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Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki YK, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. Circ J 2024; 88:1509-1595. [PMID: 37690816 DOI: 10.1253/circj.cj-22-0827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center
| | - Masaomi Chinushi
- School of Health Sciences, Niigata University School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine
| | - Kaoru Tanno
- Cardiology Division, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of Cardiology, Tokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, International University of Health and Welfare, Mita Hospital
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hirotaka Yada
- Department of Cardiology, International University of Health and Welfare, Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
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2
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Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki Y, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. J Arrhythm 2024; 40:655-752. [PMID: 39139890 PMCID: PMC11317726 DOI: 10.1002/joa3.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and GeneticsNational Cerebral and Cardiovascular Center
| | | | - Shinji Koba
- Division of Cardiology, Department of MedicineShowa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | | | - Kaoru Tanno
- Cardiovascular Center, Cardiology DivisionShowa University Koto‐Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal MedicineFujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of CardiologyTokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Toshio Kinoshita
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, Mita HospitalInternational University of Health and Welfare
| | - Nobuyuki Masaki
- Department of Intensive Care MedicineNational Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | - Hirotaka Yada
- Department of CardiologyInternational University of Health and Welfare Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular MedicineNippon Medical School
| | - Takeshi Kimura
- Cardiovascular MedicineKyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of MedicineUniversity of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric CardiologySaitama Medical University International Medical Center
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3
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Linz D, Andrade JG, Arbelo E, Boriani G, Breithardt G, Camm AJ, Caso V, Nielsen JC, De Melis M, De Potter T, Dichtl W, Diederichsen SZ, Dobrev D, Doll N, Duncker D, Dworatzek E, Eckardt L, Eisert C, Fabritz L, Farkowski M, Filgueiras-Rama D, Goette A, Guasch E, Hack G, Hatem S, Haeusler KG, Healey JS, Heidbuechel H, Hijazi Z, Hofmeister LH, Hove-Madsen L, Huebner T, Kääb S, Kotecha D, Malaczynska-Rajpold K, Merino JL, Metzner A, Mont L, Ng GA, Oeff M, Parwani AS, Puererfellner H, Ravens U, Rienstra M, Sanders P, Scherr D, Schnabel R, Schotten U, Sohns C, Steinbeck G, Steven D, Toennis T, Tzeis S, van Gelder IC, van Leerdam RH, Vernooy K, Wadhwa M, Wakili R, Willems S, Witt H, Zeemering S, Kirchhof P. Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference. Europace 2024; 26:euae070. [PMID: 38591838 PMCID: PMC11003300 DOI: 10.1093/europace/euae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
AIMS Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). METHODS AND RESULTS Eighty-three international experts met in Münster for 2 days in September 2023. Key findings are as follows: (i) Active rhythm management should be part of the default initial treatment for all suitable patients with AF. (ii) Patients with device-detected AF have a low burden of AF and a low risk of stroke. Anticoagulation prevents some strokes and also increases major but non-lethal bleeding. (iii) More research is needed to improve stroke risk prediction in patients with AF, especially in those with a low AF burden. Biomolecules, genetics, and imaging can support this. (iv) The presence of AF should trigger systematic workup and comprehensive treatment of concomitant cardiovascular conditions. (v) Machine learning algorithms have been used to improve detection or likely development of AF. Cooperation between clinicians and data scientists is needed to leverage the potential of data science applications for patients with AF. CONCLUSIONS Patients with AF and a low arrhythmia burden have a lower risk of stroke and other cardiovascular events than those with a high arrhythmia burden. Combining active rhythm control, anticoagulation, rate control, and therapy of concomitant cardiovascular conditions can improve the lives of patients with AF.
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Affiliation(s)
- Dominik Linz
- Department of Cardiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jason G Andrade
- Division of Cardiology, Vancouver General Hospital, Vancouver, Canada
- Montreal Heart Institute, Montreal, Canada
| | - Elena Arbelo
- Institut Clínic Cardiovascular, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart—ERN GUARD-Heart
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy
| | - Guenter Breithardt
- Department of Cardiovascular Medicine, University Hospital, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Wolfgang Dichtl
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Dobromir Dobrev
- Institute of Pharmacology, Faculty of Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nicolas Doll
- Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Lars Eckardt
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Department of Cardiology II—Electrophysiology, University Hospital Münster, Münster, Germany
| | | | - Larissa Fabritz
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- University Center of Cardiovascular Science, UHZ, UKE, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site: Hamburg/Kiel/Lübeck, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Michal Farkowski
- Department of Cardiology, Ministry of Interior and Administration, National Medical Institute, Warsaw, Poland
| | - David Filgueiras-Rama
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Novel Arrhythmogenic Mechanisms Program, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, C/ Profesor Martín Lagos, Madrid, Spain
| | - Andreas Goette
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Department of Cardiology and Intensive Care Medicine, St Vincenz-Hospital Paderborn, Paderborn, Germany
| | - Eduard Guasch
- Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Guido Hack
- Bristol-Myers Squibb GmbH & Co. KGaA, Munich, Germany
| | | | - Karl Georg Haeusler
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Department of Neurology, Universitätsklinikum Würzburg (UKW), Würzburg, Germany
| | - Jeff S Healey
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Hein Heidbuechel
- Antwerp University Hospital, Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Ziad Hijazi
- Antwerp University Hospital, Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Leif Hove-Madsen
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Biomedical Research Institute Barcelona (IIBB-CSIC), Barcelona, Spain
- IR Sant Pau, Hospital de Sant Pau, Barcelona, Spain
| | | | - Stefan Kääb
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart—ERN GUARD-Heart
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, Munich, Germany
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Katarzyna Malaczynska-Rajpold
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
- Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - José Luis Merino
- La Paz University Hospital, IdiPaz, Autonomous University of Madrid, Madrid, Spain
| | - Andreas Metzner
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Lluís Mont
- Institut Clínic Cardiovascular, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ghulam Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Michael Oeff
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Cardiology Department, Medizinische Hochschule Brandenburg, Brandenburg/Havel, Germany
| | - Abdul Shokor Parwani
- Department of Cardiology, Deutsches Herzzentrum der Charité (CVK), Berlin, Germany
| | | | - Ursula Ravens
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Institute of Experimental Cardiovascular Medicine, University Clinic Freiburg, Freiburg, Germany
| | - Michiel Rienstra
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Daniel Scherr
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Renate Schnabel
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site: Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Ulrich Schotten
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Departments of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Christian Sohns
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Klinik für Elektrophysiologie—Rhythmologie, Bad Oeynhausen, Germany
| | - Gerhard Steinbeck
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Center for Cardiology at Clinic Starnberg, Starnberg, Germany
| | - Daniel Steven
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Heart Center, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Tobias Toennis
- German Centre for Cardiovascular Research (DZHK), Partner Site: Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | | | - Isabelle C van Gelder
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Manish Wadhwa
- Medical Office, Philips Ambulatory Monitoring and Diagnostics, San Diego, CA, USA
| | - Reza Wakili
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- Department of Medicine and Cardiology, Goethe University, Frankfurt, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Stephan Willems
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site: Hamburg/Kiel/Lübeck, Hamburg, Germany
- Asklepios Hospital St. Georg, Department of Cardiology and Internal Care Medicine, Faculty of Medicine, Semmelweis University Campus, Hamburg, Germany
| | | | - Stef Zeemering
- Departments of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Paulus Kirchhof
- Atrial Fibrillation NETwork (AFNET), Muenster, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site: Hamburg/Kiel/Lübeck, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
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4
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Pastore MC, Degiovanni A, Grisafi L, Renda G, Sozzani M, Giordano A, Salvatici C, Lorenz V, Pierfelice F, Cappelli C, De Donno F, Focardi M, Ricci F, Benedetto U, Gallina S, Cameli M, Patti G. Left Atrial Strain to Predict Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting. Circ Cardiovasc Imaging 2024; 17:e015969. [PMID: 38227692 DOI: 10.1161/circimaging.123.015969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery being associated with poorer outcomes. Revealing before the operation of left atrial subtle structural/functional abnormalities may help to identify patients at increased risk of POAF. We investigated the role of left atrial strain parameters by preoperative speckle tracking echocardiography as independent predictors of POAF in patients undergoing coronary artery bypass graft. METHODS Consecutive patients undergoing isolated coronary artery bypass graft were prospectively enrolled at three Italian centers. All patients underwent transthoracic echocardiography before the operation. The occurrence of POAF up to discharge was monitored. RESULTS Overall, a total of 310 patients were included. POAF was demonstrated in 103 patients (33%). At receiver operating characteristic curve analysis, lower global peak atrial longitudinal strain (PALS) values significantly predicted the risk of POAF (area under the curve, 0.74; P<0.001). The optimal cutoff value for the arrhythmia prediction was a global PALS value <28%, with a specificity of 86% and a sensitivity of 36%. The incidence of POAF was 51% in patients with global PALS <28% versus 14% in those with PALS ≥28% (P<0.001), with a POAF-free survival at Kaplan-Meier analysis of 45.4% and 85.7%, respectively (P<0.001). At multivariate analysis, a global PALS <28% carried a 3.6-fold higher risk of POAF (hazard ratio, 3.6 [95% CI, 2.2-5.9]; P<0.001). The risk increase was even higher when PALS <28% was associated with age ≥70 years (adjusted hazard ratio, 11.2 [4.7-26.6], P<0.001). CONCLUSIONS A presurgery global PALS <28% is a specific parameter to stratify patients at increased risk of POAF after coronary artery bypass graft. This assessment can be useful to identify patients at higher arrhythmic risk in whom perioperative preventive strategies and stricter monitoring aimed at early diagnosing and treating POAF may be applied.
