401
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Huang BT, Huang FY, Peng Y, Liao YB, Chen F, Xia TL, Pu XB, Chen M. Relation of premature atrial complexes with stroke and death: Systematic review and meta-analysis. Clin Cardiol 2017; 40:962-969. [PMID: 28846809 DOI: 10.1002/clc.22780] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 02/05/2023] Open
Abstract
Frequent premature atrial complexes (PACs) are universal in the general population; however, their clinical significance is unclear. We hypothesize that frequent PACs are associated with increased risk of stroke and death. The PubMed (from 1966 to April 2017) and Embase (from 1974 to April 2017) databases were searched for longitudinal studies that reported the relation of PACs with incidence of stroke and death with various etiologies. Study quality was evaluated, and the relative risks (RR) of unfavorable outcomes in subjects with frequent PACs vs those without were calculated. Eleven studies with overall high quality were eligible according to inclusion criteria. The meta-analysis demonstrated that frequent PACs were associated with an increased risk of stroke (unadjusted RR: 2.20, 95% confidence interval [CI]: 1.79-2.70; adjusted RR: 1.41, 95% CI: 1.25-1.60) and death from all causes (unadjusted RR: 2.17, 95% CI: 1.80-2.63; adjusted RR: 1.26, 95% CI: 1.13-1.41), cardiovascular diseases (unadjusted RR: 2.89, 95% CI: 2.20-3.79; adjusted RR: 1.38, 95% CI: 1.24-1.54), and coronary artery disease (unadjusted RR: 2.74, 95% CI: 1.64-4.58; adjusted RR: 1.74, 95% CI: 1.27-2.37). No significant publication bias was detected. The association was robust in sensitivity analysis, subgroup analysis, and pooled analysis of estimates adjusting for confounding factors. Frequent PACs are not benign phenomena; they are associated with higher risk of unfavorable outcomes. Further research on the optimal management of subjects with frequent PACs is urgently required.
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Affiliation(s)
- Bao-Tao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Li Xia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Bo Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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402
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Hammond-Haley M, Providência R, Lambiase PD. Temporal pattern/episode duration-based classification of atrial fibrillation as paroxysmal vs. persistent: is it time to develop a more integrated prognostic score to optimize management? Europace 2017; 20:f288-f298. [PMID: 29016766 DOI: 10.1093/europace/eux178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/01/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Rui Providência
- Bart’s Heart Centre, Bart’s Health NHS Trust, St. Bartholomew's Hospital, West Smithfield, London, UK
| | - Pier D Lambiase
- Bart’s Heart Centre, Bart’s Health NHS Trust, St. Bartholomew's Hospital, West Smithfield, London, UK
- Institute of Cardiovascular Science, University College & Barts Heart Centre, Paul O’Gorman Building, Huntley St, London, UK
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403
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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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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404
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Hanif W, Alex L, Su Y, Shinde AV, Russo I, Li N, Frangogiannis NG. Left atrial remodeling, hypertrophy, and fibrosis in mouse models of heart failure. Cardiovasc Pathol 2017; 30:27-37. [PMID: 28759817 DOI: 10.1016/j.carpath.2017.06.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 12/30/2022] Open
Abstract
Left ventricular dysfunction increases left atrial pressures and causes atrial remodeling. In human subjects, increased left atrial size is a powerful predictor of mortality and adverse events in a broad range of cardiac pathologic conditions. Moreover, structural remodeling of the atrium plays an important role in the pathogenesis of atrial tachyarrhythmias. Despite the potential value of the atrium in assessment of functional endpoints in myocardial disease, atrial pathologic alterations in mouse models of left ventricular disease have not been systematically investigated. Our study describes the geometric, morphologic, and structural changes in experimental mouse models of cardiac pressure overload (induced through transverse aortic constriction), myocardial infarction, and diabetes. Morphometric and histological analysis showed that pressure overload was associated with left atrial dilation, increased left atrial mass, loss of myofibrillar content in a subset of atrial cardiomyocytes, atrial cardiomyocyte hypertrophy, and atrial fibrosis. In mice undergoing nonreperfused myocardial infarction protocols, marked left ventricular systolic dysfunction was associated with left atrial enlargement, atrial cardiomyocyte hypertrophy, and atrial fibrosis. Both infarcted animals and pressure overloaded mice exhibited attenuation and perturbed localization of atrial connexin-43 immunoreactivity, suggesting gap junctional remodeling. In the absence of injury, obese diabetic db/db mice had diastolic dysfunction associated with atrial dilation, atrial cardiomyocyte hypertrophy, and mild atrial fibrosis. Considering the challenges in assessment of clinically relevant functional endpoints in mouse models of heart disease, study of atrial geometry and morphology may serve as an important new tool for evaluation of ventricular function.
