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Mei Y, Ye F, Yin X, Wu X. Causal Effect of Atrial Fibrillation on Heart Failure Risk in East Asian Ancestry: A Bidirectional Mendelian Randomization Study Using Genome-wide Association Data. Anatol J Cardiol 2024; 28:399-405. [PMID: 38872495 PMCID: PMC11317784 DOI: 10.14744/anatoljcardiol.2024.4369] [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: 02/21/2024] [Accepted: 04/30/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) are prevalent cardiovascular conditions in East Asia, with a complex interrelationship. The directionality of the causal impact of AF on HF risk remains uncertain. This study employs Mendelian randomization (MR) to investigate the potential causal effect of AF on HF. METHODS Utilizing summary data from genome-wide association studies (GWAS) within the Medical Research Council Integrative Epidemiology Unit open GWAS database, we analyzed 8180 AF cases and 28 612 controls, alongside 9413 HF cases and 203 040 controls, all of East Asian descent. We conducted MR analysis using the inverse variance weighted (IVW) method, complemented by various sensitivity analyses, including bidirectional MR to assess causality in the reverse direction. RESULTS Genetically predicted AF was found to be causally associated with an increased risk of HF in East Asian populations (odds ratio = 1.14, 95% CI: 1.10-1.19, P <.001) as per the IVW method. These findings were consistent across multiple MR methods. Sensitivity analyses revealed no significant heterogeneity or pleiotropy. Notably, bidirectional MR analysis showed no causal effect of HF on the risk of developing AF. CONCLUSIONS The MR analysis supports a unidirectional causal relationship between AF and increased HF risk in East Asian individuals. The absence of a reverse causal effect reinforces the importance of maintaining sinus rhythm to mitigate HF risk. Further research is warranted to corroborate these findings and to explore their clinical implications in depth.
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Affiliation(s)
- Yibin Mei
- Department of Cardiology, Lishui People’s Hospital, the Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of Cardiology, First Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
| | - Fang Ye
- Department of Cardiology, Lishui People’s Hospital, the Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of Cardiology, First Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
| | - Xiaofen Yin
- Liancheng Community Health Service Center, Lishui, Zhejiang, China
| | - Xianjun Wu
- Department of Cardiology, Lishui People’s Hospital, the Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of Cardiology, First Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
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Salinet J, Molero R, Schlindwein FS, Karel J, Rodrigo M, Rojo-Álvarez JL, Berenfeld O, Climent AM, Zenger B, Vanheusden F, Paredes JGS, MacLeod R, Atienza F, Guillem MS, Cluitmans M, Bonizzi P. Electrocardiographic Imaging for Atrial Fibrillation: A Perspective From Computer Models and Animal Experiments to Clinical Value. Front Physiol 2021; 12:653013. [PMID: 33995122 PMCID: PMC8120164 DOI: 10.3389/fphys.2021.653013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/22/2021] [Indexed: 01/16/2023] Open
Abstract
Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance.
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Affiliation(s)
- João Salinet
- Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil
| | - Rubén Molero
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Fernando S. Schlindwein
- School of Engineering, University of Leicester, United Kingdom and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Joël Karel
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
| | - Miguel Rodrigo
- Electronic Engineering Department, Universitat de València, València, Spain
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications and Telematic Systems and Computation, University Rey Juan Carlos, Madrid, Spain
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI, United States
| | - Andreu M. Climent
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Brian Zenger
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Frederique Vanheusden
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Jimena Gabriela Siles Paredes
- Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil
| | - Rob MacLeod
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María S. Guillem
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Matthijs Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Pietro Bonizzi
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
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3
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Andrade JG, Deyell MW, Badra M, Champagne J, Dubuc M, Leong-Sit P, Macle L, Novak P, Roux JF, Sapp J, Tang A, Verma A, Wells GA, Khairy P. Randomised clinical trial of cryoballoon versus irrigated radio frequency catheter ablation for atrial fibrillation-the effect of double short versus standard exposure cryoablation duration during pulmonary vein isolation (CIRCA-DOSE): methods and rationale. BMJ Open 2017; 7:e017970. [PMID: 28982836 PMCID: PMC5639989 DOI: 10.1136/bmjopen-2017-017970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is an effective therapy for paroxysmal atrial fibrillation (AF), but it has limitations. The two most significant recent advances have centred on the integration of real-time quantitative assessment of catheter contact force into focal radio frequency (RF) ablation catheters and the development of dedicated ablation tools capable of achieving PVI with a single ablation lesion (Arctic Front cryoballoon, Medtronic, Minneapolis, MN, USA). Although each of these holds promise