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Heidbuchel H, Adami PE, Antz M, Braunschweig F, Delise P, Scherr D, Solberg EE, Wilhelm M, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions: Part 1: Supraventricular arrhythmias. A position statement of the Section of Sports Cardiology and Exercise from the European Association of Preventive Cardiology (EAPC) and the European Heart Rhythm Association (EHRA), both associations of the European Society of Cardiology. Eur J Prev Cardiol 2021; 28:1539-1551. [PMID: 32597206 DOI: 10.1177/2047487320925635] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 01/02/2023]
Abstract
Symptoms attributable to arrhythmias are frequently encountered in clinical practice. Cardiologists and sport physicians are required to identify high-risk individuals harbouring such conditions and provide appropriate advice regarding participation in regular exercise programmes and competitive sport. The three aspects that need to be considered are: (a) the risk of life-threatening arrhythmias by participating in sports; (b) control of symptoms due to arrhythmias that are not life-threatening but may hamper performance and/or reduce the quality of life; and (c) the impact of sports on the natural progression of the underlying arrhythmogenic condition. In many cases, there is no unequivocal answer to each aspect and therefore an open discussion with the athlete is necessary, in order to reach a balanced decision. In 2006 the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology published recommendations for participation in leisure-time physical activity and competitive sport in individuals with arrhythmias and potentially arrhythmogenic conditions. More than a decade on, these recommendations are partly obsolete given the evolving knowledge of the diagnosis, management and treatment of these conditions. The present document presents a combined effort by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology and the European Heart Rhythm Association to offer a comprehensive overview of the most updated recommendations for practising cardiologists and sport physicians managing athletes with supraventricular arrhythmias, and provides pragmatic advice for safe participation in recreational physical activities, as well as competitive sport at amateur and professional level. A companion text on recommendations in athletes with ventricular arrhythmias, inherited arrhythmogenic conditions, pacemakers and implantable defibrillators is published as Part 2 in Europace.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Paolo E Adami
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Italy
| | - Matthias Antz
- Department of Electrophysiology, Hospital Braunschweig, Germany
| | | | | | - Daniel Scherr
- Department of Medicine, Medical University of Graz, Austria
| | | | | | - Antonio Pelliccia
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Italy
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2
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Vasudevan A, Hundae A, Borodge D, McCullough PA, Wells PJ. Frequency of atrial arrhythmias after atrial flutter ablation and the effect of presenting rhythm on the day of ablation. Proc (Bayl Univ Med Cent) 2018; 31:280-283. [PMID: 29904288 DOI: 10.1080/08998280.2018.1464305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 10/16/2022] Open
Abstract
Radiofrequency catheter ablation of the cavotricuspid isthmus is a proven therapy for typical atrial flutter (AFl); however, in some patients, new atrial arrhythmias (AA) may occur after AFl ablation. This study explored the difference in the occurrence of spontaneous AA after AFl ablation as a function of the patient's presenting rhythm on the day of the AFl ablation. A retrospective study of consecutive patients who underwent AFl ablation at Baylor University Medical Center at Dallas was performed. A total of 188 subjects were included; 50% (94) presented in AFl (Group AFl) on the day of the ablation procedure and 94 presented in sinus rhythm (SR; Group SR). Group AFl patients were older (P < 0.001), more likely to have diabetes (P = 0.03), and more likely to have undergone previous heart surgery (P = 0.03). The median size of the left atrium was 4 cm (range 2.8-6.8) in Group AFl compared with 3.8 cm (range 2.6-5.6) in Group SR (P = 0.009). Atrial fibrillation was induced during the ablation procedure in 7.5% and 21.3% of patients in Groups AFl and SR, respectively (P = 0.007). Overall, 29 of 188 (15.4%) patients developed new AA within 1 year of the procedure, 13.8% in Group AFl vs 17.0% in Group SR (P = 0.57). In conclusion, patients presenting for AFl ablation in SR were younger and healthier but had more atrial fibrillation induced during their ablation procedure, with a trend toward more postablation AA due to additional arrhythmia substrate.
