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Piersma FR, Breel JS, Krul SPJ, Eberl S, Wensing AGCL, Deutekom FE, Groot JR. Atrial fibrillation: a retrospective chart review of complications, morbidity and mortality at 30 days. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2750] [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
Introduction
Atrial fibrillation (AF) increasingly burdens medical health systems. Electrical cardioversion (ECV) forms an important rhythm control treatment for AF. Complications associated with this procedure include stroke and other arrhythmias.
Currently, institutional sedation protocols state that patients have to be admitted if 24-hour supervision by family or friends cannot be provided. This implies increased costs, both financially and by occupying a hospital bed. We anticipate that this strategy of admitting patients will become a problem in the future due to the rapid increase of AF patient due to aging of the population.
Purpose
Our aim is to analyse the incidence, type and timing of complications, to determine whether additional supervision is justified.
Methods
This was a retrospective single-centre study, in a large tertiary care hospital in the Netherlands. The study was approved by the Ethical Commission, registered with the Netherlands Trial Register (NL9433). Patients were contacted, those who did not object to the reuse of care data were included. Data was extracted from the electronic patient file, entered into a research database, and analysed. This study includes all eligible elective ECV's performed under general anaesthesia, in 2019. We analysed at the number of documented complications within 2 hours (T1), between 2 and 24 hours (T2) and within 30 days of the ECV (T3).
Results
In total, 370 patients were approached, 7 patients refused consent and 363 unique patients with 564 ECV procedures were included. The majority were male (66%), mean age 65±12 years, BMI 28±6 kg/m2, 49% smoker (current or past), 19% had previously undergone a form of AF ablation, 115 (32%) patients underwent ≥2 ECV's (range 2–11), and 6 patients were admitted due to a social indication.
In T1, 22 complications in 16 ECV's were documented, mostly unrelated to anaesthesia: asystole (3, >5 seconds asystole during/after procedure), hypotension (8), extreme bradycardia (8), chest-wall burn pain (1), and arrhythmias other than AF that developed after ECV (2). Nine complications in 7 ECVs (bradycardia, asystole and arrhythmias) were considered severe enough for admission, 5 patients were diagnosed with SSS/brady-tachy syndrome and were implanted with a pacemaker later.
In T2, 11 complications were documented: bradycardia (1), skin pain (3), muscle pain (2), fatigue (4), fainting and palpitations (1). The latter patient developed bradycardia and recurrent AF, and was readmitted.In T3, 15 complications were documented of which 5 were severe (CVA, angina, heart failure, arrhythmias).
Conclusion
Based on this retrospective analysis of all eligible ECV's in a large tertiary hospital, performed in 2019, complications in T2 (1,8%) needed no further treatment. We therefore conclude that it seems safe to discharge patients to their homes without extra supervision after sedation ECV
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F R Piersma
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - J S Breel
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - S P J Krul
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - S Eberl
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - A G C L Wensing
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - F E Deutekom
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - J R Groot
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
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Wesselink R, Neefs J, van den Berg NWE, Meulendijks ER, Terpstra MM, Kawasaki M, Nariswari FA, Piersma FR, van Boven WJP, Driessen AHG, de Groot JR. Does left atrial epicardial conduction time reflect atrial fibrosis and the risk of atrial fibrillation recurrence after thoracoscopic ablation? Post hoc analysis of the AFACT trial. BMJ Open 2022; 12:e056829. [PMID: 35264365 PMCID: PMC8915322 DOI: 10.1136/bmjopen-2021-056829] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the association between left atrial epicardial conduction time (LAECT), fibrosis and atrial fibrillation (AF) recurrence after thoracoscopic surgical ablation of persistent AF. SETTING Single tertiary care centre in the Netherlands. PARTICIPANTS Patients with persistent AF from the randomised Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery (AFACT)-trial were included. Patients eligible for thoracoscopic AF ablation were included, full inclusion and exclusion criteria were previously published. All patients underwent thoracoscopic ablation, encompassing pulmonary vein isolation with an additional roof and trigone lesion. In patients with conduction block across the roof and trigone lesion, LAECT was measured. LAECT was defined as the time to local activation at one side of the roofline on pacing from the opposite side. Collagen fibre density was quantified from left atrial appendage histology. OUTCOME MEASURES Primary outcome: AF recurrence during 2 years of follow-up. RESULTS 121 patients were included, of whom 35(29%) were women, age was 60.4±7.8 and 51% (62) had at least one AF recurrence during 2 years of follow-up. LAECT was longer in patients with versus without AF recurrence (182±43 ms vs 147±29 ms, p<0.001). LAECT was longer in older patients, in patients with a higher body mass index (BMI) and in patients using class IC antiarrhythmic drugs. LAECT was shorter in patients with higher collagen fibre density. A previously failed catheter ablation, LAECT and BMI were independently associated with AF recurrence. CONCLUSION LAECT is correlated with collagen fibre density and BMI and is independently associated with AF recurrence in patients with persistent AF. In these patients, LAECT appears to reflect substrate characteristics beyond clinical AF type and left atrial volume. TRIAL REGISTRATION NUMBER NCT01091389.
