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Aebersold H, Foster-Witassek F, Serra-Burriel M, Brüngger B, Aeschbacher S, Beer JH, Blozik E, Blum M, Bonati L, Conen D, Conte G, Felder S, Huber C, Kuehne M, Moschovitis G, Mueller A, Paladini RE, Reichlin T, Rodondi N, Springer A, Stauber A, Sticherling C, Szucs T, Osswald S, Schwenkglenks M. Estimating the cost impact of atrial fibrillation using a prospective cohort study and population-based controls. BMJ Open 2023; 13:e072080. [PMID: 37709325 PMCID: PMC10503354 DOI: 10.1136/bmjopen-2023-072080] [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: 01/26/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS Atrial fibrillation (AF) costs are expected to be substantial, but cost comparisons with the general population are scarce. Using data from the prospective Swiss-AF cohort study and population-based controls, we estimated the impact of AF on direct healthcare costs from the Swiss statutory health insurance perspective. METHODS Swiss-AF patients, enrolled from 2014 to 2017, had documented, prevalent AF. We analysed 5 years of follow-up, where clinical data, and health insurance claims in 42% of the patients were collected on a yearly basis. Controls from a health insurance claims database were matched for demographics and region. The cost impact of AF was estimated using five different methods: (1) ordinary least square regression (OLS), (2) OLS-based two-part modelling, (3) generalised linear model-based two-part modelling, (4) 1:1 nearest neighbour propensity score matching and (5) a cost adjudication algorithm using Swiss-AF data non-comparatively and considering clinical data. Cost of illness at the Swiss national level was modelled using obtained cost estimates, prevalence from the Global Burden of Disease Project, and Swiss population data. RESULTS The 1024 Swiss-AF patients with available claims data were compared with 16 556 controls without known AF. AF patients accrued CHF5600 (EUR5091) of AF-related direct healthcare costs per year, in addition to non-AF-related healthcare costs of CHF11100 (EUR10 091) per year accrued by AF patients and controls. All five methods yielded comparable results. AF-related costs at the national level were estimated to amount to 1% of Swiss healthcare expenditure. CONCLUSIONS We robustly found direct medical costs of AF patients were 50% higher than those of population-based controls. Such information on the incremental cost burden of AF may support healthcare capacity planning.
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Affiliation(s)
- Helena Aebersold
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Stefanie Aeschbacher
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jürg-Hans Beer
- Department of Medicine, Baden Cantonal Hospital, Baden, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Eva Blozik
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Manuel Blum
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Leo Bonati
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino (CCT), Lugano, Switzerland
| | - Stefan Felder
- Faculty of Business and Economics, University of Basel, Basel, Switzerland
| | - Carola Huber
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Michael Kuehne
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Instituto Cardiocentro Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Andreas Mueller
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Rebecca E Paladini
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Anne Springer
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Annina Stauber
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Christian Sticherling
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Thomas Szucs
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
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2
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Luciani M, Müller D, Vanetta C, Diteepeng T, von Eckardstein A, Aeschbacher S, Rodondi N, Moschovitis G, Reichlin T, Sinnecker T, Wuerfel J, Bonati LH, Saeedi Saravi SS, Chocano-Bedoya P, Coslovsky M, Camici GG, Lüscher TF, Kuehne M, Osswald S, Conen D, Beer JH. Trimethylamine-N-oxide is associated with cardiovascular mortality and vascular brain lesions in patients with atrial fibrillation. Heart 2023; 109:396-404. [PMID: 36593094 DOI: 10.1136/heartjnl-2022-321300] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/17/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Trimethylamine-N-oxide (TMAO) is a metabolite derived from the microbial processing of dietary phosphatidylcholine and carnitine and the subsequent hepatic oxidation. Due to its prothrombotic and inflammatory mechanisms, we aimed to assess its role in the prediction of adverse events in a susceptible population, namely patients with atrial fibrillation. METHODS Baseline TMAO plasma levels were measured by liquid chromatography-tandem mass spectrometry in 2379 subjects from the ongoing Swiss Atrial Fibrillation cohort. 1722 underwent brain MRI at baseline. Participants were prospectively followed for 4 years (Q1-Q3: 3.0-5.0) and stratified into baseline TMAO tertiles. Cox proportional hazards and linear and logistic mixed effect models were employed adjusting for risk factors. RESULTS Subjects in the highest TMAO tertile were older (75.4±8.1 vs 70.6±8.5 years, p<0.01), had poorer renal function (median glomerular filtration rate: 49.0 mL/min/1.73 m2 (35.6-62.5) vs 67.3 mL/min/1.73 m2 (57.8-78.9), p<0.01), were more likely to have diabetes (26.9% vs 9.1%, p<0.01) and had a higher prevalence of heart failure (37.9% vs 15.8%, p<0.01) compared with patients in the lowest tertile. Oral anticoagulants were taken by 89.1%, 94.0% and 88.2% of participants, respectively (from high to low tertiles). Cox models, adjusting for baseline covariates, showed increased total mortality (HR 1.65, 95% CI 1.17 to 2.32, p<0.01) as well as cardiovascular mortality (HR 1.86, 95% CI 1.21 to 2.88, p<0.01) in the highest compared with the lowest tertile. When present, subjects in the highest tertile had more voluminous, large, non-cortical and cortical infarcts on MRI (log-transformed volumes; exponentiated estimate 1.89, 95% CI 1.11 to 3.21, p=0.02) and a higher chance of small non-cortical infarcts (OR 1.61, 95% CI 1.16 to 2.22, p<0.01). CONCLUSIONS High levels of TMAO are associated with increased risk of cardiovascular mortality and cerebral infarction in patients with atrial fibrillation. TRIAL REGISTRATION NUMBER NCT02105844.
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Affiliation(s)
- Marco Luciani
- Department of Medicine, Baden Cantonal Hospital, Baden, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Daniel Müller
- Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.,Laboratory Medicine, University of Basel, Basel, Switzerland
| | | | - Thamonwan Diteepeng
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | | | - Stefanie Aeschbacher
- Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland.,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ospedale Regionale di Lugano-Civico e Italiano, Lugano, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Tim Sinnecker
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland.,Medical Image Analysis Center (MIAC), Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC), Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland.,Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Seyed Soheil Saeedi Saravi
- Department of Medicine, Baden Cantonal Hospital, Baden, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Patricia Chocano-Bedoya
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
| | - Michael Coslovsky
- Cardiology Division, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.,Department of Cardiology, Royal Brompton and Harefield Hospitals Trust, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Michael Kuehne
- Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland.,Cardiology Division, University of Basel Hospital, Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland.,Cardiology Division, University of Basel Hospital, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jürg Hans Beer
- Department of Medicine, Baden Cantonal Hospital, Baden, Switzerland .,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
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3
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Aebersold H, Serra-Burriel M, Foster-Wittassek F, Moschovitis G, Aeschbacher S, Auricchio A, Beer JH, Blozik E, Bonati LH, Conen D, Felder S, Huber CA, Kuehne M, Mueller A, Oberle J, Paladini RE, Reichlin T, Rodondi N, Springer A, Stauber A, Sticherling C, Szucs TD, Osswald S, Schwenkglenks M. Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort. Heart 2022; 109:763-770. [PMID: 36332981 DOI: 10.1136/heartjnl-2022-321520] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 06/20/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectiveEvidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study, we aimed to characterise AF costs and their development over time, and to assess specific patient clusters and their cost trajectories.MethodsSwiss-AF enrolled 2415 patients with variable duration of AF between 2014 and 2017. Patient clusters were identified using hierarchical cluster analysis of baseline characteristics. Ongoing yearly follow-ups include health insurance clinical and claims data. An algorithm was developed to adjudicate costs to AF and related complications.ResultsA subpopulation of 1024 Swiss-AF patients with available claims data was followed up for a median (IQR) of 3.24 (1.09) years. Average yearly AF-adjudicated costs amounted to SFr5679 (€5163), remaining stable across the observation period. AF-adjudicated costs consisted mainly of inpatient and outpatient AF treatment costs (SFr4078; €3707), followed by costs of bleeding (SFr696; €633) and heart failure (SFr494; €449). Hierarchical analysis identified three patient clusters: cardiovascular (CV; N=253 with claims), isolated-symptomatic (IS; N=586) and severely morbid without cardiovascular disease (SM; N=185). The CV cluster and SM cluster depicted similarly high costs across all cost outcomes; IS patients accrued the lowest costs.ConclusionOur results highlight three well-defined patient clusters with specific costs that could be used for stratification in both clinical and economic studies. Patient characteristics associated with adjudicated costs as well as cost trajectories may enable an early understanding of the magnitude of upcoming AF-related healthcare costs.
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Affiliation(s)
- Helena Aebersold
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Giorgio Moschovitis
- Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Opsedale Regionale di Lugano, Lugano, Switzerland
| | - Stefanie Aeschbacher
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Angelo Auricchio
- Department of Cardiology, Instituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Jürg Hans Beer
- Department of Medicine, Cantonal Hospital of Baden, Baden, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Eva Blozik
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Leo H Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stefan Felder
- Faculty of Business and Economics, University of Basel, Basel, Switzerland
| | - Carola A Huber
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Michael Kuehne
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Andreas Mueller
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Jolanda Oberle
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Rebecca E Paladini
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Anne Springer
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Annina Stauber
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Christian Sticherling
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Thomas D Szucs
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
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Mannhart D, Lefebvre B, Gardella C, Henry C, Serban T, Knecht S, Kuehne M, Sticherling C, Badertscher P. Clinical validation of an artificial intelligence algorithm offering cross-platform detection of atrial fibrillation using smart device electrocardiograms. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2774] [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
Introduction
Multiple smart devices capable of “screening” for atrial fibrillation (AF) based on single-lead electrocardiogram (SL ECG) are presently available. Manufacturers' algorithm capabilities and accuracy for the automated detection of AF vary. Reliable artificial intelligence (AI) algorithms would be valuable to assist physicians with managing the large amount of data. We aimed to assess the clinical value of applying a smart device agnostic AI-based algorithm for the detection of AF from five different smart devices (four smartwatches, one handheld device) and compared the results to the cardiologist-interpreted 12-lead ECG in a real world cohort of patients.
Methods
This is a prospective, observational study enrolling patients presenting to a cardiology service at a tertiary referral center. Patients were prescribed a 12-lead ECG, followed by five consecutive smart device recordings from five different manufacturers. SL ECGs were exported as PDF files from the devices and analyzed by a deep neural network (DNN) based platform which allows automated AI assisted cardiac rhythm interpretation.
Results
We prospectively enrolled 157 patients (32% female, median age 66 years). AF was present in 48 patients (31%) at time of recording, as documented by the 12-lead ECG. Accuracy for the detection of AF by the DNN-based algorithm was 96.6% for the Apple Watch 6, 95.2% for the AliveCor Kardia Mobile, 96.0% for the Fitbit Sense, 95.7% for the Samsung Galaxy Watch 3 and 93.8% for the Withings Scanwatch, respectively (Figure 1, left). While diagnostic accuracy of the DNN-based algorithm was similar compared to each manufacturer's individual algorithm, the proportion of SL ECGs with a conclusive diagnosis was significantly higher for all smart devices when using the DNN-based algorithm, p<0.001 (Figure 1, right). As complementary analysis, we assessed sensitivity and specificity detection capabilities in both algorithms (Figure 2).
Conclusion
In this clinical validation, a DNN-based algorithm reported significantly more conclusive diagnoses for each smart device compared to the manufacturers' algorithms, whilst showing similarly high accuracy in the detection of AF compared to the cardiologist-interpreted standard 12-lead ECG. Given further validation, SL ECG assisted rhythm interpretation through a cross-platform AI-algorithm presents a promising clinical value for AF detection and offers a possible solution for managing the data surge for smart device-acquired ECGs.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Mannhart
- University Hospital Basel , Basel , Switzerland
| | | | | | | | - T Serban
- University Hospital Basel , Basel , Switzerland
| | - S Knecht
- University Hospital Basel , Basel , Switzerland
| | - M Kuehne
- University Hospital Basel , Basel , Switzerland
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5
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Serban T, Du Fay De Lavallaz J, Mannhart D, Knecht S, Kuehne M, Sticherling C, Badertshcer P. Echocardiographic pattern of left ventricular function recovery in tachycardia-induced cardiomyopathy patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.426] [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
Background
Tachycardia-induced Cardiomyopathy (TIC) represents a reversible type of cardiomyopathy (CM) that is underdiagnosed. Prior pilot studies suggested a specific left ventricular (LV) function recovery pattern in TIC patients. Cardiac chamber remodeling in TIC, however, remains incompletely understood.
Purpose
We aimed to explore differences in LV dimensions and functional recovery in TIC patients when compared to a control group of patients with other forms of CM and functional recovery.
Methods
We identified patients with reduced left ventricular ejection fraction (≤50%) and/or atrial fibrillation or flutter treated between 2015 and 2022. Patients had at least two serial transthoracic echocardiographies (TTE). The minimal interval between the TTEs had to be at least 3 months, and the left ventricular ejection fraction (LVEF) had to either improve (≥15% in absolute value) or normalize (LVEF at follow-up ≥50%). Patients were then divided into two groups: A) patients with atrial fibrillation or atrial flutter at baseline and sinus rhythm at follow-up. These patients were assumed to have TIC. B) Patients with sinus rhythm at both baseline and follow-up, consisting of patients with other forms of CM. The change in ventricular dimensions and function (indexed left ventricular end-systolic – LVESDI, end-diastolic diameters – LVEDDI – and volumes – LVEDVI, LVEF, and fractional shortening – FS) were compared within and across group A and B at baseline and at follow-up. The groups were compared using Kruskal (for independent data) and Wilcoxon (for paired data) tests. A p<0.05 was considered significant.
Results
A total of 261 patients were included (34% female, median age 68 years). The median time between TTEs was 25 months. 104 (39.8%) patients were considered to suffer from TIC and 157 (60.2%) patients were considered to suffer from other forms of CM. The changes in ventricular dimensions and function in both groups are shown in Figure 1 and Table 1. The TIC group showed no improvement in LVEDVI from baseline to the follow-up examination, while the control group showed significant improvement in LVEDVI (1.7% [−24.7, 22.8] vs. 12.4% [−7.1, 29.3], p=0.008). There was no difference in LVEDDI recovery between TIC and control patients (1.7% [−7.3, 10.3] versus 3.1% [−5.4, 10.2], p=0.578).
Conclusions
TIC patients have a specific pattern of functional recovery with similar improvements in systolic function and diameters compared with patients with other CMs, while diastolic parameters remained impaired.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Serban
- University Hospital Basel , Basel , Switzerland
| | | | - D Mannhart
- University Hospital Basel , Basel , Switzerland
| | - S Knecht
- University Hospital Basel , Basel , Switzerland
| | - M Kuehne
- University Hospital Basel , Basel , Switzerland
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6
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Serban T, Du Fay De Lavallaz J, Mezier J, Mertz L, Mannhart D, Kuehne M, Sticherling C, Badertscher P. Risk factors for the development of premature ventricular complex-induced cardiomyopathy: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.682] [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
Premature ventricular complexes (PVCs) can be a reversible cause of heart failure. To date, it is unclear which risk factors contribute to the development of impaired left ventricular function.