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Affiliation(s)
- Maria Concetta Pastore
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Anna Degiovanni
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
| | - Leonardo Grisafi
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Martina Sozzani
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
| | - Andrea Giordano
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
| | - Cosimo Salvatici
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Veronica Lorenz
- Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena (V.L.)
| | - Francesca Pierfelice
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Clelia Cappelli
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Federica De Donno
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Umberto Benedetto
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiac Surgery, SS. Annunziata Hospital, Chieti; Italy (U.B.)
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Giuseppe Patti
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
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5
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Kim K, Blackwell DJ, Yuen SL, Thorpe MP, Johnston JN, Cornea RL, Knollmann BC. The selective RyR2 inhibitor ent-verticilide suppresses atrial fibrillation susceptibility caused by Pitx2 deficiency. J Mol Cell Cardiol 2023; 180:1-9. [PMID: 37080450 PMCID: PMC10330243 DOI: 10.1016/j.yjmcc.2023.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/25/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of stroke and morbidity. The strongest genetic risk factors for AF in humans are variants on chromosome 4q25, near the paired-like homeobox transcription factor 2 gene PITX2. Although mice deficient in Pitx2 (Pitx2+/-) have increased AF susceptibility, the mechanism remains controversial. Recent evidence has implicated hyperactivation of the cardiac ryanodine receptor (RyR2) in Pitx2 deficiency, which may be associated with AF susceptibility. We investigated pacing-induced AF susceptibility and spontaneous Ca2+ release events in Pitx2 haploinsufficient (+/-) mice and isolated atrial myocytes to test the hypothesis that hyperactivity of RyR2 increases susceptibility to AF, which can be prevented by a potent and selective RyR2 channel inhibitor, ent-verticilide. Compared with littermate wild-type Pitx2+/+, the frequency of Ca2+ sparks and spontaneous Ca2+ release events increased in permeabilized and intact atrial myocytes from Pitx2+/- mice. Atrial burst pacing consistently increased the incidence and duration of AF in Pitx2+/- mice. The RyR2 inhibitor ent-verticilide significantly reduced the frequency of spontaneous Ca2+ release in intact atrial myocytes and attenuated AF susceptibility with reduced AF incidence and duration. Our data demonstrate that RyR2 hyperactivity enhances SR Ca2+ leak and AF inducibility in Pitx2+/- mice via abnormal Ca2+ handling. Therapeutic targeting of hyperactive RyR2 in AF using ent-verticilide may be a viable mechanism-based approach to treat atrial arrhythmias caused by Pitx2 deficiency.
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Affiliation(s)
- Kyungsoo Kim
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel J Blackwell
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samantha L Yuen
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Madelaine P Thorpe
- Department of Chemistry and Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, USA
| | - Jeffrey N Johnston
- Department of Chemistry and Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, USA
| | - Razvan L Cornea
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Björn C Knollmann
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.
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6
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Method for Solving Difficulties in Rhythm Classification Caused by Few Samples and Similar Characteristics in Electrocardiograms. Bioengineering (Basel) 2023; 10:bioengineering10020196. [PMID: 36829690 PMCID: PMC9952353 DOI: 10.3390/bioengineering10020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
A method for accurately analyzing electrocardiograms (ECGs), which are obtained from electrical signals generated by cardiac activity, is essential in heart disease diagnosis. However, rhythms are typically obtained with relatively few data samples and similar characteristics, making them difficult to classify. To solve these issues, we proposed a novel method that distinguishes a given ECG rhythm using a beat score map (BSM) image. Through the proposed method, the associations between beats and previously used features, such as the R-R interval, were considered. Rhythm classification was implemented by training a convolutional neural network model and using transfer learning with the created BSM image. As a result, the proposed method for ECG rhythms with small data samples showed significant results. It also showed good performance in differentiating atrial fibrillation (AFIB) and atrial flutter (AFL) rhythms, which are difficult to distinguish due to their similar characteristics. The performance for rhythms with a small number of samples of the proposed method is 20% better than an existing method. In addition, the performance based on the F-1 score for classifying AFIB and AFL of the proposed method is 30% better than the existing method. This study solved the previous limitations caused by small sample numbers and similar rhythms.
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7
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Irregular heart rhythm algorithm: a novel strategy to accurately detect atrial fibrillation by ambulatory monitoring of blood pressure. Hypertens Res 2022; 45:1398-1399. [PMID: 35618813 DOI: 10.1038/s41440-022-00943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/08/2022]
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8
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BONNESEN MP, DIEDERICHSEN SZ, ISAKSEN JL, FREDERIKSEN KS, HASSELBALCH SG, HAUGAN KJ, KRONBORG C, GRAFF C, HØJBERG S, KØBER L, KRIEGER DW, BRANDES A, SVENDSEN JH. Atrial fibrillation burden and cognitive decline in elderly patients undergoing continuous monitoring. Am Heart J 2021; 242:15-23. [PMID: 34428441 DOI: 10.1016/j.ahj.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/14/2021] [Indexed: 01/01/2023]
Abstract
AIMS To study the relationship between subclinical atrial fibrillation (AF) and changes in cognitive function in a large cohort of individuals with stroke risk factors. METHODS Individuals with no prior AF diagnosis but with risk factors for stroke were recruited to undergo annual cognitive assessment with the Montreal Cognitive Assessment (MoCA) along with implantable loop recorder (ILR) monitoring for AF for 3 years. If AF episodes lasting ≥6 minutes were detected, oral anticoagulation (OAC) treatment was initiated. RESULTS A total of 1194 participants (55.2 % men, mean age 74.5 (±3.9)) had a combined duration of heart rhythm monitoring of ≈1.3 million days. Among these, 339 participants (28.3%) had adjudicated AF, with a median AF burden of 0.072% (0.02, 0.39), and 324 (96%) initiated OAC. When stratifying the participants into AF burden groups (No AF, AFlow (AF burden <0.25%), and AFhigh, (AF burden >0.25%)), only participants in the AFlow group had a decrease in MoCA score over time (P = .03), although this was not significant after adjustment for stroke risk factors. A subgroup analysis of 175 participants (14.6%) with a MoCA <26 at 3 years found no association to AF diagnosis or burden. CONCLUSIONS In a high-risk population, subclinical AF detected by continuous monitoring and subsequently treated with OAC was not associated with a significant change in MoCA score over a 3-year period.
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9
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Kaplan AD, Joca HC, Boyman L, Greiser M. Calcium Signaling Silencing in Atrial Fibrillation: Implications for Atrial Sodium Homeostasis. Int J Mol Sci 2021; 22:10513. [PMID: 34638854 PMCID: PMC8508839 DOI: 10.3390/ijms221910513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, affecting more than 33 million people worldwide. Despite important advances in therapy, AF's incidence remains high, and treatment often results in recurrence of the arrhythmia. A better understanding of the cellular and molecular changes that (1) trigger AF and (2) occur after the onset of AF will help to identify novel therapeutic targets. Over the past 20 years, a large body of research has shown that intracellular Ca2+ handling is dramatically altered in AF. While some of these changes are arrhythmogenic, other changes counteract cellular arrhythmogenic mechanisms (Calcium Signaling Silencing). The intracellular Na+ concentration ([Na+])i is a key regulator of intracellular Ca2+ handling in cardiac myocytes. Despite its importance in the regulation of intracellular Ca2+ handling, little is known about [Na+]i, its regulation, and how it might be changed in AF. Previous work suggests that there might be increases in the late component of the atrial Na+ current (INa,L) in AF, suggesting that [Na+]i levels might be high in AF. Indeed, a pharmacological blockade of INa,L has been suggested as a treatment for AF. Here, we review calcium signaling silencing and changes in intracellular Na+ homeostasis during AF. We summarize the proposed arrhythmogenic mechanisms associated with increases in INa,L during AF and discuss the evidence from clinical trials that have tested the pharmacological INa,L blocker ranolazine in the treatment of AF.
