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Klinkhammer B, Glotzer TV. Management of Arrhythmias in the Cardiovascular Intensive Care Unit. Crit Care Clin 2024; 40:89-103. [PMID: 37973359 DOI: 10.1016/j.ccc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Arrhythmias in the cardiovascular intensive care unit (CVICU) can be difficult to manage because of the complex hemodynamic and respiratory states of critically ill patients. Treating physicians must be educated to prevent, diagnose, and treat a multitude of tachyarrhythmias and bradyarrhythmias. In this review article, the authors outline a pragmatic approach to patient assessment, arrhythmia diagnosis, and management of the most common arrhythmias seen in the CVICU.
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Affiliation(s)
- Brent Klinkhammer
- Division of Cardiac Electrophysiology, Hackensack University Medical Center, Hackensack, NJ 07601, USA; Hackensack Meridian School of Medicine, Hackensack, NJ 07601, USA
| | - Taya V Glotzer
- Division of Cardiac Electrophysiology, Hackensack University Medical Center, Hackensack, NJ 07601, USA; Hackensack Meridian School of Medicine, Hackensack, NJ 07601, USA.
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Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP, Lopez-Cabanillas N, Ellenbogen KA, Hua W, Ikeda T, Mackall JA, Mason PK, McLeod CJ, Mela T, Moore JP, Racenet LK. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. J Arrhythm 2023; 39:681-756. [PMID: 37799799 PMCID: PMC10549836 DOI: 10.1002/joa3.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School Ann Arbor Michigan USA
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology Palo Alto California USA
| | - Douglas P Ensch
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Taya V Glotzer
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
| | - Michael R Gold
- Medical University of South Carolina Charleston South Carolina USA
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Peter B Imrey
- Cleveland Clinic Cleveland Ohio USA
- Case Western Reserve University Cleveland Ohio USA
| | - Julia H Indik
- University of Arizona, Sarver Heart Center Tucson Arizona USA
| | - Saima Karim
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
| | - Peter P Karpawich
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
| | - Yaariv Khaykin
- Southlake Regional Health Center Newmarket Ontario Canada
| | | | - Jordana Kron
- Virginia Commonwealth University Richmond Virginia USA
| | | | - Mark S Link
- University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph E Marine
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
| | | | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University Tokyo Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences New York New York USA
| | | | - Uma N Srivatsa
- University of California Davis Sacramento California USA
| | | | | | | | | | - Cynthia M Tracy
- George Washington University Washington District of Columbia USA
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
| | | | | | - Wojciech Zareba
- University of Rochester Medical Center Rochester New York USA
| | | | - Nestor Lopez-Cabanillas
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Kenneth A Ellenbogen
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Wei Hua
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Takanori Ikeda
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Judith A Mackall
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Pamela K Mason
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Christopher J McLeod
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Theofanie Mela
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Jeremy P Moore
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Laurel Kay Racenet
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
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3
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Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm 2023; 20:e17-e91. [PMID: 37283271 PMCID: PMC11062890 DOI: 10.1016/j.hrthm.2023.03.1538] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology, Palo Alto, California
| | | | - Taya V Glotzer
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter B Imrey
- Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University, Cleveland, Ohio
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Saima Karim
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Peter P Karpawich
- The Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Yaariv Khaykin
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | | | - Jordana Kron
- Virginia Commonwealth University, Richmond, Virginia
| | | | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph E Marine
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk, Belgium and Hasselt University, Hasselt, Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ratika Parkash
- QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University, Tokyo, Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences, New York, New York
| | | | | | | | | | | | | | - Cynthia M Tracy
- George Washington University, Washington, District of Columbia
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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4
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Ferrick AM, Raj SR, Deneke T, Kojodjojo P, Lopez‐Cabanillas N, Abe H, Boveda S, Chew DS, Choi J, Dagres N, Dalal AS, Dechert BE, Frazier‐Mills CG, Gilbert O, Han JK, Hewit S, Kneeland C, Mirza SD, Mittal S, Ricci RP, Runte M, Sinclair S, Alkmim‐Teixeira R, Vandenberk B, Varma N, Davenport E, Freedenberg V, Glotzer TV, Huang J, Ikeda T, Kramer DB, Lin D, Rojel‐Martínez U, Stühlinger M, Varosy PD. 2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic. J Arrhythm 2023; 39:250-302. [PMID: 37324757 PMCID: PMC10264760 DOI: 10.1002/joa3.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.
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Affiliation(s)
| | | | | | | | | | - Haruhiko Abe
- University of Occupational and Environmental Health HospitalJapan
| | | | | | | | - Nikolaos Dagres
- Heart Center Leipzig at the University of LeipzigLeipzigGermany
| | | | | | | | | | - Janet K. Han
- VA Greater Los Angeles Healthcare SystemLos AngelesCalifornia
| | | | | | | | | | | | - Mary Runte
- University of LethbridgeLethbridgeAlbertaCanada
| | | | | | - Bert Vandenberk
- University of CalgaryCalgaryAlbertaCanada
- Department of Cardiovascular SciencesLeuvenBelgium
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5
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Ferrick AM, Raj SR, Deneke T, Kojodjojo P, Lopez-Cabanillas N, Abe H, Boveda S, Chew DS, Choi JI, Dagres N, Dalal AS, Dechert BE, Frazier-Mills CG, Gilbert O, Han JK, Hewit S, Kneeland C, Mirza SD, Mittal S, Ricci RP, Runte M, Sinclair S, Alkmim-Teixeira R, Vandenberk B, Varma N, Davenport E, Freedenberg V, Glotzer TV, Huang JL, Ikeda T, Kramer DB, Lin D, Rojel-Martínez U, Stühlinger M, Varosy PD. 2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic. Europace 2023; 25:euad123. [PMID: 37208301 PMCID: PMC10199172 DOI: 10.1093/europace/euad123] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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] [Indexed: 05/21/2023] Open
Abstract
Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.
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Affiliation(s)
| | | | | | | | | | - Haruhiko Abe
- University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
| | | | | | | | - Nikolaos Dagres
- Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Aarti S Dalal
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Olivia Gilbert
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Janet K Han
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | | | | | - Mary Runte
- University of Lethbridge, Lethbridge, Alberta, Canada
| | | | | | - Bert Vandenberk
- University of Calgary, Calgary, Alberta, Canada
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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6
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Andrade JG, Deyell MW, Macle L, Steinberg JS, Glotzer TV, Hawkins NM, Khairy P, Aguilar M. Healthcare utilization and quality of life for atrial fibrillation burden: the CIRCA-DOSE study. Eur Heart J 2023; 44:765-776. [PMID: 36459112 DOI: 10.1093/eurheartj/ehac692] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/02/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS Atrial tachyarrhythmia recurrence ≥30 s remains the primary endpoint of clinical trials; however, this definition has not been correlated with clinical outcomes or pathophysiological processes. This study sought to determine the atrial tachyarrhythmia duration and burden associated with meaningful clinical outcomes. METHODS AND RESULTS The time and duration of every atrial tachyarrhythmia episode recorded on implantable cardiac monitor were evaluated. Healthcare utilization and quality of life in the year following ablation were prospectively collected. Three hundred and forty-six patients provided 126 110 monitoring days. One-year freedom from recurrence increased with arrhythmia duration thresholds, from 52.6 (182/346) to 93.3% (323/346; P < 0.0001). Patients with atrial fibrillation (AF) recurrence limited to durations ≤1 h had rates of healthcare utilization comparable with patients free of recurrence, while patients with AF recurrences lasting >1 h had a relative risk for emergency department consultation of 3.2 [95% confidence interval (CI) 2.0-5.3], hospitalization of 5.3 (95% CI 2.9-9.6), and repeat ablation of 27.1 (95% CI 10.5-71.0). Patients with AF burden of ≤0.1% had rates of healthcare utilization comparable with patients free of recurrence, while patients with AF burden of >0.1% had a relative risk for emergency department consultation of 2.4 (95% CI 1.9-3.9), hospitalization of 6.8 (95% CI 3.6-13.0), cardioversion of 9.1 (95% CI 3.3-25.6), and repeat ablation of 21.8 (95% CI 9.2-52.2). Compared with patients free of recurrence, the disease-specific quality of life was significantly impaired with AF episode durations >24 h, or AF burdens >0.1%. CONCLUSION AF recurrence, as defined by 30 s of arrhythmia, lacks clinical relevance. AF episode durations >1 h or burdens >0.1% were associated with increased rates of healthcare utilization.
