81 results on '"Gelder, Isabelle C Van"'
Search Results
2. Emergency department visit for atrial fibrillation: sex differences in treatment and outcomes in the Global RE-LY AF Registry.
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Johnson, Linda S, Jiang, Yuxuan, Luu, Judy, Gelder, Isabelle C Van, Atzema, Clare, Conen, David, Kloosterman, Marielle, Armaganijan, Luciana, Connolly, Stuart J, Ezekowitz, Michael D, Wallentin, Lars, Johansson, Isabelle, McIntyre, William F, Oldgren, Jonas, and Healey, Jeffrey S
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EMERGENCY room visits ,ATRIAL fibrillation ,SEX factors in disease ,RHEUMATIC heart disease ,HEART failure ,TRANSIENT ischemic attack - Abstract
This article examines the disparities in treatment and outcomes for atrial fibrillation (AF) based on gender and economic status in different countries. The study analyzed data from the Global RE-LY AF Registry, which included 15,400 patients from 47 countries. The results showed that females with AF were less likely to receive certain treatments, but were slightly more likely to receive anticoagulation. The study suggests that there may be gaps in AF treatment and outcomes based on sex, and further research is needed to develop specific treatment recommendations. The article also presents a table showing data on gender disparities in different income levels and Global Gender Gap scores. Another study discussed in the article found that female sex was associated with an increased risk of stroke in AF patients, but there was no difference in other outcomes between males and females. The study also found that females were less likely to receive rhythm control therapy, especially in lower income countries and those with less gender parity. Overall, the findings suggest that there are disparities in the management and outcomes of AF based on sex. [Extracted from the article]
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- 2024
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3. Design and deployment of the STEEER-AF trial to evaluate and improve guideline adherence: a cluster-randomized trial by the European Society of Cardiology and European Heart Rhythm Association.
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Sterliński, Maciej, Bunting, Karina V, Boriani, Giuseppe, Boveda, Serge, Guasch, Eduard, Mont, Lluís, Rajappan, Kim, Sommer, Philipp, Mehta, Samir, Sun, Yongzhong, Gale, Chris P, Deutekom, Colinda van, Gelder, Isabelle C Van, Kotecha, Dipak, and Team, STEEER-AF Trial
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Aims The aim is to describe the rationale, design, delivery, and baseline characteristics of the Stroke prevention and rhythm control Treatment: Evaluation of an Educational programme of the European society of cardiology in a cluster-Randomized trial in patients with Atrial Fibrillation (STEEER-AF) trial. Methods and results STEEER-AF is a pragmatic trial designed to objectively and robustly determine whether guidelines are adhered to in routine practice and evaluate a targeted educational programme for healthcare professionals. Seventy centres were randomized in six countries (France, Germany, Italy, Poland, Spain, and UK; 2022–23). The STEEER-AF centres recruited 1732 patients with a diagnosis of atrial fibrillation (AF), with a mean age of 68.9 years (SD 11.7), CHA
2 DS2 -VASc score of 3.2 (SD 1.8), and 647 (37%) women. Eight hundred and forty-three patients (49%) were in AF at enrolment and 760 (44%) in sinus rhythm. Oral anticoagulant therapy was prescribed in 1543 patients (89%), with the majority receiving direct oral anticoagulants (1378; 89%). Previous cardioversion, antiarrhythmic drug therapy, or ablation was recorded in 836 patients (48.3%). Five hundred fifty-one patients (31.8%) were currently receiving an antiarrhythmic drug, and 446 (25.8%) were scheduled to receive a future cardioversion or ablation. The educational programme engaged 195 healthcare professionals across centres randomized to the intervention group, consisting of bespoke interactive online learning and reinforcement activities, supported by national expert trainers. Conclusion The STEEER-AF trial was successfully deployed across six European countries to investigate guideline adherence in real-world practice and evaluate if a structured educational programme for healthcare professionals can improve patient-level care. Clinical Trial Registration Clinicaltrials.gov , NCT04396418. [ABSTRACT FROM AUTHOR]- Published
- 2024
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4. Ablation of persistent atrial fibrillation: never say never again.
