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Bubnova MG, Aronov DM. Atrial Fibrillation: the Association with Physical Activity and the Effects of Cardiac Rehabilitation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-10-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review was to present modern studies that examine the relationship of physical activity and risk of atrial fibrillation (AF) development and the impact of cardiac rehabilitation programs in patients with all forms of AF. Data of 52 Russian and foreign scientific sources published in 1998- 2020 were presented. In our study, 48 patients with paroxysmal AF after radiofrequency ablation (RFA) were randomly assigned to a physical rehabilitation/standard therapy or control (standard therapy) group. Aerobic physical training was conducted for 6 months 3 times a week. AF is one of the most common cardiac arrhythmias. Despite modern advances, results of treatment of this disease are far from optimal. Many problems of patients with AF can be addressed through enrolment in multidisciplinary cardiac rehabilitation programs. But this question remains open. This is mainly due to the complexity of selection of physical rehabilitation program for patients with AF. It is known that physical activity can trigger an episode of AF. In the following review article, the approaches to functional capacity assessment of patient with AF are described, recommendations for prescribing safe exercise training to achieve a therapeutic effect are presented. Various aspects of the effects of physical rehabilitation are discussed, including its impact on cardiovascular risk factors, influence on atrial remodeling processes and associated biomarkers, prevention of AF progression and occurrence of cardiovascular complications. Results of our own research indicate effectiveness of physical training in patients with AF after RFA: increase in exercise duration by 18.6% (p<0.001) and load by 24.8% (p<0.01) during exercise test, increase in level of everyday physical activity by 23.8% (p=0.001); left atrium dimensions remain stable comparing with control group. That was combined with a decrease of post ablation atrial arrhythmias: after 6 months, they were registered in 4.5% of trained patients vs 17.4% of control group patients (p<0.01). Steady growth in the number of patients with AF and catheter ablation procedures around the world dictates the need for organization of multi-purpose medical rehabilitation.
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Affiliation(s)
- M. G. Bubnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. M. Aronov
- National Medical Research Center for Therapy and Preventive Medicine
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Lim SK, Kim JY, On YK, Jeong DS. Mid-Term Results of Totally Thoracoscopic Ablation in Patients with Recurrent Atrial Fibrillation after Catheter Ablation. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:270-276. [PMID: 32919447 PMCID: PMC7553833 DOI: 10.5090/kjtcs.19.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/25/2019] [Accepted: 04/12/2020] [Indexed: 12/26/2022]
Abstract
Background We investigated the impact of previous catheter ablation (CA) on the midterm outcomes of totally thoracoscopic ablation in patients with lone atrial fibrillation (AF). Methods Between February 2012 and July 2018, 332 patients underwent totally thoracoscopic ablation for the treatment of AF (persistent AF; n=264, 80%). The patients were stratified into CA (n=47, 14%) and non-CA (nCA; n=285, 86%) groups according to their CA history. Results All the baseline clinical characteristics and risk factors were similar between the groups except for age, percentage of male patients, prevalence of paroxysmal AF, prior percutaneous coronary intervention, and left atrial volume index (LAVI). No significant intergroup differences were observed in the incidence of early and late complications. At late follow-up, normal sinus rhythm was observed in 92% (43 of 47) of the patients in the CA group and 85% (242 of 285) of the patients in the nCA group (p=0.268). The rate of freedom from AF recurrence at 5 years was 55.3%±11.0% in the CA group, which was similar to that in the nCA group (55.7%±5.1%, p=0.690). In Cox regression analysis, preoperative brain natriuretic peptide levels and LAVI were associated with AF recurrence, but CA history was not significant. Conclusion Totally thoracoscopic ablation was safe and effective in treating AF irrespective of CA history. A history of CA did not appear to affect the procedural complexity.
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Affiliation(s)
- Suk Kyung Lim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Nyns ECA, Poelma RH, Volkers L, Plomp JJ, Bart CI, Kip AM, van Brakel TJ, Zeppenfeld K, Schalij MJ, Zhang GQ, de Vries AAF, Pijnappels DA. An automated hybrid bioelectronic system for autogenous restoration of sinus rhythm in atrial fibrillation. Sci Transl Med 2020; 11:11/481/eaau6447. [PMID: 30814339 DOI: 10.1126/scitranslmed.aau6447] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/05/2018] [Accepted: 01/17/2019] [Indexed: 11/02/2022]
Abstract
Because of suboptimal therapeutic strategies, restoration of sinus rhythm in symptomatic atrial fibrillation (AF) often requires in-hospital delivery of high-voltage shocks, thereby precluding ambulatory AF termination. Continuous, rapid restoration of sinus rhythm is desired given the recurring and progressive nature of AF. Here, we present an automated hybrid bioelectronic system for shock-free termination of AF that enables the heart to act as an electric current generator for autogenous restoration of sinus rhythm. We show that local, right atrial delivery of adenoassociated virus vectors encoding a light-gated depolarizing ion channel results in efficient and spatially confined transgene expression. Activation of an implanted intrathoracic light-emitting diode device allows for termination of AF by illuminating part of the atria. Combining this newly obtained antiarrhythmic effector function of the heart with the arrhythmia detector function of a machine-based cardiac rhythm monitor in the closed chest of adult rats allowed automated and rapid arrhythmia detection and termination in a safe, effective, repetitive, yet shock-free manner. These findings hold translational potential for the development of shock-free antiarrhythmic device therapy for ambulatory treatment of AF.
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Affiliation(s)
- Emile C A Nyns
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - René H Poelma
- Department of Microelectronics, Delft University of Technology, 2628 CD, Delft, Netherlands
| | - Linda Volkers
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Jaap J Plomp
- Department of Neurology and Neurophysiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Cindy I Bart
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Annemarie M Kip
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Katja Zeppenfeld
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Martin J Schalij
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Guo Qi Zhang
- Department of Microelectronics, Delft University of Technology, 2628 CD, Delft, Netherlands
| | - Antoine A F de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands
| | - Daniël A Pijnappels
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, Netherlands.
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Gaita F, Scaglione M, Battaglia A, Matta M, Gallo C, Galatà M, Caponi D, Di Donna P, Anselmino M. Very long-term outcome following transcatheter ablation of atrial fibrillation. Are results maintained after 10 years of follow up? Europace 2017; 20:443-450. [DOI: 10.1093/europace/eux008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/22/2017] [Indexed: 12/23/2022] Open
Affiliation(s)
- Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Marco Scaglione
- Division of Cardiology, Cardinal Massaia Hospital, Corso Dante Alighieri, 202, 14100 Asti, Italy
| | - Alberto Battaglia
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Mario Matta
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Cristina Gallo
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Michela Galatà
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Domenico Caponi
- Division of Cardiology, Cardinal Massaia Hospital, Corso Dante Alighieri, 202, 14100 Asti, Italy
| | - Paolo Di Donna
- Division of Cardiology, Cardinal Massaia Hospital, Corso Dante Alighieri, 202, 14100 Asti, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Corso Bramante 88, 10126 Turin, Italy
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