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Jemtrén A, Saygi S, Åkerström F, Asaad F, Bourke T, Braunschweig F, Carnlöf C, Drca N, Insulander P, Kennebäck G, Nordin AP, Sadigh B, Rickenlund A, Saluveer O, Schwieler J, Svennberg E, Tapanainen J, Turkmen Y, Bastani H, Jensen-Urstad M. Risk assessment in patients with symptomatic and asymptomatic pre-excitation. Europace 2024; 26:euae036. [PMID: 38363996 PMCID: PMC10873488 DOI: 10.1093/europace/euae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024] Open
Abstract
AIMS Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation. METHODS AND RESULTS This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation referred for risk assessment. All participants performed an incremental EST (bicycle) prior to an electrophysiology study (EPS). Primary data from the EST included loss of pre-excitation during exercise, and primary data from the EPS included the measurement of accessory pathway effective refractory period (APERP), shortest pre-excited RR interval (SPERRI), and inducible arrhythmia with the use of a beta-adrenergic receptor agonist if deemed necessary. One hundred and sixty-four patients (59 asymptomatic, 105 symptomatic) completed an EST and EPS. Forty-five patients (27%) demonstrated low-risk findings on EST, of which 19 were asymptomatic and 26 were symptomatic. Six patients with low-risk EST findings had SPERRI/APERP ≤ 250 ms at EPS, and two of them were asymptomatic. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of low-risk EST for excluding patients with SPERRI/APERP ≤ 250 ms were 40, 91, 87, 51, and 60%, respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic (36, 69%) and symptomatic (73, 61%) groups. CONCLUSION Sudden loss of pre-excitation during EST has a low NPV in excluding high-risk APs. The EPS with the use of isoproterenol should be considered to accurately assess the risk of patients with pre-excitation regardless of symptoms (ClinicalTrials.gov Identifier: NCT03301935).
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Affiliation(s)
- Anette Jemtrén
- Heart and Lung Disease Unit, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Serkan Saygi
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Finn Åkerström
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Fahd Asaad
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Carina Carnlöf
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Astrid Paul Nordin
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Bita Sadigh
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Anette Rickenlund
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Emma Svennberg
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Jari Tapanainen
- Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yusuf Turkmen
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Charitakis E, Metelli S, Karlsson LO, Antoniadis AP, Rizas KD, Liuba I, Almroth H, Hassel Jönsson A, Schwieler J, Tsartsalis D, Sideris S, Dragioti E, Fragakis N, Chaimani A. Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis. BMC Med 2022; 20:193. [PMID: 35637488 PMCID: PMC9153169 DOI: 10.1186/s12916-022-02385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is no consensus on the most efficient catheter ablation (CA) strategy for patients with atrial fibrillation (AF). The objective of this study was to compare the efficacy and safety of different CA strategies for AF ablation through network meta-analysis (NMA). METHODS A systematic search of PubMed, Web of Science, and CENTRAL was performed up to October 5th, 2020. Randomized controlled trials (RCT) comparing different CA approaches were included. Efficacy was defined as arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of 6 months. RESULTS In total, 67 RCTs (n = 9871) comparing 19 different CA strategies were included. The risk of recurrence was significantly decreased compared to pulmonary vein isolation (PVI) alone for PVI with renal denervation (RR: 0.60, CI: 0.38-0.94), PVI with ganglia-plexi ablation (RR: 0.62, CI: 0.41-0.94), PVI with additional ablation lines (RR: 0.8, CI: 0.68-0.95) and PVI in combination with bi-atrial modification (RR: 0.32, CI: 0.11-0.88). Strategies including PVI appeared superior to non-PVI strategies such as electrogram-based approaches. No significant differences in safety were observed. CONCLUSIONS This NMA showed that PVI in combination with additional CA strategies, such as autonomic modulation and additional lines, seem to increase the efficacy of PVI alone. These strategies can be considered in treating patients with AF, since, additionally, no differences in safety were observed. This study provides decision-makers with comprehensive and comparative evidence about the efficacy and safety of different CA strategies. SYSTEMATIC REVIEW REGISTRATION PROSPERO registry number: CRD42020169494 .
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Silvia Metelli
- Research Center of Epidemiology and Statistics (CRESS-U1153), Université Paris Cité, INSERM, Paris, France
| | - Lars O Karlsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Antonios P Antoniadis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Konstantinos D Rizas
- Medizinische Klinik Und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ioan Liuba
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Almroth
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jonas Schwieler
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Skevos Sideris
- Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Anna Chaimani
- Research Center of Epidemiology and Statistics (CRESS-U1153), Université Paris Cité, INSERM, Paris, France
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4
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Charitakis E, Metelli S, Karlsson LO, Antoniadis AP, Liuba I, Almroth H, Hassel Jönsson A, Schwieler J, Sideris S, Tsartsalis D, Dragioti E, Fragakis N, Chaimani A. Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials. Diagnostics (Basel) 2022; 12:diagnostics12020433. [PMID: 35204535 PMCID: PMC8870912 DOI: 10.3390/diagnostics12020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/14/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022] Open
Abstract
Although catheter ablation (CA) is an established treatment for paroxysmal atrial fibrillation (PAF), there is no consensus regarding the most efficient CA strategy. The objective of this network meta-analysis (NMA) was to compare the efficacy and safety of different CA strategies for PAF. A systematic search was performed in PubMed, Web of Science, and CENTRAL until the final search date, 5 October 2020. Randomised controlled trials (RCT) comparing different CA strategies and methods for pulmonary vein isolation (PVI) were included. Efficacy was defined as lack of arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of six months. In total, 43 RCTs comparing 11 different CA strategies involving 6701 patients were included. The risk of recurrence was significantly decreased in comparison with PVI with radiofrequency only for the following treatments: PVI with adjuvant ablation (RR: 0.79, CI: 0.65–0.97) and PVI with sympathetic modulation (RR: 0.64, CI: 0.46–0.88). However, PVI with radiofrequency was superior to non-PVI strategies (RR: 1.65, CI: 1.2–2.26). No statistically significant difference was found in safety between different CA strategies. Concerning different PVI strategies, no difference was observed either in efficacy or in safety between tested strategies. This NMA suggests that different PVI strategies are generally similar in terms of efficacy, while PVI with additional ablation or sympathetic modulation may be more effective than PVI alone. This study provides decision-makers with insights into the efficacy and safety of different CA strategies.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
- Correspondence:
| | - Silvia Metelli
- Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université de Paris, 75004 Paris, France; (S.M.); (A.C.)
| | - Lars O. Karlsson
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Antonios P. Antoniadis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece; (A.P.A.); (N.F.)
| | - Ioan Liuba
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Henrik Almroth
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Anders Hassel Jönsson
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Jonas Schwieler
- Heart and Vascular Theme, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Skevos Sideris
- Department of Cardiology, Hippokration Hospital, 11527 Athens, Greece;
| | - Dimitrios Tsartsalis
- Department of Clinical Physiology, Linköping University Hospital, 581 85 Linköping, Sweden;
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Linköping University Hospital, 581 85 Linköping, Sweden;
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece; (A.P.A.); (N.F.)
| | - Anna Chaimani
- Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université de Paris, 75004 Paris, France; (S.M.); (A.C.)
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Paul Nordin A, Drca N, Insulander P, Bastani H, Bourke T, Braunschweig F, Kenneback G, Von Olshausen G, Sadigh B, Saluveer O, Tapanainen J, Schwieler J, Akerstrom F, Jensen-Urstad M. Low incidence of major complications after the first six hours post-atrial fibrillation ablation – same-day discharge safe and feasible in most patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Catheter ablation of atrial fibrillation (AF) is associated with a complication risk. It is common practice to monitor patients overnight post-procedurally which is resource craving.
Purpose
To evaluate the incidence of procedural complications related to catheter ablation of AF to assess the potential feasibility and safety of same day discharge in a large cohort.
Methods
We performed an analysis of prospectively collected data of complications of all patients staying overnight after undergoing AF ablation between 2001 and 2020 at a tertiary centre. By studying medical records, we analysed complications occurring intraprocedurally until six hours post-ablation, and between six hours post-ablation until discharge the day after ablation procedure (up to 24 hours post-procedure).
Results
In 5414 AF ablations we identified a total of 108 (2.0%) major complications occurring intraprocedural or until discharge the day after procedure. Most major complications occurred early and were detected intraprocedurally or within six hours after completed procedure (n=96, 1.8%). Twelve (0.2%) major complications occurred between six hours post-ablation and until discharge the day after procedure. The most common of these were congestive heart failure (n=6) and transient ischemic attack (TIA, n=4). In addition, there were 61 (1.1%) minor complications which occurred in this time span. Factors independently associated with major complications intraprocedurally or within 24 hours were age (p=0.046), body mass index (BMI) ≥30 kg/m2 (p=0.009), significant valvular disease (p=0.001), cardiomyopathy (p<0.001), prior stroke or TIA (p=0.014), first time procedure vs. repeat procedure (p=0.013), cryoablation vs. radiofrequency (p<0.001) and procedure duration (p<0.001).
