1
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [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: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [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: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil and Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France and Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ngai-Yin Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, and Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas and Case Western Reserve University, Cleveland, Ohio and Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, USA
| | - Kevin L Thomas
- Duke University Medical Center, Durham, North Carolina, USA
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [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: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Hussain S, Srinivasan N, Ahsan S, Papageorgiou N. The Role of Risk Factor Modification in Atrial Fibrillation: Outcomes in Catheter Ablation. J Cardiovasc Dev Dis 2024; 11:97. [PMID: 38667715 PMCID: PMC11050342 DOI: 10.3390/jcdd11040097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
The management of atrial fibrillation has evolved significantly over the last ten years with advancements in medical and catheter ablation approaches, but these have limited success when used in isolation. Trends in the management of lifestyle modifications have surfaced, as it is now better understood that modifiable risk factors contribute significantly to the development and propagation of atrial fibrillation, as well as failure of treatment. International guidelines have integrated the role of lifestyle modification in the management of atrial fibrillation and specifically in the persistent form of atrial fibrillation; these guidelines must be addressed prior to considering catheter ablation. Effective risk factor modification is critical in increasing the likelihood of an arrhythmia-free survival following catheter ablation.
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Affiliation(s)
- Shahana Hussain
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (S.H.); (S.A.)
| | - Neil Srinivasan
- Department of Cardiac Electrophysiology, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK;
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (S.H.); (S.A.)
| | - Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (S.H.); (S.A.)
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
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Vanharen Y, Abugattas de Torres JP, Adriaenssens B, Convens C, Schwagten B, Tijskens M, Wolf M, Goossens E, Van Bogaert P, de Greef Y. Nurse-led care after ablation of atrial fibrillation: a randomized controlled trial. Eur J Prev Cardiol 2023; 30:1599-1607. [PMID: 37067048 DOI: 10.1093/eurjpc/zwad117] [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: 01/09/2023] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
AIMS The added value of advanced practitioner nurse (APN) care after ablation of atrial fibrillation (AF) is unknown. The present study investigates the impact of APN-led care on AF recurrence, patient knowledge, lifestyle, and patient satisfaction. METHODS AND RESULTS Sixty-five patients undergoing AF ablation were prospectively randomized to usual care (N = 33) or intervention (N = 32) group. In addition to usual care, the intervention consisted of an educational session, three consultations spread over 6 months and telephone accessibility coordinated by the APN. Primary outcome was the AF recurrence rate at 6-month follow-up. Secondary outcomes were lifestyle factors (alcohol intake, exercise, BMI, smoking), patient satisfaction and AF knowledge measured at 1 and 6 months between groups and within each group. Study demographics at 1 month were similar, except AF knowledge was higher in the intervention group (8.6 vs. 7, P = 0.001). At 6 months, AF recurrence was significantly lower in the intervention group (13.5 vs. 39.4%, P = 0.014). Between groups, patient satisfaction and AF knowledge were significantly higher in the intervention group, respectively, 9.4 vs. 8.7 (P < 0.001) and 8.6 vs. 7.0 out of 10 (P < 0.001). Within the intervention group, alcohol intake decreased from 3.9 to 2.6 units per week (P = 0.031) and physical activity increased from 224.4 ± 210.7 to 283.8 ± 169.3 (P = 0.048). No changes occurred within the usual care group. Assignment to the intervention group was the only protective factor for AF recurrence [Exp(B) 0.299, P = 0.04] in multivariable-adjusted analysis. CONCLUSION Adding APN-led care after ablation of AF improves short-term clinical outcome, patient satisfaction and physical activity and decreases alcohol intake.
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Affiliation(s)
- Yaël Vanharen
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
- Department of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen 2610, Belgium
| | | | - Bert Adriaenssens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
- Department of Cardiology, AZ Sint-Niklaas, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Carl Convens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Bruno Schwagten
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Maxime Tijskens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Michael Wolf
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Eva Goossens
- Department of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen 2610, Belgium
- Department of Public Health and Primary Care, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Peter Van Bogaert
- Department of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen 2610, Belgium
| | - Yves de Greef
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerpen, Belgium
- Heart Rhythm Management Centre, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
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6
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Yang L, Chung MK. Lifestyle changes in atrial fibrillation management and intervention. J Cardiovasc Electrophysiol 2023; 34:2163-2178. [PMID: 36598428 PMCID: PMC10318120 DOI: 10.1111/jce.15803] [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: 07/18/2022] [Revised: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias in adults, and its continued rise in the United States is complicated by the increased incidence and prevalence of several AF risk factors, such as obesity, physical inactivity, hypertension, obstructive sleep apnea, diabetes mellitus, coronary artery disease, and alcohol, tobacco, or caffeine use. Lifestyle and risk factor modification has been proposed as an additional pillar of AF therapy, added to rhythm control, rate control, and anticoagulation, to reduce AF burden and risk. Although emerging evidence largely supports the integration of lifestyle and risk factor management in clinical practice, randomized clinical trials investigating the long-term sustainability and reproducibility of these benefits remain sparse. The purpose of this review is to discuss potentially reversible risk factors on AF, share evidence for the impact on AF by modification of these risk factors, and then provide an overview of the effects of reversing or managing these risk factors on the success of various AF management strategies, such as antithrombotic, rate control, and rhythm control therapies.
