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Åkerström F, Charitakis E, Paul-Nordin A, Braunschweig F, Friberg L, Tabrizi F, Jensen-Urstad M, Drca N. Reduced dementia risk in patients with optimized anticoagulation therapy undergoing atrial fibrillation ablation. Heart Rhythm 2024:S1547-5271(24)02365-8. [PMID: 38604586 DOI: 10.1016/j.hrthm.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with the development of dementia, and observational studies have shown that oral anticoagulation and catheter ablation reduce dementia risk. However, such studies did not consistently report on periprocedural anticoagulation and long-term oral anticoagulation coverage, for which reason the separate effect of AF ablation on dementia risk could not be established. OBJECTIVE We evaluated the protective effect of AF ablation in a large cohort of patients who received optimized anticoagulation and compared them with patients who were managed medically. METHODS We retrospectively included 5912 consecutive patients who underwent first-time catheter ablation for AF between 2008 and 2018 and compared them with 52,681 control individuals from the Swedish Patient Register. Propensity score matching produced 2 cohorts of equal size (n = 3940) with similar baseline characteristics. Dementia diagnosis was identified by International Classification of Diseases codes from the patient register. RESULTS Most propensity score-matched patients were taking an oral anticoagulant at the start (94.5%) and end (75.0%) of the study. Mean follow-up was 4.9 ± 2.8 years. Catheter ablation was associated with lower risk for the dementia diagnosis compared with the control group (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.22-0.86; P = .017). The result was similar when including patients with a stroke diagnosis before inclusion (HR, 0.50; 95% CI, 0.28-0.89; P = .019) and after adjustment for the competing risk of death (HR, 0.41; 95% CI, 0.20-0.86; P = .018). CONCLUSION Catheter ablation of AF in patients with optimized oral anticoagulation therapy was associated with a reduction in dementia diagnosis, even after adjustment for potential confounders and for competing risk of death.
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Affiliation(s)
- Finn Åkerström
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.
| | - Emmanouil Charitakis
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Leif Friberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute Danderyd Hospital, Stockholm, Sweden
| | | | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
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Åkerström F, Holmström L, Topolovic M, Drca N. Wide QRS complex tachycardia: Elucidating the mechanism by atrial pacing maneuvers. Heart Rhythm 2024; 21:484-487. [PMID: 38154601 DOI: 10.1016/j.hrthm.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Finn Åkerström
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
| | | | - Mirko Topolovic
- Cardiology Department, Pediatric Clinic, University Medical Center, Ljubljana, Slovenia
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Heart and Lung Diseases Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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Nordin AP, Jensen-Urstad M, Charitakis E, Carnlöf C, Drca N. Predictors of low-voltage zones in patients with persistent atrial fibrillation eligible for catheter ablation: An observational study. J Cardiovasc Electrophysiol 2024. [PMID: 38561951 DOI: 10.1111/jce.16264] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The presence of low-voltage zones (LVZs) in the left atrium (LA) is associated with the recurrence of atrial fibrillation (AF) following pulmonary vein isolation (PVI). However, there is variability and conflict in the data regarding predictors of LVZs as reported in previous studies. The objective of this study was to identify predictors for the presence of LVZs in a cohort of patients with persistent AF. METHODS The study prospectively enrolled 439 patients with persistent AF who were scheduled for ablation. Voltage map of the LA was collected using a multipolar catheter. An LVZ was defined as an area of ≥3 cm2 exhibiting a peak-to-peak bipolar voltage of <0.5 mV. RESULTS The mean age of the cohort was 65.3 ± 8.6 years and 26.4% were female. Additionally, 25.7% had significant LVZs, most frequently located in the anterior wall of the LA. Multivariable analysis identified the following independent predictors for LVZ: advanced age (OR [odds ratio] = 1.08, 95% CI [confidence interval] = 1.03-1.13, p = .002); female sex (OR = 4.83, 95% CI = 2.66-8.76, p < .001); coronary artery disease (CAD) (OR = 3.20, 95% CI = 1.32-7.77, p = .01) and enlarged LA diameter (OR = 1.10, 95% CI = 1.04-1.17, p = .001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the final model was 0.829. CONCLUSION Approximately 25% of the patients with persistent AF had LVZs. Advanced age, female sex, CAD, and a larger LA were independent predictors for LVZs with the model demonstrating a very good AUC for the ROC curve. These findings hold the potential to be used to tailor the ablation procedure for the individual patient.
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Affiliation(s)
- Astrid Paul Nordin
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Emmanouil Charitakis
- Department of Cardiology, Linköping University Hospital and Linköping University, Linköping, Sweden
| | - Carina Carnlöf
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Jemtrén A, Saygi S, Åkerström F, Asaad F, Bourke T, Braunschweig F, Carnlöf C, Drca N, Insulander P, Kennebäck G, Nordin AP, Sadigh B, Rickenlund A, Saluveer O, Schwieler J, Svennberg E, Tapanainen J, Turkmen Y, Bastani H, Jensen-Urstad M. Risk assessment in patients with symptomatic and asymptomatic pre-excitation. Europace 2024; 26:euae036. [PMID: 38363996 PMCID: PMC10873488 DOI: 10.1093/europace/euae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024] Open
Abstract
AIMS Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation. METHODS AND RESULTS This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation referred for risk assessment. All participants performed an incremental EST (bicycle) prior to an electrophysiology study (EPS). Primary data from the EST included loss of pre-excitation during exercise, and primary data from the EPS included the measurement of accessory pathway effective refractory period (APERP), shortest pre-excited RR interval (SPERRI), and inducible arrhythmia with the use of a beta-adrenergic receptor agonist if deemed necessary. One hundred and sixty-four patients (59 asymptomatic, 105 symptomatic) completed an EST and EPS. Forty-five patients (27%) demonstrated low-risk findings on EST, of which 19 were asymptomatic and 26 were symptomatic. Six patients with low-risk EST findings had SPERRI/APERP ≤ 250 ms at EPS, and two of them were asymptomatic. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of low-risk EST for excluding patients with SPERRI/APERP ≤ 250 ms were 40, 91, 87, 51, and 60%, respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic (36, 69%) and symptomatic (73, 61%) groups. CONCLUSION Sudden loss of pre-excitation during EST has a low NPV in excluding high-risk APs. The EPS with the use of isoproterenol should be considered to accurately assess the risk of patients with pre-excitation regardless of symptoms (ClinicalTrials.gov Identifier: NCT03301935).
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Affiliation(s)
- Anette Jemtrén
- Heart and Lung Disease Unit, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Serkan Saygi
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Finn Åkerström
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Fahd Asaad
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Carina Carnlöf
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Astrid Paul Nordin
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Bita Sadigh
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Anette Rickenlund
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Emma Svennberg
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Jari Tapanainen
- Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yusuf Turkmen
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge, Department of Medicine Huddinge, Karolinska Institutet, Hälsovägen, 141 86 Stockholm, Sweden
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Akerström F, Hutter J, Charitakis E, Tabrizi F, Asaad F, Bastani H, Bourke T, Braunschweig F, Drca N, Englund A, Friberg L, Insulander P, Jönsson AH, Kennebäck G, Paul-Nordin A, Sadigh B, Saluveer O, Saygi S, Schwieler J, Svennberg E, Tapanainen J, Türkmen Y, Jensen-Urstad M. Association between catheter ablation of atrial fibrillation and mortality or stroke. Heart 2024; 110:163-169. [PMID: 37657914 PMCID: PMC10850723 DOI: 10.1136/heartjnl-2023-322883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE Catheter ablation of atrial fibrillation effectively reduces symptomatic burden. However, its long-term effect on mortality and stroke is unclear. We investigated if patients with atrial fibrillation who undergo catheter ablation have lower risk for all-cause mortality or stroke than patients who are managed medically. METHODS We retrospectively included 5628 consecutive patients who underwent first-time catheter ablation for atrial fibrillation between 2008 and 2018 at three major Swedish electrophysiology units. Control individuals with an atrial fibrillation diagnosis but without previous stroke were selected from the Swedish National Patient Register, resulting in a control group of 48 676 patients. Propensity score matching was performed to produce two cohorts of equal size (n=3955) with similar baseline characteristics. The primary endpoint was a composite of all-cause mortality or stroke. RESULTS Patients who underwent catheter ablation were healthier (mean CHA2DS2-VASc score 1.4±1.4 vs 1.6±1.5, p<0.001), had a higher median income (288 vs 212 1000 Swedish krona [KSEK]/year, p<0.001) and had more frequently received university education (45.1% vs 28.9%, p<0.001). Mean follow-up was 4.5±2.8 years. After propensity score matching, catheter ablation was associated with lower risk for the combined primary endpoint (HR 0.58, 95% CI 0.48 to 0.69). The result was mainly driven by a decrease in all-cause mortality (HR 0.51, 95% CI 0.41 to 0.63), with stroke reduction showing a trend in favour of catheter ablation (HR 0.75, 95% CI 0.53 to 1.07). CONCLUSIONS Catheter ablation of atrial fibrillation was associated with a reduction in the primary endpoint of all-cause mortality or stroke. This result was driven by a marked reduction in all-cause mortality.
