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Blum S, Aeschbacher S, Coslovsky M, Meyre PB, Reddiess P, Ammann P, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Müller R, Beer JH, Kobza R, Bonati LH, Moutzouri E, Rodondi N, Meyer-Zürn C, Kühne M, Sticherling C, Osswald S, Conen D. Long-term risk of adverse outcomes according to atrial fibrillation type. Sci Rep 2022; 12:2208. [PMID: 35140237 PMCID: PMC8828824 DOI: 10.1038/s41598-022-05688-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Sustained forms of atrial fibrillation (AF) may be associated with a higher risk of adverse outcomes, but few if any long-term studies took into account changes of AF type and co-morbidities over time. We prospectively followed 3843 AF patients and collected information on AF type and co-morbidities during yearly follow-ups. The primary outcome was a composite of stroke or systemic embolism (SE). Secondary outcomes included myocardial infarction, hospitalization for congestive heart failure (CHF), bleeding and all-cause mortality. Multivariable adjusted Cox proportional hazards models with time-varying covariates were used to compare hazard ratios (HR) according to AF type. At baseline 1895 (49%), 1046 (27%) and 902 (24%) patients had paroxysmal, persistent and permanent AF and 3234 (84%) were anticoagulated. After a median (IQR) follow-up of 3.0 (1.9; 4.2) years, the incidence of stroke/SE was 1.0 per 100 patient-years. The incidence of myocardial infarction, CHF, bleeding and all-cause mortality was 0.7, 3.0, 2.9 and 2.7 per 100 patient-years, respectively. The multivariable adjusted (a) HRs (95% confidence interval) for stroke/SE were 1.13 (0.69; 1.85) and 1.27 (0.83; 1.95) for time-updated persistent and permanent AF, respectively. The corresponding aHRs were 1.23 (0.89, 1.69) and 1.45 (1.12; 1.87) for all-cause mortality, 1.34 (1.00; 1.80) and 1.30 (1.01; 1.67) for CHF, 0.91 (0.48; 1.72) and 0.95 (0.56; 1.59) for myocardial infarction, and 0.89 (0.70; 1.14) and 1.00 (0.81; 1.24) for bleeding. In this large prospective cohort of AF patients, time-updated AF type was not associated with incident stroke/SE.
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Affiliation(s)
- Steffen Blum
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Pascal B Meyre
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Philipp Reddiess
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Peter Ammann
- Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Erne
- Laboratory for Signal Transduction, Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | | | - Dipen Shah
- University Hospital Geneva, Geneva, Switzerland
| | | | - Rahel Müller
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | | | | | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,University Hospital Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,University Hospital Bern, Bern, Switzerland
| | - Christine Meyer-Zürn
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland. .,Population Health Research Institute, McMaster University, Barton Street East, Hamilton, ON, Canada.
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Kühne M, Krisai P, Coslovsky M, Rodondi N, Müller A, Beer JH, Ammann P, Auricchio A, Moschovitis G, Hayoz D, Kobza R, Shah D, Stephan FP, Schläpfer J, Di Valentino M, Aeschbacher S, Ehret G, Eken C, Monsch A, Roten L, Schwenkglenks M, Springer A, Sticherling C, Reichlin T, Zuern CS, Meyre PB, Blum S, Sinnecker T, Würfel J, Bonati LH, Conen D, Osswald S. OUP accepted manuscript. Eur Heart J 2022; 43:2127-2135. [PMID: 35171989 PMCID: PMC9170478 DOI: 10.1093/eurheartj/ehac020] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/03/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
Aims We aimed to investigate the association of clinically overt and silent brain lesions with cognitive function in atrial fibrillation (AF) patients. Methods and results We enrolled 1227 AF patients in a prospective, multicentre cohort study (Swiss-AF). Patients underwent standardized brain magnetic resonance imaging (MRI) at baseline and after 2 years. We quantified new small non-cortical infarcts (SNCIs) and large non-cortical or cortical infarcts (LNCCIs), white matter lesions (WML), and microbleeds (Mb). Clinically, silent infarcts were defined as new SNCI/LNCCI on follow-up MRI in patients without a clinical stroke or transient ischaemic attack (TIA) during follow-up. Cognition was assessed using validated tests. The mean age was 71 years, 26.1% were females, and 89.9% were anticoagulated. Twenty-eight patients (2.3%) experienced a stroke/TIA during 2 years of follow-up. Of the 68 (5.5%) patients with ≥1 SNCI/LNCCI, 60 (88.2%) were anticoagulated at baseline and 58 (85.3%) had a silent infarct. Patients with brain infarcts had a larger decline in cognition [median (interquartile range)] changes in Cognitive Construct score [−0.12 (−0.22; −0.07)] than patients without new brain infarcts [0.07 (−0.09; 0.25)]. New WML or Mb were not associated with cognitive decline. Conclusion In a contemporary cohort of AF patients, 5.5% had a new brain infarct on MRI after 2 years. The majority of these infarcts was clinically silent and occurred in anticoagulated patients. Clinically, overt and silent brain infarcts had a similar impact on cognitive decline. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT02105844, https://clinicaltrials.gov/ct2/show/NCT02105844
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Affiliation(s)
- Michael Kühne
- Corresponding authors. Tel: +41 61 265 25 25, (M.K.), (D.C.)
| | | | - Michael Coslovsky
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Müller
- Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland
| | - Jürg H Beer
- Department of Medicine, Conatonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland
| | - Peter Ammann
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Daniel Hayoz
- Department of Internal Medicine, HRF—Hôpital Cantonal Fribourg, Fribourg, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Dipen Shah
- Division of Cardiology, Department of Medical Specialities, University Hospital Geneva, Geneva, Switzerland
| | | | - Jürg Schläpfer
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marcello Di Valentino
- Division of Cardiology, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Stefanie Aeschbacher
- Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Georg Ehret
- Division of Cardiology, Department of Medical Specialities, University Hospital Geneva, Geneva, Switzerland
| | - Ceylan Eken
- Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Monsch
- Memory Clinic, Universitäre Altersmedizin, Felix Platter Spital Basel, University of Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Anne Springer
- Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christine S Zuern
- Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Pascal B Meyre
- Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Steffen Blum
- Cardiology/Electrophysiology Division, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tim Sinnecker
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, Univesity of Basel, Basel, Switzerland
| | - Jens Würfel
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, Univesity of Basel, Basel, Switzerland
| | - Leo H. Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Conen
- Corresponding authors. Tel: +41 61 265 25 25, (M.K.), (D.C.)
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Adam L, Feller M, Syrogiannouli L, Del-Giovane C, Donzé J, Baumgartner C, Segna D, Floriani C, Roten L, Fischer U, Aeschbacher S, Moschovitis G, Schläpfer J, Shah D, Amman P, Kobza R, Schwenkglenks M, Kühne M, Bonati LH, Beer J, Osswald S, Conen D, Aujesky D, Rodondi N. Novel bleeding risk score for patients with atrial fibrillation on oral anticoagulants, including direct oral anticoagulants. J Thromb Haemost 2021; 19:931-940. [PMID: 33501722 DOI: 10.1111/jth.15251] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Balancing bleeding risk and stroke risk in patients with atrial fibrillation (AF) is a common challenge. Though several bleeding risk scores exist, most have not included patients on direct oral anticoagulants (DOACs). We aimed at developing a novel bleeding risk score for patients with AF on oral anticoagulants (OAC) including both vitamin K antagonists (VKA) and DOACs. METHODS We included patients with AF on OACs from a prospective multicenter cohort study in Switzerland (SWISS-AF). The outcome was time to first bleeding. Bleeding events were defined as major or clinically relevant non-major bleeding. We used backward elimination to identify bleeding risk variables. We derived the score using a point score system based on the β-coefficients from the multivariable model. We used the Brier score for model calibration (<0.25 indicating good calibration), and Harrel's c-statistics for model discrimination. RESULTS We included 2147 patients with AF on OAC (72.5% male, mean age 73.4 ± 8.2 years), of whom 1209 (56.3%) took DOACs. After a follow-up of 4.4 years, a total of 255 (11.9%) bleeding events occurred. After backward elimination, age > 75 years, history of cancer, prior major hemorrhage, and arterial hypertension remained in the final prediction model. The Brier score was 0.23 (95% confidence interval [CI] 0.19-0.27), the c-statistic at 12 months was 0.71 (95% CI 0.63-0.80). CONCLUSION In this prospective cohort study of AF patients and predominantly DOAC users, we successfully derived a bleeding risk prediction model with good calibration and discrimination.
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Affiliation(s)
- Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland
| | | | - Cinzia Del-Giovane
- Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Department of Medicine, Division of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Segna
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Gastroenterology and Hepatology, University Hospital of Zürich, Zurich, Switzerland
- Department of Gastroenterology, GZO Wetzikon, Wetzikon, Switzerland
| | - Carmen Floriani
- Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Stefanie Aeschbacher
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Jürg Schläpfer
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Dipen Shah
- Cardiology Service, Department of Medicine Specialities, University Hospital Geneva, Geneva, Switzerland
| | - Peter Amman
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Michael Kühne
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Leo H Bonati
- Neurology Division and Stroke Centre, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Jürg Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, Basel, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, Basel, Switzerland
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland
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4
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Bay M, Vollenweider P, Marques-Vidal P, Schläpfer J. Clinical factors associated with the intraventricular conduction disturbances in Swiss middle-aged adults: The CoLaus|PsyCoLaus study. Int J Cardiol 2020; 327:201-208. [PMID: 33309760 DOI: 10.1016/j.ijcard.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/16/2020] [Revised: 11/04/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intraventricular conduction disturbances are associated with an increased risk of adverse cardiovascular outcomes. However, data about factors associated with intraventricular conduction disturbances are sparse. We aimed to identify the clinical factors associated with intraventricular conduction disturbances in the general population. METHODS Cross-sectional study in a sample of 3704 participants (age range 45-86 years, 55.2% women). Intraventricular conduction disturbances were defined as QRS > 110 ms on electrocardiograms, and classified into right bundle branch block (RBBB), left bundle branch block (LBBB), left anterior fascicular block (LAFB) and non-specific intraventricular conduction disturbances (NIVCD). RESULTS The number of participants, the resulting prevalence (square brackets) and 95% CI (round brackets) of intraventricular conduction disturbances and subtypes (RBBB, LBBB, LAFB and NIVCD) were 187 [5.1% (4.4-5.8%)], 103 [2.9%, (2.3-3.4%)], 29 [0.8% (0.6-1.1%)], 31 (0.9% [0.6-1.2%]), and 47 [1.3% (0.9-1.7)], respectively. Multivariable logistic regression identified male sex [odds ratio and (95% CI): 2.55 (1.34-4.86)] and increasing age (p-value for trend <0.001) as being associated with RBBB; hypertension [3.08 (1.20-7.91)] and elevated NT-proBNP [3.26 (1.43-7.41)] as being associated with LBBB; elevated NT-proBNP [3.14 (1.32-7.46)] as being associated with LFAB; and male sex [5.97 (1.91-18.7)] and increased height [1.31 (1.06-1.63)] as being associated with NIVCD. CONCLUSION In a sample of the Swiss middle-aged population, the clinical factors associated with intraventricular conduction disturbances differed according to the intraventricular conduction disturbances subtype: male sex and ageing for RBBB; hypertension and elevated NT-proBNP for LBBB; elevated NT-proBNP for LAFB; and male sex and increased height for NIVCD.