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Affiliation(s)
- Waqas Hanif
- The Wilf Family Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY
| | - Linda Alex
- The Wilf Family Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY
| | - Ya Su
- The Wilf Family Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY
| | - Arti V Shinde
- The Wilf Family Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY
| | - Ilaria Russo
- The Wilf Family Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY
| | - Na Li
- The Wilf Family Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY
| | - Nikolaos G Frangogiannis
- The Wilf Family Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY.
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405
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Abstract
There has been a significant progress in our understanding of the molecular mechanisms by which calcium (Ca2+) ions mediate various types of cardiac arrhythmias. A growing list of inherited gene defects can cause potentially lethal cardiac arrhythmia syndromes, including catecholaminergic polymorphic ventricular tachycardia, congenital long QT syndrome, and hypertrophic cardiomyopathy. In addition, acquired deficits of multiple Ca2+-handling proteins can contribute to the pathogenesis of arrhythmias in patients with various types of heart disease. In this review article, we will first review the key role of Ca2+ in normal cardiac function-in particular, excitation-contraction coupling and normal electric rhythms. The functional involvement of Ca2+ in distinct arrhythmia mechanisms will be discussed, followed by various inherited arrhythmia syndromes caused by mutations in Ca2+-handling proteins. Finally, we will discuss how changes in the expression of regulation of Ca2+ channels and transporters can cause acquired arrhythmias, and how these mechanisms might be targeted for therapeutic purposes.
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Affiliation(s)
- Andrew P Landstrom
- From the Section of Cardiology, Department of Pediatrics (A.P.L.), Cardiovascular Research Institute (A.P.L., X.H.T.W.), and Departments of Molecular Physiology and Biophysics, Medicine (Cardiology), Center for Space Medicine (X.H.T.W.), Baylor College of Medicine, Houston, TX; and Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.)
| | - Dobromir Dobrev
- From the Section of Cardiology, Department of Pediatrics (A.P.L.), Cardiovascular Research Institute (A.P.L., X.H.T.W.), and Departments of Molecular Physiology and Biophysics, Medicine (Cardiology), Center for Space Medicine (X.H.T.W.), Baylor College of Medicine, Houston, TX; and Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.)
| | - Xander H T Wehrens
- From the Section of Cardiology, Department of Pediatrics (A.P.L.), Cardiovascular Research Institute (A.P.L., X.H.T.W.), and Departments of Molecular Physiology and Biophysics, Medicine (Cardiology), Center for Space Medicine (X.H.T.W.), Baylor College of Medicine, Houston, TX; and Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.).