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Affiliation(s)
- Finn Akerström
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Julie Hutter
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | | | - Fahd Asaad
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Leif Friberg
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Per Insulander
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Bita Sadigh
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Serkan Saygi
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Emma Svennberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Yusuf Türkmen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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Drca N, Larsson SC, Grannas D, Jensen-Urstad M. Elite female endurance athletes are at increased risk of atrial fibrillation compared to the general population: a matched cohort study. Br J Sports Med 2023; 57:1175-1179. [PMID: 37433586 PMCID: PMC10579174 DOI: 10.1136/bjsports-2022-106035] [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] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Previous studies have found that endurance sport activity is associated with an increased risk of atrial fibrillation (AF) in men. However, it remains unclear whether endurance sports also influence the risk of AF in women. We aimed to examine whether participation in endurance sports may affect the risk of AF in female athletes. METHODS We conducted a retrospective matched cohort study of top Swedish female endurance athletes (n=228) and reference individuals (n=1368) from the general population using the Swedish Total Population Register individually matched with a 6:1 ratio of female athletes. The athlete cohort was created by combining all Swedish women who ran the Stockholm Marathon faster than 3 hours 15 min in any of the races between 1979 and 1991, all women competing in the Swedish athletic national championships in the 10 000 metre race, and the top-ranked Swedish cyclists during the same period. We used the National Patient Register to determine whether the participants were diagnosed with AF. RESULTS Mean age at the start of follow-up was 32 (SD±8.5) years. During follow-up (mean 28.8 years; SD±4.4), 33 cases of AF were diagnosed, including 10 (4.4%) among athletes and 23 (1.7%) among references. The HR for female athletes compared with the reference population was 2.56 (95% CI 1.22 to 5.37) in the univariable model and 3.67 (95% CI 1.71 to 7.87) after adjustment for hypertension. CONCLUSION Elite female endurance athletes are at increased risk of AF than the general population.
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Affiliation(s)
- Nikola Drca
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna C Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Stockholm County, Sweden
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - David Grannas
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Paul Nordin A, Carnlöf C, Insulander P, Mohammad Ali A, Jensen-Urstad M, Saluveer O, Drca N. Validation of diagnostic accuracy of a handheld, smartphone-based rhythm recording device. Expert Rev Med Devices 2023; 20:55-61. [PMID: 36695787 DOI: 10.1080/17434440.2023.2171290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM Evaluation of the diagnostic accuracy of a rhythm recording device, for detection of atrial tachyarrhythmia (ATA) and atrial fibrillation (AF) compared to 12-lead-electrocardiogram (12-L-ECG). RESEARCH DESIGN AND METHODS Two hundred 12-L-ECGs (reference standard) and Coala Heart Monitor (CHM) recordings (index test) were collected from 189 patients. Two electrophysiologists independently performed manual analysis of all 12-L-ECGs and CHM recordings in random order. The CHM recordings were also analyzed by an automatic algorithm and compared to the results of the reference standard. RESULTS Manual analysis of CHM for ATA showed a sensitivity of 98.9% (95% confidence interval (CI): 94.0-100) and a specificity of 100% (CI: 96.6-100). Manual analysis for AF had a sensitivity of 100% (CI: 95.3-100) and a specificity of 97.5% (CI: 93.0-99.5). Automatic analysis for ATA showed a sensitivity of 93.5% (CI: 86.3-97.6) and a specificity of 92.6% (CI: 85.9-96.7). Automatic analysis for AF showed a sensitivity of 97.4% (CI: 91.0-99.7) and a specificity of 86.1% (CI: 78.6-91.7). CONCLUSION CHM has a very high accuracy for ATA and AF in manual analysis and a high accuracy for ATA and AF in automatic analysis, making the device suitable for screening.
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Affiliation(s)
- Astrid Paul Nordin
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Carina Carnlöf
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Amina Mohammad Ali
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Akerström F, Drca N, Jensen‐Urstad M, Braunschweig F. Feasibility of a novel algorithm for automated reconstruction of the left atrial anatomy based on intracardiac echocardiography. Pacing Clin Electrophysiol 2022; 45:1288-1294. [PMID: 36193687 PMCID: PMC9828825 DOI: 10.1111/pace.14599] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/31/2022] [Accepted: 09/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is frequently used to guide electrophysiology procedures. The novel automated algorithm Cartosoundfam is a model-based algorithm which reconstructs a 3D anatomy of the left atrium (LA) based on a set of 2D intracardiac echocardiography (ICE) frames, without the need to manually annotate ultrasound (US) contours. OBJECTIVE The aim of this study was to determine the feasibility of the Cartosoundfam module in routine clinical setting. METHODS We included 16 patients undergoing LA mapping/catheter ablation. Two-dimensional US frames were acquired from the right atrium (RA) and the right ventricular outflow tract. The Cartosoundfam map was validated in two steps: (1) identification of anatomical structures (pulmonary veins [PV] and LA body and appendage) by alignment of the ablation catheter to the automated map; and (2) analysis of the automated lesion tags (Visitag) location in relation to the PV antrum of the Cartosoundfam map in nine patients with paroxysmal atrial fibrillation (AF) undergoing first time pulmonary vein isolation (PVI). RESULTS Mean 2D US frames per patient were 29 ± 6 and acquisition time was 16 ± 4 min. All anatomical structures were correctly identified in all patients (step 1). In the step 2 validation, the median distance to the map was 2.0 (IQR: 2.4) mm and the majority of the Visitags were classified as satisfactory (69%) but all PV segments had some Visitags classified as unsatisfactory. CONCLUSION The automated ICE-based algorithm correctly identified the LA anatomical structures in all patients with a 69% anatomical accuracy of the Visitags alignments to the PV antrum segments.
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Affiliation(s)
- Finn Akerström
- Department of CardiologyKarolinska University HospitalStockholmSweden,Department of Medicine HuddingeKarolinska InstitutetStockholmSweden
| | - Nikola Drca
- Department of CardiologyKarolinska University HospitalStockholmSweden,Department of Medicine HuddingeKarolinska InstitutetStockholmSweden
| | - Mats Jensen‐Urstad
- Department of CardiologyKarolinska University HospitalStockholmSweden,Department of Medicine HuddingeKarolinska InstitutetStockholmSweden
| | - Frieder Braunschweig
- Department of CardiologyKarolinska University HospitalStockholmSweden,Department of Medicine SolnaKarolinska InstitutetStockholmSweden
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Paul Nordin A, Mohammad Ali A, Carnlof C, Drca N. Validation of coala heart monitor. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.416] [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/Introduction
Atrial fibrillation (AF) can be asymptomatic and it is associated with stroke and heart failure which can present as first symptoms [1,2]. There is increasing evidence of benefits of screening for AF to prevent ischemic stroke by initiating anticoagulation therapy in affected individuals [3]. There are several devices used for screening of AF [4] and one of them is Coala Heart Monitor (CHM), which is a handheld device, connected by blue-tooth to a smartphone for registration of the rhythm from the chest and the thumbs. The aim with this this study was to validate the accuracy of CHM for detecting atrial tachyarrhythmia (ATA) (AF, atrial flutter or atrial tachycardia) compared to 12-lead-ECG.
Methods
Eligible participants were ≥18 years of age, planned for a 12-lead-ECG, with a history of ATA. Exclusion criteria were; pacemaker or implantable cardioverter-defibrillator (ICD)-treatment, ongoing arrhythmia that was not ATA or if the patient was unwilling or unable to provide informed consent. One hundred and eleven 12-lead-ECG were collected and immediately after a 30 + 30 second thumb-and chest-registration from CHM where collected. 12-lead-ECG independently interpreted by two electrophysiologist was used as the reference standard (100% coherence). In one patient neither chest nor thumb-registration could be interpreted due to bad quality, and this was not included in the analysis. Eight thumb-registrations and three chest-registrations could not be interpreted and in these cases the other registration could be interpreted. In one case there was disagreement between interpreter one and two, and in this case a third interpreter was involved.
Results
Mean age was 65.2±12.1 years and 28.8% were female. Prevalence of ATA was 36.4%. The sensitivity for ATA was 100% (95% CI, 96.3% - 100%) and the specificity was 100% (95% CI, 96.3% - 100%).