Conclusion
Very few complications occurred between six hours and until discharge after ablation of atrial fibrillation. Therefore, same-day discharge may be a safe option for a large proportion of patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region Stockholm funding
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Affiliation(s)
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | - P Insulander
- Karolinska University Hospital, Stockholm, Sweden
| | - H Bastani
- Karolinska University Hospital, Stockholm, Sweden
| | - T Bourke
- Karolinska University Hospital, Stockholm, Sweden
| | | | - G Kenneback
- Karolinska University Hospital, Stockholm, Sweden
| | | | - B Sadigh
- Karolinska University Hospital, Stockholm, Sweden
| | - O Saluveer
- Karolinska University Hospital, Stockholm, Sweden
| | - J Tapanainen
- Karolinska University Hospital, Stockholm, Sweden
| | - J Schwieler
- Karolinska University Hospital, Stockholm, Sweden
| | - F Akerstrom
- Karolinska University Hospital, Stockholm, Sweden
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von Olshausen G, Jemtrén A, Schwieler J, Tapanainen J, Bourke T, Paul-Nordin A, Benson L, Saluveer O, Kennebäck G, Braunschweig F, Drca N. Cryoablation of atypical atrioventricular nodal reentry tachycardia. J Cardiovasc Electrophysiol 2021; 32:2971-2978. [PMID: 34535930 DOI: 10.1111/jce.15244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/13/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022]
Abstract
AIM Data on ablation for atypical recurrent atrioventricular nodal reentry tachycardia (AVNRT) and long-term follow-up are generally sparse. Furthermore, the rate of recurrence and safety of cryoablation for atypical AVNRT has not been established. We compared patients cryoablated for atypical AVNRT and typical AVNRT during long-term follow-up. METHODS All patients (n = 2612) who underwent catheter ablation for AVNRT at the Karolinska University Hospital between January 2009 and August 2019 were analyzed. A total of 91 patients undergoing first-time cryoablation for atypical AVNRT were included. A control group with first-time cryoablation for typical AVNRT was matched in a 1:1 ratio. Patients were followed-up for recurrences for a median of 5.0 years (interquartile range: 3.1-7.5 years). RESULTS After 5 years, AVNRT recurrence occurred in 10 patients (11.0%) in the atypical AVNRT group and in 8 patients (8.8%) in the typical AVNRT group (hazard ratio: 1.31 [95% confidence interval: 0.52-3.32]; p = 0.568). The duration of the index procedure was significantly longer for atypical compared to typical AVNRT ablation (132.1 ± 49.2 min vs. 110.1 ± 38.8 min; p = 0.001). Transient AV blocks occurred in a similar fashion in the atypical compared to typical group (11 [12.1%] vs. 4 [4.9%]; p = 0.103). However, no ablation induced persistent AV block developed in either group. CONCLUSION Cryoablation for atypical AVNRT showed similar rate of recurrences and safety compared to typical AVNRT during long-term follow-up.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Jemtrén
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, St. Göran's Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tara Bourke
- 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
| | - Lina Benson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, 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
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7
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Paul Nordin A, Drca N, Insulander P, Bastani H, Bourke T, Braunschweig F, Kennebäck G, von Olshausen G, Sadigh B, Saluveer O, Tapanainen J, Schwieler J, Åkerström F, Jensen-Urstad M. Low incidence of major complications after the first six hours post atrial fibrillation ablation: Is same-day discharge safe and feasible in most patients? J Cardiovasc Electrophysiol 2021; 32:2953-2960. [PMID: 34535936 DOI: 10.1111/jce.15243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/20/2021] [Accepted: 09/06/2021] [Indexed: 01/26/2023]
Abstract
AIMS This study evaluates the incidence of procedural complications related to catheter ablation of atrial fibrillation (AF) to assess the potential feasibility and safety of same-day discharge in a large cohort. METHODS We performed an analysis of prospectively collected data of complications of all patients staying overnight after undergoing AF ablation between 2001 and 2020 at a tertiary center. Using medical records, we analyzed complications occurring intraprocedurally until 6 h postablation and between 6 h postablation and discharge the day after the ablation procedure. RESULTS In 5414 AF ablations, we identified a total of 108 (2.0%) major complications occurring intraprocedural or before discharge. Most major complications occurred intraprocedurally or within 6 h after the procedure (n = 96, 1.8%). Twelve (0.2%) major complications occurred between 6 h Postablation and discharge. The most common of these major complications were congestive heart failure (n = 6) and transient ischemic attack (TIA, n = 4). During this time span, 61 (1.1%) minor complications occurred. Factors independently associated with major complications intraprocedurally and until discharge were body mass index (BMI) ≥ 30 kg/m2 (p = .009), significant valvular disease (p = .001), cardiomyopathy (p < .001), prior stroke or TIA (p = .014), first-time procedure versus repeat procedure (p = .013), cryoablation versus radiofrequency (p < .001), and procedure duration (p < .001). CONCLUSION After AF ablation, very few complications occurred between 6 h postprocedure and discharge the next day. Therefore, same-day discharge is a safe option for a majority of patients.
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Affiliation(s)
- Astrid Paul Nordin
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Gesa von Olshausen
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Bita Sadigh
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Finn Åkerström
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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8
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Jansson V, Schwieler J, Bergfeldt L, Kennebäck G, Jensen SM, Sciaraffia E, Blomström-Lundqvist C. The results of health-related quality of life assessment depend on the prevailing rhythm at the assessment: Experience from the CAPTAF trial (Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation). J Cardiovasc Electrophysiol 2021; 32:2159-2164. [PMID: 34223671 DOI: 10.1111/jce.15147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/20/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
AIMS To assess whether the prevailing rhythm at the time of replying to symptom and health-related quality of life (HR-QoL) questionnaires impacts the findings. METHOD A total of 150 patients from the randomized Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation-trial, comparing atrial fibrillation (AF) ablation versus drugs, were included. The effect of the prevailing rhythm on the outcome results of the HR-QoL 36-Item Short-Form Health Survey, the symptom severity questionnaire (SSQ), and the European Heart Rhythm Association (EHRA) score for classification of AF-related symptoms was assessed. RESULTS AF as the prevailing rhythm was independently associated with a significantly lower Vitality score; 18.4 points lower (95% confidence interval -32.7 to -4.1, p = .01) compared with sinus rhythm when adjusted for AF burden, median duration of episode, number of episodes, beta-blocker use, type of AF, and sex. The presence of AF did not affect the General Health score compared with sinus rhythm, nor did it influence symptoms assessed by the SSQ or EHRA score. CONCLUSION The observation that the presence of AF versus sinus rhythm when conducting HR-QoL tests had a negative impact on its outcome, leaving symptom-related questionnaires unaffected, implies that the prevailing rhythm should be taken into account when results of HR-QoL questionnaires are interpreted.
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Affiliation(s)
- Victoria Jansson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine/Cardiology, Department of Cardiology, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg and Region Västra Götaland, Gothenburg, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Steen M Jensen
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Elena Sciaraffia
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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9
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Jansson V, Bergfeldt L, Schwieler J, Kennebäck G, Rubulis A, Jensen SM, Raatikainen P, Sciaraffia E, Blomström-Lundqvist C. Atrial fibrillation burden, episode duration and frequency in relation to quality of life in patients with implantable cardiac monitor. Int J Cardiol Heart Vasc 2021; 34:100791. [PMID: 34036145 PMCID: PMC8134989 DOI: 10.1016/j.ijcha.2021.100791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
Assessing the relationship between atrial fibrillation and quality of life. Implantable loop recorders assessed rhythm continuously in symptomatic patients. Atrial fibrillation burden, episode duration and frequency were included. Higher atrial fibrillation burden was associated with impaired quality of life.
Aims To assess the relation between atrial fibrillation (AF) characteristics and health-related quality of life (QoL), and which AF characteristic had the greatest impact. Method The AF characteristics burden (percentage of time in AF), duration and number of AF episodes/month were obtained from implantable cardiac monitors during the 2-month run-in period in 150 patients included in the randomized CAPTAF trial comparing early ablation and antiarrhythmic drug therapy. The QoL was measured by the General Health and Vitality dimensions of the 36-Item Short-Form Health Survey. AF characteristics were analysed continuously and in quartiles (Q1-Q4). Results Greater AF burden (p = 0.003) and longer AF episodes (p = 0.013) were associated with impaired QoL (Vitality score only) in simple linear regression analyses. Greater AF burden was, however, the only AF characteristic associated with lower QoL, when adjusted for sex, type of AF, hypertension, heart rate above 110 beats per minute during AF, and beta-blocker use in multiple linear regression analyses. For every 10% increase in AF burden there was a 1.34-point decrease of Vitality score (95% confidence interval (CI) −2.67 to −0.02, p = 0.047). The Vitality score was 12 points lower (95% CI −22.73 to −1.27, p = 0.03) in patients with an AF burden > 33% (Q4) versus those with < 0.45% (Q1), but only in unadjusted analysis. Conclusion AF burden had a greater impact on QoL (Vitality), than the duration and number of AF episodes, corroborating that AF burden may be the preferred outcome measure of rhythm control in trials including relatively healthy AF populations.
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Affiliation(s)
- Victoria Jansson
- Department of Medical Sciences, Uppsala University, Uppsala SE 751 85, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg SE 413 45, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, Solna SE 171 76, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, Solna SE 171 76, Stockholm, Sweden
| | - Aigars Rubulis
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg SE 413 45, Sweden
| | - Steen M Jensen
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå SE 901 87, Sweden
| | - Pekka Raatikainen
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Finland
| | - Elena Sciaraffia
- Department of Medical Sciences, Uppsala University, Uppsala SE 751 85, Sweden
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Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtren A, Kennebäck G, Ljungström E, Sadigh B, Saluveer O, Scheel S, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation as standard treatment of atrial flutter: a prospective, 2-center study (CASTAF). Acta Cardiol 2021; 76:267-271. [PMID: 32208915 DOI: 10.1080/00015385.2020.1721717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cryoablation (CRYO) of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) has been shown to be non-inferior to radiofrequency ablation (RF) in terms of ablation success and is associated with less pain. However, procedural time has been significantly longer with CRYO compared to RF. A possible explanation for this could be that operators had less experience with CRYO than with RF. The purpose of this study was to test the hypothesis that in the hands of experienced operators, cryoablation of CTI-dependent AFL is effective with procedure-time similar to what is reported for RF. METHODS This prospective 2-center study included 184 patients with CTI-dependent AFL - median age 66 years (range 28-83), 159 men (86%). Cryoablation was performed using a 9 F, 8 mm tip catheter (Freezor MAX, Medtronic, Inc, MN, USA). Ablation endpoint was bidirectional CTI-block. Pain was evaluated with a visual analogue scale (VAS 0-10). All operators had experience of at least 25 previous CTI-ablations with CRYO. RESULTS The acute success rate was 89%. Procedural time including an observation period of 30 min, was 115 ± 36 min which is similar to procedural times for RF in previous studies. Fluoroscopy time was 11 ± 9 min. Cryoablation was perceived as almost pain- free by the patients, VAS (mean) 1.8 ± 1.2. Success rate at 12-month follow-up (FU) was 88% in patients with primary success. No major adverse events occurred. CONCLUSIONS Cryoablation of CTI-dependent AFL is effective, with a low level of procedure-related pain. In experienced hands, the procedure time in this prospective non-randomised trial seems to be in the level of reported procedure times for RF. The long-term relapse rate appears to be higher than for RF.
