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Pokushalov E, Ponomarenko A, Garcia C, Pak I, Shrainer E, Seryakova M, Johnson M, Miller R. The Impact of Glucomannan, Inulin, and Psyllium Supplementation (Soloways TM) on Weight Loss in Adults with FTO, LEP, LEPR, and MC4R Polymorphisms: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2024; 16:557. [PMID: 38398881 PMCID: PMC10892568 DOI: 10.3390/nu16040557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to determine the impact of a fiber supplement on body weight and composition in individuals with obesity with specific genetic polymorphisms. It involved 112 adults with obesity, each with at least one minor allele in the FTO, LEP, LEPR, or MC4R polymorphism. Participants were randomized to receive either a fiber supplement (glucomannan, inulin, and psyllium) or a placebo for 180 days. The experimental group showed significant reductions in body weight (treatment difference: -4.9%; 95% CI: -6.9% to -2.9%; p < 0.01) and BMI (treatment difference: -1.4 kg/m2; 95% CI: -1.7 to -1.2; p < 0.01) compared to placebo. Further significant decreases in fat mass (treatment difference: -13.0%; 95% CI: -14.4 to -11.7; p < 0.01) and visceral fat rating (treatment difference: -1.3; 95% CI: -1.6 to -1.0; p < 0.01) were noted. Homozygous minor allele carriers experienced greater decreases in body weight (treatment difference: -3.2%; 95% CI: -4.9% to -1.6%; p < 0.01) and BMI (treatment difference: -1.2 kg/m2; 95% CI: -2.0 to -0.4; p < 0.01) compared to heterozygous allele carriers. These carriers also had a more significant reduction in fat mass (treatment difference: -9.8%; 95% CI: -10.6 to -9.1; p < 0.01) and visceral fat rating (treatment difference: -0.9; 95% CI: -1.3 to -0.5; p < 0.01). A high incidence of gastrointestinal events was reported in the experimental group (74.6%), unlike the placebo group, which reported no side effects. Dietary supplementation with glucomannan, inulin, and psyllium effectively promotes weight loss and improves body composition in individuals with obesity, particularly those with specific genetic polymorphisms.
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Affiliation(s)
- Evgeny Pokushalov
- Center for New Medical Technologies, Novosibirsk 630090, Russia; (A.P.); (I.P.); (E.S.); (M.S.)
- Scientific Research Laboratory, Triangel Scientific, San Francisco, CA 94101, USA; (C.G.)
| | - Andrey Ponomarenko
- Center for New Medical Technologies, Novosibirsk 630090, Russia; (A.P.); (I.P.); (E.S.); (M.S.)
| | - Claire Garcia
- Scientific Research Laboratory, Triangel Scientific, San Francisco, CA 94101, USA; (C.G.)
| | - Inessa Pak
- Center for New Medical Technologies, Novosibirsk 630090, Russia; (A.P.); (I.P.); (E.S.); (M.S.)
| | - Evgenya Shrainer
- Center for New Medical Technologies, Novosibirsk 630090, Russia; (A.P.); (I.P.); (E.S.); (M.S.)
| | - Mariya Seryakova
- Center for New Medical Technologies, Novosibirsk 630090, Russia; (A.P.); (I.P.); (E.S.); (M.S.)
| | - Michael Johnson
- Scientific Research Laboratory, Triangel Scientific, San Francisco, CA 94101, USA; (C.G.)
| | - Richard Miller
- Scientific Research Laboratory, Triangel Scientific, San Francisco, CA 94101, USA; (C.G.)
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Pokushalov E, Ponomarenko A, Bayramova S, Garcia C, Pak I, Shrainer E, Voronina E, Sokolova E, Johnson M, Miller R. Evaluating the Impact of Omega-3 Fatty Acid (Soloways TM) Supplementation on Lipid Profiles in Adults with PPARG Polymorphisms: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2023; 16:97. [PMID: 38201926 PMCID: PMC10780403 DOI: 10.3390/nu16010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Emerging evidence suggests that PPARG gene polymorphisms may influence lipid metabolism and cardiovascular risk, with omega-3 fatty acids proposed to modulate these effects. This study aims to assess the effects of fish oil supplementation on cardiovascular markers among adults with PPARG gene polymorphisms in a randomized, double-blind, placebo-controlled trial. A cohort of 102 patients with LDL-C 70-190 mg/dL was randomized to receive either 2000 mg of omega-3 fatty acids or a placebo daily for 90 days. In the omega-3 group with PPARG polymorphisms, LDL-C was reduced by 15.4% (95% CI: -19.8% to -11.0%), compared with a 2.6% decrease in the placebo group (95% CI: -4.1% to -1.1%; p < 0.01). In the omega-3 group without PPARG polymorphisms, LDL-C was reduced by 3.7% (95% CI: -6.9% to -0.6%), not significantly different from the placebo group's reduction of 2.9% (95% CI: -5.1% to -0.8%; p = 0.28). The reduction in LDL-C was notably 11.7% greater in those with PPARG polymorphisms than in those without (95% CI: -19.3% to -4.0%; p < 0.01). Triglycerides decreased by 21.3% in omega-3 recipients with PPARG polymorphisms (95% CI: -26.5% to -16.2%; p < 0.01), with no significant changes in HDL-C, total cholesterol, or hsCRP levels in any groups. Minor allele frequencies and baseline characteristics were comparable, ensuring a balanced genetic representation. Omega-3 fatty acids significantly reduce LDL-C and triglycerides in carriers of PPARG polymorphisms, underlining the potential for genetic-driven personalization of cardiovascular interventions.
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Affiliation(s)
- Evgeny Pokushalov
- Center for New Medical Technologies, 630090 Novosibirsk, Russia; (A.P.); (S.B.); (I.P.); (E.S.)
- Scientific Research Laboratory, Triangel Scientific, San Francisco, CA 94101, USA; (C.G.)
| | - Andrey Ponomarenko
- Center for New Medical Technologies, 630090 Novosibirsk, Russia; (A.P.); (S.B.); (I.P.); (E.S.)
| | - Sevda Bayramova
- Center for New Medical Technologies, 630090 Novosibirsk, Russia; (A.P.); (S.B.); (I.P.); (E.S.)
| | - Claire Garcia
- Scientific Research Laboratory, Triangel Scientific, San Francisco, CA 94101, USA; (C.G.)
| | - Inessa Pak
- Center for New Medical Technologies, 630090 Novosibirsk, Russia; (A.P.); (S.B.); (I.P.); (E.S.)
| | - Evgenya Shrainer
- Center for New Medical Technologies, 630090 Novosibirsk, Russia; (A.P.); (S.B.); (I.P.); (E.S.)
| | - Elena Voronina
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (E.V.); (E.S.)
| | - Ekaterina Sokolova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (E.V.); (E.S.)
| | - Michael Johnson
- Scientific Research Laboratory, Triangel Scientific, San Francisco, CA 94101, USA; (C.G.)
| | - Richard Miller
- Scientific Research Laboratory, Triangel Scientific, San Francisco, CA 94101, USA; (C.G.)
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Paitazoglou C, Eitel I, Stiermaier T, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Vireca E, Wohlmuth P, Lucas B, Bergmann MW. Sex-related differences in outcome after left atrial appendage occlusion: Insights from Europe and the EWOLUTION registry. Catheter Cardiovasc Interv 2023. [PMID: 37393575 DOI: 10.1002/ccd.30759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/18/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life, and have a higher risk of stroke and death. There is limited availability of sex-related differences regarding left atrial appendage occlusion (LAAO). AIMS The aim of this study was to evaluate the sex-related differences in patients undergoing LAAO in EWOLUTION. METHODS A total of 1025 patients scheduled for elective LAAO therapy employing the WATCHMAN Gen 2.5 prospectively consented for participation; 1005 patients received a successful implant and were followed for 2 years. As we detected sex-related differences in baseline data we performed a propensity score matching. The primary endpoint is a combined endpoint of survival free from mortality, major bleeding, ischemic stroke, transitory ischemic attack (TIA) and systemic embolization (SE) up to 2-year clinical follow-up. Secondary Endpoints were periprocedural data and overall 2-year survival. RESULTS Women were older but had less often vascular disease and hemorrhagic stroke. There was no sex-related significant difference after LAAO at 2 years in the combined endpoint of survival free from mortality, major bleeding, ischemic stroke, TIA, and SE (female vs. male: 79% vs.76%, p = 0.24) or in overall survival (female vs. male: 85% vs. 82%, p = 0.16). Procedural data showed a higher sealing rate after the implantation in women (complete sealing female 94% vs. male 90%, p = 0.033), significantly more pericardial effusions (female 1.2% vs. male 0.2%, p = 0.031) and a similar periprocedural risk profile. CONCLUSIONS Females undergoing LAAO differ in various baseline variables, but after adjustment, we observed similar safety and efficacy of LAAO with no significant difference in long-term outcomes between women and men.
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Affiliation(s)
- Christina Paitazoglou
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Hueseyin Ince
- Department of Cardiology, Vivantes Klinikum Neukölln and Klinikum Am Urban, Berlin, Germany
- Department of Cardiology, University Rostock, Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Evgeny Pokushalov
- Department of Cardiology, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Boris Schmidt
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Tommaso Gori
- Department of Cardiology, Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz, Germany
| | | | | | | | - Boersma Lucas
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Amsterdam UMV, Amsterdam, The Netherlands
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Steinberg JS, Blount N, Ponomarev D, Shabanov V, Pokushalov E, Romanov A. The Evaluate Renal Artery Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial: arrhythmia suppression, blood pressure control, and potential interactions. Europace 2023; 25:euad107. [PMID: 37084084 PMCID: PMC10228602 DOI: 10.1093/europace/euad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Jonathan S Steinberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York 14642, USA
- Hackensack Meridian School of Medicine, 123 Metro Blvd, Nutley, NJ 07110, USA
| | - Nicholas Blount
- Hackensack Meridian School of Medicine, 123 Metro Blvd, Nutley, NJ 07110, USA
| | - Dmitry Ponomarev
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Vitaly Shabanov
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Evgeny Pokushalov
- Center of the New Medical Technologies, Novosibirsk, Russian Federation
| | - Alexander Romanov
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
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Gyöngyösi M, Pokushalov E, Romanov A, Perin E, Hare JM, Kastrup J, Fernández-Avilés F, Sanz-Ruiz R, Mathur A, Wojakowski W, Martin-Rendon E, Pavo N, Pavo IJ, Hemetsberger R, Traxler D, Spannbauer A, Haller PM. Meta-Analysis of Percutaneous Endomyocardial Cell Therapy in Patients with Ischemic Heart Failure by Combination of Individual Patient Data (IPD) of ACCRUE and Publication-Based Aggregate Data. J Clin Med 2022; 11:jcm11113205. [PMID: 35683592 PMCID: PMC9181462 DOI: 10.3390/jcm11113205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/10/2022] Open
Abstract
Individual patient data (IPD)-based meta-analysis (ACCRUE, meta-analysis of cell-based cardiac studies, NCT01098591) revealed an insufficient effect of intracoronary cell-based therapy in acute myocardial infarction. Patients with ischemic heart failure (iHF) have been treated with reparative cells using percutaneous endocardial, surgical, transvenous or intracoronary cell delivery methods, with variable effects in small randomized or cohort studies. The objective of this meta-analysis was to investigate the safety and efficacy of percutaneous transendocardial cell therapy in patients with iHF. Two investigators extracted the data. Individual patient data (IPD) (n = 8 studies) and publication-based (n = 10 studies) aggregate data were combined for the meta-analysis, including patients (n = 1715) with chronic iHF. The data are reported in accordance with PRISMA guidelines. The primary safety and efficacy endpoints were all-cause mortality and changes in global ejection fraction. The secondary safety and efficacy endpoints were major adverse events, hospitalization and changes in end-diastolic and end-systolic volumes. Post hoc analyses were performed using the IPD of eight studies to find predictive factors for treatment safety and efficacy. Cell therapy was significantly (p < 0.001) in favor of survival, major adverse events and hospitalization during follow-up. A forest plot analysis showed that cell therapy presents a significant benefit of increasing ejection fraction with a mean change of 2.51% (95% CI: 0.48; 4.54) between groups and of significantly decreasing end-systolic volume. The analysis of IPD data showed an improvement in the NYHA and CCS classes. Cell therapy significantly decreased the end-systolic volume in male patients; in patients with diabetes mellitus, hypertension or hyperlipidemia; and in those with previous myocardial infarction and baseline ejection fraction ≤ 45%. The catheter-based transendocardial delivery of regenerative cells proved to be safe and effective for improving mortality and cardiac performance. The greatest benefit was observed in male patients with significant atherosclerotic co-morbidities.