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Affiliation(s)
- Anupama Vasudevan
- Baylor Research Institute, Dallas, Texas.,Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, Texas
| | - Aneley Hundae
- Bayfront Health Port Charlotte, Port Charlotte, Florida.,Division of Cardiology, Fawcett Memorial Hospital, Port Charlotte, Florida
| | - Darara Borodge
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Peter A McCullough
- Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, Texas.,Division of Cardiology, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, Baylor Heart and Vascular Hospital, Dallas, Texas
| | - Peter J Wells
- Division of Cardiology, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, Baylor Heart and Vascular Hospital, Dallas, Texas
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García-Seara J, Gude Sampedro F, Martínez Sande JL, Fernández López XA, Rodríguez Mañero M, González Melchor L, Alvarez Alvarez B, Iglesias Alvarez D, González Juanatey JR. Is HATCH score a reliable predictor of atrial fibrillation after cavotricuspid isthmus ablation for typical atrial flutter? IJC HEART & VASCULATURE 2017; 12:88-94. [PMID: 28616550 PMCID: PMC5454134 DOI: 10.1016/j.ijcha.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/21/2016] [Accepted: 05/02/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We determined the effectiveness of the HATCH score in patients with typical atrial flutter (AFl) undergoing cavotricuspid isthmus (CTI) ablation to predict long-term atrial fibrillation (AF). METHODS We conducted an observational retrospective single-center cohort study including all patients admitted to our hospital for a CTI ablation between 1998 and 2010. The patients were divided into four categories: 1) new-onset AF (no prior AF and AF during follow-up (FU)); 2) old AF (prior AF and no AF during FU); 3) prior and post AF (AF prior and post CTI ablation); and 4) no AF. RESULTS Four hundred and eight patients were included. In patients without prior AF, the hazard ratio (HR) for new-onset AF during FU was 0.98 (CI 95%: 0.65-1.50; p = 0.95) and 1.00 (CI 95%: 0.57-1.77; p = 0.98) for HATCH ≥ 2 and HATCH ≥ 3, respectively. In patients with prior AF, the HR for AF was 1.41 (CI 95%: 0.87-2.28; p = 0.17) and 1.79 (CI 95%: 0.96-3.35; p = 0.06), for HATCH ≥ 2 and HATCH ≥ 3, respectively. Left atrial enlargement was positively correlated with the occurrence of AF during FU, especially in the subgroup without prior AF, which had a HR of 2.44 (CI 95%: 1.35-4.40; p = 0.003), a HR of 2.88 (CI 95%: 1.36-6.10; p = 0.006) and a HR of 3.68 (CI 95%: 1.71-7.94; p = 0.001), for slight, moderate and severely dilated left atrial dimension, respectively, compared with a normal value. CONCLUSIONS HATCH score did not predict AF in patients with typical AFl who underwent CTI ablation. Basal left atrium dimension could help predict new-onset AF.
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Affiliation(s)
- Javier García-Seara
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico y Universitario de Santiago de Compostela, Spain
| | - Francisco Gude Sampedro
- Unidad de Epidemiología, Servicio de Cardiología, Hospital Clínico y Universitario de Santiago de Compostela, Spain
| | - Jose L Martínez Sande
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico y Universitario de Santiago de Compostela, Spain
| | | | - Moisés Rodríguez Mañero
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico y Universitario de Santiago de Compostela, Spain
| | - Laila González Melchor
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico y Universitario de Santiago de Compostela, Spain
| | - Belén Alvarez Alvarez
- Servicio de Cardiología, Hospital Clínico y Universitario de Santiago de Compostela, Spain
| | - Diego Iglesias Alvarez
- Servicio de Cardiología, Hospital Clínico y Universitario de Santiago de Compostela, Spain
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Atrial fibrillation in highly trained endurance athletes — Description of a syndrome. Int J Cardiol 2017; 226:11-20. [DOI: 10.1016/j.ijcard.2016.10.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/22/2022]
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Brembilla-Perrot B, Olivier A, Villemin T, Vincent J, Manenti V, Beurrier D, de la Chaise AT, Selton O, Louis P, de Chillou C, Sellal JM. Prediction of atrial fibrillation in patients with supraventricular tachyarrhythmias treated with catheter ablation or not. Classical scores are not useful. Int J Cardiol 2016; 220:102-6. [DOI: 10.1016/j.ijcard.2016.06.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/04/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
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Heidbüchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P, Blomstrom-Lundqvist C, Vanhees L, Ivarhoff P, Dorwarth U, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: Supraventricular arrhythmias and pacemakers. ACTA ACUST UNITED AC 2016; 13:475-84. [PMID: 16874135 DOI: 10.1097/01.hjr.0000216543.54066.72] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This document by the Study Group on Sports Cardiology of the European Society of Cardiology extends on previous recommendations for sports participation for competitive athletes by also incorporating guidelines for those who want to perform recreational physical activity. For different supraventricular arrhythmias and arrhythmogenic conditions, a description of the relationship between the condition and physical activity is given, stressing how arrhythmias can be influenced by exertion or can be a reflection of the (patho)physiological cardiac adaptation to sports participation itself. The following topics are covered in this text: sinus bradycardia; atrioventricular nodal conduction disturbances; pacemakers; atrial premature beats; paroxysmal supraventricular tachycardia without pre-excitation; pre-excitation, asymptomatic or with associated arrhythmias (i.e. Wolff-Parkinson-White syndrome); atrial fibrillation; and atrial flutter. A related document discusses ventricular arrhythmias, channelopathies and implantable cardioverter defibrillators.