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Samuel, Michelle, Rienstra, Michiel, and Gelder, Isabelle C Van
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- 2024
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5. Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation
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Hermans, Astrid N. L., Gawalko, Monika, Slegers, Daniek P. J., Andelfinger, Nora, Pluymaekers, Nikki A. H. A., Verhaert, Dominique V. M., van der Velden, Rachel M. J., Betz, Konstanze, Evens, Stijn, Luermans, Justin G. L. M., den Uijl, Dennis W., Baumert, Mathias, Nguyen, Hien L., Isaksen, Jonas L., Kantes, Jorgen, Kanters, Jurgen K., Rienstra, Michiel, Vernooy, Kevin, Gelder, Isabelle C. Van, Hendriks, Jeroen M., Linz, Dominik, Cardiologie, RS: Carim - H01 Clinical atrial fibrillation, MUMC+: MA Med Staf Artsass Cardiologie (9), MUMC+: MA Med Staf Spec Cardiologie (9), MUMC+: MA Cardiologie (3), RS: Carim - H06 Electro mechanics, RS: Carim - H08 Experimental atrial fibrillation, and Cardiovascular Centre (CVC)
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Male ,CATHETER ABLATION ,Telemonitoring ,Time Factors ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Medizin ,Electric Countershock ,Middle Aged ,Mobile Applications ,Atrial fibrillation ,Symptom -rhythm correlation ,Electrical cardioversion ,Heart Rate ,MANAGEMENT ,Humans ,Female ,Mobile health ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Contains fulltext : 283519.pdf (Publisher’s version ) (Open Access) BACKGROUND: The assessment of symptom-rhythm correlation (SRC) in patients with persistent atrial fibrillation (AF) is challenging. Therefore, we performed a novel mobile app-based approach to assess SRC in persistent AF. METHODS: Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-s photoplethysmogram (PPG) and report symptoms once daily and in case of symptoms for four weeks prior and three weeks after ECV. Within each patient, SRC was quantified by the SRC-index defined as the sum of symptomatic AF recordings and asymptomatic non-AF recordings divided by the sum of all recordings. RESULTS: Of 88 patients (33% women, age 68 ± 9 years) included, 78% reported any symptoms during recordings. The overall SRC-index was 0.61 (0.44-0.79). The study population was divided into SRC-index tertiles: low (
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- 2022
6. Rate control: medical therapy
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Gelder, Isabelle C. Van, primary, Rienstra, Michiel, additional, Pison, Laurent, additional, and Crijns, Harry J. G. M., additional
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- 2018
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7. Atrial fibrillation progression and prevention
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Luermans, Justin G. L. M., primary, Heijman, Jordi, additional, Gelder, Isabelle C. Van, additional, and Crijns, Harry J. G. M., additional
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- 2018
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8. Time of onset of atrial fibrillation and atrial fibrillation progression data from the RACE V study.