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Affiliation(s)
- Aaron D. Kaplan
- Center for Biomedical Engineering and Technology, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.D.K.); (H.C.J.); (L.B.)
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Humberto C. Joca
- Center for Biomedical Engineering and Technology, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.D.K.); (H.C.J.); (L.B.)
| | - Liron Boyman
- Center for Biomedical Engineering and Technology, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.D.K.); (H.C.J.); (L.B.)
| | - Maura Greiser
- Center for Biomedical Engineering and Technology, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.D.K.); (H.C.J.); (L.B.)
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10
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Reissmann B, Breithardt G, Camm AJ, Van Gelder IC, Metzner A, Kirchhof P. The RACE to the EAST. In pursuit of rhythm control therapy for atrial fibrillation-a dedication to Harry Crijns. Europace 2021; 23:ii34-ii39. [PMID: 33837756 PMCID: PMC8035707 DOI: 10.1093/europace/euab023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Indexed: 11/12/2022] Open
Abstract
The RACE trial was one of the first landmark trials to establish whether restoring and maintaining sinus rhythm could reduce morbidity and mortality in patients with atrial fibrillation (AF). Its neutral outcome shaped clinical decision-making for almost 20 years. However, there were two important treatment-related factors associated with mortality of rhythm control therapy at that time: One was safety of antiarrhythmic drug therapy, and the other one withdrawal of anticoagulation after restoration of sinus rhythm. Both concerns have been overcome, and, moreover, important knowledge considering the importance of time for the treatment of AF has been gained. These insights led to the concept of the EAST-AFNET 4 trial, and after more than two decades in the pursuit of ongoing therapeutic improvement, early rhythm control therapy has demonstrated to reduce a composite of cardiovascular death, stroke, and hospitalization for worsening of HF or acute coronary syndrome, by 21% (first primary outcome, absolute reduction 1.1 per 100 patient-years). For this entire period, Harry Crijns characterized the treatment of AF patients, and contributed decisively to realizing the benefit of rhythm control therapy. It is almost easier to list the clinical trials without Harry's involvement than to list those which he co-designed and led.
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Affiliation(s)
- Bruno Reissmann
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Günter Breithardt
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany
| | - A John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Institute, St George’s University of London, London, UK
| | - Isabelle C Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andreas Metzner
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Germany
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11
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Chen C, Hua Z, Zhang R, Liu G, Wen W. Automated arrhythmia classification based on a combination network of CNN and LSTM. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101819] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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P-wave dispersion and atrial electromechanical delay in patients with inflammatory bowel disease. COR ET VASA 2019. [DOI: 10.33678/cor.2019.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Akilli H, Aribas A, İcli A, Tatar S, Gurbuz AS. Predictive value of transmitral A‐wave acceleration time for paroxysmal atrial fibrillation. Echocardiography 2019; 36:1633-1638. [DOI: 10.1111/echo.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/03/2019] [Accepted: 08/15/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hakan Akilli
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
| | - Alpay Aribas
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
| | - Abdullah İcli
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
| | - Sefa Tatar
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
| | - Ahmet Seyfeddin Gurbuz
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
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14
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Atrial Fibrillation Therapy and Heart Failure Hospitalization in Adults With Tetralogy of Fallot. JACC Clin Electrophysiol 2019; 5:618-625. [DOI: 10.1016/j.jacep.2019.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 11/18/2022]
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15
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Combinational Biomarkers for Atrial Fibrillation Derived from Atrial Appendage and Plasma Metabolomics Analysis. Sci Rep 2018; 8:16930. [PMID: 30446671 PMCID: PMC6240090 DOI: 10.1038/s41598-018-34930-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common types of arrhythmias and often leads to clinical complications. The objectives of this study were to offer insights into the metabolites of AF and to determine biomarkers for AF diagnosis or prediction. Sixty atrial appendage samples (AF group: 30; non-AF group: 30) and 163 plasma samples (AF group: 48; non-AF group: 115) from 49 AF patients and 116 non-AF patients were subjected to liquid chromatography positive ion electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) metabolomics analysis. Consequently, 24 metabolites in atrial appendage samples and 24 metabolites in plasma samples were found to reflect metabolic differences between AF and non-AF patients (variable importance in projection (VIP) ≥ 1, P ≤ 0.05). Five identical metabolites including creatinine, D-glutamic acid, choline, hypoxanthine, and niacinamide (VIP ≥ 1.5, P < 0.01, FDR < 0.05) in atrial appendage and plasma samples were considered prominent features of AF patients, and the D-glutamine and D-glutamate metabolic pathway was also identified as a feature of AF patients. Finally, in plasma samples, the combination of D-glutamic acid, creatinine, and choline had an AUC value of 0.927 (95% CI: 0.875-0.979, P < 0.001) and displayed 90.5% sensitivity and 83.3% specificity; this group of metabolites was thus defined as a combinational biomarker for the recognition of AF and non-AF patients.
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16
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Kotecha D, Breithardt G, Camm AJ, Lip GYH, Schotten U, Ahlsson A, Arnar D, Atar D, Auricchio A, Bax J, Benussi S, Blomstrom-Lundqvist C, Borggrefe M, Boriani G, Brandes A, Calkins H, Casadei B, Castellá M, Chua W, Crijns H, Dobrev D, Fabritz L, Feuring M, Freedman B, Gerth A, Goette A, Guasch E, Haase D, Hatem S, Haeusler KG, Heidbuchel H, Hendriks J, Hunter C, Kääb S, Kespohl S, Landmesser U, Lane DA, Lewalter T, Mont L, Nabauer M, Nielsen JC, Oeff M, Oldgren J, Oto A, Pison L, Potpara T, Ravens U, Richard-Lordereau I, Rienstra M, Savelieva I, Schnabel R, Sinner MF, Sommer P, Themistoclakis S, Van Gelder IC, Vardas PE, Verma A, Wakili R, Weber E, Werring D, Willems S, Ziegler A, Hindricks G, Kirchhof P. Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference. Europace 2018; 20:395-407. [PMID: 29300976 DOI: 10.1093/europace/eux318] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/20/2017] [Indexed: 12/20/2022] Open
Abstract
There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Günter Breithardt
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - A John Camm
- St George's University of London, London, UK
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Ulrich Schotten
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | | | - David Arnar
- The National University Hospital, Reykjavik, Iceland
| | - Dan Atar
- Oslo University Hospital, Oslo, Norway
| | | | - Jeroen Bax
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | - Manuel Castellá
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Harry Crijns
- University Hospital Maastricht, Maastricht, The Netherlands
| | | | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
- University Hospital Münster, Münster, Germany
| | | | | | - Andrea Gerth
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Goette
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- St Vincenz Krankenhaus, Paderborn, Germany
| | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Doreen Haase
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | | | - Karl Georg Haeusler
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Craig Hunter
- Boehringer Ingelheim Pharma GmbH & Co. KG, Germany
| | - Stefan Kääb
- Ludwig-Maximilians University Clinic, Munich, Germany & DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Ulf Landmesser
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- HaeuslerCharité-Universitätsmedizin Berlin, Berlin, Germany
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Thorsten Lewalter
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Hospital-Munich Thalkirchen, Munich, Germany
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Michael Nabauer
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | | | - Michael Oeff
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Städtisches Klinikum Brandenburg, Brandenburg, Germany
| | - Jonas Oldgren
- Department of Cardiology, Institution of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Laurent Pison
- Maastricht University, Medical Center, Maastricht, The Netherlands
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ursula Ravens
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- University Heart Center Freiburg, Freiburg, Germany
| | | | - Michiel Rienstra
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Moritz F Sinner
- Ludwig-Maximilians University Clinic, Munich, Germany & DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Sommer
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Atul Verma
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Reza Wakili
- Ludwig-Maximilians-University, Munich, Germany
| | | | - David Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | | | - André Ziegler
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
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17
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Lip G, Van Gelder I, Bax J, Hylek E, Kääb S, Schotten U, Wegscheider K, Boriani G, Ezekowitz M, Diener H, Heidbuchel H, Lane D, Mont L, Willems S, Dorian P, Vardas P, Breithardt G, John Camm A, Kirchhof P. Comprehensive risk reduction in patients with atrial fibrillation: Emerging diagnostic and therapeutic options. Thromb Haemost 2017; 106:1012-9. [DOI: 10.1160/th11-07-0517] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/13/2011] [Indexed: 01/29/2023]
Abstract
SummaryThere are exciting new developments in several areas of atrial fibrillation (AF) management that carry the hope of improving outcomes in AF patients. This paper is an executive summary that summarises the proceedings from the 3rd AFNET/EHRA consensus conference on atrial fibrillation, held in Sophia Antipolis from November 7th to 9th 2010, shortly after the release of the new ESC guidelines on AF. The conference was jointly organised by the German Atrial Fibrillation competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). This executive summary report covers four sections: 1. Risk factors and risk markers for AF, 2. Pathophysiological classification of AF, 3. Relevance of monitored AF duration for AF-related outcomes, and 4. Perspectives and needs for implementing better antithrombotic therapy.