Objective
Systematically assessing risk factors for the development of PVC-induced cardiomyopathy (PVC-CM).
Methods
We performed a structured database search of the scientific literature for studies investigating risk factors for the development of PVC-induced Cardiomyopathy. We investigated the reporting of PVC-induced Cardiomyopathy risk factors (RF) and assessed the comparative association of the different RF using random-effect meta-analysis.
Results
A total of 26 studies (9 prospective and 17 retrospective studies) involving 16.764.641 patients were analyzed (mean age 55 y, 58% women, mean PVC burden 17%). Suitable for quantitative analysis were 25 studies examining 6738 (0.04%) patients and 11 RF (≥3 occurrences in multivariable model assessing a binary change in left ventricular - LV- function). Among these risk factors, age (OR 1.02 per increase in the year of age, 95%-CI [1.01, 1.02]), the presence of symptoms (OR 0.18, 95%-CI [0.05, 0.64]), non-sustained VTs (OR 3.01, 95%-CI [1.39, 6.50]), LV origin (OR 2.20, 95%-CI [1.14, 4.23]), epicardial origin (OR 4.72, 95%-CI [1.81, 12.34]), the presence of interpolation - PVCs that do not reset the RR interval (OR 4.93, 95%-CI [1.66, 14.69]) and overall PVC burden (OR 1.06, 95%-CI [1.04, 1.08]) were all significantly associated with PVC-induced Cardiomyopathy. (Figures 1,2)
Conclusion
In this meta-analysis, the most consistent risk factors for PVC-CM were age, non-sustained VTs, LV and epicardial origin, interpolation, and PVC burden, while the presence of symptoms significantly reduced the risk. These findings help tailor stringent follow-up to patients presenting with frequent PVCs and normal LV function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Serban
- University Hospital Basel , Basel , Switzerland
| | | | - J Mezier
- University Hospital Basel , Basel , Switzerland
| | - L Mertz
- University Hospital Basel , Basel , Switzerland
| | - D Mannhart
- University Hospital Basel , Basel , Switzerland
| | - M Kuehne
- University Hospital Basel , Basel , Switzerland
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7
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Hennings E, Blum S, Aeschbacher S, Coslovsky M, Knecht S, Paladini RE, Krisai P, Kastner P, Ziegler A, Mueller C, Zuern CS, Bonati L, Conen D, Kuehne M, Osswald S. Bone morphogenetic protein 10 as predictor for adverse outcomes in patients with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.515] [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
Patients with atrial fibrillation (AF) face an increased risk of death and major adverse cardiovascular events (MACE). Bone morphogenetic protein 10 (BMP10) is a novel atrial-specific biomarker, but data about its prognostic value in AF patients are lacking.
Purpose
We aimed to assess the predictive value of BMP10 for death and MACE in AF patients in comparison to N-terminal prohormone of B-type natriuretic peptide (NT-proBNP).
Methods
Baseline concentrations of BMP10 and NT-proBNP were measured in stable patients with AF enrolled in Swiss-AF, a prospective multicenter observational cohort study. Primary outcomes were all-cause death and MACE (composite of heart failure hospitalization, cardiovascular death, stroke, systemic embolism, myocardial infarction). Measures of discriminative power were used to compare multivariable Cox proportional hazard models using the different biomarkers.
Results
A total of 2219 AF patients were included with a median follow-up of 4.3 years (IQR 3.9, 5.1). Mean age was 73±9 years and 27% were women. Incidence rate per 100 patient-years of all-cause death and MACE increased across BMP10 quartiles (Figure 1). In the multivariable adjusted Cox proportional hazard model, the hazard ratio (HR) and 95% confidence interval (CI) of BMP10 was 1.60 (1.37; 1.87) to predict all-cause death, and 1.54 (1.35; 1.76) to predict MACE. For all-cause death, the C-index (95% CI) was 0.783 (0.763; 0.809) for BMP10, 0.784 (0.765; 0.810) for NT-proBNP, and 0.789 (0.771; 0.815) for both biomarkers combined. For MACE, the C-index (95% CI) was 0.732 (0.715; 0.754) for BMP10, 0.747 (0.731; 0.768) for NT-proBNP, and 0.750 (0.734; 0.771) for both biomarkers combined. When grouping patients according to clinical used NT-proBNP categories (<300, 300–900, >900 ng/l), higher incidence rates and adjusted HRs were observed for the primary outcomes in patients with high BMP10 in the categories of low NT-proBNP (all-cause death aHR 2.28 [1.15; 4.52], MACE aHR 1.88 [1.07; 3.28]) and high NT-proBNP (all-cause death aHR 1.61 [1.14; 2.26], MACE aHR 1.38 [1.07; 1.80]) (Figure 2).
Conclusion
The novel atrial-specific biomarker BMP10 strongly predicts all-cause death and MACE in patients with AF. BMP10 provides additional prognostic information in low- and high-risk patients according to NT-proBNP stratification.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
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Affiliation(s)
- E Hennings
- University Hospital Basel , Basel , Switzerland
| | - S Blum
- University Hospital Basel , Basel , Switzerland
| | | | - M Coslovsky
- University Hospital Basel , Basel , Switzerland
| | - S Knecht
- University Hospital Basel , Basel , Switzerland
| | | | - P Krisai
- University Hospital Basel , Basel , Switzerland
| | - P Kastner
- Roche Diagnostics GmbH , Penzberg , Germany
| | - A Ziegler
- Roche Diagnostics International AG , Rotkreuz , Switzerland
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
| | - C S Zuern
- University Hospital Basel , Basel , Switzerland
| | - L Bonati
- University Hospital Basel , Basel , Switzerland
| | - D Conen
- McMaster University , Hamilton , Canada
| | - M Kuehne
- University Hospital Basel , Basel , Switzerland
| | - S Osswald
- University Hospital Basel , Basel , Switzerland
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8
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Ziswiler T, Luciani M, Vanetta C, Springer A, Diteepeng T, Von Eckardstein A, Mueller D, Barbagallo M, Conen D, Rodondi N, Moschovitis G, Osswald S, Kuehne M, Bonati LH, Beer JH. Trimethylamine N-oxide is associated with impaired cognitive function in patients with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2435] [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
Introduction
Since patients with atrial fibrillation (AF) are predisposed to suffer from major adverse cerebrovascular events (MACE), they are more likely to suffer MACE linked sequelae, such as cognitive impairment. We hypothesised that the gut microbiome derivate trimethylamine N-oxide (TMAO) may amplify this pathomechanism given its hypercoagulative, proinflammatory and proatherogenic effects.
Methods
Patients of the Swiss-AF cohort with determined TMAO plasma levels, cognitive scores (n=2'379) and cerebral magnetic resonance imaging (cMRI) (n=1'722) collected at baseline were included. TMAO levels were measured by liquid chromatography-mass spectrometry (HPLC). Overall cognitive performance was evaluated using the Cognitive Construct (CoCo) score reflecting different cognitive functions measured by four validated neuropsychological assessments, namely the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT parts A and B), Semantic Fluency Test (SFT) and Digital Symbol Substitution Test (DSST). The scores were compared with the quartiles of patients' TMAO plasma levels (Q1: 0.6–4, Q2: 4–5.8, Q3: 5.8–9.1, Q4: 9.1–164μmol/l) in linear effect models. All models were adjusted for multiple covariates correlating with this association: For TMAO (overall meat consumption >3 times per week, physical activity, glomerular filtration rate, presence of diabetes mellitus), cognitive function (EQ-5D-5L score, geriatric depression scale, education level) and cerebral affects (white matter lesions volume and total brain volume in cMRI). The relevance of high TMAO plasma levels in different stroke groups in cMRI (i.e., clinically overt, silent, or no stroke) were analysed in a subgroup analysis. The subgroups were additionally adjusted for total brain volume to eliminate the effect of simultaneous decrease of cerebral white matter.
Results
After multivariable adjustment, AF patients in the highest quartile of TMAO levels performed significantly poorer in the global cognitive score (CoCo: estimate −0.11, 95% CI [−0.17, −0.05], p=0.002) compared to patients in the lowest quartile. This was observed also in the MoCA, SFT, DSST, TMT-A and TMT-B.
In the subgroup analysis, an association between the highest TMAO quartile (compared with the lowest quartile) and lower CoCo score was found in the group of patients with overt strokes (−0.18, 95% CI [−0.33, −0.04], p=0.012). Weak evidence of the same association was found in the group of patients with silent strokes (−0.13, 95% CI [−0.25, 0.002], p=0.053) and patients with no strokes (−0.08, 95% CI [−0.16, 0.01], p=0.07).
After adjustment for decreased brain volume, the association remained for silent strokes (−0.14, 95% CI [−0.28, −0.01], p=0.036) indicating the impact of TMAO in this subgroup.
Conclusion
TMAO plasma levels were associated with cognitive impairment in patients with AF. Longitudinal data will clarify dynamics and likely causality between TMAO and cognitive impairment.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science Foundation
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Affiliation(s)
- T Ziswiler
- Cantonal Hospital of Baden, Department of General Internal Medicine , Baden , Switzerland
| | - M Luciani
- Cantonal Hospital of Baden, Department of General Internal Medicine , Baden , Switzerland
| | - C Vanetta
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Seminar for Statistics , Zurich , Switzerland
| | - A Springer
- University Hospital Basel, Cardiovascular Research Institute Basel and Cardiology Division , Basel , Switzerland
| | - T Diteepeng
- University of Zurich, Center for Molecular Cardiology , Schlieren , Switzerland
| | - A Von Eckardstein
- University Hospital Zurich, Institute of Clinical Chemistry , Zurich , Switzerland
| | - D Mueller
- University Hospital Zurich, Institute of Clinical Chemistry , Zurich , Switzerland
| | - M Barbagallo
- University Hospital Zurich, Department of Neurology , Zurich , Switzerland
| | - D Conen
- McMaster University, Population Health Research Institute , Hamilton , Canada
| | - N Rodondi
- University of Bern, Department of General Internal Medicine and Institute of Primary Health Care (BIHAM) , Bern , Switzerland
| | - G Moschovitis
- EOC Cantonal Hospital, Division of Cardiology , Lugano , Switzerland
| | - S Osswald
- University Hospital Basel, Cardiovascular Research Institute Basel and Cardiology Division , Basel , Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiovascular Research Institute Basel and Cardiology Division , Basel , Switzerland
| | - L H Bonati
- University Hospital Basel, Department of Neurology and Stroke Center , Basel , Switzerland
| | - J H Beer
- Cantonal Hospital of Baden, Department of General Internal Medicine , Baden , Switzerland
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9
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Schlageter V, Badertscher P, Krisai P, Spies F, Luca A, Osswald S, Vesin JM, Kuehne M, Sticherling C, Knecht S. An automatic single beat algorithm to discriminate farfield from nearfield bipolar voltage electrograms from the pulmonary veins. Europace 2022. [DOI: 10.1093/europace/euac053.564] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): “Stiftung für Herzschrittmacher und Elektrophysiologie” Basel, Switzerland
Background
Confirmation of pulmonary vein (PV) isolation (PVI) during ablation of atrial fibrillation can be challenging due to superimposition of nearfield (NF) PV and farfield (FF) atrial bipolar voltage electrograms (BVE).
Purpose
To develop an automatic algorithm allowing to discriminate PV nearfield (PV-NF) from atrial farfield (atrial-FF) BVE from a circular mapping catheter during cryoballoon (CB) PVI based on a single-heartbeat analysis.
Methods
BVEs from a decapolar inner-lumen diagnostic catheter (Achieve, Medtronic) during CB PVI were manually classified as PV-NF, atrial-FF and combined FF-NF signal based on the characteristics and disappearance of the PV signal during isolation (Figure, upper row). BVE power spectra were computed using the fast Fourier transform (FFT) and the automatic classification of PV-NF, atrial-FF and combined FF-NF signals was performed using the power in different frequency bands (Figure, lower row). Support vector machine classifier was used to identify PV-NF BVE due to its highest predictive accuracy for the two classes PV-NF+ (PV-NF only and combined FF-NF) and PV-NF- (atrial-FF only). Validation of the approach was performed by comparison of a subset of 80 random samples, which were classified in addition by five experienced electrophysiologists.
Results
We analysed a dataset of 355 BVEs from 57 patients. The examples were balanced between the two classes PV-NF+ and PV-NF-. The mean duration (95% CI) of the BVE was 58 ms (26 to 86), 70 ms (50 to 100) and 94 ms (71 to 139) for PV NF, atrial-FF and combined FF-NF, respectively. The overall balanced accuracy including BVE from all PVs was 82.7% (95% CI: 80.3% to 85.1%). The analysis on individual PVs showed an accuracy of 96.6%, 85.2%, 80.8%, and 76.9% for the right inferior, right superior, left inferior and left superior PV, respectively. Validation of the algorithm in the subset of 80 patients showed a comparable accuracy, sensitivity and specificity in PV-NF detection between the automatic algorithm and the experienced electrophysiologists (82.8%, 89.2%, and 76.3%, compared to 85.2%, 91.9%, and 78.5%, respectively).
Conclusion
A reliable automatic based classification algorithm to identify PV-NF BVE could be developed based on a single-beat analysis. Real-time applications as well as using other electrode configurations may improve local signal interpretation.
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Affiliation(s)
- V Schlageter
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - P Krisai
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - A Luca
- Swiss Federal Institute of Technology of Lausanne, Applied Signal Processing Group, Lausanne, Switzerland
| | - S Osswald
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - JM Vesin
- Swiss Federal Institute of Technology of Lausanne, Applied Signal Processing Group, Lausanne, Switzerland
| | - M Kuehne
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
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10
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Badertscher P, Knecht S, Zeljkovic I, Sticherling C, De Asmundis C, Conte G, Kuehne M, Boveda S. Management of conduction disorders after transcatheter aortic valve implantation: results of an EHRA survey. Europace 2022. [DOI: 10.1093/europace/euac053.411] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) and is an indicator of subsequent high-grade atrioventricular block. Consensus regarding a reasonable strategy to manage cardiac conduction disturbances after TAVI has been elusive
Methods
The European Heart Rhythm Association (EHRA) conducted a survey to capture contemporary clinical practice for conduction disorders after TAVI. A 25-item online questionnaire was developed and distributed among the EHRA electrophysiology research network centres.