Conclusion
CHM provides excellent sensitivity and specificity for ATA compared to 12-lead-ECG.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Research Council
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Affiliation(s)
| | | | - C Carnlof
- Karolinska Institutet Huddinge , Stockholm , Sweden
| | - N Drca
- Karolinska Institutet Huddinge , Stockholm , Sweden
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von Olshausen G, Paul-Nordin A, Tapanainen J, Jensen-Urstad M, Bastani H, Saluveer O, Bourke T, Drca N, Kennebäck G, Saygi S, Turkmen Y, Insulander P, Braunschweig F. Electrical cardioversion for early recurrences post pulmonary vein isolation. J Interv Card Electrophysiol 2022; 66:577-584. [PMID: 36085243 PMCID: PMC10066117 DOI: 10.1007/s10840-022-01368-w] [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: 01/27/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To study the association between timing and success of electrical cardioversion (ECV) for the treatment of early recurrences (ERs) of atrial fibrillation post pulmonary vein isolation (PVI) on long-term rhythm outcome. METHODS Data of 133 patients ablated for paroxysmal or persistent atrial fibrillation receiving ECV for ERs, i.e., atrial tachyarrhythmia recurrences within 90 days post ablation were analyzed. During 1-year follow-up, patients were screened for late recurrences (LRs), i.e., recurrences after the blanking period. RESULTS In 114 patients (85.7%), ECV was successful compared to 19 patients (14.3%) with failed ECV. A higher body mass index (odds ratio (OR) 1.19 (95% CI 1.02-1.39), p = 0.029), a lower left ventricular ejection fraction (OR 1.07 (95% CI 0.99-1.15), p = 0.079), and performance of ECV > 7 days from ER onset (OR 2.99 (95% CI 1.01-8.87), p = 0.048) remained independently associated with ECV failure. During 1-year follow-up, the rate of LR was significantly higher among patients with failed ECV as compared to patients with successful ECV (hazard ratio (HR) 3.00 (95% CI, 1.79-5.03), p < 0.001). Patients with ECV performed > 7 days from ER onset had a significantly higher risk of developing LR as compared to patients with ECV performed within ≤ 7 days from ER onset (HR 1.73 (95% CI 1.15-2.62), p = 0.009). Performance of ECV > 7 days from ER onset (HR 1.76 (95% CI 1.16-2.67), p = 0.008) and failed ECV (HR 3.32 (95% CI 1.96-5.64), p < 0.001) remained independently associated with LR. CONCLUSIONS A failed ECV and performance of ECV > 7 days from ER onset were independently associated with LR.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden.
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Serkan Saygi
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Yusuf Turkmen
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Solna, S1:02, 17176, Stockholm, Sweden
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11
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Akerstrom F, Drca N, Wekselman G, Bugauisan G, Holmstrom L, Jensen-Urstad M, Braunschweig F. Feasibility of a novel algorithm for automated reconstruction of the left atrial anatomy based on intracardiac echocardiography. Europace 2022. [DOI: 10.1093/europace/euac053.235] [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
Intracardiac echocardiography (ICE) is frequently used to guide electrophysiology procedures. The novel pre-commercial automated algorithm is a model-based algorithm, developed using machine learning methodology, which reconstructs a 3D anatomy of the left atrium (LA) and its structures based on a set of 2D ultrasound (US) frames, without the need to manually annotate US contours. Potential advantages are shortening of mapping time and better anatomy resolution when compared to conventional anatomical mapping techniques.
Purpose
Determine the early feasibility of the automated LA anatomy algorithm in routine clinical setting.
Methods
We included 16 patients (64±9 years, 88% males, body mass index 27±3, parasternal long axis LA diameter 40±3mm) undergoing LA mapping/catheter ablation (conscious sedation in 56% and general anaesthesia in the remaining cases). 2D US frames were acquired from three ICE-positions: superior vena cava/high right atrium (RA) junction, RA and right ventricular outflow tract. The automated LA anatomy map was validated in two steps: 1) identification of anatomical structures (pulmonary veins [PV] and left atrial appendage) by alignment of the ablation catheter to the automated map; and 2) assessment of PV anatomical accuracy by analysing the relationship with the automated lesion tags (3mm lesion radius, 3mm for 8sec stability criteria and 5-20g average contact force) and the PV antrum of the automated map in 9 patients with paroxysmal atrial fibrillation undergoing first time point-by-point radiofrequency PV isolation (PVI). In step 2, PV pairs were divided into 6 segments (total of 12 segments per patient) and were classified as accurate, insufficient ("floating" lesion tags), or excessive anatomy (invisible lesion tags).
Results
Mean 2D US frames per patient was 29±6 and acquisition time was 16±4 min. In the step 1 validation, all anatomical structures were correctly identified in the 16 patients by the automated algorithm. The step 2 validation showed anatomical accuracy in 76% of all 108 PV segments analysed. There was a range of 0-2 and 0-5 of the total 12 segments per patient with insufficient and excessive anatomy, respectively. In all cases with PV segment anatomical discrepancy, this was corrected with standard anatomy collection with the ablation catheter in ≤2min. In the whole patient group, catheter ablation was successfully performed on the automated map without complications.
Conclusions
The automated ICE-based 3D LA map algorithm performed overall well and correctly identified the LA anatomical structures in all patients. Anatomical PV antrum accuracy was high, and the majority of PV segments needed no manual correction before proceeding to PVI.
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Affiliation(s)
- F Akerstrom
- Karolinska University Hospital, Stockholm, Sweden
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | | | - G Bugauisan
- Biosense Webster, Virginia, United States of America
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Drca N, Larsson SC, Jensen-Urstad M. Endurance training increases the risk of atrial fibrillation in women: a matched-cohort study. Europace 2022. [DOI: 10.1093/europace/euac053.139] [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): This work was supported by research grants from Kvinnor och Hälsa and The Swedish Research Council for Sport Science (to Nikola Drca).
Objective
Previous studies have found that vigorous physical activity, mainly related to endurance sport participation, increases the risk of atrial fibrillation (AF) in men. However, it remains unclear whether vigorous physical activity also influences the risk of AF in women. We aimed to examine whether endurance sport participation may affect AF risk in women.
Methods
We conducted a matched-cohort study of top Swedish female endurance athletes (n=228 marathon runners, cyclist, and 10 000-meters track runners) active between 1979-1991 and reference individuals (n=1 368) from the general population individually matched by sex, year of birth, and area of living with a 6:1 ratio to the female athletes. The athlete cohort was created by combining all Swedish women who ran the Stockholm Marathon faster than 3.25 hours in any of the races between 1979 and 1991 with all Swedish women competing in the Swedish athletic national championship in 10 000-meter track running and the top-ranked Swedish bicyclist during the same period. Participants were followed up from study entry until AF diagnosis, death, emigration, or December 31, 2017, whichever occurred first. We used the Swedish National Patient Register to determine whether the participants were diagnosed with AF and other covariables. Cox proportional hazards regression models were used for analysis.
Results
Baseline characteristics are presented in Table 1. Mean age at study entry was 32 (SD ± 8.5) years. During follow-up (mean 28.8 years; SD ± 4.4), 33 cases of AF were diagnosed, including 10 (4.4%) among athletes and 23 (1.7%) among references. Endurance training was associated with an increased AF risk (Figure 1). The hazard ratio for female athletes compared with the reference population was 2.56 (95% confidence interval 1.22 to 5.37) in the univariable model and 3.67 (95% confidence interval 1.71 to 7.87) after adjustment for hypertension.
Conclusion
High level of endurance sport training is associated with an increased risk of AF in women.
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Affiliation(s)
- N Drca
- Karolinska Institute, Karolinska University Hospital, Huddinge, Department of Cardiology, Stockholm, Sweden
| | - SC Larsson
- Karolinska Institute, Institute of Environmental Medicine (IMM), Stockholm, Sweden
| | - M Jensen-Urstad
- Karolinska Institute, Karolinska University Hospital, Huddinge, Department of Cardiology, Stockholm, Sweden
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13
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Drca N, von Olshausen G, Braunschweig F. Response to "Classification of AVNRT: An unresolved entity". J Cardiovasc Electrophysiol 2021; 33:323. [PMID: 34935235 DOI: 10.1111/jce.15322] [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] [Received: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Nordin AP, Drca N, Jensen-Urstad M. Reply to Letter: Assessing the risk of postprocedural complications on same-day discharge in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2021; 33:143. [PMID: 34878684 DOI: 10.1111/jce.15310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Astrid P Nordin
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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15
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Saluveer O, Drca N, Sahlgren B, Jensen-Urstad M, Braunschweig F. Color Variations in Left Atrial Appendage Occluders. JACC Case Rep 2021; 3:1787-1788. [PMID: 34825211 PMCID: PMC8603049 DOI: 10.1016/j.jaccas.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 12/04/2022]
Abstract
The authors stopped a case of left atrial appendage occlusion because of miscolored brownish devices. The investigation demonstrated that devices may show a range of colors from a typical blue to a brownish hue, depending on oxide layer thickness, and this does not appear to have any impact on the performance of the device. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Ott Saluveer
- Address for correspondence: Dr Ott Saluveer, Department of Cardiology, Karolinska University Hospital, S-14186 Stockholm, Sweden.
