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Su L, Wang X, Kang F, Gong C, Chen D. Atrial fibrillation ablation compared to pacemaker therapy in patients with tachycardia-bradycardia syndrome: A systematic review and updated meta-analysis. Medicine (Baltimore) 2024; 103:e37543. [PMID: 38640303 PMCID: PMC11030008 DOI: 10.1097/md.0000000000037543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Tachycardia-bradycardia syndrome (TBS) is a subtype of sick sinus syndrome characterized by prolonged sinus pause (≥3 s) following termination of tachyarrhythmias, primarily atrial fibrillation (AF). There is controversy regarding whether the long-term prognosis of AF ablation is superior to pacemaker implantation. This study aimed to compare the effects of AF ablation and pacemaker therapy in patients with TBS. METHODS We conducted a comprehensive search of electronic databases, including PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical, up until December 1, 2023. We included studies that reported the effects of AF ablation vs pacemaker therapy in patients with TBS. From this search, we identified 5 studies comprising 843 participants with TBS who underwent catheter AF ablation or pacemaker therapy. RESULTS Our meta-analysis revealed that AF ablation and pacemaker therapy had similar effects on cardiovascular death (odds ratio [OR] = 0.62 and 95% confidence interval [CI]: 0.14-2.65), procedural complications (OR = 1.53 and 95% CI: 0.67-3.48), and cardiovascular rehospitalization (OR = 0.57 and 95% CI: 0.26-1.22). However, AF ablation provided greater benefits than pacemaker therapy in terms of all-cause mortality (OR = 0.37 and 95% CI: 0.17-0.82), thromboembolism (OR = 0.25 and 95% CI: 0.12-0.49), stroke (OR = 0.28 and 95% CI: 0.13-0.57), heart failure (OR = 0.27 and 95% CI: 0.13-0.56), freedom from AF (OR = 23.32 and 95% CI: 7.46-72.92), and prevention of progression to persistent AF (OR = 0.12 and 95% CI: 0.06-0.24). Furthermore, AF ablation resulted in a reduced need for antiarrhythmic agents (OR = 0.21 and 95% CI: 0.08-0.59). CONCLUSION AF ablation can effectively reduce the risk of all-cause mortality, thromboembolism, stroke, heart failure, and progression to persistent AF in patients with TBS. Additionally, it may eliminate the need for further pacemaker therapy in most cases after ablation. Therefore, AF ablation is considered superior to pacemaker therapy in the management of patients with TBS.
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Affiliation(s)
- Lijun Su
- Department of Rehabilitation, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Xiaoqi Wang
- Department of Emergency, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Fengguang Kang
- Department of Emergency, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Caidi Gong
- Department of Emergency, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Dezhu Chen
- Department of Emergency and Critical Care Medicine, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
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Dong H, Chen H, Hidru TH, Xia Y, Yang X. Sinus node dysfunction and stroke risk: a systematic review and meta-analysis. BMJ Open 2023; 13:e076499. [PMID: 37977871 PMCID: PMC10660976 DOI: 10.1136/bmjopen-2023-076499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The role of cardiac arrhythmia in ischaemic stroke is widely studied, but the size of the stroke risk in patients with sinus node dysfunction (SND) with and without atrial fibrillation (AF) is unclear. This systematic review and meta-analysis aimed to compare the risk of stroke and its associated factors in patients with SND with and without AF. DESIGN A systematic review and meta-analysis was conducted based on the Grading of Recommendations, Assessment, Development and Evaluation approach. DATA SOURCES PubMed, EMBASE and Cochrane Database were searched until December 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that investigate stroke in patients with SND diagnosed with or without AF/atrial flutter. DATA EXTRACTION AND SYNTHESIS Two independent authors screened studies for inclusion and extracted data. Literature quality assessment was performed using the Newcastle-Ottawa Scale and the Cochrane Collaboration Tool. The overall risk of stroke was estimated using the random-effects model. The generic inverse variance method was used to calculate the pooled estimates of stroke-associated factors. We performed a sensitivity analysis using a fixed-effects model. RESULTS Of the 929 records retrieved, 6 papers (106 163 patients) met the inclusion criteria. The average yearly stroke incidence in patients with SND was 1.542% (95% CI: 1.334% to 1.749%). The stroke incidence was similar between the isolated SND (1.587%; 95% CI: 1.510% to 1.664%) and non-isolated (SND+AF) (1.660%; 95% CI: 0.705% to 2.615%) groups. AF (HR, 95% CI: 1.53 (1.01 to 2.33)), stroke/transient ischaemia attack/other thrombotic events (HR, 95% CI: 2.54 (1.14 to 5.69)), hypertension (HR, 95% CI: 1.51 (1.11 to 2.07)) and heart failure (HR, 95% CI: 1.41 (1.01 to 1.97)) were associated with stroke in the SND population. CONCLUSION Our findings suggest that patients with SND carry a similar risk of stroke to those with combined SND and AF. Future studies are needed to investigate whether interventions targeting stroke prevention, such as anticoagulation therapy, can help to prevent stroke in patients with SND. PROSPERO REGISTRATION NUMBER CRD42023408436.
