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Zhou T, Gong P, Xu M, Yan L, Zhang Y. Efficacy of Shensong Yangxin capsule combined with dronedarone in paroxysmal atrial fibrillation after ablation. Medicine (Baltimore) 2024; 103:e37918. [PMID: 38669399 PMCID: PMC11049715 DOI: 10.1097/md.0000000000037918] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To investigate whether postoperative administration of Shensong Yangxin capsules (SSYX) and dronedarone for atrial fibrillation (AF) can reduce the recurrence of paroxysmal AF after radiofrequency ablation, thus providing a more optimal choice of antiarrhythmic medication during the blank period. METHODS We included 120 patients with paroxysmal AF who underwent radiofrequency ablation at our hospital between July 2020 and July 2022. They underwent routine circumferential pulmonary vein ablation and, subsequently, left and right atrial pressure monitoring to assess sinoatrial node recovery time under burst 400/300 ms stimulation. Postoperatively, the patients were randomly divided into 2 groups (60 patients each). The control group was administered dronedarone orally for 3 months and the study group was treated with SSYX combined with dronedarone. This study aimed to compare differences in clinical efficacy of the treatment between the 2 groups. RESULTS The left and right atrial pressures in both groups were higher than those in the preoperative period (P < .05), with no statistically significant differences between the 2 groups (P > .05). Sinoatrial node recovery time under burst 400/300 ms stimulation showed no statistical difference between the 2 groups (P > .05). At 3 months and 1 year postoperatively, the AFEQT scale scores for both groups were lower than those before treatment (P < .05), with the study group scoring lower than the control group at 3 months (P < .05). However, no statistically significant difference was observed between the 2 groups at 1 year postoperatively (P > .05). At 3 months postoperatively, the sinus rhythm maintenance rate and heart rate were higher in the intervention group than in the control group (P < .05); however, these differences between the 2 groups were not statistically significant at 1 year postoperatively (P > .05). CONCLUSION SUBSECTIONS The combination of SSYX and dronedarone could effectively reduce the early recurrence of paroxysmal AF after radiofrequency ablation, increase heart rate, and improve the quality of life.
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Affiliation(s)
- Tao Zhou
- Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Ping Gong
- Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Ming Xu
- Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Leikun Yan
- Sichuan Mianyang 404 Hospital, Mianyang, China
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Lv J, Wang R, Yang J, You L, Yang C, Zhang Y, Liu Q, Yin L, Liu JT, Xie RQ. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation. Open Med (Wars) 2024; 19:20240951. [PMID: 38623457 PMCID: PMC11017190 DOI: 10.1515/med-2024-0951] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Objective In the present study, we investigated the impact of left atrial appendage closure (LAAC) following catheter ablation (CA) on the left atrial structure and functioning of patients with paroxysmal atrial fibrillation (AF). Methods Patients with paroxysmal AF were enrolled in this single-center prospective cohort study between April 2015 and July 2021; 353 patients received CA alone, while 93 patients received CA in combination with Watchman LAAC. We used age, gender, CHA2DS2-VASc, and HAS-BLED scores as well as other demographic variables to perform propensity score matching. Patients with paroxysmal AF were randomly assigned to the CA combined with Watchman LAAC group (combined treatment group) and the simple CA group, with 89 patients in each group. The left atrial structure, reserve, ventricular diastole, and pump functions and their changes in patients were assessed using routine Doppler echocardiography and 2D speckle tracking echocardiography over the course of a 1-year follow-up. Results At 1-week follow-up, the reserve, ventricular diastole, and pump functions of the left atrium (LA) increased in both groups; these functions were gradually restored at the 1- to 3-month follow-up; they were close to or returned to their pre-operative levels at the 3-month follow-up; and no significant differences were found compared with the pre-operative levels at the 12-month follow-up. In the first 3 months, the reserve (Ƹ, SRs) and pump functions (SRa) in the combined treatment group decreased significantly when compared with the simple CA group, and the differences were statistically significant. Conclusion Patients with paroxysmal AF may experience a short term, partial effect of LAAC on LA reserve and pump functions, which are gradually restored and the effect disappears by 12 months.
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Affiliation(s)
- Jing Lv
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
- Division of Cardiology, Xingtai People’s Hospital of Hebei Medical University, Xingtai, Hebei, 054000, China
| | - Rui Wang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Jing Yang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Ling You
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Chao Yang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Yan Zhang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Qian Liu
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Lei Yin
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Jin-ting Liu
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Rui-qin Xie
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei, 050051, China
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Hwang T, Kwon O, Yu HT, Yang S, Kim D, Kim T, Uhm J, Joung B, Lee M, Hwang C, Pak H. Using computed tomogram atrial myocardial thickness maps in high-power short-duration radiofrequency pulmonary vein isolation: UTMOST AF. J Arrhythm 2024; 40:267-277. [PMID: 38586840 PMCID: PMC10995596 DOI: 10.1002/joa3.13008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/25/2024] [Accepted: 02/17/2024] [Indexed: 04/09/2024] Open
Abstract
Background High-power short-duration (HPSD) ablation creates wide, shallow lesions using radiofrequency (RF) heating. It is uncertain if adjusting RF energy based on atrial wall thickness provides extra benefits. We studied the safety and effectiveness of tailored HPSD energy based on left atrial (LA) wall thickness (LAWT) for circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (PAF). Methods We enrolled 212 patients (68.4% male, mean age: 59.5 ± 11.0 years) and randomly assigned them to two groups: LAWT-guided CPVI (WT, n = 108) and conventional CPVI (control, n = 104). Both groups used an open irrigated-tip deflectable catheter to apply 50 W for 10 s to the posterior LA, while controls used 60 W for 15 s on other LA regions. RF delivery time in WT was titrated (15 s at LAWT > 2.1 mm, 13 s at 1.4-2.1 mm, and 11 s at <1.4 mm) according to the computed tomogram-myocardial thickness color map. Results After a mean follow-up of 13.4 ± 7.0 months, the WT and control groups showed no significant difference regarding clinical recurrence rate (13.9% vs. 5.8%, respectively; p = .061) and major complication rate (4.6% vs. 3.8%, respectively; p > .999). The total procedure time, cardioversion rate, and post-procedural AAD prescription rates did not significantly differ between the groups. Conclusions The LAWT-guided energy titration strategy did not result in improved procedural safety and efficacy compared to the conventional 50-60 W-HPSD CPVI in patients with PAF.
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Affiliation(s)
- Taehyun Hwang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Oh‐Seok Kwon
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Song‐Yi Yang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Jae‐Sun Uhm
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Moon‐Hyoung Lee
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Chun Hwang
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - for UTMOST Investigators
- Division of Cardiology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
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Yano M, Egami Y, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Nishino M. Comparison of Postprocedural P-Wave Vector Magnitude on 12-Lead Electrocardiogram Between Cryoballoon and Radiofrequency Ablation. Am J Cardiol 2024; 220:1-8. [PMID: 38522652 DOI: 10.1016/j.amjcard.2024.03.018] [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: 01/09/2024] [Revised: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
Pulmonary vein isolation (PVI) causes changes in P-wave parameters. However, the difference in changes in P-wave parameters including P-wave vector magnitude (Pvm) between radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA) remains unknown. Paroxysmal atrial fibrillation (PAF) patients who underwent only PVI were enrolled. Pvm was calculated by the square root of the sum of the squared P-wave amplitude in leads II and V6 and one-half of the P-wave amplitude in V2. The patients were divided into 2 groups: RFCA and CBA. ΔPvm was calculated as ΔPvm (mV) = (Pvm at pre-PVI)-(Pvm at post-PVI). The following factors were evaluated: (1) differences in the ΔPvm between the 2 groups, (2) relation between late arrhythmia recurrence and ΔPvm in RFCA and CBA groups, and (3) the impact of relevant factors on ΔPvm. The study population included a total of 426 patients with PAF (RFCA, 167 patients; CBA, 259 patients). ΔPvm was significantly larger in CBA than in RFCA (p <0.001). Kaplan-Meier analysis showed late arrhythmia recurrence was significantly higher in patients with low ΔPvm (<0.019 mV) than high ΔPvm (≥0.019 mV) in RFCA (Log-rank p <0.001), and low ΔPvm (<0.033 mV) than high ΔPvm (≥0.033 mV) in CBA (Log-rank p <0.001). Multiple regression analysis showed that CBA and heart rate change were independently and significantly associated with ΔPvm (p <0.001 and p <0.001, respectively). In conclusion, ΔPvm was significantly larger in CBA than RFCA during procedure. Low ΔPvm had a higher risk of late arrhythmia recurrence in RFCA and CBA.
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Affiliation(s)
- Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
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Zeng L, Chen S, Zeng R, Hu H, Yang Q, Cui K, Chen Q, Fu H, Pu X. CLOSE protocol versus lower ablation index value for paroxysmal atrial fibrillation: A randomized noninferior clinical trial. J Cardiovasc Electrophysiol 2024; 35:469-477. [PMID: 38282257 DOI: 10.1111/jce.16194] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The optimized ablation index (AI) value for catheter ablation of atrial fibrillation (AF) remains to be defined. We aimed to compare the efficacy and safety of CLOSE protocol and lower AI protocol in paroxysmal AF. METHODS AND RESULTS Patients with symptomatic, drug-resistant paroxysmal AF for first ablation were prospectively enrolled from September 2020 to January 2022. The patients were randomly divided into CLOSE group (AI ≥ 550 for anterior/roof segments and ≥400 for posterior/inferior segments) and lower AI group (AI ≥ 450 for anterior/roof segments and ≥350 for posterior/inferior segments). First-pass isolation, acute pulmonary vein (PV) reconnections, 1-year arrhythmia recurrence, and major complications were assessed. Of the 270 enrolled patients, 238 completed 1-year follow-up (118 in CLOSE group and 120 in lower AI group). First-pass isolation in left PVs was higher in CLOSE group (71.2% vs. 53.3%, p = .005). Acute PV reconnections were comparable between groups (9.3% vs. 14.2%, p = .246). At 1 year, 86.4% in CLOSE group versus 81.7% in lower AI group were free from atrial arrhythmia (log rank p = .334). The proportion difference was -4.8% (95% CI: -14.1% to 4.6%), and p = .475 for noninferiority. Stroke occurred in four patients of lower AI group, and no cardiac tamponade, atrioesophageal fistula, major bleeding or death occurred post procedure. CONCLUSION For patients with paroxysmal AF and treated by AI-guided PV ablation, lower AI is not noninferior to CLOSE protocol.
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Affiliation(s)
- Lijun Zeng
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongde Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyong Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaobo Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Shoji T, Sato Y, Togashi D, Kuwata S, Izumo M, Harada T, Akashi YJ. ST-Segment Elevation During Percutaneous Left Atrial Appendage Closure. JACC Case Rep 2024; 29:102216. [PMID: 38379648 PMCID: PMC10874982 DOI: 10.1016/j.jaccas.2023.102216] [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: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 02/22/2024]
Abstract
A 70-year-old patient with paroxysmal atrial fibrillation underwent left atrial appendage closure. The patient experienced transient hypotension during device implantation. The procedure was abandoned because of ST-T-wave changes on electrocardiography and elevated coronary flow velocity on transesophageal echocardiography, which indicated that the device caused coronary artery compression.