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Affiliation(s)
- Mariann Gyöngyösi
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.P.); (R.H.); (D.T.); (A.S.)
- Correspondence: ; Tel.: +43-1-40400-46140
| | - Evgeny Pokushalov
- Center of the New and Modern Medical Technologies, 630090 Novosibirsk, Russia;
| | - Aleksander Romanov
- E. Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia;
| | - Emerson Perin
- Stem Cell Center and Adult Cardiology, Texas Heart Institute, Houston, TX 37660, USA;
| | - Joshua M. Hare
- Interdisciplinary Stem Cell Institute, Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Jens Kastrup
- Cardiology Stem Cell Centre, The Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark;
| | | | - Ricardo Sanz-Ruiz
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain; (F.F.-A.); (R.S.-R.)
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Wojcieh Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Enca Martin-Rendon
- R&D Division, National Health Service (NHS)-Blood and Transplant, Oxford Centre, Oxford OX3 9DU, UK;
| | - Noemi Pavo
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.P.); (R.H.); (D.T.); (A.S.)
| | - Imre J. Pavo
- Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
| | - Rayyan Hemetsberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.P.); (R.H.); (D.T.); (A.S.)
| | - Denise Traxler
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.P.); (R.H.); (D.T.); (A.S.)
| | - Andreas Spannbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.P.); (R.H.); (D.T.); (A.S.)
| | - Paul M. Haller
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, 20246 Hamburg, Germany;
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Pokushalov E, Losik D, Kozlova S, Konradi A, Sekacheva M, Ponomarenko A, Krivosheev Y, Mikheenko I, Kretov E, Steinberg J. Association between personalized evidence-based anticoagulation therapy and outcomes at 1-year follow-up in patients with atrial fibrillation: an analysis from the Atrial Fibrillation registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The guideline treatments based on a relatively broad set of enrollment criteria inhibits the personalized evidence-based approach. Personalized evidence-based medicine (EBM) involves the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease or their response to a specific treatment.
Objective
We report the 1-year follow-up data of the Atrial Fibrillation Registry, focusing on the relationship between personalized EBM and guideline-adherent anticoagulation therapy use and the occurrence of major clinical adverse events.
Methods
2683 patients at high risk for stroke and 1-year follow-up were enrolled in study. The primary endpoint was the percentage of guideline-based and personalized EBM recommendations acted on by clinicians. Secondary endpoints include the following: outcomes for all-cause mortality, thromboembolism (TE), bleeding, and the composite endpoints.
Results
From 2683 patients, 1971 (73.5%) EMR were guideline adherent and only 824 (30.7%) of them were personalized EBM anticoagulation therapy adherent, whilst 712 (26.5%) were non-guideline adherent and 1147 (42.8%) were guideline adherent but non-personalized EBM adherent.
The composite endpoint of cardiovascular death, any TE or bleeding was significantly lower in personalized EBM adherent patients during 1-year follow-up (P=0.02). The endpoint of all cause death and any TE is increased by >20% by guideline adherent but non-personalized EBM adherent treatment [hazard ratio (HR) 1.254 (95% CI 0.931; 1.689)] and >80% non-guideline adherent and non-personalized EBM adherent treatment [HR 1.892 (95% CI 1.359; 2.635)]. For the composite endpoint of cardiovascular death, any TE or bleeding, guideline adherent but non-personalized EBM adherent treatment increased risk by >40% [HR 1.454 (95% CI 1.037; 2.040)], and non-guideline adherent and non-personalized EBM adherent treatment by >110% [HR 2.113 (95% CI 1.453; 3.074)].
Conclusion
Personalized EBM anticoagulation management is associated with significantly better outcomes, including those related to the composite endpoint of cardiovascular death, any TE or bleeding in high-risk patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Pokushalov
- New medical technologies center, Novosibirsk, Russian Federation
| | - D Losik
- New medical technologies center, Novosibirsk, Russian Federation
| | - S Kozlova
- Almazov National Medical Research Centre, St Petersburg, Russian Federation
| | - A Konradi
- Almazov National Medical Research Centre, St Petersburg, Russian Federation
| | - M Sekacheva
- Sechenov University, Moscow, Russian Federation
| | - A Ponomarenko
- New medical technologies center, Novosibirsk, Russian Federation
| | - Y Krivosheev
- New medical technologies center, Novosibirsk, Russian Federation
| | - I Mikheenko
- New medical technologies center, Novosibirsk, Russian Federation
| | - E Kretov
- New medical technologies center, Novosibirsk, Russian Federation
| | - J.S Steinberg
- University of Rochester School of Medicine and Dentistry; The Valley Health System, New York, United States of America
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Ledwoch J, Sievert K, Boersma LVA, Bergmann MW, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov AV, Betts TR, Mazzone P, Foley D, Grygier M, De Potter T, Sievert H. Initial and long-term antithrombotic therapy after left atrial appendage closure with the WATCHMAN. Europace 2021; 22:1036-1043. [PMID: 32464648 DOI: 10.1093/europace/euaa074] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/10/2020] [Accepted: 03/23/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Evidence regarding post-procedural antithrombotic regimen other than used in randomized trials assessing percutaneous left atrial appendage (LAA) closure is limited. The present work aimed to compare different antithrombotic strategies applied in the real-world EWOLUTION study. METHODS AND RESULTS A total of 998 patients with successful WATCHMAN implantation were available for the present analysis. The composite ischaemic endpoint of stroke, transitory ischaemic attack, systemic embolism and device thrombus, and the bleeding endpoint defined as at least major bleeding were assessed during an initial period (from implant until first medication change) and long-term period (from first change up to 2 years). The antithrombotic medication chosen in the initial phase was dual antiplatelet therapy (DAPT) in 60%, oral anticoagulation (OAC) in 27%, single antiplatelet therapy (SAPT) in 7%, and no medication in 6%. In the second long-term phase, SAPT was used in 65%, DAPT in 23%, no therapy in 8%, and OAC in 4%. No significant differences were found between the groups regarding the ischaemic endpoint both in the initial period (Kaplan-Meier estimated rate 2.9% for DAPT vs. 4.3% for OAC vs. 3.9% for SAPT or no therapy) and in the second period (4.2% for SAPT vs. 1.8% for DAPT vs. 3.5% for no therapy). With respect to bleeding events, the only difference was found in the initial phase with a higher incidence in patients under SAPT or no therapy. CONCLUSIONS Tailored antithrombotic treatment using even very reduced strategies such as SAPT or no therapy showed no significant differences regarding ischaemic complications after LAA closure.
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Affiliation(s)
- Jakob Ledwoch
- CardioVascular Center CVC, Seckbacher Landstraße 65, 60389 Frankfurt, Germany.,Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, München Klinik Neuperlach, Munich, Germany
| | - Kolja Sievert
- CardioVascular Center CVC, Seckbacher Landstraße 65, 60389 Frankfurt, Germany
| | - Lucas V A Boersma
- St. Antonius Hospital Nieuwegein, and Amsterdam UMC, The Netherlands
| | | | | | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Am Main, Germany
| | - Tommaso Gori
- Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz, Germany
| | | | | | | | | | | | - Marek Grygier
- Poznan University of Medical Sciences, Poznan, Poland
| | | | - Horst Sievert
- CardioVascular Center CVC, Seckbacher Landstraße 65, 60389 Frankfurt, Germany
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Brachmann J, Sohns C, Andresen D, Siebels J, Sehner S, Boersma L, Merkely B, Pokushalov E, Sanders P, Schunkert H, Bänsch D, Dagher L, Zhao Y, Mahnkopf C, Wegscheider K, Marrouche NF. Atrial Fibrillation Burden and Clinical Outcomes in Heart Failure: The CASTLE-AF Trial. JACC Clin Electrophysiol 2021; 7:594-603. [PMID: 33640355 DOI: 10.1016/j.jacep.2020.11.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This subanalysis of the CASTLE-AF (Catheter Ablation vs. Standard Conventional Treatment in Patients With LV Dysfunction and AF) trial aimed to address the association between atrial fibrillation (AF) recurrence, AF burden, and hard clinical outcomes in heart failure (HF) patients with AF. BACKGROUND The CASTLE-AF trial demonstrated the benefit of CA compared to pharmacological treatment in decreasing mortality and CV hospitalizations in patients with AF and HFrEF. However, the impact of AF recurrence and AF burden after ablation on long-term treatment benefit remains unknown. METHODS The CASTLE-AF protocol randomized 363 patients with coexisting HF and AF in a multicenter prospective controlled fashion to catheter ablation (n = 179) versus pharmacological therapy (n = 184). Two hundred eighty patients were included in this subanalysis (as-treated), 128 of them underwent ablation and 152 received pharmacological treatment. All patients had implanted dual chamber or biventricular implantable defibrillators with activated home monitoring capabilities. The individual AF burden was calculated as the percentage of the atrial arrhythmia time per day. RESULTS AF burden at baseline was not predictive of the primary endpoint (p = 0.473) or all-cause mortality (p = 0.446). AF recurrence (defined as any episode >30 s) did not show any relationship with the primary endpoints of mortality and occurrence of HF, irrespective of the treatment arm. An AF burden below 50% after 6 months of catheter ablation, was associated with a significant decrease in primary composite outcome (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.15 to 0.71; p = 0.014) and all-cause mortality (HR: 0.23; 95% CI: 0.07 to 0.71; p = 0.031). The risk of the primary endpoint or mortality was directly related to a low (<50%) or high (≥50%) AF burden at 6 months post-ablation. CONCLUSIONS AF burden at 6 months was predictive of hard clinical outcomes in HF patients with AF. The first recurrent atrial tachyarrhythmia episode >30 s after ablation was not associated with improvement in mortality and hospitalization for HF. (Catheter Ablation vs. Standard Conventional Treatment in Patients With LV Dysfunction and AF [CASTLE-AF]; NCT00643188).
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Affiliation(s)
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | | | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luca Boersma
- Department of Cardiology, Antonius Ziekenhuis Nieuwegein, Nieuwegein, the Netherlands
| | - Béla Merkely
- Department of Cardiology, Semmelweis Medical University, Budapest, Hungary
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Munich, Germany
| | - Dietmar Bänsch
- Clinic for Electrophysiology, KMG Klinikum, Güstrow, Germany
| | - Lilas Dagher
- Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Yan Zhao
- Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nassir F Marrouche
- Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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9
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Ledwoch J, Sievert K, Boersma L, Bergmann M, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov A, Betts T, Mazzone P, Sievert H. Initial and long-term antithrombotic therapy after left atrial appendage closure with the WATCHMAN. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Evidence regarding post-procedural antithrombotic regimes other than used in randomized trials assessing percutaneous left atrial appendage (LAA) closure is limited.
Purpose
The present work aimed to compare different antithrombotic strategies applied in the real-world EWOLUTION study.
Methods
A total of 998 patients with successful WATCHMAN implantation at 47 centers were available for the present analysis. The composite ischemic endpoint of stroke, TIA, systemic embolism and device thrombus as well as the bleeding endpoint defined as at least major bleeding according to BARC were assessed during an initial period (from implant until first medication change) and long-term period (from first change until up to 2 years).
Results
The antithrombotic medication chosen in the initial phase was dual antiplatelet therapy (DAPT) in 60%, oral anticoagulation (OAC) in 27%, single antiplatelet therapy (SAPT) in 7% and no medication in 6%. In the long-term phase SAPT was used in 65%, DAPT in 23%, no therapy in 8% and OAC in 4%. No significant differences were found between the groups regarding the ischemic endpoint both in the initial period (Kaplan-Meier estimated rate 2.9% for DAPT vs. 4.3% for OAC vs. 3.9% for SAPT or no therapy; p=0.97) and in the second period (4.2% for SAPT vs. 1.8% for DAPT vs. 3.5% for no therapy; p=0.36). With respect to bleeding events the only difference was found in the initial phase with a higher incidence in patients under SAPT or no therapy (1.0% for DAPT vs. 0.8% for OAC vs. 7.4% for SAPT or no therapy; p=0.01). No differences in bleeding complications were observed during the second period (2.6% for SAPT vs. 2.9% for DAPT vs. 2.2% for no therapy; p=0.88).