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406
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Hammwöhner M, Goette A. Kidney diseases and NOAC therapy: Is there a light at the end of the tunnel? Int J Cardiol 2017; 236:162-163. [DOI: 10.1016/j.ijcard.2017.01.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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407
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Zakeri R, Van Wagoner DR, Calkins H, Wong T, Ross HM, Heist EK, Meyer TE, Kowey PR, Mentz RJ, Cleland JG, Pitt B, Zannad F, Linde C. The burden of proof: The current state of atrial fibrillation prevention and treatment trials. Heart Rhythm 2017; 14:763-782. [PMID: 28161513 PMCID: PMC5403606 DOI: 10.1016/j.hrthm.2017.01.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is an age-related arrhythmia of enormous socioeconomic significance. In recent years, our understanding of the basic mechanisms that initiate and perpetuate AF has evolved rapidly, catheter ablation of AF has progressed from concept to reality, and recent studies suggest lifestyle modification may help prevent AF recurrence. Emerging developments in genetics, imaging, and informatics also present new opportunities for personalized care. However, considerable challenges remain. These include a paucity of studies examining AF prevention, modest efficacy of existing antiarrhythmic therapies, diverse ablation technologies and practice, and limited evidence to guide management of high-risk patients with multiple comorbidities. Studies examining the long-term effects of AF catheter ablation on morbidity and mortality outcomes are not yet completed. In many ways, further progress in the field is heavily contingent on the feasibility, capacity, and efficiency of clinical trials to incorporate the rapidly evolving knowledge base and to provide substantive evidence for novel AF therapeutic strategies. This review outlines the current state of AF prevention and treatment trials, including the foreseeable challenges, as discussed by a unique forum of clinical trialists, scientists, and regulatory representatives in a session endorsed by the Heart Rhythm Society at the 12th Global CardioVascular Clinical Trialists Forum in Washington, DC, December 3-5, 2015.
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Affiliation(s)
- Rosita Zakeri
- Royal Brompton & Harefield NHS Trust, London, United Kingdom.
| | | | | | - Tom Wong
- Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | | | - E Kevin Heist
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Peter R Kowey
- Lankenau Heart Institute and Jefferson Medical College, Wynnewood, Pennsylvania
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina
| | - John G Cleland
- Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | | | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, France
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408
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Gaeta M, Bandera F, Tassinari F, Capasso L, Cargnelutti M, Pelissero G, Malavazos AE, Ricci C. Is epicardial fat depot associated with atrial fibrillation? A systematic review and meta-analysis. Europace 2017; 19:747-752. [DOI: 10.1093/europace/euw398] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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409
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Abstract
The past 3 decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported 17 independent signals for AF at 14 genomic regions. Studies have established that advanced age, male sex, and European ancestry are prominent AF risk factors. Other modifiable risk factors include sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and elevated blood pressure predispose to AF, and each factor has been shown to induce structural and electric remodeling of the atria. Both heart failure and myocardial infarction increase risk of AF and vice versa creating a feed-forward loop that increases mortality. Other cardiovascular outcomes attributed to AF, including stroke and thromboembolism, are well established, and epidemiology studies have championed therapeutics that mitigate these adverse outcomes. However, the role of anticoagulation for preventing dementia attributed to AF is less established. Our review is a comprehensive examination of the epidemiological data associating unmodifiable and modifiable risk factors for AF and of the pathophysiological evidence supporting the mechanistic link between each risk factor and AF genesis. Our review also critically examines the epidemiological data on clinical outcomes attributed to AF and summarizes current evidence linking each outcome with AF.