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Paul Nordin A, Drca N, Insulander P, Bastani H, Bourke T, Braunschweig F, Kenneback G, Von Olshausen G, Sadigh B, Saluveer O, Tapanainen J, Schwieler J, Akerstrom F, Jensen-Urstad M. Low incidence of major complications after the first six hours post-atrial fibrillation ablation – same-day discharge safe and feasible in most patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Catheter ablation of atrial fibrillation (AF) is associated with a complication risk. It is common practice to monitor patients overnight post-procedurally which is resource craving.
Purpose
To evaluate the incidence of procedural complications related to catheter ablation of AF to assess the potential feasibility and safety of same day discharge in a large cohort.
Methods
We performed an analysis of prospectively collected data of complications of all patients staying overnight after undergoing AF ablation between 2001 and 2020 at a tertiary centre. By studying medical records, we analysed complications occurring intraprocedurally until six hours post-ablation, and between six hours post-ablation until discharge the day after ablation procedure (up to 24 hours post-procedure).
Results
In 5414 AF ablations we identified a total of 108 (2.0%) major complications occurring intraprocedural or until discharge the day after procedure. Most major complications occurred early and were detected intraprocedurally or within six hours after completed procedure (n=96, 1.8%). Twelve (0.2%) major complications occurred between six hours post-ablation and until discharge the day after procedure. The most common of these were congestive heart failure (n=6) and transient ischemic attack (TIA, n=4). In addition, there were 61 (1.1%) minor complications which occurred in this time span. Factors independently associated with major complications intraprocedurally or within 24 hours were age (p=0.046), body mass index (BMI) ≥30 kg/m2 (p=0.009), significant valvular disease (p=0.001), cardiomyopathy (p<0.001), prior stroke or TIA (p=0.014), first time procedure vs. repeat procedure (p=0.013), cryoablation vs. radiofrequency (p<0.001) and procedure duration (p<0.001).
Conclusion
Very few complications occurred between six hours and until discharge after ablation of atrial fibrillation. Therefore, same-day discharge may be a safe option for a large proportion of patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region Stockholm funding
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Affiliation(s)
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | - P Insulander
- Karolinska University Hospital, Stockholm, Sweden
| | - H Bastani
- Karolinska University Hospital, Stockholm, Sweden
| | - T Bourke
- Karolinska University Hospital, Stockholm, Sweden
| | | | - G Kenneback
- Karolinska University Hospital, Stockholm, Sweden
| | | | - B Sadigh
- Karolinska University Hospital, Stockholm, Sweden
| | - O Saluveer
- Karolinska University Hospital, Stockholm, Sweden
| | - J Tapanainen
- Karolinska University Hospital, Stockholm, Sweden
| | - J Schwieler
- Karolinska University Hospital, Stockholm, Sweden
| | - F Akerstrom
- Karolinska University Hospital, Stockholm, Sweden
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von Olshausen G, Jemtrén A, Schwieler J, Tapanainen J, Bourke T, Paul-Nordin A, Benson L, Saluveer O, Kennebäck G, Braunschweig F, Drca N. Cryoablation of atypical atrioventricular nodal reentry tachycardia. J Cardiovasc Electrophysiol 2021; 32:2971-2978. [PMID: 34535930 DOI: 10.1111/jce.15244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/13/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022]
Abstract
AIM Data on ablation for atypical recurrent atrioventricular nodal reentry tachycardia (AVNRT) and long-term follow-up are generally sparse. Furthermore, the rate of recurrence and safety of cryoablation for atypical AVNRT has not been established. We compared patients cryoablated for atypical AVNRT and typical AVNRT during long-term follow-up. METHODS All patients (n = 2612) who underwent catheter ablation for AVNRT at the Karolinska University Hospital between January 2009 and August 2019 were analyzed. A total of 91 patients undergoing first-time cryoablation for atypical AVNRT were included. A control group with first-time cryoablation for typical AVNRT was matched in a 1:1 ratio. Patients were followed-up for recurrences for a median of 5.0 years (interquartile range: 3.1-7.5 years). RESULTS After 5 years, AVNRT recurrence occurred in 10 patients (11.0%) in the atypical AVNRT group and in 8 patients (8.8%) in the typical AVNRT group (hazard ratio: 1.31 [95% confidence interval: 0.52-3.32]; p = 0.568). The duration of the index procedure was significantly longer for atypical compared to typical AVNRT ablation (132.1 ± 49.2 min vs. 110.1 ± 38.8 min; p = 0.001). Transient AV blocks occurred in a similar fashion in the atypical compared to typical group (11 [12.1%] vs. 4 [4.9%]; p = 0.103). However, no ablation induced persistent AV block developed in either group. CONCLUSION Cryoablation for atypical AVNRT showed similar rate of recurrences and safety compared to typical AVNRT during long-term follow-up.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Jemtrén
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, St. Göran's Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Lina Benson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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Paul Nordin A, Drca N, Insulander P, Bastani H, Bourke T, Braunschweig F, Kennebäck G, von Olshausen G, Sadigh B, Saluveer O, Tapanainen J, Schwieler J, Åkerström F, Jensen-Urstad M. Low incidence of major complications after the first six hours post atrial fibrillation ablation: Is same-day discharge safe and feasible in most patients? J Cardiovasc Electrophysiol 2021; 32:2953-2960. [PMID: 34535936 DOI: 10.1111/jce.15243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/20/2021] [Accepted: 09/06/2021] [Indexed: 01/26/2023]
Abstract
AIMS This study evaluates the incidence of procedural complications related to catheter ablation of atrial fibrillation (AF) to assess the potential feasibility and safety of same-day discharge in a large cohort. METHODS We performed an analysis of prospectively collected data of complications of all patients staying overnight after undergoing AF ablation between 2001 and 2020 at a tertiary center. Using medical records, we analyzed complications occurring intraprocedurally until 6 h postablation and between 6 h postablation and discharge the day after the ablation procedure. RESULTS In 5414 AF ablations, we identified a total of 108 (2.0%) major complications occurring intraprocedural or before discharge. Most major complications occurred intraprocedurally or within 6 h after the procedure (n = 96, 1.8%). Twelve (0.2%) major complications occurred between 6 h Postablation and discharge. The most common of these major complications were congestive heart failure (n = 6) and transient ischemic attack (TIA, n = 4). During this time span, 61 (1.1%) minor complications occurred. Factors independently associated with major complications intraprocedurally and until discharge were body mass index (BMI) ≥ 30 kg/m2 (p = .009), significant valvular disease (p = .001), cardiomyopathy (p < .001), prior stroke or TIA (p = .014), first-time procedure versus repeat procedure (p = .013), cryoablation versus radiofrequency (p < .001), and procedure duration (p < .001). CONCLUSION After AF ablation, very few complications occurred between 6 h postprocedure and discharge the next day. Therefore, same-day discharge is a safe option for a majority of patients.
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Affiliation(s)
- Astrid Paul Nordin
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Gesa von Olshausen
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Bita Sadigh
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Finn Åkerström
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Drca N, Wolk A, Larsson SC. Occupational physical activity is associated with risk of atrial fibrillation in both men and women: a population-based cohort study. Acta Cardiol 2021; 76:712-717. [PMID: 32479142 DOI: 10.1080/00015385.2020.1770978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS Previous studies have found that excessive sport activities are associated with an increased risk of atrial fibrillation (AF). Whether occupational physical activity (OPA) increases the risk for AF is not well studied. We aimed to examine whether OPA influences the risk of AF. METHODS 80,922 men and women, free from AF, completed in 1997 a questionnaire about their OPA at that time (baseline), and also retrospectively in 1997 their OPA at the age of 30 and 50 years. Participants were categorised into three groups (low, medium and high) based on OPA load. Participants were followed-up in the Swedish National Patient Register for ascertainment of AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders. RESULTS 11,614 cases of AF were diagnosed during follow-up time of up to 17 years. We observed an increased risk of AF in relation to increased load of OPA regardless of age. Compared with men who reported a low load of OPA, the multivariable RR (95% CI) for men with a high load was 1.10 (1.03-1.17) at 30 years, 1.11 (1.04-1.17) at 50 years and 1.19 (1.10-1.29) at baseline. The results for women were similar with multivariable RR of 1.16 (1.06-1.27) at 30 years, 1.14 (1.05-1.24) at 50 years and 1.11 (0.99-1.24) at baseline. CONCLUSION These findings suggest that high load of OPA previous in life may play a role in increasing the risk for AF in both men and women.