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Affiliation(s)
- Tatsuro Shoji
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Daisuke Togashi
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shingo Kuwata
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tomoo Harada
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yoshihiro J. Akashi
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
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Ben Amor S, Achour A, Elhraiech A, Jarrar E, Ghali H, Ben Ameur O, Amara N, Hassine A, Saied H, Neffati E, Smadja D. A Simple Score for Predicting Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source in a Tunisian Cohort Study. Curr Neurovasc Res 2024; 21:CNR-EPUB-138350. [PMID: 38321906 DOI: 10.2174/0115672026301430240201094411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND The annualized recurrent stroke rate in patients with Embolic Stroke of Undetermined Source (ESUS) under antiplatelet therapy is around 4.5%. Only a fraction of these patients will develop atrial fibrillation (FA), to which a stroke can be attributed retrospectively. The challenge is to identify patients at risk of occult AF during follow-up. OBJECTIVE This work aims to determine clinical factors and electrocardiographic and ultrasound parameters that can predict occult AF in patients with ESUS and build a simple predictive score applicable worldwide. METHODS This is a single-center, registry-based retrospective study conducted at the stroke unit of Sahloul University Hospital, Sousse, Tunisia, between January 2016 and December 2020. Consecutive patients meeting ESUS criteria were monitored for a minimum of one year, with a standardized follow-up consisting of outpatient visits, including ECG every three months and a new 24-hour Holter monitoring in case of palpitations. We performed multivariate stepwise regression to identify predictors of new paroxysmal AF among initial clinical, electrocardiographic (ECG and 24-hour Holter monitoring) and echocardiographic parameters. The coefficient of each independent covariate of the fitted multivariable model was used to generate an integerbased point-scoring system. RESULTS Three hundred patients met the criteria for ESUS. Among them, 42 (14%) patients showed at least one episode of paroxysmal AF during a median follow-up of two years. In univariate analysis, age, gender, coronary artery disease, history of ischemic stroke, higher NIHSS at admission and lower NIHSS at discharge, abnormal P-wave axis, prolonged P-wave duration, premature atrial contractions (PAC) frequency of more than 500/24 hours, and left atrial (LA) mean area of more than 20 cm2 were associated with the risk of occurrence of paroxysmal AF. We proposed an AF predictive score based on (1.771 x NIHSS score at admission) + (10.015 x P-wave dispersion; coded 1 if yes and 0 if no) + (9.841x PAC class; coded 1 if ≥500 and 0 if no) + (9.828x LA class surface; coded 1 if ≥20 and 0 if no) + (0.548xNIHSS score at discharge) + 0.004. A score of ≥33 had a sensitivity of 76% and a specificity of 93%. CONCLUSION In this cohort of patients with ESUS, NIHSS at both admission and discharge, Pwave dispersion, PAC≥500/24h on a 24-hour Holter monitoring, and LA surface area≥20 cm2 provide a simple AF predictive score with very reasonable sensitivity and specificity and is applicable almost worldwide. An external validation of this score is ongoing.
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Affiliation(s)
- Sana Ben Amor
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Assil Achour
- Cardiology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Aymen Elhraiech
- Cardiology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Emna Jarrar
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Hela Ghali
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Ons Ben Ameur
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Neserine Amara
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Anis Hassine
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Houyem Saied
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Eleys Neffati
- Cardiology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Didier Smadja
- Stroke Unit, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
- Paris-Saclay University, France
- INSERM U-1266, Paris-Cité, France
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Damlakhy A, Harmouch KM, Khan ZA, Kumar N, Abdel-Qader A. Renal Infarction as the First Manifestation of Undiagnosed Atrial Fibrillation With Coexisting Left Atrial Thrombus: A Case Report and Review of the Literature. Cureus 2024; 16:e53772. [PMID: 38465080 PMCID: PMC10923261 DOI: 10.7759/cureus.53772] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Acute renal infarction, presenting with nonspecific symptoms, such as abdominal pain, nausea, vomiting, and hematuria, can lead to delayed diagnosis due to similarities with other medical conditions. Computed tomography with IV contrast is used to diagnose renal parenchymal infarction, treated through surgical, percutaneous interventions, and anticoagulation therapy. Investigation for the infarction source is crucial, particularly in the absence of prior cardiac issues, necessitating heart rhythm monitoring and an echocardiogram to evaluate paroxysmal atrial fibrillation (PAF) and intracardiac thrombus, respectively. Renal infarction may elevate blood pressure due to renin release, recommending medications like angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. We present a case of renal infarction due to PAF with a concomitant intracardiac thrombus.
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Affiliation(s)
- Ahmad Damlakhy
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
| | - Khaled M Harmouch
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
| | - Zohaib A Khan
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
| | - Nomesh Kumar
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
| | - Anas Abdel-Qader
- Internal Medicine, Detroit Medical Center/Sinai-Grace Hospital/Wayne State University, Detroit, USA
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Yano M, Egami Y, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Nishino M. Ratio of P-Wave Duration to P-Wave Amplitude and Left Atrial Remodeling: Insights from Electrophysiological Findings and Myocardial Injury After Cryoballoon Ablation. Am J Cardiol 2024; 212:109-117. [PMID: 38036050 DOI: 10.1016/j.amjcard.2023.11.046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
The impact of the P-wave morphology on clinical outcomes postcatheter ablation (post-CA) and recurrent arrhythmia characteristics or electrophysiologic findings in patients with paroxysmal atrial fibrillation (PAF) remains unclear. Patients with PAF who underwent cryoballoon ablation were enrolled. In 12-lead electrocardiography recorded within 1 month before CA, the P-wave duration (Pd) and P-wave vector magnitude (Pvm) (square root of the sum of the squared P-wave amplitude in leads II, V6, and one-half of the P-wave amplitude in V2) were measured and divided into 2 groups: patients with high and low Pd/Pvm based on a statistically calculated cut-off value. We evaluated the incidence of late recurrence of atrial fibrillation (LRAF), myocardial injury (high-sensitive troponin I), and the electrophysiologic findings in repeat ablation sessions. This study included 269 patients with PAF. The median follow-up duration was 697 days. The cut-off value of the Pd/Pvm for predicting LRAF was 740.7 ms/mV (area under the curve = 0.81, sensitivity = 58.2%, and specificity = 89.6%). Multivariable Cox proportional hazards analysis showed that high Pd/Pvm (>740.7 ms/mV) was significantly associated with LRAF (p <0.001). The high-sensitive troponin I level was significantly lower, and the ratio of DR-FLASH score >3 was significantly higher in those with high than low Pd/Pvm (p = 0.044 and p = 0.002, respectively). In the repeat ablation sessions, the Pd/Pvm in patients with atrial tachycardia-induced or spontaneously occurring during the repeat CA sessions was significantly higher than in those without (p = 0.009). There was a significant difference between the Pd/Pvm and low-voltage area (p <0.001). In conclusion, the Pd/Pvm is significantly associated with LRAF after cryoballoon ablation in patients with PAF and predicts left atrial low-voltage areas and atrial tachycardia inducibility.
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Affiliation(s)
- Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
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10
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Oguri G, Fujiu K, Oshima T, Shimizu Y, Hasumi E, Kojima T, Komuro I. Cryoballoon ablation for paroxysmal atrial fibrillation mildly improves lung function: An observational study. Medicine (Baltimore) 2023; 102:e35991. [PMID: 37986317 PMCID: PMC10659717 DOI: 10.1097/md.0000000000035991] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and a major public health burden. Catheter ablation (CA) is an effective treatment of AF. Although radiofrequency catheter ablation (RFCA) is the standard practice, cryoballoon ablation (CBA) has become increasingly popular. Pulmonary dysfunction is also associated with AF. As CA targets the pulmonary vasculature, it poses a risk to lung function. However, the effect of CA on respiration in patients with paroxysmal atrial fibrillation (PAF) post-ablation has not yet been assessed. We assessed pulmonary function after CA in a cohort of patients with AF. This prospective, single-center study included 26 patients with symptomatic PAF and 18 patients without PAF. CA techniques include RFCA, CBA, hot balloon ablation, and laser balloon-mediated ablation. Spirometry parameters included vital capacity (VC), forced vital capacity (FVC), forced expiratory volume (FEV1), and peak expiratory flow, which were all measured 6 months post-ablation. AF ablation significantly improved VC (P = .04), FVC (P = .01), and peak expiratory flow (P = .006) in all the patients. In the patients with PAF, we observed a significant increase in FEV1 (P = .04). CBA significantly improved VC (P = .012) and FVC (P = .013). A significant improvement in these pulmonary parameters was achieved, specifically in patients with PAF treated with an ablation protocol with CBA, but not with RFCA or hot balloon ablation. A significant decrease in FEV1 was observed with hot balloon ablation (P = .035). Significant improvement in pulmonary parameters was observed specifically in patients with PAF who underwent CBA. CBA may be a more suitable treatment strategy for patients with PAF, particularly those with compromised pulmonary function.
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Affiliation(s)
- Gaku Oguri
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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11
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Ponna PK, Fischell TA, Agrawal Y. Radial artery pseudoaneurysm rupture after cardiac catheterization. J Invasive Cardiol 2023; 35. [PMID: 37992332 DOI: 10.25270/jic/23.00065] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
A 73-year-old man with history significant for paroxysmal atrial fibrillation on apixaban underwent percutaneous coronary intervention (PCI) of the left anterior descending artery via transradial access. The patient was discharged on clopidogrel, atorvastatin, carvedilol, isosorbide mononitrate, losartan, and apixaban.
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Affiliation(s)
| | - Tim A Fischell
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
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12
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Ramos-Mondragón R, Lozhkin A, Vendrov AE, Runge MS, Isom LL, Madamanchi NR. NADPH Oxidases and Oxidative Stress in the Pathogenesis of Atrial Fibrillation. Antioxidants (Basel) 2023; 12:1833. [PMID: 37891912 PMCID: PMC10604902 DOI: 10.3390/antiox12101833] [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] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and its prevalence increases with age. The irregular and rapid contraction of the atria can lead to ineffective blood pumping, local blood stasis, blood clots, ischemic stroke, and heart failure. NADPH oxidases (NOX) and mitochondria are the main sources of reactive oxygen species in the heart, and dysregulated activation of NOX and mitochondrial dysfunction are associated with AF pathogenesis. NOX- and mitochondria-derived oxidative stress contribute to the onset of paroxysmal AF by inducing electrophysiological changes in atrial myocytes and structural remodeling in the atria. Because high atrial activity causes cardiac myocytes to expend extremely high energy to maintain excitation-contraction coupling during persistent AF, mitochondria, the primary energy source, undergo metabolic stress, affecting their morphology, Ca2+ handling, and ATP generation. In this review, we discuss the role of oxidative stress in activating AF-triggered activities, regulating intracellular Ca2+ handling, and functional and anatomical reentry mechanisms, all of which are associated with AF initiation, perpetuation, and progression. Changes in the extracellular matrix, inflammation, ion channel expression and function, myofibril structure, and mitochondrial function occur during the early transitional stages of AF, opening a window of opportunity to target NOX and mitochondria-derived oxidative stress using isoform-specific NOX inhibitors and mitochondrial ROS scavengers, as well as drugs that improve mitochondrial dynamics and metabolism to treat persistent AF and its transition to permanent AF.
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Affiliation(s)
- Roberto Ramos-Mondragón
- Department of Pharmacology, University of Michigan, 1150 West Medical Center Drive, 2301 Medical Science Research Building III, Ann Arbor, MI 48109, USA; (R.R.-M.); (L.L.I.)
| | - Andrey Lozhkin
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48019, USA; (A.L.); (A.E.V.); (M.S.R.)
| | - Aleksandr E. Vendrov
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48019, USA; (A.L.); (A.E.V.); (M.S.R.)
| | - Marschall S. Runge
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48019, USA; (A.L.); (A.E.V.); (M.S.R.)
| | - Lori L. Isom
- Department of Pharmacology, University of Michigan, 1150 West Medical Center Drive, 2301 Medical Science Research Building III, Ann Arbor, MI 48109, USA; (R.R.-M.); (L.L.I.)
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nageswara R. Madamanchi
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48019, USA; (A.L.); (A.E.V.); (M.S.R.)
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13
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Miyama H, Takatsuki S, Ikemura N, Kimura T, Katsumata Y, Yamashita S, Yamaoka K, Ibe S, Seki Y, Yamashita T, Hashimoto K, Ueda I, Ueno K, Ohki T, Fukuda K, Kohsaka S. Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation Type. J Am Heart Assoc 2023; 12:e029321. [PMID: 37681532 PMCID: PMC10547271 DOI: 10.1161/jaha.122.029321] [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: 12/27/2022] [Accepted: 07/18/2023] [Indexed: 09/09/2023]
Abstract
Background Catheter ablation (CA) for atrial fibrillation (AF) is preferred for paroxysmal AF (PAF) but selectively performed in patients with persistent AF (PersAF). This study aimed to investigate the prognostic differences and consequences of CA based on the AF type. Methods and Results Data from a multicenter AF cohort study were analyzed, categorizing patients as PAF or PersAF according to AF duration (≤7 or >7 days, respectively). A composite of all-cause death, heart failure hospitalization, stroke, and bleeding events during 2-year follow-up and changes in the Atrial Fibrillation Effect on Quality-of-life score were compared. Additionally, propensity score matching was performed to compare clinical outcomes of patients with and without CA in both AF types. Among 2788 patients, 51.6% and 48.4% had PAF and PersAF, respectively. Patients with PersAF had a higher incidence of the composite outcome (12.8% versus 7.2%; P<0.001) and smaller improvements in Atrial Fibrillation Effect on Quality-of-life scores than those with PAF. After adjusting for baseline characteristics, PersAF was an independent predictor of adverse outcomes (adjusted hazard ratio, 1.35 [95% CI, 1.30-1.78], P=0.031) and was associated with poor improvements in Atrial Fibrillation Effect on Quality-of-life scores. Propensity score matching analysis showed that the CA group had significantly fewer adverse events than the medication group among patients with PAF (odds ratio, 0.31 [95% CI, 0.18-0.68]; P=0.002). Patients with PersAF showed a similar but nonsignificant trend. Conclusions PersAF is a risk factor for worse clinical outcomes, including patients' health status. CA is associated with fewer adverse events, although careful consideration is required based on the AF type.