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Affiliation(s)
- R Wesselink
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - J Neefs
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - N W E van den Berg
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - E R Meulendijks
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - M M Terpstra
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - M Kawasaki
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - F A Nariswari
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - F R Piersma
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - W J P van Boven
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - A H G Driessen
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - J R de Groot
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
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Piersma FR, Neefs J, Berger WR, van den Berg NWE, Wesselink R, Krul SPJ, de Groot JR. Care and referral patterns in a large, dedicated nurse-led atrial fibrillation outpatient clinic. Neth Heart J 2021; 30:370-376. [PMID: 34919210 PMCID: PMC9270511 DOI: 10.1007/s12471-021-01651-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is the most common arrhythmia and imposes a high burden on the healthcare system. A nurse-led AF outpatient clinic may alleviate the burden on the cardiology outpatient clinic by triaging patients who need care by a cardiologist or general practitioner (GP). However, care and referral patterns after initial assessment in a nurse-led AF outpatient clinic are unknown. We examined the proportion of AF patients assessed in a nurse-led clinic without outpatient follow-up by a cardiologist. Methods All patients with AF referred to our tertiary medical centre underwent cardiac work-up in the nurse-led AF outpatient clinic and were prospectively followed. Data on patient characteristics, rhythm monitoring and echocardiography were collected and described. Odds ratio (OR) for continuing care in the nurse-led AF outpatient clinic was calculated. Results From 2014 to 2018, 478 consecutive individual patients were referred to the nurse-led AF outpatient clinic. After the initial cardiac work-up, 139 patients (29.1%) remained under nurse-led care and 121 (25.3%) were referred to a cardiologist and 218 (45.6%) to a GP. Patients who remained under nurse-led care were significantly younger, were more symptomatic, more often had paroxysmal AF and had less comorbidities than the other two groups. After multivariable testing, CHA2DS2-VASc score ≥ 2 was associated with discontinued nurse-led care (OR 0.57, 95% confidence interval 0.34–0.95). Conclusion After initial cardiac assessment in the nurse-led outpatient clinic, about half of the newly referred AF patients were referred back to their GP. This strategy may reduce the burden of AF patients on secondary or tertiary cardiology outpatient clinics. Supplementary Information The online version of this article (10.1007/s12471-021-01651-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F R Piersma
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - J Neefs
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - W R Berger
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - N W E van den Berg
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - R Wesselink
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - S P J Krul
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - J R de Groot
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
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Kougioumtzoglou AM, Neefs J, Wesselink R, Terpstra MM, Van Den Berg NWE, Berger WR, Meulendijks ER, Krul SPJ, Piersma FR, De Jong JSSG, Van Boven WJP, Driessen AHG, De Groot JR. P1837HFpEF reverses in more than a quarter of patients after thoracoscopic AF ablation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0589] [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: 11/12/2022] Open
Abstract
Abstract
Purpose
To evaluate the proportion of patients in whom parameters that define the diagnosis of HFpEF and HFmrEF persist versus normalize upon elimination of AF.
Background
Atrial fibrillation (AF) and heart failure with preserved or mid-range ejection fraction (HFpEF or HFmrEF) concur in many patients. Distinction between these two diagnoses remains challenging as one can cause or exacerbate the other. Adequate patient selection for invasive AF treatment is crucial to improve rhythm outcome.
Methods
Patients underwent thoracoscopic ablation, consisting of pulmonary vein isolation (PVI) alone or PVI with additional lines in the case of persistent AF. Patients were prospectively followed-up. HFmrEF or HFpEF was defined as left ventricular ejection fraction (LVEF) ≥40% or ≥50% respectively and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels >125 pg/ml. Patients who remained free from AF, or any atrial tachycardia of more than 30 seconds, at 6 months postoperatively, were included in this study. Patients with AF recurrences during this period were excluded. The primary outcome was the change of NT-proBNP at 6 month follow-up.
