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Kroshian G, Joseph J, Kinlay S, Peralta AO, Hoffmeister PS, Singh JP, Yuyun MF. Atrial fibrillation and risk of adverse outcomes in heart failure with reduced, mildly reduced, and preserved ejection fraction: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2024; 35:715-726. [PMID: 38348517 DOI: 10.1111/jce.16209] [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: 10/16/2023] [Revised: 01/03/2024] [Accepted: 01/28/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Heart failure (HF) and atrial fibrillation (AF) frequently co-exist. Contemporary classification of HF categorizes it into HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). Aggregate data comparing the risk profile of AF between these three HF categories are lacking. METHODS We conducted a systematic review and meta-analysis aimed at determining any significant differences in AF-associated all-cause mortality, HF hospitalizations, cardiovascular mortality (CV), and stroke between HFrEF, HFmrEF, and HFpEF. A systematic search of PubMed, EMBASE, and Cochrane Library databases until February 28, 2023. Data were combined using DerSimonian-Laird random effects model. RESULTS A total of 22 studies comprising 248 323 patients were retained: HFrEF 123 331 (49.7%), HFmrEF 40 995 (16.5%), and HFpEF 83 997 (33.8%). Pooled baseline AF prevalence was 36% total population, 30% HFrEF, 36% HFmrEF, and 42% HFpEF. AF was associated with a higher risk of all-cause mortality in the total population with pooled hazard ratio (HR) = 1.13 (95% confidence interval [CI] = 1.07-1.21), HFmrEF (HR = 1.25, 95% CI = 1.05-1.50) and HFpEF (HR = 1.16, 95% CI = 1.09-1.24), but not HFrEF (HR = 1.03, 95% CI = 0.93-1.14). AF was associated with a higher risk of HF hospitalizations in the total population (HR = 1.29, 95% CI = 1.14-1.46), HFmrEF (HR = 1.64, 95% CI = 1.20-2.24), and HFpEF (HR = 1.46, 95% CI = 1.17-1.83), but not HFrEF (HR = 1.01, 95% CI = 0.87-1.18). AF was only associated with CV in the HFpEF subcategory but was associated with stroke in all three HF subtypes. CONCLUSIONS AF appears to be associated with a higher risk of all-cause mortality and HF hospitalization in HFmrEF and HFpEF. With these findings, the paucity of data and treatment guidelines on AF in the HFmrEF subgroup becomes even more significant and warrant further investigations.
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Affiliation(s)
- Garen Kroshian
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Jacob Joseph
- VA Providence Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Brown University, Providence, Rhode Island, USA
- VA Boston Healthcare System, Boston, USA
| | - Scott Kinlay
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, Boston, USA
- Harvard Medical School, Boston, USA
- Brigham and Women's Hospital, Boston, USA
| | - Adelqui O Peralta
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, Boston, USA
- Harvard Medical School, Boston, USA
| | - Peter S Hoffmeister
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, Boston, USA
- Harvard Medical School, Boston, USA
| | - Jagmeet P Singh
- Harvard Medical School, Boston, USA
- Massachusetts General Hospital, Boston, USA
| | - Matthew F Yuyun
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, Boston, USA
- Harvard Medical School, Boston, USA
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Titus A, Syeed S, Baburaj A, Bhanushali K, Gaikwad P, Sooraj M, Saji AM, Mir WAY, Kumar PA, Dasari M, Ahmed MA, Khan MO, Titus A, Gaur J, Annappah D, Raj A, Noreen N, Hasdianda A, Sattar Y, Narasimhan B, Mehta N, Desimone CV, Deshmukh A, Ganatra S, Nasir K, Dani S. Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials. BMC Cardiovasc Disord 2024; 24:131. [PMID: 38424483 PMCID: PMC10902941 DOI: 10.1186/s12872-023-03670-5] [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] [Received: 07/22/2023] [Accepted: 12/13/2023] [Indexed: 03/02/2024] Open
Abstract
This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.