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Affiliation(s)
- Marylène Bay
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jürg Schläpfer
- Department of Heart and Vessels, Cardiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
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5
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Kovacs B, Reek S, Sticherling C, Schaer B, Linka A, Ammann P, Brenner R, Krasniqi N, Müller AS, Dzemali O, Kobza R, Grebmer C, Haegeli L, Berg J, Mayer K, Schläpfer J, Domenichini G, Reichlin T, Roten L, Burri H, Eriksson U, Saguner AM, Steffel J, Duru F, Swiss Wcd Registry. Use of the wearable cardioverter-defibrillator - the Swiss experience. Swiss Med Wkly 2020; 150:w20343. [PMID: 33035354 DOI: 10.4414/smw.2020.20343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sudden cardiac death caused by malignant arrhythmia can be prevented by the use of defibrillators. Although the wearable cardioverter defibrillator (WCD) can prevent such an event, its role in clinical practice is ill defined. We investigated the use of the WCD in Switzerland with emphasis on prescription rate, therapy adherence and treatment rate. MATERIALS AND METHODS The Swiss WCD Registry is a retrospective observational registry including patients using a WCD. Patients were included from the first WCD use in Switzerland until February 2018. Baseline characteristics and data on WCD usage were examined for the total study population, and separately for each hospital. RESULTS From 1 December 2011 to 18 February 2018, a total of 456 patients (67.1% of all WCDs prescribed in Switzerland and 81.1% of all prescribed in the participating hospitals) were included in the registry. Up to 2017 there was a yearly increase in the number of prescribed WCDs to a maximum of 271 prescriptions per year. The mean age of patients was 57 years (± 14), 81 (17.8%) were female and mean left ventricular ejection fraction (EF) was 32% (± 13). The most common indications for WCD use were new-onset ischaemic cardiomyopathy (ICM) with EF ≤35% (206 patients, 45.2%), new-onset nonischaemic cardiomyopathy (NICM) with EF ≤35% (115 patients, 25.2%), unknown arrhythmic risk (83 patients, 18.2%), bridging to implantable cardioverter-defibrillator implantation or heart transplant (37 patients, 8.1%) and congenital/inherited heart disease (15 patients, 3.3%). Median wear duration was 58 days (interquartile range [IQR] 31–94) with a median average daily wear time of 22.6 hours (IQR 20–23.2). Seventeen appropriate therapies from the WCD were delivered in the whole population (treatment rate: 3.7%) to a total of 12 patients (2.6% of all patients). The most common underlying heart disease in patients with a treatment was ICM (13/17, 76.5%). There were no inappropriate treatments. CONCLUSION The use of WCDs has increased in Switzerland over the years for a variety of indications. There is high therapy adherence to the WCD, and a treatment rate comparable to previously published registry data.  .
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Affiliation(s)
- Boldizsar Kovacs
- Division of Cardiology, University Heart Centre Zurich, Switzerland / Division of Cardiology, GZO Regional Healthcare Centre Wetzikon, Switzerland
| | - Sven Reek
- Hirslanden Klinik Aarau, Switzerland
| | | | - Beat Schaer
- Division of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - André Linka
- Division of Cardiology, Kantonsspital Winterthur, Switzerland
| | - Peter Ammann
- Division of Cardiology, Kantonsspital St Gallen, Switzerland
| | - Roman Brenner
- Division of Cardiology, Kantonsspital St Gallen, Switzerland
| | - Nazmi Krasniqi
- Division of Cardiology, GZO Regional Healthcare Centre Wetzikon, Switzerland
| | | | - Omer Dzemali
- Division of Cardiac Surgery, Triemli Hospital Zurich, Switzerland
| | - Richard Kobza
- Division of Cardiology, Luzerner Kantonsspital, Switzerland
| | | | - Laurent Haegeli
- Division of Cardiology, University Heart Centre Zurich, Switzerland / Division of Cardiology, Kantonsspital Aarau, Switzerland
| | - Jan Berg
- Division of Cardiology, Kantonsspital Aarau, Switzerland
| | - Kurt Mayer
- Division of Cardiology, Kantonsspital Graubünden, Switzerland
| | - Jürg Schläpfer
- Service of Cardiology, University Hospital Lausanne, Switzerland
| | | | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Harran Burri
- Division of Cardiology, University Hospital of Geneva, Switzerland
| | - Urs Eriksson
- Division of Cardiology, GZO Regional Healthcare Centre Wetzikon, Switzerland
| | - Ardan M Saguner
- Division of Cardiology, University Heart Centre Zurich, Switzerland
| | - Jan Steffel
- Division of Cardiology, University Heart Centre Zurich, Switzerland
| | - Firat Duru
- Division of Cardiology, University Heart Centre Zurich, Switzerland
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6
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Porretta AP, Davoine E, Superti-Furga A, Bhuiyan ZA, Domenichini G, Herrera Siklody C, Pascale P, Haddad C, Schläpfer J, Pruvot É. [Sinus node dysfunction, Brugada syndrome and long QT syndrome affecting the same patient : when genetics can't make head or tail of it]. Rev Med Suisse 2020; 16:1148-1152. [PMID: 32496703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The gene SCN5A encodes the cardiac sodium channel which, through the conduction of Na+ current into the cell, generates the fast upstroke of the action potential of cardiomyocytes. Pathogenic variants of SCN5A have been causally associated to several hereditary cardiac diseases including, among others, Brugada syndrome, congenital long QT syndrome and sinus node dysfunction. Recently, overlap syndromes have been described that are characterized by the simultaneous expression of mixed clinical phenotypes among two or more hereditary cardiac diseases associated to the gene SCN5A (HCD-SCN5A). For this reason, it is time to rethink about HCD-SCN5A as different expressions of the same complex spectrum encompassing multiple clinical phenotypes with pronounced overlaps instead of as distinct clinical entities.
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Affiliation(s)
- Alessandra Pia Porretta
- Service de cardiologie, Département cœur-vaisseaux, CHUV, 1011 Lausanne
- Université de Pavie, 27100 Pavie, Italie
| | - Emeline Davoine
- Service de médecine génétique, Département médecine de laboratoire et pathologie, CHUV, 1011 Lausanne
| | - Andrea Superti-Furga
- Service de médecine génétique, Département médecine de laboratoire et pathologie, CHUV, 1011 Lausanne
| | - Zahurul Alam Bhuiyan
- Service de médecine génétique, Département médecine de laboratoire et pathologie, CHUV, 1011 Lausanne
| | | | | | - Patrizio Pascale
- Service de cardiologie, Département cœur-vaisseaux, CHUV, 1011 Lausanne
| | - Christelle Haddad
- Service de cardiologie, Département cœur-vaisseaux, CHUV, 1011 Lausanne
| | - Jürg Schläpfer
- Service de cardiologie, Département cœur-vaisseaux, CHUV, 1011 Lausanne
| | - Étienne Pruvot
- Service de cardiologie, Département cœur-vaisseaux, CHUV, 1011 Lausanne
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7
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Bay M, Vollenweider P, Marques-Vidal P, Bocchi F, Pruvot E, Schläpfer J. Clinical determinants of the PR interval duration in Swiss middle-aged adults: The CoLaus/PsyCoLaus study. Clin Cardiol 2020; 43:614-621. [PMID: 32329928 PMCID: PMC7299001 DOI: 10.1002/clc.23356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/07/2022] Open
Abstract
Background Prolonged PR interval (PRi) is associated with adverse outcomes. However, PRi determinants are poorly known. We aimed to identify the clinical determinants of the PRi duration in the general population. Hypothesis Some clinical data are associated with prolonged PRi. Methods Cross‐sectional study conducted between 2014 and 2017. Electrocardiogram‐derived PRi duration was categorized into normal or prolonged (>200 ms). Determinants were identified using stepwise logistic regression, and results were expressed as multivariable‐adjusted odds ratio (OR) (95% confidence interval). A further analysis was performed adjusting for antiarrhythmic drugs, P‐wave contribution to PRi duration, electrolytes (kalemia, calcemia, and magnesemia), and history of cardiovascular disease. Results Overall, 3655 participants with measurable PRi duration were included (55.6% females; mean age 62 ± 10 years), and 330 (9.0%) had prolonged PRi. Stepwise logistic regression identified male sex (OR 1.41 [1.02‐1.97]); aging (65‐74 years: OR 2.29 [1.61‐3.24], and ≥ 75 years: OR 4.21 [2.81‐6.31]); increased height (per 5 cm, OR 1.15 [1.06‐1.25]); hypertension (OR 1.37 [1.06‐1.77]); and hs troponin T (OR 1.67 [1.15‐2.43]) as significantly and positively associated, and high resting heart rate (≥70 beats/min, OR 0.43 [0.29‐0.62]) as negatively associated with prolonged PRi. After further adjustment, male sex, aging and increased height remained positively, and high resting heart rate negatively associated with prolonged PRi. Hypertension and hs troponin T were no longer associated. Conclusion In a sample of the Swiss middle‐aged population, male sex, aging and increased height significantly increased the likelihood of a prolonged PRi duration, whereas a high resting heart rate decreased it.
