496 PMCID: PMC7303549 DOI: 10.1016/j.ijcha.2020.100556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022]
Abstract
Aims Atrial fibrillation (AF) and atrial flutter (AFL) are two of the most common atrial arrhythmias and often coexist. Many patients with AF or AFL are symptomatic, which impacts their quality of life (QoL). The purpose of this study was to determine whether coexistent AFL represents an added burden for AF patients. Methods We combined baseline data from two large prospective, observational, multicenter cohort studies (BEAT-AF and Swiss-AF). All 3931 patients included in this analysis had documented AF. We obtained information on comorbidities, medication, and lifestyle factors. All participants had a clinical examination and a resting ECG. Symptom burden and QoL at the baseline examination were compared between patients with and without coexistent AFL using multivariable adjusted regression models. Results Overall, 809 (20.6%) patients had a history of AFL. Patients with coexistent AFL more often had history of heart failure (28% vs 23%, p = 0.01), coronary artery disease (30% vs 26%, p = 0.007), failed therapy with antiarrhythmic drugs (44% vs 29%, p < 0.001), and more often underwent AF-related interventions (36% vs 17%, p < 0.001). They were more often symptomatic (70% vs 66%, p = 0.04) and effort intolerant (OR: 1.14; 95% CI: 1.01-1.28; p = 0.04). Documented AFL on the baseline ECG was associated with more symptoms (OR: 2.30; 95% CI: 1.26-4.20; p = 0.007). Conclusion Our data indicates that patients with coexistent AF and AFL are more often symptomatic and report poorer quality of life compared to patients suffering from AF only.
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Affiliation(s)
- Samuel Stempfel
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Steffen Blum
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Pascal Meyre
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Rebecca Gugganig
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Jürg H Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | | | - Gianluca Menghini
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Jan Novak
- Department of Cardiology, Bürgerspital Solothurn, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of General Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of General Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Fabienne Witassek
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
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Tripathi B, Arora S, Mishra A, Kundoor VR, Lahewala S, Kumar V, Shah M, Lakhani D, Shah H, Patel NV, Patel NJ, Dave M, Deshmukh A, Sudhakar S, Gopalan R. Short-term outcomes of atrial flutter ablation. J Cardiovasc Electrophysiol 2017; 28:1275-1284. [PMID: 28800179 DOI: 10.1111/jce.13311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/15/2017] [Accepted: 07/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Understanding the factors associated with early readmissions following atrial flutter (AFL) ablation is critical to reduce the cost and improving the quality of life in AFL patients. METHOD The study cohort was derived from the national readmission database 2013-2014. International Classification of Diseases, 9th Revision (ICD-9-CM) diagnosis code 427.32 and procedure code 37.34 were used to identify AFL and catheter ablation, respectively. The primary and secondary outcomes were 90-day readmission and complications including in-hospital mortality. Cox proportional regression and hierarchical logistic regression were used to generate the predictors of primary and secondary outcomes respectively. Readmission causes were identified by ICD-9-CM code in primary diagnosis field of readmissions. RESULT Readmission rate of 18.19% (n = 1,010 with 1,396 readmissions) was noted among AFL patients (n = 5552). Common etiologies for readmission were heart failure (12.23%), atrial fibrillation (11.13%), atrial flutter (8.93%), respiratory complications (9.42%), infections (7.4%), bleeding (7.39%, including GI bleed-4.09% and intracranial bleed-0.79%) and stroke/TIA (1.89%). Multivariate predictors of 90-day readmission (hazard ratio, 95% confidence interval, P value) were preexisting heart failure (1.30, 1.13-1.49, P < 0.001), chronic pulmonary disease (1.37, 1.18-1.58, P < 0.001), anemia (1.23, 1.02-1.49, P = 0.035), malignancy (1.87, 1.40-2.49, P < 0.001), weekend admission compared to weekday admission (1.23, 1.02-1.47, P = 0.029), and length of stay (LOS) ≥5 days (1.39, 1.16-1.65, P < 0.001). Note that 50% of readmissions happened within 30 days of discharge. CONCLUSION Cardiac etiologies remain the most common reason for the readmission after AFL ablation. Identifying high risk patients, careful discharge planning, and close follow-up postdischarge can potentially reduce readmission rates in AFL ablation patients.
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Affiliation(s)
| | | | | | | | - Sopan Lahewala
- RWJ Barnabas Health/Jersey City Medical Center, Jersey City, NJ, USA
| | - Varun Kumar
- Mount Sinai St Luke's, Roosevelt Hospital, New York, NY, USA
| | - Mahek Shah
- Lehigh Valley Hospital, Allentown, PA, USA
| | - Dhairya Lakhani
- Mount Sinai St Luke's, Roosevelt Hospital, New York, NY, USA
| | - Harshil Shah
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nilay V Patel
- St. Peter's University Hospital, New Brunswick, NJ, USA
| | | | - Mihir Dave
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Radha Gopalan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Atrial fibrillation inducibility during cavo-tricuspid isthmus dependent atrial flutter ablation for the prediction of clinical atrial fibrillation. Int J Cardiol 2017; 240:246-250. [DOI: 10.1016/j.ijcard.2017.01.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/27/2017] [Indexed: 11/24/2022]
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5
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Affiliation(s)
- Lior Bibas
- Division of Cardiology, McGill University Health Center, Montréal, Que
| | - Michael Levi
- Division of Cardiology, McGill University Health Center, Montréal, Que
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montréal, Que.