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Affiliation(s)
- H. Bastani
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T. Bourke
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - F. Braunschweig
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - N. Drca
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K. Gudmundsson
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P. Insulander
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A. Jemtren
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G. Kennebäck
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E. Ljungström
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - B. Sadigh
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - O. Saluveer
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S. Scheel
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - J. Schwieler
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J. Tapanainen
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M. Jensen-Urstad
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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11
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Najjar E, Dalén M, Schwieler J, Lund LH. A case report about successful treatment of refractory ventricular tachycardia with ablation under prolonged haemodynamic support with extracorporeal membrane oxygenation. Eur Heart J Case Rep 2021; 5:ytab084. [PMID: 34268471 PMCID: PMC8276616 DOI: 10.1093/ehjcr/ytab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/30/2020] [Accepted: 02/17/2021] [Indexed: 12/03/2022]
Abstract
Background In patients with severe left ventricular dysfunction, recurrent ventricular tachycardia
(VT) non-responsive to antiarrhythmic therapies may cause further deterioration of
cardiac function and haemodynamic instability. The use of extracorporeal membrane
oxygenation (ECMO) in the setting of haemodynamically unstable VT may allow rhythm
stabilization and can be effective in providing haemodynamic stability during VT
ablation procedures. Case summary We describe the clinical course of a patient with ischaemic cardiomyopathy and
recurrent VTs in the early post-myocardial infarction (MI) period. Nineteen days after
MI, the patient started to experience recurrent attacks of VT, which became more
frequent and non-responsive to medical treatment including amiodarone and lidocaine. The
patient developed cardiogenic shock and a decision was made to institute ECMO. The
patient was supported with ECMO for 32 days because of heart failure, refractory VT, and
recurrent infections. An electrophysiological study was performed 4 days after ECMO
initiation, which revealed a large scar area in the left ventricle. Radiofrequency
energy was applied 69 times, rendering the VT non-inducible. Subsequently, VT attacks
disappeared and the patient was weaned from ECMO after 32 days. The patient received a
left ventricular assist device 5 days post-ECMO weaning and was then transplanted. Discussion There is still no evidence or guidelines regarding patients with refractory VT;
however, ECMO support has been successfully used during VT ablation procedures. In this
case report, VT ablation had a crucial role in treating the culprit arrhythmia while the
implementation of ECMO allowed a complex ablation procedure to be completed safely.
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Affiliation(s)
- Emil Najjar
- Department of Medicine, Solna Karolinska University Hospital D1:04, 171 76 Stockholm, Sweden.,Cardiology Department, Heart and Vascular Theme, Karolinska University Hospital, Eugeniavägen 3, 171 76 Solna, Sweden
| | - Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Eugeniavägen 3, 171 76 Solna, Sweden.,Department of Molecular Medicine and Surgery, Karolinska University Hospital, Solna (L1:00), Anna Steckséns gata 53, 171 76 Stockholm, Sweden
| | - Jonas Schwieler
- Department of Medicine, Solna Karolinska University Hospital D1:04, 171 76 Stockholm, Sweden.,Cardiology Department, Heart and Vascular Theme, Karolinska University Hospital, Eugeniavägen 3, 171 76 Solna, Sweden
| | - Lars H Lund
- Department of Medicine, Solna Karolinska University Hospital D1:04, 171 76 Stockholm, Sweden.,Cardiology Department, Heart and Vascular Theme, Karolinska University Hospital, Eugeniavägen 3, 171 76 Solna, Sweden
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12
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von Olshausen G, Saluveer O, Schwieler J, Drca N, Bastani H, Tapanainen J, Bourke T, Paul-Nordin A, Kennebäck G, Insulander P, Jensen-Urstad M, Braunschweig F. Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences. Clin Res Cardiol 2020; 110:851-860. [PMID: 33184675 PMCID: PMC8166690 DOI: 10.1007/s00392-020-01765-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cather ablation is known to influence the autonomic nervous system. This study sought to investigate the association of sinus heart rate pre-/post-ablation and recurrences in patients with atrial fibrillation undergoing pulmonary vein isolation (PVI). METHODS Between January 2012 and December 2017, data of 482 patients undergoing their first PVI were included. Sinus heart rate was recorded before (PRE), directly post-ablation (POST) and 3 months post-ablation (3 M). All patients were screened for atrial tachyarrhythmia recurrences during the one-year follow-up. RESULTS In the total study cohort, the mean resting sinus heart rate at PRE [mean 57.9 bpm (95% CI 57.1-58.7 bpm)] increased by over 10 bpm to POST [mean 69.4 bpm (95% CI 68.5-70.3 bpm); p < 0.001] followed by a slight decrease at 3 M [mean 67.3 bpm (95% CI 66.4-68.2 bpm)] but still remaining higher compared to PRE (p < 0.001). This pattern was observed in patients with and without recurrences at POST and 3 M (both p < 0.001 compared to PRE). However, at 3 M the mean sinus heart rate was significantly lower in patients with compared to patients without recurrences (p = 0.031). In this regard, patients with a heart rate change < 11 bpm (PRE to 3 M) or, as an alternative parameter, patients with a heart rate < 60 bpm at 3 M had a significantly higher risk of recurrences compared to the remaining patients (Hazard ratio (HR) 1.82 (95% CI 1.32-2.49), p < 0.001 and HR 1.64 (95% CI 1.20-2.25), p = 0.002, respectively). CONCLUSION Our study confirms the impact of PVI on cardiac autonomic function with a significant sinus heart rate increase post-ablation. Patients with a sinus heart rate change < 11 bpm (PRE to 3 M) are at higher risk for recurrences during one-year post-PVI.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden.
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
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13
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Von Olshausen G, Saluveer O, Schwieler J, Drca N, Bastani H, Tapanainen J, Bourke T, Paul-Nordin A, Kenneback G, Insulander P, Jensen-Urstad M, Braunschweig F. Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
To investigate the association of sinus heart rate pre- and post-ablation and recurrence rates in patients undergoing catheter ablation for atrial fibrillation.
Methods
Between January 2012 and December 2017, data of 482 patients undergoing their first pulmonary vein isolation (PVI) were included. All patients were followed-up for 12 months and were screened for any atrial tachyarrhythmia. Sinus heart rate measurements were recorded before (PRE), directly post ablation (POST) and 3 months post ablation (3M).
Results
In the total study population, the mean resting sinus heart rate at PRE (mean 57.9 bpm (95% CI, 57.1–58.7 bpm)) increased by over 10 bpm to POST (mean 69.4 bpm (95% CI, 68.5–70.3 bpm); p<0.001) followed by a slight decrease at 3M (mean 67.3 bpm (95% CI, 66.4–68.2 bpm)) but still remaining higher compared to PRE (p<0.001). This pattern was observed in patients with and without recurrences at PRE, POST and 3M respectively (both p<0.001). However, only at 3M, there was a significant difference in mean heart rate being lower in patients with compared to patients without recurrences (p=0.031). In this regard, patients with a heart rate ≥60 bpm at 3M and a heart rate change ≥11 bpm (PRE to 3M) had a favorable outcome in terms of recurrences compared to the remaining patients (HR 0.61 (95% CI, 0.44–0.84), p=0.002 and HR 0.55 (95% CI, 0.40–0.76), p<0.001, respectively). These variables remained independently associated in multivariable analysis.
Conclusion
Our study confirms the impact of PVI on cardiac autonomic function with a significant heart increase post-ablation. A heart rate ≥60bpm at 3M and a heart rate change ≥11 bpm (PRE to 3M) are associated with a favorable outcome in terms of recurrences.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
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Affiliation(s)
| | - O Saluveer
- Karolinska University Hospital, Stockholm, Sweden
| | - J Schwieler
- Karolinska University Hospital, Stockholm, Sweden
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | - H Bastani
- Karolinska University Hospital, Stockholm, Sweden
| | - J Tapanainen
- Karolinska University Hospital, Stockholm, Sweden
| | - T Bourke
- Karolinska University Hospital, Stockholm, Sweden
| | | | - G Kenneback
- Karolinska University Hospital, Stockholm, Sweden
| | - P Insulander
- Karolinska University Hospital, Stockholm, Sweden
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14
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Von Olshausen G, Bourke T, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Benson L, Goedel A, Kenneback G, Insulander P, Jensen-Urstad M, Braunschweig F. Long-term outcome of patients with invasive electrophysiology procedure related cardiac tamponade. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analyzed the risk of death or serious cardiovascular events in patients suffering from EP related cardiac tamponade requiring pericardiocentesis during long-term follow-up.
Methods and results
Out of 19997 invasive EPs at our university hospital between January 1998 and September 2018, all patients with EP related periprocedural cardiac tamponade were identified (n=60) and matched (1:3 ratio) to a control group (n=180). After a follow-up of 5 years, the composite primary end point - death from any cause, acute myocardial infarction, TIA/stroke and hospitalization for heart failure – occurred in significantly more patients in the tamponade than in the control group (12 patients (20.0%) vs 19 patients (10.6%); Hazard ratio (HR) 2.53 (95% CI, 1.15–5.58); p=0.021). This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group (HR 3.75 (95% CI, 1.01–13.97); p=0.049). Death from any cause, acute myocardial infarction and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group (HR 36.0 (95% CI, 4.68–276.86); p=0.001).