Conclusions
Tailored antithrombotic treatment using even very reduced strategies such as SAPT or no therapy showed no significant differences regarding ischemic complications after LAA closure.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boston Scientific
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Affiliation(s)
- J Ledwoch
- Klinikum Neuperlach, Munich, Germany
| | - K Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - L Boersma
- St Antonius Hospital, Nieuwegein, Netherlands (The)
| | | | - H Ince
- Vivantes Klinikum Am Urban, Berlin, Germany
| | - S Kische
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | - B Schmidt
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - T Gori
- Johannes Gutenberg University Mainz (JGU), Mainz, Germany
| | - F Meincke
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - A Protopopov
- Krasnoyarsk regional hospital, Krasnoyarsk, Russian Federation
| | - T Betts
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
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10
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Sohns C, Zintl K, Zhao Y, Dagher L, Andresen D, Siebels J, Wegscheider K, Sehner S, Boersma L, Merkely B, Pokushalov E, Sanders P, Schunkert H, Bänsch D, Mahnkopf C, Brachmann J, Marrouche NF. Impact of Left Ventricular Function and Heart Failure Symptoms on Outcomes Post Ablation of Atrial Fibrillation in Heart Failure: CASTLE-AF Trial. Circ Arrhythm Electrophysiol 2020; 13:e008461. [PMID: 32903044 DOI: 10.1161/circep.120.008461] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent data demonstrate promising effects on left ventricular dysfunction and left ventricular ejection fraction (LVEF) improvement following ablation for atrial fibrillation (AF) in patients with heart failure. We sought to study the relationship between LVEF, New York Heart Association class on presentation, and the end points of mortality and heart failure admissions in the CASTLE-AF study (Catheter Ablation for Atrial Fibrillation With Heart Failure) population. Furthermore, predictors for LVEF improvement were examined. METHODS The CASTLE-AF patients with coexisting heart failure and AF (n=363) were randomized in a multicenter prospective controlled fashion to ablation (n=179) versus pharmacological therapy (n=184). Left ventricular function and New York Heart Association class were assessed at baseline (after randomization) and at each follow-up visit. RESULTS In the ablation arm, a significantly higher number of patients experienced an improvement in their LVEF to >35% at the end of the study (odds ratio, 2.17; P<0.001). Compared with the pharmacological therapy arm, both ablation patient groups with severe (<20%) or moderate/severe (≥20% and <35%) baseline LVEF had a significantly lower number of composite end points (hazard ratio [HR], 0.60; P=0.006), all-cause mortality (HR, 0.54; P=0.019), and cardiovascular hospitalizations (HR, 0.66; P=0.017). In the ablation group, New York Heart Association I/II patients at the time of treatment had the strongest improvement in clinical outcomes (primary end point: HR, 0.43; P<0.001; mortality: HR, 0.30; P=0.001). CONCLUSIONS Compared with pharmacological treatment, AF ablation was associated with a significant improvement in LVEF, independent from the severity of left ventricular dysfunction. AF ablation should be performed at early stages of the patient's heart failure symptoms.
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Affiliation(s)
- Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany (C.S.)
| | - Konstantin Zintl
- Department of Cardiology, Klinikum Coburg, Germany (K.Z., C.M., J.B.)
| | - Yan Zhao
- Department of Cardiology, Tulane University School of Medicine, New Orleans, LA (Y.Z., L.D., N.F.M.)
| | - Lilas Dagher
- Department of Cardiology, Tulane University School of Medicine, New Orleans, LA (Y.Z., L.D., N.F.M.)
| | | | | | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (K.W., S.S.)
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (K.W., S.S.)
| | - Lucas Boersma
- Department of Cardiology, Antonius Ziekenhuis Nieuwegein, the Netherlands (L.B.)
| | - Béla Merkely
- Department of Cardiology, Semmelweis Medical University, Budapest, Hungary (B.M.)
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia (E.P.)
| | - Prashanthan Sanders
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia (P.S.)
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Munich, Germany (H.S.)
| | - Dietmar Bänsch
- Clinic for Electrophysiology, KMG Klinikum, Güstrow, Germany (D.B.)
| | | | | | - Nassir F Marrouche
- Department of Cardiology, Tulane University School of Medicine, New Orleans, LA (Y.Z., L.D., N.F.M.)
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11
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Willems S, Tilz RR, Steven D, Kääb S, Wegscheider K, Gellér L, Meyer C, Heeger CH, Metzner A, Sinner MF, Schlüter M, Nordbeck P, Eckardt L, Bogossian H, Sultan A, Wenzel B, Kuck KH, Piorkowski C, Lebedev D, Kautzner J, Sticherling C, Deneke T, Rostock T, Ukena C, Kuniss M, Makimoto H, Hindricks G, Bänsch D, Schreieck J, Kolb C, Geller J, Pokushalov E, Gutleben K, Sommer P, Boldt L, Parwani A. Preventive or Deferred Ablation of Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy and Implantable Defibrillator (BERLIN VT). Circulation 2020; 141:1057-1067. [DOI: 10.1161/circulationaha.119.043400] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Catheter ablation for ventricular tachycardia (VT) reduces the recurrence of VT in patients with implantable cardioverter-defibrillators (ICDs). The appropriate timing of VT ablation and its effects on mortality and heart failure progression remain a matter of debate. In patients with life-threatening arrhythmias necessitating ICD implantation, we compared outcomes of preventive VT ablation (undertaken before ICD implantation to prevent ICD shocks for VT) and deferred ablation after 3 ICD shocks for VT.
Methods:
The BERLIN VT study (Preventive Ablation of Ventricular Tachycardia in Patients With Myocardial Infarction) was a prospective, open, parallel, randomized trial performed at 26 centers. Patients with stable ischemic cardiomyopathy, a left ventricular ejection fraction between 30% and 50%, and documented VT were randomly assigned 1:1 to a preventive or deferred ablation strategy. The primary outcome was a composite of all-cause death and unplanned hospitalization for either symptomatic ventricular arrhythmia or worsening heart failure. Secondary outcomes included sustained ventricular tachyarrhythmia and appropriate ICD therapy. We hypothesized that preventive ablation strategy would be superior to deferred ablation strategy in the intention-to-treat population.
Results:
During a mean follow-up of 396±284 days, the primary end point occurred in 25 (32.9%) of 76 patients in the preventive ablation group and 23 (27.7%) of 83 patients in the deferred ablation group (hazard ratio, 1.09 [95% CI, 0.62–1.92];
P
=0.77). On the basis of prespecified criteria for interim analyses, the study was terminated early for futility. In the preventive versus deferred ablation group, 6 versus 2 patients died (7.9% versus 2.4%;
P
=0.18), 8 versus 2 patients were admitted for worsening heart failure (10.4% versus 2.3%;
P
=0.062), and 15 versus 21 patients were hospitalized for symptomatic ventricular arrhythmia (19.5% versus 25.3%;
P
=0.27). Among secondary outcomes, the proportions of patients with sustained ventricular tachyarrhythmia (39.7% versus 48.2%;
P
=0.050) and appropriate ICD therapy (34.2% versus 47.0%;
P
=0.020) were numerically reduced in the preventive ablation group.
Conclusions:
Preventive VT ablation before ICD implantation did not reduce mortality or hospitalization for arrhythmia or worsening heart failure during 1 year of follow-up compared with the deferred ablation strategy.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02501005.
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Affiliation(s)
| | - Roland Richard Tilz
- University Hospital Lübeck, Med.Klinik II, and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.R.T., C.-H.H.)
| | - Daniel Steven
- University Heart Center Cologne, Germany (D.S., A.S.)
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian’s University Munich and German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.K., M.F.S.)
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany (K.W.)
| | - László Gellér
- Semmelweis Medical University, Budapest, Hungary (L.G.)
| | | | - Christian-Hendrik Heeger
- University Hospital Lübeck, Med.Klinik II, and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.R.T., C.-H.H.)
| | | | - Moritz F. Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian’s University Munich and German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.K., M.F.S.)
| | | | | | | | | | - Arian Sultan
- University Heart Center Cologne, Germany (D.S., A.S.)
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12
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Romanov A, Dichterman E, Schwartz Y, Ibragimov Z, Ben-David Y, Rodriguez H, Pokushalov E, Siddiqui UR, Kadlec A, Ben-Haim SA. High-resolution, real-time, and nonfluoroscopic 3-dimensional cardiac imaging and catheter navigation in humans using a novel dielectric-based system. Heart Rhythm 2019; 16:1883-1889. [DOI: 10.1016/j.hrthm.2019.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 12/19/2022]
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13
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Pagourelias E, Vassilikos V, Blomstrom-Lundqvist C, Kautzner J, Maggioni AP, Pokushalov E, Tavazzi L, Dagres N, Brugada J, Arbelo E. P4762What do atrial fibrillation ablation procedural volume differences across European centers reflect? An ESC EORP registry: atrial fibrillation long-term. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data from the European Atrial Fibrillation (AF) Ablation Long-Term Registry suggest that there are significant differences in the volume of AF ablation procedures performed across different centers even in the same country. If these differences in AF ablation volume between centers reflect regional, socioeconomic, infrastructural/technical or other disparities has not been addressed till now.
Purpose
The aim of this study was to investigate patient and non-patient related differences among European AF ablation centers according to the volume of AF ablations performed.
Methods
Data for this analysis originate from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 25th and 75th percentiles of AF ablation numbers performed, the participating centers were classified into high volume (HV) (≥250 procedures/year), medium volume (MV) (<250 and ≥58/year) and low volume (LV) (<58/year). Patient (demographics, comorbidities) and non-patient (center infrastructure, procedural characteristics) related differences were assessed.
Results
A total of 91 centers in 26 European countries enrolled 3368 patients. There were no significant differences concerning regional distribution, hospital/cardiology facilities or services provided among centers with the exception of electrophysiology procedures and labs which were more abundant in HV centers (p=0.02 and <0.001 respectively). HV and MV centers ablate twice more cases of long-standing persistent and persistent AF compared to LV centers, in which paroxysmal AF reaches 78.9% of all cases (Figure A). Accordingly, first AF ablation procedure was far more frequent in LV centers compared to MV and HV (85.8% vs 76.0% vs 76.1% respectively, p<0.001). Even though HV centers ablate significantly more high risk patients (CHA2DS2-VASc score ≥2 51.4% in HV vs 46.5% in MV vs 37.2% in LV, p<0.001) (Figure B) with accompanying comorbidities, applying more elaborate ablation techniques, fluoroscopy time and radiation dose were higher among patients undergoing AF ablation in LV centers (p<0.001 for all). Despite the above-mentioned dissimilarities, Kaplan-Meier survival analysis, based on adjusted data, demonstrated non-significant differences in complication rate (p=0.402) or AF recurrence rate (p=0.363) among HV, MV and LV centers.
Conclusions
Volume of AF ablations in a center is not correlated with regional or infrastructural characteristics. The higher volume in HV centers consists mainly by more long-term persistent AF and higher risk patients, suggesting that differences in volume reflect differences in experience and personnel's commitment towards AF ablation.
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Affiliation(s)
- E Pagourelias
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - V Vassilikos
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czechia
| | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - E Pokushalov
- State Research Institute of Circulation Pathology, 5Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - N Dagres
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - J Brugada
- University of Barcelona, Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Arbelo
- University of Barcelona, Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Barcelona, Spain
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14
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Pagourelias E, Vassilikos V, Blomstrom-Lundqvist C, Kautzner J, Maggioni AP, Pokushalov E, Tavazzi L, Dagres N, Brugada J, Arbelo E. P1028Impact of atrial fibrillation ablation procedural volume on complication and recurrence rate across European centers. An ESC EORP registry: atrial fibrillation long-term. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Catheter ablation has emerged as an effective therapy in patients with symptomatic and drug refractory atrial fibrillation (AF). Despite high success rates of the method, there is still heterogeneity of outcomes and complication rate across Europe. The impact of the annual procedural volume per center on success and complication rate of AF ablation, based on real-life data, has not been addressed till now.