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Affiliation(s)
- Hein Heidbüchel
- Department of Cardiology-Electrophysiology, University Hospital Gasthuisberg, Leuven, Belgium.
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Xu X, Alida CT, Yu B. Administration of antiarrhythmic drugs to maintain sinus rhythm after catheter ablation for atrial fibrillation: a meta-analysis. Cardiovasc Ther 2016; 33:242-6. [PMID: 26031448 DOI: 10.1111/1755-5922.12133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Whether the short-term administration of antiarrhythmic drugs (AADs) to maintain sinus rhythm following catheter ablation (CA) for atrial fibrillation (AF) can prevent the recurrence of AF is still a matter of debate. We searched the PubMed database and the Cochrane Library, and compiled a list of retrieved articles. We included only randomised controlled trials(RCTs) that compared any AADs against control (placebo or no treatment) or other AADs following CA for AF. Statistical analysis of the odds ratio (OR) and corresponding 95% confidence interval (CI) were used to determine the overall effect of both outcomes. The Mantel-Haenszel method was used to pool data of the outcomes of AF recurrence into fixed effect model meta-analyses. AIMS We performed a systematic review to determine the effectiveness of short-term treatment with AADs on the recurrence of AF after CA. RESULTS Six RCTs were included in this study, with a total of 814 patients. Post-procedural temporary administration of AADs in patients after CA for AF reduced the early recurrence of AF (antiarrhythmic drug 103 patients [25.3%], control 162 patients [39.8%]; OR 0.47 [95% CI 0.34-0.64]; χ(2) = 3.77; P = 0.58; I(2) = 0%). No significant difference in patients after CA for AF in the late recurrence of AF (antiarrhythmic drug 148 patients [36.5%], control 171 patients [42.5%]; OR 0.77 [95% CI 0.57-1.03]; χ(2) = 3.15; P = 0.68; I(2) = 0%). The heterogeneity was zero in both analyses. CONCLUSION Although the continued administration of AADs after CA for AF can decrease early atrial tachycardias (ATa), this treatment does not prevent late ATa.
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Affiliation(s)
- Xiuli Xu
- Department of Cardiology, The First Hospital Affiliated to China Medical University, Shenyang, Liaoning, China
| | - Choumi T Alida
- Department of Cardiology, The First Hospital Affiliated to China Medical University, Shenyang, Liaoning, China
| | - Bo Yu
- Department of Cardiology, The First Hospital Affiliated to China Medical University, Shenyang, Liaoning, China
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Expósito V, Rodríguez-Entem F, González-Enríquez S, Veiga G, Olavarri I, Olalla JJ. Stroke and Systemic Embolism After Successful Ablation of Typical Atrial Flutter. Clin Cardiol 2016; 39:347-51. [PMID: 27028600 DOI: 10.1002/clc.22538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/20/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Following successful cavotricuspid isthmus (CTI) ablation during typical atrial flutter (AFL), anticoagulation therapy is usually withdrawn. However, potential subsequent atrial fibrillation (AF) in these patients may increase embolic risk in the long term. Embolic rates in this setting have not been clearly established. Our aim was to determine the incidence of stroke/systemic embolism following radiofrequency ablation of AFL, particularly in those without a prior history of AF. HYPOTHESIS After succesful AFL ablation, patients may suffer embolic complications in the long-term follow-up, mainly due to asymptomatic AF episodes. METHODS We conducted a retrospective analysis of all patients who underwent CTI ablation due to AFL in our center between 2006 and 2009. RESULTS During the study period, 188 patients (mean age, 62.9 ± 8.6 years) underwent CTI ablation; 120 without prior AF were included in the study. At the end of the follow-up period (mean, 5.0 ± 2.4 years), 56.7% of patients (68/120) remained in sinus rhythm, 7/120 experienced a recurrence of AFL, and 45/120 (38%) developed AF. Ischemic stroke occurred in 11 patients and systemic embolism in 1. Of these patients, 5 had documented AF following AFL ablation. In the remaining 7 cases, previously undiagnosed AF was subsequently diagnosed at the time of stroke/embolism. CONCLUSIONS Patients with AFL who undergo successful ablation are by no means free from embolic complications during long-term follow-up, mainly due to a high rate of AF development. Given the difficulties in detecting AF and the uncertainty about the temporal relation of AF and stroke, oral anticoagulation may need to be continued in those patients with underlying stroke risk factors.