Conclusion
Patients with EP related cardiac tamponade are at higher risk for cerebrovascular events during the first two weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
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Affiliation(s)
| | - T Bourke
- Karolinska University Hospital, Stockholm, Sweden
| | - J Schwieler
- Karolinska University Hospital, Stockholm, Sweden
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | - H Bastani
- Karolinska University Hospital, Stockholm, Sweden
| | - J Tapanainen
- Karolinska University Hospital, Stockholm, Sweden
| | - O Saluveer
- Karolinska University Hospital, Stockholm, Sweden
| | - L Benson
- Karolinska Institutet, Stockholm, Sweden
| | - A Goedel
- Karolinska Institutet, Stockholm, Sweden
| | - G Kenneback
- Karolinska University Hospital, Stockholm, Sweden
| | - P Insulander
- Karolinska University Hospital, Stockholm, Sweden
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15
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von Olshausen G, Bourke T, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Benson L, Goedel A, Kennebäck G, Insulander P, Jensen-Urstad M, Braunschweig F. Long-term outcome of patients with invasive electrophysiology procedure-related cardiac tamponade. Europace 2020; 22:1547-1557. [PMID: 32772100 DOI: 10.1093/europace/euaa155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/18/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analysed the risk of death or serious cardiovascular events in patients suffering from EP-related cardiac tamponade requiring pericardiocentesis during long-term follow-up. METHODS AND RESULTS Out of 19 997 invasive EPs at the Karolinska University Hospital between January 1998 and September 2018, all patients with EP-related periprocedural cardiac tamponade were identified (n = 60) and matched (1:3 ratio) to a control group (n = 180). After a follow-up of 5 years, the composite primary endpoint - death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure - occurred in significantly more patients in the tamponade than in the control group [12 patients (20.0%) vs. 19 patients (10.6%); hazard ratio (HR) 2.53 (95% confidence interval, CI 1.15-5.58); P = 0.021]. This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group [HR 3.75 (95% CI 1.01-13.97); P = 0.049]. Death from any cause, acute myocardial infarction, and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group [HR 36.0 (95% CI 4.68-276.86); P = 0.001]. CONCLUSION Patients with EP-related cardiac tamponade are at higher risk for cerebrovascular events during the first 2 weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Lina Benson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Goedel
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
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16
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Olshausen G, Uijl A, Jensen‐Urstad M, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Bourke T, Kennebäck G, Insulander P, Deisenhofer I, Braunschweig F. Early recurrences of atrial tachyarrhythmias post pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:674-681. [DOI: 10.1111/jce.14368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Gesa Olshausen
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Alicia Uijl
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholm Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht University The Netherlands
- Health Data Research UK London, Institute for Health InformaticsUniversity College London London United Kingdom
| | - Mats Jensen‐Urstad
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Jonas Schwieler
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Nikola Drca
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Hamid Bastani
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Jari Tapanainen
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Ott Saluveer
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Tara Bourke
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Göran Kennebäck
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Per Insulander
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz‐ und KreislauferkrankungenTechnische Universität MünchenMunich Germany
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17
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Blomström-Lundqvist C, Gizurarson S, Schwieler J, Jensen SM, Bergfeldt L, Kennebäck G, Rubulis A, Malmborg H, Raatikainen P, Lönnerholm S, Höglund N, Mörtsell D. Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. JAMA 2019; 321:1059-1068. [PMID: 30874754 PMCID: PMC6439911 DOI: 10.1001/jama.2019.0335] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Quality of life is not a standard primary outcome in ablation trials, even though symptoms drive the indication. OBJECTIVE To assess quality of life with catheter ablation vs antiarrhythmic medication at 12 months in patients with atrial fibrillation. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 4 university hospitals in Sweden and 1 in Finland of 155 patients aged 30-70 years with more than 6 months of atrial fibrillation and treatment failure with 1 antiarrhythmic drug or β-blocker, with 4-year follow-up. Study dates were July 2008-September 2017. Major exclusions were ejection fraction <35%, left atrial diameter >60 mm, ventricular pacing dependency, and previous ablation. INTERVENTIONS Pulmonary vein isolation ablation (n = 79) or previously untested antiarrhythmic drugs (n = 76). MAIN OUTCOMES AND MEASURES Primary outcome was the General Health subscale score (Medical Outcomes Study 36-Item Short-Form Health Survey) at baseline and 12 months, assessed unblinded (range, 0 [worst] to 100 [best]). There were 26 secondary outcomes, including atrial fibrillation burden (% of time) from baseline to 12 months, measured by implantable cardiac monitors. The first 3 months were excluded from rhythm analysis. RESULTS Among 155 randomized patients (mean age, 56.1 years; 22.6% women), 97% completed the trial. Of 79 patients randomized to receive ablation, 75 underwent ablation, including 2 who crossed over to medication and 14 who underwent repeated ablation procedures. Of 76 patients randomized to receive antiarrhythmic medication, 74 received it, including 8 who crossed over to ablation and 43 for whom the first drug used failed. General Health score increased from 61.8 to 73.9 points in the ablation group vs 62.7 to 65.4 points in the medication group (between-group difference, 8.9 points; 95% CI, 3.1-14.7; P = .003). Of 26 secondary end points, 5 were analyzed; 2 were null and 2 were statistically significant, including decrease in atrial fibrillation burden (from 24.9% to 5.5% in the ablation group vs 23.3% to 11.5% in the medication group; difference -6.8% [95% CI, -12.9% to -0.7%]; P = .03). Of the Health Survey subscales, 5 of 7 improved significantly. Most common adverse events were urosepsis (5.1%) in the ablation group and atrial tachycardia (3.9%) in the medication group. CONCLUSIONS AND RELEVANCE Among patients with symptomatic atrial fibrillation despite use of antiarrhythmic medication, the improvement in quality of life at 12 months was greater for those treated with catheter ablation compared with antiarrhythmic medication. Although the study was limited by absence of blinding, catheter ablation may offer an advantage for quality of life. TRIAL REGISTRATION clinicaltrialsregister.eu Identifier: 2008-001384-11.
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Affiliation(s)
| | - Sigfus Gizurarson
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Schwieler
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Steen M. Jensen
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Kennebäck
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Aigars Rubulis
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Malmborg
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
| | - Pekka Raatikainen
- Tampere University Hospital, Heart Center, Department of Cardiology, Tampere, Finland
| | - Stefan Lönnerholm
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
| | - Niklas Höglund
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - David Mörtsell
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
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18
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Cars T, Lindhagen L, Malmström RE, Neovius M, Schwieler J, Wettermark B, Sundström J. Effectiveness of Drugs in Routine Care: A Model for Sequential Monitoring of New Medicines Using Dronedarone as Example. Clin Pharmacol Ther 2017; 103:493-501. [DOI: 10.1002/cpt.751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/01/2017] [Accepted: 05/16/2017] [Indexed: 12/27/2022]
Affiliation(s)
- T Cars
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
- Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - L Lindhagen
- Uppsala Clinical Research Center; Uppsala University; Uppsala Sweden
| | - RE Malmström
- Clinical Pharmacology; Karolinska University Hospital, Deptartment of Medicine Solna, Karolinska Institutet; Stockholm Sweden
| | - M Neovius
- Clinical Epidemiology Unit; Department of Medicine, Karolinska Institutet; Stockholm Sweden
| | - J Schwieler
- Department of Cardiology; Karolinska Institutet; Stockholm Sweden
| | - B Wettermark
- Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
- Centre for Pharmacoepidemiology; Department of Medicine, Karolinska Institutet; Stockholm Sweden
| | - J Sundström
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
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19
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Insulander P, Bastani H, Braunschweig F, Drca N, Kennebäck G, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation of atrioventricular nodal re-entrant tachycardia: 7-year follow-up in 515 patients-confirmed safety but very late recurrences occur. Europace 2017; 19:1038-1042. [PMID: 27738058 DOI: 10.1093/europace/euw145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/27/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Cryoablation is an alternative method to radiofrequency ablation for treatment of atrioventricular nodal re-entrant tachycardia (AVNRT). This study investigates the long-term safety and efficacy of cryoablation in AVNRT. Methods and results We studied 515 consecutive patients (317 women, mean age 50 years, range 13-89 years) undergoing a first cryoablation for AVNRT between 2003 and 2008. Ablations were performed with a 6-mm Freezor Xtra catheter. Six patients were acute failures; 494 out of 509 (97%) primarily successfully ablated patients were followed up for a mean of 7.1 years (range 2-12 years). About 11% (54/494 patients) of patients had recurrences of the index arrhythmia. Time to recurrence varied from days to 9 years; 14 patients (3%) had recurrences later than 2 years, 8 patients (2%) later than 3 years, and 6 patients (2%) later than 4 years. Recurrence rate was higher in patients with slow-slow or fast-slow AVNRT (n = 24) compared with the common slow-fast variant (25 vs. 10%; P = 0.04). Recurrence rate was not higher in patients with residual slow pathway conduction (jump with or without echo beat, n = 199, 39%). Transient atrioventricular (AV) block of the first-, second-, or third-degree during ablation was observed in 45 patients but had no impact on the risk of AVNRT recurrence. No late AV block occurred. Single vs. multiple applications or total amount of cryoenergy delivered did not differ between patients with and without recurrences. Conclusion Cryoablation in AVNRT is safe with a long-term efficacy of 88%; however, very late recurrences occur.
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20
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Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtren A, Kenneback G, Ljungstrom E, Sadigh B, Saluveer O, Scheel S, Schwieler J, Tapanainen J, Jensen-Urstad M. P888Cryoablation as standard treatment of atrial flutter (CASTAF). Europace 2017. [DOI: 10.1093/ehjci/eux151.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Matoshvili Z, Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtrén A, Kennebäck G, Saluveer O, Schwieler J, Tapanainen J, Wredlert C, Jensen-Urstad M. Safety of fluoroscopy-guided transseptal approach for ablation of left-sided arrhythmias. Europace 2017; 19:2023-2026. [DOI: 10.1093/europace/euw432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/16/2016] [Indexed: 11/13/2022] Open
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22
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Saygi S, Bastani H, Drca N, Insulander P, Wredlert C, Schwieler J, Jensen-Urstad M. Impact of cavotricuspid isthmus morphology in CRYO versus radiofrequency ablation of typical atrial flutter. SCAND CARDIOVASC J 2016; 51:69-73. [DOI: 10.1080/14017431.2016.1259496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Serkan Saygi
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Christer Wredlert
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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23
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Matoshvili Z, Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Jemtren A, Kenneback G, Saluveer O, Schwieler J, Tapanainen J, Wredlert C, Jensen-Urstad M. 136-29: Safety of transseptal approach for ablation of left sided arrhythmias. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i97b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Van Gelder IC, Hobbelt AH, Marcos EG, Schotten U, Cappato R, Lewalter T, Schwieler J, Rienstra M, Boriani G. Tailored treatment strategies: a new approach for modern management of atrial fibrillation. J Intern Med 2016; 279:457-66. [PMID: 26991684 DOI: 10.1111/joim.12489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) is not benign. Cardiovascular diseases and risk factors differ importantly amongst patients. Careful phenotyping with the aim to start tailored therapy may improve outcome and quality of life. Furthermore, structural remodelling plays an important role in initiation and progression of AF. Therapies that interfere in the remodelling processes are promising because they may modify the atrial substrate. However, success is still limited probably due to variations in the underlying substrate in individual patients. The most favourable effects of lifestyle changes on success of rhythm control have been demonstrated in obese patients with AF. Differences in genotype may also play an important role. Common gene variants have been associated with recurrence of AF after electrical cardioversion, antiarrhythmic drug therapy and catheter ablation. Therefore, both phenotyping and genotyping may become useful for patient selection in the future. Beside the choice of rate or rhythm control, and type of rhythm control, prevention of complications associated with AF may also differ depending on genotype and phenotype. Efficacy of stroke prevention has been well established, but bleeding remains a clinically relevant problem. Risk stratification is still cumbersome, especially in low-risk patients and in those with a high bleeding risk. The decision whether to start anticoagulation (and if so which type of anticoagulant) or, alternatively, to implant an occlusion device of the left atrial appendage may also be improved by genotyping and phenotyping. In this review, we will summarize new insights into the roles of phenotype and genotype in generating more tailored treatment strategies in patients with AF and discuss several patient-tailored treatment options.