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Affiliation(s)
- Hiroshi Miyama
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Seiji Takatsuki
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Nobuhiro Ikemura
- Department of CardiologyKeio University School of MedicineTokyoJapan
- Division of Molecular EpidemiologyJikei University School of MedicineTokyoJapan
| | - Takehiro Kimura
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | | | - Shuhei Yamashita
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Koki Yamaoka
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Susumu Ibe
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Yuta Seki
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | | | - Kenji Hashimoto
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Ikuko Ueda
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Koji Ueno
- Department of CardiologySaiseikai Utsunomiya HospitalTochigiJapan
| | - Takahiro Ohki
- Department of CardiologyTokyo Dental College Ichikawa General HospitalChibaJapan
| | - Keiichi Fukuda
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Shun Kohsaka
- Department of CardiologyKeio University School of MedicineTokyoJapan
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14
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Talukdar D, De Deus LF, Sehgal N. Evaluation of Atrial Fibrillation Detection in Short-Term Photoplethysmography (PPG) Signals Using Artificial Intelligence. Cureus 2023; 15:e45111. [PMID: 37842400 PMCID: PMC10568237 DOI: 10.7759/cureus.45111] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background Atrial fibrillation (AFIB) is a common atrial arrhythmia that affects millions of people worldwide. However, most of the time, AFIB is paroxysmal and can pass unnoticed in medical exams; therefore, regular screening is required. This paper proposes machine learning (ML) methods to detect AFIB from short-term electrocardiogram (ECG) and photoplethysmography (PPG) signals. Aim Several experiments were conducted across five different databases, with three of them containing ECG signals and the other two consisting of only PPG signals. Experiments were conducted to investigate the hypothesis that an ML model trained to predict AFIB from ECG segments could be used to predict AFIB from PPG segments. Materials and methods A random forest (RF) ML algorithm achieved the best accuracy and achieved a 90% accuracy rate on the University of Mississippi Medical Center (UMMC) dataset (216 samples) and a 97% accuracy rate on the Medical Information Mart for Intensive Care (MIMIC)-III datasets (2,134 samples). Results A total of 269,842 signal segments were analyzed across all datasets (212,266 were of normal sinus rhythm (NSR) and 57,576 corresponded to AFIB segments). Conclusions The ability to detect AFIB with significant accuracy using ML algorithms from PPG signals, which can be acquired via non-invasive contact or contactless, is a promising step forward toward the goal of achieving large-scale screening for AFIB.
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Affiliation(s)
- Debjyoti Talukdar
- Medical Research, Mkhitar Gosh Armenian-Russian International University, Yerevan, ARM
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15
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Osorio J, Maccioni S, Sharma R, Patel L, Spin P, Natale A. QDOT MICRO™ versus THERMOCOOL ® SMARTTOUCH™ and THERMOCOOL SMARTTOUCH ® Surround Flow in radiofrequency ablation of paroxysmal atrial fibrillation. J Comp Eff Res 2023; 12:e230005. [PMID: 37584396 PMCID: PMC10690395 DOI: 10.57264/cer-2023-0005] [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] [Received: 01/17/2023] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Aim: The objective of this study was to indirectly compare QDOT MICRO™ (QDOT), Thermocool® SmartTouch™ (ST) and Thermocool® SmartTouch® Surround Flow (STSF) to treat paroxysmal atrial fibrillation. Methods: Differences in baseline characteristics between study cohorts were reduced by reweighting patients using inverse probability of treatment weighting. The primary outcome was procedure time. Secondary outcomes were fluoroscopy time, clinical success at 12 months, and rhythm monitoring-adjusted recurrence. Results: QDOT was associated with significantly faster mean procedure and fluoroscopy time, and significant improvement in the rate of recurrence compared with pooled ST/STSF. No difference was observed for clinical success at 12 months. Conclusion: QDOT was associated with greater efficiency, greater effectiveness in rhythm monitoring-adjusted recurrence and similar effectiveness in clinical success at 12 months compared with pooled ST/STSF.
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Affiliation(s)
- Jose Osorio
- Medical Director Electrophysiology, Electrophysiology - Cardiovascular Group, HCA Florida Miami, Miami, FL 33133, USA
| | - Sonia Maccioni
- Johnson & Johnson Medical Devices, Franchise Health Economics and Market Access, Irvine, CA 92618, USA
| | - Reecha Sharma
- Johnson & Johnson Medical Devices, Clinical Research, Irvine, CA 92618, USA
| | | | - Paul Spin
- EVERSANA, Burlington, ON, L7N 3H8, Canada
| | - Andrea Natale
- Executive Medical Director, Texas Cardiac Arrhythmia Research, St. David's Medical Center, Austin, TX 78705, USA
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16
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Ye W, Chen Q, Fan G, Zhou X, Wang X, Mao W, Li J. Efficacy and safety of visually guided laser balloon versus cryoballoon ablation for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1229223. [PMID: 37674807 PMCID: PMC10478246 DOI: 10.3389/fcvm.2023.1229223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Background Newly developed catheter ablation (CA) techniques, such as laser balloon ablation (LBA) and cryoballoon ablation (CBA), have been introduced in recent years and emerged as valuable alternatives to conventional radiofrequency CA strategies for paroxysmal atrial fibrillation (PAF) patients. However, evidence comparing LBA and CBA remain controversial. Thus, we conducted this meta-analysis to assess the efficacy and safety between these two techniques. Methods Scientific databases (PubMed, Embase) and relevant websites (the Cochrane Library, ClinicalTrials.gov) were systematically searched from inception to March 2023. The primary outcomes of interest were the AF recurrence and the procedure-related complications. Secondary outcomes included procedural time, fluoroscopy time, and left atrial (LA) dwell time. Results Seven clinical trials with a total of 637 patients were finally enrolled. No significant differences were found between LBA and CBA in terms of AF recurrence [16.3% vs. 22.7%, odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.42-1.05, p = 0.078] or total procedural-related complications (8.4% vs. 6.4%, OR = 1.33, 95% CI: 0.71-2.51, p = 0.371). LBA had a significantly longer procedural time [weighted mean difference (WMD) = 38.03 min, 95% CI: 13.48-62.58 min, p = 0.002] and LA dwell time (WMD = 46.67 min, 95% CI: 14.63-78.72 min, p = 0.004) than CBA, but tended to have shorter fluoroscopy time. Conclusions LBA and CBA treatment have comparable efficacy and safety for PAF patients. LBA was associated with longer procedural and LA dwell times compared with CBA. Further large-scale studies are warranted to compare these two techniques with the newest generations.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=426513, identifier (CRD42023426513).
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Affiliation(s)
- Wenyi Ye
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Qian Chen
- Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, China
| | - Guangci Fan
- Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, China
| | - Xinbin Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Xiao Wang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Wei Mao
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - JuanJuan Li
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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Katano T, Suda S, Ohta T, Miyagami M, Kodaira Y, Konaka C, Nagashima M, Kimura K. Regular pulse checks for patients with non-cardioembolic stroke in rehabilitation hospitals to improve recognition and detection of atrial fibrillation (the ESCORT study): protocol for a prospective multicenter observational study. Front Neurol 2023; 14:1247020. [PMID: 37662047 PMCID: PMC10468993 DOI: 10.3389/fneur.2023.1247020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Cryptogenic stroke (CS) are heterogeneous in origin; however, most CS are embolic mechanism. Paroxysmal atrial fibrillation (AF) is suspected to be a major type of CS that leads to severe cerebral infarction without anticoagulant use. Therefore, the identification of AF is vital in patients with CS. However, patients are often unaware of AF because they have no symptoms, and AF may not be detected on an electrocardiogram (ECG) or Holter ECG on admission. After patients with stroke are treated in the acute phase, they are promptly transferred to a rehabilitation hospital for functional recovery. Once the patient is transferred to a hospital, a few attempts are made to detect AF. In addition, rehabilitation therapists are considered to have insufficient awareness of the possibility of undiagnosed AF. Objective This study aimed to increase the understanding of the importance of AF detection in patients with ischemic stroke among therapists in rehabilitation hospitals and to investigate whether regular pulse screening can aid in the detection of AF. If AF was detected, we determined the rate and timing of AF detection and identified the patient characteristics. Methods This multicenter prospective observational study aimed to detect AF in patients with non-cardiac stroke at rehabilitation hospitals. Therapists performed pulse checks before, during, and after rehabilitation. If arrhythmia or tachycardia was detected, an ECG was performed, and the physician checked for AF. If the patient complained of chest symptoms, electrocardiography (ECG) was performed to check for AF. We investigated the characteristics, laboratory data, cognitive status, complications, such as stroke recurrence, and functional outcomes of patients with AF. Results The study is in the enrollment phase. Recruitment began in September 2022 and will end in August 2023. Patients have provided written informed consent. The main results have been submitted for publication in your journal. Conclusion The findings of this study will help identify patients with AF in rehabilitation hospitals and improve awareness among therapists.
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Affiliation(s)
- Takehiro Katano
- Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan
| | - Satoshi Suda
- Department of Stroke Neurology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomohiro Ohta
- Department of Internal Medicine, Araki Kinen Tokyo River Side Hospital, Tokyo, Japan
| | - Mitsusuke Miyagami
- Department of Rehabilitation and Neurosurgery, Takenozuka Nohsinkei Rehabilitation Hospital, Tokyo, Japan
| | - Yuzo Kodaira
- Department of Surgery, Flowers and Forest Tokyo Hospital, Tokyo, Japan
| | - Chimori Konaka
- Department of Rehabilitation, Akabane Rehabilitation Hospital, Tokyo, Japan
| | - Masakazu Nagashima
- Department of Orthopedics, Katsushika Rehabilitation Hospital, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan
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18
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Arnautu DA, Arnautu SF, Tomescu MC, Luca S, Luca CT. Increased Left Atrial Stiffness is Significantly Associated with Paroxysmal Atrial Fibrillation in Diabetic Patients. Diabetes Metab Syndr Obes 2023; 16:2077-2087. [PMID: 37457111 PMCID: PMC10349582 DOI: 10.2147/dmso.s417675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Atrial fibrillation (AF) and diabetes mellitus (DM) are common pathogenic diseases. Diabetes is an independent risk factor for AF, and coexisting AF is a risk factor for the diabetic pa-tient's progression. The purpose of this study was to see if two-dimensional-speckle tracking echocardiography (2D-STE) might provide valuable criteria for determining the risk of AF in diabetic patients. Patients and Methods This retrospective study compared 30 adult diabetic patients with documented paroxysmal atrial fibrillation (PAF) with 30 age- and sex-matched diabetic patients without PAF. Inclusion criteria were: age ≥18 years, sinus rhythm, diabetes mellitus type 2, and the ability to sign the informed consent. Exclusion criteria included: moderate or severe valvular disease, previous myocardial infarction, left ventricular ejection fraction (LVEF) <50%, congenital heart disease, a history of cardiac surgery, paced atrial or ventricular rhythm, inadequate echocardiography imaging. The medical history, clinical, biochemical data and the results of the transthoracic cardiac ultrasound examination were registered during their evaluation at the outpatients cardiology clinics. Results The mean age of the patients was 62.5±1.7 years, 60% were men. Diabetic patients who experienced PAF episodes demonstrated significantly impaired left atrial (LA) deformation patterns, with decreased LA strains and increased LA stiffness (p < 0.05). Conclusion The present study demonstrates that LA strains and LA stiffness are significantly associated with the occurrence of PAF in diabetic patients. As 2D-STE of the LA is more sensitive than routine echocardiographic examination, it should be performed in patients suspected of being suffering from PAF.