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6
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The influence of depression and anxiety symptoms on health-related quality of life in patients with atrial fibrillation and atrial flutter. J Cardiovasc Nurs 2015; 30:66-73. [PMID: 24165697 DOI: 10.1097/jcn.0000000000000107] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The health-related quality of life (HRQoL) of patients with atrial fibrillation (AF) and atrial flutter (AFL) is an important issue in cardiovascular health management. Determinants of poor HRQoL of AF/AFL patients require further elucidation. OBJECTIVES The purpose of this study was to evaluate the influencing factors related to the HRQoL of AF/AFL patients. METHODS In 150 consecutively recruited patients in a multicenter, cross-sectional study from April 2010 to February 2011, depression and anxiety were measured with the Beck Depression Inventory II and the State Trait Anxiety Inventory, respectively, whereas HRQoL was assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Linear regression modeling was performed to determine predictors of HRQoL among variables, including the patients' age, gender, race, marital status, type of AF/AFL, frequency of AF/AFL symptoms, time since diagnosis, and anxiety and depression symptoms. RESULTS Female patients with AF/AFL reported poorer physical HRQoL than male patients did (P < .001, R² = 0.391). Symptoms of depression and anxiety were found to be associated with poorer HRQoL (P < .001, R² = 0.482). Anxiety was the strongest predictor of the mental component of the Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Younger patients had worse AF/AFL-related symptoms and severity than older patients did (P < .001, R² = 0.302). Increased frequency of symptomatic episodes was associated with worse AF/AFL-related symptoms and severity. CONCLUSION In conclusion, depression and anxiety symptoms and female gender emerged as clear indicators of poor HRQoL in AF/AFL patients. These risk factors should be used to identify patients who may require additional evaluation and treatment efforts to manage their cardiac conditions or HRQoL. Interventions to improve HRQoL in these individuals require further investigation.
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Dewland TA, Glidden DV, Marcus GM. Healthcare utilization and clinical outcomes after catheter ablation of atrial flutter. PLoS One 2014; 9:e100509. [PMID: 24983868 PMCID: PMC4077565 DOI: 10.1371/journal.pone.0100509] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/28/2014] [Indexed: 11/19/2022] Open
Abstract
Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84-0.92, p<0.001), emergency department visits (HR 0.60, 95% CI 0.54-0.65, p<0.001), and overall hospital-based healthcare utilization (HR 0.94, 95% CI 0.90-0.98, p = 0.001). Atrial flutter ablation was also associated with a statistically significant 11% reduction in the adjusted hazard of atrial fibrillation (HR 0.89, 95% CI 0.81-0.97, p = 0.01). Risk of acute stroke was not significantly reduced after ablation (HR 1.09, 95% CI 0.81-1.45, p = 0.57). In a large, real world population, atrial flutter ablation was associated with significant reductions in hospital-based healthcare utilization and a reduced risk of atrial fibrillation. These findings support the early use of catheter ablation for the treatment of atrial flutter.
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Affiliation(s)
- Thomas A. Dewland
- Department of Internal Medicine, Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, United States of America
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Gregory M. Marcus
- Department of Internal Medicine, Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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8
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Cabanas-Grandío P, García-Seara J, Gude F, Martínez-Sande JL, Fernández-López XA, González-Juanatey JR. Assessment of long-term quality of life after cavotricuspid isthmus ablation for typical atrial flutter. Health Qual Life Outcomes 2014; 12:47. [PMID: 24708680 PMCID: PMC4234208 DOI: 10.1186/1477-7525-12-47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/19/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cavotricuspid isthmus (CTI) ablation is the treatment of choice in preventing recurrences of typical atrial flutter (AFl). However, little is known about long-term quality of life (QoL) after CTI ablation. METHODS AND RESULTS From 01/2003 to 05/2005, 94 patients who consecutively underwent typical AFl ablation were included in the study. An SF-36 health questionnaire was self-administered before ablation and at follow-up. Transformed scores were calculated, adjusted for age and sex and then normalized and standardized for the Spanish population. Additionally, the minimal important differences (MID) were calculated to assess the smallest change in QoL that patients perceived as positive. A linear regression model was constructed to assess long-term QoL predictors. All SF-36 scales were lower than Spanish population scores. After a mean (SD) follow-up of 6.25 (0.5) years, all scales, except Bodily Pain, were higher than baseline. There was a significant difference for Physical Role (46.4 vs. 38.6, p < 0.001), Vitality (44.4 vs. 41.9, p = 0.038) and Mental Health (46.1 vs. 42.0, p = 0.001). However, only Physical Role achieved the criteria for MID. Recurrence of AFl, basal QoL, history of diabetes mellitus, atrial fibrillation and oral anticoagulation were predictors of long-term QoL. CONCLUSION CTI ablation provides a significant improvement in long-term QoL for the dimensions of Physical Role, Vitality and Mental Health, although the smallest positive change that patients perceive as positive was only observed for Physical Role. Previous diabetes mellitus, atrial fibrillation, oral anticoagulation, basal QoL and AFl recurrence were determinants of a worse long-term QoL.