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Affiliation(s)
- I C Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A H Hobbelt
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E G Marcos
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - U Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht Centre for Systems Biology, Maastricht, The Netherlands
| | - R Cappato
- Humanitas Clinical and Research Center, Milan, Italy
| | - T Lewalter
- Department of Medicine-Cardiology and Intensive Care, Peter Osypka Heart Center Munich, Hospital Munich-Thalkirchen, Munich, Germany
| | - J Schwieler
- Department of Cardiology, Karolinksa Insitute, Karolinska University Hospital, Stockholm, Sweden
| | - M Rienstra
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy
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25
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Saygi S, Drca N, Insulander P, Schwieler J, Jensen-Urstad M, Bastani H. Myocardial injury during radiofrequency and cryoablation of typical atrial flutter. J Interv Card Electrophysiol 2015; 46:177-81. [PMID: 26546105 DOI: 10.1007/s10840-015-0074-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/29/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Cardiac enzyme elevation after radiofrequency (RF) catheter ablation of atrial flutter (AFL) is common. Some studies found that cryoablation (CRYO) of AFL, compared to RF, is associated with higher levels of troponin, a finding that may indicate CRYO causes a greater amount of myocardial injury than RF. However, other investigations found no significant differences between troponin levels after CRYO versus RF. We have in a randomized study compared the post-procedural troponin I levels in RF and CRYO and the possible relation to procedural outcome and complications. METHODS We randomized 153 patients with cavotricuspid isthmus (CTI)-dependent AFL to CRYO or RF (78 CRYO; 75 RF). RF was performed with a 3.5-mm open-irrigated-tip catheter, and CRYO was performed with an 8-mm-tip catheter. Troponin I levels were measured before and 6 h after ablation. RESULTS Acute procedural success was achieved in 71/75 patients in the RF and in 72/78 patients in the CRYO. Troponin I levels were significantly elevated in both groups (baseline 0.012, 6th hour 0.35 ng/ml; p < 0.001). Troponin I levels were similar for RF and CRYO. Troponin I levels were higher in patients with acute failure compared to patients with acute success (0.48 ± 0.4 and 0.34 ± 0.16 ng/ml, p = 0.029); however, there was no difference between patients with or without late recurrence. There were no major complications in any group. CONCLUSION RF and CRYO for CTI-dependent AFL resulted in similar amounts of procedural myocardial injury. Troponin I levels had no prognostic value for late recurrence of AFL and there were no complications related to high troponin I levels.
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Affiliation(s)
- Serkan Saygi
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. .,Cardiology Department, Karolinska University Hospital, M52, 141 86, Huddinge, Stockholm, Sweden.
| | - Nikola Drca
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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26
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Bergfeldt L, Williamsson C, Schwieler J. Female preponderance in atrioventricular node reentrant tachycardia, but no sex related electrophysiological differences. ICFJ 2015. [DOI: 10.17987/icfj.v1i4.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mechanism behind the female preponderance for atrio-ventricular node reentrant tachycardia (AVNRT) is not clear.<br />We compared baseline electrophysiological measurements and clinical data in 141 consecutive patients (96 women) who<br />underwent successful AVNRT ablation at their fi rst therapeutic procedure. Women had on average 9% higher resting<br />heart rate than men (p<0.05), but were similar in all measures of AV node function. Isoproterenol infusion was required<br />for AVNRT induction in 69 cases (49%), and the need for isoproterenol was associated with lower resting heart rate and<br />longer anterograde and retrograde AV node refractory periods (p<0.05 for comparisons), but not with sex. We conclude<br />that the spectrum of baseline AV node physiology in AVNRT patients is wide, and is similar in men and women. The female<br />preponderance for AVNRT cannot be explained from comparisons of baseline AV node electrophysiological properties.
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27
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Insulander P, Bastani H, Braunschweig F, Drca N, Gudmundsson K, Kennebäck G, Sadigh B, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation of substrates adjacent to the atrioventricular node: acute and long-term safety of 1303 ablation procedures. Europace 2013; 16:271-6. [PMID: 23851515 DOI: 10.1093/europace/eut215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Radiofrequency (RF) ablation is effective for ablation of atrial arrhythmias. However, RF ablation in the vicinity of the atrioventricular (AV) node is associated with a risk of inadvertent, irreversible high-grade AV block, depending on the type of substrate. Cryoablation is an alternative method. The objective was to investigate the acute and long-term risks of AV block during cryoablation. METHODS AND RESULTS We studied 1303 consecutive cryoablations of substrates in the vicinity of the AV node in 1201 patients (median age 51 years, range 6-89 years) on acute and long-term impairment to the AV nodal conduction system. The arrhythmias treated were AV nodal reentrant tachycardias (n=1116), paraseptal and superoparaseptal accessory pathways (n=100), and focal atrial tachycardias (n=87). In 158 (12%) procedures, cryomapping (38 cases) or cryoablation (120 cases) were stopped due to transient AV block (first-degree AV block 74 cases, second-degree AV block 67 cases, and third-degree AV block 17 cases) after which another site was tested. Transient AV block occurred within seconds of mapping up to 3 min of ablation. The incidence of AV block was similar for different substrates. In most cases, AV nodal conduction was restored within seconds but in two cases transient AV block lasted 21 and 45 min, respectively. There were no cases of acute permanent AV blocks. No late AV blocks occurred during follow-up (mean 24 months, range 6-96 months). CONCLUSION Cryoablation adjacent to the AV node carries a negligible risk of permanent AV block. Transient AV block during ablation is a benign finding.
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Affiliation(s)
- Per Insulander
- Department of Cardiology, Karolinska University Hospital, S-141 86 Stockholm, Sweden
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28
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Wecke L, Poçi D, Schwieler J, Johansson B, Edvardsson N, Lundahl G, Bergfeldt L. Vectorcardiography shows cardiac memory and repolarization heterogeneity after ablation of accessory pathways not apparent on ECG. Int J Cardiol 2013; 166:152-7. [DOI: 10.1016/j.ijcard.2011.10.106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 09/06/2011] [Accepted: 10/18/2011] [Indexed: 11/28/2022]
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Tapanainen JM, Braunschweig F, Schwieler J, Insulander P, Bastani H, Drca N, Kennebäck G, Sadigh B, Jensen-Urstad M. Continuous warfarin therapy is safe and feasible in catheter ablation of atrial fibrillation. SCAND CARDIOVASC J 2012; 47:109-13. [DOI: 10.3109/14017431.2012.743674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jari M. Tapanainen
- Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
| | | | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
| | - Nicola Drca
- Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
| | - Bita Sadigh
- Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
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Bastani H, Drca N, Insulander P, Schwieler J, Braunschweig F, Kennebäck G, Sadigh B, Tapanainen J, Jensen-Urstad M. Cryothermal vs. radiofrequency ablation as atrial flutter therapy: a randomized comparison. ACTA ACUST UNITED AC 2012; 15:420-8. [DOI: 10.1093/europace/eus261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Braunschweig F, Christel P, Jensen-Urstad M, Andersson M, Schwieler J, Tapanainen J, Bastani H, Gadler F, Linde C, Schöls W, Bergfeldt L. Paroxysmal regular supraventricular tachycardia: the diagnostic accuracy of the transesophageal ventriculo-atrial interval. Ann Noninvasive Electrocardiol 2012; 16:327-35. [PMID: 22008487 DOI: 10.1111/j.1542-474x.2011.00459.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To establish the diagnostic accuracy of the transesophageal ventriculo-atrial (VA) interval in patients with paroxysmal supraventricular tachycardia (PSVT) and normal baseline electrocardiogram (ECG). METHODS The transesophageal VA interval during tachycardia was recorded in 318 patients (age 45 ± 17 years, 58% female) with PSVT and a normal surface ECG between attacks. Subsequently, all patients underwent an ablation procedure establishing the correct tachycardia diagnosis. RESULTS AV nodal reentrant tachycardia (AVNRT), AV reentrant tachycardia through a concealed accessory pathway (AVRT), and ectopic atrial tachycardia (EAT) were found in 213, 95, and 10 cases, respectively. Receiver operating characteristic curve analysis identified an optimal cutoff for a binary categorization of AVNRT versus AVRT/EAT at ≤80 ms (area under the curve 0.891). Owing to a biphasic distribution, AVNRT was very likely at VA intervals ≤90 ms with a sensitivity, specificity, and positive predictive value (PPV) of 87%, 91%, and 95%. In the range 91-160 ms the corresponding values for AVRT were 88%, 95%, and 88% (90%, 99%, and 98% in male patients). In the small group with VA intervals >160 ms (n = 29), the diagnosis was less clear (PPV of 67% for AVNRT). CONCLUSIONS In patients with sudden onset regular tachycardia and a normal ECG during sinus rhythm, a transesophageal VA interval of ≤80 ms has the highest diagnostic accuracy to diagnose AVNRT versus AVRT/EAT. Overall, the biphasic distribution of VA intervals suggests considering AVNRT at 90 ms and below and AVRT between 91 and 160 ms (in particular in male patients) while the diagnosis is vague at VA intervals above 160 ms.