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Affiliation(s)
- Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Susanna C. Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtren A, Kennebäck G, Ljungström E, Sadigh B, Saluveer O, Scheel S, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation as standard treatment of atrial flutter: a prospective, 2-center study (CASTAF). Acta Cardiol 2021; 76:267-271. [PMID: 32208915 DOI: 10.1080/00015385.2020.1721717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cryoablation (CRYO) of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) has been shown to be non-inferior to radiofrequency ablation (RF) in terms of ablation success and is associated with less pain. However, procedural time has been significantly longer with CRYO compared to RF. A possible explanation for this could be that operators had less experience with CRYO than with RF. The purpose of this study was to test the hypothesis that in the hands of experienced operators, cryoablation of CTI-dependent AFL is effective with procedure-time similar to what is reported for RF. METHODS This prospective 2-center study included 184 patients with CTI-dependent AFL - median age 66 years (range 28-83), 159 men (86%). Cryoablation was performed using a 9 F, 8 mm tip catheter (Freezor MAX, Medtronic, Inc, MN, USA). Ablation endpoint was bidirectional CTI-block. Pain was evaluated with a visual analogue scale (VAS 0-10). All operators had experience of at least 25 previous CTI-ablations with CRYO. RESULTS The acute success rate was 89%. Procedural time including an observation period of 30 min, was 115 ± 36 min which is similar to procedural times for RF in previous studies. Fluoroscopy time was 11 ± 9 min. Cryoablation was perceived as almost pain- free by the patients, VAS (mean) 1.8 ± 1.2. Success rate at 12-month follow-up (FU) was 88% in patients with primary success. No major adverse events occurred. CONCLUSIONS Cryoablation of CTI-dependent AFL is effective, with a low level of procedure-related pain. In experienced hands, the procedure time in this prospective non-randomised trial seems to be in the level of reported procedure times for RF. The long-term relapse rate appears to be higher than for RF.
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Affiliation(s)
- H. Bastani
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T. Bourke
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - F. Braunschweig
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - N. Drca
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K. Gudmundsson
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P. Insulander
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A. Jemtren
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G. Kennebäck
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E. Ljungström
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - B. Sadigh
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - O. Saluveer
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S. Scheel
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - J. Schwieler
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J. Tapanainen
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M. Jensen-Urstad
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Tapanainen JM, Insulander P, Drca N, Jemtrén A, Åkerström F, Jensen-Urstad M. Unmasking of pre-excitation after aortic valve surgery - A report of two cases. HeartRhythm Case Rep 2020; 7:178-181. [PMID: 33786316 PMCID: PMC7987896 DOI: 10.1016/j.hrcr.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jari M. Tapanainen
- Address reprint requests and correspondence: Dr Jari M. Tapanainen, Department of Cardiology, Karolinska University Hospital, S-171 76 Stockholm, Sweden.
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von Olshausen G, Saluveer O, Schwieler J, Drca N, Bastani H, Tapanainen J, Bourke T, Paul-Nordin A, Kennebäck G, Insulander P, Jensen-Urstad M, Braunschweig F. Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences. Clin Res Cardiol 2020; 110:851-860. [PMID: 33184675 PMCID: PMC8166690 DOI: 10.1007/s00392-020-01765-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cather ablation is known to influence the autonomic nervous system. This study sought to investigate the association of sinus heart rate pre-/post-ablation and recurrences in patients with atrial fibrillation undergoing pulmonary vein isolation (PVI). METHODS Between January 2012 and December 2017, data of 482 patients undergoing their first PVI were included. Sinus heart rate was recorded before (PRE), directly post-ablation (POST) and 3 months post-ablation (3 M). All patients were screened for atrial tachyarrhythmia recurrences during the one-year follow-up. RESULTS In the total study cohort, the mean resting sinus heart rate at PRE [mean 57.9 bpm (95% CI 57.1-58.7 bpm)] increased by over 10 bpm to POST [mean 69.4 bpm (95% CI 68.5-70.3 bpm); p < 0.001] followed by a slight decrease at 3 M [mean 67.3 bpm (95% CI 66.4-68.2 bpm)] but still remaining higher compared to PRE (p < 0.001). This pattern was observed in patients with and without recurrences at POST and 3 M (both p < 0.001 compared to PRE). However, at 3 M the mean sinus heart rate was significantly lower in patients with compared to patients without recurrences (p = 0.031). In this regard, patients with a heart rate change < 11 bpm (PRE to 3 M) or, as an alternative parameter, patients with a heart rate < 60 bpm at 3 M had a significantly higher risk of recurrences compared to the remaining patients (Hazard ratio (HR) 1.82 (95% CI 1.32-2.49), p < 0.001 and HR 1.64 (95% CI 1.20-2.25), p = 0.002, respectively). CONCLUSION Our study confirms the impact of PVI on cardiac autonomic function with a significant sinus heart rate increase post-ablation. Patients with a sinus heart rate change < 11 bpm (PRE to 3 M) are at higher risk for recurrences during one-year post-PVI.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden.
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden
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Von Olshausen G, Saluveer O, Schwieler J, Drca N, Bastani H, Tapanainen J, Bourke T, Paul-Nordin A, Kenneback G, Insulander P, Jensen-Urstad M, Braunschweig F. Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
To investigate the association of sinus heart rate pre- and post-ablation and recurrence rates in patients undergoing catheter ablation for atrial fibrillation.
Methods
Between January 2012 and December 2017, data of 482 patients undergoing their first pulmonary vein isolation (PVI) were included. All patients were followed-up for 12 months and were screened for any atrial tachyarrhythmia. Sinus heart rate measurements were recorded before (PRE), directly post ablation (POST) and 3 months post ablation (3M).
Results
In the total study population, the mean resting sinus heart rate at PRE (mean 57.9 bpm (95% CI, 57.1–58.7 bpm)) increased by over 10 bpm to POST (mean 69.4 bpm (95% CI, 68.5–70.3 bpm); p<0.001) followed by a slight decrease at 3M (mean 67.3 bpm (95% CI, 66.4–68.2 bpm)) but still remaining higher compared to PRE (p<0.001). This pattern was observed in patients with and without recurrences at PRE, POST and 3M respectively (both p<0.001). However, only at 3M, there was a significant difference in mean heart rate being lower in patients with compared to patients without recurrences (p=0.031). In this regard, patients with a heart rate ≥60 bpm at 3M and a heart rate change ≥11 bpm (PRE to 3M) had a favorable outcome in terms of recurrences compared to the remaining patients (HR 0.61 (95% CI, 0.44–0.84), p=0.002 and HR 0.55 (95% CI, 0.40–0.76), p<0.001, respectively). These variables remained independently associated in multivariable analysis.
Conclusion
Our study confirms the impact of PVI on cardiac autonomic function with a significant heart increase post-ablation. A heart rate ≥60bpm at 3M and a heart rate change ≥11 bpm (PRE to 3M) are associated with a favorable outcome in terms of recurrences.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
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Affiliation(s)
| | - O Saluveer
- Karolinska University Hospital, Stockholm, Sweden
| | - J Schwieler
- Karolinska University Hospital, Stockholm, Sweden
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | - H Bastani
- Karolinska University Hospital, Stockholm, Sweden
| | - J Tapanainen
- Karolinska University Hospital, Stockholm, Sweden
| | - T Bourke
- Karolinska University Hospital, Stockholm, Sweden
| | | | - G Kenneback
- Karolinska University Hospital, Stockholm, Sweden
| | - P Insulander
- Karolinska University Hospital, Stockholm, Sweden
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Von Olshausen G, Bourke T, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Benson L, Goedel A, Kenneback G, Insulander P, Jensen-Urstad M, Braunschweig F. Long-term outcome of patients with invasive electrophysiology procedure related cardiac tamponade. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analyzed the risk of death or serious cardiovascular events in patients suffering from EP related cardiac tamponade requiring pericardiocentesis during long-term follow-up.
Methods and results
Out of 19997 invasive EPs at our university hospital between January 1998 and September 2018, all patients with EP related periprocedural cardiac tamponade were identified (n=60) and matched (1:3 ratio) to a control group (n=180). After a follow-up of 5 years, the composite primary end point - death from any cause, acute myocardial infarction, TIA/stroke and hospitalization for heart failure – occurred in significantly more patients in the tamponade than in the control group (12 patients (20.0%) vs 19 patients (10.6%); Hazard ratio (HR) 2.53 (95% CI, 1.15–5.58); p=0.021). This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group (HR 3.75 (95% CI, 1.01–13.97); p=0.049). Death from any cause, acute myocardial infarction and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group (HR 36.0 (95% CI, 4.68–276.86); p=0.001).