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Affiliation(s)
- Anoop Titus
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | | | | | | | | | - Mannil Sooraj
- Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Kanakapura, Karnataka, India
| | | | | | | | | | | | | | - Aishwarya Titus
- Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | | | | | - Arjun Raj
- University Hospital of Leicester, Leicester, UK
| | | | - Adrian Hasdianda
- Brigham and Women's Hospital, Harvard University, Cambridge, MA, USA
| | | | - Bharat Narasimhan
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Nishaki Mehta
- Beaumont Hospital Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | | | - Sarju Ganatra
- Department of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA, 10805, USA
| | - Khurram Nasir
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Sourbha Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA, 10805, USA
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Akerström F, Hutter J, Charitakis E, Tabrizi F, Asaad F, Bastani H, Bourke T, Braunschweig F, Drca N, Englund A, Friberg L, Insulander P, Jönsson AH, Kennebäck G, Paul-Nordin A, Sadigh B, Saluveer O, Saygi S, Schwieler J, Svennberg E, Tapanainen J, Türkmen Y, Jensen-Urstad M. Association between catheter ablation of atrial fibrillation and mortality or stroke. Heart 2024; 110:163-169. [PMID: 37657914 PMCID: PMC10850723 DOI: 10.1136/heartjnl-2023-322883] [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: 04/26/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE Catheter ablation of atrial fibrillation effectively reduces symptomatic burden. However, its long-term effect on mortality and stroke is unclear. We investigated if patients with atrial fibrillation who undergo catheter ablation have lower risk for all-cause mortality or stroke than patients who are managed medically. METHODS We retrospectively included 5628 consecutive patients who underwent first-time catheter ablation for atrial fibrillation between 2008 and 2018 at three major Swedish electrophysiology units. Control individuals with an atrial fibrillation diagnosis but without previous stroke were selected from the Swedish National Patient Register, resulting in a control group of 48 676 patients. Propensity score matching was performed to produce two cohorts of equal size (n=3955) with similar baseline characteristics. The primary endpoint was a composite of all-cause mortality or stroke. RESULTS Patients who underwent catheter ablation were healthier (mean CHA2DS2-VASc score 1.4±1.4 vs 1.6±1.5, p<0.001), had a higher median income (288 vs 212 1000 Swedish krona [KSEK]/year, p<0.001) and had more frequently received university education (45.1% vs 28.9%, p<0.001). Mean follow-up was 4.5±2.8 years. After propensity score matching, catheter ablation was associated with lower risk for the combined primary endpoint (HR 0.58, 95% CI 0.48 to 0.69). The result was mainly driven by a decrease in all-cause mortality (HR 0.51, 95% CI 0.41 to 0.63), with stroke reduction showing a trend in favour of catheter ablation (HR 0.75, 95% CI 0.53 to 1.07). CONCLUSIONS Catheter ablation of atrial fibrillation was associated with a reduction in the primary endpoint of all-cause mortality or stroke. This result was driven by a marked reduction in all-cause mortality.
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Affiliation(s)
- Finn Akerström
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Julie Hutter
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | | | - Fahd Asaad
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Leif Friberg
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Per Insulander
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Bita Sadigh
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Serkan Saygi
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Emma Svennberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Yusuf Türkmen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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Serra-Burriel M, Aebersold H, Foster-Witassek F, Coslovsky M, Rodondi N, Blum MR, Sticherling C, Moschovitis G, Beer JH, Reichlin T, Krisai P, Aeschbacher S, Paladini RE, Kühne M, Osswald S, Conen D, Felder S, Schwenkglenks M. Real-World Cost-Effectiveness of Pulmonary Vein Isolation for Atrial Fibrillation: A Target Trial Approach. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1721-1729. [PMID: 37741443 DOI: 10.1016/j.jval.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/27/2023] [Accepted: 08/05/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVES Randomized controlled trials of pulmonary vein isolation (PVI) for treating atrial fibrillation (AF) have proven the procedure's efficacy. Studies assessing its empirical cost-effectiveness outside randomized trial settings are lacking. We aimed to evaluate the effectiveness and cost-effectiveness of PVI versus medical therapy for AF. METHODS We followed a target trial approach using the Swiss-AF cohort, a prospective observational cohort study that enrolled patients with AF between 2014 and 2017. Resource utilization and cost information were collected through claims data. Quality of life was measured with EQ-5D-3L utilities. We estimated incremental cost-effectiveness ratios (ICERs) from the perspective of the Swiss statutory health insurance system. RESULTS Patients undergoing PVI compared with medical therapy had a 5-year overall survival advantage with a hazard ratio of 0.75 (95% CI 0.46-1.21; P = .69) and a 19.8% SD improvement in quality of life (95% CI 15.5-22.9; P < .001), at an incremental cost of 29 604 Swiss francs (CHF) (95% CI 16 354-42 855; P < .001). The estimated ICER was CHF 158 612 per quality-adjusted life-year (QALY) gained within a 5-year time horizon. Assuming similar health effects and costs over 5 additional years changed the ICER to CHF 82 195 per QALY gained. Results were robust to the sensitivity analyses performed. CONCLUSIONS Our results show that PVI might be a cost-effective intervention within the Swiss healthcare context in a 10-year time horizon, but unlikely to be so at 5 years, if a willingness-to-pay threshold of CHF 100 000 per QALY gained is assumed. Given data availability, we find target trial designs are a valuable tool for assessing the cost-effectiveness of healthcare interventions outside of randomized controlled trial settings.