for improving the clinical success of catheter ablation of AF, there has not been a rigorous comparison of these advanced ablation technologies. Moreover, the optimal duration of cryoablation (freezing time) has not been determined. METHODS AND ANALYSIS Patients undergoing an initial PVI procedure for paroxysmal AF will be recruited. Patients will be randomised 1:1:1 between contact-force irrigated RF ablation, short duration cryoballoon ablation (2 min applications) and standard duration cryoballoon ablation (4 min applications). The primary outcome is time to first documented AF recurrence on implantable loop recorder. With a sample size of 111 per group and a two-sided 0.025 significance level (to account for the two main comparisons), the study will have 80% power (using a log-rank test) to detect a difference of 20% between contact force RF catheter ablation and either of the two cryoballoon ablation groups. Factoring in a 4% loss to follow-up, 116 patients per group should be randomised and followed for a year (total study population of 348). ETHICS AND DISSEMINATION The study was approved by the University of British Columbia Office of Research (Services) Ethics Clinical Research Ethics Board. Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT01913522; Pre-results.
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Affiliation(s)
- Jason G Andrade
- Department of Medicine, Montreal Heart Institute, Université de Montréal, British Columbia, Canada
- Department of Medicine, University of British Columbia, Montreal, Quebec, Canada
| | - Marc W Deyell
- Department of Medicine, University of British Columbia, Montreal, Quebec, Canada
| | - Mariano Badra
- Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean Champagne
- Department of Medicine, Universite Laval, Quebec, Canada
| | - Marc Dubuc
- Department of Medicine, Montreal Heart Institute, Université de Montréal, British Columbia, Canada
| | - Peter Leong-Sit
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Laurent Macle
- Department of Medicine, Montreal Heart Institute, Université de Montréal, British Columbia, Canada
| | - Paul Novak
- Department of Medicine, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Jean-Francois Roux
- Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - John Sapp
- Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony Tang
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Atul Verma
- Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - George A Wells
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, British Columbia, Canada
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Pillarisetti J, Reddy N, Biria M, Ryschon K, Nagarajan D, Murray C, Atkins D, Bommana S, Reddy MY, DiBiase L, Pimentel R, Berenbom L, Dawn B, Natale A, Lakkireddy D. Elevated brain natriuretic peptide level in patients undergoing atrial fibrillation ablation: is it a predictor of failed ablation or a mere function of atrial rhythm and rate at a point in time? J Interv Card Electrophysiol 2014; 40:161-8. [DOI: 10.1007/s10840-014-9898-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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BERTAGLIA EMANUELE, STABILE GIUSEPPE, PAPPONE ALESSIA, THEMISTOCLAKIS SAKIS, TONDO CLAUDIO, SANCTIS VALERIODE, SOLDATI EZIO, TRITTO MASSIMO, SOLIMENE FRANCESCO, GRIMALDI MASSIMO, ZOPPO FRANCO, PANDOZI CLAUDIO, AUGELLO GIUSEPPE, CALÒ LEONARDO, PAPPONE CARLO. Updated National Multicenter Registry on Procedural Safety of Catheter Ablation for Atrial Fibrillation. J Cardiovasc Electrophysiol 2013; 24:1069-74. [DOI: 10.1111/jce.12194] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/14/2013] [Accepted: 05/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- EMANUELE BERTAGLIA
- Cardiology Clinic, Department of Cardiological; Thoracic and Vascular Sciences; University of Padua Medical School
| | | | | | | | | | | | | | - MASSIMO TRITTO
- Clinical Institute Humanitas Mater Domini; Castellanza (VA)
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Guiraudon GM, Jones DL, Skanes A, Tweedie E, Klein GJ. Revisiting right atrial isolation rationale for atrial fibrillation: functional anatomy of interatrial connections. J Interv Card Electrophysiol 2013; 37:267-73. [DOI: 10.1007/s10840-013-9804-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022]
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Transseptal puncture using minimally invasive echocardiography during atrial fibrillation ablation. Europace 2010; 12:1435-8. [DOI: 10.1093/europace/euq297] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Abstract
Controversies exist with regard to the optimal management of atrial fibrillation (AF). Restoration and maintenance of sinus rhythm is a desirable goal in AF patients because the prevention of recurrences may improve cardiac function, relieve symptoms and should reduce the likelihood of adverse events. Pharmacological therapy for AF has been disappointing with unacceptable rates of AF recurrence and other proarrhythmic sequelae. Recent studies suggested that potential benefit of sinus-rhythm maintenance with respect to mortality may have been neutralized by harmful effects of currently available antiarrhythmic therapies. Because of the inefficacy and dangers with nonablative therapies currently available for maintaining sinus rhythm, alternative treatments are certainly desirable. Curative treatment of atrial fibrillation with catheter ablation is now a legitimate option for a large number of patients. In several studies AF ablation has consistently been demonstrated to be superior to antiarrhythmic medications for the maintenance of sinus rhythm. Nevertheless, many aspects of the therapy are still controversial and large-scale prospective studies are needed to confirm the efficacy and safety of this approach.