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Affiliation(s)
- Lucy Yang
- The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mina K Chung
- The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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7
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Grindal AW, Sparrow RT, McIntyre WF, Conen D, Healey JS, Wong JA. Alcohol Consumption and Atrial Arrhythmia Recurrence After Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis. Can J Cardiol 2023; 39:266-273. [PMID: 36549481 DOI: 10.1016/j.cjca.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/19/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although alcohol consumption is associated with an increased risk of atrial fibrillation (AF), it is unclear whether alcohol is associated with AF recurrences after catheter ablation for AF. We aimed to systematically review the medical literature to assess the impact of alcohol consumption on the recurrence of AF after AF ablation. METHODS A structured electronic database search of the scientific literature (Medline, Embase, and Central from inceptions to December 2021) was performed for studies reporting rates of AF recurrence after catheter ablation stratified by patients' level of alcohol consumption according to study-specific definitions. Unadjusted study-specific odds ratios (ORs) were meta-analysed with the use of random-effects models. Risk of bias was evaluated by means of the ROBINS-I tool. RESULTS We identified 9 observational studies which included 5436 patients who underwent catheter ablation for AF. Compared with patients consuming little or no alcohol, patients consuming moderate to high amounts of alcohol had a greater risk of AF recurrence (summary OR 1.45, 95% confidence interval [CI] 1.06-1.99; P = 0.02; I2 = 79%). Results remained robust when we excluded studies with < 100 participants (OR 1.40, 95% CI 1.03-1.9) or abstract-only publications (OR 1.84, 95% CI 1.21-2.8). All included studies were found to be at serious risk of bias, primarily due to confounding. CONCLUSIONS Increased alcohol consumption is associated with an increased risk of AF recurrence after catheter ablation for AF. Reduction of alcohol consumption may be beneficial in this context.
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Affiliation(s)
| | - Robert T Sparrow
- Department of Medicine, Western University, London, Ontario, Canada
| | - William F McIntyre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - David Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jorge A Wong
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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8
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Teppo K, Jaakkola J, Biancari F, Halminen O, Putaala J, Mustonen P, Haukka J, Linna M, Kinnunen J, Luojus A, Itäinen-Strömberg S, Penttilä T, Niemi M, Hartikainen J, Airaksinen KJ, Lehto M. Mental health conditions and use of rhythm control therapies in patients with atrial fibrillation: a nationwide cohort study. BMJ Open 2022; 12:e059759. [PMID: 36041755 PMCID: PMC9438075 DOI: 10.1136/bmjopen-2021-059759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Mental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving rhythm control therapies for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with a lower use of antiarrhythmic therapies (AATs). DESIGN A nationwide retrospective registry-based cohort study. SETTING The Finnish AntiCoagulation in Atrial Fibrillation cohort included records on all patients with AF in Finland during 2007-2018 identified from nationwide registries covering all levels of care as well as drug purchases. MHCs of interest were diagnosed depression, bipolar disorder, anxiety disorder, schizophrenia and any MHC. PARTICIPANTS We identified 239 222 patients (mean age 72.6±13.2 years; 49.8% women) with incident AF, in whom the prevalence of any MHC was 19.9%. OUTCOMES Primary outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. RESULTS Lower overall use of any AAT emerged in patients with any MHC than in those without MHC (16.9% vs 22.9%, p<0.001). Any MHC, depression, bipolar disorder, anxiety disorder and schizophrenia were all associated with lower incidence of any AAT with adjusted subdistribution HRs of 0.790 (95% CI 0.771 to 0.809), 0.817 (0.796 to 0.838), 0.811 (0.789 to 0.835), 0.807 (0.785 to 0.830) and 0.795 (0.773 to 0.818), respectively. Adjusted rates of AAD, cardioversion and catheter ablation use were lower in all MHC groups compared with patients without MHC. The findings in patients with any MHC were confirmed in propensity score matching analysis. CONCLUSIONS Among patients with AF, a clear disparity exists in AAT use between those with and without MHCs. TRIAL REGISTRATION NUMBER ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845.