Purpose
The aim of the study was to investigate if center AF ablation volume might be associated with one-year success or complication rate after the procedure.
Methods
Data for this analysis were extracted from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 25th and 75th percentiles of AF ablation numbers performed, the participating centers were classified into high volume (HV) (≥250 procedures/year), medium volume (MV) (<250 and ≥58/year) and low volume (LV) (<58/year). One-year success was defined as patient survival free from any atrial arrhythmia, from the end of the 3-month blanking period to 12 months following the ablation procedure.
Results
A total of 91 centers in 26 European countries enrolled 3368 patients. There was a significantly higher reporting of cardiovascular complications in LV centers (5.2%), especially pericarditis (0.6%) and cardiac perforation (1.4%), while the HV and MV centers reported cardiovascular complications in 3.0 and 4.3% of cases, respectively (p=0.039). Additionally, stroke incidence after ablation was significantly higher in LV centers (0.5% of cases vs 0% in HV and MV centers, p=0.008). Kaplan-Meier survival analysis based on adjusted data of all complications demonstrated, however, that there was not a significant difference in complication rate according to volume's center (p=0.402, Figure A). One-year success after AF ablation ranged from 77.8% in HV vs 70.5% in LV vs 77.3% in MV centers (p<0.001). Nonetheless, adjusted recurrence rate was not significantly different among centers (p=0.363, Figure B), a result driven by differences both in ablation technical characteristics and risk/severity of cases ablated in different volume centers.
Conclusions
Despite the notion that “the higher, the better”, our results suggest that AF ablation is a safe procedure with high success rates in all European centers, independent of the AF ablation procedural volume. Differences in patients and procedural characteristics may justify the equality of complication and recurrence rate among centers, since expertise level counterbalances the risk of each case.
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Affiliation(s)
- E Pagourelias
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - V Vassilikos
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czechia
| | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - E Pokushalov
- State Research Institute of Circulation Pathology, 5Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - N Dagres
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - J Brugada
- University of Barcelona, Department of Cardiology, Cardiovascular Institute,, Barcelona, Spain
| | - E Arbelo
- University of Barcelona, Department of Cardiology, Cardiovascular Institute,, Barcelona, Spain
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15
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Romanov A, Cherniavskiy A, Novikova N, Edemskiy A, Ponomarev D, Shabanov V, Losik D, Kretov E, Stenin I, Elesin D, Pokushalov E, Steinberg JS. 4282Pulmonary artery denervation in patients with residual pulmonary hypertension after pulmonary endarterectomy: one-year results of the first -in-man, sham-controlled, pilot randomized clinical trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary endarterectomy (PE) is the method of choice in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Despite the positive effect after surgery combined with medical treatment, 10–40% of patients develop residual CTEPH. Pulmonary artery denervation (PAD) is a novel treatment in PAH with optimistic results but was not tested in patients with residual CTEPH.
Objective
To assess the safety and efficacy of PAD using remote magnetic navigation system in patients with residual CTEPH after PE.
Methods
278 patients with CTEPH after PE were screened. 50 patients (mean age 47.6±14.3, 50% female) with a history of residual CTEPH (a resting pulmonary artery pressure ≥25 mm Hg or pulmonary vascular resistance >400 dyn sec cm–5 despite medical therapy 6 months after PE) were randomized into two groups: PAD (n=25; PAD group) or medical therapy with riociguat (n=25; MED group). In both groups right heart catheterization (RHC)was performed after randomization. In the PAD group, remote magnetic navigation systemwas used to target sympathetic nerve fibers, located near bifurcation and ostia of the main brunches of right and left pulmonary arteries. This study was conducted as double-blind and sham-controlled and the primary endpoint was change in pulmonary vascular resistance (PVR) by RHC at 12 months. Secondary endpoints included 6-minute walk test (6MWT), pulmonary artery pressure, and clinical outcomes. All patients were followed for 12 months after randomization. Unpaired t-test and Fisher's exact test were used for between-group comparisons of continuous and categorical variables, respectively. A p value of less than 0.05 was considered statistically significant.
Results
Two patients (one in each group) developed groin hematoma which resolved without any consequences. At the end of 12 month, the PVR was significantly low in PAD group as compared with MED group (343±149 dyn sec cm–5 vs 444±145 dyn sec cm–5, respectively; mean difference −101, 95% confidence interval: −193 to −10; p=0.032). The mean, systolic and diastolic PA pressure was also reduced significantly in PAD group compared to MED group (25.8±7.3mm Hg vs 33.8±6.4 mm Hg, 46.2±14.1mm Hg vs 54.2±8.1 mm Hg,13.2±5.3mm Hg vs 20.2±4.8mm Hg; p<0.001, p=0.002, p<0.001, respectively). The PAD group demonstrated significant improvement of the 6MWT over MED group (470±84 m vs 399±116 m, respectively, p=0.031). In the PADN group 1 (4%) patient was hospitalized due to heart failure progression compared to 7 (29%) patients in MED group (p=0.049). One patient in PAD group and two patients in MED group died.
Conclusions
Pulmonary artery denervation in patients with residual pulmonary hypertension was safe and effective, and resulted in substantial reduction of pulmonaryvascular resistance and pulmonary artery pressure during 12 months follow up, accompanied by improved 6-minute walk test and reduced need for hospitalization. Clinical Trials Registration: NCT02745106
Acknowledgement/Funding
Grant from Biosense Webster
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Affiliation(s)
- A Romanov
- E. Meshalkin National Medical Research Center, Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - A Cherniavskiy
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - N Novikova
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - A Edemskiy
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - D Ponomarev
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - V Shabanov
- E. Meshalkin National Medical Research Center, Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - D Losik
- E. Meshalkin National Medical Research Center, Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - E Kretov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - I Stenin
- E. Meshalkin National Medical Research Center, Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - D Elesin
- E. Meshalkin National Medical Research Center, Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - E Pokushalov
- E. Meshalkin National Medical Research Center, Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - J S Steinberg
- University of Rochester School of Medicine & Dentistry, NY, Rochester, United States of America
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16
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Tilz R, Dagres N, Arbelo E, Blomstroem Lundqvist CH, Pokushalov E, Crijns HJ, Kirchhof P, Kautzner J, Temporelli PL, Laroche CH, Pisapia A, Pehrson S, Lip GYH, Brugada J, Tavazzi L. P341Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EURObservational Research Programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Great heterogeneity in rhythm control management of patients with atrial fibrillation (AF) has been described. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection.
Methods
Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC-EORP EHRA AFA-LT) Registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC-EORP EHRA AF-Gen) PilotRegistry. Data collection was performed using a web-based system.
Results
In the AFA and in the AFG pilot registries 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger,more commonly male, and had significantly less co-morbidities. Lone AF was predominant in AFA patients who were at lower risk of stroke (CHA2DS2-VASc >5: 2.9% vs. 24.5%, all P<0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P<0.001) but with EHRA scores >1 and more prevalentAF-related symptoms such as palpitations, fatigue and weakness (all p<0.001)as compared to the general AF patients. AFA patients were significantly more often male, had higher LV ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P<0.001 each).
Conclusions
The comparison of the patient chorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and otherwise relatively healthy patients.
Acknowledgement/Funding
Abbott Vascular Int.; Amgen Cardiovascular, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb and Pfizer Alliance
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - N Dagres
- Heart Center of Leipzig, Electrophysiology, Leipzig, Germany
| | - E Arbelo
- University of Barcelona, Arrhythmia Section, Cardiology Department, Barcelona, Spain
| | | | - E Pokushalov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - H J Crijns
- Maastricht University, Maastricht, Netherlands (The)
| | - P Kirchhof
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - P L Temporelli
- Istituto Scientifico di Veruno, Division of Cardiology, Veruno, Italy
| | - C H Laroche
- EURObservational Research Programme (EORP), Scientific Division, European Society of Cardiology, Sophia-Antipolis, France
| | - A Pisapia
- St. Joseph Hospital of Marseille, Marseille, France
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Y H Lip
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg, Denmark
| | - J Brugada
- Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu Uni, Barcelona, Spain
| | - L Tavazzi
- Maria Cecilia Hospital, 18GVM Care and Research, E.S. Health Science Fnd, Cotignola, Italy
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17
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Trines SA, Stabile G, Arbelo E, Dagres N, Brugada J, Kautzner J, Pokushalov E, Maggioni AP, Laroche C, Anselmino M, Beinart R, Traykov V, Blomström‐Lundqvist C. Influence of risk factors in the ESC‐EHRA EORP atrial fibrillation ablation long‐term registry. Pacing Clin Electrophysiol 2019; 42:1365-1373. [DOI: 10.1111/pace.13763] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/10/2019] [Accepted: 07/02/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Serge A. Trines
- Heart Lung CentreLeiden University Medical Centre Leiden Netherlands
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano (AV), and Clinica San Michele Maddaloni (CE) Italy
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital ClínicUniversitat de Barcelona Barcelona Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
| | - Nikolaos Dagres
- Department of ElectrophysiologyHeart Center Leipzig at the University of Leipzig Leipzig Germany
| | - Josep Brugada
- Arrhythmia Section, Cardiology Department, Hospital ClínicUniversitat de Barcelona Barcelona Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM) Praha Czech Republic
| | - Evgeny Pokushalov
- E. Meshalkin National medical research center of the Ministry of Health of the Russian Federation Novosibirsk Russia
| | - Aldo P. Maggioni
- ANMCO Research Centre Florence Italy
- EURObservational Research ProgrammeEuropean Society of Cardiology Sophia‐Antipolis Cedex France
| | - Cécile Laroche
- EURObservational Research ProgrammeEuropean Society of Cardiology Sophia‐Antipolis Cedex France
| | - Matteo Anselmino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of Turin Italy
| | - Roy Beinart
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center Ramat Gan, Tel Hashomer, and Sackler School of MedicineTel Aviv University Tel Aviv Israel
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18
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Grecu M, Blomström-Lundqvist C, Kautzner J, Laroche C, Van Gelder IC, Jordaens L, Tavazzi L, Cihak R, Rubio Campal JM, Kalarus Z, Pokushalov E, Brugada J, Dagres N, Arbelo E. In-hospital and 12-month follow-up outcome from the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term registry: sex differences. Europace 2019; 22:66-73. [DOI: 10.1093/europace/euz225] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Aim
The purpose of this study was to compare sex differences of atrial fibrillation (AF) catheter ablation (CA) and to analyse the opportunities for improved outcomes.
Methods and results
All data were collected from the Atrial Fibrillation Ablation Long-Term registry, a prospective, multinational study conducted by the ESC-EORP European Heart Rhythm Association (EHRA) under the EURObservational Research Programme (ESC-EORP). A total of 104 centres in 27 European countries participated. Of 3593 included patients, 1146 (31.9%) were female. Female patients were older (61.0 vs. 56.4 years; P < 0.001), had more comorbidities (hypertension, diabetes, and obesity), more episodes of arrhythmias per month (6.9 vs. 6.2; P < 0.001), and a higher average EHRA score (2.6 vs. 2.4; P < 0.001). The duration of the procedure was shorter in females (160.1 min vs. 167.9 min; P < 0.001), irrespective of additional ablation lesions added to pulmonary vein isolation. Overall cardiovascular complications were more frequent in women than in men (5.7% vs. 3.4%; P < 0.001). Furthermore, cardiac perforations (3.8% vs. 1.3%; P = 0.011) and neurological complications (2.2% vs. 0.3%; P = 0.004) were found in females in less experienced centres than in experienced ones. On a final note, at 12 months, AF recurrence rate was similar in females and males (34.4% vs. 34.2%; P = 0.897), but more females were still on antiarrhythmic drugs (50.6% vs. 44.1%; P < 0.001) when compared with men.
Conclusion
Females underwent CA procedures for AF less frequently than males throughout Europe, despite more recurrent symptoms. With the same success rate, severe acute complications remained considerable in females, especially in less experienced centres.
