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Wu H, Sawada T, Goto T, Yoneyama T, Sasano T, Asada K. Edge AI Model Deployed for Real-Time Detection of Atrial Fibrillation Risk during Sinus Rhythm. J Clin Med 2024; 13:2218. [PMID: 38673490 DOI: 10.3390/jcm13082218] [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: 03/25/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Objectives: The study aimed to develop a deep learning-based edge AI model deployed on electrocardiograph (ECG) devices for the real-time detection of atrial fibrillation (AF) risk during sinus rhythm (SR) using standard 10 s, 12-lead electrocardiograms (ECGs). Methods: A novel approach was used to convert standard 12-lead ECGs into binary images for model input, and a lightweight convolutional neural network (CNN)-based model was trained using data collected by the Japan Agency for Medical and Research Development (AMED) between 2019 and 2022. Patients over 40 years old with digital, SR ECGs were retrospectively enrolled and divided into AF and non-AF groups. The data labeling was supervised by cardiologists. The dataset was randomly allocated into training, validation, and internal testing datasets. External testing was conducted on data collected from other hospitals. Results: The best-trained model achieved an AUC of 0.82 and 0.80, sensitivity of 79.5% and 72.3%, specificity of 77.8% and 77.7%, precision of 78.2% and 76.4%, and overall accuracy of 78.6% and 75.0% in the internal and external testing datasets, respectively. The deployed model and app package utilized 2.5 MB and 40 MB of the available ROM and RAM capacity on the edge ECG device, correspondingly. The processing time for AF risk detection was approximately 2 s. Conclusions: The model maintains comparable performance and improves its suitability for deployment on resource-constrained ECG devices, thereby expanding its potential impact to a wide range of healthcare settings. Its successful deployment enables real-time AF risk detection during SR, allowing for timely intervention to prevent AF-related serious consequences like stroke and premature death.
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Affiliation(s)
- Hongmin Wu
- Technology & Innovation Department, Fukuda Denshi Co., Ltd., Tokyo 113-8420, Japan
| | - Takumi Sawada
- Development Headquarters, Fukuda Denshi Co., Ltd., Tokyo 113-8420, Japan
| | - Takafumi Goto
- Technology & Innovation Department, Fukuda Denshi Co., Ltd., Tokyo 113-8420, Japan
| | - Tatsuya Yoneyama
- Technology & Innovation Department, Fukuda Denshi Co., Ltd., Tokyo 113-8420, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Ken Asada
- Cancer Translational Research Team, RIKEN Center for Advanced Intelligence Project, Tokyo 103-0027, Japan
- Division of Medical AI Research and Development, National Cancer Center Research Institute, Tokyo 104-0045, Japan
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Monzo L, Girerd N, Ferreira JP, Lamiral Z, Anker SD, Cleland JGF, Kondo T, McMurray JJV, Lam CSP, Mehra MR, Veldhuisen DJVAN, Greenberg B, Zannad F. High Risk of Stroke in Patients With Worsening Heart Failure, Reduced Ejection Fraction, Coronary Heart Disease and Sinus Rhythm: Risk Prediction Score Analysis From the COMMANDER-HF Trial. J Card Fail 2024; 30:618-623. [PMID: 38122924 DOI: 10.1016/j.cardfail.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm have a heightened risk of stroke. Whether anticoagulation benefits these patients is uncertain. In this post hoc analysis of the A Study to Assess the Effectiveness and Safety of Rivaroxaban in Reducing the Risk of Death, Myocardial Infarction, or Stroke in Participants with Heart Failure and Coronary Artery Disease Following an Episode of Decompensated Heart Failure (COMMANDER-HF) trial we evaluated how a previously validated risk model consisting of 3 variables (history of prior stroke, insulin-treated diabetes, and N-terminal pro-B-type natriuretic peptide level) would perform, compared with plasma d-dimer, for stroke prediction and estimation of the benefit of low-dose rivaroxaban. METHODS AND RESULTS Stroke risk and treatment effect were computed across risk score and plasma d-dimer tertiles. Risk score was available in 58% of the COMMANDER-HF population (n = 2928). Over a median follow-up of 512 days (range 342-747 days), 60 patients experienced a stroke (14.6 per 1000 patient-years). The risk model did not identify patients at higher risk of stroke and showed a low overall prognostic performance (C-index = 0.53). The effect of rivaroxaban on stroke was homogeneous across risk score tertiles (P-interaction = .67). Among patients in whom the risk score was estimated, d-dimer was available in 2343 (80%). d-dimer had an acceptable discrimination performance for stroke prediction (C-index = 0.66) and higher plasma d-dimer concentrations were associated with higher rates of stroke (ie, tertile 3 vs tertile 1, hazard ratio 3.65, 95% confidence interval 1.59-8.39, P = .002). Treatment with low-dose rivaroxaban reduced the incidence of stroke in patients at highest risk by d-dimer levels (ie, >515 ng/mL, hazard ratio 0.42, 95% confidence interval 0.18-0.95, P-interaction = .074), without any safety concerns. CONCLUSIONS In our analysis, plasma d-dimer concentrations performed better than a previously described 3-variable risk score for stroke prediction in patients with heart failure with reduced ejection fraction, a recent clinical worsening and sinus rhythm as enrolled in the COMMANDER-HF trial. In these patients, a raised plasma d-dimer concentration identified patients who might benefit most from rivaroxaban.
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Affiliation(s)
- Luca Monzo
- From the Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Nicolas Girerd
- From the Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - João Pedro Ferreira
- From the Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France; Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal
| | - Zohra Lamiral
- From the Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Stefan D Anker
- Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies, German Center for Cardiovascular Research partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John G F Cleland
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mandeep R Mehra
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dirk J VAN Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barry Greenberg
- Cardiology Division, Department of Medicine, University of California, San Diego, California
| | - Faiez Zannad
- From the Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
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Zhang L, van Schie MS, Xiang H, Liao R, Zheng J, Knops P, Taverne YJHJ, de Groot NMS. Identification of Atrial Transmural Conduction Inhomogeneity Using Unipolar Electrogram Morphology. J Clin Med 2024; 13:1015. [PMID: 38398329 PMCID: PMC10889286 DOI: 10.3390/jcm13041015] [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: 12/29/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Structural remodeling plays an important role in the pathophysiology of atrial fibrillation (AF). It is likely that structural remodeling occurs transmurally, giving rise to electrical endo-epicardial asynchrony (EEA). Recent studies have suggested that areas of EEA may be suitable targets for ablation therapy of AF. We hypothesized that the degree of EEA is more pronounced in areas of transmural conduction block (T-CB) than single-sided CB (SS-CB). This study examined the degree to which SS-CB and T-CB enhance EEA and which specific unipolar potential morphology parameters are predictive for SS-CB or T-CB. (2) Methods: Simultaneous endo-epicardial mapping in the human right atrium was performed in 86 patients. Potential morphology parameters included unipolar potential voltages, low-voltage areas, potential complexity (long double and fractionated potentials: LDPs and FPs), and the duration of fractionation. (3) Results: EEA was mostly affected by the presence of T-CB areas. Lower potential voltages and more LDPs and FPs were observed in T-CB areas compared to SS-CB areas. (4) Conclusion: Areas of T-CB could be most accurately predicted by combining epicardial unipolar potential morphology parameters, including voltages, fractionation, and fractionation duration (AUC = 0.91). If transmural areas of CB indeed play a pivotal role in the pathophysiology of AF, they could theoretically be used as target sites for ablation.
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Affiliation(s)
- Lu Zhang
- Department of Cardiology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands (J.Z.); (N.M.S.d.G.)
| | - Mathijs S. van Schie
- Department of Cardiology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands (J.Z.); (N.M.S.d.G.)
| | - Hongxian Xiang
- Department of Cardiology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands (J.Z.); (N.M.S.d.G.)
| | - Rongheng Liao
- Department of Cardiology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands (J.Z.); (N.M.S.d.G.)
| | - Jiahao Zheng
- Department of Cardiology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands (J.Z.); (N.M.S.d.G.)
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands (J.Z.); (N.M.S.d.G.)
| | - Yannick J. H. J. Taverne
- Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands
| | - Natasja M. S. de Groot
- Department of Cardiology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands (J.Z.); (N.M.S.d.G.)
- Signal Processing Systems, Department of Microelectronics, Faculty of Electrical Engineering, Mathematics and Computer Sciences, Delft University of Technology, 2628CD Delft, The Netherlands
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Ye Z, van Schie MS, Heida A, van Staveren LN, van Schaagen FRN, Taverne YJHJ, de Groot NMS. Unipolar atrial electrogram morphology is affected by age: evidence from high-resolution epicardial mapping. Ann Med 2023; 55:1431-1441. [PMID: 37194486 DOI: 10.1080/07853890.2023.2193426] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND It is unknown which features of unipolar atrial electrogram (U-AEGM) morphology are affected by ageing and whether age-related changes in U-AEGM morphology are equally distributed throughout the right and left atria. PATIENTS AND METHODS Epicardial high-resolution mapping was performed in patients undergoing coronary artery bypass grafting surgery during sinus rhythm (SR). Mapping areas include the right atrium (RA), left atrium (LA), pulmonary vein area (PVA) and Bachmann's bundle (BB). Patients were categorized into a young (age < 60) and aged (age ≥ 60) group. U-AEGM were classified as single potentials (SPs, one deflection), short double potentials (SDPs, deflection interval ≤ 15ms), long double potentials (LDPs, deflection interval > 15ms) and fractionated potentials (FPs, ≥3 deflections). RESULTS A total of 213 patients (age: 67 (59-73) years; young group N = 58, aged group N = 155) were included. Only at BB, the proportion of SPs (p = 0.007) was significantly higher in the young group, while the proportion of SDPs (p = 0.051), LDPs (p = 0.004) and FPs (p = 0.006) was higher in the aged group. After adjusting for potential confounders, older age was associated with a reduction in SPs [regression coefficient (β): -6.33, 95% confident interval (CI): -10.37 to -2.30] at the expense of an increased proportion of SDPs (β: 2.49, 95% CI: 0.09 to 4.89), LDPs (β: 1.94, 95% CI: 0.21 to 3.68) and FPs (β: 1.90, 95% CI: 0.62 to 3.18). CONCLUSIONS Age-related remodeling particularly affects BB as indicated by the decreased amount of non-SP at this location in the elderly.Key MessagesAgeing preferentially affects the morphology of unipolar atrial electrograms recorded at Bachmann's bundle.At Bachmann's bundle, the proportion of short double-, long double- and fractionated potentials increase during ageing at the expense of a decrease in the proportion of single potentials, reflecting aggravation of abnormalities in conduction.The increase in abnormal unipolar atrial electrograms at Bachmann's bundle during ageing supports the concept that Bachmann's bundle may play an important role in development of age-related arrhythmias such as atrial fibrillation.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Frank R N van Schaagen
- Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yannick J H J Taverne
- Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Song X, Que D, Zhu Y, Yu W, Xu H, Zhang X, Yan J, Wang Y, Rui B, Yang Y, Zhuang Z, Huang G, Zhao X, Yang C, Cai Y, Yang P. Guiding ablation strategies for ventricular tachycardia in patients with structural heart disease by analyzing links and conversion patterns of traceable abnormal late potential zone. J Cardiovasc Electrophysiol 2023; 34:2273-2282. [PMID: 37694672 DOI: 10.1111/jce.16051] [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: 05/17/2023] [Revised: 08/19/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Substrate-based ablation can treat uninducible or hemodynamically instability scar-related ventricular tachycardia (VT). However, whether a correlation exists between the critical VT isthmus and late activation zone (LAZ) during sinus rhythm (SR) is unknown. OBJECTIVE To demonstrate the structural and functional properties of abnormal substrates and analyze the link between the VT circuit and abnormal activity during SR. METHODS Thirty-six patients with scar-related VT (age, 50.0 ± 13.7 years and 86.1% men) who underwent VT ablation were reviewed. The automatic rhythmia ultrahigh resolution mapping system was used for electroanatomic substrate mapping. The clinical characteristics and mapping findings, particularly the LAZ characteristics during SR and VT, were analyzed. To determine the association between the LAZ during the SR and VT circuits, the LAZ was defined as five activation patterns: entrance, exit, core, blind alley, and conduction barrier. RESULTS Forty-five VTs were induced in 36 patients, 91.1% of which were monomorphic. The LAZ of all patients was mapped during the SR and VT circuits, and the consistency of the anatomical locations of the LAZ and VT circuits was analyzed. Using the ultrahigh resolution mapping system, interconversion patterns, including the bridge, T, puzzle, maze, and multilayer types, were identified. VT ablation enabled precise ablation of abnormal late potential conduction channels. CONCLUSION Five interconversion patterns of the LAZ during the SR and VT circuits were summarized. These findings may help formulate more precise substrate-based ablation strategies for scar-related VT and shorter procedure times.