Results
Of 117 respondents, 44% were affiliated with university hospitals. This survey has revealed that a standardized management protocol for advanced conduction disorders such as LBBB or AVB after TAVR is available in 63% of participating centres. Telemetry was chosen by most participants as the most frequent management strategy for patients with new or preexisting LBBB after TAVI (79%, 70%, respectively, Figure 1). Duration of telemetry in patients with new LBBB varied: 18% chose 24 hours, 35% 48 hours, 27% 72 hours and 20% ≥ 72 hours. Similarly, in patients with new LBBB after TAVI undergoing EP study, the cut-off for a prolonged HV interval for PM implantation was heterogenous among European centers (7.4% ≥ 55ms and 44% ≥ 75ms). Conduction system pacing was chosen as preferred device therapy in patients with LBBB and normal LVEF in 3.7% and in patients with LBBB and reduced LVEF in 5.6%.
Conclusions
The management of conduction disorders after TAVI is very heterogeneous across European centres. Risk stratification strategies vary substantially. The role of conduction system pacing in patients with LBBB after TAVI needs to be defined. There is a considerable room for better uniformity in clinical practice.
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Affiliation(s)
- P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - I Zeljkovic
- Silesian Center for Heart Diseases (SCHD), 2nd Department of Cardiology, Zabrze, Poland
| | - C Sticherling
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | | | - G Conte
- Cardiocentro Ticino, Lugano, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - S Boveda
- Clinic Pasteur, Toulouse, France
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11
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Krisai P, Knecht S, Badertscher P, Voellmin G, Spiess F, Schaer B, Osswald S, Sticherling C, Kuehne M. Healthy lifestyle and atrial fibrillation recurrence after pulmonary vein isolation. Europace 2022. [DOI: 10.1093/europace/euac053.206] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Data on the relationship of a healthy lifestyle at the time of atrial fibrillation (AF) ablation with AF recurrence is limited.
Purpose
We investigated the association of healthy lifestyle markers with AF recurrence after ablation.
Methods
In 1439 patients undergoing AF ablation at a tertiary university hospital, a lifestyle score was built. The score included categories of BMI, smoking, blood pressure, fish intake, fruits/vegetable intake, alcohol consumption and physical activity. A higher score indicated a healthier lifestyle and patients were grouped into tertiles. Follow-up included 24h-Holter ECGs at 3 and 6 months and 7d-Holter ECGs at 12 months. Survival analyses and Cox-regression models were used to assess associations of individual factors and score-tertiles with AF recurrence.
Results
Mean age was 61.5 years, 25.9% were female and 59.1% had paroxysmal AF. In 941 patients all lifestyle score variables were available: 129, 675 and 137 patients were in the low, intermediate and high lifestyle group, respectively. Over increasing lifestyle groups, patients were more often female (9.3, 23.3, 38.7%; p<0.0001), had less hypertension (70.5, 53.3, 32.9%; p<0.0001), diabetes (15.5, 6.2, 3.7%; p=0.0002), a smaller left atrial diameter (44.1, 41.0, 37.6mm; p<0.0001) and numerically more paroxysmal AF (56.6, 62.4, 69.4%; p=0.32) with no differences in anti-arrhythmic drugs. In survival analyses (Figure), we saw a trend of more recurrences in the healthiest group compared to the unhealthiest group (logrank p=0.06 for low vs high group). Individually, higher fish intake (logrank p=0.04) and lower blood pressure (logrank p=0.02) were associated with AF recurrence. In Cox-regression models the HR (95% CI) for increasing lifestyle groups was 1.21 (0.98; 1.50, p=0.07). In individual models only higher fish intake (1.25 [1.01; 1.55], p=0.045) was associated with AF recurrence.
Conclusion(s): AF recurrence was numerically more frequent in patients with a healthier lifestyle, despite less comorbidities and smaller LA diameters. This paradoxical relationship might be due to lifestyle changes after PVI, differences in PVI efficacy or residual confounding. Further studies are needed to better understand this association.
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Affiliation(s)
- P Krisai
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - G Voellmin
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - F Spiess
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
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12
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Badertscher P, Lischer M, Mannhart D, Knecht S, Isenegger C, Du Fay De Lavallaz J, Spiess F, Schaer B, Osswald S, Kuehne M, Sticherling C. Clinical validation of a novel smartwatch for automated detection of atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.574] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The Withings Scanwatch is a novel smartwatch able to record an intelligent (i)ECG with automated detection of AF. While the iECG function from three major manufacturers have been extensively investigated, there is a paucity of data regarding the performance of the iECG function of the Withings Scanwatch.
Methods
We performed a prospective, observational study enrolling consecutive patients presenting to a cardiology service at a tertiary referral center. The aim was to assess the diagnostic performance of the iECG function of the Withings Scanwatch to detect AF compared to a simultaneously acquired cardiologist-interpreted 12-lead ECG. All iECG rhythm strips and 12-lead ECGs were anonymized and distributed to two blinded cardiologists who independently interpreted each tracing and assigned a diagnosis of sinus rhythm, AF or unclassified.
Results
iECGs and 12-lead ECGs were simultaneously recorded in 319 patients (67 yo (IQR 54-76), 48% female, Figure 1). Using the automated algorithm, rhythm was deemed inconclusive in 44 patients (14%). Overall, AF was present in 34 patients (11%). Among the tracings where the algorithm provided a diagnosis, it correctly identified AF with 76% (95%CI 55-91%) sensitivity, 99% (95%CI 97-100%) specificity, and a Kappa (K) coefficient of 0.72 when compared with cardiologist-interpreted 12-lead ECGs. Among patients in sinus rhythm, 3 were labeled AF (false-positive). From the 44 unclassified recordings, blinded cardiologists were able to correctly diagnose AF with 100% (95%CI 59-100%) sensitivity, 93% (95%CI 77-99%) specificity, and a K coefficient of 0.49. A total of 13 iECG recordings (4.1%) were determined to be noninterpretable by the cardiologists. Of the remaining 306 patients with simultaneous recordings, cardiologist interpretation of the iECG tracings demonstrated 97% (95%CI 84-100%) sensitivity, 99% (95%CI 96-100%) specificity and a K coefficient of 0.75.
Conclusion
Automatic rhythm classification was inferior to manual interpretation of iECGs. We found a lower sensitivity for the detection of AF using the Withings iECG function compared to data published on other devices. Cardiologist-iECG interpretation, however, was highly reliable with a diagnostic accuracy of 98% (95%CI 96-100%). Clinical interpretation of iECG readings by a cardiologist is therefore strongly encouraged
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Affiliation(s)
| | - M Lischer
- University Hospital Basel, Basel, Switzerland
| | - D Mannhart
- University Hospital Basel, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - C Isenegger
- University Hospital Basel, Basel, Switzerland
| | | | - F Spiess
- University Hospital Basel, Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
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13
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Badertscher P, Vergne C, Fery C, Spies F, Schlageter V, Mannhart D, Quirin T, Kuehne M, Sticherling C, Pascal J, Knecht S. Magnetic field interactions of smartwatches and portable electronic devices with cardiovascular implantable electronic devices. Europace 2022. [DOI: 10.1093/europace/euac053.576] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Magnetic interference of portable electronic devices (PEDs), such as state-of-the-art mobile phones, with cardiovascular implantable electronic devices (CIEDs) has been reported.
Purpose
The aim of the study was to quantify the magnetic fields of latest generation Smartwatches and other PEDs and to evaluate and predict their risk of CIED interactions.
Method
High resolution magnetic field characterization of five smartwatches able to record an ECG Apple Watch, Series 6 and 7, Fitbit Sense, Samsung Galaxy Watch 3, and Withings Move ECG Watch was performed using a magnetic field camera consisting of 1024 calibrated three axis Hall sensors. Maximal distance of 1 mT (10 Gauss) field strength and 1 mT volume was calculated. Ex vivo measurements of the minimal safety distance (MSD) at which no mode switch can be observed between six representative CIEDs and the PEDs was performed. Results were compared to other PEDs, such as digital pens, headsets and their cases, and a Smartphone.
Result
Maximal 1 mT distances ranged between 10 mm and 19 mm, and 1 mT volumes between 6 cm3 and 19 cm3. The smartwatches and PEDs with measured 1 mT distance 15 mm (B: Microsoft surface pen, C: Airpods Pro case) showed device interaction up to > 15 mm (Figure). Linear regression analysis showed an inverse linear relationship of the MSD with 1 mT distance (B coefficient: 0.459; 95% CI: 0.246-0.672; p<0.001) but not with the volume (p=0.842)
Conclusions
Standardized measurements of the 1 mT field distance and volume is feasible and has the potential to assess the risk of CIED interaction. Smartwatches seem to be safe in contrast to other PEDs such as the Microsoft surface pen or Airpods Pro case with high 1mT volumes and maximal distances with regards to CIED interaction.
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Affiliation(s)
- P Badertscher
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - C Vergne
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - C Fery
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - F Spies
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - V Schlageter
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - D Mannhart
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - T Quirin
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - M Kuehne
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - J Pascal
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - S Knecht
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
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14
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Evers-Dörpfeld S, Aeschbacher S, Hennings E, Eken C, Coslovsky M, Rodondi N, Beer JH, Moschovitis G, Ammann P, Kobza R, Ceylan S, Krempke M, Meyer-Zürn CS, Moutzouri E, Springer A, Sticherling C, Bonati LH, Osswald S, Kuehne M, Conen D. Sex-specific differences in adverse outcome events among patients with atrial fibrillation. Heart 2022; 108:1445-1451. [PMID: 35135836 DOI: 10.1136/heartjnl-2021-320122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/15/2021] [Accepted: 12/28/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess whether women with atrial fibrillation (AF) have a higher risk of adverse events than men during long-term follow-up since controversial data have been published. METHODS In the context of two very similar observational multicentre cohort studies, we prospectively followed 3894 patients (28% women) with previously documented AF for a median of 4.02 (3.00-5.83) years. The primary outcome was a composite of ischaemic stroke, myocardial infarction and cardiovascular death. Secondary outcomes included the individual components of the composite outcome, hospitalisation for heart failure, major and clinically relevant non-major bleeding, stroke or systemic embolism and non-cardiovascular death. RESULTS Mean age was 73.1 years in women vs 70.8 years in men. The incidence of the primary endpoint in women versus men was 2.46 vs 3.24 per 100 patient-years, respectively (adjusted HR (aHR) 0.74, 95% CI 0.58 to 0.94; p=0.01). Women died less frequently from cardiovascular (aHR 0.57, 95% CI 0.41 to 0.78; p<0.001) and non-cardiovascular causes (aHR 0.68, 95% CI 0.47 to 0.98; p=0.04). There were no significant sex-specific differences in stroke (incidence 1.05 vs 1.00; aHR 1.02, 95% CI 0.70 to 1.49, p=0.93), myocardial infarction (incidence 0.67 vs 0.72; aHR 0.98, 95% CI 0.61 to 1.57, p=0.94), major and clinically relevant non-major bleeding (incidence 4.51 vs 4.34; aHR 0.95, 95% CI 0.79 to 1.15, p=0.63) or heart failure hospitalisation (incidence 3.28 vs 3.07; aHR 1.06, 95% CI 0.85 to 1.32, p=0.60). CONCLUSION In this large study of patients with established AF, women had a lower risk of death than men, but there were no sex-specific differences in other adverse outcomes.
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Affiliation(s)
- Simone Evers-Dörpfeld
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Elisa Hennings
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Ceylan Eken
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Michael Coslovsky
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Switzerland
| | - Nicolas Rodondi
- University of Bern Institute of Primary Health Care, Bern, Switzerland.,Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Jürg H Beer
- Department of Medicine, Baden Cantonal Hospital, Baden, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ospedale Regionale di Lugano-Civico e Italiano, Lugano, Switzerland
| | - Peter Ammann
- Department of Cardiology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Selinda Ceylan
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Melina Krempke
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Christine S Meyer-Zürn
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Elisavet Moutzouri
- University of Bern Institute of Primary Health Care, Bern, Switzerland.,Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Anne Springer
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - Michael Kuehne
- Department of Medicine, Cardiology Division, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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15
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Mork C, Pfister O, Koechlin L, Scheifele S, Morgen A, Altwegg L, Heppel D, Berdajs D, Darwisch A, Kuehne M, Reuthebuch O, Schurr U, Siegemund M, Eckstein F, Santer D, Zhou Q. Aortic Root Thrombus Directly After Left Ventricular Assist Device Implantation. CJC Open 2021; 3:1313-1315. [PMID: 34888513 PMCID: PMC8636229 DOI: 10.1016/j.cjco.2021.05.016] [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: 04/16/2021] [Accepted: 05/28/2021] [Indexed: 11/04/2022] Open
Abstract
A 70-year-old female heart failure patient could not be weaned from temporary left ventricular mechanical support with Impella CP (Abiomed Inc, Danvers, MA) after myocardial infarction; therefore, she underwent left ventricular assist device implantation (HeartMate 3; Abbott, Chicago, IL). After uneventful surgery, the patient had an early postoperative thrombus in the aortic root, and surgical thrombectomy on extracorporeal circulation was performed on the seventh postoperative day. The patient recovered well and presented in good condition with no neurologic symptoms at the 6-month follow-up visit. Surgical excision of aortic root thrombus is a feasible option even for frail patients with a left ventricular assist device.
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Affiliation(s)
- Constantin Mork
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Otmar Pfister
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Simon Scheifele
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Anne Morgen
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Lukas Altwegg
- Department of Cardiology, St Claraspital, Basel, Switzerland
| | - David Heppel
- Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Basel, Switzerland
| | - Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Ayham Darwisch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Michael Kuehne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Ulrich Schurr
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Qian Zhou
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
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16
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Luciani M, Mueller D, Vanetta C, Diteepeng T, Von Eckardstein A, Aeschbacher S, Rodondi N, Moschovitis G, Reichlin T, Bonati L, Luescher T, Kuehne M, Osswald S, Conen D, Beer J. Trimethylamine-N-oxide (TMAO) is associated with cardiovascular mortality and vascular brain lesions in patients with atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0475] [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
Introduction
Trimethylamine-N-oxide (TMAO) is a well characterized pro-atherogenic metabolite derived from the microbial processing of phosphatidylcholine and carnitine (usually present in red meat) and subsequent hepatic oxydation, which promotes endothelial dysfunction, platelet activation and thrombosis initiation. Its role concerning cerebral and cardiovascular adverse events has been assessed in various patient subpopulations but not for long term in patients with atrial fibrillation.
Methods
Baseline TMAO plasma levels were measured by high-performance liquid chromatography/mass spectrometry in plasmas of 2,379 subjects from our multicentric study. Among them, 1,722 participants at time of recruitment underwent brain MRI. Participants were stratified into TMAO tertiles and Cox PH models, linear mixed effect models or logistic mixed effect models were employed adjusting for several risk factors (age, sex, BMI, active and past smoke habit, cystatin c levels, heart failure, diabetes mellitus, hypertension, coronary artery disease and history of TIA/stroke). Subjects were prospectively followed with a median observation time of 4 years.