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Affiliation(s)
| | - Jussi Jaakkola
- University of Turku, Turku, Finland
- Satakunta Central Hospital, Pori, Finland
| | - Fausto Biancari
- Helsingin seudun yliopistollinen keskussairaala Sydän- ja keuhkokeskus, Helsinki, Finland
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | | | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Pirjo Mustonen
- Heart Center, TYKS Turun yliopistollinen keskussairaala, Turku, Finland
| | | | | | - Janne Kinnunen
- Department of Neurology, University of Helsinki, Helsinki, Finland
| | | | | | | | - Mikko Niemi
- Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
| | - Juha Hartikainen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika Lehto
- Helsinki University Hospital Heart and Lung Center, Helsinki, Finland
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9
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Ohlrogge AH, Frost L, Schnabel RB. Harmful Impact of Tobacco Smoking and Alcohol Consumption on the Atrial Myocardium. Cells 2022; 11:cells11162576. [PMID: 36010652 PMCID: PMC9406618 DOI: 10.3390/cells11162576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Tobacco smoking and alcohol consumption are widespread exposures that are legal and socially accepted in many societies. Both have been widely recognized as important risk factors for diseases in all vital organ systems including cardiovascular diseases, and with clinical manifestations that are associated with atrial dysfunction, so-called atrial cardiomyopathy, especially atrial fibrillation and stroke. The pathogenesis of atrial cardiomyopathy, atrial fibrillation, and stroke in context with smoking and alcohol consumption is complex and multifactorial, involving pathophysiological mechanisms, environmental, and societal aspects. This narrative review summarizes the current literature regarding alterations in the atrial myocardium that is associated with smoking and alcohol.
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Affiliation(s)
- Amelie H. Ohlrogge
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Lars Frost
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, 8600 Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Renate B. Schnabel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Correspondence:
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10
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Sagawa Y, Nagata Y, Miwa N, Yamaguchi T, Watanabe K, Kaneko M, Nakamura T, Nozato T, Ashikaga T, Goya M, Sasano T. Alcohol Consumption Is Associated With Postablation Recurrence but Not Changes in Atrial Substrate in Patients With Atrial Fibrillation: Insight from a High-Density Mapping Study. J Am Heart Assoc 2022; 11:e025697. [PMID: 35766315 PMCID: PMC9333400 DOI: 10.1161/jaha.121.025697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The association between alcohol consumption, atrial substrate, and outcomes after atrial fibrillation (AF) ablation remains controversial. This study evaluated the impacts of drinking on left atrial substrate and AF recurrence after ablation. Methods and Results We prospectively enrolled 110 patients with AF without structural heart disease (64±12 years) from 2 institutions. High‐density left atrial electroanatomic mapping was performed using a high‐density grid multipolar catheter. We investigated the impact of alcohol consumption on left atrial voltage, left atrial conduction velocity, and AF ablation outcome. Patients were classified as abstainers (<1 drink/wk), mild drinkers (1–7 drinks/wk), or moderate‐heavy drinkers (>7 drinks/wk). High‐density mapping (mean 2287±600 points/patient) was performed on 49 abstainers, 27 mild drinkers, and 34 moderate‐heavy drinkers. Low‐voltage zone and slow‐conduction zone were identified in 39 (35%) and 54 (49%) patients, respectively. There was no significant difference in the proportions of low‐voltage zone and slow‐conduction zone among the 3 groups. The success rate after a single ablation was significantly lower in drinkers than in abstainers (79.3% versus 95.9% at 12 months; mean follow‐up, 18±8 months; P=0.013). The success rate after a single or multiple ablations was not significantly different among abstainers and drinkers. In multivariate analysis, alcohol consumption (P=0.02) and the presence of a low‐voltage zone (P=0.032) and slow‐conduction zone (P=0.02) were associated with AF recurrence after a single ablation, while low‐voltage zone (P=0.023) and slow‐conduction zone (P=0.024) were associated with AF recurrence after a single or multiple ablations. Conclusions Alcohol consumption was associated with AF recurrence after a single ablation but not changes in atrial substrate.