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Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, Québec H1T 1C8, Canada.,Department of Medicine, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia V5Z 1M9, Canada.,Center for Cardiovascular Innovation, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada
| | - Marc W Deyell
- Department of Medicine, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia V5Z 1M9, Canada.,Center for Cardiovascular Innovation, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Jonathan S Steinberg
- Clinical Cardiovascular Research Center, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA.,SMG Arrhythmia Center, Summit Medical Group, 85 Woodland Rd, Short Hills, NJ 07078, USA
| | - Taya V Glotzer
- Hackensack Meridian School of Medicine; Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ 07601, USA
| | - Nathaniel M Hawkins
- Department of Medicine, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia V5Z 1M9, Canada.,Center for Cardiovascular Innovation, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada
| | - Paul Khairy
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Martin Aguilar
- Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, Québec H1T 1C8, Canada
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7
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Glotzer TV. Residual stroke risk in atrial fibrillation: Our patients must be our partners. Heart Rhythm O2 2022; 3:629-630. [PMID: 36589912 PMCID: PMC9795301 DOI: 10.1016/j.hroo.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Taya V. Glotzer
- Address reprint requests and correspondence: Dr Taya V. Glotzer, Hackensack University Medical Center, 20 Prospect Avenue, Suite 615, Hackensack, NJ 07601.
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8
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Jamal SM, Landers DB, Glotzer TV, Tancredi J, Hollenberg SM. Reply: POTS May Be Underestimated in Post-COVID Assessments. J Am Coll Cardiol 2022; 80:e105. [PMID: 36137680 PMCID: PMC9484735 DOI: 10.1016/j.jacc.2022.08.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 10/28/2022]
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9
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Jamal SM, Landers DB, Hollenberg SM, Turi ZG, Glotzer TV, Tancredi J, Parrillo JE. Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19. J Am Coll Cardiol 2022; 79:2325-2330. [PMID: 35381331 PMCID: PMC8976261 DOI: 10.1016/j.jacc.2022.03.357] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
Background Patients with post-acute sequela of COVID-19 (PASC) often report symptoms of orthostatic intolerance and autonomic dysfunction. Numerous case reports link postural orthostatic tachycardia syndrome (POTS) to PASC. No prospective analysis has been performed. Objectives This study performed head-up tilt table (HUTT) testing in symptomatic patients with PASC to evaluate for orthostatic intolerance suggestive of autonomic dysfunction. Methods We performed a prospective, observational evaluation of patients with PASC complaining of poor exertional tolerance, tachycardia with minimal activity or positional change, and palpitations. Exclusion criteria included pregnancy, pre-PASC autonomic dysfunction or syncope, or another potential explanation of PASC symptoms. All subjects underwent HUTT. Results Twenty-four patients with the described PASC symptoms were included. HUTT was performed a mean of 5.8 ± 3.5 months after symptom onset. Twenty-three of the 24 had orthostatic intolerance on HUTT, with 4 demonstrating POTS, 15 provoked orthostatic intolerance (POI) after nitroglycerin, 3 neurocardiogenic syncope, and 1 orthostatic hypotension. Compared with those with POTS, patients with POI described significantly earlier improvement of symptoms. Conclusions This prospective evaluation of HUTT in patients with PASC revealed orthostatic intolerance on HUTT suggestive of autonomic dysfunction in nearly all subjects. Those with POI may be further along the path of clinical recovery than those demonstrating POTS.
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Affiliation(s)
- Sameer M Jamal
- Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.
| | - David B Landers
- Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Steven M Hollenberg
- Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Zoltan G Turi
- Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Taya V Glotzer
- Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Jana Tancredi
- Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Joseph E Parrillo
- Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
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10
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Klinkhammer B, Fata MJ, Hollenberg SM, Safi LM, Landers DB, Turi Z, Talati T, Yousafzai OK, Glotzer TV, Tancredi J, Parrillo JE. PROGNOSTIC VALUE OF ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN PATIENTS WITH COVID-19 COMPLICATED BY SHOCK. J Am Coll Cardiol 2022. [PMCID: PMC8972493 DOI: 10.1016/s0735-1097(22)03138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Jamal SM, Landers D, Turi ZG, Hollenberg SM, Glotzer TV, Tancredi J, Parrillo JE. NEUROCARDIOGENIC SYNCOPE DURING HEAD-UP TILT TABLE (HUTT) TESTING IN PATIENTS WITH POST-ACUTE SEQUELA OF COVID-19 (PASC): A PROSPECTIVE EVALUATION. J Am Coll Cardiol 2022. [PMCID: PMC8972624 DOI: 10.1016/s0735-1097(22)03106-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Rivard L, Friberg L, Conen D, Healey JS, Berge T, Boriani G, Brandes A, Calkins H, Camm AJ, Yee Chen L, Lluis Clua Espuny J, Collins R, Connolly S, Dagres N, Elkind MSV, Engdahl J, Field TS, Gersh BJ, Glotzer TV, Hankey GJ, Harbison JA, Haeusler KG, Hills MT, Johnson LSB, Joung B, Khairy P, Kirchhof P, Krieger D, Lip GYH, Løchen ML, Madhavan M, Mairesse GH, Montaner J, Ntaios G, Quinn TJ, Rienstra M, Rosenqvist M, Sandhu RK, Smyth B, Schnabel RB, Stavrakis S, Themistoclakis S, Van Gelder IC, Wang JG, Freedman B. Atrial Fibrillation and Dementia: A Report From the AF-SCREEN International Collaboration. Circulation 2022; 145:392-409. [PMID: 35100023 DOI: 10.1161/circulationaha.121.055018] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Growing evidence suggests a consistent association between atrial fibrillation (AF) and cognitive impairment and dementia that is independent of clinical stroke. This report from the AF-SCREEN International Collaboration summarizes the evidence linking AF to cognitive impairment and dementia. It provides guidance on the investigation and management of dementia in patients with AF on the basis of best available evidence. The document also addresses suspected pathophysiologic mechanisms and identifies knowledge gaps for future research. Whereas AF and dementia share numerous risk factors, the association appears to be independent of these variables. Nevertheless, the evidence remains inconclusive regarding a direct causal effect. Several pathophysiologic mechanisms have been proposed, some of which are potentially amenable to early intervention, including cerebral microinfarction, AF-related cerebral hypoperfusion, inflammation, microhemorrhage, brain atrophy, and systemic atherosclerotic vascular disease. The mitigating role of oral anticoagulation in specific subgroups (eg, low stroke risk, short duration or silent AF, after successful AF ablation, or atrial cardiopathy) and the effect of rhythm versus rate control strategies remain unknown. Likewise, screening for AF (in cognitively normal or cognitively impaired patients) and screening for cognitive impairment in patients with AF are debated. The pathophysiology of dementia and therapeutic strategies to reduce cognitive impairment warrant further investigation in individuals with AF. Cognition should be evaluated in future AF studies and integrated with patient-specific outcome priorities and patient preferences. Further large-scale prospective studies and randomized trials are needed to establish whether AF is a risk factor for cognitive impairment, to investigate strategies to prevent dementia, and to determine whether screening for unknown AF followed by targeted therapy might prevent or reduce cognitive impairment and dementia.
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Affiliation(s)
- Léna Rivard
- Montreal Heart Institute, Université de Montréal, Canada (L.R., P. Khairy)
| | - Leif Friberg
- Karolinska Institute, Stockholm, Sweden (L.F., M.R.)
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy (G.B.)
| | | | | | - A John Camm
- Cardiovascular Clinical Academic Group, St Georges Hospital, London, UK (A.J.C.)
| | | | | | | | - Stuart Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Germany (N.D.)
| | | | - Johan Engdahl
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital, Stockholm, Sweden (J.E.)
| | - Thalia S Field
- University of British Columbia, Vancouver Stroke Program, Canada (T.S.F.)
| | | | | | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia (G.J.H.)
| | | | - Karl G Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Germany (K.G.H.)
| | | | | | - Boyoung Joung
- Yonsei University College of Medicine, Seoul, South Korea (B.J.)