Conclusion
Patients with EP related cardiac tamponade are at higher risk for cerebrovascular events during the first two weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
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Affiliation(s)
| | - T Bourke
- Karolinska University Hospital, Stockholm, Sweden
| | - J Schwieler
- Karolinska University Hospital, Stockholm, Sweden
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | - H Bastani
- Karolinska University Hospital, Stockholm, Sweden
| | - J Tapanainen
- Karolinska University Hospital, Stockholm, Sweden
| | - O Saluveer
- Karolinska University Hospital, Stockholm, Sweden
| | - L Benson
- Karolinska Institutet, Stockholm, Sweden
| | - A Goedel
- Karolinska Institutet, Stockholm, Sweden
| | - G Kenneback
- Karolinska University Hospital, Stockholm, Sweden
| | - P Insulander
- Karolinska University Hospital, Stockholm, Sweden
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von Olshausen G, Bourke T, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Benson L, Goedel A, Kennebäck G, Insulander P, Jensen-Urstad M, Braunschweig F. Long-term outcome of patients with invasive electrophysiology procedure-related cardiac tamponade. Europace 2020; 22:1547-1557. [PMID: 32772100 DOI: 10.1093/europace/euaa155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/18/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analysed the risk of death or serious cardiovascular events in patients suffering from EP-related cardiac tamponade requiring pericardiocentesis during long-term follow-up. METHODS AND RESULTS Out of 19 997 invasive EPs at the Karolinska University Hospital between January 1998 and September 2018, all patients with EP-related periprocedural cardiac tamponade were identified (n = 60) and matched (1:3 ratio) to a control group (n = 180). After a follow-up of 5 years, the composite primary endpoint - death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure - occurred in significantly more patients in the tamponade than in the control group [12 patients (20.0%) vs. 19 patients (10.6%); hazard ratio (HR) 2.53 (95% confidence interval, CI 1.15-5.58); P = 0.021]. This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group [HR 3.75 (95% CI 1.01-13.97); P = 0.049]. Death from any cause, acute myocardial infarction, and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group [HR 36.0 (95% CI 4.68-276.86); P = 0.001]. CONCLUSION Patients with EP-related cardiac tamponade are at higher risk for cerebrovascular events during the first 2 weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Lina Benson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Goedel
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
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Affiliation(s)
- Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine (S.C.L.), Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Surgical Sciences, The EpiHub, Uppsala University (S.C.L.)
| | - Nikola Drca
- Department of Medicine (N.D.), Huddinge, Karolinska Institutet, Stockholm, Sweden.,Division of Arrhythmia, Karolinska University Hospital, Stockholm, Sweden (N.D.)
| | - Amy M Mason
- Department of Public Health and Primary Care (A.M.M., S.B.), University of Cambridge, United Kingdom
| | - Stephen Burgess
- Department of Public Health and Primary Care (A.M.M., S.B.), University of Cambridge, United Kingdom.,MRC Biostatistics Unit (S.B.), University of Cambridge, United Kingdom
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27
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Olshausen G, Uijl A, Jensen‐Urstad M, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Bourke T, Kennebäck G, Insulander P, Deisenhofer I, Braunschweig F. Early recurrences of atrial tachyarrhythmias post pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:674-681. [DOI: 10.1111/jce.14368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Gesa Olshausen
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Alicia Uijl
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholm Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht University The Netherlands
- Health Data Research UK London, Institute for Health InformaticsUniversity College London London United Kingdom
| | - Mats Jensen‐Urstad
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Jonas Schwieler
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Nikola Drca
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Hamid Bastani
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Jari Tapanainen
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Ott Saluveer
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Tara Bourke
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Göran Kennebäck
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Per Insulander
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz‐ und KreislauferkrankungenTechnische Universität MünchenMunich Germany
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28
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Andronache M, Drca N, Viola G. High-resolution Mapping in Patients with Persistent Atrial Fibrillation: A Case-based Review of the PENTARAYTM Catheter. Arrhythm Electrophysiol Rev 2019. [DOI: 10.15420/aer.2019.8.3.s1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Ablation of AF through electrical isolation of the pulmonary veins is a well-established technique and a cornerstone in the ablation of AF, although there are a variety of techniques and ablation strategies now available. However, high numbers of patients are returning to hospital after ablation procedures such as pulmonary vein isolation (PVI). Scar tissue (as identified by contact voltage mapping) is found to be present in many of these patients, especially those with persistent AF and even those with paroxysmal AF. This scarring is associated with poor outcomes after PVI. Cardiac mapping is necessary to locate triggers and substrate so that an ablation strategy can be optimised. Multipolar mapping catheters offer more information regarding the status of the tissue than standard ablation catheters. A patient-tailored catheter ablation approach, targeting the patient-specific low voltage/fibrotic substrate can lead to improved outcomes.
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Larsson SC, Drca N, Michaëlsson K. Serum Magnesium and Calcium Levels and Risk of Atrial Fibrillation. Circ: Genomic and Precision Medicine 2019; 12:e002349. [DOI: 10.1161/circgen.118.002349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Susanna C. Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.)
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (S.C.L., K.M.)
| | - Nikola Drca
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden (N.D.)
- Division of Arrhythmia, Karolinska University Hospital, Stockholm, Sweden (N.D.)
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (S.C.L., K.M.)
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Abstract
BACKGROUND Nut consumption has been found to be inversely associated with cardiovascular disease mortality, but the association between nut consumption and incidence of specific cardiovascular diseases is unclear. We examined the association between nut consumption and incidence of seven cardiovascular diseases. METHODS This prospective study included 61 364 Swedish adults who had completed a Food Frequency Questionnaire and were followed up for 17 years through linkage with the Swedish National Patient and Death Registers. RESULTS Nut consumption was inversely associated with risk of myocardial infarction, heart failure, atrial fibrillation and abdominal aortic aneurysm in the age-adjusted and sex-adjusted analysis. However, adjustment for multiple risk factors attenuated these associations and only a linear, dose-response, association with atrial fibrillation (ptrend=0.004) and a non-linear association (pnon-linearity=0.003) with heart failure remained. Compared with no consumption of nuts, the multivariable HRs (95% CI) of atrial fibrillation across categories of nut consumption were 0.97 (0.93 to 1.02) for 1-3 times/month, 0.88 (0.79 to 0.99) for 1-2 times/week and 0.82 (0.68 to 0.99) for ≥3 times/week. For heart failure, the corresponding HRs (95% CI) were 0.87 (0.80 to 0.94), 0.80 (0.67 to 0.97) and 0.98 (0.76 to 1.27). Nut consumption was not associated with risk of aortic valve stenosis, ischaemic stroke or intracerebral haemorrhage. CONCLUSIONS These findings suggest that nut consumption or factors associated with this nutritional behaviour may play a role in reducing the risk of atrial fibrillation and possibly heart failure. TRIAL REGISTRATION NUMBER NCT01127711 and NCT01127698;Results.
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Affiliation(s)
- Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Bäck
- Divison of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Larsson SC, Drca N, Jensen-Urstad M, Wolk A. Chocolate consumption and risk of atrial fibrillation: Two cohort studies and a meta-analysis. Am Heart J 2018; 195:86-90. [PMID: 29224650 DOI: 10.1016/j.ahj.2017.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 06/16/2017] [Accepted: 09/16/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chocolate consumption has been inconsistently associated with risk of atrial fibrillation (AF). We investigated the association between chocolate consumption and risk of AF in Swedish adults from two cohort studies and conducted a meta-analysis to summarize available evidence from cohort studies on this topic. METHODS Our study population comprised 40,009 men from the Cohort of Swedish Men and 32,486 women from the Swedish Mammography Cohort. Incident AF cases were ascertained through linkage with the Swedish National Patient Register. Published cohort studies of chocolate consumption in relation to risk of AF were identified by a PubMed search through September 14, 2017. RESULTS During a mean follow-up of 14.6 years, AF was diagnosed in 9978 Swedish men and women. Compared with non-consumers, the multivariable hazard ratio of AF for those in the highest category of chocolate consumption (≥3-4 servings/week) was 0.96 (95% CI 0.88-1.04). In a random-effects meta-analysis of 5 cohort studies, including 180,454 participants and 16,356 AF cases, the hazard ratios of AF were 0.97 (95% CI 0.94-1.01) per 2 servings/week increase in chocolate consumption and 0.96 (95% CI 0.90-1.03) for the highest versus lowest category of chocolate consumption. CONCLUSION Available data provide no evidence of an association of chocolate consumption with risk of AF.
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Affiliation(s)
- Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Nikola Drca
- Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Abstract
AIM The objective of this study was to apply extended NO analysis for measurements of NO dynamics in the lung, divided into alveolar and airway contribution, in amateur runners and marathoners. METHODS The athletes participated in either a marathon or a half marathon. The athletes self-reported their age, weight, height, training distance per week, competing distance, cardio-pulmonary health, atopic status, and use of tobacco. Measurements of exhaled NO (FENO) with estimation of alveolar NO (CANO) and airway flux (JawNO), ventilation, pulse oximetry, and peak flow were performed before, immediately after, and 1 hour after completing the race. RESULTS At baseline the alveolar NO was higher in amateur runners, 2.9 ± 1.1 ppb (p = 0.041), and marathoners, 3.6 ± 1.9 ppb (p = 0.002), than in control subjects, 1.4 ± 0.5 ppb. JawNO was higher in marathoners, 0.90 ± 0.02 nL s-1 (p = 0.044), compared with controls, 0.36 ± 0.02 nL s-1, whereas the increase in amateur runners, 0.56 ± 0.02 nL s-1, did not attain statistical significance (p = 0.165). Immediately after the race there was a decrease in FENO in both amateur runners and marathoners, whereas CANO and JawNO were decreased in marathoners only. CONCLUSION Our results support the view that there is an adaptation of the lung to exercise. Thus strenuous exercise increased both airway and alveolar NO, and this might in turn facilitate oxygen uptake.