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Affiliation(s)
- Mihaela Grecu
- Department of Electrophysiology, Cardiovascular Diseases Institute, Iasi, Romania
| | | | - Josef Kautzner
- Cardiology Department, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Cecile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia Antipolis, France
| | - Isabelle C Van Gelder
- Cardiology Department, University of Groningen, University Medical Center Groningen, Thoraxcenter, Groningen, The Netherlands
| | - Luc Jordaens
- Erasmus Medical Center, Clinical Electrophysiology, Rotterdam, The Netherlands
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Robert Cihak
- Cardiology Department, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Zbigniew Kalarus
- Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Evgeny Pokushalov
- “E. Meshalkin National Medical Research Center” of the Ministry of Health of the Russian Federation, Rechkunovskaya 15, Novosibirsk, Russia
| | - Josep Brugada
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu University of Barcelona, Villarroel 170, Barcelona, Spain
- IDIBAPS, Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu University of Barcelona, Villarroel 170, Barcelona, Spain
- IDIBAPS, Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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19
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Pürerfellner H, Sanders P, Sarkar S, Reisfeld E, Reiland J, Koehler J, Pokushalov E, Urban L, Dekker LRC. Adapting detection sensitivity based on evidence of irregular sinus arrhythmia to improve atrial fibrillation detection in insertable cardiac monitors. Europace 2019; 20:f321-f328. [PMID: 29036652 PMCID: PMC6277148 DOI: 10.1093/europace/eux272] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/27/2017] [Indexed: 12/03/2022] Open
Abstract
Aims Intermittent change in p-wave discernibility during periods of ectopy and sinus arrhythmia is a cause of inappropriate atrial fibrillation (AF) detection in insertable cardiac monitors (ICM). To address this, we developed and validated an enhanced AF detection algorithm. Methods and results Atrial fibrillation detection in Reveal LINQ ICM uses patterns of incoherence in RR intervals and absence of P-wave evidence over a 2-min period. The enhanced algorithm includes P-wave evidence during RR irregularity as evidence of sinus arrhythmia or ectopy to adaptively optimize sensitivity for AF detection. The algorithm was developed and validated using Holter data from the XPECT and LINQ Usability studies which collected surface electrocardiogram (ECG) and continuous ICM ECG over a 24–48 h period. The algorithm detections were compared with Holter annotations, performed by multiple reviewers, to compute episode and duration detection performance. The validation dataset comprised of 3187 h of valid Holter and LINQ recordings from 138 patients, with true AF in 37 patients yielding 108 true AF episodes ≥2-min and 449 h of AF. The enhanced algorithm reduced inappropriately detected episodes by 49% and duration by 66% with <1% loss in true episodes or duration. The algorithm correctly identified 98.9% of total AF duration and 99.8% of total sinus or non-AF rhythm duration. The algorithm detected 97.2% (99.7% per-patient average) of all AF episodes ≥2-min, and 84.9% (95.3% per-patient average) of detected episodes involved AF. Conclusion An enhancement that adapts sensitivity for AF detection reduced inappropriately detected episodes and duration with minimal reduction in sensitivity.
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Affiliation(s)
- Helmut Pürerfellner
- Department of Cardiology, Public Hospital Elisabethinen, Academic Teaching Hospital, Ordensklinikum A-4020 Linz, Fadingerstraße 1, Austria
| | - Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shantanu Sarkar
- Research and Development, Cardiac Rhythm and Heart Failure, Medtronic Plc., Moundsview, MN, USA; Moundsview, MN, USA
| | - Erin Reisfeld
- Research and Development, Cardiac Rhythm and Heart Failure, Medtronic Plc., Moundsview, MN, USA; Moundsview, MN, USA
| | - Jerry Reiland
- Research and Development, Cardiac Rhythm and Heart Failure, Medtronic Plc., Moundsview, MN, USA; Moundsview, MN, USA
| | - Jodi Koehler
- Research and Development, Cardiac Rhythm and Heart Failure, Medtronic Plc., Moundsview, MN, USA; Moundsview, MN, USA
| | - Evgeny Pokushalov
- Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Rechkunovskaya 15, Novosibirsk, Russia Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Luboš Urban
- Department of Arrhythmias and Cardiac Pacing, The National Institute of Cardiovascular Diseases, Pod Kr´snou hôrkou 1, Bratislava 37, Slovakia
| | - Lukas R C Dekker
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, EJ Eindhoven, The Netherlands
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20
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Wyn Davies D, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Interv Card Electrophysiol 2019; 50:1-55. [PMID: 28914401 PMCID: PMC5633646 DOI: 10.1007/s10840-017-0277-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | - Joseph G Akar
- Yale University School of Medicine, New Haven, CT, USA
| | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, UK
| | - Peng-Sheng Chen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, UK
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY, USA
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA, USA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, USA
- The National Center for Cardiovascular Research Carlos III (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO, USA
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Stanley Nattel
- Montreal Heart Institute, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
- University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, ON, Canada
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21
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Wintgens L, Romanov A, Phillips K, Ballesteros G, Swaans M, Folkeringa R, Garcia-Bolao I, Pokushalov E, Boersma L. Combined atrial fibrillation ablation and left atrial appendage closure: long-term follow-up from a large multicentre registry. Europace 2019; 20:1783-1789. [PMID: 29547906 DOI: 10.1093/europace/euy025] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/09/2018] [Indexed: 01/14/2023] Open
Abstract
Aims Long-term freedom from atrial fibrillation (AF) after catheter ablation (CA) and consequently the potential for stroke reduction remain unpredictable. Percutaneous left atrial appendage closure (LAAC) is an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. This study aims to evaluate long-term clinical results of combined CA and LAAC in one single procedure. Methods and results Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective compilation of independent prospective general LAAC registries at the individual centres. Transoesophageal echocardiography (TOE) was used to evaluate device position and LAA sealing. Between 2009 and 2015, 349 patients with AF (58% male, age 63.1 ± 8.2 years; score for stroke prediction in AF patients (CHA2DS2-VASc) 3.0; score for major bleeding in patients on anticoagulation (HAS-BLED) 3.0; 56% paroxysmal AF) were included. Indications for LAAC included previous stroke (38%), history of bleeding (22%), and physician/patient preference (29%). Periprocedural complications up to 30 days included pericardial effusion (1.5%) and one minor stroke (0.3%) but no death. After 6 weeks, TOE showed successful sealing of the LAA in 98.9%. After 35 months of follow-up, 51% of patients had AF recurrence. A total of nine ischaemic strokes were recorded, resulting in an annualized stroke rate of 0.9% compared to an expected stroke rate of 3.2% without anticoagulation and combined treatment. Conclusion This large pooled multicentre analysis of five prospective registries shows that combining CA and LAAC is feasible, safe, and successful. Long-term follow-up shows greatly reduced stroke and bleeding rates despite recurrence of AF in more than half of the patients.
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Affiliation(s)
- Lisette Wintgens
- Department of Cardiology, St Antonius Hospital, Cardiology, Koekoekslaan 1, CM, Nieuwegein, The Netherlands
| | - Aleksandr Romanov
- Department of Arrhythmia and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Oblast Novosibirsk, Novosibirsk, Russian Federation
| | - Karen Phillips
- Greenslopes Private Hospital, HeartCare Partners, Newdegate St, Greenslopes, QLD, Brisbane, Australia
| | - Gabriel Ballesteros
- University Clinic of Navarra, Unidad de Arritmias, Servicio de Cardiologia, Av. de Pío XII, Pamplona, Navarra, Spain
| | - Martin Swaans
- Department of Cardiology, St Antonius Hospital, Cardiology, Koekoekslaan 1, CM, Nieuwegein, The Netherlands
| | - Richard Folkeringa
- Medical Center Leeuwarden, Cardiology, Henri Dunantweg 2, AD, Leeuwarden, The Netherlands
| | - Ignacio Garcia-Bolao
- University Clinic of Navarra, Unidad de Arritmias, Servicio de Cardiologia, Av. de Pío XII, Pamplona, Navarra, Spain
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Oblast Novosibirsk, Novosibirsk, Russian Federation
| | - Lucas Boersma
- Department of Cardiology, St Antonius Hospital, Cardiology, Koekoekslaan 1, CM, Nieuwegein, The Netherlands.,Department of Cardiology, AMC, Meibergdreef 9, AZ, Amsterdam, The Netherlands
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22
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Nikitin N, Minin S, Romanov A, Shabanov V, Losik D, Elesin D, Stenin I, Mikheenko I, Baavour R, Pokushalov E. 246Hybrid 123I-mIBG SPECT/CT cardiac imaging for identification of left atrial ganglionated plexi in healthy individuals and patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Nikitin
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - S Minin
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - A Romanov
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - V Shabanov
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - D Losik
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - D Elesin
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - I Stenin
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - I Mikheenko
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - R Baavour
- Spectrum Dynamics Medical, Caesarea, Israel
| | - E Pokushalov
- Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
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23
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Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE, Noseworthy PA, Rosenberg YD, Jeffries N, Mitchell LB, Flaker GC, Pokushalov E, Romanov A, Bunch TJ, Noelker G, Ardashev A, Revishvili A, Wilber DJ, Cappato R, Kuck KH, Hindricks G, Davies DW, Kowey PR, Naccarelli GV, Reiffel JA, Piccini JP, Silverstein AP, Al-Khalidi HR, Lee KL. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA 2019; 321:1261-1274. [PMID: 30874766 PMCID: PMC6450284 DOI: 10.1001/jama.2019.0693] [Citation(s) in RCA: 852] [Impact Index Per Article: 170.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Catheter ablation is effective in restoring sinus rhythm in atrial fibrillation (AF), but its effects on long-term mortality and stroke risk are uncertain. OBJECTIVE To determine whether catheter ablation is more effective than conventional medical therapy for improving outcomes in AF. DESIGN, SETTING, AND PARTICIPANTS The Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation trial is an investigator-initiated, open-label, multicenter, randomized trial involving 126 centers in 10 countries. A total of 2204 symptomatic patients with AF aged 65 years and older or younger than 65 years with 1 or more risk factors for stroke were enrolled from November 2009 to April 2016, with follow-up through December 31, 2017. INTERVENTIONS The catheter ablation group (n = 1108) underwent pulmonary vein isolation, with additional ablative procedures at the discretion of site investigators. The drug therapy group (n = 1096) received standard rhythm and/or rate control drugs guided by contemporaneous guidelines. MAIN OUTCOMES AND MEASURES The primary end point was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Among 13 prespecified secondary end points, 3 are included in this report: all-cause mortality; total mortality or cardiovascular hospitalization; and AF recurrence. RESULTS Of the 2204 patients randomized (median age, 68 years; 37.2% female; 42.9% had paroxysmal AF and 57.1% had persistent AF), 89.3% completed the trial. Of the patients assigned to catheter ablation, 1006 (90.8%) underwent the procedure. Of the patients assigned to drug therapy, 301 (27.5%) ultimately received catheter ablation. In the intention-to-treat analysis, over a median follow-up of 48.5 months, the primary end point occurred in 8.0% (n = 89) of patients in the ablation group vs 9.2% (n = 101) of patients in the drug therapy group (hazard ratio [HR], 0.86 [95% CI, 0.65-1.15]; P = .30). Among the secondary end points, outcomes in the ablation group vs the drug therapy group, respectively, were 5.2% vs 6.1% for all-cause mortality (HR, 0.85 [95% CI, 0.60-1.21]; P = .38), 51.7% vs 58.1% for death or cardiovascular hospitalization (HR, 0.83 [95% CI, 0.74-0.93]; P = .001), and 49.9% vs 69.5% for AF recurrence (HR, 0.52 [95% CI, 0.45-0.60]; P < .001). CONCLUSIONS AND RELEVANCE Among patients with AF, the strategy of catheter ablation, compared with medical therapy, did not significantly reduce the primary composite end point of death, disabling stroke, serious bleeding, or cardiac arrest. However, the estimated treatment effect of catheter ablation was affected by lower-than-expected event rates and treatment crossovers, which should be considered in interpreting the results of the trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00911508.