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Affiliation(s)
- Pilar Cabanas-Grandío
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Choupana, 15706 Santiago de Compostela, Spain.
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9
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Feld GK. Radiofrequency catheter ablation of Type 1 atrial flutter using a large-tip electrode catheter and high-power radiofrequency energy generator. Expert Rev Med Devices 2014; 1:187-92. [PMID: 16293039 DOI: 10.1586/17434440.1.2.187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies have demonstrated a high degree of efficacy of 8 mm electrode-tipped or saline-irrigated-tip catheters for ablation of atrial flutter (AFL). These catheters have a theoretical advantage as they produce a large ablation lesion. However, large-tip ablation catheters have a larger surface area and require a higher power radiofrequency (RF) generator with up to 100 W capacity to produce adequate ablation temperatures (50-60 degrees C). The potential advantages of a large-tip ablation catheter and high-power RF generator include the need for fewer energy applications, shorter procedure and fluoroscopy times, and greater efficacy. Therefore, the safety and efficacy of AFL ablation using 8 or 10 mm electrode catheters and a 100-W RF generator was studied using the Boston Scientific, Inc., EPT-1000 XP cardiac ablation system. There were 169 patients, aged 61 +/- 12 years involved. Acute end points were bidirectional isthmus block and no inducible AFL. Following ablation, patients were seen at 1, 3 and 6 months, with event monitoring performed weekly and for any symptoms. Three quality of life surveys were completed during follow-up. Acute success was achieved in 158 patients (93%), with 12 +/- 11 RF energy applications. The efficacy of 8 and 10 mm electrodes did not differ significantly. The number of RF energy applications (10 +/- 8 vs. 14 +/- 8) and ablation time (0.5 +/- 0.4 vs. 0.8 +/- 0.6 h) were less with 10 mm compared with 8 mm electrodes (p < 0.01). Of 158 patients with acute success, 42 were not evaluated at 6 months due to study exclusions. Of the 116 patients evaluated at 6 months, 112 (97%) had no AFL recurrence. Of those without AFL recurrence at 6 months, 95 and 93% were free of symptoms at 12 and 24 months, respectively. Ablation of AFL improved quality of life scores (p < 0.05) and reduced anti-arrhythmic and rate control drug use (p < 0.05). Complications occurred in six out of 169 patients (3.6%) but there were no deaths. It was concluded that ablation of AFL with 8 or 10 mm electrode catheters and a high-power RF generator was safe, effective and improved quality of life. The number and duration of RF applications was lower with 10 mm compared with 8 mm electrode catheters.
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Affiliation(s)
- Gregory K Feld
- Cardiac Electrophysiology Program, University of California San Diego, 200 West Arbor Drive, 8411, San Diego, CA 92103, USA.
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10
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García Seara J, Gude F, Cabanas P, Martínez-Sande JL, Fernández López X, Madrid AH, Moro C, Juanatey JRG. Health-related quality of life in different clinical subgroups with typical AFL who have undergone cavo-tricuspid isthmus ablation. Health Qual Life Outcomes 2012; 10:90. [PMID: 22866671 PMCID: PMC3462102 DOI: 10.1186/1477-7525-10-90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 07/16/2012] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate changes in health-related quality of life (HRQOL) in different sub-groups of a cohort of patients with typical atrial flutter (AFL) treated with cavotricuspid isthmus (CTI) radiofrequency catheter ablation. Methods 95 consecutive patients due to undergo CTI ablation were enrolled in a study involving their completion of two SF-36 HRQOL questionnaires, before ablation and at one-year follow-up. Results 88 of the initial 95 patients finished the study. Regardless of whether patients experienced atrial fibrillation (AF) during follow-up, a statistically significant improvement in HRQOL was observed, compared with pre-ablation scores and in all dimensions except Bodily Pain. However, patients without AF during follow-up had significantly higher absolute HRQOL scores in most dimensions. No differences were seen in most HRQOL dimensions, with respect to AFL type (paroxysmal, persistent) or duration, whether AFL was first-episode or recurrent, Class I-III drug dependent, sex, or presence of structural heart disease or tachycardiomyopathy. Patients with persistent AFL showed the greatest improvement in HRQOL when they also had a ventricular cycle length ≤500 ms. The combination of recurrent AFL, ventricular cycle length ≤500 ms and structural heart disease led to a significantly greater improvement in physical HRQOL dimensions than did first-episode AFL, no structural heart disease and ventricular cycle >500 ms. The only independent factor associated with a greater improvement was structural cardiopathy. Conclusions CTI-ablation treatment leads to a significant improvement in HRQOL in patients with typical AFL. Patients with AF during follow-up show a significantly lower HRQOL at one-year post-ablation. The only independent risk factor found to be associated with a greater improvement in the physical summary component was structural cardiopathy.