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Affiliation(s)
- Giovanni B. Forleo
- Cardiac Arrhythmia and Heart Failure Research Institute, St Camillo-Forlanini Hospital, Catholic University of Sacred Heart. Piazza Carlo Forlanini, 1. 00151, Rome, Italy
| | - Claudio Tondo
- Cardiac Arrhythmia and Heart Failure Research Institute, St Camillo-Forlanini Hospital, Catholic University of Sacred Heart. Piazza Carlo Forlanini, 1. 00151, Rome, Italy,
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9
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10
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Pratola C, Baldo E, Notarstefano P, Toselli T, Ferrari R. Radiofrequency atrial fibrillation ablation based on pathophysiology: a diversified protocol with long-term follow-up. J Cardiovasc Med (Hagerstown) 2008; 9:68-75. [DOI: 10.2459/jcm.0b013e3280bad879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Koistinen J, Valtonen M, Savola J, Airaksinen J. Thoracoscopic microwave ablation of atrial fibrillation. Interact Cardiovasc Thorac Surg 2007; 6:695-8. [PMID: 17699543 DOI: 10.1510/icvts.2006.147942] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of the study was to assess the safety and efficacy of thoracoscopic microwave ablation in treating atrial fibrillation (AF). AF predisposes to embolic complications and may cause heart failure. The treatment of AF is still challenging in spite of the promising results of endocardial radiofrequency approach. The present study is a follow-up study of 22 patients (mean age 45 years, range 21-59) with disabling paroxysmal (n=10) or persistent (n=12) AF who underwent a thoracoscopic microwave isolation of pulmonary veins. The patients had a lone AF. All the patients had suffered from severely disabling AF for >1 year (range 1-16 years) without any response to antiarrhythmic medication. The patients have been followed-up on an average of 11 months (range 3-22 months). During the follow-up, 13 (60%) patients have become asymptomatic without any documentation of AF since at least two months, six (27%) patients with anti-arrhythmic medication have clinically improved. Because of major intrathoracic bleeding and because of liver damage the thoracoscopy wound had to be expanded to open thoracotomy in two patients. Thoracoscopic AF microwave ablation seems to be a promising alternative to endocardial ablation in the treatment of highly symptomatic paroxysmal and persistent AF.