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Affiliation(s)
- Yuichiro Sagawa
- Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan
| | - Yasutoshi Nagata
- Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan
| | - Naoyuki Miwa
- Cardiovascular Center Tsuchiura Kyodo Hospital Tsuchiura Japan
| | | | - Keita Watanabe
- Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan
| | - Masakazu Kaneko
- Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan
| | - Tomofumi Nakamura
- Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan
| | - Toshihiro Nozato
- Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan
| | - Takashi Ashikaga
- Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
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11
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Lifestyle Modification and Atrial Fibrillation: Critical Care for Successful Ablation. J Clin Med 2022; 11:jcm11092660. [PMID: 35566788 PMCID: PMC9099891 DOI: 10.3390/jcm11092660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023] Open
Abstract
Management of atrial fibrillation (AF) requires a comprehensive approach due to the limited success of medical or procedural approaches in isolation. Multiple modifiable risk factors contribute to the development and progression of the underlying substrate, with a heightened risk of progression evident with inadequate risk factor management. With increased mortality, stroke, heart failure and healthcare utilisation linked to AF, international guidelines now strongly support risk factor modification as a critical pillar of AF care due to evidence demonstrating the efficacy of this approach. Effective lifestyle management is key to arrest and reverse the progression of AF, in addition to increasing the likelihood of freedom from arrhythmia following catheter ablation.
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12
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Linz B, Hertel JN, Jespersen T, Linz D. Mechanisms and therapeutic opportunities in atrial fibrillation in relationship to alcohol use and abuse. Can J Cardiol 2022; 38:1352-1363. [DOI: 10.1016/j.cjca.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 12/24/2022] Open
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13
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Wang H, Li J, Gao Y, Chen K, Gao Y, Guo J, Shi M, Zou X, Xu W, Zhao L, Su X, Wang Y, Liu J, Xu H, Kong X, Lin J, Qian X, Han J, Liu L. Prevalence and factors associated with atrial fibrillation in older patients with obstructive sleep apnea. BMC Geriatr 2022; 22:204. [PMID: 35287580 PMCID: PMC8922720 DOI: 10.1186/s12877-022-02791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose This study sought to identify the prevalence and factors associated with atrial fibrillation (AF) in older patients with obstructive sleep apnea (OSA) in China. Methods This was an explorative cross-sectional study. Between January 2015 and October 2017, we continuously recruited 1285 older patients with OSA who underwent overnight polysomnography from sleep centers of multiple hospitals. They were assessed using 12-lead ECG or 24-h dynamic ECG, and their baseline demographics, clinical characteristics, sleep parameters, and medical history were determined. Multivariate binary logistic regression analysis was used to investigate the factors related to AF in these older patients with OSA. Results The clinician classified 122 (9.5%) patients as having AF. The prevalence of AF significantly increased with age (P < 0.05) but did not significantly differ between the mild, moderate, and severe OSA groups. Additionally, the prevalence of paroxysmal AF was 7.2% among the overall study population, and it increased with OSA severity or advanced age (P < 0.05). Persistent AF was noted in 2.3% participants, and the prevalence also increased with age. The logistic regression analysis showed that age (OR = 1.054, 95%CI: 1.027–1.018, P < 0.001), history of drinking (OR = 1.752, 95%CI: 1.070–2.867, P < 0.05), chronic heart disease (OR = 1.778, 95%CI: 1.156–2.736, P < 0.01), diabetes mellitus (OR = 1.792, 95%CI: 1.183–2.713, P < 0.01), and reduced diastolic function (OR = 2.373, 95%CI = 1.298–4.337, P < 0.01) were relevant to AF among participants with OSA. Conclusion The prevalence of AF is significantly common in older patients with OSA. Age, history of drinking, chronic heart disease, diabetes mellitus, and reduced diastolic function are independently related to AF in these patients.
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Affiliation(s)
- Huanhuan Wang
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center, Chinese PLA General Hospital, Beijing, China.,Medical College, Yan'an University, Yan'an, Shaanxi Province, China
| | - JianHua Li
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yinghui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Kaibing Chen
- Sleep Center, the Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Yan Gao
- Department of General Practice, 960Th Hospital of PLA, Jinan, Shandong Province, China
| | - JingJing Guo
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Min Shi
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao Zou
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Weihao Xu
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - LiBo Zhao
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiaofeng Su
- Medical College, Yan'an University, Yan'an, Shaanxi Province, China
| | - Yabin Wang
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Juan Liu
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hu Xu
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiaoxuan Kong
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Junling Lin
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital Affiliated To Capital Medical University, Beijing, China
| | - Xiaoshun Qian
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Jiming Han
- Medical College, Yan'an University, Yan'an, Shaanxi Province, China.
| | - Lin Liu
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center, Chinese PLA General Hospital, Beijing, China.