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Affiliation(s)
- Frieder Braunschweig
- Electrophysiology & Arrhythmia Service, Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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Hjemdahl P, Allhammar A, Eklund J, Forslund T, Hulting J, Kahan T, Martinsson A, Malmström R, Rücker F, Schenck-Gustafsson K, Schwieler J, Törnerud M, Wettermark B. [Visions are good but the guidelines require evidence]. Lakartidningen 2011; 108:2444-2445. [PMID: 22468388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Hjemdahl P, Allhammar A, Eklund J, Forslund T, Hulting J, Kahan T, Martinsson A, Malmström R, Rücker F, Schenck-Gustafsson K, Schwieler J, Törnerud M, Wettermark B. [Say no to the extremes in the debate on lipid reduction]. Lakartidningen 2011; 108:1664-1665. [PMID: 22032007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Andersson T, Magnusson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D, Polovina M, Potpara T, Licina M, Mujovic N, Kocijancic A, Simic D, Ostojic MC, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Bosch RF, Kirch W, Rosin L, Willich SN, Pittrow D, Bonnemeier H, Valenza MC, Martin L, Munoz Casaubon T, Valenza G, Botella M, Serrano M, Valenza B, Cabrera I, Anderson K, Benzaquen BS, Koziolova N, Nikonova J, Shilova Y, Scherr D, Narayan S, Wright M, Krummen D, Jadidi A, Jais P, Haissaguerre M, Hocini M, Hunter R, Liu Y, Lu Y, Wang W, Schilling RJ, Bernstein S, Wong B, Rooke R, Vasquez C, Shah R, Rosenberg S, Chinitz L, Morley G, Bashir Choudhary M, Holmqvist F, Carlson J, Nilsson HJ, Platonov PG, Jadidi AS, Cochet H, Miyazaki S, Shah AJ, Scherr D, Marrouche N, Haissaguerre M, Jais P, Calvo N, Nadal M, Andreu D, Tamborero D, Diaz FE, Berruezo A, Brugada J, Mont L, Fichtner S, Hessling G, Estner HL, Jilek C, Reents T, Ammar S, Wu J, Deisenhofer I, Nakanishi H, Kashiwase K, Hirata A, Wada M, Ueda Y, Skoda J, Neuzil P, Popelova J, Petru J, Sediva L, Lavergne T, Le Heuzey JY, Mousseaux E, Hersi A, Alhabib K, Alfaleh H, Sulaiman K, Almahmeed W, Alsuwidi J, Amin H, Reddy VY, Almotarreb A, Pang HWK, Redfearn DP, Simpson CS, Michael K, Pereira EJ, Munt PW, Fitzpatrick MF, Baranchuk A, Revishvili AS, Uldry L, Simonyan G, Dzhordzhikiya T, Sopov O, Kalinin V, Locati ET, Vecchi AM, Cattafi G, Sachero A, Lunati M, Sayah S, Forclaz A, Alizadeh A, Nazari N, Hekmat M, Moradi M, Zeighami M, Ghanji H, Suzuki K, Takagi M, Maeda K, Tatsumi H, Virag N, Gomes C, Meireles A, Anjo D, Roque C, Vieira P, Lagarto V, Reis H, Torres S, Toth A, Vago H, Hocini M, Takacs P, Edes E, Marki A, Balazs GY, Huttl K, Merkely B, Lainis F, Buckley MM, Johns EJ, Seifer CM, Vesin JM, Daba L, Liebrecht K, Pietrucha AZ, Borowiec A, Mroczek-Czernecka D, Bzukala I, Wnuk M, Piwowarska W, Nessler J, Toquero Ramos J, Jais P, Perez Pereira E, Mitroi C, Castro Urda V, Fernandez Villanueva JM, Corona Figueroa A, Hernandez Reina L, Fernandez Lozano I, Bartoletti A, Bocconcelli P, Giuli S, Kappenberger L, Massa R, Svetlich C, Tarsi G, Tronconi F, Vitale E, Pietrucha AZ, Bzukala I, Wnuk M, Stryjewski P, Konduracka E, Haissaguerre M, Wegrzynowska M, Kruszelnicka O, Nessler J, Lousinha A, Labandeiro J, Antunes E, Silva S, Alves S, Timoteo A, Oliveira M, Sehra R, Cruz Ferreira R, Pietrucha AZ, Wnuk M, Jedrzejczyk-Spaho J, Bzukala I, Kruszelnicka O, Wegrzynowska M, Piwowarska W, Nessler J, Krummen D, Briggs C, Rappel WJ, Narayan S, Sediva L, Neuzil P, Petru J, Skoda J, Janotka M, Chovanec M, Yamashiro K, Takami K, Sakamoto Y, Satoh K, Suzuki T, Nakagawa H, Romanov A, Pokushalov E, Artemenko S, Shabanov V, Stenin I, Elesin D, Turov A, Yakubov A, Hioki M, Matsuo S, Ito K, Narui R, Yamashita S, Sugimoto K, Yoshimura M, Yamane T, Pokushalov E, Romanov A, Artemenko S, Shabanov V, Elesin D, Stenin I, Turov A, Yakubov A, Miyazaki S, Shah AJ, Hocini M, Jais P, Haissaguerre M, Di Biase L, Gallinghouse JD, Rajappan K, Kautzner J, Dello Russo A, Tondo C, Lorgat F, Natale A, Balta O, Buenz K, Paessler M, Anders H, Horlitz M, Deneke T, Lickfett L, Liberman I, Linhart M, Andrie R, Mittmann-Braun E, Stockigt F, Nickenig G, Schrickel J, Tilz R, Rillig A, Feige B, Metzner A, Fuernkranz A, Burchard A, Wissner E, Ouyang F, Betts TR, Jones MA, Wong KCK, Qureshi N, Bashir Y, Rajappan K, Romanov A, Pokushalov E, Corbucci G, Artemenko S, Shabanov V, Turov A, Losik D, Selina V, Crandall MA, Daniels C, Daoud E, Kalbfleisch S, Yamaji H, Murakami T, Kawamura H, Murakami M, Hina K, Kusachi S, Dakos G, Vassilikos V, Paraskevaidis S, Mantziari A, Theophylogiannakos S, Chouvarda I, Chatzizisis I, Styliadis I, Kimura T, Fukumoto K, Nishiyama N, Aizawa Y, Fukuda Y, Sato T, Miyoshi S, Takatsuki S, Navarrete Casas AJ, Ali I, Conte FC, Moran M, Graham BG, Kalejs O, Lacis R, Stradins P, Koris A, Putnins I, Vikmane M, Lejnieks A, Erglis A, Estrada A, Perez Silva A, Castrejon S, Doiny D, Merino JL, Baranchuk A, Greiss I, Simpson CS, Abdollah H, Redfearn DP, Buys-Topart M, Nitzsche R, Thibault B, Deisenhofer I, Reents T, Ammar S, Fichtner S, Kathan S, Kolb C, Hessling G, Reif S, Schade S, Taggeselle J, Frey A, Birkenhagen A, Kohler S, Schmidt M, Cano Perez O, Buendia F, Igual B, Osca JM, Sanchez JM, Sancho-Tello MJ, Olague JM, Salvador A, Calvo N, Tolosana JM, Fernandez-Armenta J, Matas M, Barbarin MC, Berruezo A, Brugada J, Mont L, Habibovic M, Van Den Broek KC, Theuns DAMJ, Jordaens L, Alings M, Van Der Voort PH, Pedersen SS, Pupita G, Molini S, Brambatti M, Capucci A, Molodykh S, Idov EM, Belyaev OV, Segreti L, Soldati E, Zucchelli G, Di Cori A, Viani S, Paperini L, De Lucia R, Bongiorni MG, Binner L, Taborsky M, Bello D, Heuer H, Ramza B, Jenniskens I, Johnson WB, Silvetti MS, Rava' L, Russo MS, Di Mambro C, Ammirati A, Gimigliano G, Prosperi M, Drago F, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Jacinto A, Trinca M, Mazzone P, Ciconte G, Marzi A, Paglino G, Vergara P, Sora N, Gulletta S, Della Bella P, Koppitz P, Fach A, Hobbiesiefken S, Fiehn E, Hambrecht R, Sperzel J, Jung M, Schmitt J, Pajitnev D, Burger H, Burger H, Goebel G, Ehrlich W, Walther T, Ziegelhoeffer T, Vancura V, Wichterle D, Melenovsky V, Kautzner J, Glikson M, Goldenberg G, Segev A, Dvir D, Kuzniec J, Finkelstein A, Hay I, Guetta V, Choo WK, Gupta S, Kirkfeldt R, Johansen J, Nohr E, Moller M, Arnsbo P, Nielsen J, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Banha M, Trinca M, Stojanov P, Raspopovic S, Vasic D, Savic D, Nikcevic G, Jovanovic V, Defaye P, Mondesert B, Mbaye A, Cassagneau R, Gagniere V, Jacon J, Sanfins V, Reis HR, Nobre JN, Martins VM, Duarte LD, Morais CM, Conceicao JC, Hero M, Rey JL, Thibault B, Ducharme A, Simpson C, Stuglin C, Blier L, Senaratne M, Khaykin Y, Pinter A, Mlynarska A, Mlynarski R, Sosnowski M, Wilczek J, Iorgulescu C, Bogdan S, Constantinescu D, Caldararu C, Dorobantu M, Radu A, Vatasescu RG, Yusu S, Ikeda T, Mera H, Miwa Y, Abe A, Miyakoshi M, Tsukada T, Yoshino H, Nayar V, Cantelon P, Rawling A, Belham MRD, Pugh PJ, Osca Asensi J, Sanchez JM, Cano O, Tejada D, Munoz B, Rodriguez M, Sancho-Tello MJ, Olague J, Wecke L, Van Hunnik A, Thompson T, Di Carlo L, Zdeblick M, Auricchio A, Prinzen F, Doltra Magarolas A, Bijnens B, Silva E, Penela D, Mont L, Tolosana JM, Brugada J, Sitges M, Ofman P, Navaravong L, Leng J, Peralta A, Hoffmeister P, Levine R, Cook J, Stoenescu M, Tettamanti ME, Revilla Orodea A, Lopez Diaz J, De La Fuente Galan L, Arnold R, Garcia Moran E, San Roman Calvar JA, Gomez Salvador I, Nakamura K, Takami M, Keida T, Mesato A, Higa S, Shimabukuro M, Masuzaki H, Proietti R, Sagone A, Domenichini G, Burri H, Valzania C, Biffi M, Sunthorn H, Gavaruzzi G, Foulkes H, Boriani G, Koh S, Hou W, Rosenberg S, Snell J, Poore J, Dalal N, Bornzin G, Kloppe A, Mijic D, Bogossian H, Ninios I, Zarse M, Lemke B, Guedon-Moreau L, Kouakam C, Klug D, Marquie C, Ziglio F, Kacet S, Mohamed Fereig Hamed H, Hamdy AMAL, Abd El Aziz AHMED, Nabih MRVAT, Hamdy REHAB, Yaminisaharif A, Davoudi GH, Kasemisaeid A, Sadeghian S, Vasheghani Farahani A, Yazdanifard P, Shafiee A, Alonso C, Grimard C, Jauvert G, Lazarus A, Fernandez-Armenta J, Berruezo A, Mont LL, Sitges M, Andreu D, Ortiz-Perez J, Caralt T, Brugada J, Escudero J, Perez F, Griffith KM, Ferreyra R, Urena P, Demas M, Muratore C, Mazzetti H, Guardado J, Sanfins V, Fernandes M, Pereira VH, Canario-Almeida F, Ferreira F, Rodrigues B, Almeida J, Sokal A, Jedrzejczyk E, Lenarczyk R, Pluta S, Kowalski O, Pruszkowska P, Swiatkowski A, Kalarus Z, Heinke M, Ismer B, Kuehnert H, Heinke T, Surber R, Osypka N, Prochnau D, Figulla HR, Iacopino