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Lande, Martijn E van de, Rama, Rajiv S, Koldenhof, Tim, Arita, Vicente Artola, Nguyen, Bao-Oanh, Deutekom, Colinda van, Weberndorfer, Vanessa, Crijns, Harry J G M, Hemels, Martin E W, Tieleman, Robert G, Melis, Mirko de, Schotten, Ulrich, Linz, Dominik, Gelder, Isabelle C Van, Rienstra, Michiel, and Investigators, for the RACE V
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Aims Atrial fibrillation (AF) progression is associated with adverse outcome, but the role of the circadian or diurnal pattern of AF onset remains unclear. We aim to assess the association between the time of onset of AF episodes with the clinical phenotype and AF progression in patients with self-terminating AF. Methods and results The Reappraisal of AF: Interaction Between Hypercoagulability, Electrical Remodelling, and Vascular Destabilization in the Progression of AF study included patients with self-terminating AF who underwent extensive phenotyping at baseline and continuous rhythm monitoring with an implantable loop recorder (ILR). In this subanalysis, ILR data were used to assess the development of AF progression and the diurnal pattern of AF onset: predominant (>80%) nocturnal AF, predominant daytime AF, or mixed AF without a predominant diurnal AF pattern. The median follow-up was 2.2 (1.6–2.8) years. The median age was 66 (59–71) years, and 117 (42%) were women. Predominant nocturnal (n = 40) and daytime (n = 43) AF onset patients had less comorbidities compared to that of mixed (n = 195) AF patients (median 2 vs. 2 vs. 3, respectively, P = 0.012). Diabetes was more common in the mixed group (12% vs. 5% vs. 0%, respectively, P = 0.031), whilst obesity was more frequent in the nocturnal group (38% vs. 12% vs. 27%, respectively, P = 0.028). Progression rates in the nocturnal vs. daytime vs. mixed groups were 5% vs. 5% vs. 24%, respectively (P = 0.013 nocturnal vs. mixed and P = 0.008 daytime vs. mixed group, respectively). Conclusion In self-terminating AF, patients with either predominant nocturnal or daytime onset of AF episodes had less associated comorbidities and less AF progression compared to that of patients with mixed onset of AF. Clinical trial registration NCT02726698 [ABSTRACT FROM AUTHOR]
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- 2023
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9. Clinical utility of the 4S-AF scheme in predicting progression of atrial fibrillation: data from the RACE V study.
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Arita, Vicente Artola, Lande, Martijn E Van De, Ekrami, Neda Khalilian, Nguyen, Bao-Oanh, Melle, Joost M Van, Geelhoed, Bastiaan, With, Ruben R De, Weberndörfer, Vanessa, Erküner, Ömer, Hillege, Hans, Linz, Dominik, Cate, Hugo Ten, Spronk, Henri M H, Koldenhof, Tim, Tieleman, Robert G, Schotten, Ulrich, Crijns, Harry J G M, Gelder, Isabelle C Van, and Rienstra, Michiel
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Aims The recent 4S-AF (scheme proposed by the 2020 ESC AF guidelines to address stroke risk, symptom severity, severity of AF burden and substrate of AF to provide a structured phenotyping of AF patients in clinical practice to guide therapy and assess prognosis) scheme has been proposed as a structured scheme to characterize patients with atrial fibrillation (AF). We aimed to assess whether the 4S-AF scheme predicts AF progression in patients with self-terminating AF. Methods and results We analysed 341 patients with self-terminating AF included in the well-phenotyped Reappraisal of Atrial Fibrillation: Interaction between HyperCoagulability, Electrical remodelling, and Vascular Destabilization in the Progression of AF (RACE V) study. Patients had continuous monitoring with implantable loop recorders or pacemakers. AF progression was defined as progression to persistent or permanent AF or progression of self-terminating AF with >3% burden increase. Progression of AF was observed in 42 patients (12.3%, 5.9% per year). Patients were given a score based on the components of the 4S-AF scheme. Mean age was 65 [interquartile range (IQR) 58–71] years, 149 (44%) were women, 103 (49%) had heart failure, 276 (81%) had hypertension, and 38 (11%) had coronary artery disease. Median CHA
2 DS2 -VASc (the CHA2 DS2 –VASc score assesses thromboembolic risk. C, congestive heart failure/left ventricular dysfunction; H, hypertension; A2 , age ≥ 75 years; D, diabetes mellitus; S2 , stroke/transient ischaemic attack/systemic embolism; V, vascular disease; A, age 65–74 years; Sc, sex category (female sex)) score was 2 (IQR 2–3), and median follow-up was 2.1 (1.5–2.6) years. The average score of the 4S-AF scheme was 4.6 ± 1.4. The score points from the 4S-AF scheme did not predict the risk of AF progression [odds ratio (OR) 1.1 95% CI 0.88–1.41, C-statistic 0.53]. However, excluding the symptoms domain, resulting in the 3S-AF (4S-AF scheme without the domain symptom severity, only including stroke risk, severity of AF burden and substrate of AF) scheme, predicted the risk of progression (OR 1.59 95% CI 1.15–2.27, C-statistic 0.62) even after adjusting for sex and age. Conclusions In self-terminating AF patients, the 4S-AF scheme does not predict AF progression. The 3S-AF scheme, excluding the symptom domain, may be a more appropriate score to predict AF progression. Trial registration numbers Clinicaltrials.gov NCT02726698 for RACE V [ABSTRACT FROM AUTHOR]- Published
- 2023
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10. Searching for atrial fibrillation: looking harder, looking longer, and in increasingly sophisticated ways. An EHRA position paper.