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Affiliation(s)
- Xudong Song
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Dongdong Que
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yingqi Zhu
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Wenjie Yu
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Haoran Xu
- Boston Scientific China, Shanghai, China
| | - Xiuli Zhang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Jing Yan
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yuxi Wang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Bowen Rui
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yashu Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Zhenyu Zhuang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Guanlin Huang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Xiaoqing Zhao
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Chaobo Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yanbin Cai
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Pingzhen Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China
- Heart Center of Zhujiang Hospital, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
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Moore BM, Al-Kaisy A, Joshi SB, Lui E, Grigg LE, Kalman JM. Noninvasive ECG imaging of the intrinsic atrial pacemaker and atrial activation in surgically repaired or palliated congenital heart disease. J Cardiovasc Electrophysiol 2023; 34:1859-1868. [PMID: 37526234 DOI: 10.1111/jce.16027] [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: 04/15/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Sinus node location, function, and atrial activation are often abnormal in patients with congenital heart disease (CHD), due to anatomical, surgical, and acquired factors. We aimed to perform noninvasive electrocardiographic imaging (ECGI) of the intrinsic atrial pacemaker and atrial activation in patients with surgically repaired or palliated CHD, compared with control patients with structurally normal hearts. METHODS AND RESULTS Atrial ECGI was performed in eight CHD patients with prespecified diagnoses (Fontan circulation, dextro transposition of the great arteries post Mustard/Senning, tetralogy of Fallot), and three controls. Activation and propagation maps were constructed in presenting rhythm. Wavefront propagation was analyzed to identify (1) intrinsic atrial pacemaker breakout site, (2) morphological right atrial (RA) activation pattern, (3) morphological left atrial (LA) breakout sites (i.e., interatrial connections), (4) LA activation pattern, and (5) putative lines of block. Physiologically appropriate atrial activation and propagation maps were able to be constructed. In the majority of patients, atrial breakouts were in keeping with the sinus node, observed in a crescent-shaped distribution from the anterior superior vena cava to the posterior RA. Ectopic atrial pacemaker sites were demonstrated in the atriopulmonary (AP) Fontan patient (very diffuse posterolateral RA) and Mustard patient (very posterior RA competing with a low RA focus). RA propagation was laminar in controls, but suggested either a line of block or conduction slowing consistent with an atriotomy scar in the tetralogy of Fallot (TOF) patients. Putative lines of block were more complex and RA propagation more abnormal in the atrial switch and AP Fontan patients, compared with the TOF patients. RA activation in the extracardiac Fontan patients was relatively laminar. Earliest LA breakout was most commonly observed in the region of Bachmann's Bundle in both controls and CHD patients, except for posterior LA breakouts in two patients. LA activation was typically more homogeneous than RA activation in CHD patients. CONCLUSION ECGI can be utilized to create a noninvasive mapping model of atrial activation in postsurgical CHD, demonstrating atrial pacemaker location, putative lines of block and interatrial connections. Once validated invasively, this may have clinical implications in predicting risk of sinus node dysfunction and atrial arrhythmias, or in guiding catheter ablation.
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Affiliation(s)
- Benjamin M Moore
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ahmed Al-Kaisy
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Subodh B Joshi
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Elaine Lui
- Department of Medical Imaging, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Leanne E Grigg
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Nairn D, Eichenlaub M, Lehrmann H, Müller-Edenborn B, Chen J, Huang T, Nagel C, Sánchez J, Luongo G, Westermann D, Arentz T, Dössel O, Jadidi A, Loewe A. Spatial correlation of left atrial low voltage substrate in sinus rhythm versus atrial fibrillation: The rhythm specificity of atrial low voltage substrate. J Cardiovasc Electrophysiol 2023; 34:1613-1621. [PMID: 37365931 DOI: 10.1111/jce.15984] [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: 04/28/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Improved sinus rhythm (SR) maintenance rates have been achieved in patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation plus additional ablation of low voltage substrate (LVS) during SR. However, voltage mapping during SR may be hindered in persistent and long-persistent AF patients by immediate AF recurrence after electrical cardioversion. We assess correlations between LVS extent and location during SR and AF, aiming to identify regional voltage thresholds for rhythm-independent delineation/detection of LVS areas. (1) Identification of voltage dissimilarities between mapping in SR and AF. (2) Identification of regional voltage thresholds that improve cross-rhythm substrate detection. (3) Comparison of LVS between SR and native versus induced AF. METHODS Forty-one ablation-naive persistent AF patients underwent high-definition (1 mm electrodes; >1200 left atrial (LA) mapping sites per rhythm) voltage mapping in SR and AF. Global and regional voltage thresholds in AF were identified which best match LVS < 0.5 mV and <1.0 mV in SR. Additionally, the correlation between SR-LVS with induced versus native AF-LVS was assessed. RESULTS Substantial voltage differences (median: 0.52, interquartile range: 0.33-0.69, maximum: 1.19 mV) with a predominance of the posterior/inferior LA wall exist between the rhythms. An AF threshold of 0.34 mV for the entire left atrium provides an accuracy, sensitivity and specificity of 69%, 67%, and 69% to identify SR-LVS < 0.5 mV, respectively. Lower thresholds for the posterior wall (0.27 mV) and inferior wall (0.3 mV) result in higher spatial concordance to SR-LVS (4% and 7% increase). Concordance with SR-LVS was higher for induced AF compared to native AF (area under the curve[AUC]: 0.80 vs. 0.73). AF-LVS < 0.5 mV corresponds to SR-LVS < 0.97 mV (AUC: 0.73). CONCLUSION Although the proposed region-specific voltage thresholds during AF improve the consistency of LVS identification as determined during SR, the concordance in LVS between SR and AF remains moderate, with larger LVS detection during AF. Voltage-based substrate ablation should preferentially be performed during SR to limit the amount of ablated atrial myocardium.
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Affiliation(s)
- Deborah Nairn
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Björn Müller-Edenborn
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juan Chen
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Taiyuan Huang
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claudia Nagel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Jorge Sánchez
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Giorgio Luongo
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Amir Jadidi
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Arrhythmia Division, Department of Cardiology, Heart Center Lucerne, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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8
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Khan HR, Yakupoglu HY, Kralj-Hans I, Haldar S, Bahrami T, Clague J, De Souza A, Hussain W, Jarman J, Jones DG, Salukhe T, Markides V, Gupta D, Khattar R, Wong T. Left Atrial Function Predicts Atrial Arrhythmia Recurrence Following Ablation of Long-Standing Persistent Atrial Fibrillation. Circ Cardiovasc Imaging 2023:e015352. [PMID: 37288553 DOI: 10.1161/circimaging.123.015352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Left atrial (LA) function following catheter or surgical ablation of de-novo long-standing persistent atrial fibrillation (AF) and its impact on AF recurrence was studied in patients participating in the CASA-AF trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation). METHODS All patients underwent echocardiography preablation, 3 and 12 months post-ablation. LA structure and function were assessed by 2-dimensional volume and speckle tracking strain measurements of LA reservoir, conduit, and contractile strain. Left ventricular diastolic function was measured using transmitral Doppler filling velocities and myocardial tissue Doppler velocities to derive the e', E/e', and E/A ratios. Continuous rhythm monitoring was achieved using an implantable loop recorder. RESULTS Eighty-three patients had echocardiographic data suitable for analysis. Their mean age was 63.6±9.7 years, 73.5% were male, had AF for 22.8±11.6 months, and had a mean LA maximum volume of 48.8±13.8 mL/m2. Thirty patients maintained sinus rhythm, and 53 developed AF recurrence. Ablation led to similar reductions in LA volumes at follow-up in both rhythm groups. However, higher LA emptying fraction (36.3±10.6% versus 27.9±9.9%; P<0.001), reservoir strain (22.6±8.5% versus 16.7±5.7%; P=0.001), and contractile strain (9.2±3.4% versus 5.6±2.5%; P<0.001) were noted in the sinus rhythm compared with AF recurrence group following ablation at 3 months. Diastolic function was better in the sinus rhythm compared with the AF recurrence group with an E/A ratio of 1.5±0.5 versus 2.2±1.2 (P<0.001) and left ventricular E/e' ratio of 8.0±2.1 versus 10.3±4.1 (P<0.001), respectively. LA contractile strain at 3 months was the only independent predictor of AF recurrence. CONCLUSIONS Following ablation for long-standing persistent AF, improvement in LA function was greater in those who maintained sinus rhythm. LA contractile strain at 3 months was the most important determinant of AF recurrence following ablation. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02755688.
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Affiliation(s)
- Habib Rehman Khan
- London Health Sciences Centre, University of Western Ontario, London, Canada (H.R.K.)
| | - Haci Yakup Yakupoglu
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Ines Kralj-Hans
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Shouvik Haldar
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Toufan Bahrami
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Jonathan Clague
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Anthony De Souza
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Wajid Hussain
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Julian Jarman
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - David Gareth Jones
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Tushar Salukhe
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Vias Markides
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, United Kingdom (D.G.)
| | - Rajdeep Khattar
- Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Trust, London, United Kingdom (H.Y.Y., I.K.-H., S.H., T.B., J.C., A.D.S., W.H., J.J., D.G.J., T.S., V.M., R.K.)
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.K., T.W.)
| | - Tom Wong
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.K., T.W.)
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Sharma P, Garg S, Malani SK. Left atrial strain predicts improvement in left atrial functions of severe rheumatic mitral stenoses undergoing successful percutaneous transmitral commissurotomy. Echocardiography 2023. [PMID: 37270686 DOI: 10.1111/echo.15627] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/06/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023] Open
Abstract
AIMS Chronic rheumatic heart disease (RHD) is prevalent in India. The mitral valve in isolation or combination with the aortic or tricuspid valve is involved in 31.6% and 52.8% of chronic RHD patients, respectively. The left atrium (LA) functions as a reservoir during the cardiac cycle. Therefore, the LA enlargement leads to longitudinal lengthening, measured as a positive strain, permitting the measurement of the longitudinal strain of LA. This study aimed to assess the LA functions using peak atrial longitudinal strain (PALS) in patients with severe rheumatic mitral stenoses (MS) in sinus rhythm who underwent successful percutaneous transvenous mitral commissurotomy (PTMC). MATERIAL AND METHODS We recruited 56 patients with severe rheumatic MS for the study, of which 06 PTMC procedures were considered unsuccessful. So, 50 patients of chronic severe rheumatic MS in sinus rhythm undergoing PTMC were enrolled in a tertiary care centre of the Armed Forces from August 2017 to May 2019. Patients included in the study were not consecutive, and patients with atrial fibrillation (AF) were excluded. RESULTS PALS improved post-PTMC (P < .001) in this study, effectively concluding that PALS is impaired in patients with severe symptomatic MS and is acutely enhanced after treatment. CONCLUSIONS PALS is a good indicator of LA function and may predict the success of PTMC on the rheumatic mitral valve.
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Affiliation(s)
- Prabhat Sharma
- Department of Cardiology, Command Hospital, Udhampur, Jammu and Kashmir, India
| | - Salil Garg
- Department of Cardiology, SGRRIMHS & Mahant Inderish Hospital, Dehradun, India
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10
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Ciaccio EJ, Coromilas J, Wan EY, Yarmohammadi H, Saluja DS, Peters NS, Garan H, Biviano AB. Lateral Boundaries of the Ventricular Tachycardia Circuit Align With Sinus Rhythm Discontinuities. JACC Clin Electrophysiol 2023; 9:851-861. [PMID: 37227361 DOI: 10.1016/j.jacep.2022.11.037] [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: 09/09/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Sinus rhythm electrical activation mapping can provide information regarding the ischemic re-entrant ventricular tachycardia (VT) circuit. The information gleaned may include the localization of sinus rhythm electrical discontinuities, which can be defined as arcs of disrupted electrical conduction with large activation time differences across the arc. OBJECTIVES This study sought to detect and localize sinus rhythm electrical discontinuities that might be present in activation maps constructed from infarct border zone electrograms. METHODS Monomorphic re-entrant VT with a double-loop circuit and central isthmus was repeatedly inducible by programmed electrical stimulation in the epicardial border zone of 23 postinfarction canine hearts. Sinus rhythm and VT activation maps were constructed from 196 to 312 bipolar electrograms acquired surgically at the epicardial surface and analyzed computationally. A complete re-entrant circuit was mappable from the epicardial electrograms of VT, and isthmus lateral boundary (ILB) locations were ascertained. The difference in sinus rhythm activation time across ILB locations, vs the central isthmus and vs the circuit periphery, was determined. RESULTS Sinus rhythm activation time differences averaged 14.4 milliseconds across the ILB vs 6.5 milliseconds at the central isthmus and 6.4 milliseconds at the periphery (ie, the outer circuit loop) (P ≤ 0.001). Locations with large sinus rhythm activation difference tended to overlap ILB (60.3% ± 23.2%) compared with their overlap with the entire grid (27.5% ± 18.5%) (P < 0.001). CONCLUSIONS Disrupted electrical conduction is evident as discontinuity in sinus rhythm activation maps, particularly at ILB locations. These areas may represent permanent fixtures relating to spatial differences in border zone electrical properties, caused in part by alterations in underlying infarct depth. The tissue properties producing sinus rhythm discontinuity at ILB may contribute to functional conduction block formation at VT onset.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey, USA
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Deepak S Saluja
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Angelo B Biviano
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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11
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Floria M, Iov DE, Tanase DM, Barboi OB, Baroi GL, Burlacu A, Grecu M, Sascau RA, Statescu C, Mihai C, Drug VL. Gastro-Esophageal Reflux Disease and Paroxysmal Atrial Fibrillation Ablation. Life (Basel) 2023; 13:life13051107. [PMID: 37240752 DOI: 10.3390/life13051107] [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: 02/14/2023] [Revised: 04/15/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Patients undergoing ablation for atrial fibrillation may be at increased risk of developing gastroesophageal reflux disease. We prospectively studied the presence of symptomatic gastroesophageal reflux disease in naïve patients who underwent atrial fibrillation ablation. METHODS The presence of typical symptoms suggestive of gastroesophageal reflux disease was clinically assessed by the gastroenterologist at baseline and at 3 months after ablation. In addition to that, all patients underwent upper gastrointestinal endoscopy. RESULTS Seventy-five patients were included in two groups: 46 patients who underwent atrial fibrillation ablation (study group) and 29 patients without ablation (control group). Patients with atrial fibrillation ablation were younger (57.76 ± 7.66 years versus 67.81 ± 8.52 years; p = 0.001), predominantly male (62.2% versus 33.3%; p = 0.030) and with higher body mass index (28.96 ± 3.12 kg/m2 versus 26.81 ± 5.19 kg/m2; p = 0.046). At three months after the ablation, in the study and control groups, there were 88.9% and 57.1% patients in sinus rhythm, respectively, (p = 0.009). Symptomatic gastroesophageal reflux disease was not more frequent in the study group (42.2% versus 61.9%; p = 0.220). There was no difference in terms of sinus rhythm prevalence in patients with versus without symptomatic gastroesophageal reflux disease (89.5% versus 88.5%; p = 0.709). CONCLUSION In this small prospective study, typical symptoms suggestive of gastroesophageal reflux disease were not more frequent three months following atrial fibrillation ablation.