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14
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Mitrani LR, Goldenthal I, Leskowitz J, Wan EY, Dizon J, Saluja D, Creber RM, Turchioe MR, Sciacca RR, Garan H, Hickey KT, Korner J, Biviano AB. Risk factor management of atrial fibrillation using mHealth: The Atrial Fibrillation – Helping Address Care with Remote Technology (AF-HEART) Pilot Study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 3:14-20. [PMID: 35265931 PMCID: PMC8890079 DOI: 10.1016/j.cvdhj.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Personalized treatment of atrial fibrillation (AF) risk factors using mHealth and telehealth may improve patient outcomes. Objective The purpose of this study was to assess the feasibility of the Atrial Fibrillation Helping Address Care with Remote Technology (AF-HEART) intervention on the following patient outcomes: (1) heart rhythm tracking; (2) weight, alcohol, blood pressure (BP), and sleep apnea reduction; (3) AF symptom reduction; and (4) quality-of-life (QOL) improvement. Methods A total of 20 patients with AF undergoing antiarrhythmic therapy, cardioversion, and/or catheter ablation were enrolled and followed for 6 months. The AF-HEART intervention included remote heart rhythm, weight, and BP tracking; televisits with a dietician focusing on AF risk factors; and referrals for sleep apnea and hypertension treatment. Results Patients transmitted a median of 181 rhythm recordings during the 6-month follow-up period. Patients lost an average of 3.5 kilograms at 6 months (P = .005). Patients had improved SF-12 scores (P = .01), AFSS score (P = .01), EQ-5D score (P = .006), and AFEQT Global Score (P = .03). There was significant correlation between weight loss and decrease in symptom severity (r = -0.45, P = .05), and between % weight loss and decrease in symptom severity (r = -0.49, P = .03). Conclusion This study described the feasibility of the AF-HEART intervention for (1) consistent remote tracking of heart rhythm, weight, and BP; (2) achievement of weight loss; (3) reduction of symptoms; and (4) improvement in QOL. Expansion to a larger randomized study is planned.
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Affiliation(s)
- Lindsey R. Mitrani
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Isaac Goldenthal
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jamie Leskowitz
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Elaine Y. Wan
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Deepak Saluja
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | | | - Robert R. Sciacca
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Judith Korner
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Angelo B. Biviano
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
- Address reprint requests and correspondence: Dr Angelo B. Biviano, Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY 10032.
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15
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Takahashi Y, Nitta J, Kobori A, Sakamoto Y, Nagata Y, Tanimoto K, Matsuo S, Yamane T, Morita N, Satomi K, Inaba O, Murata K, Sasaki Y, Yoshimoto D, Kaneko M, Tanimoto Y, Isogai R, Yamashita S, Sato H, Hanazawa R, Hirakawa A, Goya M, Sasano T. Alcohol Consumption Reduction and Clinical Outcomes of Catheter Ablation for Atrial Fibrillation. CIRCULATION. ARRHYTHMIA AND ELECTROPHYSIOLOGY 2021; 14:e009770. [PMID: 33999699 DOI: 10.1161/circep.121.009770] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Yoshihide Takahashi
- Department of Cardiovascular Medicine (Y. Takahashi, M.G., T.S.), Clinical Research Center, Tokyo Medical and Dental University
| | - Junichi Nitta
- Department of Cardiology, Japanese Red Cross Saitama Hospital (J.N., O.I., K.M.)
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital (A.K., Y. Sasaki)
| | - Yuichiro Sakamoto
- Department of Cardiology, Toyohashi Heart Center (Y. Sakamoto, D.Y.)
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital (Y.N., M.K.)
| | - Kojiro Tanimoto
- Department of Cardiology, Tokyo Medical Center (K.T., Y. Tanimoto)
| | - Seiichiro Matsuo
- Department of Cardiovascular Medicine, Jikei University Katsushika Medical Center (S.M., R.I.)
| | - Teiichi Yamane
- Department of Cardiovascular Medicine, Jikei University (T.Y., S.Y.)
| | - Norishige Morita
- Department of Cardiovascular Medicine, Tokai University Hachioji Hospital (N.M.)
| | - Kazuhiro Satomi
- Department of Cardiovascular Medicine, Tokyo Medical University, Japan (K.S.)