Results
Subjects in the highest tertile of TMAO were older (75.4 vs. 70.6 years in low tertile p<0.001) and had significantly more often comorbidities, (26.9% of subjects were diabetic vs. 9.1% in low tertile p<0.001), with higher BMI (28.1 vs 27.0, p<0.001) and worse renal function as assessed by serum cystatin C (1.46 vs 1.07, mg/dl; p<0.001). Heart failure was present in 37.9% participants in the upper compared to 15.8% in the lower tertile. (p<0.001). As shown in Figure 1, Kaplan Meier estimates showed increased cardiovascular mortality with increasing TMAO tertiles (p<0.0001). After adjustment for the abovementioned factors the upper tertile (T3) had an increased hazard ratio (HR) compared to the lowest one (HR 2.36 95% CI 1.56–3.58 p<0.01). Similar trends for global and ischemic stroke occurrences were not found although TMAO levels positively weakly correlated with NIHSS severity (Spearman's coefficient 0.31 p=0.02). Concerning brain MRI findings, TMAO tertiles identified individuals with different prevalence of small non-cortical infarcts (30.5%, 18.1% and 17.4% in high, middle and low tertiles respectively; p<0.001) and when present, larger white matter lesions volumes (5061 mm3, 4158 mm3 and 2970 mm3; p<0.001). After adjustment, the association with small non-cortical infarcts with TMAO levels remained significant in the highest tertile (T3) (OR 1.48 95% CI 1.07–2.05; p=0.02) and a trend towards larger white matter lesions volumes was observed (estimate 1307 95% CI −90–2705; p=0.07).
Conclusions
TMAO represents a robust prognostic independent biomarker identifying multimorbid, high risk patients for cardiovascular mortality and brain damage.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science Foundation (SNSF) and Theodor und Ida Herzog-Egli Foundation Figure 1. CV mortality according to TMAOFigure 2. Brain lesions assessment
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Affiliation(s)
- M Luciani
- Cantonal Hospital of Baden, Internal Medicine, Baden, Switzerland
| | - D Mueller
- University Hospital Zurich, Zurich, Switzerland
| | - C Vanetta
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - T Diteepeng
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | | | | | | | | | | | - L Bonati
- University Hospital Basel, Basel, Switzerland
| | - T.F Luescher
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Basel, Switzerland
| | - D Conen
- Population Health Research Institute, Hamilton, Canada
| | - J.H Beer
- Cantonal Hospital of Baden, Internal Medicine, Baden, Switzerland
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17
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Haemmerle P, Aeschbacher S, Springer A, Eken C, Coslovsky M, Dutilh G, Moschovitis G, Rodondi N, Chocano P, Conen D, Osswald S, Kuehne M, Zuern CS. Cardiac autonomic function and cognitive performance in patients with atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.161] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation
OnBehalf
Swiss-AF Investigators
Background
Atrial fibrillation (AF) is associated with loss of cognition and dementia. Cardiac autonomic dysfunction has been linked to cognitive decline. We aimed to investigate if reduced cardiac autonomic function (CAF) is associated with cognitive impairment in AF patients.
Methods
Patients with paroxysmal, persistent and permanent AF were enrolled from a multicenter cohort study if they presented in AF ("AF group") or in sinus rhythm ("SR group") on a baseline 5-minute ECG recording. Parameters quantifying CAF (heart rate variability triangular index (HRVI), mean heart rate (MHR), the root mean square of successive differences (RMSSD) and the standard deviation of the normal-to-normal intervals (SDNN)) were calculated. We used the Montreal Cognitive Assessment (MoCA) to assess global cognitive function.
Results
1,685 AF patients with a mean age of 73 ± 8 years, 29% females, were included. The MoCA score was 24.5 ± 3.2 in the AF group (n = 710 patients) and 25.4 ± 3.2 in the SR group (n = 975 patients). After adjusting for multiple confounders, lower HRVI was associated with lower MoCA scores, both in the SR group (β=0.049; 95% confidence interval (CI): 0.016 to 0.081; p = 0.003) and in the AF group (β=0.068; 95% CI: 0.020 to 0.116; p = 0.006). In the AF group, higher MHR was associated with a poorer performance in the MoCA (β=-0.008; 95% CI: -0.014 to -0.002; p = 0.014 ). Other parameters of CAF were not associated with cognition.
Conclusion
Our data suggest that impaired CAF is associated with worse cognitive performance in patients with AF. Elderly AF patients with impaired HRVI might undergo cognitive testing in order to screen for cognitive impairment.
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Affiliation(s)
- P Haemmerle
- University Hospital Basel, Cardiology , Basel, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Cardiology , Basel, Switzerland
| | - A Springer
- University Hospital Basel, Cardiology , Basel, Switzerland
| | - C Eken
- University Hospital Basel, Cardiology , Basel, Switzerland
| | - M Coslovsky
- University Hospital Basel, Cardiology , Basel, Switzerland
| | - G Dutilh
- University of Basel, Economic Psychology, Basel, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Cardiology , Lugano, Switzerland
| | - N Rodondi
- Inselspital - University of Bern, Primary Health Care (BIHAM) and Internal General Internal Medicine, Bern, Switzerland
| | - P Chocano
- Inselspital - University of Bern, Primary Health Care (BIHAM), Bern, Switzerland
| | - D Conen
- McMaster University, Population Health Research Institute , Hamilton, Canada
| | - S Osswald
- University Hospital Basel, Cardiology , Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology , Basel, Switzerland
| | - CS Zuern
- University Hospital Basel, Cardiology , Basel, Switzerland
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18
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Baumgartner T, Kaelin-Friedrich M, Makowski K, Noti F, Schaer B, Haeberlin A, Badertscher P, Baldinger S, Seiler J, Osswald S, Kuehne M, Roten L, Tanner H, Sticherling C, Reichlin T. Gender-related differences in patient selection for and outcomes after pace and ablate for refractory atrial fibrillation: insights from a large multicenter cohort. Europace 2021. [DOI: 10.1093/europace/euab116.172] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A pace & ablate strategy may be performed in cases of severe refractory atrial arrhythmias.
Purpose
We aimed to assess gender related differences in patient selection and clinical outcomes after pace & ablate.
Methods
In a retrospective multicenter study, patients undergoing AV-junction-ablation between 2011 and 2019 were studied. Gender-related differences in terms of baseline characteristics, device-related complications, heart failure (HF) hospitalisations and death were assessed.
Results
Overall, 513 patients underwent AV-junction-ablation (median age 75 years, 50% males). At baseline, male patients were younger (72 vs. 78 years, p < 0.001), more frequently had non-paroxysmal AF (82% vs. 72%, p = 0.006), a lower LVEF (35% vs. 55%, p < 0.001) and more often received biventricular stimulation (75% vs. 25%, p < 0.001). Interventional complications were rare in both gender (1.2% vs 1.6%, p = 0.72). Following AV-junction-ablation, improvement of EHRA-class by ≥1 and of LVEF by ≥5% occurred in 44% and 19% of patients respectively, without gender differences (p = 0.66 and p = 0.38). Patients were followed for a median of 42 months in survivors (IQR 22-62). Lead-related complications (11 patients, 2.1%), infections (1 patient, 0.2%) and upgrade to ICD or CRT (18 patients, 3.5%) were rare. In Kaplan Meier analysis, HF hospitalisations during 4 years of follow-up were more common in men (22% vs 11%, p = 0.02), as were death (28% vs 21%, p = 0.02) and the combination of death or HF hospitalisation (37% vs. 26%, p = 0.008, Figure). Gender remained an independent predictor of the combined endpoint of death or HF hospitalisation after adjustment for age, LVEF and type of stimulation.
Conclusion
A Pace & Ablate strategy is safe and results in improvement of EHRA class and LVEF in a substantial number of patients. We found significant gender differences in patient selection for pace & ablate. Female patients had a more favorable clinical course after AV-junction-ablation, which was independent of age, EF and type of stimulation. Abstract Figure. Comb. endpoint of death or heart failure
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Affiliation(s)
- T Baumgartner
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | | | - K Makowski
- Military Institute of Medicine, Warsaw, Poland
| | - F Noti
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - B Schaer
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - A Haeberlin
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - P Badertscher
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - S Baldinger
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - S Osswald
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - L Roten
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - H Tanner
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - C Sticherling
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
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19
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Auberson C, Badertscher P, Madaffari A, Malushi M, Bourquin L, Spies F, Aeschbacher S, Fahrni G, Kaiser C, Jeger R, Osswald S, Sticherling C, Kuehne M, Knecht S. Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after transcatheter aortic valve replacement. Europace 2021. [DOI: 10.1093/europace/euab116.038] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB.
Methods
We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval >55 ms.
Results
Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 131), ΔPR (OR per 10 ms increase: 1.52; 95% CI: 1.19-2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. The AUC of the ROC curve was 0.724 (95% CI) for ΔPR. A change in PR interval by 20 ms yielded a sensitivity of 26% and specificity of 83% with a positive predictive value of 45% and a negative predictive value of 84% to predict HV prolongation.
Conclusions
Simple analysis of surface ECG and a calculated ΔPR <20ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB. Abstract Figure HV
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Affiliation(s)
- C Auberson
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A Madaffari
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Malushi
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - L Bourquin
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - G Fahrni
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Kaiser
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - R Jeger
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiology, Basel, Switzerland
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20
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Badertscher P, Knecht S, Madaffari A, Spies F, Osswald S, Schaer B, Sticherling C, Kuehne M. Efficacy and safety of a high power short duration ablation-index guided protocol for pulmonary vein isolation using a single catheter. Europace 2021. [DOI: 10.1093/europace/euab116.232] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Catheter ablation for atrial fibrillation (AF) is the most common performed electrophysiological procedure. The cost of this procedure remains high.
Purpose
To improve health care utilization, we aimed to compare the efficacy and safety of a minimalistic, streamlined single radiofrequency catheter ablation approach using high power short duration ablation-index guided protocol (HPSD) vs. a standard single catheter protocol.
Methods
A circular mapping catheter free PVI with a single transseptal puncture was performed in 91 patients. A CARTO fast anatomical map was performed with the ablation catheter. Pacing maneuvers were used to confirm exit block. Procedural characteristics and success rates were compared using HPSD- vs. a standard ablation-protocol. Freedom from recurrence was defined as a 1-year absence of AF episodes > 30 s, beyond the 3-month-blanking-period.
Results
Using the HPSD-protocol the median procedure, map and RF ablation time were significantly shorter in the HPSD group compared to the standard group, 84 (IQR 76-100) vs. 118 minutes (IQR 104-141), 12 (IQR 10-16) vs. 18 minutes (IQR 15-21) and 1036 (898-1184) vs. 1949 seconds (IQR 1693-2261), respectively, P < .001 for all. First-pass-PVI was achieved using the HPSD-protocol in 23 patients (74%) and the standard-protocol in 30 patients (53%), p = 0.08. Localization of conduction gaps are illustrated for the HPSD-protocol and the standard-protocol in Figure 1. The residual gap was identified using the ablation catheter only in all patients. No procedural complication were observed. At 12 months follow-up, 60 (89.6%) patients remained free from AF with no differences between groups.
Conclusions
A minimalistic, CMC-free HPSD-guided PVI approach is very efficient, safe, likely cost-saving, and associated with excellent clinical outcomes at 1 year. Abstract Figure 1
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Affiliation(s)
- P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - A Madaffari
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - F Spies
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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21
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Zimmermann T, du Fay de Lavallaz J, Walter JE, Strebel I, Nestelberger T, Joray L, Badertscher P, Flores D, Widmer V, Geigy N, Miro O, Salgado E, Christ M, Cullen L, Than M, Martín-Sánchez FJ, Di Somma S, Peacock WF, Keller D, Costabel JP, Wussler DN, Kawecki D, Lohrmann J, Gualandro DM, Kuehne M, Reichlin T, Sun B, Mueller C. Development of an electrocardiogram-based risk calculator for a cardiac cause of syncope. Heart 2021; 107:1796-1804. [PMID: 33504514 DOI: 10.1136/heartjnl-2020-318430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/09/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop an ECG-based tool for rapid risk assessment of a cardiac cause of syncope in patients ≥40 years. METHODS In a prospective international multicentre study, 2007 patients ≥40 years presenting with syncope were recruited in the emergency department (ED) of participating centres ranging from large university hospitals to smaller rural hospitals in eight countries from May 2010 to July 2017. 12-Lead ECG recordings were obtained at ED presentation following the syncopal event. The primary diagnostic outcome, a cardiac cause of syncope, was centrally adjudicated by two independent cardiologists using all available clinical information including 12-month follow-up. ECG predictors for a cardiac cause of syncope were identified using penalised backward selection and a continuous-scale likelihood was calculated based on regression analysis coefficients. Findings were validated in an independent US multicentre cohort including 2269 patients. RESULTS In the derivation cohort, a cardiac cause of syncope was adjudicated in 267 patients (16%). Seven ECG criteria were identified as predictors for this outcome: heart rate and QTc-interval (continuous predictors), rhythm, atrioventricular block, ST-segment depression, bundle branch block and ventricular extrasystole/non-sustained ventricular tachycardia (categorical predictors). Diagnostic accuracy of these combined predictors for a cardiac cause of syncope was high (area under the curve 0.80, 95% CI 0.77 to 0.83). Overall, 138 patients (8%) were rapidly triaged towards rule-out and 181 patients (11%) towards rule-in of a cardiac cause of syncope. External validation showed similar performance. CONCLUSION In patients ≥40 years with a syncopal event, a combination of seven ECG criteria enabled rapid assessment of the likelihood that syncope was due to a cardiac cause. TRIAL REGISTRATION NUMBER NCT01548352 (BASEL IX), NCT01802398 (SRS study).
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Affiliation(s)
- Tobias Zimmermann
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy
| | - Joan Elias Walter
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy.,Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Ivo Strebel
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy
| | - Thomas Nestelberger
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy
| | - Lydia Joray
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy
| | - Patrick Badertscher
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy
| | - Dayana Flores
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Velina Widmer
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Nicolas Geigy
- Emergency Department, Kantonsspital Baselland, Liestal, Switzerland
| | - Oscar Miro
- GREAT network, Rome, Italy.,Emergency Department, Hospital Clinic, Barcelona, Spain
| | | | - Michael Christ
- Emergency Department, Kantonsspital Luzern, Luzern, Switzerland
| | - Louise Cullen
- GREAT network, Rome, Italy.,Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin Than
- GREAT network, Rome, Italy.,Emergency Department, Christchurch Hospital, Christchurch, New Zealand
| | | | - Salvatore Di Somma
- GREAT network, Rome, Italy.,Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - W Frank Peacock
- GREAT network, Rome, Italy.,Emergency Department, Baylor College of Medicine, Houston, Texas, USA
| | - Dagmar Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | | | - Desiree Nadine Wussler
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy.,Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Damian Kawecki
- Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Jens Lohrmann
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Danielle Menosi Gualandro
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy
| | - Michael Kuehne
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,GREAT network, Rome, Italy
| | - Tobias Reichlin
- GREAT network, Rome, Italy.,Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Benjamin Sun
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian Mueller
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland .,GREAT network, Rome, Italy
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22
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Zimmermann T, Du Fay De Lavallaz J, Florez D, Widmer V, Freese M, Walter J, Lopez-Ayala P, Belkin M, Boeddinghaus J, Nestelberger T, Badertscher P, Lohrmann J, Twerenbold R, Kuehne M, Mueller C. Validation of the Canadian syncope risk score in a large prospective international multicenter study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
Management and risk stratification of patients with syncope in the emergency department (ED) is often challenging. In an effort to support ED physicians in disposition decisions, the Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes.