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Affiliation(s)
- Laila Staerk
- Cardiovascular Research Centre, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States
| | - Jason A. Sherer
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Darae Ko
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Robert H. Helm
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
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410
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Thanigaimani S, Lau DH, Agbaedeng T, Elliott AD, Mahajan R, Sanders P. Molecular mechanisms of atrial fibrosis: implications for the clinic. Expert Rev Cardiovasc Ther 2017; 15:247-256. [DOI: 10.1080/14779072.2017.1299005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Shivshankar Thanigaimani
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Thomas Agbaedeng
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D. Elliott
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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411
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Atrial fibrillation prevention and treatment trials-Looking toward the future. Heart Rhythm 2017; 14:783-784. [PMID: 28254413 DOI: 10.1016/j.hrthm.2017.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Indexed: 11/23/2022]
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412
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Begg GA, Karim R, Oesterlein T, Graham LN, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. Intra-cardiac and peripheral levels of biochemical markers of fibrosis in patients undergoing catheter ablation for atrial fibrillation. Europace 2017; 19:1944-1950. [DOI: 10.1093/europace/euw315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/10/2016] [Indexed: 12/13/2022] Open
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413
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Kloosterman M, Rienstra M, Crijns HJ, Healey JS, Van Gelder IC. The left atrium: An overlooked prognostic tool. Eur J Prev Cardiol 2017; 24:389-391. [PMID: 28067538 DOI: 10.1177/2047487316686633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Mariëlle Kloosterman
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Harry J Crijns
- 2 Department of Cardiology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Jeff S Healey
- 3 Population Health Research Institute, McMaster University, Ontario, Canada
| | - Isabelle C Van Gelder
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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414
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Heijman J, Ghezelbash S, Wehrens XHT, Dobrev D. Serine/Threonine Phosphatases in Atrial Fibrillation. J Mol Cell Cardiol 2017; 103:110-120. [PMID: 28077320 DOI: 10.1016/j.yjmcc.2016.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 12/19/2022]
Abstract
Serine/threonine protein phosphatases control dephosphorylation of numerous cardiac proteins, including a variety of ion channels and calcium-handling proteins, thereby providing precise post-translational regulation of cardiac electrophysiology and function. Accordingly, dysfunction of this regulation can contribute to the initiation, maintenance and progression of cardiac arrhythmias. Atrial fibrillation (AF) is the most common heart rhythm disorder and is characterized by electrical, autonomic, calcium-handling, contractile, and structural remodeling, which include, among other things, changes in the phosphorylation status of a wide range of proteins. Here, we review AF-associated alterations in the phosphorylation of atrial ion channels, calcium-handling and contractile proteins, and their role in AF-pathophysiology. We highlight the mechanisms controlling the phosphorylation of these proteins and focus on the role of altered dephosphorylation via local type-1, type-2A and type-2B phosphatases (PP1, PP2A, and PP2B, also known as calcineurin, respectively). Finally, we discuss the challenges for phosphatase research, potential therapeutic significance of altered phosphatase-mediated protein dephosphorylation in AF, as well as future directions.
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Affiliation(s)
- Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Shokoufeh Ghezelbash
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Department of Molecular Physiology and Biophysics, Department of Medicine (Cardiology), Pediatrics, Baylor College of Medicine, Houston, USA
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.
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415
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Goette A, Heidbuchel H. Practical Implementation of Anticoagulation Strategy for Patients Undergoing Cardioversion of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2017; 6:50-54. [PMID: 28835835 DOI: 10.15420/aer.2017:3:2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Anticoagulation is routinely prescribed to patients with persistent AF before cardioversion to reduce the risk of thromboembolic events. As direct oral anticoagulants (DOACs) have a rapid onset of action, a consistent anticoagulant effect, if taken correctly, and do not need monitoring or dose adjustments, there is considerable interest in their use for patients with AF undergoing cardioversion. Post-hoc analyses show that DOACs are safe to use prior to and following cardioversion. In addition, two randomised controlled trials, X-VeRT and ENSURE-AF, have demonstrated the efficacy and safety of the DOACs rivaroxaban and edoxaban, respectively, in this setting. The use of DOACs allows cardioversions to be performed promptly and reduces the number of cancelled procedures compared with the use of warfarin.