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Affiliation(s)
- Marylène Bay
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Federica Bocchi
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Etienne Pruvot
- Department of Heart and Vessels, Service of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jürg Schläpfer
- Department of Heart and Vessels, Service of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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8
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Tzimas G, Antiochos P, Monney P, Eeckhout E, Meier D, Fournier S, Harbaoui B, Muller O, Schläpfer J. Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention. Am J Cardiol 2019; 124:1305-1314. [PMID: 31455501 DOI: 10.1016/j.amjcard.2019.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 02/18/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022]
Abstract
Early initiation of reperfusion therapy remains the cornerstone of successful management for ST-elevation myocardial infarction (STEMI). Rapid restoration of coronary blood flow relies on prompt recognition of the typical ST-segment elevation on a 12-lead electrocardiogram (ECG)-a surrogate for coronary occlusion or critical stenosis-allowing timely activation of the STEMI protocol cascade, with a major positive impact in mortality and clinical outcomes. However, atypical, very high risk ECG patterns-known as "STEMI equivalents"-are present in 10% to 25% of patients with ongoing myocardial ischemia in need of urgent primary percutaneous coronary intervention. Though briefly mentioned in the current recommendations, structured clinical data on those specific ECG presentations are lacking. By thoroughly searching MEDLINE and EMBASE we conducted a structured review of non-STEMI, albeit very high risk, ECG patterns of acute coronary syndrome, often associated with coronary occlusion or critical stenosis. After screening 997 studies, we identified the following distinct "STEMI equivalent" ECG patterns: Wellens' syndrome, de Winter sign, hyperacute T waves, left bundle branch block-including paced rhythm-and right bundle branch block. For each pattern, a brief summary of the existing evidence, together with the sensitivity, specificity, and positive predictive value-whenever available-are presented. In conclusion, prompt recognition of "STEMI equivalent" ECG patterns is crucial for every physician or paramedic dealing with acute coronary syndrome patients in the emergency department or the prehospital setting, as misinterpretation of those high risk presentations can lead to reperfusion delays and worse outcomes.
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Affiliation(s)
- Georgios Tzimas
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Panagiotis Antiochos
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - David Meier
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Brahim Harbaoui
- University Hospital la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jürg Schläpfer
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
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9
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Blum S, Aeschbacher S, Meyre P, Zwimpfer L, Reichlin T, Beer JH, Ammann P, Auricchio A, Kobza R, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Henz S, Meyer-Zürn C, Roten L, Schwenkglenks M, Sticherling C, Kühne M, Osswald S, Conen D. Incidence and Predictors of Atrial Fibrillation Progression. J Am Heart Assoc 2019; 8:e012554. [PMID: 31590581 PMCID: PMC6818023 DOI: 10.1161/jaha.119.012554] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The incidence and predictors of atrial fibrillation (AF) progression are currently not well defined, and clinical AF progression partly overlaps with rhythm control interventions (RCIs). Methods and Results We assessed AF type and intercurrent RCIs during yearly follow-ups in 2869 prospectively followed patients with paroxysmal or persistent AF. Clinical AF progression was defined as progression from paroxysmal to nonparoxysmal or from persistent to permanent AF. An RCI was defined as pulmonary vein isolation, electrical cardioversion, or new treatment with amiodarone. During a median follow-up of 3 years, the incidence of clinical AF progression was 5.2 per 100 patient-years, and 10.9 per 100 patient-years for any RCI. Significant predictors for AF progression were body mass index (hazard ratio [HR], 1.03; 95% CI, 1.01-1.05), heart rate (HR per 5 beats/min increase, 1.05; 95% CI, 1.02-1.08), age (HR per 5-year increase 1.19; 95% CI, 1.13-1.27), systolic blood pressure (HR per 5 mm Hg increase, 1.03; 95% CI, 1.00-1.05), history of hyperthyroidism (HR, 1.71; 95% CI, 1.16-2.52), stroke (HR, 1.50; 95% CI, 1.19-1.88), and heart failure (HR, 1.69; 95% CI, 1.34-2.13). Regular physical activity (HR, 0.80; 95% CI, 0.66-0.98) and previous pulmonary vein isolation (HR, 0.69; 95% CI, 0.53-0.90) showed an inverse association. Significant predictive factors for RCIs were physical activity (HR, 1.42; 95% CI, 1.20-1.68), AF-related symptoms (HR, 1.84; 95% CI, 1.47-2.30), age (HR per 5-year increase, 0.88; 95% CI, 0.85-0.92), and paroxysmal AF (HR, 0.61; 95% CI, 0.51-0.73). Conclusions Cardiovascular risk factors and comorbidities were key predictors of clinical AF progression. A healthy lifestyle may therefore reduce the risk of AF progression.
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Affiliation(s)
- Steffen Blum
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland.,Division of Internal Medicine Department of Medicine University Hospital Basel University of Basel Basel Switzerland
| | - Stefanie Aeschbacher
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland
| | - Pascal Meyre
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland
| | - Leon Zwimpfer
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland.,Division of Cardiology Department of Medicine Inselspital Bern University Hospital University of Bern Switzerland
| | - Jürg H Beer
- Department of Medicine Cantonal Hospital of Baden and Molecular Cardiology University Hospital of Zurich Zurich Switzerland
| | - Peter Ammann
- Division of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Angelo Auricchio
- Division of Cardiology Fondazione Cardiocentro Ticino Lugano Switzerland
| | - Richard Kobza
- Division of Cardiology Luzerner Kantonsspital Luzern Switzerland
| | - Paul Erne
- Laboratory for Signal Transduction Department of Biomedicine University of Basel Basel Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology Ospedale Regionale di Lugano Lugano Ticino Switzerland
| | - Marcello Di Valentino
- Division of Cardiology Ospedale San Giovanni Bellinzona Bellinzona Ticino Switzerland
| | - Dipen Shah
- Division of Cardiology University Hospital Geneva Geneva Switzerland
| | - Jürg Schläpfer
- Service of Cardiology University Hospital Lausanne Lausanne Switzerland
| | - Selina Henz
- Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland
| | - Christine Meyer-Zürn
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland
| | - Laurent Roten
- Division of Cardiology Department of Medicine Inselspital Bern University Hospital University of Bern Switzerland
| | | | - Christian Sticherling
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland
| | - Michael Kühne
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland
| | - Stefan Osswald
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland
| | - David Conen
- Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland.,Population Health Research Institute McMaster University Hamilton Ontario Canada
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10
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Good JM, Fellmann F, Bhuiyan ZA, Rotman S, Pruvot E, Schläpfer J. ACTN2 variant associated with a cardiac phenotype suggestive of left-dominant arrhythmogenic cardiomyopathy. HeartRhythm Case Rep 2019; 6:15-19. [PMID: 31956495 PMCID: PMC6962717 DOI: 10.1016/j.hrcr.2019.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Jean-Marc Good
- Department of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florence Fellmann
- Department of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Zahurul A Bhuiyan
- Department of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Etienne Pruvot
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jürg Schläpfer
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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11
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Conen D, Rodondi N, Müller A, Beer JH, Ammann P, Moschovitis G, Auricchio A, Hayoz D, Kobza R, Shah D, Novak J, Schläpfer J, Di Valentino M, Aeschbacher S, Blum S, Meyre P, Sticherling C, Bonati LH, Ehret G, Moutzouri E, Fischer U, Monsch AU, Stippich C, Wuerfel J, Sinnecker T, Coslovsky M, Schwenkglenks M, Kühne M, Osswald S, Berger S, Bernasconi R, Fröhlich L, Göldi T, Gugganig R, Kofler T, Krisai P, Mongiat M, Pudenz C, Repilado JR, Schweizer A, Springer A, Stempfel S, Szucs T, van der Stouwe J, Voellmin G, Zwimpfer L, Aujesky D, Fuhrer J, Roten L, Jung S, Mattle H, Adam L, Aubert CE, Feller M, Schneider C, Loewe A, Flückiger T, Groen C, Schwab N, Beynon C, Dillier R, Eberli F, Fontana S, Franzini C, Juchli I, Liedtke C, Nadler J, Obst T, Schneider X, Studerus K, Weishaupt D, Kuest S, Scheuch K, Hischier D, Bonetti N, Bello C, Isberg H, Grau A, Villinger J, Papaux MM, Baumgartner P, Filipovic M, Frick M, Anesini A, Camporini C, Conte G, Caputo ML, Regoli F, Moccetti T, Brenner R, Altmann D, Forrer M, Gemperle M, Firmann M, Foucras S, Berte B, Kaeppeli A, Mehmann B, Pfeiffer M, Russi I, Schmidt K, Weberndoerfer V, Young M, Zbinden M, Vicari L, Frangi J, Terrot T, Gallet H, Guillermet E, Lazeyras F, Lovblad KO, Perret P, Teres C, Lauriers N, Méan M, Salzmann S, Arenja N, Grêt A, Vitelli S, Frangi J, Gallino A, Schoenenberger-Berzins R, Witassek F, Radue EW, Benkert P, Fabbro T, Simon P, Schmid R. Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation. J Am Coll Cardiol 2019; 73:989-999. [DOI: 10.1016/j.jacc.2018.12.039] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 01/06/2023]
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12
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Ansermot N, Bochatay M, Schläpfer J, Gholam M, Gonthier A, Conus P, Eap CB. Prevalence of ECG abnormalities and risk factors for QTc interval prolongation in hospitalized psychiatric patients. Ther Adv Psychopharmacol 2019; 9:2045125319891386. [PMID: 31853363 PMCID: PMC6909271 DOI: 10.1177/2045125319891386] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Psychiatric patients are at risk of cardiovascular diseases, and many psychotropic drugs can prolong QTc interval. Requirements for electrocardiogram (ECG) monitoring have been set up in our psychiatric university hospital. The objective of this study was to determine the proportion of adult patients who had an ECG during their hospitalization, the prevalence of ECG abnormalities, the evolution of the QTc after admission, and the risk factors for QTc prolongation. METHODS Retrospective analysis of ECGs and clinical data of all patients with a complete hospitalization in 2015. Assessment of the influence of covariates on QTc using linear mixed-effects models. RESULTS At least one ECG (n = 600) was performed during 37.6% of the stays (n = 1198) and in 45.5% of the patients (n = 871). Among the patients with an ECG, 17.9% had significant ECG abnormalities, including 7.6% with a prolonged QTc. QTc measured at admission and during hospitalization did not change significantly (n = 46, 419.4 ± 29.7 ms, 417.2 ± 27.6 ms, p = 0.71). In the multivariate model (292 patients, 357 ECGs), the covariates significantly associated with the QTc were gender (+15.9 ms if female, p < 0.0001), age (+0.4 ms/year, p = 0.0001), triglyceride levels (+5.7 ms/mmol/l, p = 0.005), and drugs with known risk of torsades de pointes (+6.2 ms if ⩾1 drug, p = 0.028). CONCLUSIONS The prevalence of hospitalized psychiatric patients with an abnormal ECG indicates that ECGs should be performed systematically in this population. Prescription of psychotropic drugs should be done cautiously, particularly in patients with QTc prolongation risk factors.