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Affiliation(s)
- Diana-Aurora Arnautu
- Multidisciplinary Heart Research Center of the “Victor Babes”, Internal Medicine Department, University of Medicine and Pharmacy, Timisoara, Romania
- Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Sergiu-Florin Arnautu
- Multidisciplinary Heart Research Center of the “Victor Babes”, Internal Medicine Department, University of Medicine and Pharmacy, Timisoara, Romania
- Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Mirela-Cleopatra Tomescu
- Multidisciplinary Heart Research Center of the “Victor Babes”, Internal Medicine Department, University of Medicine and Pharmacy, Timisoara, Romania
- Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Silvia Luca
- Institute of Cardiovascular Diseases, Timisoara, Romania
- Department of Cardiology, Victor Babes University of Medicine and Pharmacy, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Constantin-Tudor Luca
- Institute of Cardiovascular Diseases, Timisoara, Romania
- Department of Cardiology, Victor Babes University of Medicine and Pharmacy, Institute of Cardiovascular Diseases, Timisoara, Romania
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19
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Tao Y, Zhou Y, Sun X, Liao W, Wang Y, Shi L, Liu X. Pulsed field ablation of superior vena cava in paroxysmal atrial fibrillation: a case report. Front Cardiovasc Med 2023; 10:1211674. [PMID: 37456819 PMCID: PMC10347413 DOI: 10.3389/fcvm.2023.1211674] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Paroxysmal atrial fibrillation originates most commonly in the pulmonary veins. However, the superior vena cava has proved to be arrhythmogenic in some cases. Pulsed field ablation, an emerging ablation technology, selectively affects myocardial tissue. Herein, we present a case of paroxysmal atrial fibrillation in a 64-year-old man who was admitted to our hospital for pulsed field ablation. The tachycardia was recurrent despite four successful pulmonary vein isolations. The superior vena cava was determined to be involved in arrhythmogenesis. The atrial fibrillation terminated immediately after the pulsed field ablation discharge at the superior vena cava.
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Rahimi O, Lee K, Lei K, Wahi-Gururaj S, Gururaj AV. Symptomatic Junctional Bradycardia Due to Untreated Hypothyroidism After Beta-Blocker Discontinuation: A Case Report. Cureus 2023; 15:e40605. [PMID: 37469810 PMCID: PMC10353883 DOI: 10.7759/cureus.40605] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/21/2023] Open
Abstract
Hypothyroidism is known to cause bradycardia, but there are no direct comparisons of the level of thyroid-stimulating hormone (TSH) to heart rate (HR) to assist in therapeutic hormonal management. This case presents a patient who developed symptomatic junctional bradycardia and underwent serial TSH testing to attempt to improve her HR while minimizing systemic toxicity from levothyroxine. The patient had a history of paroxysmal atrial fibrillation on beta-blocker therapy and hypothyroidism and developed symptomatic junctional bradycardia following a lapse in her thyroid supplementation. Upon initiation of hormonal replacement therapy, serial TSH levels were assessed as she continued to have episodic bradycardia with severe hypertension. Given the lack of evidence correlating TSH levels to HR, this case report calls for further studies to be conducted to create reliable guidelines in therapeutic management to prevent bradycardia events while minimizing systemic levothyroxine toxicity.
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Affiliation(s)
- Osman Rahimi
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Kevin Lee
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Kachon Lei
- Cardiology, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Sandhya Wahi-Gururaj
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
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Gottlieb LA, Dekker LRC, Coronel R. Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation. Front Physiol 2023; 14:1157338. [PMID: 37293260 PMCID: PMC10244566 DOI: 10.3389/fphys.2023.1157338] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023] Open
Abstract
Atrial fibrillation (AF) often requires invasive treatment by ablation to decrease symptom burden. The pulmonary veins (PV) are thought to trigger paroxysms of AF, and ablative PV isolation (PVI) is a cornerstone in AF treatment. However, incomplete PVI, where electrical conduction between the PV and left atrium (LA) is maintained, is curative of AF in a subset of patients. This implies that an antiarrhythmic effect other than electrical isolation between the PV and LA plays a role in AF prevention in these patients. We reason that the PV myocardium constitutes an arrhythmogenic substrate conducive to reentry in the patients with curative incomplete PVI. This PV substrate is amenable to ablation, even when conduction between the LA and PV persists. We propose that PV ablation strategies are differentiated to fit the arrhythmogenic mechanisms in the individual patient. PV substrate modification in patients with PV reentry may constitute a new therapeutic approach that is potentially simpler and more effective, in this subgroup of patients.
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Affiliation(s)
- Lisa A. Gottlieb
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Amsterdam UMC, location Academic Medical Centre, Department of Experimental Cardiology, University of Amsterdam, Amsterdam, Netherlands
| | - Lukas R. C. Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Ruben Coronel
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Amsterdam UMC, location Academic Medical Centre, Department of Experimental Cardiology, University of Amsterdam, Amsterdam, Netherlands
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22
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Huang B, Li J, Li P, Chen C, Cao S, Jiang Z, Zeng J. Risk Factors and Prognostic Implications of New-Onset Paroxysmal Atrial Fibrillation in Patients Hospitalized with Intracerebral Hemorrhage. Int J Gen Med 2023; 16:1973-1981. [PMID: 37251285 PMCID: PMC10224723 DOI: 10.2147/ijgm.s411722] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
Objective We aimed to assess the prevalence and risk factors of new-onset paroxysmal atrial fibrillation (PAF) in patients hospitalized with ICH and determine whether the new-onset PAF had influenced functional outcomes. Methods We analyzed a database of all consecutive patients with ICH from October 2013 to May 2022. Univariate and multivariable regression analyses were performed to identify risk factors for new-onset PAF in patients with ICH. Multivariate models were also constructed to assess whether the new-onset PAF was an independent predictor of poor functional outcome, as measured using the modified Rankin scale. Results This study included 650 patients with ICH, among whom 24 patients had new-onset PAF. In the multivariable model, older age (OR per 10-y increase, 2.26 [95% CI, 1.52-3.35]; P<0.001), hematoma volume (OR per 10-mL increase, 1.80 [95% CI, 1.26-2.57]; P=0.001), and heart failure (OR, 21.77 [95% CI, 5.52-85.91]; P<0.001) were independent risk factors for new-onset PAF. In a sensitivity analysis restricted to 428 patients with N-terminal pro-B-type natriuretic peptide (NT-proBNP), older age, larger hematoma volume, heart failure, and increased NT-proBNP were associated with new-onset PAF. After adjusting for baseline variables, new-onset PAF was an independent predictor of poor functional outcome (OR, 10.35 [95% CI, 1.08-98.80]; P=0.042). Conclusion Older age, larger hematoma volume, and heart failure were independent risk factors for new-onset PAF after ICH. Increased NT-proBNP is correlated with higher risks for new-onset PAF when their information is available at admission. Furthermore, new-onset PAF is a significant predictor of poor functional outcome.
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Affiliation(s)
- Baozi Huang
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, People’s Republic of China
- Department of Neurology of the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Jianle Li
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, People’s Republic of China
| | - Pingping Li
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, People’s Republic of China
- Department of Neurology of the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Chunyong Chen
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, People’s Republic of China
- Department of Neurology of the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Suhan Cao
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, People’s Republic of China
| | - Zimu Jiang
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, People’s Republic of China
| | - Jinsheng Zeng
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, People’s Republic of China
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23
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Djuric I, Dzudovic B, Subotic B, Dzudovic J, Matijasevic J, Benic M, Salinger S, Mitevska I, Kos L, Kovacevic-Preradovic T, Simovic S, Miloradovic V, Savicic T, Bozovic B, Bulatovic N, Kafedzic S, Neskovic AN, Kocev N, Marinković J, Obradovic S. New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men. Diagnostics (Basel) 2023; 13:diagnostics13111829. [PMID: 37296681 DOI: 10.3390/diagnostics13111829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. METHODS In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. RESULTS There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274-3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004-0.063); p = 0.013). CONCLUSION The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.
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Affiliation(s)
- Ivica Djuric
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Emergency Internal Medicine, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jelena Dzudovic
- National Poison Control Center, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
- School of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Marija Benic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, University of Nis, 18000 Nis, Serbia
| | - Irena Mitevska
- Clinic of Cardiology, School of Medicine, University of Skopje, 1000 Skopje, North Macedonia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Stefan Simovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Tanja Savicic
- Department for Internal Medicine, General Hospital Pancevo, 26000 Pancevo, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
- School of Medicine Podgorica, University of Podgorica, 81000 Podgorica, Montenegro
| | - Srdjan Kafedzic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
- School of Medicine Belgrade, University of Belgrade, 11000 Beograd, Serbia
| | - Nikola Kocev
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Jelena Marinković
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
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24
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Ntemka A, Martika A, Pozoukidou K, Spaia S. A Case of Flecainide-Induced Hyponatremia. Indian J Nephrol 2023; 33:225-227. [PMID: 37448896 PMCID: PMC10337221 DOI: 10.4103/ijn.ijn_387_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/28/2021] [Accepted: 01/09/2022] [Indexed: 07/15/2023] Open
Abstract
The complex classification for the diagnosis and treatment illustrates that hyponatremia is a very heterogeneous disorder. However, data on hyponatremia induced by flecainide, an often-prescribed antiarrhythmic agent, are scarce in the literature. A 78-year-old man with a recent history of recurrent hyponatremia and symptomatic paroxysmal atrial fibrillation presented with the complaints of dizziness and fatigue. During his repeated hospital admissions, the patient was treated with hypertonic saline, which temporarily improved serum sodium levels, but hyponatremia recurred without sustained clinical improvement. After discontinuation of the drug, the sodium levels remained stable. Doctors should be aware of not only the electrocardiographic changes associated with flecainide, but also the less-often found clinical manifestations linked with hyponatremia.
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Affiliation(s)
- Alexandra Ntemka
- Department of Nephrology, Agios Pavlos Hospital, Thessaloniki, Greece
| | - Antigoni Martika
- Department of Nephrology, Agios Pavlos Hospital, Thessaloniki, Greece
| | | | - Sofia Spaia
- Department of Nephrology, Agios Pavlos Hospital, Thessaloniki, Greece
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25
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Aryana A, Thiemann AM, Pujara DK, Cossette LL, Allen SL, Bowers MR, Gandhavadi M, Heath R, Trivedi AD, O'Neill PG, Ellis ER, d'Avila A. Pulmonary Vein Isolation With and Without Posterior Wall Isolation in Paroxysmal Atrial Fibrillation: IMPPROVE-PAF Trial. JACC Clin Electrophysiol 2023; 9:628-637. [PMID: 37225309 DOI: 10.1016/j.jacep.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Prior studies have demonstrated clinical benefits associated with cryoballoon pulmonary vein isolation (PVI) and concomitant posterior wall isolation (PWI) in patients with persistent atrial fibrillation (AF). However, the role for this approach in patients with paroxysmal atrial fibrillation (PAF) remains unclear. OBJECTIVES This study investigated the acute and long-term outcomes of PVI vs PVI+PWI using cryoballoon in patients with symptomatic PAF. METHODS This retrospective study (NCT05296824) examined the outcomes of cryoballoon PVI (n = 1,342) vs cryoballoon PVI+PWI (n = 442) in patients with symptomatic PAF during long-term follow-up. Using the nearest-neighbor method, a 1:1 matched sample of patients receiving PVI alone and PVI+PWI was created. RESULTS The matched cohort consisted of 320 patients (PVI: n = 160; PVI+PWI: n = 160). PVI+PWI was associated with longer cryoablation (23 ± 10 minutes vs 42 ± 11 minutes; P < 0.001) and procedure times (103 ± 24 minutes vs 127 ± 14 minutes; P < 0.001). In 39 (24.4%) of 160 patients, adjunct radiofrequency ablation was required for PVI+PWI. Adverse event rates were similar (PVI 3.8% vs PVI+PWI 1.9%; P = 0.31). Though there were no differences at 12 months, freedom from all atrial arrhythmias (67.5% vs 45.0%; P < 0.001) and AF (75.6% vs 55.0%; P < 0.001) were significantly greater with PVI+PWI vs PVI alone at 39 ± 9 months of follow-up. PVI+PWI was also associated with reduced long-term need for cardioversion (16.9% vs 27.5%; P = 0.02) and repeat catheter ablation (11.9% vs 26.3%; P = 0.001), and emerged as the only significant predictor of freedom from recurrent AF (HR: 2.79; 95% CI: 1.64-4.74; P < 0.001). CONCLUSIONS Compared with cryoballoon PVI, cryoballoon PVI+PWI appears to be associated with greater freedom from recurrent atrial arrhythmias and AF in patients with PAF during long-term follow-up >3 years.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.
