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Waranugraha Y, Tsai CT, Lin LY. Index-Guided High-Power Radiofrequency Catheter Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis Study. Curr Cardiol Rep 2023; 25:1397-1414. [PMID: 37874469 DOI: 10.1007/s11886-023-01968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW Studies have suggested the superiority of high-power compared to standard-power radiofrequency ablation ablation (RFCA). This study aimed to assess the efficacy and safety of high-power compared to standard-power RFCA guided by ablation index (AI) or lesion index (LSI). RECENT FINDINGS A systematic review and meta-analysis study comparing IGHP and IGLP approaches for AF ablation was conducted. The relevant published studies comparing IGHP and IGSP methods for RFCA in AF patients until October 2022 were collected from Cochrane, ProQuest, PubMed, and ScienceDirect. A total of 2579 AF patients from 11 studies were included, 1682 received IGHP RFCA, and 897 received IGSP RFCA. To achieve successful pulmonary vein isolation (PVI), the IGHP RFCA group had a significantly shorter procedure time than the IGHP RFCA group (mean difference (MD) -19.91 min; 95% CI -25.23 to -14.59 min; p < 0.01), radiofrequency (RF) application time (MD -10.92 min; 95% CI -14.70 to -7.13 min; p < 0.01), and fewer number of lesions (MD -10.90; 95% CI -18.77 to -3.02; p < 0.01) than the IGSP RFCA. First-pass PVI was significantly greater in the IGHP RFCA group than in the IGSP RFCA group (risk ratio (RR) 1.17; 95% CI 1.07 to 1.28; p < 0.01). The IGHP RFCA is an effective and efficient strategy for AF ablation. The superiority of IGHP RFCA includes the shorter procedure time, shorter RF application time, fewer number of lesions for complete PVI, and more excellent first-pass PVI.
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Affiliation(s)
- Yoga Waranugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Brawijaya, Universitas Brawijaya Hospital, Malang, Indonesia
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Uruthirakumar P, Surenthirakumaran R, Gooden TE, Lip GYH, Thomas GN, Moore DJ, Nirantharakumar K, Kumarendran B, Subaschandran K, Kaneshamoorthy S, Sheron VA, Guruparan M. The impact of rate and rhythm control strategies on quality of life for patients with atrial fibrillation: a protocol for a systematic review. Syst Rev 2023; 12:52. [PMID: 36945026 PMCID: PMC10029179 DOI: 10.1186/s13643-023-02197-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/24/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common heart arrhythmia globally and it adversely affects the quality of life (QoL). Available rate and rhythm control strategies equally reduce mortality but may impact QoL differently. A number of systematic reviews have focused on the impact of specific strategies on QoL, though a 2006 review synthesized the evidence on the effect of all strategies on QoL, allowing for a clinically important comparison between the types of strategies. Many trials have been published since the review undertook the search in 2005; therefore, an update is needed. This systematic review aims to provide an update to the 2006 review on the impact of all rate and rhythm control strategies on QoL in people with AF. METHODS The following four databases and three clinical trial registries will be searched for primary studies: CENTRAL, MEDLINE, Embase, CINAHL, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and ClinicalTrialsRegister.eu. No language restriction will be applied. The search will be limited to 2004 or later publication year to allow overlap with the search conducted by the 2006 review authors. Any randomized control trial that reports the QoL of adult (≥ 18 years) AF patients following an eligible rate or rhythm control intervention will be eligible for inclusion. Eligible interventions (and comparators) include pacing, atrioventricular node junction and bundle of HIS ablation, pharmacological therapy, radio frequency catheter ablation, cryoablation, pulmonary vein isolation, maze operation, pace maker implantation, and defibrillator implantation. Two reviewers will independently screen for eligible studies, extract the data using a piloted tool, and assess bias by QoL outcome using the RoB 2 tool. The suitability of conducting a meta-analysis will be assessed by the clinical and methodology similarities of included studies. If it is feasible, standardized mean differences will be pooled using a random-effects model and assessed appropriately. DISCUSSION The findings from this review will allow for meaningful comparisons between various rate and rhythm control strategies regarding their impact on QoL. This review will be useful for a wide range of stakeholders and will be crucial for optimizing the overall wellbeing of AF patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021290542.
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Affiliation(s)
- Powsiga Uruthirakumar
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
| | - Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gregory Y H Lip
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David J Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Balachandran Kumarendran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Kumaran Subaschandran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Shribavan Kaneshamoorthy
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Vethanayagam Antony Sheron
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
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Andrade JG, Deyell MW, Dubuc M, Macle L. Cryoablation as a first-line therapy for atrial fibrillation: current status and future prospects. Expert Rev Med Devices 2022; 19:623-631. [PMID: 36168922 DOI: 10.1080/17434440.2022.2129008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is a common chronic and progressive heart rhythm disorder. For those in whom sinus rhythm is desired, contemporary clinical practice guidelines recommend antiarrhythmic drugs (AADs) as the initial therapy. However, these medications have modest efficacy and are associated with significant adverse effects. AREAS COVERED The current article reviews the evidence surrounding first line catheter ablation, particularly the emerging evidence surrounding the use of cryoballoon ablation as a first-line therapy. The focus of the review is on the outcomes of arrhythmia freedom, quality of life, healthcare utilisation and safety. In addition, the article will review novel cryoablation systems. EXPERT OPINION : Recent evidence suggests that cryoballoon ablation significantly improves arrhythmia outcomes (e.g., freedom from any atrial tachyarrhythmia or symptomatic atrial tachyarrhythmia, reduction in arrhythmia burden), patient-reported outcomes (e.g., symptoms and quality of life), and healthcare resource utilization (e.g., hospitalization), without increasing the risk of adverse events. These findings are relevant to patients, providers, and healthcare systems, as it helps inform the decision-making regarding the initial choice of rhythm-control therapy in patients with treatment-naïve AF.