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Affiliation(s)
| | - Hein Heidbuchel
- Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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416
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417
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Nattel S. Close connections between contraction and rhythm: a new genetic cause of atrial fibrillation/cardiomyopathy and what it can teach us. Eur Heart J 2016; 38:35-37. [DOI: 10.1093/eurheartj/ehw457] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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418
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Goette A, Merino JL, Ezekowitz MD, Zamoryakhin D, Melino M, Jin J, Mercuri MF, Grosso MA, Fernandez V, Al-Saady N, Pelekh N, Merkely B, Zenin S, Kushnir M, Spinar J, Batushkin V, de Groot JR, Lip GYH. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet 2016; 388:1995-2003. [PMID: 27590218 DOI: 10.1016/s0140-6736(16)31474-x] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 07/09/2016] [Accepted: 07/13/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. METHODS We did a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin-warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The dose of edoxaban was reduced to 30 mg per day if one or more factors (creatinine clearance 15-50 mL/min, low bodyweight [≤60 kg], or concomitant use of P-glycoprotein inhibitors) were present. Block randomisation (block size four)-stratified by cardioversion approach (transoesophageal echocardiography [TEE] or not), anticoagulant experience, selected edoxaban dose, and region-was done through a voice-web system. The primary efficacy endpoint was a composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular mortality, analysed by intention to treat. The primary safety endpoint was major and clinically relevant non-major (CRNM) bleeding in patients who received at least one dose of study drug. Follow-up was 28 days on study drug after cardioversion plus 30 days to assess safety. This trial is registered with ClinicalTrials.gov, number NCT02072434. FINDINGS Between March 25, 2014, and Oct 28, 2015, 2199 patients were enrolled and randomly assigned to receive edoxaban (n=1095) or enoxaparin-warfarin (n=1104). The mean age was 64 years (SD 10·54) and mean CHA2DS2-VASc score was 2·6 (SD 1·4). Mean time in therapeutic range on warfarin was 70·8% (SD 27·4). The primary efficacy endpoint occurred in five (<1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio [OR] 0·46, 95% CI 0·12-1·43). The primary safety endpoint occurred in 16 (1%) of 1067 patients given edoxaban versus 11 (1%) of 1082 patients given enoxaparin-warfarin (OR 1·48, 95% CI 0·64-3·55). The results were independent of the TEE-guided strategy and anticoagulation status. INTERPRETATION ENSURE-AF is the largest prospective randomised clinical trial of anticoagulation for cardioversion of patients with non-valvular atrial fibrillation. Rates of major and CRNM bleeding and thromboembolism were low in the two treatment groups. FUNDING Daiichi Sankyo provided financial support for the study.
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Affiliation(s)
- Andreas Goette
- Cardiology and Intensive Care Medicine, St Vincenz-Hospital, Paderborn, Germany; Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany.
| | - Jose L Merino
- Arrhythmia and Robotic Electrophysiology Unit, Hospital Universitario La Paz, Universidad Europea, Madrid, Spain
| | - Michael D Ezekowitz
- Department of Cardiovascular Medicine, Sidney Kimmel Jefferson Medical College at Thomas Jefferson University and Lankenau Medical Center, Broomall, PA, USA
| | - Dmitry Zamoryakhin
- Cardiovascular Clinical Development, Daiichi Sankyo Development, Gerrards Cross, UK
| | - Michael Melino
- Clinical Development, Cardiovascular and Metabolism, Daiichi Sankyo Pharma Development, Edison, NJ, USA
| | - James Jin
- Biostatistics, Daiichi Sankyo Pharma Development, Edison, NJ, USA
| | - Michele F Mercuri
- Clinical Development, Cardiovascular and Metabolism, Daiichi Sankyo Pharma Development, Edison, NJ, USA
| | - Michael A Grosso
- Clinical Development, Cardiovascular and Metabolism, Daiichi Sankyo Pharma Development, Edison, NJ, USA
| | - Victor Fernandez
- Clinical Development, Cardiovascular and Metabolism, Daiichi Sankyo Pharma Development, Edison, NJ, USA
| | | | | | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Sergey Zenin
- State Budget Healthcare Institution of Novosibirsk region "Novosibirsk Region Clinical Cardiology Hospital", Novosibirsk, Russia
| | - Mykola Kushnir
- Cardiology Department, Zhytomyr Regional Clinical Hospital, Chervonogo Khresta str Zhytomyr, Ukraine
| | | | - Valeriy Batushkin
- Cardiology and Intensive Care Department, Kiev City Clinical Hospital #5, Kiev, Ukraine
| | - Joris R de Groot
- Clinical Electrophysiology, Heart Center, Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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419
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Prognosis in patients with atrial fibrillation and a presumed “temporary cause” in a community-based cohort study. Clin Res Cardiol 2016; 106:202-210. [DOI: 10.1007/s00392-016-1040-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
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