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Affiliation(s)
- Javier García Seara
- Cardiology Department, Hospital Clinico de Santiago de Compostela, Calle Choupana s/n, Santiago de Compostela 15703, Spain.
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García-Seara J, Gude F, Cabanas-Grandío P, Martínez-Sande JL, Fernández-López X, Elices-Teja J, Raposeiras Roubin S, González-Juanatey JR. Structural and functional inverse cardiac remodeling after cavotricuspid isthmus ablation in patients with typical atrial flutter. Rev Esp Cardiol 2012; 65:1003-9. [PMID: 22841435 DOI: 10.1016/j.recesp.2012.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 03/30/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The purpose of the present study is to determine the structural and functional cardiac changes that occur in patients at 1-year follow-up after ablation of typical atrial flutter. METHODS We enrolled 95 consecutive patients referred for cavotricuspid isthmus ablation. Echocardiography was performed at ≤6h post-procedure and 1-year follow-up. RESULTS Of 95 patients initially included, 89 completed 1-year follow-up. Hypertensive cardiopathy was the most frequently associated condition (39%); 24% of patients presented low baseline left ventricular systolic dysfunction. We observed a significant reduction in right and left atrial areas, end-diastolic and end-systolic left ventricular diameters, and interventricular septum. We observed substantial improvement in right atrium contraction fraction and left ventricular ejection fraction, and a reduction in pulmonary hypertension. Changes in diastolic dysfunction pattern were observed: 60% of patients progressed from baseline grade III to grade I; at 1-year follow-up, this improvement was found in 81%. We found no structural differences between paroxysmal and persistent atrial flutter at baseline and 1-year follow-up, exception for basal diastolic function. CONCLUSIONS In patients with typical atrial flutter undergoing cavotricuspid isthmus catheter ablation, we found inverse structural and functional cardiac remodeling at 1-year follow-up with much improved left ventricular ejection fraction, right atrium contraction fraction, and diastolic dysfunction pattern. Full English text available from:www.revespcardiol.org.
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Affiliation(s)
- Javier García-Seara
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
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García Seara J, Gude F, Cabanas P, Martínez Sande JL, Fernández López X, Elices J, Brugada Terradellas J, González Juanatey JR. Diferencias en la calidad de vida en pacientes con flutter auricular típico sometidos a ablación del istmo cavotricuspídeo. Rev Esp Cardiol 2011; 64:401-8. [PMID: 21482002 DOI: 10.1016/j.recesp.2010.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 12/13/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Javier García Seara
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, España.
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13
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Bandini A, Golia P, Caroli E, Biancoli S, Galvani M. Atrial fibrillation after typical atrial flutter ablation: a long-term follow-up. J Cardiovasc Med (Hagerstown) 2011; 12:110-5. [DOI: 10.2459/jcm.0b013e3283403301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Meissner A, Stifoudi I, Weismüller P, Schrage MO, Maagh P, Christ M, Butz T, Trappe HJ, Plehn G. Sustained high quality of life in a 5-year long term follow-up after successful ablation for supra-ventricular tachycardia. results from a large retrospective patient cohort. Int J Med Sci 2009; 6:28-36. [PMID: 19158961 PMCID: PMC2628552 DOI: 10.7150/ijms.6.28] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 01/09/2009] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The ablation of supraventricular tachycardias (SVT) using radiofrequency energy (RF) is a procedure with a high primary success rate. However, there is a scarcity of data regarding the long term outcome, particularly with respect to quality of life (QoL). METHODS AND RESULTS In this retrospective single-center study, 454 patients who underwent ablation of SVT between 2002 and 2007 received a detailed questionnaire addressing matters of QoL. The questionnaire was a modified version of the SF-36 Health Survey questionnaire and the Symptom Checklist--Frequency and Severity Scale.After a mean follow up of 4.5+/-1.3 years, 309 (68.1%) of the contacted 454 patients (269 female, 59.2%, mean age 58+/-6.5) completed the questionnaire. Despite of 27% of relapses in the study group, 91.7% considered the procedure a long-term success. The remainder of patients experienced no change in (3.7%) or worsening of (4.7%) symptoms. There were no significant differences between the various types of SVT (p=1). QoL in patients with Atrio-Ventricular Nodal Reentry Tachycardia (AVNRT) and Atrio-Ventricular Reentry Tachycardia (AVRT) improved significantly (p<0.0005 respectively p<0.043), whereas QoL in patients with Ectopic Atrial Tachycardia (EAT) showed a non-significant trend towards improvement. Main symptoms before ablation, such as tachycardia (91.5%), increased incidence of tachycardia episodes over time (78.1%), anxiety (55.5%) and reduced physical capacity in daily life (52%) were significantly improved after ablation (p<0.0001). CONCLUSION The high acute ablation success of SVT persists for years in long term follow up and translates into a significant improvement of QoL in most patients.