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18
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Cameli M, Incampo E, Mondillo S. Left atrial deformation: Useful index for early detection of cardiac damage in chronic mitral regurgitation. IJC HEART & VASCULATURE 2017; 17:17-22. [PMID: 29034311 PMCID: PMC5635340 DOI: 10.1016/j.ijcha.2017.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 08/20/2017] [Accepted: 08/30/2017] [Indexed: 12/02/2022]
Abstract
In chronic mitral regurgitation (MR) left atrium is one of the first cardiac structures that is involved in remodeling and ultrastructural changes for a progressive volume overload. Severe left atrial (LA) dilation on echocardiography and new onset of atrial fibrillation in asymptomatic patients with preserved Left Ventricular (LV) function, appeared as a Class IIb recommendation for consideration for surgical mitral valve repair in the actual guidelines. However, before atrial dilatation and dysfunction, several ultrastructural changes appear in the atrial muscle tissue that are difficult to identify with the standard echocardiography. Speckle tracking echocardiography (STE) can analyze LA function: it has been showed that it can indirectly identify structural tissue modifications from excessive atrial effort in the early stages of MR up to the full depression of atrial function in the late stages where there are advanced ultrastructural alterations. This review aims to summarize current knowledge on the role of atrial strain identifying early structural alterations of the atrial tissue in the rising stages of MR considering that Left Atrial Peak Longitudinal Strain (PALS) considered useful parameter for a more extensive evaluation of MR patients.
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Affiliation(s)
| | - E. Incampo
- Department of Cardiovascular Diseases, University of Siena, Policlinico “S. Maria alle Scotte”, viale Bracci 1, 53100 Siena, Italy
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Atrial fibrillation: a mechanism or just a bystander? Europace 2017; 19:1413-1415. [DOI: 10.1093/europace/eux040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Nardi F, Gulizia MM, Colivicchi F, Abrignani MG, Di Fusco SA, Di Lenarda A, Di Tano G, Geraci G, Moschini L, Riccio C, Verdecchia P, Enea I. ANMCO Position Paper: direct oral anticoagulants for stroke prevention in atrial fibrillation: clinical scenarios and future perspectives. Eur Heart J Suppl 2017; 19:D70-D88. [PMID: 28751836 PMCID: PMC5526472 DOI: 10.1093/eurheartj/sux007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
It is now 4 years since the introduction of the new direct oral anticoagulants into clinical practice. Therefore, the Italian Association of Hospital Cardiologists (ANMCO) has deemed necessary to update the previous position paper on the prevention of thrombo-embolic complications in patients with non-valvular atrial fibrillation, which was published in 2013. All available scientific evidence has been reviewed, focusing on data derived from both clinical trials and observational registries. In addition, all issues relevant to the practical clinical management of oral anticoagulation with the new direct inhibitors have been considered. Specific clinical pathways for optimal use of oral anticoagulation with the new directly acting agents are also developed and proposed for clinical implementation. Special attention is finally paid to the development of clinical algorithms for medium and long-term follow-up of patients treated with new oral direct anticoagulants.
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Affiliation(s)
- Federico Nardi
- Cardiology Department, S.O.C. Cardiologia, Ospedale Castelli, ASL VCO, Via Fiume 18, 28922, Verbania, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | - Furio Colivicchi
- CCU-Cardiology Department, Presidio Ospedaliero San Filippo Neri, Rome, Italy
| | | | | | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Giuseppe Di Tano
- Cardiology Department, Azienda Ospedali Riuniti Villa Sofia-Cervello Palermo, Italy
| | - Giovanna Geraci
- Cardiology Department, Azienda Ospedali Riuniti Villa Sofia-Cervello Palermo, Italy
| | | | - Carmine Riccio
- Prevention and cardiac rehabilitation Department, A.O. Sant'Anna e San Sebastiano, Caserta, Italy
| | - Paolo Verdecchia
- Internal Medicine Unit, Ospedale di Assisi, Assisi, Perugia, Italy
| | - Iolanda Enea
- Emergency Care Department, S. Anna e S. Sebastiano Hospital, Caserta, Italy
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21
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Wiles BM, Child N, Roberts PR. How to achieve ultrasound-guided femoral venous access: the new standard of care in the electrophysiology laboratory. J Interv Card Electrophysiol 2017; 49:3-9. [DOI: 10.1007/s10840-017-0227-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/24/2017] [Indexed: 12/22/2022]
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Ertem AG, Yayla Ç, Açar B, Ünal S, Erdol MA, Sonmezer MÇ, Kaya Kiliç E, Ataman Hatipoglu Ç, Gokaslan S, Kafes H, Akboga MK, Aladag P, Demirtas K, Tulek N, Erdinç FS, Aydogdu S. Assessment of the atrial electromechanical properties of patients with human immunodeficiency virus. J Infect Public Health 2017; 10:721-724. [PMID: 28162963 DOI: 10.1016/j.jiph.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 09/10/2016] [Accepted: 10/01/2016] [Indexed: 11/19/2022] Open
Abstract
The relationship between atrial fibrillation and human immunodeficiency virus (HIV) infection was evaluated. Electro-echocardiographic methods can be used to predict the development of atrial fibrillation (AF). In this study, we aimed to investigate the atrial electromechanical delay (AEMD) parameters of HIV (+) patients. Forty-two HIV (+) patients and 40 HIV (-) healthy volunteers were prospectively enrolled in this study. The electromechanical properties of the subjects' atria were evaluated with tissue Doppler imaging. The left-AEMD, right-AEMD and inter-AEMD were increased in the HIV (+) patients relative to the controls (p=0.003, p<0.001, and p<0.001, respectively). The CD4 count was inversely correlated with the inter-AEMD (r=-0.428, p<0.001). The CD4 count was an independent predictor of the inter-AEMD (β=0.523, p=0.007). Our study demonstrated that both the inter- and intra-atrial electromechanical delays were prolonged in the patients with HIV. This non-invasive and simple technique may provide significant contributions to the assessment of the risk of atrial arrhythmia in patients with HIV.
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Affiliation(s)
- Ahmet G Ertem
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
| | - Çağrı Yayla
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Burak Açar
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Sefa Ünal
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Mehmet A Erdol
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Meliha Ç Sonmezer
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Esra Kaya Kiliç
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Çiğdem Ataman Hatipoglu
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Serkan Gokaslan
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Habibe Kafes
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Mehmet K Akboga
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Pelin Aladag
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Koray Demirtas
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Necla Tulek
- Ankara Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Fatma S Erdinç
- Ankara Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Sinan Aydogdu
- Türkiye Yüksek İhtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
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Luca A, Kallmyer T, Virag N. Atrial fibrillation septal pacing: translation of modelling results. Europace 2016; 18:iv53-iv59. [PMID: 28011831 DOI: 10.1093/europace/euw360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/29/2016] [Indexed: 11/12/2022] Open
Abstract
AIMS Atrial fibrillation (AF) septal pacing consists of rapid pacing from a ring of electrodes around the atrial septum, leading to local capture of both atria during AF. The present model-based study evaluated the impact of the number of stimulation electrodes in the septal ring on AF capture for different types of sustained AF dynamics. METHODS AND RESULTS Using a biophysical model of AF based on CT scans from an AF patient, models with different AF substrates (Cholinergic AF and Meandering Wavelets) were created by varying the atrial membrane kinetics. Rapid pacing was applied from the septum area with a ring of 1, 2, 3, 4, 6, 8, or 12 electrodes during 20 seconds at a pacing cycle lengths (PCLs) in the range 60-100% of AF cycle length (AFCL), in 4% steps. Percentage of captured tissue during rapid pacing was determined using 24 sensing electrode pairs evenly distributed on the atrial surface. Results were averaged over 10 AF simulations. For Cholinergic AF, the number of stimulation electrodes on the septal ring had no significant impact on AF capture independently of AF dynamics. For Meandering Wavelets, more electrodes were needed to achieve AF capture in the presence of complex AF. CONCLUSION Changes in AF substrate significantly impacted septal pacing outcomes and response to rapid AF pacing may similarly vary patient-to-patient. The number of stimulation electrodes had a lesser impact, suggesting that the design of a ring with 3-4 electrodes around the septum would be sufficient for most AF dynamics.