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Kalarus, Zbigniew, Mairesse, Georges H, Sokal, Adam, Boriani, Giuseppe, Średniawa, Beata, Casado-Arroyo, Ruben, Wachter, Rolf, Frommeyer, Gerrit, Traykov, Vassil, Dagres, Nikolaos, Lip, Gregory Y H, Boersma, Lucas, Peichl, Petr, Dobrev, Dobromir, Bulava, Alan, Blomström-Lundqvist, Carina, Groot, Natasja M S de, Schnabel, Renate, Heinzel, Frank, and Gelder, Isabelle C Van
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- 2023
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11. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS):The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC
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Hindricks, Gerhard, Potpara, Tatjana, Dagres, Nikolaos, Arbelo, Elena, Bax , Jeroen J., Blomstro¨m-Lundqvist, Carina, Boriani, Giuseppe, Castella, Manuel, Dan, Gheorghe-Andrei, Dilaveris, Polychronis E., Fauchier, Laurent, Filippatos, Gerasimos, Kalman, Jonathan M., Meir, Mark La, Lane, Deirdre A, Lebeau, Jean-Pierre, Lettino, Maddalena, Lip, Gregory Y H, Pinto, Fausto J, Thomas, G Neil, Valgimigli, Marco, Gelder, Isabelle C Van, Putte, Bart P Van, Watkins, Caroline L, Kirchhof, Paulus, Kühne, Michael, Aboyans, Victor, Ahlsson, Anders, Balsam, Pawel, Bauersachs, Johann, Benussi, Stefano, Brandes, Axel, Braunschweig, Frieder, Camm, A John, Capodanno, Davide, Casadei, Barbara, Conen, David, Crijns, Harry J G M, Delgado, Victoria, Dobrev, Dobromir, Drexel, Heinz, Eckardt, Lars, Fitzsimons, Donna, Folliguet, Thierry, Gale, Chris P., Gorenek, Bulent, Haeusler, Karl Georg, Heidbuchel, Hein, Iung, Bernard, Katus, Hugo A, Kotecha, Dipak, Landmesser, Ulf, Leclercq, Christophe, Lewis, Basil S, Mascherbauer, Julia, Merino, Jose Luis, Merkely, Béla, Mont, Lluis, Mueller, Christian, Nagy, Klaudia V., Oldgren, Jonas, Pavlovic, Nikola, Pedretti, Roberto F.E., Petersen, Steffen Ellebæk, Piccini, Jonathan P, Popescu, Bogdan A, Pürerfellner, Helmut, Richter, Dimitrios J., Roffi, Marco, Rubboli, Andrea, Scherr, Daniel, Schnabel, Renate B, Simpson, Iain, Shlyakhto, Evgeny, Sinner, Moritz F, Steffel, Jan, Sousa-Uva, Miguel, Suwalski, Piotr, Svetlosak, Martin, and Touyz, Rhian M.