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Affiliation(s)
- Haoyu Dong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hao Chen
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | | | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiaolei Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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3
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Dong H, Zhang Y, Sun D, Wang G, Zhang Q, Hidru TH, Yang Y, Wang S, Wei Y, Liu F, Zhang J, Xia Y, Yang X. Refining prediction of stroke in sinus node dysfunction patients without atrial fibrillation using a P-combined score: a multi-centre study. Eur J Prev Cardiol 2023:zwad267. [PMID: 37651722 DOI: 10.1093/eurjpc/zwad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
AIMS Isolated sinus node dysfunction (ISND) is a sinus node dysfunction without atrial fibrillation. A high risk of ischaemic stroke (IS) has been reported in ISND populations. However, current guidelines do not recommend anticoagulation in ISND management. P-wave indicates ISND-related atrial remodelling. P-wave indices and the CHA2DS2-VASc score may contribute to risk stratification for ISND-related IS. METHODS AND RESULTS In this multi-centre longitudinal cohort, ISND patients were divided into development (n = 1185) and external validation (n = 988) cohorts. Ischaemic stroke prediction capacity of the P-combined score was assessed with regard to discrimination, calibration, and clinical effectiveness. The cut-off value of the score was confirmed by using a restricted cubic spline curve. One hundred and twenty-four (10.46%) ISND patients developed IS [1.63%/year; 95% confidence interval (CI): 1.49-1.78%/year] after a median 3.02-year follow-up in the development cohort. The P-wave terminal force in electrocardiogram-lead V1 (PTFV1) was the only significantly abnormal P-wave index (adjusted hazard ratio: 2.56; 95% CI: 1.72-3.80). Therefore, we incorporated the PTFV1 with the CHA2DS2-VASc score to generate a P-combined score. For a 5-year IS risk, the P-combined score improved Harrell's C-statistic (95% CI) from 0.678 (0.618-0.738) to 0.716 (0.657-0.774) and 0.747 (0.677-0.816) to 0.808 (0.747-0.868) in the development and validation cohorts, respectively, along with calibration and decision curve analyses. The cut-off value of the score was 3 in the development cohort and well-discriminated in the validation cohort. CONCLUSION Chinese ISND patients have a higher IS risk than the general population. Compared with the CHA2DS2-VASc score, the PTFV1-combined CHA2DS2-VASc score shows a better risk-stratification capacity for ISND-related IS.
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Affiliation(s)
- Haoyu Dong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Yan Zhang
- Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, School of Basic Medical Sciences, Ministry of Education, Peking University Health Science Center, Beijing, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Peking University, Beijing 100191, China
| | - Dongxu Sun
- Vascular Surgery Subgroup, Department of General Surgery, Qilu Hospital of Shandong University (Qingdao), No. 758 Hefei Road, Shibei District, Qing Dao 266011, China
| | - Gaopin Wang
- Department of Cardiology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, China
| | - Qinglong Zhang
- Department of Cardiology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, China
| | - Tesfaldet H Hidru
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Yiheng Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Shihao Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Yushan Wei
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Fei Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Jinpu Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
| | - Xiaolei Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, No. 193 Lianhe Road, Xigang District, Dalian 116000, China
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Defaye P, Biffi M, El-Chami M, Boveda S, Glikson M, Piccini J, Vitolo M. Cardiac pacing and lead devices management: 25 years of research at EP Europace journal. Europace 2023; 25:euad202. [PMID: 37421338 PMCID: PMC10450798 DOI: 10.1093/europace/euad202] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Cardiac pacing represents a key element in the field of electrophysiology and the treatment of conduction diseases. Since the first issue published in 1999, EP Europace has significantly contributed to the development and dissemination of the research in this area. METHODS In the last 25 years, there has been a continuous improvement of technologies and a great expansion of clinical indications making the field of cardiac pacing a fertile ground for research still today. Pacemaker technology has rapidly evolved, from the first external devices with limited longevity, passing through conventional transvenous pacemakers to leadless devices. Constant innovations in pacemaker size, longevity, pacing mode, algorithms, and remote monitoring highlight that the fascinating and exciting journey of cardiac pacing is not over yet. CONCLUSION The aim of the present review is to provide the current 'state of the art' on cardiac pacing highlighting the most important contributions from the Journal in the field.