Methods
The CSRS was developed in a Canadian multicenter study and contains nine predictors: predisposition to vasovagal syncope, heart disease, systolic pressure <90 or >180mmHg in the ED, troponin level >99th percentile, abnormal QRS axis, QRS duration >130ms, QTc interval >480ms and an ED diagnosis of vasovagal or cardiac syncope. Patients can achieve a CSRS score between −3 and +11 points. We validated the CSRS in a large prospective international multicenter study recruiting patients 40 years or older presenting to the ED with a syncopal event within the last 12 hours. Recruitment centers contained smaller provincial hospitals, as well as big University Hospitals in eight countries on three continents. Primary outcome measure were 30-day serious arrhythmic and non-arrhythmic adverse events, as defined by the authors of the original score.
Results
1581 patients were eligible for this analysis. The population in this validation cohort was older (mean age 68 vs 54 years) and had a considerably higher rate of serious outcomes compared to the derivation cohort (n=186 (11.8%) vs n=147 (3.6%)). The area under the receiver operating characteristic curve (AUC) for the CSRS was 0.88 (95% confidence interval (CI) 0.86–0.91) and significantly higher compared to the validated OESIL score (AUC 0.75, 95% CI 0.71–0.78, p<0.001). Calibration curve analysis showed an underestimation of risk in patients with a low CSRS and an overestimation in patients with a high CSRS. The rate of observed serious outcomes within 30d increased from 0.8% in the very low risk group (CSRS equal to or below −2) to 48% in the (very) high risk group (CSRS equal to or above 4, Hazard ratio 79.4, 95% CI 11.1–570.9). A Kaplan-Meier plot was used to visualize rates of serious outcomes in three different risk groups (Figure).
Conclusion
This is the first validation of the Canadian Syncope Risk Score in a large international syncope cohort. The prognostic discrimination of the CSRS for 30-day serious outcomes was very good in our validation cohort and comparable to that of the Canadian derivation study. Despite suboptimal calibration, prognostic analysis showed a high rate of serious outcomes in the CSRS (very) high risk group and a low rate of serious outcomes in the very low risk group. Allowing the clinical judgement of the ED physician in the form of suspected syncope etiology to be a part of the score seems to largely contribute to the high performance of the CSRS. Additional validation studies might be needed to further increase the accuracy of the CSRS in different patient populations with a different incidence of outcomes in settings outside of Canada.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation; Swiss Heart Foundation
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Affiliation(s)
| | | | - D Florez
- University Hospital Basel, Basel, Switzerland
| | - V Widmer
- University Hospital Basel, Basel, Switzerland
| | - M Freese
- University Hospital Basel, Basel, Switzerland
| | - J Walter
- University Hospital Basel, Basel, Switzerland
| | | | - M Belkin
- University Hospital Basel, Basel, Switzerland
| | | | | | | | - J Lohrmann
- University Hospital Basel, Basel, Switzerland
| | | | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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23
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Zimmermann T, Du Fay De Lavallaz J, Nestelberger T, Gualandro D, Strebel I, Lopez-Ayala P, Florez D, Koechlin L, Walter J, Diebold M, Wussler D, Belkin M, Kuehne M, Sun B, Mueller C. Development and validation of an ECG-based cardiac syncope risk calculator. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0703] [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
The early diagnosis of cardiac syncope is often challenging. We therefore developed an ECG-based risk calculator as an aid for rapid rule-out or rule-in of cardiac syncope and aimed to validate this decision tool.
Methods
In a prospective diagnostic international multicenter study (derivation cohort), 2007 patients, 40 years or older, presenting with syncope to the emergency department were recruited. The primary diagnostic outcome, cardiac syncope, was centrally adjudicated by two independent cardiologists using all clinical information obtained during syncope work-up including 12-month follow up. 12-lead ECG was recorded at presentation and read by residents blinded to clinical information. Significant ECG predictors of cardiac syncope were identified using penalized backward selection. Findings were validated in an independent US multicenter cohort with 2'269 syncope patients.
Results
In the derivation cohort (median age 71 years, 40% women), centrally adjudicated cardiac syncope was present in 267 patients (16%). Seven ECG criteria (rhythm, heart rate, corrected QT-interval, ST-segment depression, atrioventricular-block, bundle-branch-block and ventricular extrasystole/non-sustained ventricular tachycardia) were identified as significant predictors for cardiac syncope and combined into the bAseL Ecg Risk calculaTor for Cardiac Syncope (ALERT-CS). Diagnostic accuracy of ALERT-CS for cardiac syncope, as quantified by the area under the receiver-operating characteristics curve (AUC), was high (0.80, 95%-confidence interval (CI) 0.77–0.83) and significantly higher compared to the EGSYS score (0.73, 95% CI 0.70–0.76, p<0.001). In combination, ALERT-CS significantly increased the AUC of BNP (0.82, 95% CI 0.79–0.85 vs 0.77, 95% CI 0.74–0.81, p=0.003), hs-cTnT (0.84, 95% CI 0.0.81–0.87 vs 0.77, 95% CI 0.74–0.80, p<0.001) and integrated clinical judgment in the ED (0.90, 95% CI 0.89–0.92 vs 0.87, 95% CI 0.84–0.90, p<0.001).
A predicted probability for cardiac syncope below 5.5% by ALERT-CS identified 138 patients (8%) eligible for triage towards rapid rule-out of cardiac syncope with a sensitivity of 99%. A predicted probability above 37.5% identified 181 patients (11%) eligible for triage towards rapid rule-in of cardiac syncope with a specificity of 95%. Prognostic verification for 30-day major adverse cardiac events (MACE) showed a high rate of MACE in the rule-in group and a very low rate of MACE in the rule-out group (Figure).
External validation (median age 72 years, 48% women) showed similar diagnostic accuracy (AUC 0.76, 95% CI 0.73–0.79) and prognostic results.
Conclusion
Combining seven ECG criteria within the simple ALERT-CS may aid ED physicians in the early rule-out or rule-in of cardiac syncope.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
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Affiliation(s)
| | | | | | - D Gualandro
- University Hospital Basel, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Basel, Switzerland
| | | | - D Florez
- University Hospital Basel, Basel, Switzerland
| | - L Koechlin
- University Hospital Basel, Basel, Switzerland
| | - J Walter
- University Hospital Basel, Basel, Switzerland
| | - M Diebold
- University Hospital Basel, Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | - M Belkin
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - B Sun
- University of Pennsylvania, Department of Emergency Medicine, Philadelphia, United States of America
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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24
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Benz A, Aeschbacher S, Krisai P, Blum S, Meyre P, Blum M, Rodondi N, Di Valentino M, Kobza R, De Perna M, Bonati L, Beer J, Kuehne M, Osswald S, Conen D. Association of biomarkers of inflammation with hospitalization for heart failure and death in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0497] [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
Background
Hospitalization for heart failure and death are among the most common adverse clinical outcomes in patients with atrial fibrillation (AF). The underlying mechanisms are poorly understood.
Purpose
We hypothesised that inflammation, quantified by plasma levels of C-reactive protein (CRP) and interleukin 6 (IL-6), is independently associated with hospitalization for heart failure and death in a large, contemporary cohort of AF patients.
Methods
Patients with established AF and 65 years of age or older were enrolled in two large, prospective, multicentre cohort studies in Switzerland. Plasma levels of high-sensitivity (hs) CRP and IL-6 were measured from frozen EDTA plasma samples obtained at baseline. Using these two biomarkers, we calculated an inflammation score ranging from 0 to 4 (1 point for each biomarker between the 50th and 75th percentile, 2 points for each biomarker above the 75th percentile). We constructed multivariable Cox proportional hazards models to quantify the associations of hs-CRP, IL-6 and the inflammation score with time to first hospitalization for heart failure and time to all-cause mortality, respectively.
Results
A total of 3,784 patients with AF (median age 72 years, 28% women, 24% with a prior history of heart failure and 84% anticoagulation use at baseline) were followed for a median (interquartile range [IQR]) of 4.0 (2.9–5.1) years. The median (IQR) plasma levels of hs-CRP and IL-6 at baseline were 1.64 (0.81–3.69) mg/L and 3.42 (2.14–5.60) pg/mL, respectively. The incidence rates of hospitalization for heart failure and death were 3.04 and 2.80 per 100 person-years, respectively. After multivariable adjustment, both biomarkers were significantly associated with the risk of hospitalization for heart failure (per increase in 1 standard deviation [SD], adjusted hazard ratio [aHR] 1.22, 95% confidence interval [CI] 1.11–1.34 for log-transformed hs-CRP, and aHR 1.48, 95% CI 1.35–1.62 for log-transformed IL-6) and death (per increase in 1 SD, aHR 1.40, 95% CI 1.27–1.54 for log-transformed hs-CRP, and aHR 1.67, 95% CI 1.53–1.81 for log-transformed IL-6). Incidence rates of hospitalization for heart failure increased from 1.34 to 7.31 per 100 person-years across categories of the inflammation score (Figure 1). A strong relationship persisted after multivariable adjustment. Similar findings were observed for all-cause mortality.
Conclusions
Inflammation is a strong predictor of hospitalization for heart failure and death in patients with AF. Targeting inflammation may be a promising treatment strategy to improve outcomes in these patients at high risk for adverse outcomes.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation
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Affiliation(s)
- A.P Benz
- Population Health Research Institute, Hamilton, Canada
| | - S Aeschbacher
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - P Krisai
- University Hospital Basel, Cardiovascular Research Institute Basel, Cardiology Division, Basel, Switzerland
| | - S Blum
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - P Meyre
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - M.R Blum
- University of Bern, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - N Rodondi
- University of Bern, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - M Di Valentino
- Hospital of San Giovanni, Division of Cardiology, Bellinzona, Switzerland
| | - R Kobza
- Lucerne Cantonal Hospital, Division of Cardiology, Lucerne, Switzerland
| | - M.L De Perna
- Lugano Regional Hospital, Division of Cardiology, Lugano, Switzerland
| | - L.H Bonati
- University Hospital Basel, Department of Neurology and Stroke Center, Basel, Switzerland
| | - J.H Beer
- Cantonal Hospital of Baden, Department of Medicine, Baden, Switzerland
| | - M Kuehne
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - D Conen
- Population Health Research Institute, Hamilton, Canada
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25
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Meyre P, Aeschbacher S, Blum S, Coslovsky M, Beer J, Moschovitis G, Rodondi N, Baretella O, Kobza R, Sticherling C, Bonati L, Schwenkglenks M, Kuehne M, Osswald S, Conen D. The Admit-AF risk score: a clinical risk score for predicting hospital admissions in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0352] [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
Background
Patients with atrial fibrillation (AF) have a high risk of hospital admissions, but there is no validated prediction tool to identify those at highest risk.
Purpose
To develop and externally validate a risk score for all-cause hospital admissions in patients with AF.
Methods
We used a prospective cohort of 2387 patients with established AF as derivation cohort. Independent risk factors were selected from a broad range of variables using the least absolute shrinkage and selection operator (LASSO) method fit to a Cox regression model. The developed risk score was externally validated in a separate prospective, multicenter cohort of 1300 AF patients.
Results
In the derivation cohort, 891 patients (37.3%) were admitted to the hospital over a median follow-up 2.0 years. In the validation cohort, hospital admissions occurred in 719 patients (55.3%) during a median follow-up 1.9 years. The most important predictors for admission were age (75–79 years: adjusted hazard ratio [aHR], 1.33; 95% confidence interval [95% CI], 1.00–1.77; 80–84 years: aHR, 1.51; 95% CI, 1.12–2.03; ≥85 years: aHR, 1.88; 95% CI, 1.35–2.61), prior pulmonary vein isolation (aHR, 0.74; 95% CI, 0.60–0.90), hypertension (aHR, 1.16; 95% CI, 0.99–1.36), diabetes (aHR, 1.38; 95% CI, 1.17–1.62), coronary heart disease (aHR, 1.18; 95% CI, 1.02–1.37), prior stroke/TIA (aHR, 1.28; 95% CI, 1.10–1.50), heart failure (aHR, 1.21; 95% CI, 1.04–1.41), peripheral artery disease (aHR, 1.31; 95% CI, 1.06–1.63), cancer (aHR, 1.33; 95% CI, 1.13–1.57), renal failure (aHR, 1.18, 95% CI, 1.01–1.38), and previous falls (aHR, 1.44; 95% CI, 1.16–1.78). A risk score with these variables was well calibrated, and achieved a C-index of 0.64 in the derivation and 0.59 in the validation cohort.
Conclusions
Multiple risk factors were associated with hospital admissions in AF patients. This prediction tool selects high-risk patients who may benefit from preventive interventions.
The Admit-AF risk score
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swiss National Science Foundation (Grant numbers 33CS30_1148474 and 33CS30_177520), the Foundation for Cardiovascular Research Basel and the University of Basel
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Affiliation(s)
- P Meyre
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Blum
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Coslovsky
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - J.H Beer
- Cantonal Hospital of Baden, Department of Medicine, Baden, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Cardiology, Lugano, Switzerland
| | - N Rodondi
- Bern University Hospital, Inselspital, Department of General Medicine, Bern, Switzerland
| | - O Baretella
- Bern University Hospital, Inselspital, Department of General Medicine, Bern, Switzerland
| | - R Kobza
- Kantonsspital Lucerne, Department of Cardiology, Lucerne, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - L.H Bonati
- University Hospital Basel, Department of Neurology and Stroke Center, Basel, Switzerland
| | - M Schwenkglenks
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Conen
- McMaster University, Population Health Research Institute, Hamilton, Canada
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26
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Du Fay De Lavallaz J, Zimmermann T, Badertscher P, Flores D, Widmer V, Walter J, Belkin M, Boeddinghaus J, Nestelberger T, Reichlin T, Kuehne M, Christ M, Miro O, Martin-Sanchez J, Mueller C. Validation of the FAINT risk score in a large prospective international multicenter study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0699] [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
Background
Risk stratification of older patients presenting to the Emergency Department (ED) with syncope remains an unmet clinical need. The FAINT Score was derived in a large American cohort in an attempt to predict 30-day serious cardiac outcomes in patients >60y.o. While a FAINT score of 0 showed high sensitivity to exclude death and serious outcomes at 30 days in the derivation cohort, it remains unvalidated.