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Canada (L.R., P. Khairy)
| | - Paulus Kirchhof
- University Heart and Vascular Center UKE Hamburg, Germany (P. Kirchhof)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (P. Kirchhof)
- Institute of Cardiovascular Sciences, University of Birmingham, UK, and AFNET, Münster, Germany (P. Kirchhof)
| | - Derk Krieger
- University Hospital of Zurich, Switzerland (D.K.)
| | | | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø (M.L.L.)
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M.)
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain (J.M.)
- Stroke Research Program, Institute of Biomedicine of Seville, Spain (J.M.)
- IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Spain (J.M.)
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain (J.M.)
| | | | | | - Michiel Rienstra
- Karolinska Institute, Stockholm, Sweden (L.F., M.R.)
- University of Groningen, University Medical Center Groningen, the Netherlands (M.R., I.C.V.G.)
| | | | | | - Breda Smyth
- Department of Public Health, Health Service Executive West, Galway, Ireland (B.S.)
| | | | | | | | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, the Netherlands (M.R., I.C.V.G.)
| | - Ji-Guang Wang
- Jiaotong University School of Medicine, China (J.G.W.)
| | - Ben Freedman
- Charles Perkins Centre and Concord Hospital Cardiology, University of Sydney, Australia (B.F.)
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13
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Glotzer TV. Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices: Editorial comment. Europace 2021; 24:353-354. [PMID: 34741616 DOI: 10.1093/europace/euab242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Taya V Glotzer
- Hackensack Meridian School of Medicine, Hackensack University Medical Center, 20 Prospect Avenue, Suite 615, Hackensack, NJ 07601, USA
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14
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Arbelo E, Aktaa S, Bollmann A, D'Avila A, Drossart I, Dwight J, Hills MT, Hindricks G, Kusumoto FM, Lane DA, Lau DH, Lettino M, Lip GYH, Lobban T, Pak HN, Potpara T, Saenz LC, Van Gelder IC, Varosy P, Gale CP, Dagres N, Boveda S, Deneke T, Defaye P, Conte G, Lenarczyk R, Providencia R, Guerra JM, Takahashi Y, Pisani C, Nava S, Sarkozy A, Glotzer TV, Martins Oliveira M. Quality indicators for the care and outcomes of adults with atrial fibrillation. Europace 2021; 23:494-495. [PMID: 32860039 DOI: 10.1093/europace/euaa253] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS To develop quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). METHODS AND RESULTS We followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of AF care for the diagnosis and management of AF (by a group of experts including members of the ESC Clinical Practice Guidelines Task Force for AF); (ii) the construction of candidate QIs (including a systematic review of the literature); and (iii) the selection of the final set of QIs (using a modified Delphi method). Six domains of care for the diagnosis and management of AF were identified: (i) Patient assessment (baseline and follow-up), (ii) Anticoagulation therapy, (iii) Rate control strategy, (iv) Rhythm control strategy, (v) Risk factor management, and (vi) Outcomes measures, including patient-reported outcome measures (PROMs). In total, 17 main and 17 secondary QIs, which covered all six domains of care for the diagnosis and management of AF, were selected. The outcome domain included measures on the consequences and treatment of AF, as well as PROMs. CONCLUSION This document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes), and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.
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Affiliation(s)
| | | | - Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | - André D'Avila
- Cardiac Arrhythmia Service, Hospital SOS Cardio, Florianopolis, SC, Brazil; Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Inga Drossart
- European Society of Cardiology, Sophia Antipolis, France; ESC Patient Forum, Sophia Antipolis, France
| | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | - Fred M Kusumoto
- Cardiology Department, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maddalena Lettino
- Cardiovascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Trudie Lobban
- Arrhythmia Alliance/AF Association/STARS, Chipping Norton, UK
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Luis C Saenz
- Fundación Cardio Infantil-Instituto de Cardiología, Bogotá, Colombia
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Paul Varosy
- Rocky Mountain Regional Veterans Affairs Medical Center and the University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, 31076 Toulouse, France
| | | | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Centre RHÖN-KLINIKUM Campus Bad Neustadt, Germany
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Radoslaw Lenarczyk
- First Department of Cardiology and Angiology, Silesian Centre for Heart Disease, Curie-Sklodowskiej Str 9, 41-800 Zabrze, Poland
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK and Institute of Health Informatics, University College of London, London, UK
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Yoshihide Takahashi
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Santiago Nava
- Head of Electrocardiology Department, Instituto Nacional de Cardiologia 'Ignacio Chavez', Mexico
| | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - Taya V Glotzer
- Hackensack Meridian-Seton Hall School of Medicine, Rutgers New Jersey Medical School; Director of Cardiac Research, Hackensack University Medical Center, Hackensack, USA
| | - Mario Martins Oliveira
- Hospital Santa Marta, Department of Cardiology, Rua Santa Marta, 1167-024 Lisbon, Portugal
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Affiliation(s)
- Taya V Glotzer
- Hackensack Meridian-Seton Hall School of Medicine, Rutgers New Jersey Medical School, Hackensack University Medical Center, Hackensack, New Jersey.
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16
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Schnabel RB, Haeusler KG, Healey JS, Freedman B, Boriani G, Brachmann J, Brandes A, Bustamante A, Casadei B, Crijns HJGM, Doehner W, Engström G, Fauchier L, Friberg L, Gladstone DJ, Glotzer TV, Goto S, Hankey GJ, Harbison JA, Hobbs FDR, Johnson LSB, Kamel H, Kirchhof P, Korompoki E, Krieger DW, Lip GYH, Løchen ML, Mairesse GH, Montaner J, Neubeck L, Ntaios G, Piccini JP, Potpara TS, Quinn TJ, Reiffel JA, Ribeiro ALP, Rienstra M, Rosenqvist M, Themistoclakis S, Sinner MF, Svendsen JH, Van Gelder IC, Wachter R, Wijeratne T, Yan B. Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration. Circulation 2019; 140:1834-1850. [PMID: 31765261 DOI: 10.1161/circulationaha.119.040267] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non-vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non-vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.
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Affiliation(s)
- Renate B Schnabel
- University Heart Centre, Hamburg, Germany; German Cardiovascular Research Center (DZHK), Partner Site Hamburg/Kiel/Lübeck (R.B.-S.)
| | | | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
- Division of Cardiology, McMaster University; Arrhythmia Services, Hamilton Health Sciences; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J. Healey)
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.)
| | - Giuseppe Boriani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, Italy (G.B.)
| | | | - Axel Brandes
- Odense University Hospital, Denmark (A. Brandes)
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR), Barcelona, Spain (A. Bustamante, J.M.)
| | - Barbara Casadei
- Division of Cardiovascular Medicine, British Heart Foundation Centre for Research Excellence, NIHR Oxford Biomedical Research Centre (B.C.), University of Oxford, United Kingdom
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, the Netherlands (H.J.G.M.C.)
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), partner site Berlin, and BIH Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Germany (W.D.)
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden (G.E., L.J.)
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France (L.F.)
| | - Leif Friberg
- Karolinska Institute, Stockholm, Sweden (L.F., M. Rosenqvist)
| | - David J Gladstone
- Department of Medicine, University of Toronto; and Hurvitz Brain Sciences Program and Regional Stroke Centre, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, Toronto, Canada (D.J.G.)
| | | | - Shinya Goto
- Tokai University School of Medicine, Metabolic Disease Research Center, Kanagawa, Japan (S.G.)
| | - Graeme J Hankey
- Medical School, The University of Western Australia, Perth; and Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.)
| | | | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, Harris Manchester College (F.D.R.H.), University of Oxford, United Kingdom
| | - Linda S B Johnson
- Department of Clinical Sciences, Lund University, Malmö, Sweden (G.E., L.J.)
| | - Hooman Kamel
- Weill Cornell Medical College, New York, NY (H.K.)
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; Sandwell and West Birmingham Hospitals and University Hospitals Birmingham NHS trusts, United Kingdom; AFNET, Muenster, Germany (P.K.)
| | - Eleni Korompoki
- Division of Brain Science, Imperial College London, United Kingdom (E.K.)
| | - Derk W Krieger
- Mohammed Bin Rashid University, Dubai, United Arab Emirates; and Neurosciences, Mediclinic City Hospital, Dubai, United Arab Emirates (D.W.K.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom (G.Y.H.L.)
| | - Maja-Lisa Løchen
- University Hospital of North Norway, Department of Cardiology, Tromsø (M.-L.L.)