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12
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Bertaglia E, Zoppo F, Tondo C, Colella A, Mantovan R, Senatore G, Bottoni N, Carreras G, Corò L, Turco P, Mantica M, Stabile G. Early complications of pulmonary vein catheter ablation for atrial fibrillation: A multicenter prospective registry on procedural safety. Heart Rhythm 2007; 4:1265-71. [PMID: 17905330 DOI: 10.1016/j.hrthm.2007.06.016] [Citation(s) in RCA: 178] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 06/14/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Data on the procedural safety of pulmonary vein radiofrequency catheter ablation for atrial fibrillation (AF) are as yet scant. OBJECTIVE The aims of the present study were to prospectively evaluate the incidence of early complications of pulmonary vein ablation for AF in an unselected population of consecutive patients, and to identify possible predictors. METHODS From April 2005 to October 2006, data from 1,011 consecutive patients who were undergoing radiofrequency catheter ablation for every type of AF in 10 Italian centers were collected. All complications occurring from the admission of the patient up to the 30th day were considered. RESULTS No procedure-related death was observed. Complications occurred in 40 patients (3.9%): 12 (1.2%) had peripheral vascular complications, 8 (0.8%) had conservatively treated pericardial effusion, 6 (0.6%) had cardiac tamponade (successfully drained), 5 (0.5%) had cerebral embolisms, 4 (0.4%) presented pulmonary vein stenosis >50%, and 5 (0.5%) presented other isolated adverse events. History of coronary artery disease (odds ratio 5,603, 95% confidence interval 1,559 to 20,139, P < .008) characterized patients who presented with hemorrhagic complications. CONCLUSION Early complications of pulmonary vein catheter ablation seem to be fewer than in the early years of AF ablation, but still occur in 3.9% of procedures.
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Affiliation(s)
- Emanuele Bertaglia
- Dipartimento di Cardiologia, Ospedale Civile di Mirano, Via Ca'Rossa 35, 30173 Venice, Italy.
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Pratola C, Baldo E, Notarstefano P, Ferrari R. Radiofrequency catheter ablation to cure atrial fibrillation: may be a wrong target. J Cardiovasc Med (Hagerstown) 2007; 8:718-9. [PMID: 17700402 DOI: 10.2459/jcm.0b013e3280101de8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Claudio Pratola
- Chair of Cardiology, S. Anna University Hospital, Corso Giovecca 203, 44100 Ferrara, Italy.
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Bakir I, Casselman FP, Brugada P, Geelen P, Wellens F, Degrieck I, Van Praet F, Vermeulen Y, De Geest R, Vanermen H. Current strategies in the surgical treatment of atrial fibrillation: review of the literature and Onze Lieve Vrouw Clinic's strategy. Ann Thorac Surg 2007; 83:331-40. [PMID: 17184704 DOI: 10.1016/j.athoracsur.2006.07.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 07/15/2006] [Accepted: 07/18/2006] [Indexed: 10/23/2022]
Abstract
Atrial fibrillation is the most common rhythm disturbance in clinical practice. It is a major source of stroke and morbidity. Although the Cox maze procedure effectively eliminates atrial fibrillation in most patients, the procedure has not found widespread application. As a consequence, new operations that use alternative sources of energy, such as radiofrequency, microwave, cryothermy, laser, and ultrasound have emerged to surgically create lesion sets to treat atrial fibrillation. This article reviews the fundamentals and current strategies in the surgical treatment of atrial fibrillation.
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Affiliation(s)
- Ihsan Bakir
- Cardiovascular and Thoracic Surgery Department, Onze Lieve Vrouw Clinic, Aalst, Belgium
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15
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Zimetbaum P, Falk RH. Atrial Fibrillation. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Date T, Yamane T, Inada K, Matsuo S, Miyanaga S, Sugimoto K, Shibayama K, Taniguchi I, Mochizuki S. Plasma brain natriuretic peptide concentrations in patients undergoing pulmonary vein isolation. Heart 2006; 92:1623-7. [PMID: 16740921 PMCID: PMC1861210 DOI: 10.1136/hrt.2005.083022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine whether raised plasma brain natriuretic peptide (BNP) concentrations decrease after successful pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). METHODS 53 patients (mean age 53 years) with drug-refractory, paroxysmal lone AF underwent segmental ostial PVI. Blood samples were collected before and after PVI. BNP concentrations were determined by immunoassays. RESULTS Median plasma BNP concentrations were significantly higher in patients with lone AF than in controls (patients with supraventricular tachyarrhythmias, n = 21) (64.6 (71.9) v 13.9 (7.8) pg/ml, p < 0.01). AF recurred in 21 patients after the initial PVI procedure (recurrent AF group), and the others were free from AF without antiarrhythmic drugs (non-recurrent AF group). BNP concentrations were significantly decreased by PVI in the non-recurrent AF group (38.9 (39.1) to 18.3 (16.1) pg/ml, p < 0.01) but not in the recurrent AF group. CONCLUSIONS Raised plasma BNP concentrations decreased after successful segmental ostial PVI in patients with AF.