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Affiliation(s)
- Víctor Expósito
- Arrhythmia Unit, Cardiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Felipe Rodríguez-Entem
- Arrhythmia Unit, Cardiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Susana González-Enríquez
- Arrhythmia Unit, Cardiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Gabriela Veiga
- Arrhythmia Unit, Cardiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Iván Olavarri
- Arrhythmia Unit, Cardiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Juan J Olalla
- Arrhythmia Unit, Cardiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
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García Seara J, Gude Sampedro F, Martínez Sande JL, Fernández López XA, González Melchor L, López López A, Bouzas Cruz N, Alvarez Alvarez B, Riziq-Yousef Abumuaileq R, Iglesias Alvarez D, González Juanatey JR. RETRACTED ARTICLE: Long-term mortality prediction of CHA2DS2VASc and HATCH scores in a cohort of patients with typical atrial flutter. Clin Res Cardiol 2015. [DOI: 10.1007/s00392-015-0913-5] [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] [Indexed: 11/29/2022]
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10
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Risk and outcome after ablation of isthmus-dependent atrial flutter in elderly patients. PLoS One 2015; 10:e0127672. [PMID: 26000772 PMCID: PMC4441372 DOI: 10.1371/journal.pone.0127672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/17/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose of the research To study the influence of age on the clinical presentation and long-term outcome of patients referred for atrial flutter (AFL) ablation. Age-related differences have been reported regarding the prognosis of arrhythmias. Methods A total of 1187 patients with a mean age 65±12 years consecutively referred for AFL ablation were retrospectively analyzed in the study. Results 445 (37.5%) patients were aged ≥70 (range 70 to 93) among which 345 were aged 70 to 79 years (29.1%) and 100 were aged ≥80 (8.4%). In multivariable analysis, AFL-related rhythmic cardiomyopathy and presentation with 1/1 AFL were less frequent (respectively adjusted OR = 0.44, 0.27–0.74, p = 0.002 and adjusted OR = 0.29, 0.16–0.52, p<0.0001). AFL ablation-related major complications were more frequent in patients ≥70 although remained lower than 10% (7.4% in ≥70 vs. 4.2% in <70, adjusted OR = 1.74, 1.04–2.89, p = 0.03). After 2.1±2.7 years, AFL recurrence was less frequent in patients ≥70 (adjusted OR = 0.54, 0.37–0.80, p = 0.002) whereas atrial fibrillation (AF) occurrence was as frequent in the 70–79 and ≥80 age subsets. As expected, cardiac mortality was higher in older patients. Patients aged ≥80 also had a low probability of AFL recurrence (5.0%) and AF onset (19.0%). Conclusions Older patients represent 37.5% of patients referred for AFL ablation and displayed a <10% risk of ablation-related complications. Importantly, AFL recurrences were less frequent in patients ≥70 while AF occurrence was as frequent as in patients <70. Similar observations were made in patients ≥80 years. AFL ablation appears to be safe and efficient and should not be ruled out in elderly patients.
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Starek Z, Lehar F, Jez J, Wolf J, Novák M. Hybrid therapy in the management of atrial fibrillation. Curr Cardiol Rev 2015; 11:167-79. [PMID: 25028165 PMCID: PMC4356725 DOI: 10.2174/1573403x10666140713172231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/02/2014] [Accepted: 07/11/2014] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field.
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Affiliation(s)
| | | | | | | | - Miroslav Novák
- International Clinical Research Center, 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic.
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García Seara J, Raposeiras Roubin S, Gude Sampedro F, Balboa Barreiro V, Martínez Sande JL, Rodríguez Mañero M, González Juanatey JR. Failure of hybrid therapy for the prevention of long-term recurrence of atrial fibrillation. Int J Cardiol 2014; 176:74-9. [DOI: 10.1016/j.ijcard.2014.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/30/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
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Walters TE, Kalman JM. Development of atrial fibrillation after atrial flutter ablation: more a question of when than whether. J Cardiovasc Electrophysiol 2014; 25:821-823. [PMID: 24762080 DOI: 10.1111/jce.12446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tomos E Walters
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
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BREMBILLA-PERROT BÉATRICE, GIRERD NICOLAS, SELLAL JEANMARC, OLIVIER ARNAUD, MANENTI VLADIMIR, VILLEMIN THIBAUT, BEURRIER DANIEL, DE CHILLOU CHRISTIAN, LOUIS PIERRE, SELTON OLIVIER, DE LA CHAISE ARNAUDTERRIER. Risk of Atrial Fibrillation After Atrial Flutter Ablation: Impact of AF History, Gender, and Antiarrhythmic Drug Medication. J Cardiovasc Electrophysiol 2014; 25:813-820. [DOI: 10.1111/jce.12413] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/20/2014] [Accepted: 03/12/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | - NICOLAS GIRERD
- INSERM, Centre d’Investigations Cliniques 9501; Université de Lorraine; Institut Lorrain du cœur et des vaisseaux; CHU de Nancy Nancy France
| | - JEAN MARC SELLAL
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-les-Nancy France
| | - ARNAUD OLIVIER
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-les-Nancy France
| | - VLADIMIR MANENTI
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-les-Nancy France
| | - THIBAUT VILLEMIN
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-les-Nancy France
| | - DANIEL BEURRIER
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-les-Nancy France
| | - CHRISTIAN DE CHILLOU
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-les-Nancy France
| | - PIERRE LOUIS
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-les-Nancy France
| | - OLIVIER SELTON
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-les-Nancy France
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Abstract
Regular exercise provides substantial health benefits, mostly by reducing cardiovascular risk factors. However, it may also trigger acute cardiac events and cause sudden cardiac death in individuals with a pre-existing condition. In an otherwise healthy population, intense regular exercise may lead to morphological and electrical cardiac adaptations commonly referred as "athlete's heart." Recent data suggest that this may itself produce structural changes of atrial and ventricular myocardium with enlargement and fibrosis, creating the substrate for development of arrhythmias in apparently healthy athletes. The state of the art in this controversial issue is reviewed.