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR), Barcelona, Spain (A. Bustamante, J.M.)
| | - Lis Neubeck
- Edinburgh Napier University, United Kingdom (L.N.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Jonathan P Piccini
- Duke University Medical Center; and Duke Clinical Research Institute, Durham, NC (J.P.P.)
| | - Tatjana S Potpara
- Internal Medicine/Cardiology, School of Medicine, University of Belgrade, Serbia (T.S.P.)
| | - Terence J Quinn
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, United Kingdom (T.Q.)
| | - James A Reiffel
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY (J.A.R.)
| | - Antonio Luiz Pinho Ribeiro
- Internal Medicine Department, School of Medicine, Federal University of Minas Gerais (UFMG); Hospital das Clínicas, UFMG, Belo Horizonte, Brazil (A.L.P.R.)
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (M. Rienstra)
| | | | - Sakis Themistoclakis
- Unit of Electrophysiology and Cardiac Pacing, Ospedale dell'Angelo Venice-Mestre, Italy (T.S.)
| | - Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian's University, Munich, Germany (M.F.S.)
- German Centre for Cardiovascular Research, partner site: Munich Heart Alliance, Munich, Germany (M.F.S.)
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (J.H.S.)
- Department of Clinical Medicine, University of Copenhagen, Denmark (J.H.S.)
| | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, the Netherlands (I.v.G.)
| | - Rolf Wachter
- University Hospital Leipzig, Germany (R.W.)
- University Medicine Göttingen, Germany (R.W.)
- German Cardiovascular Research Center (DZHK), partner site: Göttingen (R.W.)
| | - Tissa Wijeratne
- Department of Neurology and Stroke Medicine, The University of Melbourne and Western Health, Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital St Albans, Australia (T.W.)
| | - Bernard Yan
- Royal Melbourne Hospital, Comprehensive Stroke Centre, Australia (B.Y.)
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Waks JW, Passman RS, Matos J, Reynolds M, Thosani A, Mela T, Pederson D, Glotzer TV, Zimetbaum P. Intermittent anticoagulation guided by continuous atrial fibrillation burden monitoring using dual-chamber pacemakers and implantable cardioverter-defibrillators: Results from the Tailored Anticoagulation for Non-Continuous Atrial Fibrillation (TACTIC-AF) pilot study. Heart Rhythm 2018; 15:1601-1607. [DOI: 10.1016/j.hrthm.2018.06.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 11/25/2022]
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Glotzer TV, Shah M, Jain S, Zimmerman JM. Unusual case of late dislodgment of a superior vena cava coil. HeartRhythm Case Rep 2018; 4:405-407. [PMID: 30228965 PMCID: PMC6140412 DOI: 10.1016/j.hrcr.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Taya V. Glotzer
- Hackensack University Medical Center, Hackensack, New Jersey
- Address reprint requests and correspondence: Dr Taya V. Glotzer, Hackensack University Medical Center, 20 Prospect Ave, Suite 701, Hackensack, NJ 07601.
| | - Monali Shah
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Shashank Jain
- Rutgers New Jersey Medical School, Newark, New Jersey
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19
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Affiliation(s)
- Taya V Glotzer
- Hackensack Meridian-Seton Hall School of Medicine, Rutgers New Jersey Medical School, Hackensack, New Jersey; Hackensack University Medical Center, Hackensack, New Jersey; Electrophysiology Associates of Northern New Jersey, Hackensack, New Jersey.
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20
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Boriani G, Glotzer TV, Ziegler PD, De Melis M, Mangoni di S. Stefano L, Sepsi M, Landolina M, Lunati M, Lewalter T, Camm AJ. Detection of new atrial fibrillation in patients with cardiac implanted electronic devices and factors associated with transition to higher device-detected atrial fibrillation burden. Heart Rhythm 2018; 15:376-383. [DOI: 10.1016/j.hrthm.2017.11.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 11/30/2022]
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Kaplan RM, Ziegler PD, Koehler J, Glotzer TV, Passman RS. Atrial fibrillation variability on long-term monitoring of implantable cardiac rhythm management devices. Clin Cardiol 2017; 40:1044-1048. [PMID: 28800149 PMCID: PMC6490419 DOI: 10.1002/clc.22766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/23/2017] [Accepted: 06/29/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) burden and duration are predictors of thromboembolic events. The random nature of these measures may affect clinical decision making. The objective of this study was to determine temporal changes in AF burden as detected by continuous monitoring. HYPOTHESIS AF burden changes over time when detected by continuous monitoring. METHODS A post hoc analysis of patients enrolled in the TRENDS (A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics) study with ≥1 stroke risk factor(s) who were implanted with a dual-chamber cardiac rhythm management device (CRMD) and had AF burden data available for ≥2 years was performed. AF burden was defined as no AF, low AF (<5.5 hours on any given day), or high AF burden (≥5.5 hours in a day), and was first assessed over the initial 30 days following enrollment and then reassessed at 6-month intervals for 2 years. RESULTS Among 394 patients included, the average age was 70.2 ± 10.9 years, 71% were male, and mean CHA2 DS2- VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or TIA, vascular disease, age 65-74 years, sex category) score was 3.7 ± 1.6. In the 30-day baseline period, 75.1% of patients had no AF, 11.2% had low AF, and 13.7% had high AF. Over the subsequent 2 years, 40.0% of patients initially classified as no AF or low AF experienced periods with high AF, whereas 59.3% of patients initially classified as high AF experienced ≥6 consecutive months with no AF or low AF. Advanced age was the sole predictor of AF progression. CONCLUSIONS Significant temporal variability in AF burden exists when measured continuously with an implantable CRMD.
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Affiliation(s)
- Rachel M. Kaplan
- Department of Cardiology, Northwestern UniversityFeinberg School of MedicineChicagoIllinois
| | - Paul D. Ziegler
- Cardiac Rhythm Disease Management, Medtronic, Inc.MinneapolisMinnesota
| | - Jodi Koehler
- Cardiac Rhythm Disease Management, Medtronic, Inc.MinneapolisMinnesota
| | - Taya V. Glotzer
- Department of Cardiology, Hackensack University Medical CenterHackensackNew Jersey
| | - Rod S. Passman
- Department of Cardiology, Northwestern UniversityFeinberg School of MedicineChicagoIllinois
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Gorenek B, Bax J, Boriani G, Chen SA, Dagres N, Glotzer TV, Healey JS, Israel CW, Kudaiberdieva G, Levin LÅ, Lip GYH, Martin D, Okumura K, Svendsen JH, Tse HF, Botto GL, Sticherling C, Linde C, Kutyifa V, Bernat R, Scherr D, Lau CP, Iturralde P, Morin DP, Savelieva I, Lip G, Gorenek B, Sticherling C, Fauchier L, Goette A, Jung W, Vos MA, Brignole M, Elsner C, Dan GA, Marin F, Boriani G, Lane D, Lundqvist CB, Savelieva I. Device-detected subclinical atrial tachyarrhythmias: definition, implications and management—an European Heart Rhythm Association (EHRA) consensus document, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2017; 19:1556-1578. [DOI: 10.1093/europace/eux163] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/04/2017] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Jeroen Bax
- Leiden University Medical Center (Lumc), Leiden, the Netherlands
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
| | - Shih-Ann Chen
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig – Heart Center, Leipzig, Germany
| | - Taya V Glotzer
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - David Martin
- Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | | | - Hung-Fat Tse
- Cardiology Division, Department of Medicine; The University of Hong Kong, Hong Kong
| | | | | | | | | | | | | | | | | | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, USA
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Freedman B, Boriani G, Glotzer TV, Healey JS, Kirchhof P, Potpara TS. Management of atrial high-rate episodes detected by cardiac implanted electronic devices. Nat Rev Cardiol 2017; 14:701-714. [DOI: 10.1038/nrcardio.2017.94] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Freedman B, Camm J, Calkins H, Healey JS, Rosenqvist M, Wang J, Albert CM, Anderson CS, Antoniou S, Benjamin EJ, Boriani G, Brachmann J, Brandes A, Chao TF, Conen D, Engdahl J, Fauchier L, Fitzmaurice DA, Friberg L, Gersh BJ, Gladstone DJ, Glotzer TV, Gwynne K, Hankey GJ, Harbison J, Hillis GS, Hills MT, Kamel H, Kirchhof P, Kowey PR, Krieger D, Lee VWY, Levin LÅ, Lip GYH, Lobban T, Lowres N, Mairesse GH, Martinez C, Neubeck L, Orchard J, Piccini JP, Poppe K, Potpara TS, Puererfellner H, Rienstra M, Sandhu RK, Schnabel RB, Siu CW, Steinhubl S, Svendsen JH, Svennberg E, Themistoclakis S, Tieleman RG, Turakhia MP, Tveit A, Uittenbogaart SB, Van Gelder IC, Verma A, Wachter R, Yan BP, Al Awwad A, Al-Kalili F, Berge T, Breithardt G, Bury G, Caorsi WR, Chan NY, Chen SA, Christophersen I, Connolly S, Crijns H, Davis S, Dixen U, Doughty R, Du X, Ezekowitz M, Fay M, Frykman V, Geanta M, Gray H, Grubb N, Guerra A, Halcox J, Hatala R, Heidbuchel H, Jackson R, Johnson L, Kaab S, Keane K, Kim YH, Kollios G, Løchen ML, Ma C, Mant J, Martinek M, Marzona I, Matsumoto K, McManus D, Moran P, Naik N, Ngarmukos T, Prabhakaran D, Reidpath D, Ribeiro A, Rudd A, Savalieva I, Schilling R, Sinner M, Stewart S, Suwanwela N, Takahashi N, Topol E, Ushiyama S, Verbiest van Gurp N, Walker N, Wijeratne T. Screening for Atrial Fibrillation. Circulation 2017; 135:1851-1867. [DOI: 10.1161/circulationaha.116.026693] [Citation(s) in RCA: 369] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.