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Affiliation(s)
- Pascal Defaye
- Cardiology Department, University Hospital and Grenoble Alpes University, CS 10217, Grenoble Cedex 9, Grenoble 38043, France
| | - Mauro Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mikhael El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, Toulouse, France
| | - Michael Glikson
- Cardiology Department, Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jonathan Piccini
- Duke University, Duke Clinical Research Institute, Durham, NC, USA
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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5
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Sathnur N, Ebin E, Benditt DG. Sinus Node Dysfunction. Cardiol Clin 2023; 41:349-367. [PMID: 37321686 DOI: 10.1016/j.ccl.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Sinus node dysfunction (SND) is a multifaceted disorder most prevalent in older individuals, but may also occur at an earlier age. In most cases, the SND diagnosis is ultimately established by documenting its ECG manifestations. EPS has limited utility. The treatment strategy is largely dictated by symptoms and ECG manifestations. Not infrequently, both bradycardia and tachycardia coexist in the same patients, along with other diseases common in the elderly (e.g., hypertension, coronary artery disease), thereby complicating treatment strategy. Prevention of the adverse consequences of both bradyarrhythmia and tachyarrhythmia is important to reduce susceptibility to syncope, falls, and thromboembolic complications.
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Affiliation(s)
- Neeraj Sathnur
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA; Cardiac Electrophysiology, Park-Nicollet Medical Center, St Louis Park, Minneapolis, MN, USA
| | - Emanuel Ebin
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - David G Benditt
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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6
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Abstract
Sinus node dysfunction (SND) is a multifaceted disorder most prevalent in older individuals, but may also occur at an earlier age. In most cases, the SND diagnosis is ultimately established by documenting its ECG manifestations. EPS has limited utility. The treatment strategy is largely dictated by symptoms and ECG manifestations. Not infrequently, both bradycardia and tachycardia coexist in the same patients, along with other diseases common in the elderly (e.g., hypertension, coronary artery disease), thereby complicating treatment strategy. Prevention of the adverse consequences of both bradyarrhythmia and tachyarrhythmia is important to reduce susceptibility to syncope, falls, and thromboembolic complications.
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Affiliation(s)
- Neeraj Sathnur
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA; Cardiac Electrophysiology, Park-Nicollet Medical Center, St Louis Park, Minneapolis, MN, USA
| | - Emanuel Ebin
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - David G Benditt
- Cardiac Arrhythmia Service, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA; Cardiovascular Medicine, University of Minnesota Medical School, Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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7
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Galenko-Yaroshevsky PA, Nechepurenko AA, Pokrovskaya TG, Shimonovsky NL, Dukhanin AS, Suzdalev KF, Maslova PD, Makhnova NM, Shneivais VV, Abushkevich VG, Zelenskaya AV, Seletskaya VV, Ahedzhak-Naguse SK, Korotkov KG. Role of indole derivative SS-68 in increasing the frequency range of cardiac rhythm control (reflex stimulation of the sinoatrial node). RESEARCH RESULTS IN PHARMACOLOGY 2021. [DOI: 10.3897/rrpharmacology.7.75337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Cardiac pacing is indicated for sick sinus syndrome. It is performed with a pacemaker via electrodes implanted in the heart. This technique has several disadvantages. The search for alternative methods of cardiac pacing is underway. One of them is control of heart rhythm through stimulation of the tragus.
Objective: To perform the reflex stimulation of the sinoatrial node and to study the influence of the SS-68 substance on it.
Materials and methods: Two electrodes were fixed in the reflexogenic zone of rabbits’ auricles, volleys of electrical impulses from an electrical stimulator were applied to the electrodes, and the synchronization range of volley frequency and cardiac contractions was recorded. This range was re-recorded again after injecting the SS-68 substance (2-phenyl-1-(3-pyrrolidine-1-cyclopropyl)-1H-indole hydrochloride) intravenously at a dose of 50 µg/kg. In other experiments on frogs in a high-frequency electromagnetic field, the process of excitation of the area of the medulla oblongata associated with the heart rhythm was visualized. After the application of SS-68 (50 μM) to the surface of this zone, the process of its excitation was recorded.