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Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada.,Department of Medicine, University of British Columbia, Canada.,Center for Cardiovascular Innovation, Vancouver, Canada
| | - Marc W Deyell
- Department of Medicine, University of British Columbia, Canada.,Center for Cardiovascular Innovation, Vancouver, Canada
| | - Marc Dubuc
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada
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Sly D, Husted M, McKeague L, Everington T. "I just didn't want to trust it at all": Atrial fibrillation patient's treatment experience of rivaroxaban and warfarin. J Eval Clin Pract 2022; 28:436-444. [PMID: 34636130 DOI: 10.1111/jep.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the treatment of atrial fibrillation (AF), anticoagulant medications such as warfarin and rivaroxaban are commonly prescribed to reduce the risk of ischaemic strokes, and other thromboembolic events. Research has highlighted advantages and disadvantages of each of these medications, but there remains an absence of qualitative evidence regarding the lived experiences of AF patients. The present study helps address this gap and obtain a greater understanding of the patient experience and beliefs surrounding their anticoagulant medication. METHOD Semi-structured qualitative interviews with a purposive sample of 20 participants (10 warfarin, 10 rivaroxaban). Interviews were transcribed verbatim and thematically analysed. RESULTS Data analysis led to the generation of three key themes: positive perceptions of medication, distrust of alternatives, and inconsistencies in support experiences. CONCLUSIONS Positive perceptions of one anticoagulant medication (ACM) and distrust of alternatives may influence patients' confidence in switching medications. This is potentially problematic where there is a lack of patient engagement in medication changes, as seen during the COVID pandemic. Gaps in patient understanding of anticoagulation, including lack of clarity around medications selection and misconceptions about treatment, were evident. By addressing these misconceptions, clinicians may be better positioned to support people with AF in self-management of their ACM.
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Affiliation(s)
- Dan Sly
- Haematology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Margaret Husted
- Psychology Department, University of Winchester, Winchester, UK
| | - Lynn McKeague
- Psychology Department, University of Winchester, Winchester, UK
| | - Tamara Everington
- Haematology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
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Casteigt B, Samuel M, Laplante L, Shohoudi A, Apers S, Kovacs AH, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Brouillette J, Moons P, Khairy P. Atrial arrhythmias and patient-reported outcomes in adults with congenital heart disease: An international study. Heart Rhythm 2020; 18:793-800. [PMID: 32961334 DOI: 10.1016/j.hrthm.2020.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/31/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Atrial arrhythmias (ie, intra-atrial reentrant tachycardia and atrial fibrillation) are a leading cause of morbidity and hospitalization in adults with congenital heart disease (CHD). Little is known about their effect on quality of life and other patient-reported outcomes (PROs) in adults with CHD. OBJECTIVE The purpose of this study was to assess the impact of atrial arrhythmias on PROs in adults with CHD and explore geographic variations. METHODS Associations between atrial arrhythmias and PROs were assessed in a cross-sectional study of adults with CHD from 15 countries spanning 5 continents. A propensity-based matching weight analysis was performed to compare quality of life, perceived health status, psychological distress, sense of coherence, and illness perception in patients with and those without atrial arrhythmias. RESULTS A total of 4028 adults with CHD were enrolled, 707 (17.6%) of whom had atrial arrhythmias. After applying matching weights, patients with and those without atrial arrhythmias were comparable with regard to age (mean 40.1 vs 40.2 years), demographic variables (52.5% vs 52.2% women), and complexity of CHD (15.9% simple, 44.8% moderate, and 39.2% complex in both groups). Patients with atrial arrhythmias had significantly worse PRO scores with respect to quality of life, perceived health status, psychological distress (ie, depression), and illness perception. A summary score that combines all PRO measures was significantly lower in patients with atrial arrhythmias (-3.3%; P = .0006). Differences in PROs were consistent across geographic regions. CONCLUSION Atrial arrhythmias in adults with CHD are associated with an adverse impact on a broad range of PROs consistently across various geographic regions.
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Affiliation(s)
| | - Michelle Samuel
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Azadeh Shohoudi
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Koen Luyckx
- KU Leuven-University of Leuven, Psychology and Development in Context, Leuven, Belgium and UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
| | - Maayke A Sluman
- Department of Cardiology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands and Coronel Institute for Occupational Health, Academic Medical Centre, Amsterdam, the Netherlands
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | | | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Department of Cardiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg and Department of Health Sciences, University West, Trollhättan, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Lyon, France
| | - Susan M Fernandes
- Department of Pediatrics and Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, and University of Missouri, Saint Louis, Missouri
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center, University of Nebraska Medical Center/Children's Hospital & Medical Center, Omaha, Nebraska
| | | | - Philip Moons
- KU Leuven-University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden, and Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Canada.
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