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Affiliation(s)
- Ben Freedman
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - John Camm
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Hugh Calkins
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Jeffrey S. Healey
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Mårten Rosenqvist
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Jiguang Wang
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Christine M. Albert
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Craig S. Anderson
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Sotiris Antoniou
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Emelia J. Benjamin
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Giuseppe Boriani
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Johannes Brachmann
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Axel Brandes
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Tze-Fan Chao
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - David Conen
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Johan Engdahl
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Laurent Fauchier
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - David A. Fitzmaurice
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Leif Friberg
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Bernard J. Gersh
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - David J. Gladstone
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Taya V. Glotzer
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Kylie Gwynne
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Graeme J. Hankey
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Joseph Harbison
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Graham S. Hillis
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Mellanie T. Hills
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Hooman Kamel
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Paulus Kirchhof
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Peter R. Kowey
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Derk Krieger
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Vivian W. Y. Lee
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Lars-Åke Levin
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Gregory Y. H. Lip
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Trudie Lobban
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Nicole Lowres
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Georges H. Mairesse
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Carlos Martinez
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Lis Neubeck
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Jessica Orchard
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Jonathan P. Piccini
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Katrina Poppe
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Tatjana S. Potpara
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Helmut Puererfellner
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Michiel Rienstra
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Roopinder K. Sandhu
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Renate B. Schnabel
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Chung-Wah Siu
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Steven Steinhubl
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Jesper H. Svendsen
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Emma Svennberg
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Sakis Themistoclakis
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Robert G. Tieleman
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Mintu P. Turakhia
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Arnljot Tveit
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Steven B. Uittenbogaart
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Isabelle C. Van Gelder
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Atul Verma
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Rolf Wachter
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
| | - Bryan P. Yan
- From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham
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Ricci RP, Glotzer TV. Home Screening for Detecting Subclinical Atrial Fibrillation. J Atr Fibrillation 2015; 8:1326. [PMID: 27957232 PMCID: PMC5135191 DOI: 10.4022/jafib.1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/23/2015] [Accepted: 11/24/2015] [Indexed: 06/06/2023]
Abstract
The advent of cardiac implanted electronic devices with accurate atrial arrhythmia diagnostic capabilities has revealed a large burden of "silent " atrial fibrillation that is present in the cardiac population. Many studies have been completed, and many more are ongoing, to determine the correct treatment course when these atrial arrhythmias are detected. Alongside the development of accurate atrial diagnostics within the devices, has been the growth an entire network of wireless home monitoring capability. It is now possible to see, over the internet, individual patients' atrial arrhythmia burden on every day. This capability has tremendous promise for patient care, with the possibility of reducing strokes, decreasing heart failure, preventing cardiomyopathies, and likely substantially reducing health care costs. As this innovative diagnostic capability is generating large amounts of data, protocols for what should be done with the plethora of new information are being developed. In the pages that follow, we will present what is known about home monitoring for silent atrial fibrillation, and present the results of recent studies published in this arena.
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Affiliation(s)
- Renato Pietro Ricci
- Department of Cardiovascular Diseases, San Filippo Neri Hospital, Rome, Italy
| | - Taya V Glotzer
- Hackensack University Medical Center, Hackensack, New Jersey
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Glotzer TV, Hellkamp AS, Lee KL, Lamas GA. CHA2DS2-VAS(C) and CHADS2 Scores Predict Adverse Clinical Events in Patients With Pacemakers and Sinus Node Dysfunction Independent of Atrial Fibrillation. Can J Cardiol 2015; 31:1004-11. [PMID: 26076964 DOI: 10.1016/j.cjca.2015.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND CHA2DS2-VASc and CHADS2 scores were derived and validated for stroke-risk stratification in patients who have a diagnosis of atrial fibrillation (AF). We hypothesized that these scores would predict adverse cardiovascular events even in the absence of AF. METHODS The CHA2DS2-VASc and CHADS2 scores for 2010 patients with sick sinus syndrome who underwent pacemaker implantation and were enrolled in the Mode Selection Trial (MOST) were calculated. The association of these risk scores with main trial end points, including the composite of death and stroke, were evaluated to determine whether the associations differed by history of AF. RESULTS Of the 2010 patients, 12% had a CHA2DS2-VASc score of 0-1, 16% had a score of 2, 41% had a score of 3-4, and 31% had a score ≥ 5 (the distribution for CHADS2 was similar); 42% had a clinical history of AF. Both scores were associated with death or stroke (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.05-1.23 for each 1-point increase in CHA2DS2-VASc; P = 0.001; HR, 1.11; 95% CI, 1.02-1.21 for each 1-point increase in CHADS2; P = 0.016). Association of scores with outcomes of death, stroke, and heart failure hospitalization were not different for patients with vs those without a history of AF (interaction P ≥ 0.55 for CHA2DS2-VASc and ≥ 0.30 for CHADS2). CONCLUSIONS Both CHA2DS2-VASc and CHADS2 scores predict risk of death or stroke in patients with sick sinus syndrome, regardless of AF history. These scores could be risk-stratification tools for clinical events that might respond to new therapies—ie, anticoagulation or other interventions—even in the absence of AF.
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Affiliation(s)
- Taya V Glotzer
- Hackensack University Medical Center, Hackensack, New Jersey, USA.
| | - Anne S Hellkamp
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kerry L Lee
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Gervasio A Lamas
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida, USA
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Affiliation(s)
- Peter Zimetbaum
- From the Department of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.Z., J.W.W., E.R.E.); Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.); and Division of Cardiology, Hackensack University Medical Center, NJ (T.V.G.).
| | - Jonathan W Waks
- From the Department of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.Z., J.W.W., E.R.E.); Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.); and Division of Cardiology, Hackensack University Medical Center, NJ (T.V.G.)
| | - Ethan R Ellis
- From the Department of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.Z., J.W.W., E.R.E.); Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.); and Division of Cardiology, Hackensack University Medical Center, NJ (T.V.G.)
| | - Taya V Glotzer
- From the Department of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.Z., J.W.W., E.R.E.); Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.); and Division of Cardiology, Hackensack University Medical Center, NJ (T.V.G.)
| | - Rod S Passman
- From the Department of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.Z., J.W.W., E.R.E.); Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.); and Division of Cardiology, Hackensack University Medical Center, NJ (T.V.G.)