Results and discussion: Stimulation of the auricular reflexogenic zone of rabbits produced a synchronization of volley frequency and heart rate in the range from 173.5 ± 2.0 to 214.0 ± 1.8 per minute. SS-68 extended this range from 168.2 ± 1.9 to 219.4 ± 1.5 per minute. In the frog’s medulla oblongata, an area synchronous to the heart rhythm glowed in the high-frequency electromagnetic field. SS-68 increased the area of glow by 131.0%.
Conclusion: The substance SS-68 increases the frequency range of heart rhythm control by activating reflex stimulation of the sinoatrial node. The main point of application of SS-68 is the medulla oblongata. Glow in the high-frequency electromagnetic field reflects the process of neuron excitation. The increase in the glow zone under the influence of SS-68 indicates synchronously excited neurons, which leads to the assimilation of the central heart rhythm generation by the sinoatrial node.
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Dideriksen JR, Christiansen MK, Johansen JB, Nielsen JC, Bundgaard H, Jensen HK. Long-term outcomes in young patients with atrioventricular block of unknown aetiology. Eur Heart J 2021; 42:2060-2068. [PMID: 33599276 PMCID: PMC8169155 DOI: 10.1093/eurheartj/ehab060] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/17/2020] [Accepted: 01/31/2021] [Indexed: 12/20/2022] Open
Abstract
Aims Atrioventricular block (AVB) of unknown aetiology is rare in the young, and outcome in these patients is unknown. We aimed to assess long-term morbidity and mortality in young patients with AVB of unknown aetiology. Methods and results We identified all Danish patients younger than 50 years receiving a first pacemaker due to AVB between January 1996 and December 2015. By reviewing medical records, we included patients with AVB of unknown aetiology. A matched control cohort was established. Follow-up was performed using national registries. The primary outcome was a composite endpoint consisting of death, heart failure hospitalization, ventricular tachyarrhythmia, and cardiac arrest with successful resuscitation. We included 517 patients, and 5170 controls. Median age at first pacemaker implantation was 41.3 years [interquartile range (IQR) 32.7–46.2 years]. After a median follow-up of 9.8 years (IQR 5.7–14.5 years), the primary endpoint had occurred in 14.9% of patients and 3.2% of controls [hazard ratio (HR) 3.8; 95% confidence interval (CI) 2.9–5.1; P < 0.001]. Patients with persistent AVB at time of diagnosis had a higher risk of the primary endpoint (HR 10.6; 95% CI 5.7–20.0; P < 0.001), and risk was highest early in the follow-up period (HR 6.8; 95% CI 4.6–10.0; P < 0.001, during 0–5 years of follow-up). Conclusion Atrioventricular block of unknown aetiology presenting before the age of 50 years and treated with pacemaker implantation was associated with a three- to four-fold higher rate of the composite endpoint of death or hospitalization for heart failure, ventricular tachyarrhythmia, or cardiac arrest with successful resuscitation. Patients with persistent AVB were at higher risk. These findings warrant improved follow-up strategies for young patients with AVB of unknown aetiology.