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Affiliation(s)
- Miquel Serra-Burriel
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Helena Aebersold
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Fabienne Foster-Witassek
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Michael Coslovsky
- Department of Clinical Research, University of Basel, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel, University of Basel, University Hospital, Basel, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University of Basel, University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ente Ospedaliero Cantonale, Regional Hospital of Lugano, Lugano, Switzerland
| | - Jürg H Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zurich, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Krisai
- Cardiovascular Research Institute Basel, University of Basel, University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University of Basel, University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rebecca E Paladini
- Cardiovascular Research Institute Basel, University of Basel, University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University of Basel, University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University of Basel, University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Stefan Felder
- Department of Business and Economics, University of Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland; Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
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de Lima-Conceição MR, Teixeira-Fonseca JL, Roman-Campos D. Chasing New Non-Invasive Parameters to Predict Atrial Fibrillation after Radiofrequency Catheter Ablation. Arq Bras Cardiol 2023; 120:e20230091. [PMID: 37018793 PMCID: PMC10392827 DOI: 10.36660/abc.20230091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Michael Ramon de Lima-Conceição
- Escola Paulista de MedicinaUniversidade Federal de São PauloDepartamento de BiofísicaSão PauloSPBrasilEscola Paulista de Medicina, Universidade Federal de São Paulo – Laboratório de Cardiobiologia, Departamento de Biofísica, São Paulo, SP – Brasil
| | - Jorge Lucas Teixeira-Fonseca
- Escola Paulista de MedicinaUniversidade Federal de São PauloDepartamento de BiofísicaSão PauloSPBrasilEscola Paulista de Medicina, Universidade Federal de São Paulo – Laboratório de Cardiobiologia, Departamento de Biofísica, São Paulo, SP – Brasil
| | - Danilo Roman-Campos
- Escola Paulista de MedicinaUniversidade Federal de São PauloDepartamento de BiofísicaSão PauloSPBrasilEscola Paulista de Medicina, Universidade Federal de São Paulo – Laboratório de Cardiobiologia, Departamento de Biofísica, São Paulo, SP – Brasil
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Ellis CR, McMaster WG, Stevenson WG. Cheating death in a maze of surgical ablation data. Heart Rhythm 2023; 20:12-13. [PMID: 36370982 DOI: 10.1016/j.hrthm.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher R Ellis
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - William G McMaster
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William G Stevenson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Outcomes of catheter ablation versus antiarrhythmic therapy in patients with atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022; 65:773-802. [PMID: 36057733 DOI: 10.1007/s10840-022-01365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent data have shown an advantage of rhythm control over rate control for the treatment of atrial fibrillation (AF). Nevertheless, the data regarding efficacy of catheter ablation (CA) compared with antiarrhythmic drugs (AADs) in patients with AF is lacking. Therefore, we sought to evaluate recurrence of arrhythmia, all-cause mortality, cardiovascular deaths, stroke/TIA, and all-cause readmissions of CA compared with AAD in patients with AF. METHODS Systematically searched through PubMed, Google Scholar, EMBASE, and Cochrane for randomized control trials that compared CA and AAD in atrial fibrillation patients. Review Manager 5.4 and OpenMetaAnalyst were used to analyze the data. Data was pooled for the outcomes using random-effect models (DerSimonian and Laird) and reported as pooled odds ratio (OR). RESULTS A total of 4822 patients were included. The CA group had 2417 patients while the AAD group included 2405 patients. Pooled data demonstrated that the CA arm had a statistically significant decrease in risk for recurrence of arrhythmia as compared to AAD (OR 0.25; [95% CI, 0.18-0.36]; p < 0.001). All-cause readmission was statistically significantly lower in CA as compared to AAD (OR 0.33; [95%CI, 0.17-0.63]; p < 0.001). For other secondary outcomes, there was no statistically significant difference between CA and AAD with regard to all-cause mortality (OR 0.75; [95% CI, 0.55-1.03]), cardiovascular death (OR 0.76; [95% CI, 0.22-2.54]), bleeding (OR 1.09, [95% CI 0.74, 1.61]), or stroke/TIA outcome (OR 0.90, [95% CI, 0.59-1.37]). CONCLUSIONS In this study of pooled data from 16 RCTs, CA utilization for atrial fibrillation had improved freedom from arrhythmia as well as reduced all-cause readmission compared with AAD.
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Loring Z, Bahnson TD. Is there a mortality benefit of atrial fibrillation ablation? J Cardiovasc Electrophysiol 2021; 33:194-196. [PMID: 34911158 DOI: 10.1111/jce.15328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Zak Loring
- Clinical Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Duke University, Durham, North Carolina, USA
| | - Tristram D Bahnson
- Clinical Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Duke University, Durham, North Carolina, USA.,Duke Center for Atrial Fibrillation, Duke Health System, Durham, North Carolina, USA
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