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Affiliation(s)
- F Bisbal
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
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Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common arrhythmia and an important cause of hospitalization, morbidity, and mortality. A myriad of drugs can induce AF. However, drug-induced AF (DIAF) receives little attention. Thus, this review is an attempt to attract the attention on this adverse effect. AREAS COVERED Published reports of drug-induced AF (DIAF) are reviewed in this paper, from January 1974 to December 2011, using the PubMed/Medline database and lateral references. EXPERT OPINION In most cases, DIAF is paroxysmal and terminates spontaneously, but sometimes AF persists and it is necessary to perform a cardioversion to restore sinus rhythm and avoid progression to persistent AF. Because of the short duration of DIAF, in addition to physicians/patients not being knowledgeable about this side effect, the real incidence and clinical consequences of DIAF are presently unknown. DIAF is an increasing problem, as some widely prescribed drugs can present this adverse effect. The risk is expected to increase in the elderly and in patients with comorbidities. It is important that physicians understand the significance of DIAF, to increase the collaboration between cardiac and non-cardiac professionals, and to educate patients to make them aware of this adverse side effect.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, 28040 Madrid, Spain.
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Nearly uniform failure of atrial flutter ablation and continuation of antiarrhythmic agents (hybrid therapy) for the long-term control of atrial fibrillation. J Interv Card Electrophysiol 2012; 35:57-61. [PMID: 22552760 DOI: 10.1007/s10840-012-9679-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
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Kim JB, Choi S, Joung B, Lee MH, Kim SS. The effects of a bidirectional cavo-tricuspid isthmus block in persistent atrial fibrillation. Yonsei Med J 2012; 53:76-82. [PMID: 22187235 PMCID: PMC3250333 DOI: 10.3349/ymj.2012.53.1.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Hybrid therapy with catheter ablation of the cavo-tricuspid isthmus (CTI) and continuation of anti-arrhythmic drugs (AAD), or electrical cardioversion with AADs might be alternative treatments for patients with persistent atrial fibrillation (AF). The goal of study was to assess the long term success rate of hybrid therapy for persistent AF compared to antiarrhythmic medication therapy after electrical cardioversion and identify the independent risk factors associated with recurrence after hybrid therapy. MATERIALS AND METHODS A total of 32 patients with persistent AF who developed atrial flutter after the administration of a class Ic or III anti-arrhythmic drug were enrolled. This group was compared with a group (33 patients) who underwent cardioversion and received direct current cardioversion with AADs. Baseline data were collected, and electrocardiogram and symptom driven Holter monitoring were performed every 2-4 months. RESULTS There was no significant difference in the baseline characteristics between the groups. The 12 month atrial arrhythmia free survival was better in the hybrid group, 49.0% vs. 33.1%, p=0.048. However, during a mean 55.7+/- 43.0 months of follow up, the improved survival rate regressed (p=0.25). A larger left atrium size was an independent risk factor for the recurrence of AF after adjusting for confounding factors. CONCLUSION Despite favorable outcome during 12 month, the CTI block with AADs showed outcomes similar to AAD therapy after electrical cardioversion over a 12 month follow up period. Minimal substrate modification with AADs might be an alternative treatment for persistent AF with minimal atrial remodeling.