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Affiliation(s)
- Nicolas Ansermot
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Hospital of Cery, 1008 Prilly, Switzerland
| | - Meredith Bochatay
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Jürg Schläpfer
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mehdi Gholam
- Centre of Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Ariane Gonthier
- General Internal Medicine Practice, Lausanne, Switzerland; University Institute of Medicine of the Family, University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
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13
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Ruperti Repilado FJ, Doerig L, Blum S, Aeschbacher S, Krisai P, Ammann P, Erne P, Moschovitis G, di Valentino M, Shah D, Schläpfer J, Stempfel S, Kühne M, Sticherling C, Osswald S, Conen D. Prevalence and predictors of atrial fibrillation type among individuals with recent onset of atrial fibrillation. Swiss Med Wkly 2018; 148:w14652. [PMID: 30378644 DOI: 10.4414/smw.2018.14652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is considered to be a progressive disease, starting with intermittent episodes that progress over time to more sustained events. However, little is known about the prevalence of and predictors for AF type among patients with recent-onset AF. We aimed to address these issues among a selected population of patients with AF. METHODS The Basel atrial fibrillation cohort (BEAT-AF) study is an ongoing prospective multicentre cohort study among patients with AF. At baseline, we obtained information on the date of AF diagnosis, AF type, comorbidities, medication and lifestyle factors. For this analysis, 486 (31.4%) out of 1550 participants with recent-onset AF (defined as AF duration <24 months) were included. Predictors for AF type (non-paroxysmal vs paroxysmal) were obtained using multivariable adjusted logistic regression models. RESULTS Mean age was 67 (59-75) years and 136 (28%) were women. Recent-onset paroxysmal AF was observed in 301 (62%) participants, 185 (38%) had non-paroxysmal AF - persistent AF in 148 (30.4%) and permanent AF in 37 (7.6%). In multivariable models, odds ratios for having non-paroxysmal AF around AF diagnosis were 1.03 per year increasing in age (95% confidence interval [CI] 1.01-1.05, p = 0.01); 2.70 (1.5-4.68, p = 0.0004) for history of heart failure; 3.82 (1.05-13.87, p = 0.04) for a history of hyperthyroidism and 1.04 (1.02-1.05, p <0.0001) per beat increase in heart rate. CONCLUSION We found a substantial proportion of AF patients with the non-paroxysmal form shortly after diagnosis. Predictors for non-paroxysmal AF were increasing age, history of heart failure or hyperthyroidism, and a higher heart rate.
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Affiliation(s)
- Francisco J Ruperti Repilado
- Division of Internal Medicine, Department of Medicine, University Hospital Basel, Switzerland, Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Laura Doerig
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Steffen Blum
- Division of Internal Medicine, Department of Medicine, University Hospital Basel, Switzerland, Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | | | - Philipp Krisai
- Division of Internal Medicine, Department of Medicine, University Hospital Basel, Switzerland, Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Peter Ammann
- Division of Cardiology, Kantonsspital St. Gallen, Switzerland
| | - Paul Erne
- Lab Signal Transduction, Department of Biomedicine, University of Basel, Switzerland
| | | | | | - Dipen Shah
- Division of Cardiology, University Hospital Geneva, Switzerland
| | - Jürg Schläpfer
- Service of Cardiology, University Hospital Lausanne, Switzerland
| | - Samuel Stempfel
- Division of Internal Medicine, Department of Medicine, University Hospital Basel, Switzerland, Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland, Division of Cardiology, Department of Medicine, University Hospital Basel, Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland, Division of Cardiology, Department of Medicine, University Hospital Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland, Division of Cardiology, Department of Medicine, University Hospital Basel, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland, Division of Cardiology, Department of Medicine, University Hospital Basel, Switzerland, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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14
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Eggimann L, Blum S, Aeschbacher S, Reusser A, Ammann P, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Mondet N, Kühne M, Sticherling C, Osswald S, Conen D. Risk factors for heart failure hospitalizations among patients with atrial fibrillation. PLoS One 2018; 13:e0191736. [PMID: 29394253 PMCID: PMC5823079 DOI: 10.1371/journal.pone.0191736] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Patients with atrial fibrillation (AF) have an increased risk for the
development of heart failure (HF). In this study, we aimed to detect
predictors of HF hospitalizations in an unselected AF population. Methods The Basel Atrial Fibrillation Cohort Study is an ongoing observational
multicenter cohort study in Switzerland. For this analysis, 1193 patients
with documented AF underwent clinical examination, venous blood sampling and
resting 12-lead ECG at baseline. Questionnaires about lifestyle and medical
history were obtained in person at baseline and during yearly follow-up
phone calls. HF hospitalizations were validated by two independent
physicians. Cox regression analyses were performed using a forward selection
strategy. Results Overall, 29.8% of all patients were female and mean age was 69 ±12 years.
Mean follow-up time was 3.7 ±1.5 years. Hospitalization for HF occurred in
110 patients, corresponding to an incidence of 2.5 events per 100 person
years of follow-up. Independent predictors for HF were body mass index (HR
1.40 [95%CI 1.17; 1.66], p = 0.0002), chronic kidney disease (2.27 [1.49;
3.45], p = 0.0001), diabetes mellitus (2.13 [1.41; 3.24], p = 0.0004), QTc
interval (1.25 [1.04; 1.49], p = 0.02), brain natriuretic peptide (2.19
[1.73; 2.77], p<0.0001), diastolic blood pressure (0.79 [0.65; 0.96], p =
0.02), history of pulmonary vein isolation or electrical cardioversion (0.54
[0.36; 0.80], p = 0.003) and serum chloride (0.82 [0.70; 0.96], p =
0.02). Conclusions In this unselected AF population, several traditional cardiovascular risk
factors and arrhythmia interventions predicted HF hospitalizations,
providing potential opportunities for the implementation of strategies to
reduce HF among AF patients.
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Affiliation(s)
- Lucien Eggimann
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Steffen Blum
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Reusser
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter Ammann
- Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Erne
- Laboratory for Signal Transduction, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Dipen Shah
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Jürg Schläpfer
- Service of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Nadine Mondet
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Conen
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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15
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Reusser A, Blum S, Aeschbacher S, Eggimann L, Ammann P, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Manser S, Reichlin T, Kühne M, Sticherling C, Osswald S, Conen D. QTc interval, cardiovascular events and mortality in patients with atrial fibrillation. Int J Cardiol 2018; 252:101-105. [DOI: 10.1016/j.ijcard.2017.11.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/07/2017] [Accepted: 11/22/2017] [Indexed: 01/08/2023]
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16
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Schläpfer J, Wellens HJ. Computer-Interpreted Electrocardiograms: Benefits and Limitations. J Am Coll Cardiol 2017; 70:1183-1192. [PMID: 28838369 DOI: 10.1016/j.jacc.2017.07.723] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [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: 05/30/2017] [Revised: 07/05/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
Abstract
Computerized interpretation of the electrocardiogram (CIE) was introduced to improve the correct interpretation of the electrocardiogram (ECG), facilitating health care decision making and reducing costs. Worldwide, millions of ECGs are recorded annually, with the majority automatically analyzed, followed by an immediate interpretation. Limitations in the diagnostic accuracy of CIE were soon recognized and still persist, despite ongoing improvement in ECG algorithms. Unfortunately, inexperienced physicians ordering the ECG may fail to recognize interpretation mistakes and accept the automated diagnosis without criticism. Clinical mismanagement may result, with the risk of exposing patients to useless investigations or potentially dangerous treatment. Consequently, CIE over-reading and confirmation by an experienced ECG reader are essential and are repeatedly recommended in published reports. Implementation of new ECG knowledge is also important. The current status of automated ECG interpretation is reviewed, with suggestions for improvement.