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital (J.N., O.I., K.M.)
| | - Kazuya Murata
- Department of Cardiology, Japanese Red Cross Saitama Hospital (J.N., O.I., K.M.)
| | - Yasuhiro Sasaki
- Department of Cardiology, Kobe City Medical Center General Hospital (A.K., Y. Sasaki)
| | - Daisuke Yoshimoto
- Department of Cardiology, Toyohashi Heart Center (Y. Sakamoto, D.Y.)
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital (Y.N., M.K.)
| | - Yoko Tanimoto
- Department of Cardiology, Tokyo Medical Center (K.T., Y. Tanimoto)
| | - Ryota Isogai
- Department of Cardiovascular Medicine, Jikei University Katsushika Medical Center (S.M., R.I.)
| | - Seigo Yamashita
- Department of Cardiovascular Medicine, Jikei University (T.Y., S.Y.)
| | - Hiroyuki Sato
- Division of Biostatistics and Data Science (H.S., R.H., A.H.), Clinical Research Center, Tokyo Medical and Dental University
| | - Ryoichi Hanazawa
- Division of Biostatistics and Data Science (H.S., R.H., A.H.), Clinical Research Center, Tokyo Medical and Dental University
| | - Akihiro Hirakawa
- Division of Biostatistics and Data Science (H.S., R.H., A.H.), Clinical Research Center, Tokyo Medical and Dental University
| | - Masahiko Goya
- Department of Cardiovascular Medicine (Y. Takahashi, M.G., T.S.), Clinical Research Center, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine (Y. Takahashi, M.G., T.S.), Clinical Research Center, Tokyo Medical and Dental University
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16
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Yilmaz M, Candemir B. Approach to recurrence of atrial fibrillation after catheter ablation. Minerva Cardiol Angiol 2021; 69:81-93. [PMID: 33691388 DOI: 10.23736/s2724-5683.20.05173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation (AF) is the most commonly observed sustained rhythm disorder during adult ages. Since it has been shown that the ectopic beat initiating AF is usually caused by pulmonary veins, AF ablation has become the mainstay of therapy worldwide. Cryoballoon and radiofrequency ablation are the most commonly used methods in today's technologies. However, despite technological advances, the success of a single procedure in AF ablation is still limited and multiple procedures may be required for the majority of patients. In cases in which a redo ablation is required, pulmonary vein isolation is still the main target, but non-pulmonary vein targets should also be considered in AF episodes that continue despite multiple ablations. Many issues are still unclear as to which energy to choose in the first procedure, and what ablation strategy will be utilized when a redo ablation is required. The studies on this subject are very limited but, it still seems feasible and a rational approach to utilize a customized treatment strategy in each specific patient subgroup.
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Affiliation(s)
- Mustafa Yilmaz
- Department of Cardiology, Faculty of Medicine, Baskent University, Adana, Turkey -
| | - Basar Candemir
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
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17
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Abstract
Modifiable risk factor management is becoming one of the 3 treatment pillars in atrial fibrillation management along with anticoagulation as well as conventional rate and rhythm control strategies. Preventive therapies, such as reducing blood pressure and treating obstructive sleep apnea, are paramount in the strategy of preventing atrial fibrillation. Identification of new modifiable risk factors and triggers also could help in the global strategy to reduce atrial fibrillation. This article covers alcohol intake, tobacco smoking, caffeine, chocolate, cannabis use, and air pollution as social risk factors related to lifestyle habits that potentially could contribute to atrial fibrillation development.
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Affiliation(s)
- Andres Klein
- Arrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Mohammad Shenasa
- Department of Cardiovascular Services, Heart and Rhythm Medical Group, 18324 Twin Creeks Road, Monte Sereno, CA 95030, USA
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
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18
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Abstract
PURPOSE OF REVIEW To evaluate (1) the impact of acute and habitual alcohol consumption on atrial fibrillation (AF) and atrial remodeling and (2) the role of alcohol reduction and/or abstinence in the primary and secondary prevention of AF. RECENT FINDINGS Acute alcohol consumption appears to be a common AF trigger, with animal and human studies demonstrating changes in electrophysiological parameters, autonomic tone, and cellular properties expected to promote AF. Habitual consumption is associated with adverse atrial remodeling, higher risk of incident AF, and AF recurrence. Randomized data suggest that reduction in excessive alcohol consumption may reduce the risk of recurrent AF episodes and AF burden. Alcohol is an increasingly recognized risk factor for both new onset AF and discrete AF episodes. Excessive consumption should be avoided for primary and secondary prevention of AF.