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Affiliation(s)
- Axel Meissner
- Department of Cardiology and Angiology, Ruhr-University Bochum, Germany.
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Laurent V, Fauchier L, Pierre B, Grimard C, Babuty D. Incidence and predictive factors of atrial fibrillation after ablation of typical atrial flutter. J Interv Card Electrophysiol 2008; 24:119-25. [PMID: 18982436 DOI: 10.1007/s10840-008-9323-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 09/15/2008] [Indexed: 11/27/2022]
Affiliation(s)
- Valérie Laurent
- Pôle CTVH, Centre Hospitalier Universitaire Trousseau, 37044 Tours Cedex 1, France
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Thornton AS, Janse P, Alings M, Scholten MF, Mekel JM, Miltenburg M, Jessurun E, Jordaens L. Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters. J Interv Card Electrophysiol 2008; 21:241-8. [PMID: 18363087 PMCID: PMC2292475 DOI: 10.1007/s10840-008-9209-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 01/11/2008] [Indexed: 12/01/2022]
Abstract
Objectives To compare the acute success and short-term follow-up of ablation of atrial flutter using 8 mm tip radiofrequency (RF) and cryocatheters. Methods Sixty-two patients with atrial flutter were randomized to RF or cryocatheter (cryo) ablation. Right atrial angiography was performed to assess the isthmus. End point was bidirectional isthmus block on multiple criteria. A pain score was used and the analgesics were recorded. Patients were followed for at least 3 months. Results The acute success rate for RF was 83% vs 69% for cryo (NS). Procedure times were similar (mean 144 ± 48 min for RF, vs 158 ± 49 min for cryo). More applications were given with RF than with cryo (26 ± 17 vs. 18 ± 10, p < 0.05). Fluoroscopy time was longer with RF (29 ± 15 vs. 19 ± 12 min, p < 0.02). Peak CK, CK-MB and CK-MB mass were higher, also after 24 h in the cryo group. Troponin T did not differ. Repeated transient block during application (usually with cryoablation) seemed to predict failure. Cryothermy required significantly less analgesia (p < 0.01), and no use of long sheaths (p < 0.005). The isthmus tended to be longer in the failed procedures (p = 0.117). This was similar for both groups, as was the distribution of anatomic variations. Recurrences and complaints in the successful patients were similar for both groups, with a very low recurrence of atrial flutter after initial success. Conclusions In this randomized study there was no statistical difference but a trend to less favorable outcome with 8 mm tip cryocatheters compared to RF catheters for atrial flutter ablation. Cryoablation was associated with less discomfort, fewer applications, shorter fluoroscopy times and similar procedure times. The recurrence rate was very low. Cryotherapy can be considered for atrial flutter ablation under certain circumstances especially when it has been used previously in the same patient, such as in an AF ablation.