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Affiliation(s)
- Alexandra Thornadtsson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden
| | - Nikola Drca
- Department of Medicine, Huddinge, Karolinska Institute, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Fabio Ricciardolo
- Division of Respiratory Disease, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Marieann Högman
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- CONTACT Marieann Högman Department of Medical Sciences, University Hospital, 751 85 Uppsala, Sweden
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Insulander P, Bastani H, Braunschweig F, Drca N, Kennebäck G, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation of atrioventricular nodal re-entrant tachycardia: 7-year follow-up in 515 patients-confirmed safety but very late recurrences occur. Europace 2017; 19:1038-1042. [PMID: 27738058 DOI: 10.1093/europace/euw145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/27/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Cryoablation is an alternative method to radiofrequency ablation for treatment of atrioventricular nodal re-entrant tachycardia (AVNRT). This study investigates the long-term safety and efficacy of cryoablation in AVNRT. Methods and results We studied 515 consecutive patients (317 women, mean age 50 years, range 13-89 years) undergoing a first cryoablation for AVNRT between 2003 and 2008. Ablations were performed with a 6-mm Freezor Xtra catheter. Six patients were acute failures; 494 out of 509 (97%) primarily successfully ablated patients were followed up for a mean of 7.1 years (range 2-12 years). About 11% (54/494 patients) of patients had recurrences of the index arrhythmia. Time to recurrence varied from days to 9 years; 14 patients (3%) had recurrences later than 2 years, 8 patients (2%) later than 3 years, and 6 patients (2%) later than 4 years. Recurrence rate was higher in patients with slow-slow or fast-slow AVNRT (n = 24) compared with the common slow-fast variant (25 vs. 10%; P = 0.04). Recurrence rate was not higher in patients with residual slow pathway conduction (jump with or without echo beat, n = 199, 39%). Transient atrioventricular (AV) block of the first-, second-, or third-degree during ablation was observed in 45 patients but had no impact on the risk of AVNRT recurrence. No late AV block occurred. Single vs. multiple applications or total amount of cryoenergy delivered did not differ between patients with and without recurrences. Conclusion Cryoablation in AVNRT is safe with a long-term efficacy of 88%; however, very late recurrences occur.
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Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtren A, Kenneback G, Ljungstrom E, Sadigh B, Saluveer O, Scheel S, Schwieler J, Tapanainen J, Jensen-Urstad M. P888Cryoablation as standard treatment of atrial flutter (CASTAF). Europace 2017. [DOI: 10.1093/ehjci/eux151.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Matoshvili Z, Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtrén A, Kennebäck G, Saluveer O, Schwieler J, Tapanainen J, Wredlert C, Jensen-Urstad M. Safety of fluoroscopy-guided transseptal approach for ablation of left-sided arrhythmias. Europace 2017; 19:2023-2026. [DOI: 10.1093/europace/euw432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/16/2016] [Indexed: 11/13/2022] Open
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Saygi S, Bastani H, Drca N, Insulander P, Wredlert C, Schwieler J, Jensen-Urstad M. Impact of cavotricuspid isthmus morphology in CRYO versus radiofrequency ablation of typical atrial flutter. SCAND CARDIOVASC J 2016; 51:69-73. [DOI: 10.1080/14017431.2016.1259496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Serkan Saygi
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Christer Wredlert
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Matoshvili Z, Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Jemtren A, Kenneback G, Saluveer O, Schwieler J, Tapanainen J, Wredlert C, Jensen-Urstad M. 136-29: Safety of transseptal approach for ablation of left sided arrhythmias. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i97b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Saygi S, Drca N, Insulander P, Schwieler J, Jensen-Urstad M, Bastani H. Myocardial injury during radiofrequency and cryoablation of typical atrial flutter. J Interv Card Electrophysiol 2015; 46:177-81. [PMID: 26546105 DOI: 10.1007/s10840-015-0074-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/29/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Cardiac enzyme elevation after radiofrequency (RF) catheter ablation of atrial flutter (AFL) is common. Some studies found that cryoablation (CRYO) of AFL, compared to RF, is associated with higher levels of troponin, a finding that may indicate CRYO causes a greater amount of myocardial injury than RF. However, other investigations found no significant differences between troponin levels after CRYO versus RF. We have in a randomized study compared the post-procedural troponin I levels in RF and CRYO and the possible relation to procedural outcome and complications. METHODS We randomized 153 patients with cavotricuspid isthmus (CTI)-dependent AFL to CRYO or RF (78 CRYO; 75 RF). RF was performed with a 3.5-mm open-irrigated-tip catheter, and CRYO was performed with an 8-mm-tip catheter. Troponin I levels were measured before and 6 h after ablation. RESULTS Acute procedural success was achieved in 71/75 patients in the RF and in 72/78 patients in the CRYO. Troponin I levels were significantly elevated in both groups (baseline 0.012, 6th hour 0.35 ng/ml; p < 0.001). Troponin I levels were similar for RF and CRYO. Troponin I levels were higher in patients with acute failure compared to patients with acute success (0.48 ± 0.4 and 0.34 ± 0.16 ng/ml, p = 0.029); however, there was no difference between patients with or without late recurrence. There were no major complications in any group. CONCLUSION RF and CRYO for CTI-dependent AFL resulted in similar amounts of procedural myocardial injury. Troponin I levels had no prognostic value for late recurrence of AFL and there were no complications related to high troponin I levels.
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Affiliation(s)
- Serkan Saygi
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. .,Cardiology Department, Karolinska University Hospital, M52, 141 86, Huddinge, Stockholm, Sweden.
| | - Nikola Drca
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Hamid Bastani
- All Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Larsson SC, Drca N, Jensen-Urstad M, Wolk A. Combined impact of healthy lifestyle factors on risk of atrial fibrillation: Prospective study in men and women. Int J Cardiol 2015; 203:46-9. [PMID: 26512817 DOI: 10.1016/j.ijcard.2015.10.106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/22/2015] [Accepted: 10/13/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The combined impact of multiple lifestyle factors on risk of atrial fibrillation (AF) remains unclear. We investigated the joint association of four modifiable lifestyle factors on incidence of AF in a prospective study of men and women. METHODS The study cohort comprised 39 300 men in the Cohort of Swedish Men and 33 090 women in the Swedish Mammography Cohort who were 45-83 years of age and free from atrial fibrillation at baseline. Healthy lifestyle was defined as body mass index <25 kg/m(2), regular exercise for ≥ 20 min/day, no or light-to-moderate alcohol consumption (≤ 2 drinks/day for men and ≤ 1 drink/day for women), and not smoking. Incident AF cases were identified through linkage with the Swedish National Inpatient Register. RESULTS During a mean follow-up of 10.9 years, AF occurred in 4028 men and 2539 women. Compared with men and women with no healthy lifestyle factors, the multivariable relative risks (95% confidence interval) of AF were 0.83 (0.65-1.07) for one, 0.74 (0.58-0.94) for two, 0.62 (0.49-0.79) for three, and 0.50 (0.39-0.64) for four healthy lifestyle factors (P for trend <0.0001). The inverse association was similar in men and women. CONCLUSIONS Four healthy lifestyle factors combined were associated with a halving of the risk of AF.
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Affiliation(s)
- Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Larsson SC, Drca N, Jensen-Urstad M, Wolk A. Coffee consumption is not associated with increased risk of atrial fibrillation: results from two prospective cohorts and a meta-analysis. BMC Med 2015; 13:207. [PMID: 26394673 PMCID: PMC4579587 DOI: 10.1186/s12916-015-0447-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether coffee consumption affects the risk of developing atrial fibrillation (AF) remains unclear. We sought to investigate the association between coffee consumption and incidence of AF in two prospective cohorts, and to summarize available evidence using a meta-analysis. METHODS Our study population comprised 41,881 men in the Cohort of Swedish Men and 34,594 women in the Swedish Mammography Cohort who had provided information on coffee consumption in 1997 and were followed up for 12 years. Incident cases of AF were ascertained by linkage with the Swedish Hospital Discharge Register. For the meta-analysis, prospective studies were identified by searching PubMed and Embase through 22 July 2015, and by reviewing the reference lists of retrieved articles. Study-specific relative risks were combined using a random effects model. RESULTS We ascertained 4,311 and 2,730 incident AF cases in men and women, respectively, in the two cohorts. Coffee consumption was not associated with AF incidence in these cohort studies. The lack of association was confirmed in a meta-analysis, including six cohort studies with a total of 10,406 cases of AF diagnosed among 248,910 individuals. The overall relative risk (95% confidence interval) of AF was 0.96 (0.84-1.08) for the highest versus lowest category of coffee consumption, and 0.99 (0.94-1.03) per 2 cups/day increment of coffee consumption. CONCLUSIONS We found no evidence that coffee consumption is associated with increased risk of AF.