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Affiliation(s)
- Adrian Luca
- Applied Signal Processing Group, Swiss Federal Institute of Technology, Route Cantonale, Station 22, 1015 Lausanne, Switzerland
| | - Todd Kallmyer
- Medtronic Tempe Campus, 2343 W Medtronic Way, Tempe, AZ 85281, USA
| | - Nathalie Virag
- Medtronic Europe, Route du Molliau 31, 1131 Tolochenaz, Switzerland
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24
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Helms TM, Silber S, Schäfer A, Masuhr F, Palm F, Darius H, Schrör K, Bänsch D, Bramlage P, Hankowitz J, Karle CA, Stargardt T, Weil J, Geller JC. [Consensus statement: Management of oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2016; 27:295-306. [PMID: 27576696 DOI: 10.1007/s00399-016-0447-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With the introduction of edoxaban last year in Germany, four nonvitamin K antagonist oral anticoagulants are now available for stroke prevention in patients with nonvalvular atrial fibrillation. These novel oral anticoagulants (NOAC) represent an attractive new option compared to vitamin K antagonists (e.g., warfarin or phenprocoumon) due to simple use and fewer interactions with other drugs or food. Therefore, no INR monitoring and dosage adjustments are required for NOAC. The compelling clinical advantage of NOAC is the dramatic risk reduction of hemorhagic stroke and intracranial bleeding compared to current standard. In addition, total mortality is significantly reduced by 10 %. These effects are demonstrated for all four NOAC (dabigatran, rivaroxaban, apixaban and edoxaban). Therefore, current national and international guidelines recommend NOAC as the preferred option or at least as an attractive alternative compared to the former standard of vitamin K antagonists. The economic impact and reimbursement by Statutory Health Insurance (GKV) is of major importance for treatment in an outpatient setting. For apixaban and edoxaban, an additional benefit was granted by the institution of G‑BA and IQWiG in this clinical setting, whereas dabigatran and rivaroxaban were not assessed due to market entrance prior to 2011 before the AMNOG procedure was initiated. The members of this consensus paper recommend NOAC as the preferred option for patients with nonvalvular atrial fibrillation who are currently not treated with anticoagulant drugs in spite of clear indication for anticoagulation. For new patients with nonvalvular fibrillation, it should be decided on an individual basis which treatment option is adequate for the patient with their respective comorbidities.
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Affiliation(s)
- Thomas Maria Helms
- Büro Berlin, Deutsche Stiftung für chronisch Kranke, Pariser Platz 6, 10117, Berlin, Deutschland
| | - Sigmund Silber
- Kardiologische Praxis und Herzkatheterlabor München, München, Deutschland
| | - Andreas Schäfer
- Klinik für Kardiologie und Angiologie, MHH Hannover, Hannover, Deutschland
| | | | - Frederick Palm
- Neurologische Klinik, Städt. Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | | | - Karsten Schrör
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Dietmar Bänsch
- Medizinische Klinik I, Kardiologie - Sektion Rhythmologie, Universitätsklinikum Rostock AoR, Rostock, Deutschland
| | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, München, Deutschland
| | | | | | - Tom Stargardt
- Center for Health Economics, Universität Hamburg, Hamburg, Deutschland
| | - Joachim Weil
- Klinik für Kardiologie, Sana Kliniken Lübeck, Lübeck, Deutschland
| | - Johann Christoph Geller
- Klinik für Kardiologie, Abteilung für Rhythmologie und invasive Elektrophysiologie, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland.
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25
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Efe TH, Cimen T, Ertem AG, Coskun Y, Bilgin M, Sahan HF, Pamukcu HE, Yayla C, Sunman H, Yuksel I, Yeter E. Atrial Electromechanical Properties in Inflammatory Bowel Disease. Echocardiography 2016; 33:1309-16. [PMID: 27158773 DOI: 10.1111/echo.13261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is much evidence linking inflammation to the initiation and continuation of atrial fibrillation (AF). Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic systemic inflammatory disorders. Atrial electromechanical delay (EMD) has been known as an early marker of AF. The objectives of this study were to evaluate the atrial electromechanical properties in patients with IBD. METHODS Fifty-two patients with IBD and 26 healthy controls were recruited in the study. Twenty-five of patients with IBD were on active period, and the remaining 27 were on remission period. Atrial electromechanical properties were measured by using transthoracic echocardiography and tissue Doppler imaging and simultaneous surface ECG recording. Interatrial EMD, left intraatrial EMD, and right intraatrial EMD were calculated. RESULTS Patients on activation with IBD had significantly prolonged left and right intraatrial EMDs and interatrial EMD compared to patients on remission (P = 0.048, P = 0.036, P < 0.001, respectively) and healthy controls (P < 0.001, for all comparisons). Left and right intraatrial EMDs and interatrial EMD were also found to be higher when patients on remission with IBD compared with healthy controls. No statistical difference was observed between UC and CD in terms of inter- and intraatrial EMDs. CONCLUSIONS Atrial electromechanical conduction is prolonged in IBD, and exposure to chronic inflammation may lead to structural and electrophysiological changes in the atrial tissue that causes slow conduction. Measurement of atrial EMD parameters might be used to predict the risk for the development of AF in patients with IBD.
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Affiliation(s)
- Tolga Han Efe
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey.
| | - Tolga Cimen
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Ahmet Goktug Ertem
- Department of Cardiology, Turkiye Yuksek Ihtisas Education and Training Hospital, Ankara, Turkey
| | - Yusuf Coskun
- Department of Gastroenterology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Murat Bilgin
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Haluk Furkan Sahan
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Hilal Erken Pamukcu
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Cagri Yayla
- Department of Cardiology, Turkiye Yuksek Ihtisas Education and Training Hospital, Ankara, Turkey
| | - Hamza Sunman
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Ilhami Yuksel
- Department of Gastroenterology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Ekrem Yeter
- Department of Cardiology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
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26
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Abstract
Atrial fibrillation (AF) is the most common arrhythmia with a substantial effect on individual morbidity and mortality as well as healthcare expenditure. The management of AF is complex and fraught with many uncertain and contentious issues. We have seen substantial progress in AF management in the last two decades including better understanding of the epidemiology, genomics, monitoring, drug and non-pharmacological treatment of the arrhythmia, its complications and stroke risk reduction. In this review, we present a comprehensive discussion on AF with emphasis on most recent updates.
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27
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Kirchhof P, Goette A, Näbauer M, Schotten U. [AFNET. A translational research network develops into an academic research organization]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:514-22. [PMID: 26979716 DOI: 10.1007/s00103-016-2323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
"The whole is greater than the sum of its parts" (Aristotle).Atrial fibrillation (AF) is the most common sustained arrhythmia and affects 1-2 % of the population in developed countries, especially the elderly. We expect that the prevalence of AF will double in the next few decades. The last decades have seen important improvements in the management of atrial fibrillation, but many questions remain regarding the optimal diagnosis and management of the condition. The German Atrial Fibrillation NETwork (AFNET) was one of three cardiovascular competence networks in medicine funded by the German Ministry of Education and Research between 2003-2014. AFNET has contributed to the understanding of atrial fibrillation, and AFNET-led studies have led to improved clinical practices and practice guidelines in Germany and in Europe. This work has been expanded and is continuing in the AFNET association (AFNET e. V.). The AFNET association, founded in 2010 and continuing to this day, has developed into a small but fully formed academic research organisation that conducts investigator-initiated clinical trials as the responsible sponsor in Germany, Europe, and beyond. The AFNET association currently cooperates with EHRA (The European Heart Rhythm Association), ESC (The European Society of Cardiology) and DZHK (The German Centre for Cardiovascular Research) and receives funding from the European Union to generate evidence that can in the future lead to better prevention and management of AF.
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Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trusts, B15 2TT, Birmingham, UK.
- Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland.
- AFNET e. V., Münster, Deutschland.
- Kompetenznetz Vorhofflimmern, Mendelstraße 11, 48149, Münster, Deutschland.
| | - Andreas Goette
- AFNET e. V., Münster, Deutschland
- Vincenz-Krankenhaus, Paderborn, Deutschland
| | - Michael Näbauer
- AFNET e. V., Münster, Deutschland
- Klinikum der Ludwig Maximilian Universität, München, Deutschland
| | - Ulrich Schotten
- AFNET e. V., Münster, Deutschland
- Department of Physiology, Maastricht University, Maastricht, Niederlande
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28
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Efe TH, Ertem AG, Coskun Y, Bilgin M, Algul E, Beton O, Asarcikli LD, Erat M, Ayturk M, Yuksel I, Yeter E. Atrial Electromechanical Properties in Coeliac Disease. Heart Lung Circ 2016; 25:160-5. [PMID: 26412487 DOI: 10.1016/j.hlc.2015.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/31/2015] [Accepted: 08/17/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coeliac disease (CD) is an autoimmune and inflammatory disorder of the small intestine. There is reasonable evidence linking inflammation to the initiation and continuation of atrial fibrillation (AF) in inflammatory conditions. Atrial electro-mechanic delay (EMD) was suggested as an early marker of AF in previous studies. The objectives of this study were to evaluate atrial electromechanical properties measured by tissue Doppler imaging and simultaneous electrocardiography (ECG) tracing in patients with CD. METHODS Thirty-nine patients with coeliac disease (CD), and 26 healthy volunteers, matched for age and sex, were enrolled in the study. Atrial electromechanical properties were measured by using transthoracic echocardiography and surface ECG. Interatrial electro-mechanic delay (EMD), left intraatrial EMD, right intratrial EMD were calculated. RESULTS There was no difference between CD patients and healthy volunteers in terms of basal characteristics. Patients with CD had significantly prolonged left and right intraatrial EMDs, and interatrial EMD compared to healthy controls (p= 0.03, p= 0.02, p<0.0001, respectively). Interatrial EMD was positively correlated with age, disease duration, anti-gliadin IgG, anti-endomysium and disease status. In multiple linear regression, interatrial EMD was independently associated with disease duration, anti-endomysium and disease status after adjusting for age and sex. CONCLUSIONS In the present study, atrial EMDs were found significantly higher in patients with CD compared with healthy individuals. Measurement of atrial EMD parameters might be used to predict the risk of development of AF in patients with CD.