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Affiliation(s)
- Johnni Resdal Dideriksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Morten K Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, 5000 Odense C, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Henning Bundgaard
- Department of Cardiology B2142, Unit for Inherited Cardiovascular Diseases, The Heart Centre, National University Hospital, 2100 Copenhagen, Denmark
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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9
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Zhang R, Wang Y, Yang M, Yang Y, Wang Z, Yin X, Dong Y, Yu X, Xiao X, Gao L, Xia Y. Risk Stratification for Atrial Fibrillation and Outcomes in Tachycardia-Bradycardia Syndrome: Ablation vs. Pacing. Front Cardiovasc Med 2021; 8:674471. [PMID: 34169100 PMCID: PMC8217458 DOI: 10.3389/fcvm.2021.674471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/06/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Catheter ablation of atrial fibrillation is an alternative treatment for patients with tachycardia-bradycardia syndrome (TBS) to avoid pacemaker implantation. The risk stratification for atrial fibrillation and outcomes between ablation and pacing has not been fully evaluated. Methods: This retrospective study involved 306 TBS patients, including 141 patients who received catheter ablation (Ablation group, age: 62.2 ± 9.0 months, mean longest pauses: 5.2 ± 2.2 s) and 165 patients who received pacemaker implement (Pacing group, age: 62.3 ± 9.1 months, mean longest pauses: 6.0 ± 2.3 s). The primary endpoint was a composite of call cause mortality, cardiovascular-related hospitalization or thrombosis events (stroke, or peripheral thrombosis). The second endpoint was progress of atrial fibrillation and heart failure. Results: After a median follow-up of 75.4 months, the primary endpoint occurred in significantly higher patients in the pacing group than in the ablation group (59.4 vs.15.6%, OR 6.05, 95% CI: 3.73–9.80, P < 0.001). None of deaths was occurred in ablation group, and 1 death occurred due to cancer. Cardiovascular-related hospitalization occurred in 50.9% of the pacing group compared with 14.2% in the ablation group (OR: 4.87, 95% CI: 2.99–7.95, P < 0.001). More thrombosis events occurred in the pacing group than in the ablation group (12.7 vs. 2.1%, OR 6.06, 95% CI: 1.81–20.35, P = 0.004). Significant more patients progressed to persistent atrial fibrillation in pacing group than in ablation group (23.6 vs. 2.1%, P < 0.001). The NYHA classification of the pacing group was significantly higher than that of the ablation group (2.11 ± 0.83 vs. 1.50 ± 0.74, P < 0.001). The proportion of antiarrhythmic drugs and anticoagulants used in the pacing group was significantly higher than that in the ablation group (41.2 vs. 7.1%, P < 0.001; 16.4 vs. 2.1%, P = 0.009). Conclusion: Catheter ablation for patients with TBS was associated with a significantly lower rate of a composite end point of cardiovascular related hospitalization and thromboembolic events. Furthermore, catheter ablation reduced the progression of atrial fibrillation and heart failure.
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Affiliation(s)
- Rongfeng Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yue Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Minghui Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yiheng Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhengyan Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yingxue Dong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaohong Yu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xianjie Xiao
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianjun Gao
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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10
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Riedlbauchová L, Durdil V, Honěk J, Veselka J. Nonpharmacological Treatment of Atrial Fibrillation: What Is the Role of Device Therapy? Int J Angiol 2020; 29:113-122. [PMID: 32476811 DOI: 10.1055/s-0040-1708529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation is the most common arrhythmia in the adult population, and its incidence and prevalence are still rising. Cardiac devices are widely used in clinical practice in the management of various rhythm disturbances and heart failure treatment. Many patients who receive a pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy also experience atrial fibrillation in the course of their life. Therefore, this review aims to describe the role of these devices in the treatment and prevention of atrial fibrillation in the device recipients. In addition, all these implantable devices also serve as permanent ECG (electrocardiogram) monitors, thus providing important information about the presence and characteristics of atrial fibrillation that may or may not be detected by the patient but can modify our therapeutical approach with regard to the stroke prevention.
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Affiliation(s)
- Lucie Riedlbauchová
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Václav Durdil
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Honěk
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Bodin A, Bisson A, Gaborit C, Herbert J, Clementy N, Babuty D, Lip GYH, Fauchier L. Ischemic Stroke in Patients With Sinus Node Disease, Atrial Fibrillation, and Other Cardiac Conditions. Stroke 2020; 51:1674-1681. [PMID: 32390547 DOI: 10.1161/strokeaha.120.029048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and Purpose- Atrial fibrillation (AF) is known to increase risk of ischemic stroke (IS), but the risk of IS in isolated sinus node disease (SND) is unclear. We compared the incidence of IS in patients with SND, patients with AF, and in a control population with other cardiac diseases (disease of the circulatory system using the International Classification of Diseases, Tenth Revision). Methods- This French longitudinal cohort study was based on the national database covering hospital care for the entire population from 2008 to 2015. Results- Of 1 692 157 patients included in the cohort, 100 366 had isolated SND, 1 564 270 had isolated AF, and 27 521 had AF associated with SND. Incidence of IS during follow-up was higher in isolated patients with AF than in AF associated with SND (yearly rate 2.22% versus 2.06%) and in isolated patients with AF than in isolated patients with SND (yearly rate 2.22% versus 1.59%). The incidence of IS was lower in a control population with other cardiac conditions (n=479 108) compared with SND and patients with AF (0.96%/y, 1.59%/y, and 2.22%/y, respectively). After 1:1 propensity score matching, SND was associated with lower incidence of IS compared to AF (hazard ratio, 0.77 [95% CI, 0.73-0.82]) but higher incidence of IS compared to control population (hazard ratio, 1.27 [95%CI, 1.19-1.35]). Conclusions- Patients with SND had a lower risk of thromboembolic events than patients with AF but a higher risk than a control population with other cardiac diseases. Randomized clinical trial in a selected SND population, with, for example, a high CHA2DS2-VASc score, would be required to determine the value of IS prevention by anticoagulation.