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Voskoboinik A, Kalman JM, De Silva A, Nicholls T, Costello B, Nanayakkara S, Prabhu S, Stub D, Azzopardi S, Vizi D, Wong G, Nalliah C, Sugumar H, Wong M, Kotschet E, Kaye D, Taylor AJ, Kistler PM. Alcohol Abstinence in Drinkers with Atrial Fibrillation. N Engl J Med 2020; 382:20-28. [PMID: 31893513 DOI: 10.1056/nejmoa1817591] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear. METHODS We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up. RESULTS Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01). CONCLUSIONS Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).
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Affiliation(s)
- Aleksandr Voskoboinik
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Jonathan M Kalman
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Anurika De Silva
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Thomas Nicholls
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Benedict Costello
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Shane Nanayakkara
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Sandeep Prabhu
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Dion Stub
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Sonia Azzopardi
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Donna Vizi
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Geoffrey Wong
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Chrishan Nalliah
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Hariharan Sugumar
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Michael Wong
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Emily Kotschet
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - David Kaye
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Andrew J Taylor
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
| | - Peter M Kistler
- From the Heart Center, Alfred Hospital (A.V., T.N., B.C., S.N., S.P., D.S., S.A., D.V., H.S., D.K., A.J.T., P.M.K.), the Baker Heart and Diabetes Institute (A.V., B.C., S.P., D.S., H.S., A.J.T., P.M.K.), the Department of Cardiology, Royal Melbourne Hospital (A.V., J.M.K., S.P., G.W., C.N., H.S.), the Department of Medicine (A.V., J.M.K., P.M.K.) and the Centre for Epidemiology and Biostatistics (A.D.S.), University of Melbourne, the Department of Cardiology, Cabrini Hospital (P.M.K.), the Department of Cardiology, Western Health (D.S., M.W.), Monash Heart, Monash Medical Centre (E.K.), and the Department of Epidemiology and Preventive Medicine (D.S.) and Medicine (A.J.T.), Monash University - all in Melbourne, VIC, Australia
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Day E, Rudd JHF. Alcohol use disorders and the heart. Addiction 2019; 114:1670-1678. [PMID: 31309639 PMCID: PMC6771559 DOI: 10.1111/add.14703] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022]
Abstract
Alcohol use is an important preventable and modifiable cause of non-communicable disease, and has complex effects on the cardiovascular system that vary with dose. Observational and prospective studies have consistently shown a lower risk of cardiovascular and all-cause mortality in people with low levels of alcohol consumption when compared to abstainers (the 'J'-shaped curve). Maximum potential benefit occurs at 0.5 to one standard drinks (7-14 g pure ethanol) per day for women (18% lower all-cause mortality, 95% confidence interval (CI) = 13-22%) and one to two standard drinks (14-28 g ethanol) per day for men (17% lower all-cause mortality, 95% CI = 15-19%). However, this evidence is contested, and overall the detrimental effects of alcohol far outweigh the beneficial effects, with the risk of premature mortality increasing steadily after an average consumption of 10 g ethanol/day. Blood pressure (BP) is increased by regular alcohol consumption in a dose-dependent manner, with a relative risk for hypertension (systolic BP > 140 mm Hg or diastolic > 90 mm Hg) of 1.7 for 50 g ethanol/day and 2.5 at 100 g/day. Important reductions in BP readings can be expected after as little as 1 month of abstinence from alcohol. Heavy alcohol consumption in a binge pattern is associated with the development of acute cardiac arrhythmia, even in people with normal heart function. Atrial fibrillation is the most common arrhythmia associated with chronic high-volume alcohol intake, and above 14 g alcohol/day the relative risk increases 10% for every extra standard drink (14 g ethanol). Ethanol and its metabolites have toxic effects on cardiac myocytes, and alcoholic cardiomyopathy (ACM) accounts for a third of all cases of non-ischaemic dilated cardiomyopathy. Screening people drinking alcohol above low-volume levels and delivering a brief intervention may prevent the development of cardiovascular complications. Although people with established cardiovascular disease show improved outcomes with a reduction to low-volume alcohol consumption, there is no safe amount of alcohol to drink and patients with ACM should aim for abstinence in order to optimize medical treatment.