S, Landolina M, Proclemer A, Padeletti L, Calvi V, Pierantozzi A, Di Stefano P, Boriani G, Bauer A, Bode F, Le Gal F, Deharo JC, Delay M, Nitzsche R, Clementy J, Kawamura M, Munetsugu Y, Tanno K, Kobayashi Y, Cannom D, Hosoda J, Ishikawa T, Andoh K, Nobuyoshi M, Fujii S, Shizuta S, Kimura T, Isshiki T, Castel MA, Tolosana JM, Perez-Villa F, Mont L, Sitges M, Vidal B, Brugada J, Pluta S, Lenarczyk R, Kowalski O, Pruszkowska-Skrzep P, Sokal A, Szulik M, Kukulski T, Kalarus Z, Gianfranchi L, Bettiol K, Pacchioni F, Alboni P, Abu Sham'a R, Buber J, Nof E, Kuperstein R, Feinberg M, Luria D, Eldar M, Glikson M, Parks K, Stone JR, Singh JP, Hatzinikolaou-Kotsakou E, Kotsakou M, Beleveslis TH, Moschos G, Reppas E, Latsios P, Tsakiridis K, Kazemisaeid A, Davoodi G, Yamini Sharif A, Sadeghian S, Sheikhvatan M, Toniolo M, Zanotto G, Rossi A, Tomasi L, Vassanelli C, Versteeg H, Van Den Broek KC, Theuns DAMJ, Mommersteeg PMC, Alings M, Van Der Voort PH, Jordaens L, Pedersen SS, Vergara G, Blauer J, Ranjan R, Vijayakumar S, Kholmovski E, Volland N, Macleod R, Marrouche N, Aguinaga Arrascue LE, Bravo A, Garcia Freire P, Gallardo P, Hasbani E, Dantur J, Quintana R, Adragao PP, Cavaco D, Parreira L, Reis Santos K, Carmo P, Miranda R, Marcelino S, Cabrita D, Sommer P, Gaspar T, Rolf S, Arya A, Piorkowski C, Hindricks G, Valles Gras E, Bazan V, Portillo L, Suarez F, Bruguera J, Marti J, Huo Y, Arya A, Richter S, Schoenbauer R, Sommer P, Hindricks G, Piorkowski C, Rivas N, Casaldaliga J, Roca I, Dos L, Perez-Rodon J, Pijuan A, Garcia-Dorado D, Moya A, Carter HB, Garg A, Hegrenes J, Sih HJ, Teplitsky LR, Kuroki K, Tada H, Seo Y, Ishizu T, Igawa M, Sekiguchi Y, Kuga K, Aonuma K, Rodriguez A C, Mejias J, Hidalgo P, Hidalgo L JA, Orczykowski M, Derejko P, Walczak F, Szufladowicz E, Urbanek P, Bodalski R, Bieganowska K, Szumowski L, Peichl P, Wichterle D, Cihak R, Skalsky I, Kautzner J, Kubus P, Vit P, Zaoral L, Peichl P, Gebauer RA, Fiala M, Janousek J, Hiroshima K, Goya M, Ohe M, Hayashi K, Makihara Y, Nagashima M, An Y, Nobuyoshi M, Schloesser M, Lawrenz T, Meyer Zu Vilsendorf D, Strunk-Mueller C, Stellbrink C, Papagiannis J, Avramidis D, Kokkinakis C, Kirvassilis G, Eidelman G, Arenal A, Datino T, Atienza F, Gonzalez Torrecilla E, Miracle A, Hernandez J, Fernandez Aviles F, Ene E, Caldararu C, Iorgulescu C, Dorobantu M, Vatasescu RG, Insulander P, Bastani H, Braunschweig F, Drca N, Kenneback G, Schwieler J, Tapanainen J, Jensen-Urstad M, Andrea B, Andrea EMA, Maciel WM, Siqueira LS, Cosenza RC, Mittidieri FM, Farah SF, Atie JA, Kanoupakis E, Kallergis E, Mavrakis H, Goudis C, Saloustros I, Malliaraki N, Chlouverakis G, Vardas P, Bonnes JL, Jaspers Focks J, Westra SW, Brouwer MA, Smeets JLRM, Inama G, Pedrinazzi C, Landolina M, Oliva F, Senni M, Proclemer A, Zoni Berisso M, Mostov S, Haim M, Nevzorov R, Hasadi D, Starsberg B, Porter A, Kuschyk J, Schoene A, Streitner F, Veltmann CG, Schimpf R, Borggrefe M, Luesebrink U, Gardiwal A, Oswald H, Koenig T, Duncker D, Klein G, Bastiaenen R, Batchvarov V, Atty O, Cheng JH, Behr ER, Gallagher MM, Starrenburg AH, Kraaier K, Pedersen SS, Scholten MF, Van Der Palen J, Adhya S, Smith LA, Zhao T, Bannister C, Kamdar RH, Martinelli M, Siqueira S, Greco R, Nishioka SAD, Pedrosa AAA, Alkmim-Teixeira R, Peixoto GL, Costa R, Pedersen SS, Versteeg H, Nielsen JC, Mortensen PT, Johansen JB, Kwasniewski W, Filipecki A, Urbanczyk-Swic D, Orszulak W, Trusz - Gluza M, Jimenez-Candil J, Hernandez J, Morinigo J, Ledesma C, Martin-Luengo C, Vogtmann T, Gomer M, Stiller S, Kuehlkamp V, Zach G, Loescher S, Kespohl S, Baumann G, Snell JD, Korsun N, Rooke R, Snell JR, Morley B, Bharmi R, Nabutovsky Y, Mollerus M, Naslund L, Meyer A, Lipinski M, Libey B, Dornfeld K, Jimenez-Candil J, Hernandez J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, De Bie MK, Van Rees JB, Borleffs CJ, Thijssen J, Jukema JW, Schalij MJ, Van Erven L, Van Der Velde ET, Witteman TA, Foeken H, Van Erven L, Schalij MJ, Szili-Torok T, Akca F, Caliskan K, Ten Cate F, Jordaens L, Michels M, Cozma DC, Petrescu L, Mornos C, Dragulescu SI, Groeneweg JA, Velthuis BK, Cox MGPJ, Loh P, Dooijes D, Cramer MJ, De Bakker JMT, Hauer RNW, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Kim DH, Kwan J, Iorio A, Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lundqvist CB, Schwieler J. [Catheter ablation of atrial fibrillation good when medication doesn't help]. Lakartidningen 2011; 108:1126-1130. [PMID: 21815347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Walfridsson H, Johansson B, Englund A, Kennebäck G, Schwieler J, Kongstad O, Wåhlander K, Malm AR, Edvardsson N. Effects of AZD0837, a Novel Direct Thrombin Inhibitor, on the Electrophysiological Properties of the Human Heart. Clin Drug Investig 2010; 30:461-71. [DOI: 10.2165/11536300-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Bastani H, Insulander P, Schwieler J, Tabrizi F, Braunschweig F, Kenneback G, Drca N, Jensen-Urstad M. Cryoablation of superoparaseptal and septal accessory pathways: a single centre experience. Europace 2010; 12:972-7. [DOI: 10.1093/europace/euq079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schwieler J, Drca N, Bastani H, Braunschweig F, Insulander P, Jensen-Urstad M, Kennebäck G, Kongstad O, Sadigh B, Tapanainen J, Bergfeldt L. [Asymptomatic preexcitation--a risk marker for sudden death]. Lakartidningen 2009; 106:3176-3178. [PMID: 20077644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Jensen-Urstad M, Bastani H, Braunschweig F, Drca N, Insulander P, Kenneback G, Schwieler J, Tabrizi F. Cryoballoon ablation: a novel technique for treating focal atrial tachycardias from the pulmonary veins. Europace 2009; 11:1445-7. [DOI: 10.1093/europace/eup298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hjemdahl P, Allhammar A, Heaton C, Hulting J, Kahan T, Malmström R, Martinsson A, Rücker F, Schenck-Gustafsson K, Schwieler J, Törnerud M, Wettermark B. [Lower and lower cholesterol targets increase adverse effects]. Lakartidningen 2009; 106:2550-2551. [PMID: 19908628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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41
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Tabrizi F, Insulander P, Kennebãck G, Schwieler J, Bastani H, Braunschweig F, Drca N, Sadigh B, Grahn A, Wredlert C, Jensen-Urstad M. [Cryoballoon technique in atrial fibrillation--quick, simple and effective therapy]. Lakartidningen 2009; 106:2045-2048. [PMID: 19769144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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42
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Hjemdahl P, Allhammar A, Heaton C, Hulting J, Kahan T, Malmström R, Martinsson A, Rücker F, Schenck-Gustafsson K, Schwieler J, Törnerud M, Wettermark B. [SBU should investigate what is an evidence-based and cost-effective use of statins]. Lakartidningen 2009; 106:1992-1994. [PMID: 19764381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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43
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Bastani H, Schwieler J, Insulander P, Tabrizi F, Braunschweig F, Kenneback G, Drca N, Sadigh B, Jensen-Urstad M. Acute and long-term outcome of cryoablation therapy of typical atrioventricular nodal reentrant tachycardia. Europace 2009; 11:1077-82. [DOI: 10.1093/europace/eup177] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abdelwahab A, Basta M, Parkash R, Gardner M, Sapp J, Nault I, Maury P, Sacher F, Deplagne A, Hocini M, Lellouche N, Haissaguerre M, Jais P, Konstantinidou M, Wissner E, Koektuerk B, Schmidt B, Zerm T, Ouyang F, Kuck KH, Chun JKR, Herrera Siklody C, Letsas K, Weber R, Schiebeling-Roemer J, Stockinger J, Astheimer K, Kalusche D, Arentz T, Nakamura K, Naito S, Kumagai K, Goto K, Iwamoto J, Ueda M, Oshima S, Komuro I, Vassilikos V, Dakos G, Chouvarda I, Maglaveras N, Paraskevaidis S, Mochlas S, Styliadis I, Parcharidis G, Insulander P, Bastani H, Braunschweig F, Kenneback G, Schwieler J, Tabrizi F, Jensen-Urstad M, Hanazawa K, Kaitani K, Yoshitani K, Miyake M, Motooka M, Izumi T, Izumi C, Nakagawa Y, Romanov A, Pokushalov E, Shugaev P, Artemenko S, Turov A, Albenque JP, Bortone A, El Bayomy M, Combes N, Hausman P, Combes S, Donzeau JP, Boveda S. Moderated Posters: Outcome of catheter ablation. Europace 2009. [DOI: 10.1093/europace/euq196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Groot NMS, Atary JZ, Blom NA, Van Kuijk JP, Schalij MJ, Tomaske M, Candinas R, Weiss M, Bauersfeld U, Fassa