Results
From 2008 to 2017, 92 patients undergoing thoracoscopic AF ablation fulfilled the aforementioned criteria and were included. Of these patients, mean age was 61±8 years and 66 (72%) were male. Median NT-proBNP was 366 pg/ml (128–2916) and mean LVEF was 53±7%. Thirty (35%) patients had a LVEF of 40–49%. Six months after elimination of AF, NT-proBNP was <125 pg/ml (Figure 1A: median 87 (50–122) vs 459 (137 – 2916) pg/ml at baseline; p<0.001) in 26 patients (28%), whereas in the remaining patients NT-proBNP was unchanged (Figure 1B: median 298 (126–1568) vs. 318 (128–2387) pg/ml at baseline; p=0.011).
Figure 1. NT-proBNP alterations after thoracoscopic AF ablation from baseline to 6 month follow-up. A. Patients with normalization of NT-proBNP. B. Patients with unchanged high levels of NT-proBNP.
Conclusion
In 28% of patients the diagnostic criteria of HFpEF/HFmrEF are caused by AF and normalize upon elimination of AF with thoracoscopic ablation.
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Affiliation(s)
| | - J Neefs
- Amsterdam UMC, location AMC, Amsterdam, Netherlands (The)
| | - R Wesselink
- Amsterdam UMC, location AMC, Amsterdam, Netherlands (The)
| | - M M Terpstra
- Amsterdam UMC, location AMC, Amsterdam, Netherlands (The)
| | | | - W R Berger
- Hospital Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands (The)
| | | | - S P J Krul
- Amsterdam UMC, location AMC, Amsterdam, Netherlands (The)
| | - F R Piersma
- Amsterdam UMC, location AMC, Amsterdam, Netherlands (The)
| | - J S S G De Jong
- Hospital Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands (The)
| | | | - A H G Driessen
- Amsterdam UMC, location AMC, Amsterdam, Netherlands (The)
| | - J R De Groot
- Amsterdam UMC, location AMC, Amsterdam, Netherlands (The)
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Neefs J, Wesselink R, Terpstra MM, Van Den Berg NWE, Berger WR, Meulendijks ER, Krul SPJ, Piersma FR, De Jong JSSG, Van Boven WJP, Driessen AHG, De Groot JR. P1017Thoracoscopic AF ablation is a successful treatment for patients with a giant left atrium. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0608] [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
Severely enlarged left atrial (LA) volume is associated with a considerable ineffective outcome of ablation for atrial fibrillation (AF). Therefore, in patients with AF and a giant atrial volume catheter ablation is not recommended. However, thoracoscopic AF ablation is being performed in patients with AF and giant LA, but with unknown efficacy.
Purpose
To determine efficacy of thoracoscopic AF ablation in patients with AF and a giant LA.
Methods
Patients underwent thoracoscopic AF ablation (paroxysmal AF) plus additional left atrial ablations (persistent AF) and were prospectively followed. Giant LA was defined as left atrial volume index (LAVI)≥50 ml/m2, outcome was also assessed for LAVI≥55 ml/m2. Follow-up was performed with ECGs and 24-hour Holters every three months. After a 3-month blanking period, all AADs were discontinued. Primary outcome was recurrence of any atrial tachycardia ≥30 sec during one year of follow-up.
Results
Between 2008–2017, 357 patients underwent thoracoscopic AF ablation. At baseline, giant LA was diagnosed in 72 (20.2%) patients (mean LAVI: 59.5±9.6 ml/m2), while 285 (79.8%) had a smaller left atrium (mean LAVI: 36.3±7.8 ml/m2), p<0.001. Giant LA patients were older (mean: 61.7±6.9 vs 59.3±9.0 years, p=0.03) and more often diagnosed with persistent AF (n=60, 83.3%) compared to control (n=164, 57.5%), p<0.001. Sex (female: n=19, 26.4% vs n=79, 27.7%, p=0.82) and history of AF (median: 4.0 [IQR: 2.0–6.0] vs 4.0 [IQR: 2.0–8.0] years, p=0.10) were equally distributed. Freedom of any atrial tachycardia did not differ significantly between both groups (n=43, 59.7% vs n=195, 68.4%, log rank p=0.91), figure. This was similar for the cut-off of LAVI≥55 ml/m2: n=24/43 (55.8%) vs n=214/314 (68.2%), p=0.15). AF recurred in 16 (22.2%) patients with giant LA compared to 55 (19.3%) patients, while atrial tachycardia recurred in 21 (29.2%) vs 56 (19.6%) patients, respectively, p=0.06.
Kaplan-Meier analysis of AF recurrence i
Conclusion
Thoracoscopic AF ablation is an effective therapy in patients with a giant LA. Thoracoscopic AF ablation may therefore be a feasible treatment for patients with a giant LA.