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Affiliation(s)
- A S Thornton
- Department of Clinical Electrophysiology, Thoraxcentre, Erasmus MC, Room Ba581, s Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
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Maury P, Raczka F, Gaty D, Duparc A, Couderc P, Hollington L, Celse D, Delay M, Fauvel JM, Puel J, Davy JM. Radio-Frequency Ablation of Atrial Flutter: Long-Term Results and Predictive Value of Cavo-Tricuspid Isthmus Bidirectional Block as Determined by a Simplified Technique. Cardiology 2008; 110:17-28. [DOI: 10.1159/000109402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 03/20/2007] [Indexed: 11/19/2022]
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Meissner A, Christ M, Maagh P, Borchard R, van Bracht M, Wickenbrock I, Trappe HJ, Plehn G. Quality of life and occurrence of atrial fibrillation in long-term follow-up of common type atrial flutter ablation: ablation with irrigated 5 mm tip and conventional 8 mm tip electrodes. Clin Res Cardiol 2007; 96:794-802. [PMID: 17721735 DOI: 10.1007/s00392-007-0559-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Accepted: 05/31/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The ablation of common type atrial flutter is mainly performed by two approved techniques, whose efficacy and outcome in terms of quality of life have not been evaluated so far in a long-term follow-up study over years. A high proportion of patients suffer from coexistent atrial fibrillation, which may worsen the ablation result. The question arises whether one technique is more effective than the other when immediate ablation results, the occurrence of atrial fibrillation and the quality of life are compared. Considering these facts, it is reasonable to think about new ablation strategies for common type atrial flutter in the era of new concepts in catheter ablation of atrial fibrillation. METHODS In a retrospective study we evaluated a detailed questionnaire in 132 patients who underwent ablation of common type between 1999 and 2004. Radiofrequency ablation was performed irrespective of coexistent atrial fibrillation either with an irrigated tip or the 8 mm tip electrode. Acute and long-term ablation outcome, and the associated quality of life, pre-, under- and post-ablation was compared in the two different ablation groups. Recurrent tachycardia were re-evaluated by 12 lead ECG analysis and assessed for both ablation groups. RESULTS 88 (67%) of the 132 patients contacted answered the questionnaire polling the perceived benefits of the procedure. Of the other 44 patients (33%); 4 (3%) had died, 7 (5.3%) had moved, 33 patients (25%) could not be included due to missing or incoherent answers. Independent of the ablation technique there was a high acute and long-term ablation success rate at about 95%. After a mean of 3 years of follow-up this benefit persists in spite of a high proportion of recurrent tachycardia, mainly atrial fibrillation (55/88 patients, 59.1%). Despite the occurrence of secondary tachycardia, there was a high significant long-term symptomatic benefit in the state of healthy and daily practice work, evaluated with a p-value of < 0.0005. The frequency of episodes and the symptom "tachycardia" were significantly reduced after effective ablation of common type atrial flutter, p-values of 0.003 and 0.002, respectively. Therefore the need for hospitalization was significant reduced (p = 0.001). Comparison of both approaches revealed that there was no significant difference related to the incidence and occurrence of atrial fibrillation. CONCLUSIONS The two mainly accepted and applied techniques for the ablation of common type atrial flutter show an excellent outcome under the aspect of ablation efficacy and quality of life in longterm follow-up. Three years after the ablation procedure the majority of patients consider the intervention beneficial. Despite the relatively high appearance of atrial fibrillation in the long-term follow-up this effect is still traceable.
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Affiliation(s)
- Axel Meissner
- Medizinische Klinik II, Schwerpunkte Kardiologie und Angiologie Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.
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Cade S, Sedighian S, Bortone A, Gervasoni R, Macia JC, Leclercq F, Grolleau R, Pasquié JL. Atrial fibrillation and its determinants after radiofrequency ablation of chronic common atrial flutter. Indian Pacing Electrophysiol J 2005; 5:272-8. [PMID: 16943876 PMCID: PMC1431601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM Atrial fibrillation (AFib) is a major clinical issue and its occurrence is the main problem after catheter ablation of atrial flutter. The long-term occurrence of AFib after common atrial flutter ablation is still matter of debate as it may influence the therapeutic approach. So, the aim of our study was to analyze the determinants and the time course of AFib after radiofrequency catheter ablation of chronic common atrial flutter. METHODS AND RESULT 89 consecutive patients (67.5 +/- 12.0 yrs) underwent RF ablation of chronic common atrial flutter. 38.2 % had previous history of paroxysmal AFib. 51% had no underlying structural heart disease. Over a mean follow-up of 38 +/- 13 months, the occurrence rate of AFib progressively increased up to 32.9% at the end of follow-up. The median occurrence time for AFib was 8 months. AFib occurrence was significantly associated with previous AFib history (P=0.01) but not with the presence of underlying heart disease (P=n.s.). Of particular interest, in our study, AFib never occurred in patients without previous AFib history. Palpitations after chronic common atrial flutter ablation was mostly related to AFib. CONCLUSION In conclusion, after chronic common atrial flutter ablation, AFib incidence progressively increased over the follow-up in all patients. Patients with prior AFib history appeared to be a very high risk group. In these patients, closer monitoring is mandatory and the persistent risk of AFib recurrences may justify prolonged anticoagulation policy.
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Affiliation(s)
- Stéphane Cade
- Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire, Montpellier, France
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Jansens JL, Ducart A, Preumont N, Jottrand M, Stefanidis C, Stoupel E, de Cannière D. Pulmonary Vein Isolation by Robotic-Enhanced Thoracoscopy for Symptomatic Paroxysmal Atrial Fibrillation. Heart Surg Forum 2004; 7:E595-8. [PMID: 15769694 DOI: 10.1532/hsf98.20041107] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) has been shown to be effective treatment of patients with symptomatic paroxysmal atrial fibrillation (PAF). The percutaneous approach is currently the technique of choice. Unfortunately, this procedure has limitations and complications that lead to fluctuating success rates. We explored an alternative technique of robotic-enhanced, closed-chest PVI with an endoscopic microwave-based catheter. METHODS Seven symptomatic PAF patients were included in the study. The pulmonary veins were isolated through right (only) robotic-enhanced thoracoscopy on the beating heart. RESULTS Six patients underwent successful endoscopic PVI. In 1 patient the operation was converted into small right thoracotomy. Operative assessment of the ablation line showed a successful electric block in every patient. Three months after the procedure, the first 5 patients were in permanent sinus rhythm. The 2 other patients had AF but had less frequent and less symptomatic episodes compared with the preoperative situation. CONCLUSIONS On the basis of this preliminary experience, we believe that in the near future endoscopic right-chest robotic-enhanced PVI on the beating heart may become a valid option in the treatment of symptomatic PAF patients. This procedure allows for more-reproducible ablation lines and may avoid many of the pitfalls and drawbacks of the percutaneous approach. Therefore this technique deserves larger prospective evaluation in the treatment of AF.