| | - Anna M Thiemann
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Deep K Pujara
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Laura L Cossette
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Shelley L Allen
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | | | - Russell Heath
- University of Colorado Health, Fort Collins, Colorado, USA
| | - Amar D Trivedi
- University of Colorado Health, Fort Collins, Colorado, USA
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Ethan R Ellis
- University of Colorado Health, Fort Collins, Colorado, USA
| | - André d'Avila
- Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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26
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Rosca CI, Branea HS, Sharma A, Nicoras VA, Borza C, Lighezan DF, Morariu SI, Kundnani NR. Rhythm Disturbances in Post-Acute COVID-19 Syndrome in Young Men without Pre-Existing Known Cardiovascular Disease-A Case Series. Biomedicines 2023; 11:biomedicines11041146. [PMID: 37189764 DOI: 10.3390/biomedicines11041146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Current data indicate the existence of post-acute COVID-19 syndrome frequently expressing as cardiovascular and respiratory health issues. The long-term evolution of these complications is not yet fully known or predictable. Among the most common clinical manifestations of post-acute COVID-19 syndrome are dyspnea, palpitations, and fatigue, in most cases being transient and without underlying any morphological or functional changes. A single-center retrospective observational study was performed on cases that had presented with new-onset cardiac symptoms post-COVID-19 infection. Records of three male patients without pre-existing chronic cardiovascular pathology who had presented for dyspnea, fatigue, and palpitations around four weeks post-COVID-19 acute phase were studied in detail. The three post-COVID-19 cases exhibited arrhythmic complications after completely healing from the acute phase of the infection. Palpitations, along with chest pain, and possible aggravation or appearance of dyspnea, with syncopal episodes, were found to be present. All the three cases were non-vaccinated against COVID-19 infection. Isolated case reports showing arrhythmic complications such as atrial fibrillation and ventricular tachycardia on a small number of patients with these complications indicate the need for arrhythmic evaluation of large groups of patients in the post-acute stage of the COVID-19 syndrome for a better understanding of the phenomenon and implicitly better care of these patients. It would also be useful to evaluate large groups of patients divided into vaccinated/non-vaccinated against COVID-19 categories to determine whether vaccination per se can provide protection in the occurrence of these types of complications.
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Affiliation(s)
- Ciprian Ilie Rosca
- Center of Advanced Research in Cardiovascular Pathology and Haemostasis, Department of Internal Medicine I-Medical Semiotics I, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Horia Silviu Branea
- Department of Internal Medicine I-Medical Semiotics II, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Abhinav Sharma
- Department of Cardiology-Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | | | - Claudia Borza
- Center for Translational Research and Systems Medicine, Department of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Daniel Florin Lighezan
- Center of Advanced Research in Cardiovascular Pathology and Haemostasis, Department of Internal Medicine I-Medical Semiotics I, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Stelian I Morariu
- General Medicine Faculty, "Vasile Goldis" West University, 473223 Arad, Romania
| | - Nilima Rajpal Kundnani
- Department of Cardiology-Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
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27
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Li X, Li M, Shao Y, Gu W, Ni B, Gu J, Chen M. Thoracoscopic ablation delays progression from paroxysmal to persistent atrial fibrillation. J Thorac Cardiovasc Surg 2023; 165:1387-94. [PMID: 33992460 DOI: 10.1016/j.jtcvs.2021.03.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The study objective was to determine whether mini-invasive transthoracoscopic atrial fibrillation ablation can delay the progression of atrial fibrillation from paroxysmal to persistent. METHODS Patients aged 18 to 80 years with paroxysmal nonvalvular atrial fibrillation and a history of stroke or systemic thromboembolism were consecutively enrolled from September 2014 to June 2019. In the treatment group, patients underwent transthoracoscopic atrial fibrillation ablation plus left atrial appendage excision (atrial fibrillation ablation plus left atrial appendage excision group). Patients unwilling to receive surgical intervention were treated with antiarrhythmic drugs and oral anticoagulants and recruited as a control group (atrial fibrillation plus antiarrhythmic drugs group). The primary end point was the progression of atrial fibrillation from paroxysmal to persistent. RESULTS This study included 49 patients in the atrial fibrillation plus antiarrhythmic drugs group (29 men) and 77 patients in the atrial fibrillation ablation plus left atrial appendage excision group (48 men). In the atrial fibrillation ablation plus left atrial appendage excision group, after a median follow-up of 951 days (interquartile range, 529-1366 days), 8 patients (10.4%) progressed to persistent atrial fibrillation. In the atrial fibrillation plus antiarrhythmic drugs group, after a median follow-up of 835 days (interquartile range, 548-1214 days), 14 patients (28.6%) progressed to persistent atrial fibrillation. The atrial fibrillation ablation plus left atrial appendage excision group had a significantly lower incidence of atrial fibrillation progression than the atrial fibrillation plus antiarrhythmic drugs group during follow-up (3.9 vs 12.3 per 100 person-years, log-rank 8.6, P = .003). CONCLUSIONS Patients with paroxysmal nonvalvular atrial fibrillation who chose to undergo transthoracoscopic atrial fibrillation ablation had a lower incidence of progression to persistent atrial fibrillation than patients who chose conservative therapy. This strategy might be especially suitable for patients with paroxysmal nonvalvular atrial fibrillation at high risk of stroke and high risk of bleeding.
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28
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Huang J, Chen H, Zhang Q, Yang R, Peng S, Wu Z, Liu N, Tang L, Liu Z, Zhou S. Development and Validation of a Novel Prognostic Tool to Predict Recurrence of Paroxysmal Atrial Fibrillation after the First-Time Catheter Ablation: A Retrospective Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13061207. [PMID: 36980515 PMCID: PMC10047797 DOI: 10.3390/diagnostics13061207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/07/2023] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
There is no gold standard to tell frustrating outcomes after the catheter ablation of paroxysmal atrial fibrillation (PAF). The study aims to construct a prognostic tool. We retrospectively analyzed 315 patients with PAF who underwent first-time ablation at the Second Xiangya Hospital of Central South University. The endpoint was identified as any documented relapse of atrial tachyarrhythmia lasting longer than 30 s after the three-month blanking period. Univariate Cox regression analyzed eleven preablation parameters, followed by two supervised machine learning algorithms and stepwise regression to construct a nomogram internally validated. Five factors related to ablation failure were as follows: female sex, left atrial appendage emptying flow velocity ≤31 cm/s, estimated glomerular filtration rate <65.8 mL/(min·1.73 m2), P wave duration in lead aVF ≥ 120 ms, and that in lead V1 ≥ 100 ms, which constructed a nomogram. It was correlated with the CHA2DS2-VASc score but outperformed the latter evidently in discrimination and clinical utility, not to mention its robust performances in goodness-of-fit and calibration. In addition, the nomogram-based risk stratification could effectively separate ablation outcomes. Patients at risk of relapse after PAF ablation can be recognized at baseline using the proposed five-factor nomogram.
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Affiliation(s)
- Junjie Huang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Hao Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Quan Zhang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Rukai Yang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Shuai Peng
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhijian Wu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Na Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhenjiang Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Shenghua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
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29
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Uemura T, Kondo H, Sato H, Takahashi M, Shinohara T, Mitarai K, Fukui A, Hirota K, Fukuda T, Kodama N, Miyoshi M, Ogawa N, Wada M, Yamasaki H, Iwanaga K, Uno A, Tawara K, Yonezu K, Akioka H, Teshima Y, Yufu K, Nakagawa M, Takahashi N. Predictors of outcome after catheter ablation for atrial fibrillation: Group analysis categorized by age and type of atrial fibrillation. Ann Noninvasive Electrocardiol 2023; 28:e13020. [PMID: 36527236 PMCID: PMC10023880 DOI: 10.1111/anec.13020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The outcome of catheter ablation could probably differ among patients with atrial fibrillation (AF), depending on age and AF type. We aimed to investigate the difference in predictors of outcome after catheter ablation for AF among the patient categories divided by age and AF type. METHODS AND RESULTS A total of 396 patients with AF (mean age 65.69 ± 11.05 years, 111 women [28.0%]) who underwent catheter ablation from January 2018 to December 2019 were retrospectively analyzed. We divided the patients into four categories: patients with paroxysmal AF (PAF) or persistent AF (PeAF) who were 75 years or younger (≤75 years) or older than 75 years (>75 years). Kaplan-Meier survival analysis demonstrated that patients with PAF aged ≤75 years had the lowest AF recurrence among the four groups (log-rank test, p = .0103). In the patients with PAF aged ≤75 years (N = 186, 46.7%), significant factors associated with recurrence were female sex (p = .008) and diabetes (p = .042). In the patients with PeAF aged ≤75 years (N = 142, 35.9%), the only significant factor associated with no recurrence was medication with a renin-angiotensin system inhibitor (p = .044). In the patients with PAF aged >75 years (N = 53, 14.4%), diabetes was significantly associated with AF recurrence (p = .021). No significant parameters were found in the patients with PeAF aged >75 years (N = 15, 4.1%). CONCLUSIONS Our findings indicate that the risk factors for AF recurrence after catheter ablation differed by age and AF type.
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Affiliation(s)
- Tetsuya Uemura
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Masaki Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Kazuki Mitarai
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Kei Hirota
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Tomoko Fukuda
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Nozomi Kodama
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Miho Miyoshi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Naoko Ogawa
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Masato Wada
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Hirochika Yamasaki
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Kenzo Iwanaga
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Akihiro Uno
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Katsunori Tawara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita UniversityYufuOitaJapan
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Martin CA, Tilz RRR, Anic A, Defaye P, Luik A, de Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht EM, Raybuck JD, Richards E, Cielen N, Yap SC. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR ICE study. J Cardiovasc Electrophysiol 2023; 34:833-840. [PMID: 36786515 DOI: 10.1111/jce.15861] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/03/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is well established as a primary treatment for atrial fibrillation (AF). The POLAR ICE study was designed to collect prospective real world data on the safety and effectiveness of the POLARxTM cryoballoon for PVI to treat paroxysmal AF. METHODS POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 399 patients across 19 European centers. Procedural characteristics, such as time to isolation, cryoablations per pulmonary vein (PV), balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing. RESULTS Data on 372 de novo PVI procedures (n = 2190 ablations) were collected. Complete PVI was achieved in 96.8% of PVs. Procedure and fluoroscopy times were 68.2 ± 24.6 and 15.6 ± 9.6 min, respectively. Left atrial dwell time was 46.6 ± 18.3 min. Grade 3 or 4 occlusion was achieved in 98.2% of PVs reported and 71.2% of PVs isolation required only a single cryoablation. Of 2190 cryoapplications, 83% had a duration of at least 120 s; nadir temperature of these ablations averaged -56.3 ± 6.5°C. There were 6 phrenic nerve palsy events, 2 of which resolved within 3 months of the procedure. CONCLUSION This real-world usage data on a novel cryoballoon suggests this device is effective, safe, and relatively fast in centers with cryoballoon experience. These data are comparable to prior POLARx reports and in keeping with reported data on other cryoballoons. Future studies should examine the long-term outcomes and the relationship between biophysical parameters and outcomes for this novel cryoballoon.
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Affiliation(s)
- Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust and Cambridge University, Cambridge, UK
| | - Roland R R Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ante Anic
- Klinicki Bolnicki Centar Split, Split, Croatia
| | - Pascal Defaye
- University Grenoble Alpes, INSERM unité 1039 and Grenoble university Hospital, Cardiology Department, Grenoble, France
| | - Armin Luik
- Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Laure Champ-Rigot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Cardiology Department, Caen, France
| | | | - Philipp Sommer
- Clinic for Electrophysiology Herz und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | | | | | - Nele Cielen
- Boston Scientific, Arden Hills, Minnesota, USA
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Yadav R, Brilliant J, Akhtar T, Milstein J, Sampognaro JR, Marine J, Berger R, Calkins H, Spragg D. Relationship between amiodarone response prior to ablation and 1-year outcomes of catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:860-868. [PMID: 36738148 DOI: 10.1111/jce.15845] [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: 09/20/2022] [Revised: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Catheter ablation for atrial fibrillation (AF) is a common therapeutic strategy for patients with either paroxysmal AF (PAF) or persistent AF (persAF), but long-term ablation success rates are imperfect. Maintenance of sinus rhythm immediately before ablation with antiarrhythmic drug (AAD) therapy has been associated with improved outcomes in patients undergoing ablation. Amiodarone has superior efficacy relative to other AADs. Whether failure of amiodarone to maintain sinus rhythm before ablation for either PAF or persAF is associated with poor outcomes is unknown. METHODS A total of 307 patients who received amiodarone in a 1-year window before undergoing catheter ablation for AF were included. Patients were divided into amiodarone success (n = 183) and amiodarone failure (n = 124) groups based on the response to pre-ablation amiodarone treatment. Analysis of procedural outcomes as a function of response to amiodarone therapy was performed. Patients were followed for at least 12 months postablation, to assess outcomes (adverse events and arrhythmia recurrence). Procedural success was defined by the absence of documented arrhythmia (>30 s) without any antiarrhythmic agents beyond a 90-day blanking period. RESULTS Following ablation for either PAF or persAF, freedom from any recurrent atrial arrhythmia at 1 year was 57.7% for the entire cohort. One-year freedom from recurrent arrhythmia in the amiodarone success group was comparable to that in the amiodarone failure group (55.7% vs. 60.5%; p = .54). Success rates following ablation did not vary by the response to amiodarone when analyzed for PAF or persAF subgroups. CONCLUSION Failure to restore and maintain sinus rhythm with amiodarone before ablation for either PAF or persAF is not a predictor of ablation procedural failure. Amiodarone failure alone should not deter practitioners from considering ablation therapy for patients with AF.