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Affiliation(s)
- Mariana Floria
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Internal Medicine Clinic, Saint Spiridon Emergency Hospital, 700115 Iași, Romania
| | - Diana-Elena Iov
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Institute of Gastroenterology and Hepatology, 700115 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Internal Medicine Clinic, Saint Spiridon Emergency Hospital, 700115 Iași, Romania
| | - Oana Bogdana Barboi
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Internal Medicine Clinic, Saint Spiridon Emergency Hospital, 700115 Iași, Romania
| | - Genoveva Livia Baroi
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Vascular Surgery, Saint Spiridon Emergency Hospital, 700115 Iași, Romania
| | - Alexandru Burlacu
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Department, Cardiovascular Disease Institute, 700503 Iași, Romania
| | - Mihaela Grecu
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Department, Cardiovascular Disease Institute, 700503 Iași, Romania
| | - Radu Andy Sascau
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Department, Cardiovascular Disease Institute, 700503 Iași, Romania
| | - Cristian Statescu
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Department, Cardiovascular Disease Institute, 700503 Iași, Romania
| | - Catalina Mihai
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Institute of Gastroenterology and Hepatology, 700115 Iasi, Romania
| | - Vasile Liviu Drug
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
- Institute of Gastroenterology and Hepatology, 700115 Iasi, Romania
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12
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Li W, Seo J, Kokkinidis DG, Palaiodimos L, Nagraj S, Korompoki E, Milionis H, Doehner W, Lip GYH, Ntaios G. Efficacy and safety of vitamin-K antagonists and direct oral anticoagulants for stroke prevention in patients with heart failure and sinus rhythm: An updated systematic review and meta-analysis of randomized clinical trials. Int J Stroke 2023; 18:392-399. [PMID: 35689348 DOI: 10.1177/17474930221109149] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Heart failure (HF) is a major public health issue associated with significantly increased risk of stroke. It remains uncertain whether oral anticoagulation (OAC) in patients with heart failure and sinus rhythm (HF-SR) could improve prognosis. METHODS We performed a systematic search of PubMed and Embase databases for randomized controlled clinical trials assessing oral anticoagulants versus antiplatelets or placebo in patients with HF or ventricular dysfunction/cardiomyopathy without clinical HF and SR. The outcomes assessed were stroke/systemic embolism, major bleeding, myocardial infarction, all-cause mortality, and HF hospitalization. RESULTS Seven trials of 15,794 patients were eligible for our analyses. The overall follow-up duration was 32,367 patient-years corresponding to a mean follow-up of 2.05 years per patient. Four trials included patients treated with warfarin and three included patients treated with rivaroxaban. OAC was associated with reduced rate of stroke or systemic embolism compared to control (odds ratio (OR): 0.57, 95% confidence interval (CI): 0.44, 0.73, number needed to treat (NNT): 71.9) but higher rate of major bleeding (OR: 1.92, 95% CI: 1.47, 2.50, number needed to harm (NNH): 57.1). In the subgroup analysis according to the type of OAC, rivaroxaban was associated with significantly reduced rate of stroke or systemic embolism (1.24 vs 1.97 events per 100 patient-years, respectively, OR: 0.63, 95% CI: 0.45, 0.88, NNT: 82) and higher risk of major bleeding (OR: 1.66, 95% CI: 1.26, 2.20) compared to antiplatelets or placebo. There was no significant differences between groups for the outcomes of myocardial infarction, all-cause mortality, and HF hospitalization. CONCLUSION This analysis shows that any benefit of OAC for stroke prevention may be offset by an increased risk of major bleeding in HF-SR patients. A well-designed randomized controlled trial of newer safer OACs is needed in this population.
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Affiliation(s)
- Weijia Li
- Department of Medicine, New York City Health + Hospitals/Jacobi, Bronx, NY, USA
| | - Jiyoung Seo
- Department of Medicine, New York City Health + Hospitals/Jacobi, Bronx, NY, USA
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Sanjana Nagraj
- Department of Medicine, New York City Health + Hospitals/Jacobi, Bronx, NY, USA
| | - Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | | | - Wolfram Doehner
- Berlin Institute of Health at Charité, BIH Center for Regenerative Therapies (BCRT), and Department of Cardiology (Virchow Klinikum) and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - George Ntaios
- Department of Internal Medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
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13
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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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14
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Komarov RN, Matsuganov DA, Nuzhdin MD, Shonbin AN, Bystrov DO. [Surgical concepts for atrial fibrillation in patients with concomitant mitral valve disease]. Khirurgiia (Mosk) 2023:14-19. [PMID: 37916553 DOI: 10.17116/hirurgia202310114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To analyze in-hospital results after «Cox-maze III» and «Cox-maze IV» procedures with concomitant mitral valve surgery. MATERIAL AND METHODS This study included patients who underwent «Cox-maze III» and «Cox-maze IV» procedures between January 2015 and February 2022. We distinguished 2 groups using propensity score matching: «Cox-maze III» group (n=15), «Cox-maze IV» group (n=14). All patients had preoperative atrial fibrillation: paroxysmal (3 (10.3%) patients), persistent (5 (17.2%)) and long-standing persistent (21 (72.4%) patients). Mean duration of AF before surgery was 11 [9-60] months in both groups. We used standard statistical methods using the IBM SPSS Statistics 26.0 software package (USA). RESULTS Aortic cross-clamping time was significantly less in the «Cox-maze IV» group (p<0.001). There was no in-hospital mortality in both groups. Mean duration of mechanical ventilation was significantly less in the «Cox-maze IV» group (5 [3.5-9] vs. 14 [12-18] hours, respectively, p<0.001). Drainage output in the first postoperative day was significantly less in the «Cox-maze IV» group (295 [220-370] vs. 400 [325-500] ml, respectively, p=0.02). Temporary pacemaker was required in 73.3% and 42.8% of cases, respectively (p=0.03). CONCLUSION We should emphasize high efficiency of sinus rhythm recovery after both procedures without significant difference (p=0.16). However, time of aortic cross-clamping, mechanical ventilation and volume of postoperative bleeding were significantly less in the «Cox-maze IV» group.
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Affiliation(s)
- R N Komarov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - D A Matsuganov
- Chelyabinsk Regional Clinical Hospital, Chelyabinsk, Russia
| | - M D Nuzhdin
- Chelyabinsk Regional Clinical Hospital, Chelyabinsk, Russia
| | - A N Shonbin
- Volosevich Arkhangelsk City First Clinical Hospital, Arkhangelsk, Russia
| | - D O Bystrov
- Volosevich Arkhangelsk City First Clinical Hospital, Arkhangelsk, Russia
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15
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Seitz J, Durdez TM, Albenque JP, Pisapia A, Gitenay E, Durand C, Monteau J, Moubarak G, Théodore G, Lepillier A, Zhao A, Bremondy M, Maluski A, Cauchemez B, Combes S, Guyomar Y, Heuls S, Thomas O, Penaranda G, Siame S, Appetiti A, Milpied P, Bars C, Kalifa J. Artificial intelligence software standardizes electrogram-based ablation outcome for persistent atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:2250-2260. [PMID: 35989543 PMCID: PMC9826214 DOI: 10.1111/jce.15657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 07/04/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Multiple groups have reported on the usefulness of ablating in atrial regions exhibiting abnormal electrograms during atrial fibrillation (AF). Still, previous studies have suggested that ablation outcomes are highly operator- and center-dependent. This study sought to evaluate a novel machine learning software algorithm named VX1 (Volta Medical), trained to adjudicate multipolar electrogram dispersion. METHODS This study was a prospective, multicentric, nonrandomized study conducted to assess the feasibility of generating VX1 dispersion maps. In 85 patients, 8 centers, and 17 operators, we compared the acute and long-term outcomes after ablation in regions exhibiting dispersion between primary and satellite centers. We also compared outcomes to a control group in which dispersion-guided ablation was performed visually by trained operators. RESULTS The study population included 29% of long-standing persistent AF. AF termination occurred in 92% and 83% of the patients in primary and satellite centers, respectively, p = 0.31. The average rate of freedom from documented AF, with or without antiarrhythmic drugs (AADs), was 86% after a single procedure, and 89% after an average of 1.3 procedures per patient (p = 0.4). The rate of freedom from any documented atrial arrhythmia, with or without AADs, was 54% and 73% after a single or an average of 1.3 procedures per patient, respectively (p < 0.001). No statistically significant differences between outcomes of the primary versus satellite centers were observed for one (p = 0.8) or multiple procedures (p = 0.4), or between outcomes of the entire study population versus the control group (p > 0.2). Interestingly, intraprocedural AF termination and type of recurrent arrhythmia (i.e., AF vs. AT) appear to be predictors of the subsequent clinical course. CONCLUSION VX1, an expertise-based artificial intelligence software solution, allowed for robust center-to-center standardization of acute and long-term ablation outcomes after electrogram-based ablation.
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16
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Xiao H, Chen Q, Tao L. Long-term nifekalant use in a patient with dilated cardiomyopathy and recurrent ventricular tachycardia. J Int Med Res 2022; 50:3000605221133704. [PMID: 36300319 PMCID: PMC9620144 DOI: 10.1177/03000605221133704] [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] [Indexed: 11/07/2022] Open
Abstract
The potential utility of nifekalant, a new Class III antiarrhythmic drug, to
offer long-term protection against ventricular arrhythmia has been investigated
in this case report. A 44-year-old male patient with dilated cardiomyopathy
complicated with heart failure and persistent ventricular tachycardia was
treated with nifekalant. The patient was treated with nifekalant for 31 days,
which effectively terminated ventricular tachycardia and maintained sinus
rhythm, with no clinical adverse reactions. After heart transplantation,
postoperative follow-up showed good cardiac function and no arrhythmia. On the
basis of nifekalant’s working mechanism, there is a good chance that it can cure
ventricular arrhythmia on a long-term basis.
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Affiliation(s)
- Hongyan Xiao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital
Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei,
P.R. China,Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei,
P.R. China
| | - Qitong Chen
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital
Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei,
P.R. China,Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei,
P.R. China
| | - Liang Tao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital
Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei,
P.R. China,Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei,
P.R. China,Liang Tao, Department of Cardiac Surgery,
Wuhan Asia Heart Hospital Affiliated with the Wuhan University of Science and
Technology, No.753 Jinghan Ave, Wuhan, Hubei 430022, P.R. China. E-mail:
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17
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Katritsis DG, Anderson RH. New Insights Into the Mechanisms of Fast and Slow Conduction in the Atrioventricular Node. Heart Rhythm 2022; 20:627-630. [PMID: 36049588 DOI: 10.1016/j.hrthm.2022.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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18
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Tymińska A, Ozierański K, Wawrzacz M, Balsam P, Maciejewski C, Kleszczewska M, Zawadzka M, Marchel M, Crespo-Leiro MG, Maggioni AP, Drożdż J, Opolski G, Grabowski M, Kapłon-Cieślicka A. Heart rate control and its predictors in patients with heart failure and sinus rhythm. Data from the European Society of Cardiology Long-Term Registry. Cardiol J 2022; 30:VM/OJS/J/88117. [PMID: 35975794 PMCID: PMC10713215 DOI: 10.5603/cj.a2022.0076] [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: 01/24/2022] [Revised: 07/04/2022] [Accepted: 07/17/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Higher resting heart rate (HR) in patients with heart failure (HF) and sinus rhythm (SR) is associated with increased mortality. In patients hospitalized for HF, the aim herein, was to assess the use and dosage of guideline-recommended HR lowering medications, HR control at discharge and predictors of HR control. METHODS In the present study, were Polish participants of the European Society of Cardiology HF Long-Term (ESC-HF-LT) Registry. Those selected were hospitalized for HF, with reduced ejection fraction (HFrEF) and SR at discharge (n = 236). The patients were divided in two groups ( < 70 and ≥ 70 bpm). Logistic regression was used to identify the predictors of HR ≥ 70 bpm. RESULTS Of patients with HFrEF and SR, 59% had HR ≥ 70 bpm at hospital discharge. At discharge, 96% and only 0.5% of the patients with HFrEF and SR received beta-blocker and ivabradine, respectively. In the HF groups < 70 and ≥ 70 bpm, only 11% and 4% of patients received beta-blocker target doses, respectively. There was no difference in the use of other guideline-recommended medications. Age, New York Heart Association class, HR on admission and lack of HR lowering medications were predictors of discharge HR ≥ 70 bpm. CONCLUSIONS Heart rate control after hospitalization for HFrEF is unsatisfactory, which may be attributed to suboptimal doses of beta-blockers, and negligence in use other HR lowering drugs (including ivabradine).