Methods
We validated the FAINT score (History of heart failure, history of arrhythmia, initial ECG result abnormal, elevate NT-proBNP, elevated hs-troponin T) in a large prospective international multicenter study recruiting patients 40 years presenting to the ED with syncope within the last 12 hours in eight countries on three continents. Main outcome measure was 30-day serious cardiac events or mortality. We assessed the performance and calibration of the FAINT score for validation and compared it to the OESIL score (Age >64y, cardiovascular disease history, syncope without prodromes, abnormal ECG).
Results
1885 patients were eligible for this validation analysis. 169 (8.9%) patients experienced 30-day serious adverse events.
A FAINT score of 0 was present for 378 patients (20% of the cohort) and allowed for a sensitivity of 0.97 to rule out adverse events and death at 30-days. A FAINT score of 0 or 1 was present for 626 patients (33% of the cohort) and allowed for a sensitivity of 0.92.
The area under the receiver operating characteristic curve (AUC) for the FAINT score was 0.75 (95%, Confidence Interval (CI) 0.72–0.79), which was comparable to the performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) or high-sensitivity Troponin T (hs-cTnT) alone, which are two biomarkers used in the FAINT score. The score did not outperform the OESIL score.
A calibration curve showed that the score was extremely well calibrated for low-risk patients.
Conclusion
This is the first validation of the FAINT score in a large international syncope cohort. The safety of a FAINT score of 0 or 1 was good and comparable to the results obtained in the derivation cohort. While the score is suitable to highlight low-risk patients and calibrates well in an external cohort, its discrimination for higher risk patients is not better than biomarkers alone or an older, less complex risk score.
Figure 1. Area under the Receiver Operating Curve (ROC) for the FAINT score and for NT-proBNP and hs-cTnT as continuous markers as well as for the OESIL score. CI = Confidence Interval.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): University Hospital Basel, Switzerland
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Affiliation(s)
| | - T Zimmermann
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - P Badertscher
- Medical University of South Carolina, Electrophysiology, Charleston, United States of America
| | - D Flores
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - V Widmer
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - J Walter
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - M Belkin
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - J Boeddinghaus
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Christ
- Kantonsspital Lucerne, Lucerne, Switzerland
| | - O Miro
- Barcelona Hospital Clinic, Barcelona, Spain
| | | | - C Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
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27
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Schaerli N, Knecht S, Spies F, Madaffari A, Osswald S, Sticherling C, Kuehne M. A simple method to detect phrenic nerve impairment during cryoballoon ablation of atrial fibrillation using aVF in the standard surface ECG. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0606] [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
Phrenic nerve palsy (PNP) is the most common complication in cryoballoon ablation of atrial fibrillation. Monitoring techniques such as compound motor action potential (CMAP) measurements using additional leads, or catheters positioned in the subdiaphragmatic hepatic vein or the esophagus have demonstrated to be effective to prevent PNP.
Purpose
This study investigates the safety and feasibility of a simple monitoring strategy using the lead aVF of the standard surface 12 lead ECG for CMAP monitoring to prevent PNP.
Methods
In 263 continuous patients undergoing cryoballoon ablation, a decapolar catheter was placed in the right subclavian vein to stimulate the phrenic nerve during ablation of the right sided pulmonary veins (12V@2.9 ms at 60 bpm). Capture was continuously monitored using the CMAP potential in the inferior aVF lead of the surface ECG and manually by palpation of the abdominal movement. The freeze was terminated early if the amplitude of the aVF signal decrease by >25% in three consecutive beats or if the diaphragmatic contraction decreased.
Results
Phrenic nerve injury documented by a reduction of the signal in aVF was observed in 13 of the 263 patients (5%) during freezes of the right superior pulmonary vein. Reduced diaphragmatic contraction detected by palpation of the abdomen was never observed without previous reduced amplitude in the surface aVF signal and was therefore never the trigger to stop a freeze. In patients with phrenic nerve injury, the mean initial amplitude was 1mV (SD ±0.3mV) and the mean minimal amplitude was 0.3mV (SD ±0.2mV). Mean time to recovery of the aVF amplitude was 160 seconds. Twelve patients (4.6%) showed complete recovery whereas one patient (0.4%) showed only partial recovery, as demonstrated in a sniff test at the end of the procedure. This patient showed no clinical signs of phrenic nerve palsy the following day, and full recovery was demonstrated in a sniff test 3 months later.
Conclusion
Monitoring of CMAP using the aVF signal from a standard 12-lead ECG during phrenic nerve stimulation to reduce the incidence of phrenic nerve palsy is safe and feasible. This technique is readily available during every standard ablation without placing additional electrodes and more sensitive than manual palpation.
aVF signal before and during ablation
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Schaerli
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - F Spies
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - A Madaffari
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute (CRIB), Basel, Switzerland
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28
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Haemmerle P, Eick C, Bauer A, Rizas K, Coslovsky M, Krisai P, Vesin J, Beer J, Moschovitis G, Bonati L, Sticherling C, Conen D, Osswald S, Kuehne M, Zuern C. Impaired heart rate variability triangular index to identify clinically silent strokes in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2438] [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
Introduction
The identification of clinically silent strokes in patients with atrial fibrillation (AF) is of high clinical relevance as they have been linked to cognitive impairment. Overt strokes have been associated with disturbances of the autonomic nervous system.
Purpose
We therefore hypothesize that impaired heart rate variability (HRV) can identify AF patients with clinically silent strokes.
Methods
We enrolled 1358 patients with AF without a history of stroke or transient ischemic attack from the multicenter SWISS-AF cohort study who were in sinus rhythm (SR-group, n=816) or AF (AF-group, n=542) on a 5 minute resting ECG recording. HRV triangular index (HRVI), the standard deviation of normal-to-normal intervals (SDNN) and the mean heart rate (MHR) were calculated. Brain MRI was performed at baseline to assess the presence of large non-cortical or cortical infarcts, which were considered silent strokes without history of stroke or transient ischemic attack. We constructed binary logistic regression models to analyze the association between HRV parameters and silent strokes.
Results
At baseline, silent strokes were detected in 10.5% in the SR group and 19.9% in the AF group. In the SR-group, HRVI <15 was the only parameter independently associated with the presence of silent strokes (odds ratio (OR) 1.69; 95% confidence interval (CI): 1.04–2.72; p=0.033) after adjustment for various clinical covariates (age, sex, systolic blood pressure, history of hypertension, history of diabetes, history of heart failure, prior myocardial infarction, prior major bleeding, intake of oral anticoagulation, antiarrhythmics or betablockers). Similarly, in the AF-group, HRVI<15 was independently associated with the presence of silent strokes (OR 1.65, 95% CI: 1.05–2.57; p=0.028). SDNN<70ms and MHR<80 were not associated with silent strokes, neither in the SR group, nor in the AF group (Figure).
Conclusions
Reduced HRVI is independently associated with the presence of clinically silent strokes in an AF population, both when assessed during SR and during AF. Our data suggest that a short-term measurement of HRV in routine ECG recordings might contribute to identifying AF patients with clinically silent strokes.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation
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Affiliation(s)
- P Haemmerle
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Eick
- University Hospital of Tuebingen, Cardiology, Tuebingen, Germany
| | - A Bauer
- Medical University of Innsbruck, Cardiology and Angiology, Innsbruck, Austria
| | - K.D Rizas
- Ludwig-Maximilians University, Department of Medicine I, Munich, Germany
| | - M Coslovsky
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Krisai
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - J.M Vesin
- Swiss Federal Institute of Technology of Lausanne, Lausanne, Switzerland
| | - J Beer
- Cantonal Hospital of Baden, Department of Medicine, Baden, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Cardiology, Lugano, Switzerland
| | - L.H Bonati
- University Hospital Basel, Neurology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Conen
- McMaster University, Division of Cardiology, Hamilton, Canada
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C.S Zuern
- University Hospital Basel, Cardiology, Basel, Switzerland
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29
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Zimmermann T, Du Fay De Lavallaz J, Nestelberger T, Gualandro D, Badertscher P, Lopez-Ayala P, Widmer V, Freese M, Twerenbold R, Wussler D, Koechlin L, Walter J, Kuehne M, Reichlin T, Mueller C. Incidence, characteristics, determinants and prognostic impact of recurrent syncope. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0700] [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
The incidence, characteristics, determinants, and prognostic impact of recurrent syncope are largely unknown, causing uncertainty for both patients and physicians.
Methods
We characterized recurrent syncope including sex-specific aspects and its impact on death and major adverse cardiovascular events (MACE) in a large prospective international multicenter study enrolling patients ≥40 years presenting with syncope to the emergency department (ED). Syncope etiology was centrally adjudicated by two independent and blinded cardiologists using all information becoming available during syncope work-up and 12-month follow-up. MACE were defined as a composite of all-cause death, acute myocardial infarction, surgical or percutaneous coronary intervention, life-threatening arrhythmia including cardiac arrest, pacemaker or implantable cardioverter defibrillator implantation, valve intervention, heart-failure, gastrointestinal bleeding or other bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke or transient ischemic attack, sepsis and pulmonary embolism.
Results
Incidence of recurrent syncope among 1790 patients was 20% (95%-confidence interval (CI) 18% to 22%) within 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95%-CI 1.11 to 2.01) or syncope of unknown etiology even after central adjudication (HR 2.11, 95%-CI 1.54 to 2.89) had an increased risk for syncope recurrence (Figure). LASSO regression fit on all patient information available early in the ED identified more than three previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95%-CI 1.64 to 2.75). Recurrent syncope within the first 12 months after the index event carried an increased risk for all-cause death (HR 1.59, 95%-CI 1.06 to 2.38) and MACE (HR 2.24, 95%-CI 1.67 to 3.01), whereas recurrences after 12 months did not have a significant impact on outcome measures.
Conclusion
Recurrence rates of syncope are substantial and vary depending on syncope etiology. There seem to be no reliable patient characteristics available early on the ED that allow for the prediction of recurrent syncope with only a history of more than three previous syncope being associated with a higher risk for future recurrences. Importantly, recurrent syncope within the first 12 months carries an increased risk for death and MACE.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
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Affiliation(s)
| | | | | | - D Gualandro
- University Hospital Basel, Basel, Switzerland
| | | | | | - V Widmer
- University Hospital Basel, Basel, Switzerland
| | - M Freese
- University Hospital Basel, Basel, Switzerland
| | | | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | - L Koechlin
- University Hospital Basel, Basel, Switzerland
| | - J Walter
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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30
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Moront MG, Kuehne M, Redfern RE. Minimally invasive triple valve surgery: A single center experience. J Card Surg 2020; 35:2567-2573. [PMID: 32667082 DOI: 10.1111/jocs.14835] [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] [Received: 05/21/2020] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Minimally invasive surgery is a widely accepted surgical treatment for valve disease, however triple valve surgery (TVS) is a complex and challenging procedure. The objective of this study was to describe the morbidity and mortality related to minimally invasive TVS at our institution. METHODS This was a retrospective review of all minimally invasive TVS performed between 2012 and 2019. Baseline and perioperative characteristics were reviewed, as were postoperative outcomes. RESULTS Eighteen patients underwent TVS; 12 patients underwent additional procedures at the time of TVS. Median time to initial extubation was 11.5 hours (interquartile range [IQR] 9.8-13.3). Intensive care unit and total length of stay were 1.22 (IQR, 1.16-1.31) and 9 (IQR, 6-17) days, respectively. No hospital deaths occurred; 30-, 90-, and 365-day mortality were 0%. Two postoperative neurologic complications occurred, two patients had acute kidney injuries. The most common complication was rhythm disturbance with five patients requiring permanent pacemaker implantation. Mean follow-up was 39.9 months (252-2642 days). CONCLUSIONS Our findings demonstrate that minimally invasive TVS utilizing femoral cannulation results in an acceptable risk of complication. Short and intermediate term survival were excellent.
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Affiliation(s)
- Michael G Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio
| | - Michael Kuehne
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio
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31
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Krisai P, Streicher O, Meyre P, Haemmerle P, Steiner F, Reddiess P, Zeljkovic I, Pavlovic N, Ammann P, Roten L, Reichlin T, Madaffari A, Kuehne M, Novak J, Sticherling C. P993Incidence of atrial fibrillation early after cavotricuspid isthmus ablation. Europace 2020. [DOI: 10.1093/europace/euaa162.184] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a common finding in patients undergoing cavotricuspid isthmus ablation for isthmus dependent right atrial flutter (RAF). Little is known about the time of its occurrence.
Purpose
We aimed to investigate the incidence of AF early after RAF ablation in a well-defined, prospective cohort.
Methods
A total of 255 participants with RAF ablation from 5 centers and at least one completed follow-up were included. Structured clinical follow-up was performed at 3, 6 and 12 months including a 24 hour Holter-ECG. The endpoint was incidence of AF detected clinically or by Holter-ECG. Risk factors associated with the occurrence of AF were assessed using separate, univariate Cox proportional-hazards models.
Results
Mean age was 67 years, 80% were male and previous episodes of AF were known in 40%. Over a mean follow-up of 7.4 (±4.4) months AF was detected in 35 (13.7%) participants after RAF ablation (Figure A). After 3, 6 and 12 months AF was detected in 18 (7.1%), 30 (11.7%) and 34 (13.3%) patients. No difference in the incidence of AF after RAF ablation was found comparing patients with and without a history of AF (log-rank p value = 0.44) (Figure B). Comparing patients with and without AF during follow-up, there was no difference in age (68 vs 66 years, p = 0.36), sex (69 vs 81% male, p = 0.08), prior heart failure (29 vs 19%, p = 0.20), hypertension (43 vs 38%, p = 0.56) or left atrial volume (46.6 vs 39.6 ml, p = 0.10), but patients with previous AF had a lower left ventricular ejection fraction (LVEF) (45.7 vs 52.3%, p = 0.02). In separate, univariate Cox proportional-hazards models only increasing LVEF (Hazard ratio 0.97, 95% confidence interval (0.95; 0.99, p = 0.02)) was associated with a lower risk of incident AF after RAF ablation, but no other risk factor.
Conclusions
AF occurred in 13.7% of patients early after cavotricuspid isthmus ablation for RAF. There was no difference in the occurrence of AF between patients with and without previously known episodes of AF. Only impaired LVEF was associated with AF occurrence.
Abstract Figure
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Affiliation(s)
- P Krisai
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - O Streicher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Meyre
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Haemmerle
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - F Steiner
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Reddiess
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - I Zeljkovic
- University of Zagreb School of Medicine, KBC Sestre Milosrdnice, Zagreb, Croatia
| | - N Pavlovic
- University of Zagreb School of Medicine, KBC Sestre Milosrdnice, Zagreb, Croatia
| | - P Ammann
- Cantonal Hospital St. Gallen, Cardiology department, St Gallen, Switzerland
| | - L Roten
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - A Madaffari
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - J Novak
- Cantonal Hospital Solothurn, Herz- und Nierenzentrum Aare AG, Solothurn, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
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32
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Zimmermann T, Du Fay De Lavallaz J, Badertscher P, Puelacher C, Nestelberger T, Boeddinghaus J, Walter JE, Wussler D, Twerenbold R, Kuehne M, Reichlin T, Mueller C. P5673Combination of high-sensitivity cardiac troponin and B-Type natriuretic peptide (BNP) for diagnosis and risk-stratification of syncope. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0615] [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
Background
While high-sensitivity cardiac troponin (hs-cTn) and B-Type natriuretic peptide (BNP) have been assessed separately for the diagnosis and risk-stratification of patients with syncope, their combined accuracy is unknown.