AA, Ashrafpoor G, Sunthorn H, Burri H, Gentil-Baron P, Shah D, Wijnmaalen AP, Delgado V, Schalij MJ, Holman ER, Bax JJ, Zeppenfeld K, Kuhne M, Oral H, Morady F, Bogun F, Schwagten B, Szili-Torok T, Knops P, Kimman G, Thornton A, Jordaens L, Satomi K, Roland T, Kamakura S, Kuck K, Ouyang F, Nowak S, Wnuk-Wojnar AM, Hoffmann A, Czerwinski C, Szydlo K, Rybicka-Musialik A, Wozniak-Skowerska I, Trusz-Gluza M, Krynski T, Stec SM, Stec SM, Hachiya H, Hirao K, Sasaki T, Higuchi K, Isobe M, Etsadashvili K, Hintringer F, Stuehlinger X, Berger T, Dichtl W, Roithinger FX, Pachinger O, Stuehlinger M, Tanno K, Onuki T, Minoura Y, Kawamura M, Asano T, Kobayashi Y, Bonet A, Merce Klein J, De Castro R, Valdovinos P, Colomer I, Garcia MI, Serrano I, Bardaji A, Peichl P, Cihak R, Polasek R, Kucera P, Bytesnik J, Kautzner J, Schlueter S, Grebe O, Vester EV, Maury P, Fourcade J, Duparc A, Hebrard A, Mondoly P, Rollin A, Rumeau P, Delay M, De Boeck BWL, Teske AJ, Mohamed Hoesein FAA, Van Driel VJH, Loh P, Cramer MJM, Prinzen FW, Doevendans PAF, Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N, Richter B, Gwechenberger M, Socas A, Zorn G, Albinni S, Wojta J, Binder T, Goessinger H, Kettering K, Mollnau H, Gramley F, Weiss C, Berkowitsch A, Neumann T, Kuniss M, Zaltsberg S, Wojcik M, Pitschner HF, Wichterle D, Peca M, Bulkova V, Cihak R, Peichl P, Kautzner J, Suzuki A, Yamauchi Y, Okada H, Obayashi T, Sekiguchi Y, Aonuma K, Isobe M, Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N, Zoppo F, Bertaglia E, Zerbo F, Brandolino G, Bacchiega E, Lickfett L, Bellmann B, Linhart M, Schrickel JW, Lewalter T, Schwab JO, Nickenig G, Mittmann-Braun EL, Dabrowski P, Kozluk E, Stefanczyk P, Kleinrok A, Opolski G, Andronache M, Abdelaal A, Magnin-Poull I, Cedano J, Groben L, Mandry D, Aliot E, De Chillou C, Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA, Manfai B, Faludi R, Fodi E, Rausch P, Simor T, Sciarra L, Rebecchi M, De Ruvo E, De Luca L, Zuccaro LM, Fagagnini A, Delise P, Calo L, Mikhaylov E, Van Belle Y, Janse P, Lebedev D, Kanidieva A, Jordaens L, Szili-Torok T, Patel D, Shaheen M, Sonne K, Mohanty P, Di-Biase L, Popova L, Burkhardt D, Natale A, Mccann CJ, Gal B, Goethals P, Peychev P, Geelen P, Vatasescu RG, Iorgulescu C, Ieremciuc I, Alexandru R, Dorobantu M, Insulander P, Bastani H, Braunschweig F, Jensen-Urstad M, Schwieler J, Tabrizi F, Kenneback G, Foldesi CSABA, Kardos A, Mihalcz A, Abraham PAL, Som ZOLTAN, Borbola JOZSEF, Vanyi JOZSEF, Szili-Torok TAMAS, Pastor Fuentes A, Nunez A, Tur N, Berzal B, G Cosio F, Mujovic N, Grujic M, Mrdja S, Kocijancic A, Potpara T, Polovina M, Vujisic-Tesic B, Petrovic M, Hayashi T, Hachiya H, Hirao K, Higuchi K, Sasaki T, Furukawa T, Kawabata M, Isobe M, Lavalle C, Ficili S, Galeazzi M, Russo M, Pandozi A, Pandozi C, Venditti F, Santini M, Wichterle D, Pavlikova K, Psenicka M, Anger Z, Linhart A, Sonne K, Narten A, Gamelin A, Mittag J, Patel D, Raffa S, Geller JC, Mocini D, Russo M, Venditti F, Ficili S, Galeazzi M, Lavalle C, Pandozi C, Santini M, Groenveld HF, Rienstra M, Van Den Berg MP, Hillege HL, Van Veldhuisen DJ, Van Gelder IC, Morani G, Manica A, Angheben C, Cicoira MA, Pozzani L, Tomasi L, Zanotto G, Vassanelli C, Ahmed S, Ranchor AV, Rienstra M, Wiesfeld ACP, Van Veldhuisen DJ, Van Gelder IC. Poster Session 1: Ablation of SVT and VT. Europace 2009. [DOI: 10.1093/europace/euq212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bastani H, Insulander P, Schwieler J, Tabrizi F, Braunschweig F, Kenneback G, Drca N, Sadigh B, Jensen-Urstad M. Safety and efficacy of cryoablation of atrial tachycardia with high risk of ablation-related injuries. Europace 2009; 11:625-9. [DOI: 10.1093/europace/eup004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Insulander P, Schwieler J, Kennebäck G, Bastani H, Braunschweig F, Tabrizi F, Bergfeldt L, Andersson M, Wredlert C, Jensen-Urstad M. [Ablation as first line therapy in supraventricular tachycardias. Good results and few complications in a study of 2 207 consecutive patients]. Lakartidningen 2008; 105:3644-3647. [PMID: 19177929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Wecke L, Poci D, Schwieler J, Johansson B, Lundahl G, Bergfeldt L. P3-64. Heart Rhythm 2006. [DOI: 10.1016/j.hrthm.2006.02.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ericsson H, Schwieler J, Lindmark BO, Löfdahl P, Thulin T, Regårdh CG. Enantioselective pharmacokinetics of the enantiomers of clevidipine following intravenous infusion of the racemate in essential hypertensive patients. Chirality 2001; 13:130-4. [PMID: 11270321 DOI: 10.1002/1520-636x(2001)13:3<130::aid-chir1009>3.0.co;2-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of the study was to characterize the individual pharmacokinetics of (-)-R- and (+)-S-clevidipine following intravenous constant rate infusion of rac-clevidipine to essential hypertensive patients. Twenty patients received three out of five randomized treatments with clevidipine. The pharmacokinetics of the separate enantiomers were evaluated by compartmental analysis of blood concentrations vs. time curves using the population approach. The derived pharmacokinetic parameters were used to simulate the time for 50 and 90% postinfusion decline following various infusion times of rac-clevidipine. A two-compartment model was used to describe the dispositions of the enantiomers; there were only minor differences between the estimated pharmacokinetic parameters of the separate enantiomers. The mean blood clearance values of (-)-R- and (+)-S-clevidipine were 0.103 and 0.096 l/min/kg, and the corresponding volumes of distribution at steady state were 0.39 and 0.54 l/kg, respectively. The context-sensitive half-time was approximately 2 min regardless of stereochemical configuration, and a 90% decline in concentration was achieved approximately 8 min postinfusion for (-)-R-clevidipine and 11 min for (+)-S-clevidipine, following clinically relevant infusion times with clevidipine. In conclusion, both enantiomers are high-clearance compounds with similar blood clearance values. The volume of distribution for the enantiomers is slightly different, presumably due to differences in the protein binding. From a pharmacokinetic point of view, the use of a single enantiomer as an alternative to the racemic clevidipine will not offer any clinical advantages.
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Affiliation(s)
- H Ericsson
- AstraZeneca, R&D Mölndal, Mölndal, Sweden.
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Pernow J, Schwieler J, Kahan T, Hjemdahl P, Oberle J, Wallin BG, Lundberg JM. Influence of sympathetic discharge pattern on norepinephrine and neuropeptide Y release. Am J Physiol 1989; 257:H866-72. [PMID: 2782443 DOI: 10.1152/ajpheart.1989.257.3.h866] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effects of sympathetic nerve stimulation on vasoconstrictor responses and overflow of norepinephrine (NE) and neuropeptide Y-like immunoreactivity (NPY-LI) were studied in the dog gracilis muscle and pig spleen in vivo. A continuous regular impulse activity was compared with irregular human sympathetic and regular bursting patterns. During control conditions, stimulation with the irregular activity induced larger peak vasoconstriction than the regular activity at 0.59 Hz, but not at higher frequencies in the muscle, at 0.59 and 2.0 Hz in the spleen. The nerve stimulation-evoked overflow of NE and NPY-LI from the muscle were not influenced by the pattern of stimulation. The overflow of NPY-LI, but not that of NE, from the spleen was enhanced by the irregular activity at 0.59 and 2.0 Hz, and both NPY-LI and NE overflows were enhanced by regular burst activity at 2.0 Hz. After blockade of alpha- and beta-adrenoceptors by phenoxybenzamine and propranolol, respectively, which enhanced nerve stimulation-evoked overflow of both NE and NPY-LI, the NE overflow from the muscle evoked by the irregular activity was slightly larger at 0.59 Hz but smaller at higher frequencies compared with that evoked by regular activity, whereas the detectable overflow of NPY-LI was not largely influenced by the stimulation pattern. In conclusion, both the vasoconstrictor response and the overflow of NPY-LI and NE seem to be influenced by the pattern and frequency of sympathetic nerve stimulation.
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Affiliation(s)
- J Pernow
- Department of Pharmacology, Karolinska Institute, Stockholm, Sweden
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