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Affiliation(s)
- Alexandre Bodin
- From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France
| | - Arnaud Bisson
- From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France
| | - Christophe Gaborit
- Service D'Information Médicale et d'Épidémiologie, Centre Hospitalier Universitaire et EA7505 (C.G., J.H.), Université François Rabelais, Tours, France
| | - Julien Herbert
- From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France.,Service D'Information Médicale et d'Épidémiologie, Centre Hospitalier Universitaire et EA7505 (C.G., J.H.), Université François Rabelais, Tours, France
| | - Nicolas Clementy
- From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France
| | - Dominique Babuty
- From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom (G.Y.H.L.)
| | - Laurent Fauchier
- From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France
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12
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Long VP, Bonilla IM, Baine S, Glynn P, Kumar S, Schober K, Mowrey K, Weiss R, Lee NY, Mohler PJ, Györke S, Hund TJ, Fedorov VV, Carnes CA. Chronic heart failure increases negative chronotropic effects of adenosine in canine sinoatrial cells via A1R stimulation and GIRK-mediated I Kado. Life Sci 2019; 240:117068. [PMID: 31751583 DOI: 10.1016/j.lfs.2019.117068] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/07/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022]
Abstract
AIMS Bradycardia contributes to tachy-brady arrhythmias or sinus arrest during heart failure (HF). Sinoatrial node (SAN) adenosine A1 receptors (ADO A1Rs) are upregulated in HF, and adenosine is known to exert negative chronotropic effects on the SAN. Here, we investigated the role of A1R signaling at physiologically relevant ADO concentrations on HF SAN pacemaker cells. MAIN METHODS Dogs with tachypacing-induced chronic HF and normal controls (CTL) were studied. SAN tissue was collected for A1R and GIRK mRNA quantification. SAN cells were isolated for perforated patch clamp recordings and firing rate (bpm), slope of slow diastolic depolarization (SDD), and maximum diastolic potential (MDP) were measured. Action potentials (APs) and currents were recorded before and after addition of 1 and 10 μM ADO. To assess contributions of A1R and G protein-coupled Inward Rectifier Potassium Current (GIRK) to ADO effects, APs were measured after the addition of DPCPX (selective A1R antagonist) or TPQ (selective GIRK blocker). KEY FINDINGS A1R and GIRK mRNA expression were significantly increased in HF. In addition, ADO induced greater rate slowing and membrane hyperpolarization in HF vs CTL (p < 0.05). DPCPX prevented ADO-induced rate slowing in CTL and HF cells. The ADO-induced inward rectifying current, IKado, was observed significantly more frequently in HF than in CTL. TPQ prevented ADO-induced rate slowing in HF. SIGNIFICANCE An increase in A1R and GIRK expression enhances IKAdo, causing hyperpolarization, and subsequent negative chronotropic effects in canine chronic HF at relevant [ADO]. GIRK blockade may be a useful strategy to mitigate bradycardia in HF.
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Affiliation(s)
- Victor P Long
- College of Pharmacy, The Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Ingrid M Bonilla
- College of Pharmacy, The Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Stephen Baine
- College of Pharmacy, The Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Patric Glynn
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Sanjay Kumar
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Karsten Schober
- College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | | | - Raul Weiss
- Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Nam Y Lee
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Peter J Mohler
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA; Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA
| | - Sandor Györke
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA; Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA
| | - Thomas J Hund
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Vadim V Fedorov
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA; Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA
| | - Cynthia A Carnes
- College of Pharmacy, The Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA.
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13
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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14
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15
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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16
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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17
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary. J Am Coll Cardiol 2019; 74:932-987. [DOI: 10.1016/j.jacc.2018.10.043] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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19
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm 2018; 16:e227-e279. [PMID: 30412777 DOI: 10.1016/j.hrthm.2018.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/22/2022]
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20
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation 2018; 140:e333-e381. [PMID: 30586771 DOI: 10.1161/cir.0000000000000627] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | | | - Kenneth A Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,ACC/AHA Representative
| | - Michael R Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative
| | | | | | - José A Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative.,Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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