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Affiliation(s)
- Agata Tymińska
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Marek Wawrzacz
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Paweł Balsam
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | | | | | | | - Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Aldo P Maggioni
- Centro Studi ANMCO (Associazione Nazionale Medici Cardiologi Ospedalieri), Florence, Italy
| | - Jarosław Drożdż
- Department of Cardiology, 1st Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
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19
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Marwick TH, Brugger N. Effects of Atrial Fibrillation and Sinus Rhythm on Cardiac Remodeling and Valvular Regurgitation. J Am Coll Cardiol 2022; 79:962-964. [PMID: 35272800 DOI: 10.1016/j.jacc.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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20
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Naser JA, Pislaru C, Roslan A, Ciobanu AO, Jouni H, Nkomo VT, Kane GC, Pislaru SV. Unfavorable Tricuspid Annulus Dynamics: A Novel Concept to Explain Development of Tricuspid Regurgitation in Atrial Fibrillation. J Am Soc Echocardiogr 2022; 35:664-666. [PMID: 35245669 DOI: 10.1016/j.echo.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/06/2022] [Accepted: 02/20/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Cristina Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Andrea O Ciobanu
- University of Medicine and Pharmacy Carol Davila, Bucharest; University and Emergency Hospital Bucharest, Romania
| | - Hayan Jouni
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
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21
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Frontera A, Limite LR, Pagani S, Cireddu M, Vlachos K, Martin C, Takigawa M, Kitamura T, Bourier F, Cheniti G, Pambrun T, Sacher F, Derval N, Hocini M, Quarteroni A, Della Bella P, Haissaguerre M, Jaïs P. Electrogram fractionation during sinus rhythm occurs in normal voltage atrial tissue in patients with atrial fibrillation. Pacing Clin Electrophysiol 2021; 45:219-228. [PMID: 34919281 DOI: 10.1111/pace.14425] [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] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/08/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Electrogram (EGM) fractionation is often associated with diseased atrial tissue; however, mechanisms for fractionation occurring above an established threshold of 0.5 mV have never been characterized. We sought to investigate during sinus rhythm (SR) the mechanisms underlying bipolar EGM fractionation with high-density mapping in patients with atrial fibrillation (AF). METHODS Forty-five patients undergoing AF ablation (73% paroxysmal, 27% persistent) were mapped at high density (18562 ± 2551 points) during SR (Rhythmia). Only bipolar EGMs with voltages above 0.5 mV were considered for analysis. When fractionation (>40 ms and >4 deflections) was detected, we classified the mechanisms as slow conduction, wave-front collision, or a pivot point. The relationship between EGM duration and amplitude, and tissue anisotropy and slow conduction, was then studied using a computational model. RESULTS Of the 45 left atria analyzed, 133 sites of EGM fragmentation were identified with voltages above 0.5 mV. The most frequent mechanism (64%) was slow conduction (velocity 0.45 m/s ± 0.2) with mean EGM voltage of 1.1 ± 0.5 mV and duration of 54.9 ± 9.4 ms. Wavefront collision was the second most frequent (19%), characterized by higher voltage (1.6 ± 0.9 mV) and shorter duration (51.3 ± 11.3 ms). Pivot points (9%) were associated with the highest degree of fractionation with 70.7 ± 6.6 ms and 1.8 ± 1 mV. In 10 sites (8%) fractionation was unexplained. The EGM duration was significantly different among the 3 mechanisms (p = 0.0351). CONCLUSION In patients with a history of AF, EGM fractionation can occur at amplitudes > 0.5 mV when in SR in areas often considered not to be diseased tissue. The main mechanism of EGM fractionation is slow conduction, followed by wavefront collision and pivot sites. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Antonio Frontera
- Department of Arrhythmology, San Raffaele Hospital, Milan, 20132, Italy.,Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | | | - Stefano Pagani
- MOX, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Manuela Cireddu
- Department of Arrhythmology, San Raffaele Hospital, Milan, 20132, Italy
| | - Kostantinos Vlachos
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | | | - Masateru Takigawa
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | - Takeshi Kitamura
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France
| | - Felix Bourier
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | - Ghassen Cheniti
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | - Thomas Pambrun
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France
| | - Frederic Sacher
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | - Nicolas Derval
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | - Meleze Hocini
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | - Alfio Quarteroni
- MOX, Department of Mathematics, Politecnico di Milano, Milan, Italy.,Professor Emeritus, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Paolo Della Bella
- Department of Arrhythmology, San Raffaele Hospital, Milan, 20132, Italy
| | - Michel Haissaguerre
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
| | - Pierre Jaïs
- Electrophysiology laboratories, Hopital Haut Leveque, Pessac, 33600, France.,LIRYC institute, Pessac, 33600, France
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22
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van Staveren LN, van der Does WFB, Heida A, Taverne YJHJ, Bogers AJJC, de Groot NMS. AF Inducibility Is Related to Conduction Abnormalities at Bachmann's Bundle. J Clin Med 2021; 10:5536. [PMID: 34884237 DOI: 10.3390/jcm10235536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/01/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
We investigated whether patterns of activation at Bachmann’s bundle are related to AF inducibility. Epicardial mapping of Bachmann’s bundle during sinus rhythm was performed prior to cardiac surgery (192 electrodes, interelectrode distances: 2 mm). Compared to non-inducible patients (N = 20), patients with inducible AF (N = 34) had longer lines of conduction block (18(2–164) mm vs. 6(2–28) mm, p = 0.048), prolonged total activation time (55(28–143) ms vs. 46(24–73) ms, p = 0.012), multiple wavefronts entering Bachmann’s bundle more frequently (64% vs. 37%, p = 0.046) and more often areas of simultaneous activation (conduction velocity > 1.7 m/s, 45% vs. 16%, p = 0.038). These observations further support a relation between conduction abnormalities at Bachmann’s bundle and AF inducibility. The next step is to examine whether Bachmann’s bundle activation patterns can also be used to identify patients who will develop AF after cardiac surgery during both short- and long-term follow-up.
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23
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Mukhopadhyay S, Dwivedi Y, Yusuf J, Uppal A, Mehta V. Prevalence and predictors of left atrial appendage inactivity in patients of rheumatic mitral stenosis in sinus rhythm: An observational study. Echocardiography 2021; 38:1860-1869. [PMID: 34672389 DOI: 10.1111/echo.15223] [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: 06/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Systemic thromboembolism is a known complication of rheumatic mitral stenosis (RMS) in sinus rhythm (SR). Left atrial appendage (LAA), the commonest site of thrombus formation is usually hypocontractile (inactive) in such patients. We aimed to study the prevalence of LAA inactivity (LAAI) in severe RMS and assess its independent predictors. METHODS The study population consisted of 100 patients of severe RMS in SR. Transthoracic and transesophageal echocardiography were done to assess LAA contractile function. Patients with LAA-peak emptying velocity < 25 cm/seconds were defined as having LAAI. RESULTS The mean age of study subjects was 31.66±8.69 years and 56% were females. 73% patients had LAAI (Group A), while remaining 27% had normal LAA function (Group B). Mitral-valve area (MVA) and lateral annulus systolic velocity (Sa-wave) were significantly lower while mitral valve mean gradient (MVMG) and serum fibrinogen were significantly higher (all p-values < 0.001) in group A patients. On multivariate binary logistic regression analysis, MVMG (p < 0.001), Sa-wave (p = 0.02), and serum fibrinogen (p = 0.005) were independent predictors of LAAI. Optimal cut-off values of MVMG, Sa-wave and serum fibrinogen for predicting LAAI were 11.5 mm Hg, 6.8 cm/seconds and 300 mg/dl, respectively. Sixty-Seven (90.55%) patients in group A compared to 13(48.1%) in group B had LA/LAA smoke. LAAI was the only independent predictor of left atrium (LA)/LAA smoke with or without associated thrombus. CONCLUSION There is high prevalence of LAAI in patients of severe MS in SR. MVMG, Sa-wave, and serum fibrinogen levels are independent predictors of LAAI. LAAI is an independent predictor of LA/LAA smoke with or without associated thrombus.
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Affiliation(s)
- Saibal Mukhopadhyay
- Department of Cardiology, G.B. Pant Postgraduate Institute of Medical Research (GIPMER), New Delhi, India
| | - Yogesh Dwivedi
- Department of Cardiology, G.B. Pant Postgraduate Institute of Medical Research (GIPMER), New Delhi, India
| | - Jamal Yusuf
- Department of Cardiology, G.B. Pant Postgraduate Institute of Medical Research (GIPMER), New Delhi, India
| | - Abhimanyu Uppal
- Department of Cardiology, G.B. Pant Postgraduate Institute of Medical Research (GIPMER), New Delhi, India
| | - Vimal Mehta
- Department of Cardiology, G.B. Pant Postgraduate Institute of Medical Research (GIPMER), New Delhi, India
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24
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Krisai P, Roten L, Zeljkovic I, Pavlovic N, Ammann P, Reichlin T, Auf der Maur E, Streicher O, Knecht S, Kühne M, Osswald S, Novak J, Sticherling C. Prospective Evaluation of a Standardized Screening for Atrial Fibrillation after Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter. J Clin Med 2021; 10:jcm10194453. [PMID: 34640470 PMCID: PMC8509798 DOI: 10.3390/jcm10194453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022] Open
Abstract
Aims: We aimed to prospectively investigate the effectiveness of a standardized follow-up for AF-detection after common atrial flutter (cAFL) ablation. Methods: A total of 309 patients after cAFL ablation without known AF, from 5 centers, and at least one completed, standardized follow-up at 3, 6 and 12 months, including a 24 h Holter-electrocardiogram (ECG), were included. The primary outcome was incident atrial fibrillation (AF), or atrial tachycardia (AT). Predictors were investigated by Cox proportional-hazards models. Results: The mean age was 67.9 years; 15.2% were female and the mean CHA2DS2-VASc (Congestive heart failure, Hypertension, Age, Diabetes, Stroke, Vascular disease, Sex category) score was 2.4 points. The great majority of patients (90.3%) were anticoagulated. Over a mean follow-up of 12.2 months with a standardized approach, AF/AT was detected in 73 patients, corresponding to 11.7% at 3 months, 18.4% at 6 months and 28.2% at 12 months of follow-up. AF was found in 64 patients, AT in 9 and both in 2 patients. Occurrence of AF was recorded in 40 (60.6%) patients by Holter-ECG and in the remaining 26 (39.4%) by clinical follow-up only. There was no difference in male versus female (p = 0.08), or in younger versus older patients (p = 0.96) for AF/AT detection. Only coronary artery disease (hazard ratio [95% confidence intervals] 1.03 [1.01–1.05], p = 0.01) was associated with the primary outcome. Conclusions: AF or AT was detected in a large proportion of cAFL patients after cavotricuspid-isthmus (CTI) ablation, using a standardized follow-up over 1 year. This standardized screening can be easily implemented with high patient acceptance. The high proportion of post-ablation AF needs to be taken into consideration when deciding on long-term oral anticoagulation.
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Affiliation(s)
- Philipp Krisai
- Cardiovascular Research Institute Basel, Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (P.K.); (O.S.); (S.K.); (M.K.); (S.O.)
- Electrophysiology and Ablation Unit, Centre Hospitalier Universitaire de Bordeaux, 33600 Bordeaux-Pessac, France
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (L.R.); (T.R.); (E.A.d.M.)
| | - Ivan Zeljkovic
- Department of Cardiology, University Hospital Sestre Milosrdnice, 10000 Zagreb, Croatia; (I.Z.); (N.P.)
| | - Nikola Pavlovic
- Department of Cardiology, University Hospital Sestre Milosrdnice, 10000 Zagreb, Croatia; (I.Z.); (N.P.)
| | - Peter Ammann
- Department of Cardiology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland;
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (L.R.); (T.R.); (E.A.d.M.)
| | - Eric Auf der Maur
- Department of Cardiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (L.R.); (T.R.); (E.A.d.M.)
| | - Olivia Streicher
- Cardiovascular Research Institute Basel, Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (P.K.); (O.S.); (S.K.); (M.K.); (S.O.)
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Sven Knecht
- Cardiovascular Research Institute Basel, Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (P.K.); (O.S.); (S.K.); (M.K.); (S.O.)
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (P.K.); (O.S.); (S.K.); (M.K.); (S.O.)
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (P.K.); (O.S.); (S.K.); (M.K.); (S.O.)
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Jan Novak
- Herz-und Nierenzentrum Aare, 4500 Solothurn, Switzerland;
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (P.K.); (O.S.); (S.K.); (M.K.); (S.O.)