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Affiliation(s)
- Jürg Schläpfer
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
| | - Hein J Wellens
- Cardiovascular Research Institute, Maastricht, the Netherlands
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17
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Blum S, Muff C, Aeschbacher S, Ammann P, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Fischer A, Merkel T, Kühne M, Sticherling C, Osswald S, Conen D. Prospective Assessment of Sex-Related Differences in Symptom Status and Health Perception Among Patients With Atrial Fibrillation. J Am Heart Assoc 2017; 6:JAHA.116.005401. [PMID: 28666988 PMCID: PMC5586278 DOI: 10.1161/jaha.116.005401] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background We prospectively assessed sex‐specific differences in health perception, overall symptom status, and specific symptoms in a large cohort of patients with atrial fibrillation. Methods and Results We performed a prospective multicenter observational cohort study of 1553 patients with atrial fibrillation. Patients completed questionnaires about personal characteristics, comorbidities, and symptoms on a yearly basis. Mean age was 70±11 years among women and 67±12 years among men. Health perception on a visual analogue scale ranging from 0 to 100 (with higher scores indicating better health perception) was significantly lower in women than in men (70 [interquartile range: 50–80] versus 75 [interquartile range: 60–85]; P<0.0001). More women than men had any symptoms (85.0% versus 68.3%; P<0.0001), palpitations (65.2% versus 44.4%; P<0.0001), dizziness (25.6% versus 13.5%; P<0.0001), dyspnea (35.7% versus 21.8%; P<0.0001), and fatigue (25.3% versus 19.1%; P=0.006). At 1‐year follow‐up, symptoms decreased in both sexes but remained more frequent in women (49.1% versus 32.6%, P<0.0001). In multivariable adjusted longitudinal regression models, female sex remained an independent predictor for lower health perception (ß=−4.8; 95% CI, −6.5 to −3.1; P<0.0001), any symptoms (odds ratio [OR]: 2.6; 95% CI, 2.1–3.4; P<0.0001), palpitations (OR: 2.6; 95% CI, 2.1–3.2; P<0.0001), dizziness (OR: 2.9; 95% CI, 2.1–3.9; P<0.0001), dyspnea (OR: 2.1; 95% CI, 1.6–2.8; P<0.0001), fatigue (OR: 1.6; 95% CI, 1.2–2.2; P=0.0008), and chest pain (OR: 1.8; 95% CI, 1.3–2.6; P=0.001). Conclusions Women with atrial fibrillation have a substantially higher symptom burden and lower health perception than men. These relationships persisted after multivariable adjustment and during prospective follow‐up.
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Affiliation(s)
- Steffen Blum
- Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christoph Muff
- Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Peter Ammann
- Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Erne
- Lab Signal Transduction, Department of Biomedicine, University of Basel, Switzerland
| | | | | | - Dipen Shah
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Jürg Schläpfer
- Service of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Andreas Fischer
- Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Tamara Merkel
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland .,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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18
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Zimny M, Blum S, Ammann P, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Vogt C, Tabord A, Kühne M, Sticherling C, Osswald S, Conen D. Uptake of non-vitamin K antagonist oral anti coagulants in patients with atrial fibrillation - a prospective cohort study. Swiss Med Wkly 2017; 147:w14410. [PMID: 28322423 DOI: 10.4414/smw.2017.14410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS We aimed to assess the uptake of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation between 2010 and 2015 in Switzerland. METHODS We performed a prospective observational cohort study. At the baseline examination and during yearly follow-ups, we used questionnaires to obtain information about clinical characteristics and antithrombotic treatment. Stroke risk was assessed using the CHA2DS2-VASc score. RESULTS 1545 patients were enrolled across seven centres in Switzerland. Mean age was 68 ± 12 years and 29.5% were female. The percentage of anticoagulated patients with an indication for oral anticoagulation (CHA2DS2-VASc score ≥2 in women and ≥1 in men) was 75% in 2010 and 80% in 2015 (p = 0.2). There was a gradual increase in the use of NOACs from 0% in 2010 to 29.8% in 2015 (p <0.0001). Out of 888 patients, who initially received a vitamin K antagonist (VKA), 86 (9.7%) were switched to an NOAC during follow-up. Use of aspirin as a monotherapy decreased from 23% in 2010 to 11% in 2015 (p <0.0001). CONCLUSION After regulatory approval, the use of NOACs in Switzerland steadily increased to about 30% in 2015, whereas switches from VKAs to NOACs were infrequent. In parallel, the prescription of aspirin as monotherapy was more than halved, suggesting significant guideline-concordant improvements in oral anticoagulation use among patients with atrial fibrillation.
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Affiliation(s)
- Matylda Zimny
- Department of Medicine, University Hospital Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Steffen Blum
- Department of Medicine, University Hospital Basel, Switzerland; b Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Division of Cardiology, University Hospital Basel, Switzerland
| | - Peter Ammann
- Division of Cardiology, Kantonsspital St. Gallen, Switzerland
| | - Paul Erne
- Lab Signal Transduction, Department of Biomedicine, University of Basel, Switzerland
| | | | | | - Dipen Shah
- Division of Cardiology, University Hospital Geneva, Switzerland
| | | | - Cyrill Vogt
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Alexandra Tabord
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Department of Medicine, Regionalspital Surselva, Graubünden, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; c Division of Cardiology, University Hospital Basel, Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Division of Cardiology, University Hospital Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Division of Cardiology, University Hospital Basel, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland; Division of Cardiology, University Hospital Basel, Switzerland; Population Health Research Institute, McMaster University, Hamilton, Canada
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19
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Galland-Decker C, Schläpfer J, Wuerzner G, Monti M. [Not Available]. Rev Med Suisse 2016; 12:2008-2013. [PMID: 28696608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | | | - Matteo Monti
- Service de médecine interne, CHUV, 1011 Lausanne
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20
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Porretta AP, Park CI, Di Bernardo S, Bisch L, Schläpfer J, Pascale P, Buss G, Prior J, Pruvot E. 73-05: Focal Hypermetabolic Left Ventricular Cardiomyopathy: An Underdiagnosed Life-threatening Arrhythmogenic Disease. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i57] [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: 11/13/2022] Open
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21
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Mahida S, Derval N, Sacher F, Leenhardt A, Deisenhofer I, Babuty D, Schläpfer J, de Roy L, Frank R, Yli-Mayry S, Mabo P, Rostock T, Nogami A, Pasquié JL, de Chillou C, Kautzner J, Jesel L, Maury P, Berte B, Yamashita S, Roten L, Lim HS, Denis A, Bordachar P, Ritter P, Probst V, Hocini M, Jaïs P, Haïssaguerre M. Role of electrophysiological studies in predicting risk of ventricular arrhythmia in early repolarization syndrome. J Am Coll Cardiol 2015; 65:151-9. [PMID: 25593056 DOI: 10.1016/j.jacc.2014.10.043] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 06/05/2014] [Revised: 09/27/2014] [Accepted: 10/21/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The early repolarization (ER) pattern is associated with an increased risk of arrhythmogenic sudden death. However, strategies for risk stratification of patients with the ER pattern are not fully defined. OBJECTIVES This study sought to determine the role of electrophysiology studies (EPS) in risk stratification of patients with ER syndrome. METHODS In a multicenter study, 81 patients with ER syndrome (age 36 ± 13 years, 60 males) and aborted sudden death due to ventricular fibrillation (VF) were included. EPS were performed following the index VF episode using a standard protocol. Inducibility was defined by the provocation of sustained VF. Patients were followed up by serial implantable cardioverter-defibrillator interrogations. RESULTS Despite a recent history of aborted sudden death, VF was inducible in only 18 of 81 (22%) patients. During follow-up of 7.0 ± 4.9 years, 6 of 18 (33%) patients with inducible VF during EPS experienced VF recurrences, whereas 21 of 63 (33%) patients who were noninducible experienced recurrent VF (p = 0.93). VF storm occurred in 3 patients from the inducible VF group and in 4 patients in the noninducible group. VF inducibility was not associated with maximum J-wave amplitude (VF inducible vs. VF noninducible; 0.23 ± 0.11 mV vs. 0.21 ± 0.11 mV; p = 0.42) or J-wave distribution (inferior, odds ratio [OR]: 0.96 [95% confidence interval (CI): 0.33 to 2.81]; p = 0.95; lateral, OR: 1.57 [95% CI: 0.35 to 7.04]; p = 0.56; inferior and lateral, OR: 0.83 [95% CI: 0.27 to 2.55]; p = 0.74), which have previously been demonstrated to predict outcome in patients with an ER pattern. CONCLUSIONS Our findings indicate that current programmed stimulation protocols do not enhance risk stratification in ER syndrome.
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Affiliation(s)
- Saagar Mahida
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France.
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Antoine Leenhardt
- AP-HP, Hôpital Bichat, Service de Cardiologie et Centre de Référence des Maladies Cardiaques Héréditaires, INSERM, U698, Université Paris Diderot, Paris, France
| | | | | | | | - Luc de Roy
- Clinique Mont Godinne Leuven, Leuven, Belgium
| | - Robert Frank
- Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | | | - Philippe Mabo
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | - Jean-Luc Pasquié
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic
| | - Laurence Jesel
- Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Philippe Maury
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Laurent Roten
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Han S Lim
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Vincent Probst
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
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Hofer F, Fellmann F, Schläpfer J, Michaud K. Sudden cardiac death in the young (5-39 years) in the canton of Vaud, Switzerland. BMC Cardiovasc Disord 2014; 14:140. [PMID: 25291980 PMCID: PMC4198689 DOI: 10.1186/1471-2261-14-140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 05/23/2014] [Accepted: 10/03/2014] [Indexed: 12/24/2022] Open
Abstract
Background Sudden cardiac death (SCD) among the young is a rare and devastating event, but its exact incidence in many countries remains unknown. An autopsy is recommended in every case because some of the cardiac pathologies may have a genetic origin, which can have an impact on the living family members. The aims of this retrospective study completed in the canton of Vaud, Switzerland were to determine both the incidence of SCD and the autopsy rate for individuals from 5 to 39 years of age. Methods The study was conducted from 2000 to 2007 on the basis of official statistics and analysis of the International Classification of Diseases codes for potential SCDs and other deaths that might have been due to cardiac disease. Results During the 8 year study period there was an average of 292′546 persons aged 5-39 and there were a total of 1122 deaths, certified as potential SCDs in 3.6% of cases. The calculated incidence is 1.71/100′000 person-years (2.73 for men and 0.69 for women). If all possible cases of SCD (unexplained deaths, drowning, traffic accidents, etc.) are included, the incidence increases to 13.67/100′000 person-years. However, the quality of the officially available data was insufficient to provide an accurate incidence of SCD as well as autopsy rates. The presumed autopsy rate of sudden deaths classified as diseases of the circulatory system is 47.5%. For deaths of unknown cause (11.1% of the deaths), the autopsy was conducted in 13.7% of the cases according to codified data. Conclusions The incidence of presumed SCD in the canton of Vaud, Switzerland, is comparable to the data published in the literature for other geographic regions but may be underestimated as it does not take into account other potential SCDs, as unexplained deaths. Increasing the autopsy rate of SCD in the young, better management of information obtained from autopsies as well developing of structured registry could improve the reliability of the statistical data, optimize the diagnostic procedures, and the preventive measures for the family members.