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Affiliation(s)
- Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart 2015; 101:1627-30. [DOI: 10.1136/heartjnl-2014-307145] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/29/2015] [Indexed: 11/04/2022] Open
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Larsson SC, Drca N, Jensen-Urstad M, Wolk A. Incidence of atrial fibrillation in relation to birth weight and preterm birth. Int J Cardiol 2015; 178:149-52. [DOI: 10.1016/j.ijcard.2014.10.138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/27/2014] [Accepted: 10/21/2014] [Indexed: 01/19/2023]
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Larsson SC, Drca N, Wolk A. Alcohol consumption and risk of atrial fibrillation: a prospective study and dose-response meta-analysis. J Am Coll Cardiol 2014; 64:281-9. [PMID: 25034065 DOI: 10.1016/j.jacc.2014.03.048] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [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: 01/14/2014] [Revised: 03/08/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although high alcohol consumption has been associated with increased risk of atrial fibrillation (AF), the role of light to moderate drinking remains unclear. OBJECTIVES The study sought to investigate the association between alcohol consumption and AF risk in a prospective study of Swedish men and women and to conduct a meta-analysis of prospective studies to summarize available evidence. METHODS We followed 79,019 men and women who, at baseline, were free from AF and had completed a questionnaire about alcohol consumption and other risk factors for chronic diseases. Incident AF cases were ascertained by linkage to the Swedish Inpatient Register. For the meta-analysis, studies were identified by searching PubMed through January 10, 2014, and by reviewing references of pertinent publications. Study-specific relative risks (RRs) were combined using a random effects model. RESULTS Over 859,420 person-years of follow-up (1998 to 2009), 7,245 incident AF cases were identified in our own cohort study. The association between alcohol consumption and AF did not differ by sex (p for interaction = 0.74). Compared with current drinkers of <1 drink/week (12 g alcohol/drink), the multivariable RRs of AF were 1.01 (95% confidence interval [CI]: 0.94 to 1.09) for 1 to 6 drinks/week, 1.07 (95% CI: 0.98 to 1.17) for 7 to 14 drinks/week, 1.14 (95% CI: 1.01 to 1.28) for 15 to 21 drinks/week, and 1.39 (95% CI: 1.22 to 1.58) for >21 drinks/week. Results were similar after excluding binge drinkers. In a meta-analysis of 7 prospective studies, including 12,554 AF cases, the RRs were 1.08 (95% CI: 1.06 to 1.10) for 1 drink/day, 1.17 (95% CI: 1.13 to 1.21) for 2 drinks/day, 1.26 (95% CI: 1.19 to 1.33) for 3 drinks/day, 1.36 (95% CI: 1.27 to 1.46) for 4 drinks/day, and 1.47 (95% CI: 1.34 to 1.61) for 5 drinks/day, compared with nondrinkers. CONCLUSIONS These findings indicate that alcohol consumption, even at moderate intakes, is a risk factor for atrial fibrillation.
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Affiliation(s)
- Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Abstract
OBJECTIVE This study examines the influence of physical activity at different ages and of different types, on the risk of developing atrial fibrillation (AF) in a large cohort of Swedish men. METHODS Information about physical activity was obtained from 44 410 AF-free men, aged 45-79 years (mean age=60), who had completed a self-administered questionnaire at baseline in 1997. Participants reported retrospectively their time spent on leisure-time exercise and on walking or bicycling throughout their lifetime (at 15, 30 and 50 years of age, and at baseline (mean age=60)). Participants were followed-up in the Swedish National Inpatient Register for ascertainment of AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% CIs, adjusted for potential confounders. RESULTS During a median follow-up of 12 years, 4568 cases of AF were diagnosed. We observed a RR of 1.19 (95% CI 1.05 to 1.36) of developing AF in men who at the age of 30 years had exercised for >5 h/week compared with <1 h/week. The risk was even higher (RR 1.49, 95% CI 1.14 to 1.95) among the men who exercised >5 h/week at age 30 and quit exercising later in life (<1 h/week at baseline). Walking/bicycling at baseline was inversely associated with risk of AF (RR 0.87, 95% CI 0.77 to 0.97 for >1 h/day vs almost never) and the association was similar after excluding men with previous coronary heart disease or heart failure at baseline (corresponding RR 0.88, 95% CI 0.77 to 0.998). CONCLUSIONS Leisure-time exercise at younger age is associated with an increased risk of AF, whereas walking/bicycling at older age is associated with a decreased risk.
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Affiliation(s)
- Nikola Drca
- Department of Cardiology at the Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Alicja Wolk
- Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology at the Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna C Larsson
- Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Insulander P, Bastani H, Braunschweig F, Drca N, Gudmundsson K, Kennebäck G, Sadigh B, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation of substrates adjacent to the atrioventricular node: acute and long-term safety of 1303 ablation procedures. Europace 2013; 16:271-6. [PMID: 23851515 DOI: 10.1093/europace/eut215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Radiofrequency (RF) ablation is effective for ablation of atrial arrhythmias. However, RF ablation in the vicinity of the atrioventricular (AV) node is associated with a risk of inadvertent, irreversible high-grade AV block, depending on the type of substrate. Cryoablation is an alternative method. The objective was to investigate the acute and long-term risks of AV block during cryoablation. METHODS AND RESULTS We studied 1303 consecutive cryoablations of substrates in the vicinity of the AV node in 1201 patients (median age 51 years, range 6-89 years) on acute and long-term impairment to the AV nodal conduction system. The arrhythmias treated were AV nodal reentrant tachycardias (n=1116), paraseptal and superoparaseptal accessory pathways (n=100), and focal atrial tachycardias (n=87). In 158 (12%) procedures, cryomapping (38 cases) or cryoablation (120 cases) were stopped due to transient AV block (first-degree AV block 74 cases, second-degree AV block 67 cases, and third-degree AV block 17 cases) after which another site was tested. Transient AV block occurred within seconds of mapping up to 3 min of ablation. The incidence of AV block was similar for different substrates. In most cases, AV nodal conduction was restored within seconds but in two cases transient AV block lasted 21 and 45 min, respectively. There were no cases of acute permanent AV blocks. No late AV blocks occurred during follow-up (mean 24 months, range 6-96 months). CONCLUSION Cryoablation adjacent to the AV node carries a negligible risk of permanent AV block. Transient AV block during ablation is a benign finding.
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Affiliation(s)
- Per Insulander
- Department of Cardiology, Karolinska University Hospital, S-141 86 Stockholm, Sweden
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Bastani H, Drca N, Insulander P, Schwieler J, Braunschweig F, Kennebäck G, Sadigh B, Tapanainen J, Jensen-Urstad M. Cryothermal vs. radiofrequency ablation as atrial flutter therapy: a randomized comparison. ACTA ACUST UNITED AC 2012; 15:420-8. [DOI: 10.1093/europace/eus261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Andersson T, Magnusson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D, Polovina M, Potpara T, Licina M, Mujovic N, Kocijancic A, Simic D, Ostojic MC, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Bosch RF, Kirch W, Rosin L, Willich SN, Pittrow D, Bonnemeier H, Valenza MC, Martin L, Munoz Casaubon T, Valenza G, Botella M, Serrano M, Valenza B, Cabrera I, Anderson K, Benzaquen BS, Koziolova N, Nikonova J, Shilova Y, Scherr D, Narayan S, Wright M, Krummen D, Jadidi A, Jais P, Haissaguerre M, Hocini M, Hunter R, Liu Y, Lu Y, Wang W, Schilling RJ, Bernstein S, Wong B, Rooke R, Vasquez C, Shah R, Rosenberg S, Chinitz L, Morley G, Bashir Choudhary M, Holmqvist F, Carlson J, Nilsson HJ, Platonov PG, Jadidi AS, Cochet H, Miyazaki S, Shah AJ, Scherr D, Marrouche N, Haissaguerre M, Jais P, Calvo N, Nadal M, Andreu D, Tamborero D, Diaz FE, Berruezo A, Brugada J, Mont L, Fichtner S, Hessling G, Estner HL, Jilek C, Reents T, Ammar S, Wu J, 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Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bastani H, Insulander P, Schwieler J, Tabrizi F, Braunschweig F, Kenneback G, Drca N, Jensen-Urstad M. Cryoablation of superoparaseptal and septal accessory pathways: a single centre experience. Europace 2010; 12:972-7. [DOI: 10.1093/europace/euq079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schwieler J, Drca N, Bastani H, Braunschweig F, Insulander P, Jensen-Urstad M, Kennebäck G, Kongstad O, Sadigh B, Tapanainen J, Bergfeldt L. [Asymptomatic preexcitation--a risk marker for sudden death]. Lakartidningen 2009; 106:3176-3178. [PMID: 20077644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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