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Affiliation(s)
- Jean Luc Jansens
- Department of Cardiac Surgery, Erasme University Hospital, Brussels, Belgium.
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Feld G, Wharton M, Plumb V, Daoud E, Friehling T, Epstein L. Radiofrequency catheter ablation of type 1 atrial flutter using large-tip 8- or 10-mm electrode catheters and a high-output radiofrequency energy generator. J Am Coll Cardiol 2004; 43:1466-72. [PMID: 15093885 DOI: 10.1016/j.jacc.2003.11.036] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Revised: 10/24/2003] [Accepted: 11/12/2003] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We studied the safety and efficacy of atrial flutter (AFL) ablation using 8- or 10-mm electrode catheters and a 100-W radiofrequency (RF) generator. BACKGROUND Large-tip electrode catheters may be more effective for ablation of AFL. METHODS There were 169 patients (age 61 +/- 12 years). Short-term end points were bidirectional isthmus block and no inducible AFL. After ablation, patients were seen at one, three, and six months, with event monitoring performed weekly and for any symptoms. Three quality-of-life (QOL) surveys were completed during follow-up. RESULTS Short-term success was achieved in 158 patients (93%), with 12 +/- 11 RF applications. The efficacy of 8- and 10-mm electrodes was similar (p = NS). The number of RF applications (10 +/- 8 vs. 14 +/- 8) and ablation time (0.5 +/- 0.4 h vs. 0.8 +/- 0.6 h) were less with the 10- versus 8-mm electrode, respectively (p < 0.01). Of 158 patients with short-term success, 42 patients were not evaluated for success at six months because of study exclusions. Of 116 patients with short-term success evaluated at six months, 112 (97%) patients had no AFL recurrence. Of those without AFL recurrence at six months, 95% and 93% remained free of symptoms at 12 and 24 months, respectively. Ablation of AFL improved QOL scores (p < 0.05) and reduced anti-arrhythmic and rate-control drug use (p < 0.05). Complications occurred in 6 (3.6%) of 169 patients, but there were no deaths. CONCLUSIONS Ablation of AFL with 8- or 10-mm electrode catheters and a high-power RF generator was safe and effective and improved QOL. The number and duration of RF applications were lower with 10- versus 8-mm electrode catheters.
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Affiliation(s)
- Gregory Feld
- UCSD Medical Center, University of California, San Diego, California 92103, USA.
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Babaev A, Suma V, Tita C, Steinberg JS. Recurrence rate of atrial flutter after initial presentation in patients on drug treatment. Am J Cardiol 2003; 92:1122-4. [PMID: 14583371 DOI: 10.1016/j.amjcard.2003.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Atrial flutter (AFl) recurrence after initial in-patient presentation, cardioversion, and drug treatment is almost universal, often leading to rehospitalization and risk of serious clinical consequences. Radiofrequency ablation of AFl, which has an excellent safety record, should be evaluated as a first-line approach for most patients with AFl.