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Affiliation(s)
- Jin-Bae Kim
- Cardiology Division, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seonghoon Choi
- Cardiology Division, Kang-Nam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Soon Kim
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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19
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Govindan M, Savelieva I, Catanchin A, Camm AJ. Atrial fibrillation-the final frontier. J Cardiovasc Pharmacol Ther 2010; 15:36S-50S. [PMID: 20940451 DOI: 10.1177/1074248410371947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and represents a significant health care issue. The diagnosis and management of AF uses a significant proportion of the health care budget and is responsible for substantial morbidity and mortality. Restoration and maintenance of sinus rhythm is still an important treatment option for symptomatic AF. Anti-arrhythmic drugs (AADs) have had inconsistent results for the prevention of recurrent AF and have been hampered by significant adverse effects. Catheter ablation has rapidly evolved and is fast becoming an alternative for AF prevention. Although multiple treatment options exist, no single modality is effective for all patients. This review outlines best current practice for AF prevention and future perspectives, focusing on new and promising developments in antiarrhythmic drug therapy, strategies for ablation therapy, and forms of hybrid therapy that may offer improved outcomes in selected patients.
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Affiliation(s)
- Malini Govindan
- Division of Cardiac & Vascular Sciences, St George's University of London, London, UK
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20
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Laurent V, Fauchier L, Pierre B, Grimard C, Babuty D. Incidence and predictive factors of atrial fibrillation after ablation of typical atrial flutter. J Interv Card Electrophysiol 2008; 24:119-25. [PMID: 18982436 DOI: 10.1007/s10840-008-9323-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 09/15/2008] [Indexed: 11/27/2022]
Affiliation(s)
- Valérie Laurent
- Pôle CTVH, Centre Hospitalier Universitaire Trousseau, 37044 Tours Cedex 1, France
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21
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Govindan M, Catanchin A, Camm AJ. The place of hybrid therapies with drugs to supplement nonpharmacological therapies in atrial fibrillation. J Cardiovasc Pharmacol 2008; 52:210-21. [PMID: 18806601 DOI: 10.1097/fjc.0b013e3181799677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias, and its prevalence continues to rise as the aged population increases. Comparative studies of rhythm control and rate control have been equivocal; however, the benefits of rhythm control may have been offset by the limitations of antiarrhythmic drugs. More recently, nonpharmacological therapies have emerged that provide hope of more effective rhythm control. Catheter ablation techniques have gained favour with high success rates in specialized centers, although these techniques are not without complications and require considerable expertise. Pacing therapies designed to reduce harmful right ventricular pacing and increase physiological pacing have shown benefit in AF patients with bradycardia. Despite this progress, no single modality confers benefit for all patients. Strategies to combine these treatment modalities in a hybrid approach has shown increasing promise for subgroups of AF patients.
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Affiliation(s)
- Malini Govindan
- Division of Cardiac and Vascular Sciences, St Georges Hospital University of London, London, UK.
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22
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Luria DM, Hodge DO, Monahan KH, Haroldson JM, Shen WK, Asirvatham SJ, Hammill SC, Munger TM, Glikson M, Gersh BJ, Packer DL, Friedman PA. Effect of radiofrequency ablation of atrial flutter on the natural history of subsequent atrial arrhythmias. J Cardiovasc Electrophysiol 2008; 19:1145-50. [PMID: 18554204 DOI: 10.1111/j.1540-8167.2008.01206.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Flutter Ablation and Subsequent Arrhythmia. INTRODUCTION Patients with atrial flutter (AFL) treated medically are at high risk for subsequent development of atrial fibrillation (AF). Whether curative radiofrequency ablation of AFL can modify the natural history of arrhythmia progression is not clear. We aimed to determine whether ablation of AFL decreases the subsequent development of AF in patients without previous AF. METHODS AND RESULTS Patients with AFL as the sole atrial arrhythmia were selected from patients who underwent successful AFL ablation at Mayo Clinic between 1997 and 2003 (N = 137). The cohort was divided by presence (n = 50) or absence (n = 87) of structural heart disease. A control group comprised 59 patients with AFL and no history of paroxysmal AF, who received only medical therapy. Occurrence of AF after AFL ablation was compared among study groups and controls. Symptomatic AF occurred in 49 patients during 5 years of follow-up after AFL ablation, with similar frequency in both study groups. The cumulative probability of paroxysmal and chronic AF was similar in controls and each study group. By multivariate analysis, the AFL ablation procedure carries significant risk of AF occurrence during follow-up. Fifty patients discontinued antiarrhythmic drugs after AFL ablation, and the rate of cardioversions decreased. CONCLUSION Successful ablation of AFL does not improve the natural history of atrial arrhythmia progression; postablation AF is frequent. This suggests that AFL may be initiated by bursts of AF and that in the absence of AFL substrate the AF continues to progress.