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Affiliation(s)
| | | | | | - Katarzyna Michaud
- University Center of Legal Medicine, Lausanne and Geneva, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
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23
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Wenger N, Pellaton C, Bruchez P, Schläpfer J. Atrial fibrillation, complete atrioventricular block and escape rhythm with bundle-branch block morphologies: an exceptional presentation of Lyme carditis. Int J Cardiol 2012; 160:e12-4. [PMID: 22305810 DOI: 10.1016/j.ijcard.2012.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/01/2012] [Indexed: 11/24/2022]
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24
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Pascale P, Monney P, Jeanrenaud X, Aebischer N, Yerly P, Vogt P, Pruvot E, Schläpfer J. Reduced atrial emptying after orthotopic heart transplantation masquerading as restrictive transmitral Doppler flow pattern?*. Echocardiography 2011; 28:168-74. [PMID: 21276073 DOI: 10.1111/j.1540-8175.2010.01280.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND An elevated early (E) to late (A) diastolic filling velocities ratio, typically seen in advanced diastolic dysfunction, has also been observed after cardioversion of atrial fibrillation as a consequence of the depressed left atrial (LA) contractility. We hypothesized that the impaired LA contractile function demonstrated after orthotopic cardiac transplantation (OCT) could also lead to this "pseudorestrictive" pattern. METHOD E/A ratio related to the tissue Doppler early mitral annular velocity (Ea) as preload-independent index of LV relaxation was evaluated in all consecutive OCT patients between 2005 and 2007. RESULTS The study population comprised 48 patients 97 ± 77 months after OCT. Thirty-two patients (67%) had an E/A ratio > 2. LV systolic function and myocardial relaxation assessed by the Ea velocity were similar compared to patients with normal ratio (61 ± 6% vs. 60 ± 12%, P = 0.854 and 15 ± 4 cm/s vs. 14 ± 3 cm/s, r = 0.15, P = 0.323, respectively). On the other hand, the proportion of the recipient and donor LA cuffs as estimated by the recipient/global LA area ratio and the LA emptying fraction significantly correlated with the E/A ratio (r = 0.40, P = 0.005 and r =-0.33, P = 0.022, respectively). CONCLUSION Our study shows that there is a high prevalence of elevated E/A ratio after standard OCT which seems mainly related to reduced LA contractility. Recognition of this "pseudorestrictive" pattern may avoid misdiagnosis of diastolic dysfunction.
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Affiliation(s)
- Patrizio Pascale
- Service of Cardiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
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25
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Grilo LS, Schläpfer J, Fellmann F, Abriel H. Patient with Syncope and LQTS Carrying a Mutation in the PAS Domain of the hERG1 Channel. Ann Noninvasive Electrocardiol 2011; 16:213-8. [DOI: 10.1111/j.1542-474x.2011.00419.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Pascale P, Pruvot E, Graf D, Metzger J, Fromer M, Schläpfer J. [Idiopathic premature ventricular complexes originating from the ventricular outflow tract: evaluation, prognosis and management]. Rev Med Suisse 2010; 6:1140-1145. [PMID: 20572358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Idiopathic premature ventricular complexes originating from the ventricular outflow tract: evaluation, prognosis and management The prognosis of ventricular premature complexes (VPC) in the absence of heart disease is considered benign. VPC usually originate from the right or, less commonly, left ventricular outflow tract. QRS complexes therefore usually assume a left bundle branch block and inferior axis morphology. These VPC, particularly if very frequent (> 20,000 per day), may adversely affect left ventricular function and their suppression can restore normal function. Moreover, there is a clinical overlap with arrhythmogenic right ventricular dysplasia and this diagnosis should be considered when facing a left bundle branch block shaped VPC. However, the prognosis of outflow tract VPC is good for appropriately selected patients with normal left ventricular function, absence of syncope or ventricular tachycardia, and no evidence of cardiac disease.
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Ansermot N, Albayrak O, Schläpfer J, Crettol S, Croquette-Krokar M, Bourquin M, Déglon JJ, Faouzi M, Scherbaum N, Eap CB. Substitution of (R,S)-methadone by (R)-methadone: Impact on QTc interval. ACTA ACUST UNITED AC 2010; 170:529-36. [PMID: 20308640 DOI: 10.1001/archinternmed.2010.26] [Citation(s) in RCA: 65] [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] [Indexed: 11/14/2022]
Abstract
BACKGROUND Methadone is administered as a chiral mixture of (R,S)-methadone. The opioid effect is mainly mediated by (R)-methadone, whereas (S)-methadone blocks the human ether-à-go-go-related gene (hERG) voltage-gated potassium channel more potently, which can cause drug-induced long QT syndrome, leading to potentially lethal ventricular tachyarrhythmias. METHODS To investigate whether substitution of (R,S)-methadone by (R)-methadone could reduce the corrected QT (QTc) interval, (R,S)-methadone was replaced by (R)-methadone (half-dose) in 39 opioid-dependent patients receiving maintenance treatment for 14 days. (R)-methadone was then replaced by the initial dose of (R,S)-methadone for 14 days (n = 29). Trough (R)-methadone and (S)-methadone plasma levels and electrocardiogram measurements were taken. RESULTS The Fridericia-corrected QT (QTcF) interval decreased when (R,S)-methadone was replaced by a half-dose of (R)-methadone; the median (interquartile range [IQR]) values were 423 (398-440) milliseconds (ms) and 412 (395-431) ms (P = .06) at days 0 and 14, respectively. Using a univariate mixed-effect linear model, the QTcF value decreased by a mean of -3.9 ms (95% confidence interval [CI], -7.7 to -0.2) per week (P = .04). The QTcF value increased when (R)-methadone was replaced by the initial dose of (R,S)-methadone for 14 days; median (IQR) values were 424 (398-436) ms and 424 (412-443) ms (P = .01) at days 14 and 28, respectively. The univariate model showed that the QTcF value increased by a mean of 4.7 ms (95% CI, 1.3-8.1) per week (P = .006). CONCLUSIONS Substitution of (R,S)-methadone by (R)-methadone reduces the QTc interval value. A safer cardiac profile of (R)-methadone is in agreement with previous in vitro and pharmacogenetic studies. If the present results are confirmed by larger studies, (R)-methadone should be prescribed instead of (R,S)-methadone to reduce the risk of cardiac toxic effects and sudden death.
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Affiliation(s)
- Nicolas Ansermot
- Center for Psychiatric Neurosciences, Department of Psychiatry, Hospital of Cery, Prilly-Lausanne, Switzerland
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Eap CB, Crettol S, Rougier JS, Schläpfer J, Sintra Grilo L, Déglon JJ, Besson J, Croquette-Krokar M, Carrupt PA, Abriel H. Stereoselective Block of hERG Channel by (S)-Methadone and QT Interval Prolongation in CYP2B6 Slow Metabolizer: Evidence of a Safer Cardiac Profile of (R)-Methadone. Pharmacopsychiatry 2008. [DOI: 10.1055/s-0028-1088244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schläpfer J, Stahlberger-Saitbekova N, Küffer J, Dolf G. Genetic mapping of the prion protein gene (PRNP) on bovine chromosome 13. J Anim Breed Genet 2008. [DOI: 10.1111/j.1439-0388.2000.00999.x] [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: 12/01/2022]
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Lingaas F, Aarskaug T, Gerlach JA, Juneja RK, Fredholm M, Sampson J, Suter N, Holmes NG, Binns MM, Ryder EJ, Van Haeringen WA, Venta PJ, Brouillette JA, Yuzbasiyan-Gurkan V, Wilton AN, Bredbacka P, Koskinen M, Dunner S, Parra D, Schmutz S, Schelling C, Schläpfer J, Dolf G. A canine linkage map: 39 linkage groups. J Anim Breed Genet 2008. [DOI: 10.1111/j.1439-0388.2001.00270.x] [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: 11/28/2022]
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31
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Sarasin FP, Pruvot E, Louis-Simonet M, Hügli OW, Sztajzel JM, Schläpfer J, Herrera M, Graz J, Berchier C, Mischler C, Yersin B. Stepwise evaluation of syncope: A prospective population-based controlled study. Int J Cardiol 2008; 127:103-11. [PMID: 17698219 DOI: 10.1016/j.ijcard.2007.04.077] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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] [Received: 11/27/2006] [Revised: 04/17/2007] [Accepted: 04/23/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evaluation of syncope remains often unstructured. The aim of the study was to assess the effectiveness of a standardized protocol designed to improve the diagnosis of syncope. METHODS Consecutive patients with syncope presenting to the emergency departments of two primary and tertiary care hospitals over a period of 18 months underwent a two-phase evaluation including: 1) noninvasive assessment (phase I); and 2) specialized tests (phase II), if syncope remained unexplained after phase I. During phase II, the evaluation strategy was alternately left to physicians in charge of patients (control), or guided by a standardized protocol relying on cardiac status and frequency of events (intervention). The primary outcomes were the diagnostic yield of each phase, and the impact of the intervention (phase II) measured by multivariable analysis. RESULTS Among 1725 patients with syncope, 1579 (92%) entered phase I which permitted to establish a diagnosis in 1061 (67%) of them, including mainly reflex causes and orthostatic hypotension. Five-hundred-eighteen patients (33%) were considered as having unexplained syncope and 363 (70%) entered phase II. A cause for syncope was found in 67 (38%) of 174 patients during intervention periods, compared to 18 (9%) of 189 during control (p<0.001). Compared to control periods, intervention permitted diagnosing more cardiac (8%, vs 3%, p=0.04) and reflex syncope (25% vs 6%, p<0.001), and increased the odds of identifying a cause for syncope by a factor of 4.5 (95% CI: 2.6-8.7, p<0.001). Overall, adding the diagnostic yield obtained during phase I and phase II (intervention periods) permitted establishing the cause of syncope in 76% of patients. CONCLUSION Application of a standardized diagnostic protocol in patients with syncope improved the likelihood of identifying a cause for this symptom. Future trials should assess the efficacy of diagnosis-specific therapy.