Methods
We assessed the diagnostic and prognostic accuracy of the combination of hs-cTnI and BNP in a prospective international multicenter study enrolling patients 40 years and older presenting with syncope to the emergency department (ED). Hs-cTnI (Architect) and BNP (Architect) concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by two independent physicians using all available clinical information including one year follow-up, was the diagnostic endpoint. MACE were defined as death, resuscitation, life-threatening arrhythmia, implantation of a pacemaker or implantable cardioverter defibrillator (ICD), acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack (TIA), intracranial bleeding or valvular intervention. Patients were classified in three risk groups (low (<10%), medium (10–30%), high (>30%)) for cardiac syncope based on hs-cTnI and BNP levels.
Results
Among 1533 patients, cardiac syncope was the adjudicated final diagnosis in 233 (15.2%). Hs-cTnI and BNP concentrations both remained independent predictors of cardiac syncope in multivariable models. The diagnostic accuracy of the combination hs-cTnI/BNP for cardiac syncope was good with an area under the curve (AUC) of 0.81 (95%-CI 0.78–0.84) and significantly better than each biomarker separately or a set of clinical variables (each p<0.001). The classification of patients in three risk groups, depending on the probability for cardiac syncope based on their hs-cTnI and BNP values, translated well in predictions for MACE (AUC 0.79, 95%-CI 0.77–0.82) and death (AUC 0.78, 95%-CI 0.74–0.82) at 2 years follow-up. Based on these results, we designed a visual tool allowing convenient patient-specific diagnostic and prognostic risk evaluation based solely on hs-cTnI and BNP concentrations (Figure).
Risk stratification based on hs-cTnI/BNP
Conclusion
The combination hs-cTnI/BNP may have clinical utility in patients presenting to the ED with syncope as it allows good diagnostic as well as prognostic discrimination.
Acknowledgement/Funding
Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Basel
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Affiliation(s)
| | | | | | - C Puelacher
- University Hospital Basel, Basel, Switzerland
| | | | | | - J E Walter
- University Hospital Basel, Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | | | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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33
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Zimmermann T, Du Fay De Lavallaz J, Walter JE, Strebel I, Nestelberger T, Badertscher P, Boeddinghaus J, Twerenbold R, Koechlin L, Lohrmann J, Steude JS, Gualandro DM, Kuehne M, Reichlin T, Mueller C. 2409ALERT-CS - Development of an ECG-based cardiac syncope risk calculator. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0162] [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
Syncope is a common symptom with rising incidence, often leading to emergency department (ED) visits. Early determination of diagnosis is often difficult in patients with syncope and there is an unmet clinical need for tools that can support physicians in their decision making. We hypothesized that an electrocardiogram (ECG)-based cardiac syncope risk calculator might create a simple and attractive clinical decision tool for the diagnosis and risk stratification of patients with syncope.
Methods
Based on a large prospective diagnostic international multicenter study enrolling patients who presented to the ED with syncope, we derived a cardiac syncope risk calculator by penalized stepwise backward-selection and multivariable logistic regression utilizing predefined ECG criteria. Primary diagnostic endpoint was cardiac syncope, as adjudicated by two independent physicians taking into account all available information including cardiac work-up and 12-month follow-up. Major adverse cardiac events (MACE) including life-threatening arrhythmias, myocardial infarction, pulmonary embolism, stroke, transient ischemic attack, valvular surgery, and death within 30 days were the prognostic endpoint.
Results
Median age in our cohort was 71 years and 40% of patients were women. Of all 2007 patients enrolled, 1696 patients were eligible for the prognostic analysis and 1550 patients were eligible for the diagnostic analysis.
We identified seven ECG criteria (rhythm, heart rate, corrected QT-interval, ST-segment depression, atrioventricular-block, bundle-branch-block and ventricular extrasystole/non-sustained ventricular tachycardia) as significant predictors for cardiac syncope and combined them into the bAseL Ecg Risk calculaTor for Cardiac Syncope (ALERT-CS). Diagnostic accuracy for cardiac syncope, as quantified by the area under the receiver operating characteristic curve (AUC), was high (AUC 0.80, 95%-confidence interval (CI) 0.77 to 0.83), and significantly higher compared to that of the EGSYS score (AUC 0.73, 95%-CI 0.70 to 0.76, p<0.001). Prognostic verification of the ALERT-CS to predict 30-day overall MACE showed similar accuracy (AUC 0.75, 95%-CI 0.71 to 0.79).
Comparison of diagnostic discrimination
Conclusion
Combining seven ECG criteria within a simple risk calculator for cardiac syncope may aid physicians in the diagnosis and risk stratification of patients presenting to the ED with syncope.
Acknowledgement/Funding
Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Basel
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Affiliation(s)
| | | | - J E Walter
- University Hospital Basel, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Basel, Switzerland
| | | | | | | | | | - L Koechlin
- University Hospital Basel, Basel, Switzerland
| | - J Lohrmann
- University Hospital Basel, Basel, Switzerland
| | - J S Steude
- University Hospital Basel, Basel, Switzerland
| | | | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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Krisai P, Blum S, Aeschbacher S, Beer JH, Moschovitis G, Witassek F, Kobza R, Rodondi N, Mahmood A, Meyer-Zuern C, Kuehne M, Osswald S, Conen D. P1876Atrial fibrillation related symptoms and cardiovascular outcomes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0625] [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
Comprehensive information on the impact of atrial fibrillation (AF)-related symptoms and quality of life (QoL) on adverse outcomes is sparse.
Purpose
We aimed to investigate whether AF-related symptoms and/or QoL are associated with cardiovascular outcomes in a large cohort of AF patients.
Methods
A total of 3902 participants with documented AF from two nationwide prospective cohort studies in Switzerland were included. Information on AF-related symptoms was assessed yearly by standardized questionnaires, QoL was quantified using a visual analog scale (0–100, with higher scores indicating better QoL). The primary endpoint was a composite of stroke and systemic embolism. The secondary endpoint was a composite of cardiovascular death, hospitalization for heart failure and myocardial infarction. We assessed associations using multivariable, time-updated Cox proportional-hazards models including age, sex, study cohort, history of heart failure, hypertension, diabetes, prior stroke, prior myocardial infarction, vascular disease and prior catheter ablation for AF as covariates.
Results
Mean age was 72 years, and 72% were male. The median QoL score was 75 points, and 2572 (66%) participants had AF-related symptoms. Symptomatic individuals were younger (71 vs 75 years) and had more often paroxysmal AF (29 vs 23%) (p for both <0.001). The most frequent symptoms were palpitations (42%), dyspnea (25%) and fatigue (18%). In multivariable, time-updated models, the hazard ratio (HR) was 1.24 (95% confidence intervals (CI) 0.72; 2.11, p=0.43) for the primary endpoint and HR 0.83 (95% CI 0.65; 1.06, p=0.14) for the secondary endpoint in symptomatic vs non-symptomatic individuals. There was a significant, inverse association for a 5-point increase in the QoL score with both the primary (HR 0.94 (95% CI 0.88; 0.99), p=0.04) and secondary (HR 0.91 (95% CI 0.88; 0.93), p<0.0001) endpoints.
Conclusions
AF-related symptoms are not associated with adverse cardiovascular events in AF patients. In contrast, QoL is inversely associated with to adverse cardiovascular outcomes.
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Affiliation(s)
- P Krisai
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Blum
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - J H Beer
- Cantonal Hospital of Baden, Internal Medicine, Baden, Switzerland
| | | | - F Witassek
- University Hospital Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - R Kobza
- Kantonsspital Lucerne, Cardiology, Lucerne, Switzerland
| | - N Rodondi
- Bern University Hospital, Department of General Internal Medicine and Institute of Primary Health Care, Bern, Switzerland
| | - A Mahmood
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Meyer-Zuern
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Conen
- Population Health Research Institute, Cardiology, Hamilton, Canada
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35
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Meyre P, Gugganig R, Aeschbacher S, Leong DP, Blum S, Coslovsky M, Beer JH, Moschovitis G, Mueller D, Rodondi N, Stempfel S, Mueller C, Kuehne M, Conen D, Osswald S. P3782Frailty to predict unplanned hospitalizations, stroke, bleeding and death in atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0631] [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
Aim
We investigated the prevalence of frailty, and the relationships between frailty and the risk of adverse clinical outcomes in patients with atrial fibrillation (AF).
Methods
Patients with known AF were enrolled in a nation-wide observational cohort study in Switzerland. Information on medical history, medication, lifestyle factors and clinical measurements were obtained. The primary outcome was unplanned hospitalizations, secondary outcomes were all-cause mortality, bleeding and stroke. The frailty index (FI) was measured using a cumulative deficit approach according to previously published criteria. Participants were divided into three groups (non-frail, pre-frail and frail) according to their FI at study entry. The association between frailty and clinical outcomes was assessed using multivariable adjusted Cox proportional hazard models.
Results
We included 2369 patients with a mean age of 73±8 years (27.3% female). The prevalence of frailty and pre-frailty was 10.6% and 60.7%, respectively. Frailty was associated with unplanned hospitalization (adjusted hazard ratio [HR] 3.59; 95% confidence interval [95% CI], 2.78–4.63; p<0.001), all-cause mortality (adjusted HR 16.72; 95% CI 7.75–36.05; p<0.001), bleeding (adjusted HR 2.46; 95% CI 1.61–3.77; p<0.001), and stroke (adjusted HR 3.29; 95% CI 1.29–8.39; p=0.01) (Figure). Similarly, pre-frailty was significantly associated with unplanned hospitalization (adjusted HR 1.82; 95% CI 1.49–2.22; p<0.001), all-cause mortality (adjusted HR 5.07; 95% CI 2.43–10.59; p<0.001) and bleeding (adjusted HR 1.53; 95% CI 1.11–2.13; p=0.01), but not with stroke.
Cumulative incidence of adverse events
Conclusion
In our cohort, more than two thirds of AF patients were either pre-frail or frail. These patients have a high risk of unplanned hospitalizations and other adverse outcomes, indicating that frailty is a powerful tool to predict adverse clinical outcomes in AF patients.
Acknowledgement/Funding
Swiss National Science Foundation; Foundation for Cardiovascular Research Basel; University of Basel
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Affiliation(s)
- P Meyre
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - R Gugganig
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D P Leong
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - S Blum
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Coslovsky
- University Hospital Basel, Department of Clinical Research, Basel, Switzerland
| | - J H Beer
- Cantonal Hospital of Baden, Department of Medicine, Baden, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Department of Cardiology, Lugano, Switzerland
| | - D Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - N Rodondi
- Bern University Hospital, Department of General Medicine, Bern, Switzerland
| | - S Stempfel
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Conen
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
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Meyre P, Froehlich L, Aeschbacher S, Blum S, Djokic D, Kuehne M, Osswald S, Kaufmann B, Conen D. P1258Left atrial dimension and risk of cardiovascular outcomes in patients with and without atrial fibrillation: a systematic review and meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0216] [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
Background
The prognostic value of left atrial (LA) dimensions measured by transthoracic echocardiogram among patients with versus without atrial fibrillation (AF) is uncertain. We aimed to investigate the association of LA echocardiographic parameters with the risk of cardiovascular events in AF patients compared to non-AF patients.
Methods
MEDLINE and EMBASE were searched from inception to July 2018. Records were retained if they studied the association between LA echocardiographic parameters and cardiovascular outcomes in AF patients, and in populations with no or less than 10% of AF patients. Left atrial dimensions had to be measured by transthoracic echocardiography, and parameters of interest were the following: LA diameter (LAD), LA diameter indexed to body surface (LADI), LA volume (LAV) and LA volume indexed to body surface (LAVI). Data were independently abstracted by 2 reviewers and pooled using inverse variance random-effects meta-analysis. The primary outcome was incident stroke and thromboembolic events. Secondary outcomes were heart failure, all-cause mortality and major adverse cardiac events (MACE).
Results
Twenty-three studies of AF patients (14'939 patients) and 69 studies of non-AF patients (52'654 patients) were included. Summary of the meta-analyses for the associations of LA parameters with cardiovascular outcomes is presented in the Figure. Increasing LAD was significantly associated with the risk of stroke and thromboembolic events in non-AF patients (P=0.03), but not among AF patients (P=0.27), and the association did not differ between population (P for difference=0.05) (Figure, A). Greater LADI was associated with risk of stroke and thromboembolic events in AF patients (P<0.001) and in non-AF patients (P=0.04), but the association did not differ between populations (P for difference=0.49). For MACE, increasing LADI was significantly associated with the outcome in AF patients (P<0.001) and in non-AF patients (P<0.001), but the association was stronger in non-AF populations (P for difference<0.001). Increasing LAVI was associated with high risk of MACE in AF patients (P=0.03) and in non-AF populations (P<0.001). Again, the correlation was stronger among non-AF patients (P for difference<0.001). Other associations did not differ between populations, and meta-analysis of LAV was not conducted by the limited number of studies.
Summary of meta-analysis
Conclusions
Left atrial echocardiographic parameters are powerful predictors of adverse cardiovascular events, mainly among individuals without AF.
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Affiliation(s)
- P Meyre
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - L Froehlich
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Blum
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Djokic
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - B Kaufmann
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Conen
- McMaster University, Population Health Research Institute, Hamilton, Canada
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Froehlich L, Meyre P, Aeschbacher S, Blum S, Djokic D, Kuehne M, Osswald S, Kaufmann BA, Conen D. Left atrial dimension and cardiovascular outcomes in patients with and without atrial fibrillation: a systematic review and meta-analysis. Heart 2019; 105:1884-1891. [DOI: 10.1136/heartjnl-2019-315174] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/15/2019] [Accepted: 07/24/2019] [Indexed: 12/28/2022] Open
Abstract
ObjectiveThe prognostic value of left atrial (LA) dimensions may differ between patients with and without atrial fibrillation (AF).MethodsMEDLINE and EMBASE were searched for studies that investigated the association between LA echocardiographic parameters measured by transthoracic echocardiography and cardiovascular outcomes in patients with or without AF. Data were independently abstracted by two reviewers and pooled using random-effects meta-analysis. The primary outcome was incident stroke or thromboembolic events. Secondary outcomes were heart failure, all-cause mortality and major adverse cardiac events (MACE).ResultsTwenty-three studies of patients with AF (14 939 patients) and 68 studies of patients without AF (50 720 patients) in this systematic review. Increasing LA diameter was significantly associated with stroke and thromboembolic events in patients without AF (risk ratio (RR) 1.38, 95% CI 1.02 to 1.87; p=0.03), but not in patients with AF (RR 1.02, 95% CI 0.98 to 1.07; p=0.27; p for difference=0.05). Increasing LA diameter index was significantly associated with MACE in patients with AF (RR 1.13, 95% CI 1.09 to 1.17; p<0.001) and in patients without AF (RR 2.98, 95% CI 1.90 to 4.66; p<0.001), with stronger effects in non-AF populations (p for difference <0.001). Greater LA volume index was significantly associated with the risk of MACE in patients with AF (RR 1.01, 95% CI 1.00 to 1.02; p=0.03) and in non-AF populations (RR 1.08, 95% CI 1.05 to 1.10; p<0.001), the association being stronger in individuals without AF (p for difference <0.001).ConclusionsLarger LA parameters were associated with various adverse cardiovascular events. Many of these associations were stronger in individuals without AF, highlighting the potential importance of LA myopathy.