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Abstract
BACKGROUND Stroke without an identifiable cause is frightening to patients and their families and is frustrating for the caring physician. Approximately 30% of patients with cardiac implanted electronic devices have some evidence of atrial fibrillation (AF), and much of it is silent: asymptomatic, and previously unrecognized. OBJECTIVE The purpose of this review is to examine "silent AF" as a potential cause of cryptogenic stroke. METHODS/RESULTS We begin by reviewing most of the published literature on screening for AF with different monitoring technologies in the setting of cryptogenic stroke. We present the results of 2 recent large randomized trials, CRYSTAL AF and EMBRACE, which compare standard of care monitoring in cryptogenic stroke patients to invasive and noninvasive monitoring strategies, respectively. Finally, we review the relationship of silent AF to stroke in the cardiac implanted electronic device population. Patient selection, duration of monitoring, sensitivity and specificity of monitoring technology, patient compliance, and several other factors affect the yield of AF detection during monitoring. CONCLUSION Data suggest that silent AF is identified in approximately 30% of cryptogenic stroke patients and has important therapeutic implications. Oral anticoagulation likely should be prescribed when silent AF is detected.
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Affiliation(s)
- Taya V Glotzer
- Hackensack University Medical Center, Hackensack, New Jersey,.
| | - Paul D Ziegler
- Cardiac Rhythm Disease Management Division, Medtronic Inc, Mounds View, Minnesota
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Charitos EI, Pürerfellner H, Glotzer TV, Ziegler PD. Clinical Classifications of Atrial Fibrillation Poorly Reflect Its Temporal Persistence. J Am Coll Cardiol 2014; 63:2840-8. [DOI: 10.1016/j.jacc.2014.04.019] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/02/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
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30
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Abstract
The precise role atrial fibrillation (AF) plays in increasing the risk of stroke is less well understood; this is especially true for the implanted device population. Current cardiac implanted electronic devices have a very high sensitivity and specificity for true AF detection. It does not seem to matter if the AF episode is proximal to the stroke event, and risk seems to be increased by relatively brief AF episodes. The appearance of new atrial high-rate episodes increases thromboembolic event rates. Until larger trials or registries are conducted, it is important to follow established guidelines regarding anticoagulation.
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Affiliation(s)
- Taya V Glotzer
- Hackensack University Medical Center, Hackensack, NJ 07601, USA.
| | - Paul D Ziegler
- Medtronic Cardiac Rhythm Disease Management Division, Medtronic Inc, 8200 Coral Sea St. NE, Mounds View, MN 55112, USA
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Boriani G, Glotzer TV, Santini M, West TM, De Melis M, Sepsi M, Gasparini M, Lewalter T, Camm JA, Singer DE. Device-detected atrial fibrillation and risk for stroke: an analysis of >10,000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices). Eur Heart J 2013; 35:508-16. [PMID: 24334432 PMCID: PMC3930873 DOI: 10.1093/eurheartj/eht491] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [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: 11/12/2022] Open
Abstract
Objective The aim of this study was to assess the association between maximum daily atrial fibrillation (AF) burden and risk of ischaemic stroke. Background Cardiac implanted electronic devices (CIEDs) enhance detection of AF, providing a comprehensive measure of AF burden. Design, setting, and patients A pooled analysis of individual patient data from five prospective studies was performed. Patients without permanent AF, previously implanted with CIEDs, were included if they had at least 3 months of follow-up. A total of 10 016 patients (median age 70 years) met these criteria. The risk of ischaemic stroke associated with pre-specified cut-off points of AF burden (5 min, 1, 6, 12, and 23 h, respectively) was assessed. Results During a median follow-up of 24 months, 43% of 10 016 patients experienced at least 1 day with at least 5 min of AF burden and for them the median time to the maximum AF burden was 6 months (inter-quartile range: 1.3–14). A Cox regression analysis adjusted for the CHADS2 score and anticoagulants at baseline demonstrated that AF burden was an independent predictor of ischaemic stroke. Among the thresholds of AF burden that we evaluated, 1 h was associated with the highest hazard ratio (HR) for ischaemic stroke, i.e. 2.11 (95% CI: 1.22–3.64, P = 0.008). Conclusions Device-detected AF burden is associated with an increased risk of ischaemic stroke in a relatively unselected population of CIEDs patients. This finding may add to the basis for timely and clinically appropriate decision-making on anticoagulation treatment.
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Affiliation(s)
- Giuseppe Boriani
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S.Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna 40138, Italy
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Glotzer TV, Ziegler PD. Silent Atrial Fibrillation as a Stroke Risk Factor and Anticoagulation Indication. Can J Cardiol 2013; 29:S14-23. [DOI: 10.1016/j.cjca.2013.03.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 11/25/2022] Open
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Ziegler PD, Glotzer TV, Daoud EG, Singer DE, Ezekowitz MD, Hoyt RH, Koehler JL, Coles J, Wyse DG. Detection of previously undiagnosed atrial fibrillation in patients with stroke risk factors and usefulness of continuous monitoring in primary stroke prevention. Am J Cardiol 2012; 110:1309-14. [PMID: 22819433 DOI: 10.1016/j.amjcard.2012.06.034] [Citation(s) in RCA: 122] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/13/2012] [Accepted: 06/13/2012] [Indexed: 11/16/2022]
Abstract
The detection of undiagnosed atrial tachycardia/atrial fibrillation (AT/AF) among patients with stroke risk factors could be useful for primary stroke prevention. We analyzed newly detected AT/AF (NDAF) using continuous monitoring in patients with stroke risk factors but without previous stroke or evidence of AT/AF. NDAF (AT/AF >5 minutes on any day) was determined in patients with implantable cardiac rhythm devices and ≥1 stroke risk factors (congestive heart failure, hypertension, age ≥75 years, or diabetes). All devices were capable of continuously monitoring the daily cumulative time in AT/AF. Of 1,368 eligible patients, NDAF was identified in 416 (30%) during a follow-up of 1.1 ± 0.7 years and was unrelated to the CHADS(2) score (congestive heart failure, hypertension [blood pressure consistently >140/90 mm Hg or hypertension treated with medication], age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack). The presence of AT/AF >6 hours on ≥1 day increased significantly with increased CHADS(2) scores and was present in 158 (54%) of 294 patients with NDAF and a CHADS(2) score of ≥2. NDAF was sporadic, and 78% of patients with a CHADS(2) score of ≥2 with NDAF experienced AT/AF on <10% of the follow-up days. The median interval to NDAF detection in these higher risk patients was 72 days (interquartile range 13 to 177). In conclusion, continuous monitoring identified NDAF in 30% of patients with stroke risk factors. In patients with NDAF, AT/AF occurred sporadically, highlighting the difficulty in detecting paroxysmal AT/AF using traditional monitoring methods. However, AT/AF also persisted for >6 hours on ≥1 days in most patients with NDAF and multiple stroke risk factors. Whether patients with CHADS(2) risk factors but without a history of AF might benefit from implantable monitors for the selection and administration of anticoagulation for primary stroke prevention merits additional investigation.
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Ziegler PD, Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD. Response to Letter by Willey. Stroke 2010. [DOI: 10.1161/strokeaha.110.584821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - D. George Wyse
- Libin Cardiovascular Institute of Alberta, Alberta, Canada
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Ziegler PD, Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD, Koehler JL, Hilker CE. Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events. Stroke 2009; 41:256-60. [PMID: 20044517 DOI: 10.1161/strokeaha.109.571455] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Evidence of atrial tachycardia/atrial fibrillation (AT/AF) is often sought in patients with ischemic stroke or transient ischemic attack. We studied patients with previous thromboembolic events (TE) who were implanted with devices capable of continuous arrhythmia monitoring to comprehensively quantify the incidence and duration of newly detected AT/AF. METHODS This study represents a subgroup analysis of the TRENDS trial, which included patients with clinical indications for pacemakers or defibrillators and >or=1 stroke risk factors (heart failure, hypertension, age 65 or older, diabetes, or previous TE). A history of AF was not required. All implanted devices were capable of continuously monitoring the cumulative time spent in AT/AF each day. This analysis focuses primarily on the incidence and duration of newly detected AT/AF (defined as >or=5 minutes of AT/AF on any day) in patients with previous TE, no documented history of AF, and no warfarin or antiarrhythmic drug use. RESULTS A total of 319 patients had a history of TE and >or=1 day of device data. Patients with a documented history of AF (n=80), warfarin use (n=56), or antiarrhythmic drug use (n=20) were excluded from analysis. Of the remaining 163 patients, newly detected AT/AF was identified via the device in 45 patients (28%) over a mean follow-up of 1.1+/-0.7 years. AT/AF recurred infrequently, with only 12 patients experiencing AT/AF on >10% of follow-up days. CONCLUSIONS Newly detected episodes of AT/AF were found via continuous monitoring in 28% of patients with previous TE. Most episodes would not have been detected by standard intermittent monitoring techniques.