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Affiliation(s)
- David M Luria
- Sheba Medical Center and Tel Aviv University, Tel Hashomer, Israel
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23
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Clinical Efficacy of Bepridil for Class I Antiarrhythmic Drug-Induced Atrial Flutter in Patients with Paroxysmal Atrial Fibrillation. J Arrhythm 2008. [DOI: 10.1016/s1880-4276(08)80011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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24
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Gupta D, Earley MJ, Haywood GA, Richmond L, Fitzgerald M, Kojodjojo P, Sporton SC, Peters NS, Broadhurst P, Schilling RJ. Can atrial fibrillation with a coarse electrocardiographic appearance be treated with catheter ablation of the tricuspid valve-inferior vena cava isthmus? Results of a multicentre randomised controlled trial. Heart 2006; 93:688-93. [PMID: 17135218 PMCID: PMC1955209 DOI: 10.1136/hrt.2006.102061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To see if strategy of ablating the tricuspid annulus-inferior vena cava isthmus (TV-IVC) is superior to electrical cardioversion to prevent recurrences in patients with coarse atrial fibrillation. DESIGN Prospective randomised controlled multicentre study. SETTING Four tertiary referral hospitals in the UK. PATIENTS 57 patients with persistent coarse atrial fibrillation (irregular P waves > or =0.15 mV in > or =1 ECG lead). INTERVENTIONS Patients were randomised to receive external cardioversion (group A, n = 30) or TV-IVC ablation +/- DC cardioversion (group B, n = 27). MAIN OUTCOME MEASURES Cardiac rhythm, scores on quality of life and symptom questionnaires were assessed at 4, 16 and 52 weeks after the procedure. RESULTS 20 (67%) patients in group A and 19 (70%) patients in group B were in sinus rhythm immediately after their index procedure. At 4, 16 and 52 weeks, the number of patients in sinus rhythm were 5, 3 and 2 in group A and 3, 3 and 1 in group B (p = NS). The quality of life and symptom questionnaire scores were similar in the two groups at each period of follow-up, although they were significantly better for sinus rhythm than for atrial fibrillation at each follow-up visit. CONCLUSIONS As a first-line strategy, TV-IVC ablation offers no advantages over direct current cardioversion for the management of coarse atrial fibrillation.
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Affiliation(s)
- Dhiraj Gupta
- St Bartholomew's Hospital, West Smithfield, London, UK
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25
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García Cosío F, Pastor A, Núñez A, Magalhaes AP, Awamleh P. Flúter auricular: perspectiva clínica actual. Rev Esp Cardiol 2006. [DOI: 10.1157/13091886] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Heidbüchel H, Anné W, Willems R, Adriaenssens B, Van de Werf F, Ector H. Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter. Int J Cardiol 2006; 107:67-72. [PMID: 16337500 DOI: 10.1016/j.ijcard.2005.02.043] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Revised: 02/14/2005] [Accepted: 02/19/2005] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sports activity has been associated with the development of atrial arrhythmias. Atrial fibrillation (AF) is frequently observed after successful ablation for atrial flutter. Sports activity as a risk factor for AF development after flutter ablation has not been studied. METHODS We analyzed outcome in 137 patients (83% men) after ablation for isthmus-dependent atrial flutter (excluding patients with concomitant ablation for atrial tachycardia or fibrillation). Sports activity before and after ablation was evaluated by detailed questionnaires. Endurance sports was defined as (semi-)competitive participation in cycling, running or swimming for > or =3 h/week (and for > or =3 years pre-ablation). Median follow-up was 2.5 years. Survival free of AF was evaluated with Kaplan-Meier curves and log-rank statistics. Multivariate analysis was based on Cox proportional hazard evaluation. RESULTS Acute ablation success was 99% and flutter recurrence 4.4%. Thirty-one patients (23%) had been regularly engaged in endurance sports before ablation and 19 (14%) continued regular sports activity afterwards. Those performing sports were slightly younger. A history of endurance sports was a significant risk factor for post-ablation AF (univariate HR 1.96 (1.19-3.22), p<0.01, and multivariate HR 1.81 (1.10-2.98), p=0.02). Also continuation of endurance sports activity after ablation showed a trend for increased risk to develop AF despite a relatively small sample size (n=19; multivariate HR 1.68 (0.92-3.06), p=0.08). Cox proportional hazard calculations revealed a 10% and 11% increased risk for AF development per weekly hour sport performed before and after ablation respectively (p<0.01 for both). CONCLUSION A history of endurance sports activity is associated with the development of AF after ablation of atrial flutter.