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Redfern RE, Fleming K, March RL, Bobulski N, Kuehne M, Chen JT, Moront M. Thromboelastography-Directed Transfusion in Cardiac Surgery: Impact on Postoperative Outcomes. Ann Thorac Surg 2019; 107:1313-1318. [DOI: 10.1016/j.athoracsur.2019.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 12/11/2018] [Accepted: 01/07/2019] [Indexed: 01/08/2023]
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Fleming K, Redfern R, Bobulski N, Naimy G, Kuehne M, Moront M. THE EFFECT OF PLATELET MAPPING ON LENGTH OF STAY AND CLINICAL OUTCOMES IN A COHORT OF PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32001-7] [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: 11/24/2022]
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40
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Blum S, Kuehne M, Rodondi N, Mueller A, Ammann P, Moschovitis G, Kobza R, Schlaepfer J, Meyre P, Bonati LH, Ehret G, Sticherling C, Schwenkglenks M, Osswald S, Conen D. 1358Prevalence of silent vascular brain lesions among patients with atrial fibrillation and no known history of stroke. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1358] [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: 11/13/2022] Open
Affiliation(s)
- S Blum
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - N Rodondi
- University of Bern, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - A Mueller
- Triemli Hospital, Department of Cardiology, Zurich, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, Department of Cardiology, St. Gallen, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Department of Cardiology, Lugano, Switzerland
| | - R Kobza
- Kantonsspital Lucerne, Department of Cardiology, Lucerne, Switzerland
| | - J Schlaepfer
- University Hospital Centre Vaudois (CHUV), Service of Cardiology, Lausanne, Switzerland
| | - P Meyre
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - L H Bonati
- University Hospital Basel, Neurology Division and Stroke Centre, Department of Clinical Research, Basel, Switzerland
| | - G Ehret
- Geneva University Hospitals, Cardiology Service, Department of Medicine Specialities, Geneva, Switzerland
| | - C Sticherling
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - M Schwenkglenks
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - S Osswald
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - D Conen
- McMaster University, Population Health Research Institute, Hamilton, Canada
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Ebrahimi R, Strebel I, Van Dam PM, Kuehne M, Knecht S, Spies F, Abaecherli R, Badertscher P, Kozhuharov N, Zeljkovic I, Schaer B, Osswald S, Sticherling C, Reichlin T. P4849Man vs. machine: comparison of manual vs. automated 12-lead ECG prediction of the origin of idiopathic ventricular arrhythmias to guide catheter ablation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] Open
Affiliation(s)
- R Ebrahimi
- University Hospital Basel, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Basel, Switzerland
| | - P M Van Dam
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Basel, Switzerland
| | | | | | | | - I Zeljkovic
- University Hospital Basel, Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Basel, Switzerland
| | | | - T Reichlin
- University Hospital Basel, Basel, Switzerland
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42
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Brenner R, Aeschbacher S, Blum S, Meyre P, Ammann P, Erne P, Moschovitis G, Di Valentino M, Shah D, Schlaepfer J, Kuehne M, Sticherling C, Osswald S, Conen D. P980Physical activity and outcome in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p980] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Brenner
- Kantonsspital St. Gallen, St. Gallen, Switzerland, Division of Cardiology, St.Gallen, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Division of Cardiology, Basel, Switzerland
| | - S Blum
- University Hospital Basel, Division of Cardiology, Basel, Switzerland
| | - P Meyre
- University Hospital Basel, Division of Cardiology, Basel, Switzerland
| | - P Ammann
- Kantonsspital St. Gallen, St. Gallen, Switzerland, Division of Cardiology, St.Gallen, Switzerland
| | - P Erne
- University of Basel, Department of Biomedicine, Basel, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Division of Cardiology, Lugano, Switzerland
| | - M Di Valentino
- Hospital of San Giovanni, Division of Cardiology, Bellinzona, Switzerland
| | - D Shah
- Geneva University Hospitals, Division of Cardiology, Geneva, Switzerland
| | - J Schlaepfer
- University Hospital Centre Vaudois (CHUV), Division of Cardiology, Lausanne, Switzerland
| | - M Kuehne
- University Hospital Basel, Division of Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Division of Cardiology, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Division of Cardiology, Basel, Switzerland
| | - D Conen
- Population Health Research Institute, Hamilton, Canada
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Du Fay De Lavallaz J, Badertscher P, Nestelberger T, Miro O, Twerenbold R, Cullen L, Than M, Martin-Sanchez FJ, Keller D, Kuehne M, Reichlin T, Mueller C. P4836Sex-specific symptoms in the early diagnosis of syncope. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4836] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - P Badertscher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - O Miro
- Hospital Clinic de Barcelona, Emergency Department, Barcelona, Spain
| | - R Twerenbold
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - L Cullen
- Royal Brisbane and Women's Hospital, Cardiology, Brisbane, Australia
| | - M Than
- Christchurch Hospital, Cardiology, Christchurch, New Zealand
| | | | - D Keller
- University Hospital Zurich, Emergency Department, Zurich, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - T Reichlin
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
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Reichlin T, Baldinger S, Seiler J, Pruvot E, Bisch L, Ammann P, Berte B, Haegeli L, Mueller A, Namdar M, Burri H, Auricchio A, Knecht S, Kuehne M, Sticherling C. 2114Impact of contact force sensing technology on catheter ablation success of idiopathic premature ventricular contractions originating from the outflow tracts. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Reichlin
- University Hospital Basel, Basel, Switzerland
| | | | - J Seiler
- Bern University Hospital, Bern, Switzerland
| | - E Pruvot
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - L Bisch
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - B Berte
- Kantonsspital Lucerne, Lucerne, Switzerland
| | - L Haegeli
- University Hospital Zurich, Zurich, Switzerland
| | - A Mueller
- Triemli Hospital, Zurich, Switzerland
| | - M Namdar
- Geneva University Hospitals, Geneva, Switzerland
| | - H Burri
- Geneva University Hospitals, Geneva, Switzerland
| | | | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
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Reichlin T, Knecht S, Spies F, Schaer B, Osswald S, Sticherling C, Kuehne M. P3873Introduction of leadless transcatheter intracardiac pacing: assessing the initial learning curve. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3873] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/15/2022] Open
Affiliation(s)
- T Reichlin
- University Hospital Basel, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Basel, Switzerland
| | | | - M Kuehne
- University Hospital Basel, Basel, Switzerland
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Celikyurt U, Knecht S, Kuehne M, Reichlin T, Muehl A, Spies F, Osswald S, Sticherling C. Incidence of new-onset atrial fibrillation after cavotricuspid isthmus ablation for atrial flutter. Europace 2018; 19:1776-1780. [PMID: 28069839 DOI: 10.1093/europace/euw343] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 07/05/2016] [Accepted: 10/07/2016] [Indexed: 11/14/2022] Open
Abstract
Aims In patients with cavotricuspid isthmus (CTI) ablation for atrial flutter (AFL), the decision to hold oral anticoagulation (OAC) often becomes an issue. The purpose of this study was to describe the incidence of the development of atrial fibrillation (AF) after CTI ablation in patients with documented AFL with and without a previous history of AF and to identify risk predictors for the occurrence of AF after CTI. Methods and results We included 364 consecutive patients undergoing successful CTI ablation. Thereof, 230 patients (170 male; age 66 ± 11 years) had AFL only (AFL group) and 134 patients (94 male; age 65 ± 11 years) had AFL and previously documented AF (AFL and AF group). Over a mean follow-up of 22 ± 20 months, 163 (71%) patients in the AFL group and 67 (50%) patients in the AFL and AF groups had no documentation of a recurrent atrial arrhythmia (P < 0.001). AF developed in 51 patients (22%) in the AFL group and in 57 (43%) patients in the AFL and AF groups (P < 0.001). In patients without history of AF, left atrial diameter was the only predictor of development of AF (HR 1.058 [95%CI 1.011-1.108], P = 0.016). Multivariate analysis of the total population identified history of AF (HR 1.918 [95%CI 1.301-2.830], P = 0.001) and BMI as predictors for AF development (HR 1.052 [95%CI 1.012-1.093], P = 0.011). Conclusion Our results indicate that new-onset AF develops in a significant proportion of patients undergoing CTI for AFL. One should therefore be careful to withhold OAC. Furthermore, pulmonary vein isolation should be considered in conjunction with CTI, particularly in patients with previously documented AF.
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Affiliation(s)
- Umut Celikyurt
- Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland
| | - Michael Kuehne
- Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland
| | - Aline Muehl
- Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland
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47
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Ebrahimi R, Kuehne M, Knecht S, Spies F, Schaer B, Osswald S, Sticherling C, Reichlin T. P1128Catheter ablation of idiopathic premature ventricular contractions and idiopathic ventricular tachycardia - origin determines success. Europace 2018. [DOI: 10.1093/europace/euy015.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Ebrahimi
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Basel, Switzerland
| | | | - T Reichlin
- University Hospital Basel, Basel, Switzerland
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48
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Ebrahimi R, Kuehne M, Knecht S, Spies F, Schaer B, Osswald S, Sticherling C, Reichlin T. P297Impact of contact force sensing technology on catheter ablation success of idiopathic ventricular arrhythmias originating from the outflow tracts. Europace 2018. [DOI: 10.1093/europace/euy015.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Ebrahimi
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Basel, Switzerland
| | | | - T Reichlin
- University Hospital Basel, Basel, Switzerland
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49
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Badertscher P, Du Fay De Lavallaz J, Nestelberger T, Isenrich R, Strebel I, Sabti Z, Puelacher C, Kuehne M, Mueller C, Reichlin T. P453Prospective Validation of Diagnostic and Prognostic Syncope Scores in the Emergency Department. Europace 2018. [DOI: 10.1093/europace/euy015.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J Du Fay De Lavallaz
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - R Isenrich
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Z Sabti
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Puelacher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Reichlin
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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50
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Badertscher P, Nestelberger T, de Lavallaz JDF, Than M, Morawiec B, Kawecki D, Miró Ò, López B, Martin-Sanchez FJ, Bustamante J, Geigy N, Christ M, Di Somma S, Peacock WF, Cullen L, Sarasin F, Flores D, Tschuck M, Boeddinghaus J, Twerenbold R, Wildi K, Sabti Z, Puelacher C, Rubini Giménez M, Kozhuharov N, Shrestha S, Strebel I, Rentsch K, Keller DI, Poepping I, Buser A, Kloos W, Lohrmann J, Kuehne M, Osswald S, Reichlin T, Mueller C. Prohormones in the Early Diagnosis of Cardiac Syncope. J Am Heart Assoc 2017; 6:JAHA.117.006592. [PMID: 29426039 PMCID: PMC5779001 DOI: 10.1161/jaha.117.006592] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Indexed: 02/01/2023]
Abstract
Background The early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional–pro‐A‐type natriuretic peptide (MRproANP), C‐terminal proendothelin 1, copeptin, and midregional‐proadrenomedullin. Methods and Results We prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study. ED probability of cardiac syncope was quantified by the treating ED physician using a visual analogue scale. Prohormones were measured in a blinded manner. Two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information, including 1‐year follow‐up. Among 689 patients, cardiac syncope was the adjudicated final diagnosis in 125 (18%). Plasma concentrations of MRproANP, C‐terminal proendothelin 1, copeptin, and midregional‐proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (P<0.001). The diagnostic accuracies for cardiac syncope, as quantified by the area under the curve, were 0.80 (95% confidence interval [CI], 0.76–0.84), 0.69 (95% CI, 0.64–0.74), 0.58 (95% CI, 0.52–0.63), and 0.68 (95% CI, 0.63–0.73), respectively. In conjunction with the ED probability (0.86; 95% CI, 0.82–0.90), MRproANP, but not the other prohormone, improved the area under the curve to 0.90 (95% CI, 0.87–0.93), which was significantly higher than for the ED probability alone (P=0.003). An algorithm to rule out cardiac syncope combining an MRproANP level of <77 pmol/L and an ED probability of <20% had a sensitivity and a negative predictive value of 99%. Conclusions The use of MRproANP significantly improves the early detection of cardiac syncope among unselected patients presenting to the ED with syncope. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01548352.
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Affiliation(s)
- Patrick Badertscher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Martin Than
- GREAT Network, Rome, Italy.,Christchurch Hospital, Christchurch, New Zealand
| | - Beata Morawiec
- GREAT Network, Rome, Italy.,2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Damian Kawecki
- GREAT Network, Rome, Italy.,2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Òscar Miró
- GREAT Network, Rome, Italy.,Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Beatriz López
- GREAT Network, Rome, Italy.,Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | - F Javier Martin-Sanchez
- GREAT Network, Rome, Italy.,Emergency Department, Hospital Clínico San Carlos, Madrid, Spain
| | - José Bustamante
- GREAT Network, Rome, Italy.,Emergency Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Nicolas Geigy
- Department of Emergency Medicine, Hospital of Liestal, Switzerland
| | - Michael Christ
- GREAT Network, Rome, Italy.,Department of Emergency Care, Lucerne General Hospital, Lucerne, Switzerland
| | - Salvatore Di Somma
- GREAT Network, Rome, Italy.,Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sant'Andrea Hospital University Sapienza Rome, Rome, Italy
| | - W Frank Peacock
- GREAT Network, Rome, Italy.,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Louise Cullen
- GREAT Network, Rome, Italy.,Royal Brisbane and Women's Hospital, Herston, Australia
| | - François Sarasin
- Emergency Department, Hôpitaux Universitaires de Genève, Switzerland
| | - Dayana Flores
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Michael Tschuck
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy.,Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | - Karin Wildi
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Zaid Sabti
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Christian Puelacher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Maria Rubini Giménez
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Ivo Strebel
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Katharina Rentsch
- Laboratory Medicine, University Hospital Basel University of Basel, Switzerland
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Imke Poepping
- Department of Internal Medicine, Hospital of Lachen, Switzerland
| | - Andreas Buser
- Department of Hematology, University Hospital Basel University of Basel, Switzerland.,Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
| | - Wanda Kloos
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland
| | - Jens Lohrmann
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland
| | - Michael Kuehne
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.,GREAT Network, Rome, Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland .,GREAT Network, Rome, Italy
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