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Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD, Hilker C, Miller C, Qi D, Ziegler PD. The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circ Arrhythm Electrophysiol 2009; 2:474-80. [PMID: 19843914 DOI: 10.1161/circep.109.849638] [Citation(s) in RCA: 640] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unknown if brief episodes of device-detected atrial fibrillation (AF) increase thromboembolic event (TE) risk. METHODS AND RESULTS TRENDS was a prospective, observational study enrolling patients with > or = 1 stroke risk factor (heart failure, hypertension, age > or = 65 years, diabetes, or prior TE) receiving pacemakers or defibrillators that monitor atrial tachycardia (AT)/AF burden (defined as the longest total AT/AF duration on any given day during the prior 30-day period). This time-varying exposure was updated daily during follow-up and related to TE risk. Annualized TE rates were determined according to AT/AF burden subsets: zero, low (<5.5 hours [median duration of subsets with nonzero burden]), and high (> or = 5.5 hours). A multivariate Cox model provided hazard ratios including terms for stroke risk factors and time-varying AT/AF burden and antithrombotic therapy. Patients (n=2486) had at least 30 days of device data for analysis. During a mean follow-up of 1.4 years, annualized TE risk (including transient ischemic attacks) was 1.1% for zero, 1.1% for low, and 2.4% for high burden subsets of 30-day windows. Compared with zero burden, adjusted hazard ratios (95% CIs) in the low and high burden subsets were 0.98 (0.34 to 2.82, P=0.97) and 2.20 (0.96 to 5.05, P=0.06), respectively. CONCLUSIONS The TE rate was low compared with patients with traditional AF with similar risk profiles. The data suggest that TE risk is a quantitative function of AT/AF burden. AT/AF burden > or = 5.5 hours on any of 30 prior days appeared to double TE risk. Additional studies are needed to more precisely investigate the relationship between stroke risk and AT/AF burden.
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Affiliation(s)
- Taya V Glotzer
- Hackensack University Medical Center, Hackensack, NJ, USA.
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Glotzer TV, Daoud EG, Wyse DG, Singer DE, Holbrook R, Pruett K, Smith K, Hilker CE. Rationale and design of a prospective study of the clinical significance of atrial arrhythmias detected by implanted device diagnostics: The TRENDS study. J Interv Card Electrophysiol 2006; 15:9-14. [PMID: 16680544 DOI: 10.1007/s10840-006-7622-y] [Citation(s) in RCA: 32] [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: 06/22/2005] [Accepted: 02/05/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sustained atrial fibrillation (AF) is a common risk factor for stroke. While intermittent AF also appears to pose a substantial stroke risk, the quantitative relationship between the percentage of time spent in AF and stroke risk is poorly specified and "intermittent" AF is not the same as paroxysmal AF. Improved assessment of the impact of AF burden on stroke risk will allow more targeted and safer use of antithrombotic therapy. METHODS AND RESULTS The primary objective of this study is to determine if AT/AF (all device detected atrial tachyarrhythmias, including atrial flutter, atrial fibrillation, and atrial tachycardia) burden over a 30 day period is an independent predictor of the occurrence of ischemic stroke, transient ischemic attack (TIA) and/or systemic embolism in subjects not receiving anticoagulation therapy. TRENDS is a prospective, post-market, non-randomized, multicenter study designed to enroll 3100 subjects who have an independent Class I/II indication for cardiac rhythm device implantation and who have demographic features suggestive of an increased risk for thromboembolic complications related to AT/AF. All implanted devices will have the ability to collect long-term AT/AF burden trending data and will be equivalently programmed to ensure consistent data collection. All subjects will be followed with device interrogations every 3 months and clinic visits every 6 months for 1 year. Subjects with a documented history of AT/AF prior to enrollment and those who develop AT/AF during the 12-month follow-up will be followed until the last subject enrolled in the study has completed their 24-month follow-up. CONCLUSIONS The results of the TRENDS study should help clarify the implications of data retrieved from an implantable device with regard to the risk for thromboembolic complications from atrial arrhythmias, even in the absence of symptoms.
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MESH Headings
- Anti-Arrhythmia Agents/therapeutic use
- Atrial Fibrillation/complications
- Atrial Fibrillation/epidemiology
- Atrial Fibrillation/physiopathology
- Atrial Fibrillation/therapy
- Atrial Flutter/complications
- Atrial Flutter/epidemiology
- Atrial Flutter/physiopathology
- Atrial Flutter/therapy
- Cardiac Pacing, Artificial
- Defibrillators, Implantable
- Follow-Up Studies
- Heart Rate
- Humans
- Intracranial Embolism/epidemiology
- Intracranial Embolism/etiology
- Ischemic Attack, Transient/epidemiology
- Ischemic Attack, Transient/etiology
- Pacemaker, Artificial
- Predictive Value of Tests
- Product Surveillance, Postmarketing
- Prospective Studies
- Quality of Life
- Research Design
- Risk Factors
- Stroke/epidemiology
- Stroke/etiology
- Tachycardia, Ectopic Atrial/complications
- Tachycardia, Ectopic Atrial/epidemiology
- Tachycardia, Ectopic Atrial/physiopathology
- Tachycardia, Ectopic Atrial/therapy
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Taya V Glotzer
- Hackensack University Medical Center, Hackensack, NJ, USA.
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38
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Sweeney MO, Hellkamp AS, Ellenbogen KA, Glotzer TV, Silverman R, Yee R, Lee KL, Lamas GA. Prospective Randomized Study of Mode Switching in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction. J Cardiovasc Electrophysiol 2004; 15:153-60. [PMID: 15028043 DOI: 10.1046/j.1540-8167.2004.03146.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is common in pacemaker patients with sinus node dysfunction (SND) and may result in rapid ventricular pacing (RVP) in the DDDR mode. Mode switching (MS) reduces RVP, but its clinical benefit in patients with SND is unknown. METHODS AND RESULTS Two hundred two patients in the Mode Selection Trial (MOST; 2,010-patient, 6-year trial of DDDR vs VVIR pacing in SND) randomized to DDDR pacemakers with atrial high-rate episode (AHRE) storage capabilities were subrandomized to MS ON (N = 96) or MS OFF (N = 106). Cardiovascular symptoms, quality of life (QOL), reprogramming due to RVP, death, stroke, and heart failure hospitalization (HFH) were compared between groups. The treatment groups were similar with regard to AF history (59% MS ON vs 57% MS OFF). AHREs occurred in 49% patients during median follow-up of 2.2 years. Median AHRE duration (in min; MS ON 116 vs MS OFF 58, P = 0.29), frequency AHREs/week (MS ON 3.5 vs MS OFF 6.4, P = 0.23), and time spent in AHRE (min/week) (MS ON 450, MS OFF 268) were similar. Reprogramming due to any RVP during AHREs occurred more in MS OFF vs MS ON (13.2% vs 3.1%, P = 0.011) and marginally more for symptomatic RVP (8.5% vs 2.1%, P = 0.062). Cardiovascular symptoms occurred in 93.6% MS ON vs 90.2% MS OFF (P = 0.38). Median number of symptoms reported per visit was similar (MS ON 1.3 vs MS OFF 1.5, P = 0.62). Median symptom frequency/severity, summed and averaged over visits, was similar (MS ON 4.3 vs MS OFF 4.5, P = 0.74). QOL was not different between groups. Death, stroke, and HFH were not different between groups. CONCLUSION MS reduces pacemaker reprogramming due to RVP during AHREs in a small number of patients but does not improve QOL or cardiovascular symptoms overall among patients with SND.