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Affiliation(s)
- Ritu Yadav
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Justin Brilliant
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Tauseef Akhtar
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jenna Milstein
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - James R Sampognaro
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Joseph Marine
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - David Spragg
- Division of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Jin S, Lin W, Fang X, Liao H, Zhan X, Fu L, Jiang J, Ye X, Liu H, Chen Y, Pu S, Wu S, Deng H, Xue Y. High-Power, Short-Duration Ablation under the Guidance of Relatively Low Ablation Index Values for Paroxysmal Atrial Fibrillation: Long-Term Outcomes and Characteristics of Recurrent Atrial Arrhythmias. J Clin Med 2023; 12:jcm12030971. [PMID: 36769620 PMCID: PMC9917927 DOI: 10.3390/jcm12030971] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the difference in effectiveness and safety of high-power, short-duration (HPSD) radiofrequency catheter ablation (RFA) guided by relatively low ablation index (AI) values and conventional RFA in paroxysmal atrial fibrillation (PAF) patients. METHODS The HPSD RFA strategy (40-50 W, AI 350-400 for anterior, 320-350 for posterior wall; n = 547) was compared with the conventional RFA strategy (25-40 W, without AI; n = 396) in PAF patients who underwent their first ablation. Propensity-score matching analyses were used to compare the outcomes of the two groups while controlling for confounders. RESULTS After using propensity-score matching analysis, the HPSD group showed a higher early recurrence rate (22.727% vs. 13.636%, p = 0.003), similar late recurrence rate, and comparable safety (p = 0.604) compared with the conventional group. For late recurrent atrial arrhythmia types, the rate of regular atrial tachycardia was significantly higher in the HPSD group (p = 0.013). Additionally, the rate of chronic pulmonary vein reconnection and non-pulmonary vein triggers during repeat procedures was similar in both groups. CONCLUSIONS For PAF patients, compared with the conventional RFA strategy, the HPSD RFA strategy at relatively low AI settings had a higher early recurrence rate, similar long-term success rate, and comparable safety.
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Affiliation(s)
- Shuyu Jin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Weidong Lin
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xianhong Fang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Hongtao Liao
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xianzhang Zhan
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Lu Fu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Junrong Jiang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xingdong Ye
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Huiyi Liu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Yanlin Chen
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Sijia Pu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Shulin Wu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Hai Deng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Correspondence: (H.D.); (Y.X.)
| | - Yumei Xue
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Correspondence: (H.D.); (Y.X.)
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Li X, Chen Y, Chen G, Deng C, Tang C, Zhang J. Single ring isolation of pulmonary veins combined with electrical isolation of the superior vena cava in patients with paroxysmal atrial fibrillation. Front Cardiovasc Med 2023; 9:1028053. [PMID: 36698934 PMCID: PMC9869763 DOI: 10.3389/fcvm.2022.1028053] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Single-ring isolation (SRI) of the pulmonary veins and the left atrial post wall (LAPW) is an accepted strategy in atrial fibrillation ablation. Whether SRI combined with superior vena cava isolation (SVCI) could further increase the success rate of paroxysmal atrial fibrillation (PAF) has not been reported. Objective This study aimed to investigate whether SRI combined with SVCI was feasible and whether it could improve the success rate of PAF ablation. Methods and results In our study, sixty patients with PAF from May 2019 to March 2021 were included. SRI plus SVCI was completed with ablation index (AI)-guided high-power ablation. The success rates of SRI and SVCI were 100% and 97%, respectively. One-pass SRI was achieved in 41 out of 60 patients, with 19 out of 60 patients requiring additional ablation to complete the SRI. SVC was not isolated in 2 out of the 60 cases due to concerns about the phrenic nerve (PN) injury. Among the enrolled patients, 2 patients had anomalous pulmonary veins (PVs) (common ostium of inferior PVs). SRI was applied to achieve the PV and PW isolation. After ablation, one patient had an ischemic stroke but recovered without severe morbidity. The average follow-up period was (20 ± 7) months, and single-procedure freedom from atrial arrhythmia was 91.7%. AT/AF recurred in five patients, and 2 out of 5 patients underwent redo ablation. The multi-procedure freedom from atrial arrhythmia was 95%. Conclusion Our novel ablation strategy, SRI combined with SVCI, in patients with PAF was feasible and safe, with a relatively high success rate.
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Li X, Zhao C, Li M, Yu H, Liu X, Zhu Q, Song X, Wang Y, Yu B, Ma C. Predictive value of HMGB1 for atrial fibrillation recurrence after cryoballoon ablation in paroxysmal atrial fibrillation patients. Clin Cardiol 2022; 45:1229-1235. [PMID: 36124718 DOI: 10.1002/clc.23904] [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: 04/20/2022] [Revised: 06/28/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cryoballoon ablation (CBA) is recommended for patients with symptomatic drug refractory paroxysmal atrial fibrillation (pAF). However, substantial atrial fibrillation (AF) recurrence is common during follow-up. Searching for a potential biomarker representing both myocardial injury and inflammation to identify patients at high risk of AF recurrence after CBA is very meaningful for postoperative management of AF patients. HYPOTHESIS To evaluate the clinical efficacy of high-mobility group box 1 (HMGB1) protein released from the left atrium to predict AF recurrence in pAF patients after CBA at 1-year follow-up. METHODS We included 72 pAF patients who underwent CBA. To determine the expression levels of HMGB1, left atrial blood samples were collected from the patients before CBA and after the procedure through the transseptal sheath. Patients were followed up for AF recurrence for 1 year. RESULTS A total of 19 patients of the 72 experienced AF recurrence. The level of postoperative HMGB1 (HMGB1post) was higher in the AF recurrence group than in the AF non recurrence group (p = .03). However, no differences were noted in the levels of other biomarkers such as preoperative high-sensitivity C-reactive protein (hs-CRP), postoperativehs-CRP, and preoperative HMGB1 between the two groups. Multiple logistic regression analysis revealed that a higher level of serum HMGB1post was associated with AF recurrence (odds ratio: 5.29 [1.17-23.92], p = .04). Receiver operating characteristic analysis revealed that HMGB1post had a moderate predictive power for AF recurrence (area under the curve: 0.68; sensitivity: 72%; and specificity: 68%). The 1-year AF-free survival was significantly lower in patients with a high HMGB1post level than in those with a low HMGB1post level (hazard ratio: 3.81 [1.49-9.75], p = .005). CONCLUSION In pAF patients who under went CBA, the level of HMGB1 after CBA was associated with AF recurrence and demonstrated a moderate predictive power. Thus, we offer a potential biomarker to identify pAF patients at high risk of AF recurrence.
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Affiliation(s)
- Xinxin Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Cuiting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Meng Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongxiao Yu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiping Liu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qing Zhu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaokun Song
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bo Yu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Muacevic A, Adler JR, Inman BL. Electroconvulsive Therapy-Induced Paroxysmal Atrial Fibrillation in Healthy Young Male. Cureus 2022; 14:e31989. [PMID: 36589202 PMCID: PMC9797374 DOI: 10.7759/cureus.31989] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Electroconvulsive therapy (ECT) is a widely used and highly effective treatment for psychiatric disorders. This is an overall safe option for the management of antidepressant-resistant depression; however, there are known possibilities of cardiac complications. The majority of documented cardiac-related complications due to ECT are found in patients who are middle-aged or older and generally have comorbidities, including prior myocardial infarction, known arrhythmias, hypertension, obesity, diabetes mellitus, family history of cardiac disease, alcohol abuse, and smoking. We present a case of an overall healthy, 21-year-old male with no prior cardiac disease who developed paroxysmal atrial fibrillation (AF) after a routine ECT treatment, his evaluation in the emergency department, treatment, and follow-up.
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Affiliation(s)
| | | | - Brannon L Inman
- Emergency Medicine, San Antonio Military Medical Center, San Antonio, USA
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Fang D, Xu J, Bai B, Chen H. Acute myocardial infarction occurring after hypertrophic obstructive cardiomyopathy with paroxysmal atrial fibrillation: a case report. J Int Med Res 2022; 50:3000605221133702. [PMID: 36310497 PMCID: PMC9619288 DOI: 10.1177/03000605221133702] [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: 01/24/2023] Open
Abstract
Atheromatous plaque rupture and coronary artery stenosis/occlusion are leading causes of acute myocardial infarction (AMI). Other reasons for AMI are frequently overlooked. We report a rare case of AMI occurring after hypertrophic obstructive cardiomyopathy with paroxysmal atrial fibrillation. Although the patient showed multiple lead ST-T changes on an electrocardiogram and elevated circulating cardiac troponin I concentrations, no stenotic lesions were observed by repeated invasive coronary angiography examinations. Hypertrophic obstructive cardiomyopathy with paroxysmal atrial fibrillation was suspected as the primary cause of AMI. The patient received radiofrequency catheter ablation therapy and was free of atrial fibrillation and myocardial infarction 1 year postoperatively. The clinical management and outcome of the patient are also discussed.
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Affiliation(s)
| | | | | | - Haibo Chen
- Haibo Chen, Department of Cardiology, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, No. 3002 Sungang West Road, Futian District, Shenzhen 518035, China.
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Fu G, He B, Wang B, Feng M, Du X, Liu J, Yu Y, Gao F, Zhuo W, Xu Y, Qi Y, Chu H. Unipolar Electrogram-Guided versus Lesion Size Index-Guided Catheter Ablation in Patients with Paroxysmal Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9. [PMID: 35877591 DOI: 10.3390/jcdd9070229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background: This research explores the relationship between the unipolar electrogram (UP-EGM) and lesion size index (LSI) in different regions of continuous circular lesions (CCLs) and to assess the safety and efficacy of UP-EGM-guided versus LSI-guided radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF). Methods: A total of 120 patients with drug-refractory PAF who underwent index RFCA were scheduled to be consecutively included from March 2020 to April 2021. All the patients were randomly divided 1:1 into two groups: the UP-EGM group and the LSI group. The first-pass PVI rate, acute PVI rate, and the sinus rhythm maintenance rate were compared. Results: A total of 120 patients with PAF were included in the study: the UP-EGM group (n = 60) and the LSI group (n = 60). All the LSI values in the UP-EGM group were less than those in the corresponding regions in the LSI group (all p < 0.001). There were no significant differences in the first-pass PVI rate and acute PVI rate between the two groups. After a mean follow-up period of 11.31 ± 1.70 months, the sinus rhythm maintenance rate in the UP-EGM group was comparable to that in the LSI group (90% vs. 91.7%, p = 0.752). Conclusion: UP-EGM-guided and LSI-guided RFCA are both effective and safe in patients with PAF. However, UP-EGM may be more suitable than LSI for guiding individual RFCA.
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Zhang J, Tan Q, Lina W, Zhaoqian Z. Endothelial dysfunction predicted cardiovascular events in patients with paroxysmal atrial fibrillation. Saudi Med J 2022; 43:708-714. [PMID: 35830994 PMCID: PMC9749696 DOI: 10.15537/smj.2022.43.7.20220214] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine the relationship between endothelial dysfunction and adverse cardiovascular events in patients with paroxysmal atrial fibrillation (AF). METHODS In this prospective observational study, flow-mediated dilation (FMD) was measured by ultrasound in 291 patients with paroxysmal AF. Then, the patients were divided into low FMD group (n=97, FMD of <5.9%) or high FMD group (n=194, FMD of ≥5.9%). Patients were followed up for at least 30 months. Primary end point was cardiovascular events (stroke, heart failure hospitalization, cardiovascular death, and non-fatal myocardial infarction) and second endpoint was heart failure hospitalization, or stroke. RESULTS Rate of cardiovascular events was higher in low FMD group compared with high FMD group (37.1% versus 18%, p<0.001). This higher risk of cardiovascular events in patients with low FMD was primarily due to a higher risk of heart failure hospitalization compared with patients with high FMD (19.6% versus 10.8%, p<0.05). There was no significant difference of stroke between both groups. Cox proportional hazards ratio (HR) analysis showed that low FMD (HR: 3.036, 95% CI: [1.546-5.963], CHA2DS2-VASc scores (HR: 1.383, 95% CI: [1.035-1.847]), and left atrial diameter (HR: 1.304, 95% CI: [1.001-1.069]) were independent predictors for composite cardiovascular events. CONCLUSION In patients with paroxysmal AF, endothelial dysfunction was associated with composite cardiovascular events. Flow-mediated dilation was a significant predictor of cardiovascular events in patients with paroxysmal AF.