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Affiliation(s)
- Ed Day
- Institute for Mental Health, School of Psychology, University of Birmingham, and Honorary Consultant in Addiction Psychiatry, Solihull Integrated Addiction ServiceUK
| | - James H. F. Rudd
- Division of Cardiovascular MedicineUniversity of Cambridge, Honorary Consultant Cardiologist, Addenbrooke's HospitalCambridgeUK
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Barmano N, Charitakis E, Kronstrand R, Walfridsson U, Karlsson JE, Walfridsson H, Nystrom FH. The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation. PLoS One 2019; 14:e0215121. [PMID: 30970005 PMCID: PMC6457637 DOI: 10.1371/journal.pone.0215121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 03/28/2019] [Indexed: 12/14/2022] Open
Abstract
Background Information on alcohol consumption in patients undergoing radiofrequency ablation (RFA) of atrial fibrillation (AF) is often limited by the reliance on self-reports. The aim of this study was to describe the long-term alcohol consumption, measured as ethyl glucuronide in hair (hEtG), in patients undergoing RFA due to AF, and to examine potential associations with cardiac biomarkers, left atrial size and re-ablation within one year after the initial RFA. Methods The amount of hEtG was measured in patients referred for RFA, and a cut-off of 7 pg/mg was used. N-terminal pro B-type natriuretic peptide (NT-proBNP) and the mid-regional fragment of pro atrial natriuretic peptide (MR-proANP) were examined and maximum left atrium volume index (LAVI) was measured. The number of re-ablations was examined up to one year after the initial RFA. Analyses were stratified by gender, and adjusted for age, systolic blood pressure, body mass index, presence of heart failure and heart rhythm for analyses regarding NT-proBNP, MR-proANP and LAVI and heart rhythm being replaced by type of AF for analyses regarding re-ablation. Results In total, 192 patients were included in the study. Median (25th– 75th percentile) NT-proBNP in men with hEtG ≥ 7 vs. < 7 pg/mg was 250 (96–695) vs. 130 (49–346) pg/ml (p = 0.010), and in women it was 230 (125–480) vs. 230 (125–910) pg/ml (p = 0.810). Median MR-proANP in men with hEtG ≥ 7 vs. < 7 pg/mg was 142 (100–224) vs. 117 (83–179) pmol/l (p = 0.120) and in women it was 139 (112–206) vs. 153 (93–249) pmol/l (p = 0.965). The median of maximum LAVI was 30.1 (26.7–33.9) vs. 25.8 (21.4–32.0) ml/m2 (p = 0.017) in men, and 25.0 (18.9–29.6) vs. 25.7 (21.7–34.6) ml/m2 (p = 0.438) in women, with hEtG ≥ 7 vs. < 7 pg/ml, respectively. Adjusted analyses showed similar results, except for MR-proANP turning out significant in men with hEtG ≥ 7 vs. < 7 pg/mg (p = 0.047). The odds ratio of having a re-ablation was 3.5 (95% CI 1.3–9.6, p = 0.017) in men with hEtG ≥ 7 vs. < 7 pg/mg, while there was no significant difference in women. Conclusions In male patients with AF and hEtG ≥ 7 pg/mg, NT-proBNP and MR-proANP were higher, LA volumes larger, and there was a higher rate of re-ablations, as compared to men with hEtG < 7 pg/mg. This implies that men with an alcohol consumption corresponding to an hEtG-value ≥ 7, have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.
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Affiliation(s)
- Neshro Barmano
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
- * E-mail:
| | - Emmanouil Charitakis
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Robert Kronstrand
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- National Board of Forensic Medicine, Linköping, Sweden
| | - Ulla Walfridsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Håkan Walfridsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Fredrik H. Nystrom
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Centrum, Norrköping, Sweden
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Hussein A, Das M, Riva S, Morgan M, Ronayne C, Sahni A, Shaw M, Todd D, Hall M, Modi S, Natale A, Dello Russo A, Snowdon R, Gupta D. Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients. Circ Arrhythm Electrophysiol 2018; 11:e006576. [DOI: 10.1161/circep.118.006576] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmed Hussein
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | - Moloy Das
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (M.D.)
| | - Stefania Riva
- Centro Cardiologico Monzino, Milan, Italy (S.R., A.D.R.)
| | - Maureen Morgan
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | - Christina Ronayne
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | - Ankita Sahni
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | - Matthew Shaw
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | - Derick Todd
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | - Mark Hall
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | - Simon Modi
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | | | | | - Richard Snowdon
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
| | - Dhiraj Gupta
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)
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