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence:
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25
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Heida A, van der Does WFB, van Staveren LN, Taverne YJHJ, Roos-Serote MC, Bogers AJJC, de Groot NMS. Conduction Heterogeneity: Impact of Underlying Heart Disease and Atrial Fibrillation. JACC Clin Electrophysiol 2021; 6:1844-1854. [PMID: 33357582 DOI: 10.1016/j.jacep.2020.09.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The goal of this study is to investigate the impact of various underlying heart diseases (UHDs) and prior atrial fibrillation (AF) episodes on conduction heterogeneity. BACKGROUND It is unknown whether intra-atrial conduction during sinus rhythm differs between various UHD or is influenced by AF episodes. METHODS Epicardial sinus rhythm mapping of the right atrium, Bachmann's bundle (BB), left atrium and pulmonary vein area was performed in 447 participants (median age: 67 [interquartile range (IQR): 59 to 73] years) with or without AF undergoing cardiac surgery for ischemic heart disease, (ischemic and) valvular heart disease, or congenital heart disease. Conduction times (CTs) were defined as Δ local activation time between 2 adjacent electrodes and used to assess frequency (CTs ≥ 4 ms) and magnitude of conduction disorders (in increments of 10 ms). RESULTS When comparing the 3 types of UHD, there were no differences in frequencies and magnitude of CTs at all locations (p ≥ 0.017 and p ≥ 0.005, respectively). Prior AF episodes were associated with conduction slowing throughout both atria (14.9% [IQR: 11.8 to 17.0] vs. 12.8% [IQR: 10.9 to 14.6]; p < 0.001). At BB, CTs with magnitudes ≥30 ms were more common in patients with AF (n = 56.2% vs. n = 36.0%; p < 0.004). CONCLUSIONS UHD has no impact on the frequency and severity of conduction disorders. AF episodes are associated with more conduction disorders throughout both atria and with more severe conduction disorders at BB. The next step will be to determine the relevance of these conduction disorders for AF development and maintenance.
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Affiliation(s)
- Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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26
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Habib MB, Elshafei M, Rahhal A, Mohamed MFH. Severe sinus bradycardia associated with favipiravir in a COVID-19 patient. Clin Case Rep 2021; 9:e04566. [PMID: 34401155 PMCID: PMC8346599 DOI: 10.1002/ccr3.4566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
The antiviral medication "favipiravir" should be considered as a possible cause of unexplained sinus bradycardia.
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Affiliation(s)
- Mhd Baraa Habib
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | | | - Alaa Rahhal
- Department of PharmacyHamad Medical CorporationDohaQatar
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27
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Müller C, Hengstmann U, Fuchs M, Kirchner M, Kleinjung F, Mathis H, Martin S, Bläse I, Perings S. Distinguishing atrial fibrillation from sinus rhythm using commercial pulse detection systems: The non-interventional BAYathlon study. Digit Health 2021; 7:20552076211019620. [PMID: 34104466 PMCID: PMC8145579 DOI: 10.1177/20552076211019620] [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: 11/05/2020] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Objective Early diagnosis of atrial fibrillation (AFib) is a priority for stroke prevention. We sought to test four commercial pulse detection systems (CPDSs) for ability to distinguish AFib from normal sinus rhythm using a published algorithm (Zhou et al., PLoS One 2015;10:e0136544), compared with visual diagnosis by electrocardiogram inspection. Methods BAYathlon was a prospective, non-interventional, single-centre study. Adult cardiology patients with documented AFib or sinus rhythm who were due to have a routine 5-min electrocardiogram were randomized to undergo a parallel 5-min pulse assessment with a Polar V800, eMotion Faros 360, TomTom heart rate monitor, or Adidas miCoach Smart Run. Results 144 patients (73 with AFib, 71 with sinus rhythm (based on electrocardiograms); median age: 73 years; 53.5% male) were analysed. Algorithm sensitivities (primary endpoint) and specificities for AFib when applied to CPDS recordings were 93.3% and 94.1% with the Polar V800, 90.0% and 84.2% with the eMotion Faros 360, and 0% and 100% with the other CPDSs (analysis period: 127 heart rate signals + 2 min). When applied to routine electrocardiograms, the algorithm correctly detected AFib in 71/73 patients. Different analysis periods (127 heart rate signals +1 or 3 min) only slightly changed the sensitivities with the Polar V800 and eMotion Faros 360 and had no effect on the sensitivities with the other CPDSs. Conclusion AFib screening using the applied algorithm is feasible with the Polar V800 and eMotion Faros 360 (which provide RR interval data) but not with the other CPDSs (which provide pre-processed heart rate time series). ClinicalTrials.gov identifier: NCT02875106
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Affiliation(s)
| | | | - Michael Fuchs
- Fraunhofer-Institut für Angewandte Informationstechnik FIT, Sankt Augustin, Germany
| | | | | | - Harald Mathis
- Fraunhofer-Institut für Angewandte Informationstechnik FIT, Sankt Augustin, Germany
| | - Stephan Martin
- Verbund Katholischer Kliniken Düsseldorf, Düsseldorf, Germany
| | - Ingo Bläse
- Cardio Centrum Düsseldorf, Düsseldorf, Germany
| | - Stefan Perings
- Cardio Centrum Düsseldorf, Düsseldorf, Germany.,Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich-Heine-University, Düsseldorf, Germany
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28
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Ferre-Vallverdu M, Ligero C, Vidal-Perez R, Martinez-Rubio A, Vinolas X, Alegret JM. Improvement in Atrial Fibrillation-Related Symptoms After Cardioversion: Role of NYHA Functional Class and Maintenance of Sinus Rhythm. Clin Interv Aging 2021; 16:739-745. [PMID: 33953552 PMCID: PMC8092854 DOI: 10.2147/cia.s305619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background The European Heart Rhythm Association (EHRA) score is a proven and validated tool for assessing the symptoms of atrial fibrillation (AF). Little is known about the variables related to this score and how it changes after cardioversion. Methods We analyzed 744 patients undergoing elective cardioversion in whom AF-related symptoms were assessed at baseline and after 6 months of follow-up using the EHRA score. We assessed the association between the EHRA score and other clinical and echocardiographic variables at baseline and after 6 months of follow-up. Results At 6 months of follow-up, we observed a reduction in the EHRA score in 50% and worsening in 2.8% of patients who remained in sinus rhythm (SR) compared with 34.6% and 11.3%, respectively, of patients with AF episodes (p<0.0001). Patients who maintained SR at 6 months were less symptomatic than those with AF (EHRA score 1.13 ± 0.35 vs 1.42 ± 0.59; p<0.0001). The independent predictors for reduction in the EHRA score after cardioversion were NYHA ≥II at baseline and maintenance of SR (p<0.0001). Conclusion The greatest improvement in AF-related symptoms was in patients who remained in SR at 6 months after cardioversion and in patients with worse NYHA functional class at baseline.
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Affiliation(s)
- Maria Ferre-Vallverdu
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
| | - Carmen Ligero
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
| | - Rafael Vidal-Perez
- Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Xavier Vinolas
- Department of Cardiology, Hospital de la Sta, Creu i St Pau, Barcelona, Spain
| | - Josep M Alegret
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
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29
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Ye Z, van Schie MS, de Groot NMS. Signal Fingerprinting as a Novel Diagnostic Tool to Identify Conduction Inhomogeneity. Front Physiol 2021; 12:652128. [PMID: 33841188 PMCID: PMC8033016 DOI: 10.3389/fphys.2021.652128] [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: 01/11/2021] [Accepted: 03/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Inhomogeneous intra-atrial conduction facilitates both initiation and perpetuation of atrial fibrillation (AF) and is reflected in electrogram (EGM) morphology. Objective The primary objective of this study is to investigate regional differences in features of different EGM types during sinus rhythm (SR) and to design a patient-specific signal fingerprint, which quantifies the severity and extensiveness of inhomogeneity in conduction. Methods Patients (N = 189, 86% male; mean age 65 ± 9 years) undergoing coronary artery bypass grafting (CABG) underwent high-resolution mapping of the right atrium (RA), left atrium (LA), and pulmonary vein area (PVA) including Bachmann’s bundle (BB). EGMs during 5 s of SR were classified as single potentials (SPs), short double potentials (SDPs, interval between deflections < 15 ms), long double potentials (LDPs, deflection interval > 15 ms), or fractionated potentials (FPs, ≥3 deflections). Of all SPs, differences in relative R- and S-wave amplitude were calculated (R/S ratios). Time difference between first and last deflection was determined (fractionation duration, FD) and potentials with amplitudes < 1.0 mV were labeled as low-voltage. Conduction block (CB) was defined as a difference in local activation time (LAT) between adjacent electrodes of ≥12 ms. Results A total of 1,763,593 EGMs (9,331 ± 3,336 per patient) were classified (Table 1). Conclusion The signal fingerprint, consisting of quantified EGM features, including the R/S ratio of SPs, the relative frequency distribution of unipolar voltages, the proportion of low-voltage areas, the proportion of the different types of EGMs, and durations of LDP and FDP, may serve as a diagnostic tool to determine the severity and extensiveness of conduction inhomogeneity. Further studies are required to determine whether the signal fingerprint can be used to identify patients at risk for AF onset or progression.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
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30
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Lin AY, Dinatolo E, Metra M, Sbolli M, Dasseni N, Butler J, Greenberg BH. Thromboembolism in Heart Failure Patients in Sinus Rhythm: Epidemiology, Pathophysiology, Clinical Trials, and Future Direction. JACC Heart Fail 2021; 9:243-253. [PMID: 33714744 DOI: 10.1016/j.jchf.2021.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022]
Abstract
Despite advances in medical and device therapy, patients with heart failure remain at high risk for morbidity and mortality. Experimental and clinical studies have shown an association between heart failure and a hypercoagulable state, and that patients with heart failure experience an increased incidence of stroke and other thromboembolic events, regardless of whether they are in atrial fibrillation. Although oral anticoagulation is recommended when atrial fibrillation is present, the benefits of this therapy in patients with heart failure in sinus rhythm are uncertain. Older randomized controlled trials comparing warfarin with antiplatelet therapy were, for the most part, underpowered and failed to show convincing benefits of warfarin therapy in this population. Several recent studies that assessed the effects of low-dose direct-acting oral anticoagulant therapy in patients with coronary artery disease in sinus rhythm either included or specifically targeted patients with heart failure. Post hoc analysis of their results showed that this treatment strategy was associated with improved outcomes in patients with acute coronary syndrome or stable coronary artery disease and also a significant reduction in thromboembolic events, including ischemic stroke. This review presents the rationale for anticoagulant therapy in patients with heart failure in sinus rhythm, discusses gaps in our knowledge base, offers suggestions for when anticoagulation might be considered, and identifies potential directions for future research.
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Affiliation(s)
- Andrew Y Lin
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
| | - Elisabetta Dinatolo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
| | - Marco Sbolli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
| | - Nicolò Dasseni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Barry H Greenberg
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA.
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31
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Krisai P, Hämmerle P, Blum S, Meyre P, Aeschbacher S, Melchiorre-Mayer P, Baretella O, Rodondi N, Conen D, Osswald S, Kühne M, Zuern CS. Prognostic significance of present atrial fibrillation on a single office electrocardiogram in patients with atrial fibrillation. J Intern Med 2021; 289:395-403. [PMID: 32914467 DOI: 10.1111/joim.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence for the association of atrial fibrillation (AF) present on the ECG and cardiovascular outcomes in AF patients is limited. OBJECTIVE To investigate the prognostic significance of AF on a single surface ECG for cardiovascular outcomes in AF patients. METHODS A total of 3642 AF patients were prospectively enrolled. Main exclusion criteria were rhythms other than sinus rhythm (SR) or AF. The primary end-point was a composite of all-cause death and hospitalizations for congestive heart failure (CHF). Secondary end-points were all-cause death, CHF hospitalizations, cardiovascular death, myocardial infarction, any stroke and stroke subtypes. Associations were assessed with multivariable Cox proportional hazards models. RESULTS Mean age was 71 years, 28% were female, and mean follow-up was 3.4 years. Patients with SR on the ECG at study enrolment (56%) were younger (69 vs. 74 years, P < 0.0001), had more often paroxysmal AF (73 vs. 18%, P < 0.0001) and fewer comorbidities. The incidence of the primary end-point was 1.8 and 3.1 per 100 person-years in patients with SR and AF, respectively. The multivariable-adjusted hazard ratio was 1.4 (95% confidence intervals 1.1; 1.7; P = 0.001) for patients with AF on the ECG compared to patients with SR. The hazard ratios (95% confidence intervals) were 1.4 (1.1; 1.8; P = 0.006) for all-cause death, 1.5 (1.2; 1.9; P = 0.001) for CHF and 1.6 (1.1; 2.2; P = 0.006) for cardiovascular death. None of the other associations were statistically significant. CONCLUSIONS The presence of AF in a single office ECG had significant prognostic implications with regard to mortality and CHF hospitalizations in patients with AF. These patients present a high-risk group and might benefit from intensified treatment.
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Affiliation(s)
- P Krisai
- From the, Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - P Hämmerle
- From the, Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - S Blum
- From the, Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - P Meyre
- From the, Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - S Aeschbacher
- From the, Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - P Melchiorre-Mayer
- Department of Cardiology, Cardiocentro Ticino Lugano, Lugano, Switzerland
| | - O Baretella
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - N Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.,Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - S Osswald
- From the, Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - M Kühne
- From the, Department of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - C S Zuern
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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32
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Dixit A, Tewari P, Chandra B. Left atrial thrombus in a case of severe aortic stenosis with severe left ventricular dysfunction: An Incidental finding on transesophageal echocardiography. Ann Card Anaesth 2021; 24:87-89. [PMID: 33938840 PMCID: PMC8081127 DOI: 10.4103/aca.aca_98_19] [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] [Indexed: 11/09/2022] Open
Abstract
Left atrial thrombus in a patient with aortic stenosis and aortic regurgitation in sinus rhythm is an infrequent finding and is most commonly associated with cases of mitral stenosis. This case report emphasizes upon the importance of suspecting the presence of left atrial thrombus in other valvular lesions when additional risk factors such as dilated left ventricle are present. The undeniable role of comprehensive perioperative transesophageal echocardiography is also depicted in this case report.