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Affiliation(s)
- François P Sarasin
- Emergency Center, Hopital Cantonal, University of Geneva Medical School, Geneva, Switzerland.
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Petitprez S, Jespersen T, Pruvot E, Keller DI, Corbaz C, Schläpfer J, Abriel H, Kucera JP. Analyses of a novel SCN5A mutation (C1850S): conduction vs. repolarization disorder hypotheses in the Brugada syndrome. Cardiovasc Res 2008; 78:494-504. [PMID: 18252757 DOI: 10.1093/cvr/cvn023] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Séverine Petitprez
- Department of Pharmacology and Toxicology, University of Lausanne, 27, Bugnon, 1005 Lausanne, Vaud, Switzerland
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Zerm T, Forclaz A, Pruvot E, Graf D, Metzger J, Schläpfer J, Fromer M. [Past, present and future of percutaneous catheter ablation technologies for cardiac arrhythmias]. Rev Med Suisse 2007; 3:1368, 1370-2, 1374. [PMID: 17645050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Drug therapy treatment of cardiac arrhythmias has been disappointing, while percutaneous catheter ablation, efficient and at low risk, has become the first line therapy of the majority of rhythm disturbances, in only two decades. The ultimate challenge, which is atrial fibrillation ablation, is on the way to be successfully solved. This is mainly due to: innovative ablational energy sources; 3D virtual electro-anatomical reconstructions of heart cavities, to map and understand complex arrhythmias' circuits; revolutionary magnetic navigation systems that permit the target positioning of the catheters in the most inaccessible places, even though the operator works at a command board placed away from the patient.
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Affiliation(s)
- T Zerm
- Unité du trouble du rythme cardiaque Service de Cardiologie, CHUV, Lausanne.
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34
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Eap CB, Crettol S, Rougier JS, Schläpfer J, Sintra Grilo L, Déglon JJ, Besson J, Croquette-Krokar M, Carrupt PA, Abriel H. Stereoselective Block of hERG Channel by (S)-Methadone and QT Interval Prolongation in CYP2B6 Slow Metabolizers. Clin Pharmacol Ther 2007; 81:719-28. [PMID: 17329992 DOI: 10.1038/sj.clpt.6100120] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Methadone inhibits the cardiac potassium channel hERG and can cause a prolonged QT interval. Methadone is chiral but its therapeutic activity is mainly due to (R)-methadone. Whole-cell patch-clamp experiments using cells expressing hERG showed that (S)-methadone blocked the hERG current 3.5-fold more potently than (R)-methadone (IC50s (half-maximal inhibitory concentrations) at 37 degrees C: 2 and 7 microM). As CYP2B6 slow metabolizer (SM) status results in a reduced ability to metabolize (S)-methadone, electrocardiograms, CYP2B6 genotypes, and (R)- and (S)-methadone plasma concentrations were obtained for 179 patients receiving (R,S)-methadone. The mean heart-rate-corrected QT (QTc) was higher in CYP2B6 SMs (*6/*6 genotype; 439+/-25 ms; n=11) than in extensive metabolizers (non *6/*6; 421+/-25 ms; n=168; P=0.017). CYP2B6 SM status was associated with an increased risk of prolonged QTc (odds ratio=4.5, 95% confidence interval=1.2-17.7; P=0.03). This study reports the first genetic factor implicated in methadone metabolism that may increase the risk of cardiac arrhythmias and sudden death. This risk could be reduced by the administration of (R)-methadone.
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Affiliation(s)
- C B Eap
- Unit of Biochemistry and Clinical Psychopharmacology, Centre for Psychiatric Neurosciences, University Department of Psychiatry-CHUV, Hospital of Cery, Prilly-Lausanne, Switzerland.
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35
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Keller DI, Rougier JS, Kucera JP, Benammar N, Fressart V, Guicheney P, Madle A, Fromer M, Schläpfer J, Abriel H. Brugada syndrome and fever: genetic and molecular characterization of patients carrying SCN5A mutations. Cardiovasc Res 2006; 67:510-9. [PMID: 15890323 DOI: 10.1016/j.cardiores.2005.03.024] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 03/25/2005] [Accepted: 03/29/2005] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Brugada syndrome (BrS) is characterized by ventricular tachyarrhythmias leading to sudden cardiac death and is caused, in part, by mutations in the SCN5A gene encoding the sodium channel Na(v)1.5. Fever can trigger or exacerbate the clinical manifestations of BrS. The aim of this work was to characterize the genetic and molecular determinants of fever-dependent BrS. METHODS Four male patients with typical BrS ST-segment elevation in V1-V3 or ventricular arrhythmias during fever were screened for mutations in the SCN5A gene. Wild-type (WT) and mutant Na(v)1.5 channels were expressed in HEK293 cells. The sodium currents (I(Na)) were analysed using the whole-cell patch clamp technique at various temperatures. Protein expression of WT and mutant channels was studied by Western blot experiments. RESULTS Two mutations in SCN5A, L325R and R535X, were identified. Expression of the two mutant Na(v)1.5 channels in HEK293 cells revealed in each case a severe loss-of-function. Upon the increase of temperature up to 42 degrees C, we observed a pronounced acceleration of Na(v)1.5 activation and fast inactivation kinetics. Cardiac action potential modelling experiments suggest that in patients with reduced I(Na), fever could prematurely shorten the action potential by virtue of its effect on WT channels. Further experiments revealed that L325R channels are likely misfolded, since their function could be partially rescued by mexiletine or curcumin. In co-expression experiments, L325R channels interfered with the proper function of WT channels, suggesting that a dominant negative phenomenon may underlie BrS triggered by fever. CONCLUSIONS The genetic background of BrS patients sensitive to fever is heterogeneous. Our experimental data suggest that the clinical manifestations of fever-exacerbated BrS may not be mutation specific.
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Schläpfer J, Gollut E, Pruvot E. Form “fruste” of long QT syndrome as a possible cause for unexplained syncope revealed by dobutamine infusion. Int J Cardiol 2006; 106:257-9. [PMID: 16321700 DOI: 10.1016/j.ijcard.2004.12.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 12/31/2004] [Indexed: 11/19/2022]
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37
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Schläpfer J. [What is your diagnosis? Sinus tachycardia]. Praxis (Bern 1994) 2005; 94:1329-30. [PMID: 16171003 DOI: 10.1024/0369-8394.94.35.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- J Schläpfer
- Service de cardiologie, BH-16, CHUV, Lausanne
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38
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Schläpfer J. [What is your diagnosis? Hyperkalemia]. Praxis (Bern 1994) 2005; 94:1015-6. [PMID: 15997718 DOI: 10.1024/0369-8394.94.24.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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39
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Katz E, Metzger JT, Jaussi A, Schläpfer J, Fromer M, Fishmann D, Kappenberger L. [What do we actually know about out-of-hospital cardiac arrest?]. Rev Med Suisse 2005; 1:628-30, 632-3. [PMID: 15813340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Each year at least 300,000 people in the United States and 8000 to 10,000 people in Switzerland suffer from out-of-hospital cardiac arrest, mostly due to ventricular fibrillation. Early defibrillation provides definitive treatment for most of cardiac arrest victims. Semi-automatic external defibrillators are easy to handle devices allowing to deliver an early electric shock and can be successfully used by lay people following minimal training. Newer strategies of defibrillation designed to respond faster to out-of-hospital cardiac arrest, including public access defibrillation, as well as improvement of each link of the chain of survival appears as the best strategy for the management of out-of-hospital cardiac arrest.
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Affiliation(s)
- E Katz
- Service de Cardiologie, Centre Interdisciplinaire des Urgences CHUV, 1011, Lausanne.
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40
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Abriel H, Schläpfer J, Keller DI, Gavillet B, Buclin T, Biollaz J, Stoller R, Kappenberger L. Molecular and clinical determinants of drug-induced long QT syndrome: an iatrogenic channelopathy. Swiss Med Wkly 2005; 134:685-94. [PMID: 15616901 DOI: 2004/47/smw-10532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
More than 70 drugs present on the Swiss market can cause drug-induced long QT syndrome (LQTS), which is associated with torsades de pointes (TdP) arrhythmias, potentially leading to sudden cardiac death. Basic and clinical investigations performed during the last decade have helped a better understanding of the mechanisms and risk factors of this serious public health problem. In their vast majority, QT interval prolonging drugs block the human ERG (hERG) channel involved in the repolarisation phase of the cardiac action potential, and thus lengthen the QT interval. Beside the well-known QT interval prolonging action of class IA, IC and III anti-arrhythmic drugs, many antibiotics, neurotropic, antifungal, and antimalarial drugs are also able to cause drug-induced LQTS. Reviewing the literature indicates that the risk of QT interval prolongation and TdP is increased in females, in patients with organic heart diseases and hypokalaemia. Furthermore in a few cases, genetic factors have also been reported. However thus far, no genetic test is available to detect at-risk patients, and in consequence, drug prescribers are still relying only on the clinical history and findings to perform an evaluation of the risk. Treatment of drug-induced LQTS and TdP includes identifying and withdrawing the culprit drug(s), infusing magnesium and, in resistant cases acceleration of the heart rate. In this review article we provide a list of QT interval prolonging drugs adapted to the pharmaceuticals found on the Swiss market that can be used as a check-list for drug prescribers and at-risk patients.