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Affiliation(s)
- Hein Heidbüchel
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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27
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Hirao K, Okishige K, Yamamoto N, Otomo K, Azegami K, Isobe M. Long-term efficacy of hybrid pharmacologic and ablation therapy in patients with pilsicainide-induced atrial flutter. Clin Cardiol 2005; 28:338-42. [PMID: 16075827 PMCID: PMC6654304 DOI: 10.1002/clc.4960280707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combination therapy with catheter ablation of the cavo-tricuspid isthmus and continued drug therapy, that is, "hybrid therapy," in patients with atrial fibrillation (AF) and drug-induced atrial flutter (AFL) is reported to be an alternative means of achieving and maintaining sinus rhythm. With respect to choosing this method among the rhythm control therapies, its long-term efficacy and the prevalence of AFL in patients with AF are very important and have not been fully elucidated. HYPOTHESIS The purpose of this study was to investigate the long-term effectiveness of this hybrid therapy and the dose prevalence in Ic drug-induced AFL. METHODS The subjects were 89 patients (aged 62.4 years, 72 men) with episodes of AF (paroxysmal type: 65, persistent type: 11, permanent type: 13). After 4 weeks of oral pilsicainide administration, the dose was increased in those with no documented AFL. The patients who experienced AFL with pilsicainide (Ic-AFL) underwent ablation. RESULTS Pilsicainide administration resulted in the common type AFL in 17 patients (19.1%). The pilsicainide plasma concentration in the patients with Ic-AFL was significantly higher than in those without AFL (0.79 +/- 0.41 vs. 0.51 +/- 0.24 microg/ml, respectively, p < 0.01). During a 10-54 (mean 37 +/- 14) month follow-up period, sinus rhythm was maintained in 10 of 12 patients after successful ablation followed by continued antiarrhythmic drug administration. CONCLUSIONS Hybrid therapy with ablation and high doses of pilsicainide was useful in maintaining sinus rhythm in some selected patients with AF and drug-induced AFL.
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Affiliation(s)
- Kenzo Hirao
- Department of Cardiovascular Medicine, School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
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28
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Turco P, De Simone A, La Rocca V, El Jamal B, Nocerino P, Astarita C, De Matteis C, Messina V, Greco L, Rotunno R, Di Napoli T, Vitale DF, Stabile G. Long-Term Results of Hybrid Therapy in Patients with Atrial Fibrillation Who Develop Atrial Flutter During Flecainide Infusion. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28 Suppl 1:S124-7. [PMID: 15683478 DOI: 10.1111/j.1540-8159.2005.00032.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The flecainide infusion test has been proposed to screen candidates for hybrid pharmacological and ablation therapy. We report the long-term follow-up of 154 consecutive patients with paroxysmal or persistent atrial fibrillation (AF) who developed atrial flutter (AFL) during flecainide infusion (IC AFL), treated with inferior vena cava-tricuspid annulus isthmus catheter ablation and oral flecainide (hybrid therapy). Over a mean of 54.1 +/- 13.1 months 82 patients (53%) remained free of AF and AFL. Flecainide was discontinued because of adverse effects in 6 patients (4%). A history of persistent AF, and the documentation of >/=1 spontaneous AFL episode before the flecainide test were independent predictors of successful hybrid therapy. In patients with paroxysmal AF without documented spontaneous AFL, the long-term efficacy of hybrid therapy was 38.5% (P = 0.03). The flecainide infusion test reliably detects candidates for hybrid therapy. The efficacy of this therapy is maintained over the long-term with a high patient compliance.
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Affiliation(s)
- Pietro Turco
- Laboratorio di Elettrofisiologia, Villa Maria Cecilia Hospital, Cotignola (RA), Italy
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29
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Bertaglia E, Bonso A, Zoppo F, Proclemer A, Verlato R, Corò L, Mantovan R, Themistoclakis S, Raviele A, Pascotto P. Different Clinical Courses and Predictors of Atrial Fibrillation Occurrence After Transisthmic Ablation in Patients with Preablation Lone Atrial Flutter, Coexistent Atrial Fibrillation, and Drug Induced Atrial Flutter. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1507-12. [PMID: 15546305 DOI: 10.1111/j.1540-8159.2004.00668.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.
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Bottoni N, Donateo P, Quartieri F, Tomasi C, Oddone D, Lolli G, Menozzi C, Brignole M. Outcome after cavo-tricuspid isthmus ablation in patients with recurrent atrial fibrillation and drug-related typical atrial flutter. Am J Cardiol 2004; 94:504-8. [PMID: 15325941 DOI: 10.1016/j.amjcard.2004.04.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Revised: 04/19/2004] [Accepted: 04/19/2004] [Indexed: 11/30/2022]
Abstract
This study evaluates the long-term clinical outcome of 56 consecutive patients affected by atrial fibrillation and drug-related typical atrial flutter who underwent cavo-tricuspid isthmus radiofrequency ablation. Symptomatic arrhythmic events recurred after ablation in 64% of the patients during follow-up of 19 +/- 9 months. Even in those who had recurrences, there was a substantial reduction in the incidence of episodes, quality of life was improved, and hospitalizations decreased.
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Affiliation(s)
- Nicola Bottoni
- Unità Operativa di Cardiologia Interventistica, Dipartimento di Cardiologia, Azienda Ospedaliera S. Maria Nuova, V. Risorgimento 80, Reggio Emilia, Italy.
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