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Affiliation(s)
- Tolga Han Efe
- Department of Cardiology, Diskapi Education and Training Hospital, Ankara, Turkey.
| | - Ahmet Goktug Ertem
- Department of Cardiology, Ankara Ataturk Education and Training Hospital, Ankara, Turkey
| | - Yusuf Coskun
- Department of Gastroenterology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Murat Bilgin
- Department of Cardiology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Engin Algul
- Department of Cardiology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Osman Beton
- Department of Cardiology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Lale Dinc Asarcikli
- Department of Cardiology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Mehmet Erat
- Department of Cardiology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Mehmet Ayturk
- Department of Cardiology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Ilhami Yuksel
- Department of Gastroenterology, Diskapi Education and Training Hospital, Ankara, Turkey
| | - Ekrem Yeter
- Department of Cardiology, Diskapi Education and Training Hospital, Ankara, Turkey
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29
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Shah Z, Masoomi R, Tadros P. Managing Antiplatelet Therapy and Anticoagulants in Patients with Coronary Artery Disease and Atrial Fibrillation. J Atr Fibrillation 2015; 8:1318. [PMID: 27957230 DOI: 10.4022/jafib.1318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/09/2015] [Accepted: 10/27/2015] [Indexed: 01/15/2023]
Abstract
Oral anticoagulation (OAC) is essential in patients with atrial fibrillation (AF). Interestingly coronary artery disease coexists in 20-30% of these patients.[1,2] Balancing the risk of bleeding and thromboembolism is very important for the management of patients on OAC, especially than when such patients require percutaneous coronary intervention (PCI). Lack of data and clear societal guidelines for peri-procedural and post-procedural management of anticoagulated patients has resulted in diverse clinical practices among clinicians, hospitals, and countries. Furthermore with expanding number of available oral antiplatelet and anticoagulant agents, the uncertainty regarding optimal combination therapy in this growing pool of the patients with overlapping clinical indications is also growing. Given the high proportion of patients with atherothrombosis and requiring OAC for conditions particularly like AF, it is important that physicians are aware of the clinical implications and management of these overlapping syndromes. In this article we discuss; this evolving dilemma of peri-procedural and post-procedural management of anticoagulated patient's, burden of the disease, available data, risk factors that could identify high risk patients and propose a well-balanced management strategy.
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Affiliation(s)
- Zubair Shah
- Division of Cardiovascular Diseases, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Reza Masoomi
- Division of Cardiovascular Diseases, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Peter Tadros
- Division of Cardiovascular Diseases, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, KS
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Podd SJ, Freemantle N, Furniss SS, Sulke N. First clinical trial of specific IKACh blocker shows no reduction in atrial fibrillation burden in patients with paroxysmal atrial fibrillation: pacemaker assessment of BMS 914392 in patients with paroxysmal atrial fibrillation. Europace 2015; 18:340-6. [PMID: 26462707 DOI: 10.1093/europace/euv263] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/11/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess the efficacy of BMS 914392 on atrial fibrillation (AF) burden reduction in 20 patients with pacemakers and paroxysmal atrial fibrillation (PAF). BMS 914392 is a potent, selective, oral inhibitor of the IKACh current and has been shown to suppress AF, whilst having no effect on the ventricular refractory period. This is the first efficacy study of BMS 914392 in patients with PAF. METHODS AND RESULTS The study was a four-way, crossover, double-blind design. A total of 20 patients with PAF and dual-chamber pacemakers were recruited. The pacemakers allowed beat-to-beat monitoring. Anti-arrhythmic drugs were withdrawn. Patients received low-dose (10 mg OD), medium-dose (10 mg TDS), and high-dose (20 mg TDS) BMS 914392 or placebo for 3 weeks before being crossed to the next phase. Patients underwent a washout period, four treatment phases and a final washout phase. Atrial fibrillation burden was downloaded from their pacemakers at the end of each study phase. BMS 914392 did not reduce AF burden when compared with placebo (10 mg OD P = 0.56, 10 mg TDS P = 0.22, 20 mg TDS P = 0.23). Heart rate and corrected QT (QTc) were not affected by BMS 914392. Adverse event (AE) rates did not differ from placebo in any of the treatment groups, with no serious AEs recorded. CONCLUSION BMS 914932 has not been shown to reduce AF burden in patients with PAF and pacemakers using beat-to-beat pacemaker monitoring throughout the study. BMS 914392 was well tolerated and did not affect QTc or reduce heart rate. TRIAL REGISTRATION Clinicaltrials.gov: NCT01356914.
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Affiliation(s)
- Steven J Podd
- Cardiology Research Department, East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK
| | - Nicholas Freemantle
- Department of Primary Care and Population Health, PRIMENT Clinical Trials Unit, UCL Medical School, London, UK
| | - Stephen S Furniss
- Cardiology Research Department, East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK
| | - Neil Sulke
- Cardiology Research Department, East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK
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Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015; 17:1467-507. [PMID: 26324838 DOI: 10.1093/europace/euv309] [Citation(s) in RCA: 723] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/10/2015] [Indexed: 12/24/2022] Open
Abstract
The current manuscript is an update of the original Practical Guide, published in June 2013[Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-51; Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013;34:2094-106]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with non-valvular atrial fibrillation (AF). Both physicians and patients have to learn how to use these drugs effectively and safely in clinical practice. Many unresolved questions on how to optimally use these drugs in specific clinical situations remain. The European Heart Rhythm Association set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group defined what needs to be considered as 'non-valvular AF' and listed 15 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 15 topics are (i) practical start-up and follow-up scheme for patients on NOACs; (ii) how to measure the anticoagulant effect of NOACs; (iii) drug-drug interactions and pharmacokinetics of NOACs; (iv) switching between anticoagulant regimens; (v) ensuring adherence of NOAC intake; (vi) how to deal with dosing errors; (vii) patients with chronic kidney disease; (viii) what to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a risk of bleeding?; (xi) management of bleeding complications; (x) patients undergoing a planned surgical intervention or ablation; (xi) patients undergoing an urgent surgical intervention; (xii) patients with AF and coronary artery disease; (xiii) cardioversion in a NOAC-treated patient; (xiv) patients presenting with acute stroke while on NOACs; and (xv) NOACs vs. VKAs in AF patients with a malignancy. Additional information and downloads of the text and anticoagulation cards in >16 languages can be found on an European Heart Rhythm Association web site (www.NOACforAF.eu).