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Affiliation(s)
- Aanchal Dixit
- Department of Anesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Prabhat Tewari
- Department of Anesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Bipin Chandra
- Department of Cardiovascular and Thoracic Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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33
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Bakalli A, Georgievska-Ismail L, Krasniqi X, Sejdiu B, Bekteshi T, Grbolar A, Sadiku S. Predictors of Spontaneous Echo Contrast in Left Heart Chambers in Patients with Dilated Cardiomyopathy: Slowing Down Might not Always Mean Enjoying Life. J Cardiovasc Echogr 2020; 30:93-99. [PMID: 33282647 PMCID: PMC7706372 DOI: 10.4103/jcecho.jcecho_18_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/03/2020] [Accepted: 06/25/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction: Spontaneous echo contrast(SEC) is usually detected in heart chambers as a result of reduced flow velocity in the cavity. The clinical importance of SEC lies in its association with embolic events. The aim of our study was to determine the frequency of SEC in left heart chambers in sinus rhythm patients with dilated cardiomyopathy and predictors for its emergence. Materials and Methods: This was a prospective cross-sectional transesophageal echocardiography study conducted in 101 sinus rhythm patients with dilated heart and mild-to-moderate systolic dysfunction. Results: Moderate-degree SEC was found in the left ventricle(LV) in around 9% of patients, in the left atrium(LA) in 12% and in left atrial appendage(LAA) in 40%. Multiple regression analysis showed that lower heart rate(95% confidence interval[CI]: 0.845–0.978; P = 0.011) and larger LV end-systolic diameter(LVESD)(95% CI: 1.034–1.394; P = 0.017) were independent predictors for LV SEC presence. Lower LV ejection fraction(LVEF) (95% CI: [−0.079]–[−0.037]; P = 0.0001) was the only independent predictor for SEC in the LA. Whereas, independent predictors for SEC in LAA were lower heart rate(95% CI:[−0.030]–[−0.003]; P = 0.018), greater LA indexed diameter (95% CI: 0.016–0.116; P = 0.010), and higher value of C-reactive protein(CRP)(95% CI: 0.0026–0.031; P = 0.027). Conclusions: SEC in left heart chambers is a frequent finding in patients with dilated cardiomyopathy in sinus rhythm. Lower heart rate and LVEF, larger LVESD and LA, as well as higher CRP, predict the presence of SEC in left heart chambers. Lower heart rate might be an essential predictor for SEC presence and severity in these patients.
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Affiliation(s)
- Aurora Bakalli
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosova, Pristina, Kosovo
| | | | - Xhevdet Krasniqi
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosova, Pristina, Kosovo
| | - Basri Sejdiu
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosova, Pristina, Kosovo
| | - Tefik Bekteshi
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosova, Pristina, Kosovo
| | - Adem Grbolar
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosova, Pristina, Kosovo
| | - Shemsedin Sadiku
- Clinic of Haematology, University Clinical Center of Kosova, Pristina, Kosovo
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Nygaard MH, Hvas AM, Grove EL. Efficacy and Safety of Oral Anticoagulants in Patients with Systolic Heart Failure in Sinus Rhythm: A Systematic Review and Meta-analysis of Randomized Controlled Trials and Cohort Studies. TH Open 2020; 4:e383-e392. [PMID: 33274311 PMCID: PMC7704246 DOI: 10.1055/s-0040-1720961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction
There is conflicting evidence on the risk–benefit ratio of oral anticoagulants (OAC) in heart failure (HF) patients without atrial fibrillation. We aimed to evaluate the efficacy and safety of OAC in HF patients in sinus rhythm.
Methods
A systematic literature search was conducted using PubMed and Embase. We included randomized controlled trials (RCT) and cohort studies, comparing OAC with antiplatelet or no treatment/placebo in patients with HF. Outcomes evaluated were stroke, myocardial infarction (MI), all-cause mortality, and major bleeding.
Results
Five RCTs and three cohort studies were included. OAC was associated with a reduced risk of ischemic stroke when compared with no treatment/placebo (odds ratio [OR] = 0.67, 95% confidence interval [CI]: [0.47, 0.94]) and antiplatelet therapy (OR = 0.55, 95% CI: [0.37, 0.81]). No significant reduction was found in MI, when OAC was compared with no treatment/placebo (OR = 0.82, 95% CI: [0.63, 1.07]) or antiplatelet therapy (OR = 1.04, 95% CI: [0.60, 1.81]). The all-cause mortality analysis showed no significant reduction when comparing OAC with no treatment/placebo (OR = 0.99, 95% CI: [0.87, 1.12]) or antiplatelet therapy (OR = 1.00, 95% CI: [0.86, 1.16]). The nonsignificant effect of OAC on all-cause mortality was supported by a meta-analysis of the three cohort studies (OR = 1.02, 95% CI: [0.75, 1.38]). Patients treated with OAC had a significantly higher risk of major bleeding than patients receiving antiplatelet therapy (OR = 2.16, 95% CI: [1.55, 3.00]) and a numerically higher risk when compared with no treatment/placebo (OR = 2.38, 95% CI: [0.87, 6.49]).
Conclusion
The present study does not support the routine use of OAC in patients with HF in sinus rhythm.
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Affiliation(s)
- Marie H Nygaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Biochemistry, Thrombosis and Hemostasis Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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35
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Lee S, Sahadevan J. Conduction Slowing: Association or Causation in Atrial Fibrillation. JACC Clin Electrophysiol 2020; 6:1855-1857. [PMID: 33357583 PMCID: PMC8045138 DOI: 10.1016/j.jacep.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Seungyup Lee
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jayakumar Sahadevan
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Division of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.
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36
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Platiša MM, Radovanović NN, Kalauzi A, Milašinović G, Pavlović SU. Multiscale Entropy Analysis: Application to Cardio-Respiratory Coupling. Entropy (Basel) 2020; 22:e22091042. [PMID: 33286811 PMCID: PMC7597100 DOI: 10.3390/e22091042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/30/2020] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
It is known that in pathological conditions, physiological systems develop changes in the multiscale properties of physiological signals. However, in real life, little is known about how changes in the function of one of the two coupled physiological systems induce changes in function of the other one, especially on their multiscale behavior. Hence, in this work we aimed to examine the complexity of cardio-respiratory coupled systems control using multiscale entropy (MSE) analysis of cardiac intervals MSE (RR), respiratory time series MSE (Resp), and synchrony of these rhythms by cross multiscale entropy (CMSE) analysis, in the heart failure (HF) patients and healthy subjects. We analyzed 20 min of synchronously recorded RR intervals and respiratory signal during relaxation in the supine position in 42 heart failure patients and 14 control healthy subjects. Heart failure group was divided into three subgroups, according to the RR interval time series characteristics (atrial fibrillation (HFAF), sinus rhythm (HFSin), and sinus rhythm with ventricular extrasystoles (HFVES)). Compared with healthy control subjects, alterations in respiratory signal properties were observed in patients from the HFSin and HFVES groups. Further, mean MSE curves of RR intervals and respiratory signal were not statistically different only in the HFSin group (p = 0.43). The level of synchrony between these time series was significantly higher in HFSin and HFVES patients than in control subjects and HFAF patients (p < 0.01). In conclusion, depending on the specific pathologies, primary alterations in the regularity of cardiac rhythm resulted in changes in the regularity of the respiratory rhythm, as well as in the level of their asynchrony.
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Affiliation(s)
- Mirjana M. Platiša
- Institute of Biophysics, Faculty of Medicine, University of Belgrade, KCS, PO Box 22, 11129 Belgrade, Serbia
- Correspondence: ; Tel.: +381-11-360-7158; Fax: +381-11-360-7061
| | - Nikola N. Radovanović
- Pacemaker Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (N.N.R.); (G.M.); (S.U.P.)
| | - Aleksandar Kalauzi
- Department for Life Sciences, Institute for Multidisciplinary Research, University of Belgrade, 11000 Belgrade, Serbia;
| | - Goran Milašinović
- Pacemaker Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (N.N.R.); (G.M.); (S.U.P.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Siniša U. Pavlović
- Pacemaker Center, Clinical Center of Serbia, 11000 Belgrade, Serbia; (N.N.R.); (G.M.); (S.U.P.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Mlynarska A, Mlynarski R, Marcisz C, Golba KS. Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population. Clin Interv Aging 2020; 15:1193-1199. [PMID: 32764905 PMCID: PMC7381784 DOI: 10.2147/cia.s255853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Frailty is a common geriatric syndrome that causes an elevated risk of catastrophic declines in the health and function among older adults – we hypothesized that frailty may be related to the maintenance of sinus rhythm after cardioversion. Methods The study sample was a group of 199 consecutive patients over 60 (average age 71.41 ± 6.99; 40.2% women) with AF who were hospitalized in order to perform electrical cardioversion. The Tilburg Frailty Indicator (TFI) was used to assess frailty before cardioversion. The six-month visit after the electrical cardioversion was a follow-up. The follow-up period for the maintenance of sinus rhythm after electrical cardioversion was 180 ± 14 days. Results Patients in whom cardioversion was effective had a statistically significantly lower severity of frailty syndrome (3.44 ± 1.83 vs 5.87 ± 1.12; p=0.000) and its components: physical components (2.14 ± 1.33 vs 3.62 ± 1.05 p=0.000); emotional components (0.92 ± 0.79 vs 1.29 ± 0.86 p=0.037) and social components (0.37 ± 0.56 vs 0.96 ± 0.46; p=0.000) compared to those patients in which cardioversion was ineffective. In the logistic regression, frailty (OR: 0.65, 95% CI:0.5010–0.8330; p=0.000) was observed to be an independent predictor for maintaining sinus rhythm. Conclusion Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and the maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4 improved the prediction of the effectiveness of electrical cardioversion as well as the maintenance of sinus rhythm.
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Affiliation(s)
- Agnieszka Mlynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland.,Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland
| | - Rafal Mlynarski
- Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.,Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Czeslaw Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Golba
- Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.,Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
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Ziegelhoeffer T, Pecha S, Rahmani R, Thaqi N, Ackermann X, Hakmi S, Choi YH, Burger H. Probability of sinus rhythm conversion and maintenance in cardiac resynchronization therapy patients with atrial fibrillation during 5-year follow-up. J Cardiovasc Electrophysiol 2020; 31:2393-2402. [PMID: 32652754 DOI: 10.1111/jce.14668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is a high prevalence of atrial fibrillation (AF) in patients with heart failure presented for cardiac resynchronization therapy (CRT). It remains unclear whether an atrial lead should be implanted in these patients. We, therefore, analyzed outcomes and course of rhythm in AF patients undergoing CRT implantation during long-term follow-up. METHODS AND RESULTS Between 2004 and 2018, 328 consecutive patients with a history of AF receiving CRT implantation were included in this study. 132 patients had preoperatively paroxysmal AF (px-AF), while 70 and 126 patients had persistent AF (ps-AF) and long-standing persistent AF (lp-AF), respectively. The outcome data were collected in our institutional database and analyzed retrospectively. Two hundred and seventy-seven patients received an atrial lead at the time of implantation, nine during follow-up. No major lead implantation-associated complications were observed. In patients with px-AF, sinus rhythm (SR) was present in 78.8% at admission, 95.5% (p < .001) at discharge, and 85.7% (p = .965) after 5 years. In ps-AF patients SR was present in 28.6%, 91.4% (p < .001) and 69.7% (p < .001), while all lp-AF patients showed AF at admission and had SR rate of 50.8% (p < .001) at discharge and 44.1% after 5 years (p < .001). CONCLUSION We observed a high rate of conversion and long-term persistence of SR in AF patients undergoing CRT implantation. Due to the low rate of lead implantation-associated complications and the high successful SR conversion rates, we recommend the implantation of an atrial lead in CRT patients with AF.
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Affiliation(s)
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Rilind Rahmani
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Nobel Thaqi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Xenia Ackermann
- Justus-Liebig-University Gießen, Campus Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Samer Hakmi
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany.,Justus-Liebig-University Gießen, Campus Kerckhoff-Klinik, Bad Nauheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Frankfurt/Main, Germany
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
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Frontera A, Melillo F, Baldetti L, Radinovic A, Bisceglia C, D'Angelo G, Foppoli L, Gigli L, Peretto G, Cireddu M, Sala S, Mazzone P, Della Bella P. High-Density Characterization of the Ventricular Electrical Substrate During Sinus Rhythm in Post-Myocardial Infarction Patients. JACC Clin Electrophysiol 2020; 6:799-811. [PMID: 32703562 DOI: 10.1016/j.jacep.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/09/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to characterize, during sinus rhythm, the electric activation abnormalities in post-myocardial infarction patients undergoing ablation of ventricular tachycardia (VT) in order to identify specific signatures of those abnormal electrograms (EGMs). BACKGROUND In the setting of VT ablation, substrate characterization hinges on the identification of local abnormal ventricular activity (LAVA) and late potentials (LPs) that are considered to be related to the VT circuit. METHODS Patients scheduled for VT ablation underwent high-density ventricular substrate mapping. The substrate map during sinus rhythm was then compared with the activation maps of the clinical VT. Abnormal EGMs (LAVA and LPs) during sinus rhythm were characterized according to their configuration, duration, and amplitude and distinguished as belonging to bystander region or to the re-entrant circuit. Underlying electrophysiological mechanisms (wave-front collision, slow conduction) were identified on the activation maps and assigned to corresponding EGMs. RESULTS Ten patients satisfied the criteria to be enrolled in the study. A mean of 5 ± 1 slow-conduction areas and 4 ± 2 wave-front collisions were identified. LAVA was due to slow conduction in 60.5%, followed by wave-front collision (17.5%). LPs were caused by slow conduction in 52% of cases and by wave-front collision in 43% of cases. During sinus rhythm, entrance and exit sites were characterized by LAVA, while at the VT isthmus, only LPs were identified. Cutoff values of duration <24.5 ms (95% sensitivity and 99% specificity) and amplitude <0.14 mV (90% sensitivity and 48.1% specificity) discriminated those LPs belonging to the circuit from those playing a bystander role. CONCLUSIONS In the setting of post-myocardial infarction cardiomyopathy, specific EGM signatures are expressions of distinct electrophysiological phenomena. LAVA and LPs may play a bystander or an active role in the VT circuit, but only LPs with low amplitude and short duration predicted the VT isthmus.