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Affiliation(s)
- Jing Zhang
- From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China
| | - Qiang Tan
- From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China
- Address correspondence and reprint request to: Dr. Qiang Tan, Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China. E-mail: ORCID ID: https://orcid.org/0000-0003-1621-4428
| | - Wang Lina
- From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China
| | - Zhang Zhaoqian
- From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China
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Camm AJ, Naccarelli GV, Mittal S, Crijns HJGM, Hohnloser SH, Ma CS, Natale A, Turakhia MP, Kirchhof P. The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:1932-1948. [PMID: 35550691 DOI: 10.1016/j.jacc.2022.03.337] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [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: 11/19/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/16/2022]
Abstract
The considerable mortality and morbidity associated with atrial fibrillation (AF) pose a substantial burden on patients and health care services. Although the management of AF historically focused on decreasing AF recurrence, it evolved over time in favor of rate control. Recently, more emphasis has been placed on reducing adverse cardiovascular outcomes using rhythm control, generally by using safe and effective rhythm-control therapies (typically antiarrhythmic drugs and/or AF ablation). Evidence increasingly supports early rhythm control in patients with AF that has not become long-standing, but current clinical practice and guidelines do not yet fully reflect this change. Early rhythm control may effectively reduce irreversible atrial remodeling and prevent AF-related deaths, heart failure, and strokes in high-risk patients. It has the potential to halt progression and potentially save patients from years of symptomatic AF; therefore, it should be offered more widely.
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Affiliation(s)
- A John Camm
- Cardiovascular Clinical Academic Group, St George's University of London, London, United Kingdom.
| | - Gerald V Naccarelli
- Penn State Heart and Vascular Institute, Penn State University, Hershey, Pennsylvania, USA
| | - Suneet Mittal
- Snyder Center for Comprehensive Atrial Fibrillation and Department of Cardiology, Valley Health System, Ridgewood, New Jersey, USA
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre (MUMC) and Cardiovascular Research Institute (CARIM), Maastricht, the Netherlands
| | | | - Chang-Sheng Ma
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Mintu P Turakhia
- Center for Digital Health and Department of Medicine, Stanford University, Stanford, California, USA
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany; Atrial Fibrillation Network (AFNET), Münster, Germany; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Siegler JE, Thau L, Hester T, Yeager T, Vigilante N, Kamen S, Heslin M, Shannon R, Zhang L, Butler M, Higham C, Oak S, Wolfe J, Patel P, Patel P, Thon JM. Unique Clinicopathologic Subclassifiers of Cryptogenic Cerebral Emboli. J Stroke Cerebrovasc Dis 2022; 31:106427. [PMID: 35279004 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Ipsilateral nonstenotic (<50%) internal carotid artery (ICA) plaque, cardiac atriopathy, and patent foramen ovale (PFO) may account for a substantial proportion of embolic stroke of undetermined source (ESUS). METHODS Consecutive stroke patients at our center (2019-2021) with unilateral, anterior circulation ESUS were categorized into the following mutually exclusive etiologies: (1) nonstenotic ipsilateral ICA plaque (NSP, ≥3mm in maximal axial diameter), (2) sex-adjusted mod-to-severe left atrial enlargement (LAE), (3) PFO, and (4) "occult ESUS" (patients who failed to meet criteria for these 3 groups). Descriptive statistics and multivariable logistic regression were used to model group characteristics. RESULTS Of 132 included patients, the median age was 65 (IQR 56-73), 74 (56%) of whom were White, and 54 (41%) were female. Twenty-one patients (16%) had NSP proximal to the infarct territory, 17 (13%) had LAE, 9 (7%) had a PFO, and 85 (64%) had no other mechanism. Patients with LAE were older (p=0.004), and had more frequent intracranial occlusions of the internal carotid and proximal middle cerebral artery (p=0.048), while tobacco use was most commonly found among patients with NSP (75%) when compared to other ESUS groups (p=0.02). Five of 9 patients with LAE who underwent outpatient telemetry had paroxysmal atrial fibrillation (56%), while zero patients with PFO or NSP had paroxysmal atrial fibrillation (p=0.005). Older age (adjusted OR [aOR] 1.05, 95%CI 1.03-1.07), coronary artery disease (aOR 3.22, 95%CI 1.61-6.44) and hypertension (aOR 2.16, 95%CI 1.14-4.06) were independently associated with LAE, while only tobacco use was associated with NSP when compared to other ESUS subclassifiers (OR 3.18, 95%CI 1.08-0.42). Age and tobacco use were both inversely associated with PFO (aOR 0.93, 95%CI 0.88-0.98, and aOR 0.10, 95%CI 0.02-0.90, respectively). CONCLUSIONS Certain clinical and radiographic features may be useful in predicting the proximal source of occult cerebral emboli, and can be used for cost-effective outpatient diagnostic testing.
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Gündüz ZB, Sertdemir AL, Buyukterzi Z. Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study. SAO PAULO MED J 2022; 140:182-187. [PMID: 35195235 PMCID: PMC9610249 DOI: 10.1590/1516-3180.2021.0156.r2.08062021] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiography (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of paroxysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke patients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptomatic carotid stenosis. CONCLUSIONS Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.
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Affiliation(s)
- Zahide Betül Gündüz
- MD, PhD. Assistant Professor, Department of Neurology, Saglik Bilimleri University, Konya State Hospital, Konya, Turkey.
| | - Ahmet Lutfi Sertdemir
- MD, PhD. Assistant Professor, Department of Cardiology, Necmettin Erbakan University, Konya, Turkey.
| | - Zafer Buyukterzi
- MD, PhD. Associate Professor, Department of Cardiology, Saglik Bilimleri University, Konya State Hospital, Konya, Turkey.
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Hughes G, Schneir A. Paroxysmal Atrial Fibrillation Associated With the Trigger Sequence of Strenous Exercise Followed By Cold Water Ingestion. J Emerg Med 2022; 62:390-2. [PMID: 35063321 DOI: 10.1016/j.jemermed.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients often present to the emergency department with paroxysmal atrial fibrillation. There is increasing recognition that, in a subset of patients, certain clinical triggers mediated via the autonomic nervous system may precipitate episodes of atrial fibrillation. Although identification of these triggers may be critical for prevention of future episodes, they may be overlooked by treating physicians. CASE REPORT We describe an otherwise healthy 64-year-old physician who presented on two separate occasions to the emergency department with atrial fibrillation. He was electrically cardioverted successfully into normal sinus rhythm and discharged without medications both times. The patient ultimately recognized that both episodes occurred in the setting of strenuous exercise followed soon after by ingestion of cold water. Since avoiding this sequence he has not had any episodes of atrial fibrillation in the ensuing 7 years. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians often encounter patients who present with paroxysmal atrial fibrillation, some of whom may have autonomic triggers or trigger sequences that precipitated it. Although our single case report cannot prove that the sequence described caused the atrial fibrillation, we hope the case can serve to highlight the increasing awareness that, in a subset of patients with paroxysmal atrial fibrillation, identification of specific triggers could be critical in prevention and should be sought.
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Trippoli S, Di Spazio L, Chiumente M, Messori A. Medical Therapy, Radiofrequency Ablation, or Cryoballoon Ablation as First-Line Treatment for Paroxysmal Atrial Fibrillation: Interpreting Efficacy Through the Shiny Method. Cureus 2022; 14:e22645. [PMID: 35237496 PMCID: PMC8882246 DOI: 10.7759/cureus.22645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 01/22/2023] Open
Abstract
In patients with paroxysmal atrial fibrillation, cryoballoon ablation (CBA) and radiofrequency ablation (RFA) represent two therapeutic approaches supported by increasing literature. While both these ablation techniques play a role during different stages of the patient’s therapeutic pathway, their use as first-line is being increasingly recognized. This scoping review comparatively examined the evidence of effectiveness for these two ablation techniques. Our analysis was limited to the evaluation of the end-point of time to recurrence of atrial fibrillation (or other forms of atrial arrhythmias), which was the primary end-point in most clinical trials. The method used for pooling the information from clinical trials (Shiny method) is original and based on an artificial intelligence (AI) method that reconstructs individual patient data from published Kaplan-Meier time-to-event curves. Because a network meta-analysis has been published on this same clinical material, one objective of the present work was to compare the meta-analytic results with those generated by the Shiny method. A standard literature search was conducted on PubMed/Medline. Only randomized studies comparing CBA versus medical therapy, RFA versus medical therapy, or CBA versus RFA in previously untreated patients were eligible. Trials presenting a Kaplan-Meier curve to present the above-mentioned end-point were included. Patient-level data were reconstructed by application of the Shiny method. These individual patient data were then analyzed by standard statistical testing based on hazard ratio (HR) for risk of recurrence and medians of time to recurrence. Our analysis compared the two ablation treatments and medical therapy. A total of five trials were identified through our literature search. Information from these trials was pooled according to the three treatments (CBA: three trials, n = 365; RFA: two trials, n = 99; medical therapy: five trials, n = 457). CBA showed higher effectiveness than medical therapy (HR, 0.51; 95% confidence interval (CI): 0.38 to 0.67). In comparison with medical therapy, RFA showed a numerical trend that remained far from statistical significance (HR, 0.89; 95% CI: 0.62 to 1.27). Medians for time to recurrence were 14.1 months (95% CI: 10.0 to not reached) for RFA and 11.5 months (95% CI: 9.3 to 25.3) for medical therapy. This parameter was not reached for CBA. The current evidence from five randomized trials suggests that CBA ranks first in effectiveness, followed by RFA and medical therapy. In our comparison between the results generated by the Shiny method with those published in the previous meta-analysis, the Shiny method confirmed its ability to account for the length of follow-up in individual trials, whereas the meta-analytic approach confirmed its ability to account for the effects of randomizations performed in the trials.
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Affiliation(s)
- Sabrina Trippoli
- Health Technology Assessment Unit, Regione Toscana, Firenze, ITA
| | - Lorenzo Di Spazio
- Hospital Pharmacy Department, Santa Chiara Trento Hospital, Trento, ITA
| | - Marco Chiumente
- Scientific Direction, Società Italiana di Farmacia Clinica e Terapia (SIFaCT), Milano, ITA
| | - Andrea Messori
- Health Technology Assessment Unit, Regione Toscana, Firenze, ITA
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Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is commonly seen in patients with atrial fibrillation (AF) but it is unclear to what extent this relationship is one of causation or association. We examined a cohort of patients with paroxysmal AF to determine if the presence of OSA (apnea-hypopnea index ≥ 15) affects the time of onset of symptomatic AF episodes. METHODS Subjects with a recent emergency room (ER) visit for a symptomatic episode of paroxysmal AF were recruited from an AF clinic. The time of onset of the AF attack was classified as occurring in "sleeping hours" or "waking hours" based on direct history from the subject and ER visit documentation. RESULTS Of 152 patients with paroxysmal AF, 67 underwent polysomnography; 1 (1.5%) had central sleep apnea, 46 (68.7%) had mild or no OSA (M-NSA), 20 (29.8%) had OSA. In the OSA group, 14/20 (70.0%) had their symptomatic AF attack in sleeping hours compared to 12/46 (26.1%) in the M-NSA group (p=0.001). Compared with those having a paroxysmal AF attack in waking hours, and adjusting for confounders, those having a paroxysmal AF attack in sleeping hours had almost six times the odds of having OSA (odds ratio: 5.53; p=0.007). CONCLUSIONS Compared to paroxysmal AF patients with M-NSA, those with OSA were far more likely to have a symptomatic AF attack during sleeping hours, supporting a causal role for OSA in the pathogenesis of AF in this population. These findings strongly suggest that patients having nocturnal AF attacks should be evaluated for OSA.