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Bode F, Blanck O, Gebhard M, Hunold P, Grossherr M, Brandt S, Vonthein R, Thiele H, Dunst J, Rades D. Pulmonary vein isolation by radiosurgery: implications for non-invasive treatment of atrial fibrillation. Europace 2015; 17:1868-74. [DOI: 10.1093/europace/euu406] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 12/22/2014] [Indexed: 11/13/2022] Open
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Kirchhof P, Purmah Y, Verma A. Oral anticoagulation after catheter ablation of atrial fibrillation: caught in the attribution trap? Eur Heart J 2015; 36:267-9. [PMID: 25411194 DOI: 10.1093/eurheartj/ehu443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Paulus Kirchhof
- University of Birmingham Centre for Cardiovascular Sciences, Clinical and Integrated Cardiovascular Sciences, and SWBH NHS trust, Birmingham, UK Atrial Fibrillation Competence NETwork (AFNET), Münster, Germany Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
| | - Yanish Purmah
- University of Birmingham Centre for Cardiovascular Sciences, Clinical and Integrated Cardiovascular Sciences, and SWBH NHS trust, Birmingham, UK
| | - Atul Verma
- Southlake Regional Health Centre, Heart Rhythm Program, Newmarket, Ontario, Canada
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Hakalahti A, Biancari F, Nielsen JC, Raatikainen MJP. Radiofrequency ablation vs. antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis. Europace 2015; 17:370-8. [PMID: 25643988 DOI: 10.1093/europace/euu376] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS New evidence about first-line radiofrequency catheter ablation (RFA) in symptomatic atrial fibrillation (AF) has emerged. In a single study the comparative treatment effect is potentially diminished by the high rate of cross-over to the alternative therapy. Therefore, we conducted a systematic review and meta-analysis of the available data to further evaluate the efficacy and safety of RFA vs. antiarrhythmic drugs (AADs). METHODS AND RESULTS Five databases were searched for randomized controlled trials comparing RFA and AAD therapy as first-line treatment of AF in August 2014. Three studies with 491 patients with recurrent symptomatic AF were included. The patients were relatively young and the majority of them had paroxysmal AF (98.7%) and no major comorbidity. Radiofrequency catheter ablation was associated with significantly higher freedom from AF recurrence compared with AAD therapy [risk ratio (RR) 0.63, 95% confidence interval (CI) 0.44-0.92, P = 0.02]. The difference in the rate of symptomatic AF recurrences was not statistically significant (RR 0.57, 95% CI 0.30-1.08, P = 0.09). There was one procedure-related death and seven tamponades with RFA, whereas symptomatic bradycardia was more frequent with AAD therapy. CONCLUSION Radiofrequency catheter ablation seems to be more effective than medical therapy as first-line treatment of paroxysmal AF in relatively young and otherwise healthy patients, but may also cause more severe adverse effects. These findings support the use of RFA as first-line therapy in selected patients, who understand the benefits and risks of the procedure.
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Affiliation(s)
- Antti Hakalahti
- Division of Cardiology, Oulu University Hospital, P.O. Box 5000, Oulu 90014, Finland
| | - Fausto Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | | | - M J Pekka Raatikainen
- Heart Center Co., Tampere University Hospital, Tampere, Finland Central Finland Central Hospital, Jyväskylä, Finland
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Rusu A, Jacquemet V, Vesin JM, Virag N. Influence of atrial substrate on local capture induced by rapid pacing of atrial fibrillation. Europace 2015; 16:766-73. [PMID: 24798967 DOI: 10.1093/europace/euu003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Preliminary studies showed that the septum area was the only location allowing local capture of both the atria during rapid pacing of atrial fibrillation (AF) from a single site. The present model-based study investigated the influence of atrial substrate on the ability to capture AF when pacing the septum. METHODS AND RESULTS Three biophysical models of AF with an identical anatomy from human atria but with different AF substrates were used: (i) AF based on multiple wavelets, (ii) AF based on heterogeneities in vagal activation, (iii) AF based on heterogeneities in repolarization. A fourth anatomical model without Bachmann's bundle (BB) was also implemented. Rapid pacing was applied from the septum at pacing cycle lengths in the range of 50-100% of AF cycle length. Local capture was automatically assessed with 24 pairs of electrodes evenly distributed on the atrial surface. The results were averaged over 16 AF simulations. In the homogeneous substrate, AF capture could reach 80% of the atrial surface. Heterogeneities degraded the ability to capture during AF. In the vagal substrate, the capture tended to be more regular and the degradation of the capture was not directly related to the spatial extent of the heterogeneities. In the third substrate, heterogeneities induced wave anchorings and wavebreaks even in areas close to the pacing site, with a more dramatic effect on AF capture. Finally, BB did not significantly affect the ability to capture. CONCLUSION Atrial fibrillation substrate had a significant effect on rapid pacing outcomes. The response to therapeutic pacing may therefore be specific to each patient.
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Affiliation(s)
- Alexandru Rusu
- Applied Signal Processing Group, Swiss Federal Institute of Technology, CH-1015 Lausanne, Switzerland
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Aliot E, Botto GL, Crijns HJ, Kirchhof P. Quality of life in patients with atrial fibrillation: how to assess it and how to improve it. Europace 2014; 16:787-96. [PMID: 24469433 DOI: 10.1093/europace/eut369] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Atrial fibrillation (AF) is the most frequent cardiac rhythm disorder and presents a considerable public health burden that is likely to increase in the next decades due to the ageing population. Current management strategies focus on the heart rate and rhythm control, thromboembolism prevention, and treatment of underlying diseases. The concept of quality of life (QoL) has gained significant importance in recent years as an outcome measure in AF studies evaluating therapeutic interventions and as a relevant component of a comprehensive treatment plan. Quality of life is impaired in the majority of patients with AF, and both rate and rhythm control strategies show significant improvement in QoL measures in highly symptomatic patients. This article reviews generic and specialized instruments for measuring QoL in the context of AF, discusses their applications and limitations to integration in clinical practice, and addresses the potential of early therapy for improving QoL outcomes. The development and validation of new QoL assessment tools will have a central role in the advancement of therapies and treatment guidelines for AF.
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Affiliation(s)
- Etienne Aliot
- Cardiology Department, Institut Lorrain du Coeur et des Vaisseaux, CHU de Nancy, 54500 Vandoeuvre-lès-Nancy Cedex, France
| | | | - Harry J Crijns
- Department of Cardiology and CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paulus Kirchhof
- University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, Institute for Biomedical Research, Birmingham B15 2TT, UK Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
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von Eisenhart Rothe AF, Goette A, Kirchhof P, Breithardt G, Limbourg T, Calvert M, Baumert J, Ladwig KH. Depression in paroxysmal and persistent atrial fibrillation patients: a cross-sectional comparison of patients enroled in two large clinical trials†. ACTA ACUST UNITED AC 2013; 16:812-9. [DOI: 10.1093/europace/eut361] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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von Eisenhart Rothe A, Bielitzer M, Meinertz T, Limbourg T, Ladwig KH, Goette A. Predictors of discordance between physicians' and patients' appraisals of health-related quality of life in atrial fibrillation patients: findings from the Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation Trial. Am Heart J 2013; 166:589-96. [PMID: 24016511 DOI: 10.1016/j.ahj.2013.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/27/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessing health status is fundamental when weighing treatment options for atrial fibrillation (AF) patients. Most health-related quality-of-life (HRQoL) data stem from self-ratings, whereas treatment decisions are based upon physicians' estimations. METHODS The degree of congruence between patients' and physicians' assessments of the patients' subjective health status was used as an indicator of good communication and shared understanding. A total of 334 patients with paroxysmal AF without significant concomitant heart diseases and their physicians were asked in a prospective blinded study to rate the patients' HRQoL. The Short Form-12 was used for self-ratings; the Short Form-8, for physician ratings. Using baseline data, intraclass correlations and Bland-Altman graphs were used to assess concordance; cross-sectional multivariate regression analyses assessed patient characteristics associated with discordance. RESULTS On average, physicians rated their patients' HRQoL higher than patients did (∆mental component score [MCS] = -3.23, P < .0001, and ∆physical component score [PCS] = -2.21, P = .0001). Intraclass correlations and Bland-Altman graphs showed unsatisfactory concordance. Physical inactivity (∆ = 4.84) had the greatest bivariate effect on PCS discordance, and major depressive disorder (∆ = 7.01), on MCS discordance. In the regression analyses, depression was significantly associated with discord in the MCS (β = -0.94, P < .001) and the PCS (β = -0.37, P < .002). Sleeping disorder was associated with discord in the MCS (β = -4.13, P < .002), and physical inactivity, with discord in the PCS (β = -1.47, P = .006). CONCLUSIONS In patients with AF, even in the absence of significant concomitant cardiac diseases, depression, followed by sleeping disorder and physical inactivity, was significantly associated with discordance. These findings should be considered by physicians when choosing treatment strategies.