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Affiliation(s)
- Antonio Frontera
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Francesco Melillo
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Baldetti
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Radinovic
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Giuseppe D'Angelo
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Foppoli
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Gigli
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Manuela Cireddu
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Sala
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrizio Mazzone
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
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Teuwen CP, van der Does LJ, Kik C, Mouws EM, Lanters EA, Knops P, Taverne YJ, Bogers AJ, de Groot NM. Sinus Rhythm Conduction Properties across Bachmann's Bundle: Impact of Underlying Heart Disease and Atrial Fibrillation. J Clin Med 2020; 9:jcm9061875. [PMID: 32560096 PMCID: PMC7355925 DOI: 10.3390/jcm9061875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
Valvular heart disease (VHD) is a common risk factor for atrial fibrillation (AF). Conduction abnormalities (CA) during sinus rhythm (SR) across Bachmann’s bundle (BB) are associated with AF development. The study goal is to compare electrophysiological characteristics across BB during SR between patients with ischemic (IHD) and/or VHD either with or without ischemic heart disease ((I)VHD), with/without AF history using high-resolution intraoperative epicardial mapping. In total, 304 patients (IHD: n = 193, (I)VHD: n = 111) were mapped; 40 patients (13%) had a history of AF. In 116 patients (38%) there was a mid-entry site with a trend towards more mid-entry sites in patients with (I)VHD vs. IHD (p = 0.061), whereas patients with AF had significant more mid-entry sites than without AF (p = 0.007). CA were present in 251 (95%) patients without AF compared to 39 (98%) with AF. The amount of CA was comparable in patients with IHD and (I)VHD (p > 0.05); AF history was positively associated with the amount of CA (p < 0.05). Receiver operating characteristic (ROC) curve showed 85.0% sensitivity and 86.4% specificity for cut-off values of CA lines of respectively ≤ 6 mm and ≥ 26 mm. Patients without a mid-entry site or long CA lines (≥ 12 mm) were unlikely to have AF (sensitivity 90%, p = 0.002). There are no significant differences in entry-sites of wavefronts and long lines of CA between patients with IHD compared to (I)VHD. However, patients with AF have more wavefronts entering in the middle of BB and a higher incidence of long CA lines compared to patients without a history of AF. Moreover, in case of absence of a mid-entry site or long line of CA, patients most likely have no history of AF.
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Affiliation(s)
- Christophe P. Teuwen
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
| | - Lisette J.M.E. van der Does
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
| | - Charles Kik
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.K.); (Y.J.H.J.T.); (A.J.J.C.B.)
| | - Elisabeth M.J.P. Mouws
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.K.); (Y.J.H.J.T.); (A.J.J.C.B.)
| | - Eva A.H. Lanters
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
| | - Paul Knops
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
| | - Yannick J.H.J. Taverne
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.K.); (Y.J.H.J.T.); (A.J.J.C.B.)
| | - Ad J.J.C. Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.K.); (Y.J.H.J.T.); (A.J.J.C.B.)
| | - Natasja M.S. de Groot
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.P.T.); (L.J.M.E.v.d.D.); (E.M.J.P.M.); (E.A.H.L.); (P.K.)
- Correspondence: ; Tel.: +31-10-703-5018; Fax: +31-10-703-5258
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Houck CA, Lanters EAH, Heida A, Taverne YJHJ, van de Woestijne PC, Knops P, Roos-Serote MC, Roos-Hesselink JW, Bogers AJJC, de Groot NMS. Distribution of Conduction Disorders in Patients With Congenital Heart Disease and Right Atrial Volume Overload. JACC Clin Electrophysiol 2020; 6:537-548. [PMID: 32439038 DOI: 10.1016/j.jacep.2019.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/15/2019] [Revised: 11/06/2019] [Accepted: 12/05/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study sought to quantify characteristics of atrial conduction disorders in patients with right atrial (RA) volume overload. BACKGROUND Patients with an interatrial shunt are prone to developing atrial fibrillation (AF), which may be related to conduction disorders occurring due to atrial stretch. METHODS Thirty-one patients undergoing surgery for an interatrial shunt (49 ± 14 years of age) underwent epicardial sinus rhythm mapping of the RA, Bachmann's bundle (BB), and left atrium (LA). Conduction delay (CD) was defined as interelectrode conduction time (CT) of 7 to 11 ms and conduction block (CB) as CT ≥12 ms. Prevalence of CD or CB (percentage of mapped region), length of lines, and severity of CB (75th percentile of CTs ≥12 ms) were analyzed. RESULTS All patients had some degree of CD and CB. Prevalence of CD and CB was higher in the RA and BB than in the LA (p < 0.0083 after Bonferroni correction). The longest CB line within each patient was found in the RA in most patients (52%). Interindividual variation in prevalence and lengths of lines was considerable. CB was more severe in the RA than in the LA (p < 0.0083). Within the RA, conduction disorders were more prevalent and more severe in the intercaval region than in the RA free wall (p < 0.05). CONCLUSIONS In patients with an interatrial shunt, conduction disorders during sinus rhythm are most pronounced in the RA-particularly the intercaval region-and BB. Knowledge of the conduction during sinus rhythm is essential to determine the relevance of conduction disorders for initiation and perpetuation of AF.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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Providência R, Adragão P, de Asmundis C, Chun J, Chierchia G, Defaye P, Anselme F, Creta A, Lambiase PD, Schmidt B, Chen S, Cavaco D, Hunter RJ, Carmo J, Combes S, Honarbakhsh S, Combes N, Sousa MJ, Jebberi Z, Albenque J, Boveda S. Impact of Body Mass Index on the Outcomes of Catheter Ablation of Atrial Fibrillation: A European Observational Multicenter Study. J Am Heart Assoc 2019; 8:e012253. [PMID: 31581876 PMCID: PMC6818047 DOI: 10.1161/jaha.119.012253] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022]
Abstract
Background Outcomes of catheter ablation of atrial fibrillation (AF) are variable and the predictors of success require further elucidation since the identification of correctable risk factors could help to optimize therapy. We aimed to assess the impact of body mass index (BMI) in the overall safety and efficacy of catheter ablation of AF, with emphasis on the use of cryoballoon ablation and novel oral anticoagulants. Methods and Results There were 2497 consecutive patients undergoing catheter ablation of AF in 7 European high volume centers were stratified according to BMI (normal weight <25 kg/m2, pre-obese 25-30 kg/m2, obesity 30-35 kg/m2, and morbid obesity ≥35 kg/m2) and comparisons of procedural outcomes evaluated. Pre-obese and obese patients presented more comorbidities (hypertension, diabetes mellitus, and sleep apnea), and had higher rates of non-paroxysmal AF ablation procedures. The rate of atrial 12-month arrhythmia relapse increased alongside with BMI (35.2%, 35.7%, 43.6%, and 48.0% P<0.001). During a median follow-up of 18.8 months (interquartile range 11-28), after adjusting for all baseline differences, BMI was an independent predictor of relapse (hazard ratio=1.01 per kg/m2; 95% CI 1.01-1.02; P=0.002), adding incremental predictive value to obstructive sleep apnea. BMI was not a predictor for any of the reported complications. Using novel oral anticoagulants and cryoballoon ablation was safe and efficacy was comparable with vitamin-K antagonists and radiofrequency ablation. Conclusions Obese patients present with a more adverse comorbidity profile, more advanced forms of AF, and have lower chances of being free from AF relapse after ablation. Use of novel oral anticoagulants and cryoballoon ablation may be an option in this patient group.
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Affiliation(s)
- Rui Providência
- Clinic Pasteur of ToulouseToulouseFrance
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
- Institute of Health Informatics ResearchUniversity College of LondonUnited Kingdom
| | - Pedro Adragão
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
| | - Carlo de Asmundis
- Heart Rhythm Management CentreUniversiteit Ziekenhuis BrusselBelgium
- Postgraduate program in Cardiac Electrophysiology and PacingVrije Universiteit BrusselBelgium
| | - Julian Chun
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Gianbattista Chierchia
- Heart Rhythm Management CentreUniversiteit Ziekenhuis BrusselBelgium
- Postgraduate program in Cardiac Electrophysiology and PacingVrije Universiteit BrusselBelgium
| | | | | | - Antonio Creta
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Pier D. Lambiase
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Boris Schmidt
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Shaojie Chen
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Diogo Cavaco
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
| | - Ross J. Hunter
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - João Carmo
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
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Brasier N, Engelter S, Kolbitsch T, Tabord A, Knobeloch J, Kühne M, Conen D, Traenka C, Kreutzberger T, Völlmin G, Eckstein J. The quest for indicators of paroxysmal atrial fibrillation in sinus rhythm - the DETECT AF trial. Acta Cardiol 2019; 74:301-307. [PMID: 30122130 DOI: 10.1080/00015385.2018.1493248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Atrial fibrillation (AF) is related to an increased stroke risk. At present, differentiation between patients with paroxysmal AF (pAF) and without is only possible during AF episodes and not during sinus rhythm. If AF could be diagnosed more quickly and reliably, anticoagulation therapy may be administered and prevent from cardioembolic strokes. The DETECT AF trial evaluated the hypothesis that propagation of electric activities in patients with pAF differs from propagation in healthy atria and that this can be detected with a three-dimensional electrocardiogram in patients during sinus rhythm. Methods: We conducted a case-control study including patients with a history of pAF and a control group with no history of AF. Vectorcardiographic beat-to-beat variability of atrial activation in sinus rhythm was tested and compared between the two groups. Results: One hundred and eight patients with a history of pAF in sinus rhythm and 121 controls in sinus rhythm were included. With a combination of specific vectorcardiographic beat-to-beat variability parameters discrimination between the two groups was possible with a specificity of 82% and a sensitivity of 71% (p≤.01). Using heart rate independent parameters, both specificity and sensitivity were reduced to 70%. Conclusions: Analysis of atrial vectorcardiographic beat-to-beat variability indicates that atrial conduction variability in patients with pAF differs from patients without AF and may be used as an indicator to estimate the risk for pAF in patients during sinus rhythm. Further studies to investigate the potential of this parameter are needed. Clinical trial registration number: NCT02270112.
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Affiliation(s)
- N. Brasier
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - S. Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - T. Kolbitsch
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - A. Tabord
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | | | - M. Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - D. Conen
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - C. Traenka
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | | | - G. Völlmin
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - J. Eckstein
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
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Jiang Q, Liu SZ, Jiang L, Huang KL, Guo J, Hu SS. Comparison of two radiofrequency ablation devices for atrial fibrillation concomitant with a rheumatic valve procedure. Chin Med J (Engl) 2019; 132:1414-1419. [PMID: 31205098 PMCID: PMC6629330 DOI: 10.1097/cm9.0000000000000276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Perioperative and median-term follow-up outcomes have not been compared among procedures using radiofrequency ablation devices for permanent atrial fibrillation with concomitant rheumatic valve disease. We compared the sinus rhythm restoration efficacy of "non-irrigation" ablation forceps and an "irrigation" ablation device in patients with rheumatic valve disease undergoing a modified Cox maze radiofrequency ablation procedure due to permanent atrial fibrillation. METHODS Data of 278 patients with rheumatic valve disease from the Cardiac Surgery Department of Sichuan Provincial People's Hospital who underwent the modified Cox maze radiofrequency ablation procedure between May 2013 and May 2017 were reviewed. The procedure was performed using "non-irrigation" ablation forceps (AtriCure, group A) in 149 patients and an "irrigation" ablation device (Medtronic, group M) in 129 patients. Data were collected prospectively, and follow-up was documented and compared between the groups. RESULTS The radiofrequency procedure duration was 28.9 ± 3.8 min in group A and 29.5 ± 2.8 min in group M (t = 1.623, P = 0.106). The predicted radiofrequency time to the left atrium diameter was (Ya = 0.4964 X + 0.3762, R = 0.74) in group A and (Ym = 0.4331 X + 4.3563, R = 0.8435) in group M. The sinus rhythm (SR) conversion rate without use of anti-arrhythmic drugs was similarly good in groups A and M, with 75.2%, 72.5%, and 70.5% vs. 73.6%, 71.3%, and 69.8% at discharge, 6 and 12 months, respectively (F = 0.084, F = 0.046, F = 0.046, P > 0.05, respectively). CONCLUSION Two types of radiofrequency ablation devices characteristic of "non-irrigation" and "irrigation" bipolar ablation forceps were similarly efficient at SR restoration.