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Affiliation(s)
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | | | | | | | | | | | - Yves D. Rosenberg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Neal Jeffries
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Evgeny Pokushalov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Alexander Romanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | | | | | - Andrey Ardashev
- Medical Science Center of Moscow State University, Moscow, Russia
| | | | | | | | | | | | | | - Peter R. Kowey
- Sidney Kimmel Medical College, Thomas Jefferson University, Wynnewood, Pennsylvania
| | | | | | | | | | | | - Kerry L. Lee
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
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Boersma LV, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov AV, Betts T, Mazzone P, Foley D, Grygier M, Sievert H, De Potter T, Vireca E, Stein K, Bergmann MW, Al Nooryani A, Fiedler T, Senatore G, Brigadeau F, Defaye P, Teiger E, Bonnet JL, Wald C, Szili-Torok T, Tschishow W, Crossland D, Vahanian A, Cruz-Gonzalez I, Thambo JB, Al Smadi F, Mudra H, Molitoris R, Folkeringa R, Stevenhagen Y, Gras D, Tamburino C, Molon G, Spence M, Infante Oliveira E, Merkulov E, Sukiennik A, Wong T, Busch M, Boldt LH, Nickenig G, Neef M. Evaluating Real-World Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology. Circ Arrhythm Electrophysiol 2019; 12:e006841. [DOI: 10.1161/circep.118.006841] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lucas V. Boersma
- Department of Cardiology, St Antonius Ziekenhuis Nieuwegein/AUMC Amsterdam, the Netherlands (L.V.B.)
| | - Hueseyin Ince
- Department of Cardiology, Vivantes Klinikum Urban (H.I.)
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany (H.I., S.K.)
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany (H.I., S.K.)
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation (E.P.)
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus Essen, Germany (T.S.)
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt/Main (B.S.)
| | - Tommaso Gori
- Department of Cardiology, Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz (T.G.)
| | - Felix Meincke
- Asklepios Klinik St Georg, Cardiology, Hamburg, Germany (F.M.)
| | | | - Timothy Betts
- Department of Cardiology, Oxford University Hospitals NHS Trust, United Kingdom (T.B.)
| | - Patrizio Mazzone
- Department of Cardiology, Ospedale San Raffaele, Milano, Italy (P.M.)
| | - David Foley
- Department of Cardiology, Beaumont Hospital, Dublin, Ireland (D.F.)
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Poland (M.G.)
| | | | - Tom De Potter
- Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst (T.D.P.)
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25
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Phillips KP, Pokushalov E, Romanov A, Artemenko S, Folkeringa RJ, Szili-Torok T, Senatore G, Stein KM, Razali O, Gordon N, Boersma LVA. Combining Watchman left atrial appendage closure and catheter ablation for atrial fibrillation: multicentre registry results of feasibility and safety during implant and 30 days follow-up. Europace 2019; 20:949-955. [PMID: 29106523 PMCID: PMC5982721 DOI: 10.1093/europace/eux183] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 05/11/2017] [Indexed: 01/19/2023] Open
Abstract
Aims Long-term results from catheter ablation therapy for atrial fibrillation (AF) remain uncertain and clinical practice guidelines recommend continuation of long-term oral anticoagulation in patients with a high stroke risk. Left atrial appendage closure (LAAC) with Watchman has emerged as an alternative to long-term anticoagulation for patients accepting of the procedural risks. We report on the initial results of combining catheter ablation procedures for AF and LAAC in a multicentre registry. Methods and results Data were pooled from two prospective, real-world Watchman LAAC registries running in parallel in Europe/Middle-East/Russia (EWOLUTION) and Asia/Australia (WASP) between 2013 and 2015. Of the 1140 patients, 139 subjects at 10 centres underwent a concomitant AF ablation and LAAC procedure. The mean CHA2DS2-VASc score was 3.4 ± 1.4 and HAS-BLED score 1.5 ± 0.9. Successful Watchman implantation was achieved in 100% of patients. The overall 30-day serious adverse event (SAE) rate was 8.7%, with the device and/or procedure-related SAE rate of 1.4%. One pericardial effusion required percutaneous drainage, but there were no strokes, device embolization, or deaths at 30 days. The 30-day bleeding SAE rate was 2.9% with 55% of patients prescribed NOAC and 38% taking warfarin post-procedure. Conclusion The outcomes from these international, multicentre registries support the feasibility and safety of performing combined procedures of ablation and Watchman LAAC for patients with non-valvular AF and high stroke risk. Further data are needed on long-term outcomes for the hybrid technique on all-cause stroke and mortality.
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Affiliation(s)
- Karen P Phillips
- HeartCare Partners, Greenslopes Private Hospital, Brisbane, Australia
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Aleksandr Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Sergey Artemenko
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | | | | | | | - Omar Razali
- National Heart Institute, Kuala Lumpur, Malaysia
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Stabile G, Trines SA, Arbelo E, Dagres N, Brugada J, Kautzner J, Pokushalov E, Maggioni AP, Laroche C, Anselmino M, Beinart R, Traykov V, Blomström Lundqvist C. Atrial fibrillation history impact on catheter ablation outcome. Findings from the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry. Pacing Clin Electrophysiol 2019; 42:313-320. [DOI: 10.1111/pace.13600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Serge A. Trines
- Heart Lung Centre; Leiden University Medical Centre; Leiden Netherlands
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clınic de Barcelona; University of Barcelona; Barcelona Spain
| | - Nikolaos Dagres
- Department of Electrophysiology; Heart Center Leipzig; Leipzig Germany
| | - Josep Brugada
- Department of Cardiology, Cardiovascular Institute, Hospital Clınic de Barcelona; University of Barcelona; Barcelona Spain
| | - Josef Kautzner
- Department of Cardiology; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Evgeny Pokushalov
- Arrhythmia Department and Electrophysiology Laboratory; State Research Institute of Circulation Pathology; Novosibirsk Russia
| | - Aldo P. Maggioni
- ANMCO Research Centre; Florence Italy
- EURObservational Research Programme; European Society of Cardiology; Sophia-Antipolis France
| | - Cecile Laroche
- EURObservational Research Programme; European Society of Cardiology; Sophia-Antipolis France
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Citta della Salute e della Scienza; University of Turin; Turin Italy
| | - Roy Beinart
- Arrhythmia Center; Sheba Medical Center, Ramat Gan, and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Vassil Traykov
- Department of Invasive Cardiac Electrophysiology; Acibadem City Clinic Tokuda Hospital; Sofia Bulgaria
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27
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Romanov A, Pokushalov E, Ponomarev D, Bayramova S, Shabanov V, Losik D, Stenin I, Elesin D, Mikheenko I, Strelnikov A, Sergeevichev D, Kozlov B, Po SS, Steinberg JS. Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: Three-year follow-up of a randomized study. Heart Rhythm 2018; 16:172-177. [PMID: 30414841 DOI: 10.1016/j.hrthm.2018.08.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Botulinum toxin (BTX) injections into epicardial fat pads in patients undergoing coronary artery bypass grafting (CABG) has resulted in suppression of atrial fibrillation (AF) during the early postoperative period through 1-year of follow-up in a pilot program. OBJECTIVE The purpose of this study was to report 3-year AF patterns by the use of implantable cardiac monitors (ICMs). METHODS Sixty patients with a history of paroxysmal AF and indications for CABG were randomized 1:1 to either BTX or placebo injections into 4 posterior epicardial fat pads. All patients received an ICM with regular follow-up for 3 years after surgery. The primary end point of the extended follow-up period was incidence of any atrial tachyarrhythmia after 30 days of procedure until 36 months on no antiarrhythmic drugs. The secondary end points included clinical events and AF burden. RESULTS At the end of 36 months, the incidence of any atrial tachyarrhythmia was 23.3% in the BTX group vs 50% in the placebo group (hazard ratio 0.36; 95% confidence interval 0.14-0.88; P = .02). AF burden at 12, 24, and 36 months was significantly lower in the BTX group than in the placebo group: 0.22% vs 1.88% (P = .003), 1.6% vs 9.5% (P < .001), and 1.3% vs 6.9% (P = .007), respectively. In the BTX group, 2 patients (7%) were hospitalized during follow-up compared with 10 (33%) in the placebo group (P = .02). CONCLUSION Injection of BTX into epicardial fat pads in patients undergoing CABG resulted in a sustained and substantial reduction in atrial tachyarrhythmia incidence and burden during 3-year follow-up, accompanied by reduction in hospitalizations.
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Affiliation(s)
- Alexander Romanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Evgeny Pokushalov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Dmitry Ponomarev
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Sevda Bayramova
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Vitaliy Shabanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Denis Losik
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Ilya Stenin
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Dmitry Elesin
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Igor Mikheenko
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Artem Strelnikov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - David Sergeevichev
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Boris Kozlov
- Institute of Cardiology, Siberian Division of Russian Academy of Medical Sciences, Tomsk, Russian Federation
| | - Sunny S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jonathan S Steinberg
- Heart Research Follow-up Program, University of Rochester School of Medicine & Dentistry, Rochester, New York; SMG Arrhythmia Center, Summit Medical Group, Short Hills, New Jersey.
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28
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Mörtsell D, Arbelo E, Dagres N, Brugada J, Laroche C, Trines SA, Malmborg H, Höglund N, Tavazzi L, Pokushalov E, Stabile G, Blomström-Lundqvist C. Cryoballoon vs. radiofrequency ablation for atrial fibrillation: a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish catheter ablation registry. Europace 2018; 21:581-589. [DOI: 10.1093/europace/euy239] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 09/21/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- David Mörtsell
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | - Josep Brugada
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Serge A Trines
- Heart-Lung Centre, Department of Cardiology, Leiden University Medical Centre, RC, Leiden, The Netherlands
| | - Helena Malmborg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Niklas Höglund
- Department of Cardiology, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy
| | - Evgeny Pokushalov
- Arrhythmia Department and EP Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
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Glover BM, Hong KL, Dagres N, Arbelo E, Laroche C, Riahi S, Bertini M, Mikhaylov EN, Galvin J, Kiliszek M, Pokushalov E, Kautzner J, Calvo N, Blomström-Lundqvist C, Brugada J. Impact of body mass index on the outcome of catheter ablation of atrial fibrillation. Heart 2018; 105:244-250. [DOI: 10.1136/heartjnl-2018-313490] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectivesThe association between obesity and atrial fibrillation (AF) is well-established. We aimed to evaluate the impact of index body mass index (BMI) on AF recurrence at 12 months following catheter ablation using propensity-weighted analysis. In addition, periprocedural complications and fluoroscopy details were examined to assess overall safety in relationship to increasing BMI ranges.MethodsBaseline, periprocedural and follow-up data were collected on consecutive patients scheduled for AF ablation. There were no specific exclusion criteria. Patients were categorised according to baseline BMI in order to assess the outcomes for each category.ResultsAmong 3333 patients, 728 (21.8%) were classified as normal (BMI <25.0 kg/m2), 1537 (46.1%) as overweight (BMI 25.5–29.0 kg/m2) and 1068 (32.0%) as obese (BMI ≥30.0 kg/m2). Procedural duration and radiation dose were higher for overweight and obese patients compared with those with a normal BMI (p=0.002 and p<0.001, respectively). An index BMI ≥30 kg/m2 led to a 1.2-fold increased likelihood of experiencing recurrent AF at 12-months follow-up as compared with overweight patients (HR 1.223; 95% CI 1.047 to 1.429; p=0.011), while no significant correlation was found between overweight and normal BMI groups (HR 0.954; 95% CI 0.798 to 1.140; p=0.605) and obese versus normal BMI (HR 1.16; 95% CI 0.965 to 1.412; p=0.112).ConclusionsPatients with a baseline BMI ≥30 kg/m2 have a higher recurrence rate of AF following catheter ablation and therefore lifestyle modification to target obesity preprocedure should be considered in these patients.