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Affiliation(s)
- Alexander von Eisenhart Rothe
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
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Kirchhof P, Breithardt G, Aliot E, Al Khatib S, Apostolakis S, Auricchio A, Bailleul C, Bax J, Benninger G, Blomstrom-Lundqvist C, Boersma L, Boriani G, Brandes A, Brown H, Brueckmann M, Calkins H, Casadei B, Clemens A, Crijns H, Derwand R, Dobrev D, Ezekowitz M, Fetsch T, Gerth A, Gillis A, Gulizia M, Hack G, Haegeli L, Hatem S, Georg Hausler K, Heidbuchel H, Hernandez-Brichis J, Jais P, Kappenberger L, Kautzner J, Kim S, Kuck KH, Lane D, Leute A, Lewalter T, Meyer R, Mont L, Moses G, Mueller M, Munzel F, Nabauer M, Nielsen JC, Oeff M, Oto A, Pieske B, Pisters R, Potpara T, Rasmussen L, Ravens U, Reiffel J, Richard-Lordereau I, Schafer H, Schotten U, Stegink W, Stein K, Steinbeck G, Szumowski L, Tavazzi L, Themistoclakis S, Thomitzek K, Van Gelder IC, von Stritzky B, Vincent A, Werring D, Willems S, Lip GYH, Camm AJ. Personalized management of atrial fibrillation: Proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference. Europace 2013; 15:1540-56. [DOI: 10.1093/europace/eut232] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Engdahl J, Holmén A, Rosenqvist M, Strömberg U. Uptake of atrial fibrillation screening aiming at stroke prevention: geo-mapping of target population and non-participation. BMC Public Health 2013; 13:715. [PMID: 23914772 PMCID: PMC3737106 DOI: 10.1186/1471-2458-13-715] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 08/01/2013] [Indexed: 12/02/2022] Open
Abstract
Background In a screening study for silent atrial fibrillation (AF), which is a frequent source of cardiac emboli with ischemic stroke, the proportion of non-participants was considerable and their clinical profile differed from the participants’ profile. We intended to geo-map the target population and non-participation in an attempt to understand factors related to screening uptake and, thereby, obtain useful information needed to intervene for improved uptake. Method In the municipality of Halmstad, Sweden, all residents born in 1934–1935 were invited to the screening study during April 2010 to February 2012. The total study group included 848 participants and 367 non-participants from 12 parishes. Geo-maps displaying participation, along with target-population-based geo-maps displaying proportion of immigrants and ischemic stroke incidence, were used. Results Smoothed non-participation ratios (SmNPR) varied from 0.81 to 1.24 across different parishes (SmNRP = 1 corresponds to the expected participation based on the total study group). Among high risk individuals, the geographical variation was more pronounced (SmNPR range 0.75–1.51). Two parishes with higher share of immigrants and elevated population-based ischemic stroke incidence showed markedly lower participation, particularly among high-risk individuals. Conclusion AF screening uptake varied evidently between parishes, particularly among high-risk individuals. Geo-mapping of target population and non-participation yielded useful information needed to intervene for improved screening uptake.
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Affiliation(s)
- Johan Engdahl
- Department of Medicine, Halland Hospital, SE-301 85 Halmstad, Sweden.
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Heemstra HE, Nieuwlaat R, Meijboom M, Crijns HJ. The burden of atrial fibrillation in the Netherlands. Neth Heart J 2013; 19:373-8. [PMID: 21761194 DOI: 10.1007/s12471-011-0175-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained atrial arrhythmia and it is independently associated with an increased morbidity and mortality. As a result of the high prevalence of AF, the economic and clinical impact of the disease is substantial. This study describes the economic and clinical impact of AF in the Netherlands. METHODS Epidemiological data on AF in the Netherlands were projected on population estimates of the Netherlands in 2009 and combined with data on the cost of AF and its interventions. RESULTS Overall prevalence of AF in the Netherlands is 5.5% in the population over 55 years, corresponding to about 250,000 AF patients. The prevalence increases with age, and the mean age of AF patients is 69.3 years. Incidence of AF in the Netherlands varies with age, from 1188 new cases in the age group of 55 to 59 up to 7074 new cases in the age group 75 to 79. Total new cases amounts to 45,085 patients per year in the Netherlands. Total costs of AF in the Netherlands are <euro> 583 million, of which the majority (70%) were accounted for by hospitalisations and in-hospital procedures. Pharmacotherapeutic management of AF totalled <euro> 17 million in the Netherlands in 2009. DISCUSSION AF is a serious disease with a high clinical and economic burden, especially due to hospitalisations as a result of cardiovascular events. The number of patients with AF in the Netherlands is considerable and will increase with the ageing population in the future.
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Affiliation(s)
- H E Heemstra
- Pharmerit International, Marten Meesweg 107, 3068 AV, Rotterdam, the Netherlands,
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Mazza A, Bendini MG, Cristofori M, Leggio M, Nardi S, Giordano A, De Cristofaro R, Giordano G. C-reactive protein and P-wave in hypertensive patients after conversion of atrial fibrillation. J Cardiovasc Med (Hagerstown) 2013; 14:520-7. [DOI: 10.2459/jcm.0b013e32835224b5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Boriani G, Maniadakis N, Auricchio A, Muller-Riemenschneider F, Fattore G, Leyva F, Mantovani L, Siebert M, Willich SN, Vardas P, Kirchhof P. Health technology assessment in interventional electrophysiology and device therapy: a position paper of the European Heart Rhythm Association. Eur Heart J 2013; 34:1869-1874. [DOI: 10.1093/eurheartj/eht031] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Kircher S, Hindricks G, Sommer P. Long-term success and follow-up after atrial fibrillation ablation. Curr Cardiol Rev 2013; 8:354-61. [PMID: 22920479 PMCID: PMC3492818 DOI: 10.2174/157340312803760758] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 04/12/2012] [Accepted: 04/12/2012] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia in clinical practice. It is associated with significant morbidity and mortality and has been identified as an independent risk factor for ischemic stroke and thromboembolic events. Catheter ablation has become an established rhythm control therapy in patients with highly symptomatic drug-refractory AF. The definition of ablation success remains controversial since current symptom-based or intermittent electrocardiogram monitoring strategies fail to sufficiently disclose rhythm outcome. This failure is mainly related to the high incidence of asymptomatic AF recurrences, the unpredictable nature of arrhythmia relapses, and the poor correlation of symptoms and AF episodes. There is a clear correlation between the intensity of the monitoring strategy and the sensitivity for it to detect arrhythmia recurrences. Furthermore, several clinical studies assessing the long-term efficacy of catheter ablation procedures have reported late AF recurrences in patients who were initially considered responders to catheter ablation. In certain subsets of patients, precise long-term monitoring may help to guide therapy, e.g. patients in whom withdrawal of antithrombotic therapy may be considered if they are free of arrhythmia recurrences. Recently, sub-cutaneous implantable cardiac monitors (ICM) have been introduced for prolonged and continuous rhythm monitoring. The performance of a leadless ICM equipped with a dedicated AF detection algorithm has recently been assessed in a clinical trial demonstrating a high sensitivity and overall accuracy for identifying patients with AF. The clinical impact of ICM-based follow-up strategies, however, has to be evaluated in prospective clinical trials.
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Affiliation(s)
- S Kircher
- University of Leipzig, Heart Center, Department of Electrophysiology, Struempellstr. 39, 04289 Leipzig, Germany
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Jover E, Marín F, Roldán V, Montoro-García S, Valdés M, Lip GYH. Atherosclerosis and thromboembolic risk in atrial fibrillation: focus on peripheral vascular disease. Ann Med 2013; 45:274-90. [PMID: 23216106 DOI: 10.3109/07853890.2012.732702] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. It results in a 5-fold increased risk for stroke and thromboembolism and is associated with a high morbidity and mortality. AF shares several risk factors and pathophysiological features with atherosclerosis. Hence AF is often complicated by a variety of other cardiovascular conditions. Indeed, peripheral vascular disease (PVD) is highly prevalent among AF patients and associates with increased mortality. Inclusion of PVD within stroke risk scoring systems such as the CHA2DS2-VASc score improves risk stratification of AF patients. Of note, PVD has not been previously well documented nor looked for in observational studies or clinical trials. The aim of this present review article is to provide an overview of the association between atherosclerosis (with particular focus on PVD) and AF as well as its complications.
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Affiliation(s)
- Eva Jover
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Actualización detallada de las guías de la ESC para el manejo de la fibrilación auricular de 2012. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Samol A, Masin M, Gellner R, Otte B, Pavenstädt HJ, Ringelstein EB, Reinecke H, Waltenberger J, Kirchhof P. Prevalence of unknown atrial fibrillation in patients with risk factors. ACTA ACUST UNITED AC 2012; 15:657-62. [DOI: 10.1093/europace/eus366] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Vardas P, Al-Attar N, Alfieri O, Angelini A, Blömstrom-Lundqvist C, Colonna P, De Sutter J, Ernst S, Goette A, Gorenek B, Hatala R, Heidbüchel H, Heldal M, Kristensen SD, Kolh P, Le Heuzey JY, Mavrakis H, Mont L, Filardi PP, Ponikowski P, Prendergast B, Rutten FH, Schotten U, Van Gelder IC, Verheugt FW. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33:2719-47. [PMID: 22922413 DOI: 10.1093/eurheartj/ehs253] [Citation(s) in RCA: 2368] [Impact Index Per Article: 197.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- A John Camm
- Division of Clinical Sciences, St.George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
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Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace 2012; 14:1385-413. [PMID: 22923145 DOI: 10.1093/europace/eus305] [Citation(s) in RCA: 955] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- A John Camm
- Division of Clinical Sciences, St.George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
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Hooft van Huysduynen B, Rienstra M. Atrial fibrillation: is there evidence to support an early ablation strategy? Europace 2012; 14:613-4. [PMID: 22310152 DOI: 10.1093/europace/eus008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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