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Affiliation(s)
- T Date
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
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Chan PS, Vijan S, Morady F, Oral H. Cost-effectiveness of radiofrequency catheter ablation for atrial fibrillation. J Am Coll Cardiol 2006; 47:2513-20. [PMID: 16781382 DOI: 10.1016/j.jacc.2006.01.070] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 01/27/2006] [Accepted: 01/30/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to compare the cost-effectiveness of left atrial catheter ablation (LACA), amiodarone, and rate control therapy in the management of atrial fibrillation (AF). BACKGROUND Left atrial catheter ablation has been performed to eliminate AF, but its cost-effectiveness is unknown. METHODS We developed a decision-analytic model to evaluate the cost-effectiveness of LACA in 55- and 65-year-old cohorts with AF at moderate and low stroke risk. Costs, health utilities, and transition probabilities were derived from published literature and Medicare data. We performed primary threshold analyses to determine the minimum level of LACA efficacy and stroke risk reduction needed to make LACA cost-effective at 50,000 dollars and 100,000 dollars per quality-adjusted life-year (QALY) thresholds. RESULTS In 65-year-old subjects with AF at moderate stroke risk, relative reduction in stroke risk with an 80% LACA efficacy rate for sinus rhythm restoration would need to be > or =42% and > or =11% to yield incremental cost-effectiveness ratios (ICERs) <50,000 dollars and 100,000 dollars per QALY, respectively. Higher and lower LACA efficacy rates would require correspondingly lower and higher stroke risk reduction for equivalent ICER thresholds. In the 55-year-old moderate stroke risk cohort, lower LACA efficacy rates or stroke risk reduction would be needed for the same ICER thresholds. In patients at low stroke risk, LACA was unlikely to be cost-effective. CONCLUSIONS The use of LACA may be cost-effective in patients with AF at moderate risk for stroke, but it is not cost-effective in low-risk patients. Our threshold analyses may provide a framework for the design of future clinical trials by providing effect size estimates for LACA efficacy needed.
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Affiliation(s)
- Paul S Chan
- Division of Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
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18
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Maksimović R, Dill T, Ristić AD, Seferović PM. Imaging in percutaneous ablation for atrial fibrillation. Eur Radiol 2006; 16:2491-504. [PMID: 16715238 DOI: 10.1007/s00330-006-0235-0] [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] [Received: 11/02/2005] [Revised: 02/20/2006] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients includes imaging before and after ablative treatment using different noninvasive and invasive techniques such as conventional angiography, transoesophageal and intracardiac echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI), which offer different information with variable diagnostic accuracy. Evaluation before percutaneous ablation involves assessment of PVs (PV pattern, branching pattern, orientation and ostial size) to facilitate position and size of catheters and reduce procedure time as well as examining the left atrium (presence of thrombi, dimensions and volumes). Imaging after the percutaneous ablation is important for assessment of overall success of the procedure and revealing potential complications. Therefore, imaging methods enable depiction of PVs and the anatomy of surrounding structures essential for preprocedural management and early detection of PV stenosis and other ablation-related procedures, as well as long-term follow-up of these patients.
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Affiliation(s)
- Ruzica Maksimović
- Department of Radiology, Erasmus Medical Center, 40, Doctor Molewaterplein, 3015, GD Rotterdam, The Netherlands.
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Abstract
The safest long-term management strategy for elderly patients with persistent or recurrent episodes of atrial fibrillation (AF) is careful rate control with medications in conjunction with appropriate oral warfarin anticoagulation. Atrioventricular junctional ablation, with pacemaker implantation, may be necessary in patients who cannot have their rate controlled adequately, or have marked fluctuations in rate with standard medical therapies. Maintenance of sinus rhythm with repeat cardioversions, antiarrhythmic medications, device therapy, or atrial ablation approaches are appropriate to consider for younger patients and those elderly patients who suffer from substantial symptoms shown to be related directly to AF.
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Affiliation(s)
- Brian Olshansky
- Division of Cardiology, University of Iowa Hospitals, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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