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30
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Brignole M, Pokushalov E, Pentimalli F, Palmisano P, Chieffo E, Occhetta E, Quartieri F, Calò L, Ungar A, Mont L, Menozzi C, Alboni P, Bertero G, Klersy C, Noventa F, Brignole M, Oddone D, Donateo O, Maggi R, Croci F, Solano A, Pentimalli F, Palmisano P, Landolina M, Chieffo E, Taravelli E, Occhetta E, Quartieri F, Bottoni N, Iori M, Calò L, Sgueglia M, Pieragnoli, Giorni A, Nesti M, Giannini I, Ungar A, Padeletti L, Pokushalov E, Romanov A, Peregudov I, Vidorreda S, Nunez R, Mont L, Corbucci G, Valsecchi S, Lovecchio M. A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS. Eur Heart J 2018; 39:3999-4008. [DOI: 10.1093/eurheartj/ehy555] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/16/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- Michele Brignole
- Department of Cardiology, Ospedali del Tigullio, Via don Bobbio, Lavagna, Italy
| | - Evgeny Pokushalov
- Department of Cardiology, Novosibirsk Research Institute, Novosibirsk, Russia
| | | | | | - Enrico Chieffo
- Department of Cardiology, Ospedale Maggiore, Crema, Italy
| | - Eraldo Occhetta
- Department of Cardiology, Ospedale Maggiore della Carità, Novara, Italy
| | - Fabio Quartieri
- Department of Cardiology, Ospedale S. Maria Nuova, Reggio Emilia, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Roma, Italy
| | - Andrea Ungar
- Department of Cardiology, Ospedale Careggi, Firenze, Italy
| | - Lluis Mont
- Department of Cardiology, Hospital Clinic, Barcelona, Spain
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Romanov A, Shabanov V, Mikheenko I, Losik D, Stenin I, Elesin D, Schwartz Y, Ben-Haim S, Pokushalov E. P1917Usefulness of real-time 3D panoramic view for execution of guided ablation procedures for cardiac arrhythmias. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - V Shabanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Mikheenko
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - D Losik
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Stenin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - D Elesin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | | | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
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32
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Romanov A, Minin S, Nikitin N, Breault C, Shabanov V, Mikheenko I, Losik D, Elesin D, Stenin I, Stirrup J, Pokushalov E. P5767The effect of catheter ablation on visualized sympathetic innervation activity patterns by iodine-123 meta-iodobenzylguanidine in patients with atrial fibrillation: long-term follow up data. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - S Minin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - N Nikitin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | - V Shabanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Mikheenko
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - D Losik
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - D Elesin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Stenin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - J Stirrup
- Royal Berkshire NHS Foundation Trust, London, United Kingdom
| | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
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Romanov A, Shabanov V, Mikheenko I, Stenin I, Elesin D, Schwart Y, Ben-Haim S, Kuck KH, Pokushalov E. P6615Real-time gap detection during atrial fibrillation ablation using novel dielectric sensing system: results of the Durable-I clinical trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - V Shabanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Mikheenko
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Stenin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - D Elesin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | | | - K.-H Kuck
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
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Obedinskiy AA, Kretov EI, Boukhris M, Kurbatov VP, Osiev AG, Ibn Elhadj Z, Obedinskaya NR, Kasbaoui S, Grazhdankin IO, Prokhorikhin AA, Zubarev DD, Biryukov A, Pokushalov E, Galassi AR, Baystrukov VI. The IMPACTOR-CTO Trial. JACC Cardiovasc Interv 2018; 11:1309-1311. [DOI: 10.1016/j.jcin.2018.04.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/10/2018] [Indexed: 10/28/2022]
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Bergmann MW, Betts TR, Sievert H, Schmidt B, Pokushalov E, Kische S, Schmitz T, Meincke F, Stein KM, Boersma LVA, Ince H. Safety and efficacy of early anticoagulation drug regimens after WATCHMAN left atrial appendage closure: three-month data from the EWOLUTION prospective, multicentre, monitored international WATCHMAN LAA closure registry. EUROINTERVENTION 2018; 13:877-884. [PMID: 28606886 DOI: 10.4244/eij-d-17-00042] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS While LAA closure has recently been incorporated into both European and US guidelines for stroke prevention, uncertainties regarding post-procedural drug therapy so far limit its adoption. The aim of this analysis is to compare real-world outcome data stratified for the post-procedural drug regimen employed. METHODS AND RESULTS One thousand and five patients were implanted with a WATCHMAN device in the prospective EWOLUTION study at 47 centres; 73.5% of the patients were deemed contraindicated for long-term OAC therapy. Here we report on three-month data including the first follow-up TOE exam for 94% of the study population. Following LAA closure, patients received DAPT, VKA, NOAC, single antiplatelet or no therapy (60.3%, 15.4%, 10.9%, 7% and 6.5%, respectively). Device thrombus (2.6%), stroke (0.4%) and major bleeding SAE (2.6%) rates were low overall and did not vary by post-implantation medication strategy. Patients on NOAC had the lowest bleeding rate, without an increase in device thrombus or stroke rates. CONCLUSIONS LAA closure with the WATCHMAN device is feasible in patients with a relative or absolute contraindication to oral anticoagulation. Neither DAPT nor NOAC therapy leads to a significant increase in device thrombus, stroke or bleeding compared to the standard VKA regimen. Numerically, NOAC therapy had the lowest event rate.
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Schmidt B, Betts TR, Sievert H, Bergmann MW, Kische S, Pokushalov E, Schmitz T, Meincke F, Mazzone P, Stein KM, Ince H, Boersma LVA. Incidence of pericardial effusion after left atrial appendage closure: The impact of underlying heart rhythm-Data from the EWOLUTION study. J Cardiovasc Electrophysiol 2018; 29:973-978. [PMID: 29722469 DOI: 10.1111/jce.13626] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pericardial effusion/tamponade (PE/PT) is a rare but serious complication following left atrial appendage closure (LAAC). It may be speculated that LAA contraction during sinus rhythm (SR) exerts mechanical force on the device that eventually leads to PE. We sought to determine the incidence and predictors of PE following LAAC using Watchman with special emphasis on the underlying heart rhythm during implant. METHODS AND RESULTS From 47 centers in 13 European countries 1,020 patients underwent LAAC and data on baseline rhythm were available from 1,010 patients (mean age 73 ± 9 years, 60% male, median CHA2DS2-VASc = 4). Data were collected via electronic case report forms. A Cox proportional hazard model was calculated adjusting for multiple variables: age, gender, number of recaptures, and device oversizing. During implant, 41% and 59% of patients were in SR and atrial fibrillation (AF), respectively. PE/PT rate was significantly lower in patients implanted during AF at day 30 postimplant (n = 1; 0.2% vs. n = 6; 1.5%; P = 0.02). No PE requiring intervention occurred in the AF group compared to 5 events (1.2%) in the SR group (P = 0.01). While univariate analysis identified SR and gender as predictors for PE/tamponade, multivariate analysis only showed a statistical trend for both variables. CONCLUSION The overall incidence of PE/PT was very low after LAAC using Watchman. Although SR was not identified as an independent predictor of PE/PT, all events requiring intervention occurred in patients with SR. It may be advisable to perform an extended echocardiographic follow-up in that patient population.
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Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Am Main, Germany
| | | | - Horst Sievert
- CardioVascular Center Frankfurt, Cardiology, Frankfurt Am Main, Germany
| | | | - Stephan Kische
- Vivantes Klinikum Friedrichshain, Cardiology, Berlin, Germany
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Cardiology, Novosibirsk, Russian Federation
| | | | - Felix Meincke
- Asklepios Klinik St Georg, Cardiology, Hamburg, Germany
| | | | | | - Hüseyin Ince
- Vivantes Klinikum am Urban, Cardiology, Berlin, Germany
| | - Lucas V A Boersma
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands/PI Cardiology, AMC, Amsterdam, Netherlands
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Romanov A, Pokushalov E, Ponomarev D, Strelnikov A, Shabanov V, Losik D, Karaskov A, Steinberg JS. Pulmonary vein isolation with concomitant renal artery denervation is associated with reduction in both arterial blood pressure and atrial fibrillation burden: Data from implantable cardiac monitor. Cardiovasc Ther 2018; 35. [PMID: 28423234 DOI: 10.1111/1755-5922.12264] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 03/23/2016] [Accepted: 04/13/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Renal artery denervation (RDN) has provided incremental atrial fibrillation (AF) suppression after pulmonary vein isolation (PVI) in patients with AF in the setting of drug-resistant hypertension. OBJECTIVE To assess the relationship between changes of mean blood pressure (BP) and AF recurrences/AF burden after PVI combined with RDN. METHODS All patients from two randomized studies with symptomatic paroxysmal AF and/or persistent AF and resistant hypertension who underwent PVI-only (n=37) or PVI with RDN (n=39), and implantable cardiac monitor (ICM) implantation were eligible for this study. Mixed-effects linear models were used to investigate the effect of RDN on mean BP and mean AF burden and associations between the two during the 12-month follow-up. RESULTS Concomitant RDN was associated with a significant reduction in both mean AF burden (2.43 [95% CI: 1.76-3.09] % vs 6.95 [95% CI: 5.44-8.45] %) and mean BP (104 [95% CI: 103-106] mm Hg vs 112 [95% CI: 110-113] mm Hg). Decrease in mean BP was positively correlated with decline in mean AF burden: reduction of 5-10 mm Hg was accompanied by a 7.0% decreased mean AF burden, with greater reduction (up to 20 mm Hg) associated with on average 17.7% lower mean AF burden. CONCLUSIONS Renal artery denervation when added to PVI decreases AF recurrences, AF burden, and mean BP. Reduction in mean BP is associated with both AF burden and recurrences. Further large-scale studies are needed to define the mechanistic pathway(s) of the antiarrhythmic effects of RDN.
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Affiliation(s)
- Alexander Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Dmitry Ponomarev
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Artem Strelnikov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Vitaliy Shabanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Denis Losik
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
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Kretov Е, Naryshkin I, Baystrukov V, Grazhdankin I, Prokhorikhin A, Zubarev D, Biryukov A, Verin V, Boykov A, Malaev D, Pokushalov E, Romanov A, Bergmann MW. Three-months optical coherence tomography analysis of a biodegradable polymer, sirolimus-eluting stent. J Interv Cardiol 2018; 31:442-449. [PMID: 29651802 DOI: 10.1111/joic.12510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 02/07/2017] [Accepted: 03/01/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We aimed to assess early neointimal healing by optical coherence tomography (OCT) 3 months after implantation of the ultrathin Orsiro® sirolimus-eluting stent with biodegradable polymer. BACKGROUND New generations of drug-eluting stents with biodegradable polymer have been developed to avoid the continued vascular irritation of durable polymers. METHODS In this prospective, open-label study, 34 patients received an Orsiro® sirolimus-eluting stent with biodegradable polymer. In a subgroup of patients (n = 15), the intervention was performed under OCT guidance. All patients underwent OCT-examination at three months. The primary endpoint was 3-month neointimal healing (NIH) score, calculated by weighing the presence of filling defects, malapposed and uncovered struts. Secondary endpoint was maturity of tissue coverage at 3 months. RESULTS At 3 months, NIH score was 13.7 (5.4-22), covered struts per lesion were 90% (84-97%), malapposed struts were 2.7% (0.8-5.4%) and rate of mature tissue coverage was 47% (42-53%). No target lesion failure occurred up to 12 months. Patients with OCT-guided stent implantation demonstrated a trend toward earlier stent healing as demonstrated by superior NIH scores (angio guided: 17.6% [8.8-26.4]; OCT-guided: 9.8% [4.0-15.5]; mean difference -8, [95%CI: -18.7-2.9], P = 0.123). This group had significantly more covered struts per lesion (angio-guided: 86% [82-90]; 95% [92-99]; mean difference 9% [95%CI: 3-15], P = 0.001). CONCLUSION The Orsiro® sirolimus-eluting stent with biodegradable polymer shows early vascular healing with a high rate of strut coverage at 3-month follow-up. OCT guided stent implantation had a positive impact on early vascular healing.