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Affiliation(s)
- Chou-Han Lin
- Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Women's College Hospital, Toronto, Canada.,Division of Respiratory Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Maria Timofeeva
- Department of Medicine, Women's College Hospital, Toronto, Canada
| | - Tara O'Brien
- Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Women's College Hospital, Toronto, Canada
| | - Owen D Lyons
- Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Women's College Hospital, Toronto, Canada.,Women's College Research Institute, Toronto, Canada.,The Sleep Research Laboratory of UHN-TRI KITE, Toronto, Canada
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45
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Li Q, Su B, Liu J. Diagnostic values of different ECG durations in paroxysmal AF diagnosis. Ann Noninvasive Electrocardiol 2021; 27:e12921. [PMID: 34913221 PMCID: PMC8916583 DOI: 10.1111/anec.12921] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the application value of different-duration electrocardiograms (ECGs) in paroxysmal atrial fibrillation (AF) diagnosis. METHODS A total of 220 patients with paroxysmal atrial fibrillation diagnosed by 24-h dynamic electrocardiogram in our hospital from January 2019 to December 2020 were selected as the study subjects. The patients were monitored for 10 s, 5 min, and 24 hr, respectively. The results of the three different-duration ECGs were compared and analyzed in order to evaluate their paroxysmal AF diagnosis value. RESULTS Paroxysmal AF was detected in 18 patients (8.2%) with the 10-s ECG; in 89 patients (40.5%) with the 5-min ECG; and in 199 patients (90.5%) with the 24-h dynamic ECG. CONCLUSION In patients with paroxysmal AF, ECGs with longer detection times had higher detection rates.
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Affiliation(s)
- Qian Li
- Department of Clinical Electrophysiology, Harrison International Peace Hospital, Hengshui, China
| | - Bing Su
- Department of Clinical Electrophysiology, Harrison International Peace Hospital, Hengshui, China
| | - Juan Liu
- Department of Clinical Electrophysiology, Harrison International Peace Hospital, Hengshui, China
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46
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Elsayed M, Abdelfattah OM, Sayed A, Prasad RM, Barakat AF, Elgendy IY, Andrade J, Jared Bunch T, Thosani A, Saliba WI, Wazni OM, Hussein AA. Bayesian network meta-analysis comparing cryoablation, radiofrequency ablation, and antiarrhythmic drugs as initial therapies for atrial fibrillation. J Cardiovasc Electrophysiol 2021; 33:197-208. [PMID: 34855270 DOI: 10.1111/jce.15308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Antiarrhythmic drugs (AADs) and catheter ablation are first line treatments of paroxysmal atrial fibrillation (PAF), however, there exists a paucity of data regarding the potential benefit of different catheter ablation technologies versus AADs as an early rhythm strategy. OBJECTIVE To assess the safety and efficacy of cryoablation versus radiofrequency ablation (RFA) versus AADs as a first line therapy of PAF. METHODS MEDLINE, Embase, Scopus and CENTRAL were searched to retrieve randomized clinical trials (RCTs) comparing cryoablation, RFA or AADs to one another as first line therapies for atrial fibrillation (AF). The primary outcome was overall freedom from arrhythmia recurrence (AF, atrial flutter [AFL], atrial tachycardia). Secondary outcomes included freedom from symptomatic arrhythmia recurrence, hospitalization, and serious adverse events. A random-effects Bayesian network meta-analysis was used to calculate odds ratios (OR) and 95% credible intervals (CrI). RESULTS Six RCTs (N = 1212) met the inclusion criteria (605 AADs, 365 Cryoablation, and 245 RFA). Compared with AADs, overall recurrence was reduced with RFA (OR: 0.31; 95% CrI: 0.10-0.71) and cryoablation (OR: 0.39; 95% CrI: 0.16-1.00). Comparing ablation (cryoablation and RFA) with AADs in respect to freedom from symptomatic AF recurrence, neither cryoablation (OR: 0.35; 95% CrI: 0.06-1.96) nor RFA (OR: 0.34; 95% CrI: 0.07-1.27) resulted in statistically significant reductions individually compared to AADs, though pooled ablation with both technologies showed lower odds of arrhythmia recurrence (OR: 0.35; 95% CrI: 0.13-0.79). In terms of serious adverse events rates, neither cryoablation (OR: 0.77; 95% CrI: 0.44-1.39) nor RFA (OR: 1.45; 95% CrI: 0.67-3.23) were significantly different to AADs. RFA resulted in a statistically significant reduction in hospitalizations compared to AAD (OR: 0.08; 95% CrI: 0.01-0.99), whereas cryoablation did not (OR: 0.77; 95% CrI: 0.44-1.39). The surface under the cumulative ranking curve showed RFA to be the most effective treatment at reducing overall rates of recurrence, symptomatic recurrence and hospitalizations; whereas cryoablation was most likely to reduce serious adverse events. CONCLUSION Cryoablation and RFA are both effective and safe first line therapies for AF compared to AADs, with RFA being the most effective at reducing recurrences.
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Affiliation(s)
- Mahmoud Elsayed
- Department of Cardiovascular Medicine, Cardiovascular Institute at Allegheny Health Network, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Omar M Abdelfattah
- Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Ahmed Sayed
- Department of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rohan Madhu Prasad
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Amr F Barakat
- Division of Cardiovascular Disease, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Jason Andrade
- Division of Cardiology, Montreal Heart Institute, Université de Montréal, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Jared Bunch
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amit Thosani
- Division of Cardiac Electrophysiology, Department of Cardiology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kewcharoen J, Prasitlumkum N, Chokesuwattanaskul R, Yi R, Jongnarangsin K, Bunch TJ, Ranjan R, Navaravong L. Ablation versus medication as initial therapy for paroxysmal atrial fibrillation: An updated meta-analysis of randomized controlled trials. J Arrhythm 2021; 37:1448-1458. [PMID: 34887949 PMCID: PMC8637078 DOI: 10.1002/joa3.12641] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Recent randomized controlled trials (RCTs) suggest that ablation is superior to antiarrhythmic drugs (AADs) as an initial therapy for paroxysmal atrial fibrillation (pAF) to prevent arrhythmia recurrences. We performed an updated meta-analysis of RCTs, to include recent data from cryoballoon-based ablation and to compare arrhythmia-free survival and adverse events between ablation and AADs. METHODS We searched MEDLINE and EMBASE from inception to December 2020. We included RCT comparing patients with pAF undergoing ablation or receiving AADs as an initial therapy. We combined data using the random-effects model to calculate hazards ratio (HR) for arrhythmia-free survival and odds ratio (OR) for adverse events. RESULTS Five studies from 2005 to 2020 involving 985 patients were included (495 patients and 490 patients underwent ablation and medication as initial therapy, respectively). Patients who underwent ablation had higher freedom from atrial tachyarrhythmias (ATs) during the 12-24 months follow-up period (pooled HR = 0.48, 95% CI: 0.40-0.59, P < .001). In a subgroup analysis of ablation method used, both cryoablation group (pooled HR = 0.49, 95% CI: 0.38-0.64, P < .001) and radiofrequency ablation group (pooled HR = 0.47, 95%CI: 0.35-0.64, P < .001) showed reduction in AT recurrence compared with AAD group. There were no differences in adverse events including cerebrovascular accident, pericardial effusion or tamponade, pulmonary vein stenosis, acute coronary syndrome, deep vein thrombosis and pulmonary embolism, and bradycardia requiring a pacemaker. CONCLUSION Catheter ablation (both cryoablation and radiofrequency ablation) is superior to AAD as an initial therapy for pAF in efficacy for reducing AT recurrences without a compromise in adverse events.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiovascular MedicineLoma Linda University HealthLoma LindaCAUSA
| | - Narut Prasitlumkum
- Division of CardiologyUniversity of California Riverside School of MedicineRiversideCAUSA
| | - Ronpichai Chokesuwattanaskul
- Division of CardiologyDepartment of MedicineFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand
| | - Ruiyang Yi
- Department of Internal MedicineJohn A. Burns School of MedicineHonoluluHawaiiUSA
| | - Krit Jongnarangsin
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Thomas J. Bunch
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Ravi Ranjan
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Leenhapong Navaravong
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
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Isogai T, Agrawal A, Saad AM, Kuroda S, Shekhar S, Abushouk AI, Wazni OM, Hussein AA, Krishnaswamy A, Kapadia SR. Periprocedural and Short-Term Outcomes of Percutaneous Left Atrial Appendage Closure According to Type of Atrial Fibrillation. J Am Heart Assoc 2021; 10:e022124. [PMID: 34729996 PMCID: PMC8751924 DOI: 10.1161/jaha.121.022124] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Ankit Agrawal
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Anas M Saad
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Shunsuke Kuroda
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Shashank Shekhar
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Abdelrahman I Abushouk
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Oussama M Wazni
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Ayman A Hussein
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
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Ramanathan A, Pearl JP, Li M, Wang X, Sadana D, Duggal A. Atrial fibrillation of new onset during acute illness: prevalence of, and risk factors for persistence after hospital discharge. Acute Crit Care 2021; 36:317-321. [PMID: 34784660 PMCID: PMC8907468 DOI: 10.4266/acc.2021.00577] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Atrial fibrillation (AF) of new onset during acute illness (AFNOAI) has a variable incidence of 1%–44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years after hospital discharge for critically ill patients. Methods This was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1, 2012, to October 31, 2015, were screened. Those designated with AF for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox’s proportional hazards model. Results Two-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02–5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02–5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71–3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91–4.37) also showed a trend towards association with AFNOAI persistence. Conclusions Our study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient’s individual AFNOAI persistence risk.
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Affiliation(s)
| | - John Paul Pearl
- Department of Critical Care, Cleveland Clinic, Cleveland, OH, USA
| | - Manshi Li
- Quantitative Health Sciences, Lerner Research institute, Cleveland, OH, USA
| | - Xiaofeng Wang
- Quantitative Health Sciences, Lerner Research institute, Cleveland, OH, USA
| | - Divyajot Sadana
- Department of Critical Care, Cleveland Clinic, Cleveland, OH, USA
| | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, OH, USA
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Jiang C, Zhao D, Tang K, Wang Y, Li X, Jia P, Xu Y, Han B. Effectiveness and Safety of Cryoablation in Patients With Atrial Fibrillation Episodes of <24 h Duration: A Propensity-Matched Analysis. Front Cardiovasc Med 2021; 8:724378. [PMID: 34765651 PMCID: PMC8576169 DOI: 10.3389/fcvm.2021.724378] [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: 06/13/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Paroxysmal atrial fibrillation (AF) is closely related to pathophysiologic processes and clinical outcomes. However, it is uncertain whether cryoablation of pulmonary veins isolation is effective and safe for patients with symptomatic and drug refractory AF episodes of <24-h duration. Methods: The patients were designed into Group A (253 patients with paroxysmal AF episodes of <24-h duration) and Group B (253 patients with paroxysmal AF lasting for 24 h or longer) on a 1:1 basis by identical propensity scores. Mortality, stroke/transient ischemic attack (TIA), and complications relevant to the cryoablation procedure were compared, and recurrence of atrial tachyarrhythmia was analyzed for clinical independent predictors. Results: The rate of atrial tachyarrhythmia recurrence was 21.74% in Group A and 30.04% in Group B, respectively (P = 0.042). At 12-month follow-up from the procedure, lower incidences of stroke/TIA endpoint of the patients were observed in Group A compared with Group B by Kaplan–Meier analysis [HR 0.34 (0.13–0.87), P = 0.025]. No significant differences in mortality and complications relevant to the cryoablation procedure were observed between Group A and Group B. Moreover, adjusted multivariable Cox regression analysis showed that <24-h paroxysmal AF type (HR 0.644, 95% CI: 0.455–0.913, P = 0.014) and left atrium diameter (LAD) (>40 mm) (HR 1.696, 95% CI: 1.046–2.750, P = 0.032) were independently associated with the incidence of recurrence of atrial tachyarrhythmia in the study. Conclusion: Our findings indicated that <24-h paroxysmal AF type was obviously associated with an increased success rate of cryoablation and reduced incidence of stroke/TIA during the follow-up period. Therefore, there is superior effectiveness and similar safety in patients with AF episodes of <24-h duration compared with patients with longer paroxysmal AF duration.
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Affiliation(s)
- Chunying Jiang
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China.,Department of Cardiology, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital, Xuzhou, China
| | - Dongdong Zhao
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Kai Tang
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yiqian Wang
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Xiang Li
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Peng Jia
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Bing Han
- Department of Cardiology, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital, Xuzhou, China
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