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Affiliation(s)
- J Neefs
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - R Wesselink
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - M M Terpstra
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - N W E Van Den Berg
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - W R Berger
- Hospital Onze Lieve Vrouwe Gasthuis, Cardiology, Amsterdam, Netherlands (The)
| | - E R Meulendijks
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - S P J Krul
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - F R Piersma
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - J S S G De Jong
- Hospital Onze Lieve Vrouwe Gasthuis, Cardiology, Amsterdam, Netherlands (The)
| | - W J P Van Boven
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - A H G Driessen
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
| | - J R De Groot
- Academic Medical Center of Amsterdam, Heart centre, Amsterdam, Netherlands (The)
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Wesselink R, Neefs J, Van Den Berg NWE, Baalman SWE, Berger WR, Krul SPJ, Van Praag EM, Terpstra MM, Piersma FR, Van Boven WJP, Driessen AHG, De Groot JR. 465Left atrial conduction time during evaluation of conduction block in thoracoscopic surgery for advanced atrial fibrillation is associated with 1-year freedom of atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.465] [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)
- R Wesselink
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J Neefs
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - N W E Van Den Berg
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - S W E Baalman
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - W R Berger
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - S P J Krul
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - E M Van Praag
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - M M Terpstra
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - F R Piersma
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - W J P Van Boven
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - A H G Driessen
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J R De Groot
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
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Berger WR, Neefs J, Krul SPJ, Van Praag EM, Van Den Berg NWE, Piersma FR, De Jong JSSG, Van Boven WJP, Driessen AHG, De Groot JR. 1003Ganglion Plexus Ablation in Patients with Advanced Atrial Fibrillation: 2-Year Outcomes of the AFACT study. Europace 2018. [DOI: 10.1093/europace/euy015.552] [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: 11/14/2022] Open
Affiliation(s)
- W R Berger
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
| | - J Neefs
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
| | - SPJ Krul
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
| | - E M Van Praag
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
| | - NWE Van Den Berg
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
| | - F R Piersma
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
| | - JSSG De Jong
- Hospital Onze Lieve Vrouwe Gasthuis, Heart Center, Department of Cardiology, Amsterdam, Netherlands
| | - WJP Van Boven
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
| | - AHG Driessen
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
| | - J R De Groot
- Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Cardiothoracic Surgery and Experimental Cardiology, Amsterdam, Netherlands
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van den Berg NWE, Neefs J, Berger WR, Baalman SWE, Meulendijks E, Kawasaki M, Kemper EM, Piersma FR, Veldkamp MW, Wesselink R, Krul SPJ, de Groot JR. Can we spice up our Christmas dinner? : Busting the myth of the 'Chinese restaurant syndrome'. Neth Heart J 2017; 25:664-668. [PMID: 29127646 PMCID: PMC5691820 DOI: 10.1007/s12471-017-1053-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/28/2022] Open
Abstract
Background Monosodium glutamate (MSG), also referred to as Vetsin or E621, is a flavour enhancer frequently used in Asian cuisine and abundantly present in the famous Chinese dish Peking duck. MSG is notorious for triggering the onset of the so-called ‘Chinese restaurant syndrome’ (CRS), a complex of unpleasant symptoms, which might include flushing, sweating and the onset of atrial fibrillation (AF). This study aims to determine the effects of MSG on the occurrence of AF. Methods We conducted a placebo self-controlled single-arm study in the Academic Medical Centre in Amsterdam. We included paroxysmal AF patients who reported a consistent onset of AF upon MSG intake. During three admissions, participants were subsequently administered: placebo, 1.5 g and 3 g MSG. If AF was recorded after the dose of 1.5 g MSG, patients were given another placebo instead of 3 g MSG. The primary outcome was the onset of AF registered by 24-hour Holter monitoring. The secondary outcomes were any other arrhythmia and the onset of CRS defined as two or more symptoms of CRS after MSG intake. Results Six men participated in the study. Both 1.5 g and 3 g MSG were unrelated to CRS, arrhythmias or AF occurrence. Conclusion Peking duck can be put on the Christmas menu without risking guests to be admitted to the emergency department with new episodes of AF. Electronic supplementary material The online version of this article (10.1007/s12471-017-1053-5) contains study inlcusion and exclusion criteria and recipe of Peking duck, which is available to authorized users.
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Affiliation(s)
- N W E van den Berg
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Neefs
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - W R Berger
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S W E Baalman
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - E Meulendijks
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M Kawasaki
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - E M Kemper
- Department of Hospital Pharmacy, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - F R Piersma
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M W Veldkamp
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R Wesselink
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S P J Krul
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J R de Groot
- Heart Centre, Departments of Cardiothoracic Surgery and Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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