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Affiliation(s)
- Еvgeny Kretov
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Ivan Naryshkin
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Vitaly Baystrukov
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Igor Grazhdankin
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Aleksei Prokhorikhin
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Dmitry Zubarev
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Alexey Biryukov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | | | - Andrey Boykov
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Dastan Malaev
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Evgeny Pokushalov
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Alexander Romanov
- Novosibirsk Scientific Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - Martin W Bergmann
- Interventional Cardiology, Cardiologicum Hamburg Standort Wandsbek, Hamburg, Germany
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Romanov A, Pokushalov E, Bayramova S, Ponomarev D, Shabanov V, Losik D, Stenin I, Elesin D, Mikheenko I, Steinberg JS. Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: Three-year outcomes of the PREVENT AF I study. J Cardiovasc Electrophysiol 2018; 29:872-878. [PMID: 29570894 DOI: 10.1111/jce.13485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The PREVENT AF I study demonstrated that prophylactic pulmonary vein isolation (PVI) in patients with pure typical atrial flutter (AFL) resulted in substantial reduction of new-onset atrial fibrillation (AF) during 1-year follow-up as assessed by continuous implantable cardiac monitor (ICM). The objective of this study was to assess 3-year outcomes. METHODS AND RESULTS Fifty patients with documented AFL were randomized to either cavotricuspid isthmus (CTI) ablation alone (n = 25) or CTI with concomitant PVI (n = 25). The primary endpoint of the study was the occurrence of any atrial tachyarrhythmia with the monthly burden exceeding 0.5% on the ICM. At the end of 3 years, freedom from any atrial tachyarrhythmia was 48% (95% confidence interval [CI]: 32-72%) in the CTI plus PVI group as compared to 20% (95% CI: 9-44%) in the CTI-only group (P = 0.01). Freedom from redo procedures was also higher: 92% (95% CI: 82-100%) versus 68% (95% CI: 52-89%), respectively (P = 0.027). The 3-year AF burden favored the combined ablation group: 6.2% versus 16.8% (P = 0.03). In the CTI-only group, 12 (48%) patients were hospitalized compared to 4 (16%) in the PVI + CTI group (P = 0.03). Two patients in the CTI-only group developed stroke with no serious adverse events in the PVI + CTI group. CONCLUSION Prophylactic PVI in patients with only typical AFL resulted in a significant reduction of new-onset AF and burden during long-term follow-up as assessed by ICM, with consequent reduction in hospitalizations and need to perform repeat ablation for AF.
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Affiliation(s)
- Alexander Romanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Evgeny Pokushalov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Sevda Bayramova
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Dmitry Ponomarev
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Vitaliy Shabanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Denis Losik
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Ilya Stenin
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Dmitry Elesin
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Igor Mikheenko
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Jonathan S Steinberg
- Heart Research Follow-up Program, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.,The SMG Arrhythmia Center, Summit Medical Group, Short Hills, NJ, USA
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Arbelo E, Brugada J, Blomström-Lundqvist C, Laroche C, Kautzner J, Pokushalov E, Raatikainen P, Efremidis M, Hindricks G, Barrera A, Maggioni A, Tavazzi L, Dagres N. Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Eur Heart J 2018; 38:1303-1316. [PMID: 28104790 DOI: 10.1093/eurheartj/ehw564] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The ESC-EHRA Atrial Fibrillation Ablation Long-Term registry is a prospective, multinational study that aims at providing an accurate picture of contemporary real-world ablation for atrial fibrillation (AFib) and its outcome. Methods and results A total of 104 centres in 27 European countries participated and were asked to enrol 20-50 consecutive patients scheduled for first and re-do AFib ablation. Pre-procedural, procedural and 1-year follow-up data were captured on a web-based electronic case record form. Overall, 3630 patients were included, of which 3593 underwent an AFib ablation (98.9%). Median age was 59 years and 32.4% patients had lone atrial fibrillation. Pulmonary vein isolation was attempted in 98.8% of patients and achieved in 95-97%. AFib-related symptoms were present in 97%. In-hospital complications occurred in 7.8% and one patient died due to an atrioesophageal fistula. One-year follow-up was performed in 3180 (88.6%) at a median of 12.4 months (11.9-13.4) after ablation: 52.8% by clinical visit, 44.2% by telephone contact and 3.0% by contact with the general practitioner. At 12-months, the success rate with or without antiarrhythmic drugs (AADs) was 73.6%. A significant portion (46%) was still on AADs. Late complications included 14 additional deaths (4 cardiac, 4 vascular, 6 other causes) and 333 (10.7%) other complications. Conclusion AFib ablation in clinical practice is mostly performed in symptomatic, relatively young and otherwise healthy patients. Overall success rate is satisfactory, but complication rate remains considerable and a significant portion of patients remain on AADs. Monitoring after ablation shows wide variations. Antithrombotic treatment after ablation shows insufficient guideline-adherence.
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Affiliation(s)
- Elena Arbelo
- Department of Cardiology, Cardiovascular Institute. Hospital Clínic de Barcelona. University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- Department of Cardiology, Cardiovascular Institute. Hospital Clínic de Barcelona. University of Barcelona, Barcelona, Spain
| | | | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Evgeny Pokushalov
- Arrhythmia Department and EP Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Gerhard Hindricks
- Department of Electrophysiology, University Leipzig - Heart Center, Leipzig, Germany
| | - Alberto Barrera
- Arrhythmia Unit, Cardiology Department, University Hospital Virgen de la Victoria, Malaga
| | - Aldo Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France.,Associazione Nazionale Medici Cardiologi Ospedalieri Research Center (AMCO Research Center), Florence, Italy
| | - Luigi Tavazzi
- GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig - Heart Center, Leipzig, Germany
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Grecu M, Dagres N, Brugada J, Laroche C, Van Gelder IC, Cihak R, Jordaens L, Rubio Campal JM, Maggioni AP, Pokushalov E, Kautzner J, Tavazzi L, Blomstrom Lundqvist C, Arbelo E, Arbelo E. 198In Hospital and 12-month Follow-up Outcome from the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry: Gender Differences. Europace 2018. [DOI: 10.1093/europace/euy015.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Grecu
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu" , Iasi, Romania
| | - N Dagres
- Heart Center of Leipzig, Electrophysiology, Leipzig, Germany
| | - J Brugada
- Hospital Clinic de Barcelona, Electrophysiology, Barcelona, Spain
| | - C Laroche
- European Society of Cardiology, EURObservational Research Programme (EORP), Sophia Antipolis, France
| | - I C Van Gelder
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
| | - R Cihak
- Institute for Clinical and Experimental Medicine (IKEM), Cardiology, Prague, Czech Republic
| | - L Jordaens
- Erasmus Medical Center, Electrophysiology, Rotterdam, Netherlands
| | | | | | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Cardiology, Prague, Czech Republic
| | - L Tavazzi
- University of Pavia, Cardiology, Pavia, Italy
| | | | - E Arbelo
- Hospital Clinic de Barcelona, Electrophysiology, Barcelona, Spain
| | - E Arbelo
- Hospital Clinic de Barcelona, Electrophysiology, Barcelona, Spain
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42
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Trines SA, Stabile G, Arbelo E, Brugada J, Dagres N, Kautzner J, Maggioni A, Pokushalov E, Tavazzi L, Anselmino M, Compier MG, Laroche C, Blomstrom-Lundqvist C. 1015Influence of risk factors and co-morbidities on outcome, re-ablation and complications in the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry. Europace 2018. [DOI: 10.1093/europace/euy015.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S A Trines
- Leiden University Medical Center, Heart-Lung Center, Leiden, Netherlands
| | - G Stabile
- Clinica Mediterranea, Laboratorio di Elettrofisiologia, Naples, Italy
| | - E Arbelo
- Hospital Clinic de Barcelona, Department of Cardiology, Thorax Institute, Barcelona, Spain
| | - J Brugada
- Hospital Clinic de Barcelona, Department of Cardiology, Thorax Institute, Barcelona, Spain
| | - N Dagres
- University of Leipzig, Heart Center Leipzig, Leipzig, Germany
| | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czech Republic
| | - A Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | - E Pokushalov
- State Research Institute of Circulation Pathology, Arrhythmia Department and EP Laboratory, Novosibirsk, Russian Federation
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy
| | - M Anselmino
- University of Turin, Division of Cardiology, Department of Medical Sciences, Turin, Italy
| | - M G Compier
- Leiden University Medical Center, Heart-Lung Center, Leiden, Netherlands
| | - C Laroche
- European Society of Cardiology, EURObservational Research Programme, Sophia-Antipolis, France
| | - C Blomstrom-Lundqvist
- Uppsala University, Department of Cardiology, Institution of Medical Science, Uppsala, Sweden
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Romanov A, Pokushalov E, Shabanov V, Mikheenko I, Stenin I, Schwartz Y, Ben-Haim SA, Kuck KH. 742 Real-time gap detection during atrial fibrillation ablation using novel dielectric sensing system: results of the Durable-I clinical trial. Europace 2018. [DOI: 10.1093/europace/euy015.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - V Shabanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Mikheenko
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Stenin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | | | - K H Kuck
- Asklepios Clinic St. Georg, Hamburg, Germany
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Schmidt B, Brugada J, Arbelo E, Laroche C, Bayramova S, Bertini M, Letsas K, Pison L, Pokushalov E, Romanov D, Scherr D, Tilz R, Maggioni A, Dagres N. 1011Ablation Strategies for different types of atrial fibrillation in Europe - Results of the EORP Atrial Fibrillation Ablation Long-Term Registry. Europace 2018. [DOI: 10.1093/europace/euy015.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - J Brugada
- University of Barcelona, Barcelona, Spain
| | - E Arbelo
- University of Barcelona, Barcelona, Spain
| | - C Laroche
- European Society of Cardiology, Sophia-Antipolis, France
| | - S Bayramova
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - M Bertini
- Arcispedale Sant'Anna, Ferrara, Italy
| | - K Letsas
- “KAT” General Hospital of Attica, Athens, Greece
| | - L Pison
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - E Pokushalov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - D Romanov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - D Scherr
- Medical University of Graz, Graz, Austria
| | - R Tilz
- Medical University, Lübeck, Germany
| | - A Maggioni
- European Society of Cardiology, Sophia-Antipolis, France
| | - N Dagres
- Heart Center of Leipzig, Leipzig, Germany
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Romanov A, Minin S, Breault C, Nikitin N, Stirrup S, Shabanov V, Losik D, Elesin D, Stenin I, Mikheenko I, Pokushalov E. P347The effect of catheter ablation on visualized sympathetic innervation activity patterns by iodine-123 meta-iodobenzylguanidine in patients with atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - S Minin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | - N Nikitin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - S Stirrup
- Royal Berkshire NHS Foundation Trust, London, United Kingdom
| | - V Shabanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - D Losik
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - D Elesin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Stenin
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - I Mikheenko
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
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Scherr D, Dagres N, Brugada J, Laroche C, Tilz R, Schmidt B, Maggioni AP, Pokushalov E, Kautzner J, Tavazzi L, Blomstroem Lundqvist C, Arbelo E. 1017Is there a difference in rhythm outcome between patients undergoing first line versus second line paroxysmal atrial fibrillation ablation? - Results of the EORP AF Ablation Long-Term Registry. Europace 2018. [DOI: 10.1093/europace/euy015.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Scherr
- Medical University of Graz, Graz, Austria
| | - N Dagres
- Heart Center of Leipzig, Leipzig, Germany
| | - J Brugada
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - C Laroche
- European Society of Cardiology (ESC), Sophia Antipolis, France
| | - R Tilz
- University of Lubeck, Lubeck, Germany
| | - B Schmidt
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | | | - E Pokushalov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - L Tavazzi
- Maria Cecilia Hospital, Cotignola, Italy
| | | | - E Arbelo
- Hospital Clinic de Barcelona, Barcelona, Spain
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Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med 2018; 378:417-427. [PMID: 29385358 DOI: 10.1056/nejmoa1707855] [Citation(s) in RCA: 1366] [Impact Index Per Article: 227.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. METHODS We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. RESULTS After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medical-therapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P=0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P=0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P=0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P=0.009). CONCLUSIONS Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF ClinicalTrials.gov number, NCT00643188 .).
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Affiliation(s)
- Nassir F Marrouche
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Johannes Brachmann
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Dietrich Andresen
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Jürgen Siebels
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Lucas Boersma
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Luc Jordaens
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Béla Merkely
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Evgeny Pokushalov
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Prashanthan Sanders
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Jochen Proff
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Heribert Schunkert
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Hildegard Christ
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Jürgen Vogt
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Dietmar Bänsch
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot NMS(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace 2018; 20:157-208. [PMID: 29016841 PMCID: PMC5892164 DOI: 10.1093/europace/eux275] [Citation(s) in RCA: 332] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 681] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Romanov A, Minin S, Breault C, Nikitin N, Stirrup J, Shabanov V, Mikheenko I, Losik D, Stenin I, Pokushalov E. 073_16731-A1 Visualisation of Left Atrial Sympathetic Activity Distribution and Its Physiological Variation Over Time in Healthy Individuals. JACC Clin Electrophysiol 2017. [DOI: 10.1016/j.jacep.2017.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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