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Affiliation(s)
- Qin Jiang
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan 610072, China
| | - Sheng-Zhong Liu
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan 610072, China
| | - Lu Jiang
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan 610072, China
| | - Ke-Li Huang
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan 610072, China
| | - Jing Guo
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan 610072, China
| | - Sheng-Shou Hu
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Filos D, Tachmatzidis D, Maglaveras N, Vassilikos V, Chouvarda I. Understanding the Beat-to-Beat Variations of P-Waves Morphologies in AF Patients During Sinus Rhythm: A Scoping Review of the Atrial Simulation Studies. Front Physiol 2019; 10:742. [PMID: 31275161 PMCID: PMC6591370 DOI: 10.3389/fphys.2019.00742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/15/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
The remarkable advances in high-performance computing and the resulting increase of the computational power have the potential to leverage computational cardiology toward improving our understanding of the pathophysiological mechanisms of arrhythmias, such as Atrial Fibrillation (AF). In AF, a complex interaction between various triggers and the atrial substrate is considered to be the leading cause of AF initiation and perpetuation. In electrocardiography (ECG), P-wave is supposed to reflect atrial depolarization. It has been found that even during sinus rhythm (SR), multiple P-wave morphologies are present in AF patients with a history of AF, suggesting a higher dispersion of the conduction route in this population. In this scoping review, we focused on the mechanisms which modify the electrical substrate of the atria in AF patients, while investigating the existence of computational models that simulate the propagation of the electrical signal through different routes. The adopted review methodology is based on a structured analytical framework which includes the extraction of the keywords based on an initial limited bibliographic search, the extensive literature search and finally the identification of relevant articles based on the reference list of the studies. The leading mechanisms identified were classified according to their scale, spanning from mechanisms in the cell, tissue or organ level, and the produced outputs. The computational modeling approaches for each of the factors that influence the initiation and the perpetuation of AF are presented here to provide a clear overview of the existing literature. Several levels of categorization were adopted while the studies which aim to translate their findings to ECG phenotyping are highlighted. The results denote the availability of multiple models, which are appropriate under specific conditions. However, the consideration of complex scenarios taking into account multiple spatiotemporal scales, personalization of electrophysiological and anatomical models and the reproducibility in terms of ECG phenotyping has only partially been tackled so far.
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Affiliation(s)
- Dimitrios Filos
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nicos Maglaveras
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL, United States
| | - Vassilios Vassilikos
- 3rd Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Chouvarda
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Yan ZT, Huang JM, Luo WL, Liu JW, Zhou K. Combined metabolic, phenomic and genomic data to prioritize atrial fibrillation-related metabolites. Exp Ther Med 2019; 17:3929-3934. [PMID: 31007735 PMCID: PMC6468506 DOI: 10.3892/etm.2019.7443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/26/2018] [Accepted: 02/14/2019] [Indexed: 12/19/2022] Open
Abstract
Metabolites in atrial fibrillation (AF) were characterized to further explore the molecular mechanisms of AF by integrating metabolic, phenomic and genomic data. Gene expression data on AF (E-GEOD-79768) were downloaded from the EMBL-EBI database, followed by identification of differentially expressed genes (DEGs) which were used to construct gene-gene network. Then, multi-omics composite networks were constructed. Subsequently, random walk with restart was expanded to a multi-omics composite network to identify and prioritize the metabolites according to the AF-related seed genes deposited in the OMIM database, the whole metabolome as candidates and the phenotype of AF. Using the interaction score among metabolites, we extracted the top 50 metabolites, and identified the top 100 co-expressed genes interacted with the top 50 metabolites. Based on the FDR <0.05, 622 DEGs were extracted. In order to demonstrate the intrinsic mode of this method, we sorted the metabolites of the composite network in descending order based on the interaction scores. The top 5 metabolites were respectively weighed potassium, sodium ion, chitin, benzo[a]pyrene-7,8-dihydrodiol-9,10-oxide, and celebrex (TN). Potassium and sodium ion possessed higher degrees in the subnetwork of the entire composite network and the co-expressed network. Metabolites such as potassium and sodium ion may provide valuable clues for early diagnostic and therapeutic targets for AF.
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Affiliation(s)
- Zhi-Tao Yan
- Department of Cardiology, The First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Jin-Mei Huang
- Department of General Surgery, The First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Wen-Li Luo
- Department of Gerontology, The First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Ji-Wen Liu
- Department of Internal Medicine, Affiliated Midong Hospital of the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830000, P.R. China
| | - Kang Zhou
- Department of Cardiology, The First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang 832000, P.R. China
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Lv JH, Wang D, Zhang MN, Bai ZH, Sun JL, Shi Y, Pei HH, Zhang ZL, Wang H. The related factors for the recovery and maintenance time of sinus rhythm in hospitalized patients with cardiopulmonary resuscitation: A single-center retrospective case-control study. Medicine (Baltimore) 2019; 98:e14303. [PMID: 30702602 PMCID: PMC6380744 DOI: 10.1097/md.0000000000014303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
No matter in or outside hospital, the success rate of cardiopulmonary resuscitation (CPR) is very low. The sign of successful CPR is the recovery of spontaneous circulation. The premise of the recovery of spontaneous circulation is the recovery and maintenance of sinus rhythm, but there is still no related research.We aim to study the factors for the recovery and maintenance time of sinus rhythm in patients with CPR.A single-center retrospective case-control study.Ethical review was obtained (ethical approval number: 20180031).The second affiliated hospital of Xi'an Jiaotong University, Xi'an Shaanxi, China.From January 2011 to December 2016, totally 344 cases met the inclusion and exclusion criteria, sinus rhythm recovered group (SR group) (n = 130 cases), sinus rhythm unrecovered group (SUR group) (n = 214 cases).The multivariate logistic regression analysis showed that red blood cell counts (OR = 1.30, 95% CI:1.04-1.63, P = .02), rescue time (OR = 0.95, 95% CI:0.94-0.97, P <.001), the usage of norepinephrine (OR = 2.14, 95% CI:1.06-4.35, P = .04) were important factor for the recovery of sinus rhythm in patients with CPR. Multivariate linear regression analysis showed that the dosage of epinephrine, the usage of naloxone and diagnosis were important factors for maintenance time of sinus rhythm after resuscitation, P <.05. The rescue time had high accuracy to predict the recovery of sinus rhythm, the area under the receiver operator characteristic (ROC) curve (AUC) was 0.84 (0.80, 0.88), sensitivity and specificity are respectively 71.54% and 93.46%.Red blood cell counts, the rescue time and the usage of norepinephrine might be important factors for the recovery of sinus rhythm, and the dosage of epinephrine, the usage of naloxone and the diagnosis might be important factors for the maintenance time of sinus rhythm in patients with CPR.
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Mouws EMJP, Kik C, van der Does LJME, Lanters EAH, Teuwen CP, Knops P, Bogers AJJC, de Groot NMS. Novel Insights in the Activation Patterns at the Pulmonary Vein Area. Circ Arrhythm Electrophysiol 2018; 11:e006720. [PMID: 30520348 DOI: 10.1161/circep.118.006720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extensiveness of conduction delay and block at the pulmonary vein area (PVA) was quantified in a previous study. We hypothesized that the combination of lines of conduction block with multiple concomitantly entering sinus rhythm wavefronts at the PVA may result in increased arrhythmogenicity and susceptibility to atrial fibrillation (AF). METHODS Intraoperative high-density epicardial mapping of PVA (N≈450 sites, interelectrode distances: 2 mm) was performed during sinus rhythm in 327 patients (241 male [74%], 67±10 [21-84] years) with and without preoperative AF. For each patient, activation patterns at the PVA were quantified, including the location of entry sites of wavefronts, direction of propagation, and their relative activation times. The association between activation patterns and the presence of AF was examined. RESULTS Excitation of the PVA occurred via multiple consecutive wavefronts in the vast majority of patient (N=216, 81%). In total, 561 wavefronts were observed, which mostly propagated through the septal or paraseptal regions towards the PVA (N=461, 82%). A substantial dissociation of consecutive wavefronts was observed with Δactivation times of 10.6±8.8 (0-46) ms. No difference was observed in Δactivation times of consecutive wavefronts during sinus rhythm between patients without and with AF. An excitation-based risk factor model, including conduction delay ≥6 mm, conduction block ≥6 mm, and conduction delay and block ≥16 mm, wavefronts via the posteroinferior to posterosuperior regions and multiple opposing wavefronts, demonstrated a 5-fold risk of AF when multiple risk factors were present. CONCLUSIONS In contrast to previous findings, quantification of activation patterns at the PVA on high-resolution scale demonstrated complex patterns with often multiple entry sites and high interindividual variability. Altered patterns of activation, consisting of multiple opposing wavefronts combined with long lines of conduction slowing, were associated with the presence of AF.
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Affiliation(s)
- Elisabeth M J P Mouws
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.).,Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., C.K., A.J.J.C.B.)
| | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., C.K., A.J.J.C.B.)
| | - Lisette J M E van der Does
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
| | - Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., C.K., A.J.J.C.B.)
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (E.M.J.P.M., L.J.M.E.v.d.D., E.A.H.L., C.P.T., P.K., N.M.S.d.G.)
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Vasudevan A, Hundae A, Borodge D, McCullough PA, Wells PJ. Frequency of atrial arrhythmias after atrial flutter ablation and the effect of presenting rhythm on the day of ablation. Proc (Bayl Univ Med Cent) 2018; 31:280-283. [PMID: 29904288 DOI: 10.1080/08998280.2018.1464305] [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: 02/07/2018] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 10/16/2022] Open
Abstract
Radiofrequency catheter ablation of the cavotricuspid isthmus is a proven therapy for typical atrial flutter (AFl); however, in some patients, new atrial arrhythmias (AA) may occur after AFl ablation. This study explored the difference in the occurrence of spontaneous AA after AFl ablation as a function of the patient's presenting rhythm on the day of the AFl ablation. A retrospective study of consecutive patients who underwent AFl ablation at Baylor University Medical Center at Dallas was performed. A total of 188 subjects were included; 50% (94) presented in AFl (Group AFl) on the day of the ablation procedure and 94 presented in sinus rhythm (SR; Group SR). Group AFl patients were older (P < 0.001), more likely to have diabetes (P = 0.03), and more likely to have undergone previous heart surgery (P = 0.03). The median size of the left atrium was 4 cm (range 2.8-6.8) in Group AFl compared with 3.8 cm (range 2.6-5.6) in Group SR (P = 0.009). Atrial fibrillation was induced during the ablation procedure in 7.5% and 21.3% of patients in Groups AFl and SR, respectively (P = 0.007). Overall, 29 of 188 (15.4%) patients developed new AA within 1 year of the procedure, 13.8% in Group AFl vs 17.0% in Group SR (P = 0.57). In conclusion, patients presenting for AFl ablation in SR were younger and healthier but had more atrial fibrillation induced during their ablation procedure, with a trend toward more postablation AA due to additional arrhythmia substrate.
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Affiliation(s)
- Anupama Vasudevan
- Baylor Research Institute, Dallas, Texas.,Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, Texas
| | - Aneley Hundae
- Bayfront Health Port Charlotte, Port Charlotte, Florida.,Division of Cardiology, Fawcett Memorial Hospital, Port Charlotte, Florida
| | - Darara Borodge
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Peter A McCullough
- Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, Texas.,Division of Cardiology, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, Baylor Heart and Vascular Hospital, Dallas, Texas
| | - Peter J Wells
- Division of Cardiology, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, Baylor Heart and Vascular Hospital, Dallas, Texas
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50
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Mouws EMJP, Lanters EAH, Teuwen CP, van der Does LJME, Kik C, Knops P, Yaksh A, Bekkers JA, Bogers AJJC, de Groot NMS. Impact of Ischemic and Valvular Heart Disease on Atrial Excitation:A High-Resolution Epicardial Mapping Study. J Am Heart Assoc 2018. [PMID: 29519812 PMCID: PMC5907575 DOI: 10.1161/jaha.117.008331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The influence of underlying heart disease or presence of atrial fibrillation (AF) on atrial excitation during sinus rhythm (SR) is unknown. We investigated atrial activation patterns and total activation times of the entire atrial epicardial surface during SR in patients with ischemic and/or valvular heart disease with or without AF. Methods and Results Intraoperative epicardial mapping (N=128/192 electrodes, interelectrode distances: 2 mm) of the right atrium, Bachmann's bundle (BB), left atrioventricular groove, and pulmonary vein area was performed during SR in 253 patients (186 male [74%], age 66±11 years) with ischemic heart disease (N=132, 52%) or ischemic valvular heart disease (N=121, 48%). As expected, SR origin was located at the superior intercaval region of the right atrium in 232 patients (92%). BB activation occurred via 1 wavefront from right‐to‐left (N=163, 64%), from the central part (N=18, 7%), or via multiple wavefronts (N=72, 28%). Left atrioventricular groove activation occurred via (1) BB: N=108, 43%; (2) pulmonary vein area: N=9, 3%; or (3) BB and pulmonary vein area: N=136, 54%; depending on which route had the shortest interatrial conduction time (P<0.001). Ischemic valvular heart disease patients more often had central BB activation and left atrioventricular groove activation via pulmonary vein area compared with ischemic heart disease patients (N=16 [13%] versus N=2 [2%]; P=0.009 and N=86 [71%] versus N=59 [45%]; P<0.001, respectively). Total activation times were longer in patients with AF (AF: 136±20 [92–186] ms; no AF: 114±17 [74–156] ms; P<0.001), because of prolongation of right atrium (P=0.018) and BB conduction times (P<0.001). Conclusions Atrial excitation during SR is affected by underlying heart disease and AF, resulting in alternative routes for BB and left atrioventricular groove activation and prolongation of total activation times. Knowledge of atrial excitation patterns during SR and its electropathological variations, as demonstrated in this study, is essential to further unravel the pathogenesis of AF.
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Affiliation(s)
- Elisabeth M J P Mouws
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ameeta Yaksh
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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