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Affiliation(s)
- Anvar Babaev
- Arrhythmia Service and Division of Cardiology, St. Luke's-Roosevelt Hospital Center, and Columbia University College of Physicians & Surgeons, New York, New York 10025, USA
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Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW, Stevenson WG, Tomaselli GF, Antman EM, Smith SC, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MAA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JCA, Oto A, Smiseth O, Trappe HJ. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary. Circulation 2003; 108:1871-909. [PMID: 14557344 DOI: 10.1161/01.cir.0000091380.04100.84] [Citation(s) in RCA: 312] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW, Stevenson WG, Tomaselli GF, Antman EM, Smith SC, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MAA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JCA, Oto A, Smiseth O, Trappe HJ. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias∗∗This document does not cover atrial fibrillation; atrial fibrillation is covered in the ACC/AHA/ESC guidelines on the management of patients with atrial fibrillation found on the ACC, AHA, and ESC Web sites.—executive summary. J Am Coll Cardiol 2003; 42:1493-531. [PMID: 14563598 DOI: 10.1016/j.jacc.2003.08.013] [Citation(s) in RCA: 379] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
MESH Headings
- Anti-Arrhythmia Agents/therapeutic use
- Atrial Flutter/diagnosis
- Atrial Flutter/therapy
- Cardiac Pacing, Artificial
- Catheter Ablation
- Costs and Cost Analysis
- Diagnosis, Differential
- Electrocardiography
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Conduction System/physiopathology
- Heart Defects, Congenital/complications
- Humans
- Male
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Quality of Life
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/therapy
- Tachycardia, Ectopic Atrial/diagnosis
- Tachycardia, Ectopic Atrial/therapy
- Tachycardia, Ectopic Junctional/diagnosis
- Tachycardia, Ectopic Junctional/therapy
- Tachycardia, Paroxysmal/diagnosis
- Tachycardia, Paroxysmal/therapy
- Tachycardia, Sinus/diagnosis
- Tachycardia, Sinus/therapy
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/therapy
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Deaton C, Dunbar SB, Moloney M, Sears SF, Ujhelyi MR. Patient experiences with atrial fibrillation and treatment with implantable atrial defibrillation therapy. Heart Lung 2003; 32:291-9. [PMID: 14528186 DOI: 10.1016/s0147-9563(03)00074-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patient perspectives about their illness experiences, symptoms, and treatment are essential aspects of quality of life and provide direction for patient and provider decision making regarding innovative therapies such as implantable devices for arrhythmia. PURPOSE The purpose of this qualitative study was to describe: 1) the experience of patients living with symptomatic, drug-refractory atrial fibrillation (AF) and 2) patient experiences and acceptance of treatment with the implantable cardioverter defibrillator (ICD) with atrial therapies (ICD-AT) including ventricular and atrial defibrillation therapy. PARTICIPANTS Subjects were 3 women and 8 men, 35 to 80 years of age, who received the Medtronic Jewel AF 7250 ICD-AT as therapy for recurrent, drug-refractory AF, had a history of AF for 3 to 20 years and had experienced multiple treatment modalities including frequent external cardioversion in an effort to control their AF. METHODS A semi-structured interview addressed experiences of symptoms and prior treatment for AF and experiences, concerns, and perceived benefits of the ICD-AT. Interviews were recorded and transcribed verbatim. Narratives were coded and categorized using Atlas Ti(R) software. Qualitative interpretive analysis methods were used to identify key themes. RESULTS Before ICD-AT, patient themes focused on AF that was: 1) misdiagnosed, minimized, and poorly treated; 2) distressful because of frequent and intense AF symptoms (fatigue, dizziness, shortness of breath, and anxiety) before ICD-AT; 3) limiting of activities of daily living; 4) associated with distress from enduring previous treatment; and 5) associated with the continuous pursuit of successful treatment and maintenance of normalcy. Decision making regarding ICD-AT therapy included weighing symptom or treatment distress versus anticipated risks or benefits, hope for better outcomes, and lack of options. After ICD-AT, themes included positive perceptions of the device because of AF symptom relief, ability to resume normalcy, and medication tolerance; incorporation of shock experiences into life routines; and patient suggestions regarding preparation and social support. IMPLICATIONS Symptoms of AF have a major negative impact on overall quality of life. Treatment with the ICD-AT confers a sense of security and reduced symptom distress. Greater provider attention to patient preparation and facilitating social support are important for future ICD-AT patient care.
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Affiliation(s)
- Christi Deaton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia 30322, USA
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Tada H, Naito S, Kurosaki K, Ueda M, Ito S, Shinbo G, Takahashi T, Hoshizaki H, Oshima S, Taniguchi K, Nogami A. Segmental Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Improves Quality of Life and Clinical Outcomes. Circ J 2003; 67:861-5. [PMID: 14578620 DOI: 10.1253/circj.67.861] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to clarify the change in the quality of life (QOL) and clinical outcomes following segmental pulmonary vein (PV) isolation for paroxysmal atrial fibrillation (AF) in 50 patients with drug-refractory, paroxysmal AF. The left superior, left inferior, and right superior PVs were targeted for isolation in all patients, and the right inferior PV was isolated in 4 patients. AF recurred in 22 of 50 patients, and these patients were treated with class I or class III antiarrhythmic drugs that had been ineffective before the ablation procedure. The symptom severity and frequency was scored and the QOL was assessed using the Short-Form-36 questionnaire (SF-36) before the PV isolation and at the end of the follow-up period (6.0+/-3.0 months). PV isolation resulted in a reduction in the symptom severity (p<0.001) and symptom frequency (p<0.001) scores as compared with the pre-ablation values. Ninety percent of the patients had a >90% reduction in the frequency of symptomatic episodes of AF after the ablation procedure. The mean SF-36 physical and mental component summary scores also significantly improved after PV isolation as compared with the pre-ablation values (both for p<0.001). With a segmental isolation approach that targets at least 3 PVs, satisfactory improvement in the symptoms and QOL can be achieved in patients with drug-refractory, paroxysmal AF.
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Affiliation(s)
- Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
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