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41
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Abriel H, Schläpfer J, Keller DI, Gavillet B, Buclin T, Biollaz J, Stoller R, Kappenberger L. Molecular and clinical determinants of drug-induced long QT syndrome: an iatrogenic channelopathy. Swiss Med Wkly 2004; 134:685-94. [PMID: 15616901 DOI: 10.4414/smw.2004.10532] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
More than 70 drugs present on the Swiss market can cause drug-induced long QT syndrome (LQTS), which is associated with torsades de pointes (TdP) arrhythmias, potentially leading to sudden cardiac death. Basic and clinical investigations performed during the last decade have helped a better understanding of the mechanisms and risk factors of this serious public health problem. In their vast majority, QT interval prolonging drugs block the human ERG (hERG) channel involved in the repolarisation phase of the cardiac action potential, and thus lengthen the QT interval. Beside the well-known QT interval prolonging action of class IA, IC and III anti-arrhythmic drugs, many antibiotics, neurotropic, antifungal, and antimalarial drugs are also able to cause drug-induced LQTS. Reviewing the literature indicates that the risk of QT interval prolongation and TdP is increased in females, in patients with organic heart diseases and hypokalaemia. Furthermore in a few cases, genetic factors have also been reported. However thus far, no genetic test is available to detect at-risk patients, and in consequence, drug prescribers are still relying only on the clinical history and findings to perform an evaluation of the risk. Treatment of drug-induced LQTS and TdP includes identifying and withdrawing the culprit drug(s), infusing magnesium and, in resistant cases acceleration of the heart rate. In this review article we provide a list of QT interval prolonging drugs adapted to the pharmaceuticals found on the Swiss market that can be used as a check-list for drug prescribers and at-risk patients.
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42
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Schläpfer J. [What is your diagnosis? Cardiac amyloidosis]. Praxis (Bern 1994) 2004; 93:1337-1338. [PMID: 15468689 DOI: 10.1024/0369-8394.93.34.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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43
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Schläpfer J. [What is your diagnosis? Tachycardia with wide QRS complexes]. Praxis (Bern 1994) 2004; 93:1279-1280. [PMID: 15453430 DOI: 10.1024/0369-8394.93.33.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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44
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Fumeaux T, Cornuz J, Polikar R, Blanc E, Junod A, Kappenberger L, Nicod P, Schläpfer J. Guidelines for the clinical management of atrial fibrillation: a practical perspective. Swiss Med Wkly 2004; 134:235-47. [PMID: 15243851 DOI: 10.4414/smw.2004.10514] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Since the management of atrial fibrillation may be difficult in the individual patient, our purpose was to develop simple clinical recommendations to help the general internist manage this common clinical problem. DATA SOURCES Systematic review of the literature with evaluation of data-related evidence and framing of graded recommendations. DATA SYNTHESIS Atrial fibrillation affects some 1% of the population in Western countries and is linked to a significant increase in morbidity and mortality. The management of atrial fibrillation requires individualised evaluation of the risks and benefits of therapeutic modalities, relying whenever possible on simple and validated tools. The two main points requiring a decision in clinical management are 1) whether or not to implement thromboembolic prevention therapy, and 2) whether preference should be given to a "rate control" or "rhythm control" strategy. Thromboembolic prophylaxis should be prescribed after individualised risk assessment: for patients at risk, oral anticoagulation with warfarin decreases the rate of embolic complications by 60% and aspirin by 20%, at the expense of an increased incidence of haemorrhagic complications. "Rate control" and "rhythm control" strategies are probably equivalent, and the choice should also be made on an individualised basis. To assist the physician in making his choices for the care of an atrial fibrillation patient we propose specific tables and algorithms, with graded recommendations. CONCLUSIONS On the evidence of data from the literature we propose simple algorithms and tables for the clinical management of atrial fibrillation in the individual patient.
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Affiliation(s)
- Thierry Fumeaux
- Department of Internal Medicine, University Hospital, Geneva, Switzerland
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45
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Fumeaux T, Cornuz J, Polikar R, Blanc E, Junod A, Kappenberger L, Nicod P, Schläpfer J. Guidelines for the clinical management of atrial fibrillation: a practical perspective. Swiss Med Wkly 2004; 134:235-47. [PMID: 15243851 DOI: 2004/17/smw-10514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Since the management of atrial fibrillation may be difficult in the individual patient, our purpose was to develop simple clinical recommendations to help the general internist manage this common clinical problem. DATA SOURCES Systematic review of the literature with evaluation of data-related evidence and framing of graded recommendations. DATA SYNTHESIS Atrial fibrillation affects some 1% of the population in Western countries and is linked to a significant increase in morbidity and mortality. The management of atrial fibrillation requires individualised evaluation of the risks and benefits of therapeutic modalities, relying whenever possible on simple and validated tools. The two main points requiring a decision in clinical management are 1) whether or not to implement thromboembolic prevention therapy, and 2) whether preference should be given to a "rate control" or "rhythm control" strategy. Thromboembolic prophylaxis should be prescribed after individualised risk assessment: for patients at risk, oral anticoagulation with warfarin decreases the rate of embolic complications by 60% and aspirin by 20%, at the expense of an increased incidence of haemorrhagic complications. "Rate control" and "rhythm control" strategies are probably equivalent, and the choice should also be made on an individualised basis. To assist the physician in making his choices for the care of an atrial fibrillation patient we propose specific tables and algorithms, with graded recommendations. CONCLUSIONS On the evidence of data from the literature we propose simple algorithms and tables for the clinical management of atrial fibrillation in the individual patient.
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Affiliation(s)
- Thierry Fumeaux
- Department of Internal Medicine, University Hospital, Geneva, Switzerland
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46
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Schläpfer J. [What is your diagnosis? Diffuse ECG changes after cerebral infarct]. Praxis (Bern 1994) 2004; 93:397-398. [PMID: 15061106 DOI: 10.1024/0369-8394.93.11.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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47
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Szczerbal I, Rogalska-Niznik N, Schelling C, Schläpfer J, Dolf G, Switonski M. Development of a cytogenetic map for the Chinese raccoon dog (Nyctereutes procyonoides procyonoides) and the arctic fox (Alopex lagopus) genomes, using canine-derived microsatellite probes. Cytogenet Genome Res 2004; 102:267-71. [PMID: 14970715 DOI: 10.1159/000075761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2003] [Accepted: 07/28/2003] [Indexed: 11/19/2022] Open
Abstract
New chromosomal assignments of canine-derived cosmid clones containing microsatellites to the Chinese raccoon dog and arctic fox genomes are presented in the study. The localizations are in agreement with data obtained from comparative chromosome painting experiments between the dog and arctic fox genomes. However, paracentric inversions have been detected by comparing the loci order in canid karyotypes. The number of physically mapped loci increased to thirty-five both in the Chinese raccoon dog and in the arctic fox. Furthermore, the present status of the cytogenetic map of the Chinese raccoon dog and arctic fox is presented in this study.
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Affiliation(s)
- I Szczerbal
- Department of Genetics and Animal Breeding, August Cieszkowski Agricultural University of Poznan, Poznan, Poland
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48
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Dolf G, Schläpfer J, Gaillard C, Randi E, Lucchini V, Breitenmoser U, Stahlberger-Saitbekova N. Differentiation of the Italian wolf and the domestic dog based on microsatellite analysis. Genet Sel Evol 2004; 32:533-41. [PMID: 14736381 PMCID: PMC2706877 DOI: 10.1186/1297-9686-32-5-533] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Italian wolf is in the process of regaining the Alpine region which comes into conflict with the extensive sheep keeping practiced in Switzerland during the summer. As in Switzerland, the wolf is a protected species, the government reimburses losses caused by wolves. Therefore we wanted to know whether the Italian wolf could be distinguished from the domestic dog by microsatellite analysis if DNA samples of the predators could be secured. The evaluation of combined genotypes for the microsatellites CanBern6, CPH4, CPH7, CPH9, CPH12, CPH22 and ZuBeCa1 made it possible to identify an individual as either a domestic dog or an Italian wolf. The assignment of an individual to either one of the two populations is based on the logarithm of the likelihood ratio of an individual being an Italian wolf rather than a domestic dog, given a specific combined genotype. The distribution of the Italian wolf combined genotypes (n=42) is clearly distinct from the distribution of the domestic dog combined genotypes (n=90). The likelihood ratio for the "worst" Italian wolf combined genotype was 2.3 E+5 and for the "worst" domestic dog combined genotype was 3.8 E-5.
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Affiliation(s)
- G Dolf
- Institute of Animal Breeding, University of Berne, Bremgartenstrasse 109a, 3012 Berne, Switzerland.
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49
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Schläpfer J. [What is your diagnosis? Wolff-Parkinson-White syndrome]. Praxis (Bern 1994) 2003; 92:1073-1074. [PMID: 12830670 DOI: 10.1024/0369-8394.92.23.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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50
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Rogalska-Niznik N, Szczerbal I, Dolf G, Schläpfer J, Schelling C, Switonski M. Canine-derived cosmid probes containing microsatellites can be used in physical mapping of Arctic fox (Alopex lagopus) and Chinese raccoon dog (Nyctereutes procyonoides procyonoides) genomes. J Hered 2003; 94:89-93. [PMID: 12692168 DOI: 10.1093/jhered/esg005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rapid development of the canine marker genome map facilitates genome mapping of other Canidae species. In this study we present chromosomal localization of 18 canine-derived cosmid probes containing microsatellites in the arctic fox (Alopex lagopus) and Chinese raccoon dog (Nyctereutes procyonoides procyonoides) genomes by the use of fluorescence in situ hybridization (FISH). The chromosome localizations in the arctic fox are in general agreement with data obtained from comparative genome maps of the dog and the fox. However, our studies showed that the order of the loci on some chromosomes was changed during karyotype evolution. Therefore, we suggest that small intrachromosomal rearrangements took place.
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Affiliation(s)
- N Rogalska-Niznik
- Department of Genetics and Animal Breeding, August Cieszkowski Agricultural University, Poznán, Poland
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