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Affiliation(s)
- Michael O Sweeney
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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39
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Glotzer TV, Hellkamp AS, Zimmerman J, Sweeney MO, Yee R, Marinchak R, Cook J, Paraschos A, Love J, Radoslovich G, Lee KL, Lamas GA. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST). Circulation 2003; 107:1614-9. [PMID: 12668495 DOI: 10.1161/01.cir.0000057981.70380.45] [Citation(s) in RCA: 563] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some current pacing systems can automatically detect and record atrial tachyarrhythmias that may be asymptomatic. We prospectively studied a 312-patient (pt) subgroup of MOST (MOde Selection Trial), a 2010-patient, 6-year randomized trial of DDDR versus VVIR pacing in sinus node dysfunction (SND). The purpose of the study was to correlate atrial high rate events (AHREs) detected by pacemaker diagnostics with clinical outcomes. METHODS AND RESULTS Pacemakers were programmed to log an AHRE when the atrial rate was >220 bpm for 10 consecutive beats. Analysis was confined to patients with at least 1 AHRE duration exceeding 5 minutes. The 312 patients were median age 74 years, 55% female, and 60% had a history of SVT. 160 of 312 (51.3%) patients enrolled had at least 1 AHRE >5 minutes duration over median follow-up of 27 months. Cox proportional hazards analysis assessed the relationship of AHREs with clinical events, adjusting for prognostic variables and baseline covariates. The presence of any AHRE was an independent predictor of the following: total mortality (hazard ratio AHRE versus no AHRE and 95% confidence intervals=2.48 [1.25, 4.91], P=0.0092); death or nonfatal stroke (2.79 [1.51, 5.15], P=0.0011); and atrial fibrillation (5.93 [2.88, 12.2], P=0.0001). There was no significant effect of pacing mode on the presence or absence of AHREs. CONCLUSIONS AHRE detected by pacemakers in patients with SND identify patients that are more than twice as likely to die or have a stroke, and 6 times as likely to develop atrial fibrillation as similar patients without AHRE.
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Affiliation(s)
- Taya V Glotzer
- Division of Electrophysiology , Hackensack University Medical Center, Hackensack, NJ, USA.
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40
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Glotzer TV, Radoslovich GA, Neglia J, Zimmerman JM. Variability of atrial sensing during exercise in a patient with a dual chamber ICD caused inappropriate ICD discharges. Pacing Clin Electrophysiol 1999; 22:1838-41. [PMID: 10642144 DOI: 10.1111/j.1540-8159.1999.tb00424.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present the case of a patient with a dual chamber implantable cardioverter defibrillator (ICD) who experienced inappropriate ICD discharges during exercise. Interrogation of the ICD revealed intermittent atrial undersensing during exercise that was responsible for the erroneous classification by the ICD of sinus tachycardia as ventricular tachycardia. Monitoring of the intracardiac electrograms and Marker Channels during an exercise test confirmed a marked decrease in P wave amplitude during exercise. By increasing the atrial sensitivity setting the problem was resolved.
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Affiliation(s)
- T V Glotzer
- Section of Electrophysiology, Hackensack University Medical Center, NJ 07601, USA
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Glotzer TV, Gordon M, Sparta M, Radoslovich G, Zimmerman J. Electromagnetic interference from a muscle stimulation device causing discharge of an implantable cardioverter defibrillator: epicardial bipolar and endocardial bipolar sensing circuits are compared. Pacing Clin Electrophysiol 1998; 21:1996-8. [PMID: 9793098 DOI: 10.1111/j.1540-8159.1998.tb00021.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This case report is about two patients with two different types of ICDs who underwent electrical muscle stimulation (EMS) therapy. In one patient with an ICD that has epicardial screw-in bipolar sensing leads, electromagnetic interference (EMI) from the EMS device caused the delivery of an inappropriate ICD discharge. In a second patient with an ICD with endocardial true bipolar sensing, there was no evidence of EMI during the EMS therapy despite all of our attempts to reproduce it. The sensing circuits in the two different ICDs are compared.
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Affiliation(s)
- T V Glotzer
- Department of Medicine, Hackensack University Medical Center, New Jersey 07601, USA
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Abstract
Supraventricular arrhythmias, often seen in patients after cardiac surgery, may be associated with scars produced in the atria at the time of surgery. Double potentials, found in the presence of functional or anatomical block, can define the limits and critical regions of a reentrant circuit associated with the atriotomy scars. We describe six patients with seven distinct atrial tachycardias in whom atriotomy scars were successfully mapped during intraatrial reentry utilizing the presence and interelectrogram relationship of observed double potentials. The reentrant circuit was mapped in all patients by following the relationship between double potentials along the surgical scar, assuming that they would be widely split in the middle of the scar and merge into a single continuous fractionated potential at the apex of the scar. At this site, atrial pacing was performed to entrain the tachycardia and confirm the participation of the atriotomy scar in the clinically relevant atrial tachycardia. Radiofrequency ablation was performed from the site of electrogram fusion to the nearest anatomical obstacle. Five of seven atrial tachycardias were successfully ablated utilizing this technique over a mean follow-up of 10 months. We proposed that these double potentials and their interelectrogram relationship are an effective means of mapping atriotomy scars and guiding successful radiofrequency ablation.
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Affiliation(s)
- L A Chinitz
- New York University Medical Center, New York 10016, USA
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Abstract
The biatrial approach to exposing the mitral valve during surgery has the potential for improving visualization of the valve with minimal cardiac manipulation. This procedure, involving a right atriotomy and an extended transseptal incision, may isolate the sinus node from its normal blood supply and autonomic innervation. Thirty-eight consecutive patients undergoing this procedure were examined. Twenty-two of these patients (58%) were admitted in normal sinus rhythm and 15 (40%) were in atrial fibrillation (AF) or atrial flutter. Of the 22 patients admitted in normal sinus rhythm, only 3 patients remained in this rhythm at discharge. Fourteen of the 22 patients were discharged in a slow, low atrial rhythm. All of the patients admitted in AF were discharged in AF. Of the 14 patients discharged in a low atrial rhythm, the rhythm persisted in eleven patients (80%) at a mean of 6-month follow-up. The routine use of this transseptal approach to mitral valve surgery needs further assessment in light of the predictable loss of the sinus mechanism.
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Affiliation(s)
- N E Bernstein
- Department of Cardiac Electrophysiology, New York University Medical Center, New York 10016, USA
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Glotzer TV, Tunick PA, Kloth H, Galloway AC, Kronzon I. Thrombosis of a Starr-Edwards tricuspid prosthesis: diagnosis by Doppler echocardiography and treatment with thrombolysis. Am Heart J 1994; 127:705-8. [PMID: 8122627 DOI: 10.1016/0002-8703(94)90688-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 01/28/2023]
Affiliation(s)
- T V Glotzer
- Department of Medicine, New York University Medical Center, NY
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Glotzer TV, Liebes LF, Kanganis D, Silber R. Relationship of fluorescence polarization to cell lineage in lymphocytes from normal subjects and patients with chronic lymphocytic leukemia. Am J Hematol 1987; 26:229-36. [PMID: 3499816 DOI: 10.1002/ajh.2830260304] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Previous investigations have shown differences in fluorescence polarization between normal and chronic lymphocytic leukemia lymphocytes following incubation with the probe 1,6-diphenyl-1,3,5-hexatriene. In the present study, we determined the fluorescence polarization of unseparated or enriched subpopulations of T and B lymphocytes from normal subjects and patients with chronic lymphocytic leukemia. As had been observed by others, the mean polarization (P) value at 25 degrees C for unseparated chronic lymphocytic leukemia lymphocytes, .240 +/- .007 (N = 22), was lower than that of unseparated normal lymphocytes, .248 +/- .005 (N = 18), P less than .001 (Student's t-test). The difference was greater when B-enriched populations were compared. The mean P value of B-cell-enriched chronic lymphocytic leukemia lymphocytes, .240 +/- .007 (N = 5), was significantly lower than that of B-cell-enriched normal preparations, .256 +/- .004 (N = 5), P less than .001. In contrast, no significant difference was found between normal and chronic lymphocytic leukemia T cells. The anomalous fluorescence polarization manifested by chronic lymphocytic leukemia lymphocytes of B-cell origin serves to distinguish this lineage from its normal counterpart and from T cells of either source.
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Affiliation(s)
- T V Glotzer
- Department of Medicine, New York University School of Medicine, NY 10016
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