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rhythm control ,left atrial ablation ,left atrial appendage occlusion ,AF surgery ,non-vitamin K antagonist oral anticoagulants ,screening ,Cardiology ,Anticoagulants ,Thoracic Surgery ,Guidelines ,upstream therapy ,stroke ,Europe ,vitamin K antagonists ,cardioversion ,antiarrhythmic drugs ,recommendations ,catheter ablation ,Atrial Fibrillation/diagnosis ,Humans ,atrial fibrillation ,ABC pathway ,anticoagulation ,pulmonary vein isolation ,rate control - Published
- 2021
12. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
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Hindricks, Gerhard Potpara, Tatjana Dagres, Nikolaos Arbelo, Elena Bax, Jeroen J. Blomstroem-Lundqvist, Carina Boriani, Giuseppe Castella, Manuel Dan, Gheorghe-Andrei Dilaveris, Polychronis E. Fauchier, Laurent Filippatos, Gerasimos and Kalman, Jonathan M. La Meir, Mark Lane, Deirdre A. Lebeau, Jean-Pierre Lettino, Maddalena Lip, Gregory Y. H. Pinto, Fausto J. Thomas, G. Neil Valgimigli, Marco Van Gelder, Isabelle C. Van Putte, Bart P. Watkins, Caroline L.
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- 2021
13. Early rhythm control therapy in patients with atrial fibrillation and heart failure
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Rillig, Andreas, Ozga, Ann-Kathrin, Wegscheider, Karl, Magnussen, Christina, Brandes, Axel, Breithardt, Günter Ernst, John Camm, A., J.G.M. Crijns, Harry, Eckhardt, Lars, Elvan, Arif, Gulizia, Michele, Haegeli, Laurent M., Heidbuchel, Hein, Kuck, Karl-Heinz, Andre Ng, G., Szumowski, Lukasz, Gelder, Isabelle C Van, and Kirchhof, Paulus
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- 2021
14. Pathophysiological pathways in patients with heart failure and atrial fibrillation
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Santema, Bernadet T. Arita, Vicente Artola Sama, Iziah E. Kloosterman, Mariëlle van den Berg, Maarten P. Nienhuis, Hans L. A. Van Gelder, Isabelle C. van der Meer, Peter Zannad, Faiez Metra, Marco Ter Maaten, Jozine M. Cleland, John G. Ng, Leong L. Anker, Stefan D. Lang, Chim C. Samani, Nilesh J. Dickstein, Kenneth Filippatos, Gerasimos van Veldhuisen, Dirk J. Lam, Carolyn S. P. Rienstra, Michiel Voors, Adriaan A.
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AIMS: Atrial fibrillation (AF) and heart failure (HF) are two growing epidemics that frequently co-exist. We aimed to gain insights into underlying pathophysiological pathways in HF patients with AF by comparing circulating biomarkers using pathway overrepresentation analyses. METHODS AND RESULTS: From a panel of 92 biomarkers from different pathophysiological domains available in 1,620 patients with HF, we first tested which biomarkers were dysregulated in patients with HF and AF (n = 648) compared with patients in sinus rhythm (n = 972). Secondly, pathway overrepresentation analyses were performed to identify biological pathways linked to higher plasma concentrations of biomarkers in patients who had HF and AF. Findings were validated in an independent HF cohort (n = 1,219, 38\% with AF). Patient with AF and HF were older, less often women, and less often had a history of coronary artery disease compared with those in sinus rhythm. In the index cohort, 24 biomarkers were upregulated in patients with AF and HF. In the validation cohort, 8 biomarkers were upregulated, which all overlapped with the 24 biomarkers found in the index cohort. The strongest up-regulated biomarkers in patients with AF were spondin-1 (fold change 1.18, p = 1.33x10-12), insulin-like growth factor-binding protein-1 (fold change 1.32, p = 1.08x10-8), and insulin-like growth factor-binding protein-7 (fold change 1.33, p = 1.35x10-18). Pathway overrepresentation analyses revealed that the presence of AF was associated with activation amyloid-beta metabolic processes, amyloid-beta formation, and amyloid precursor protein catabolic processes with a remarkable consistency observed in the validation cohort. CONCLUSION: In two independent cohorts of patients with HF, the presence of AF was associated with activation of three pathways related to amyloid-beta. These hypothesis-generating results warrant confirmation in future studies. TRANSLATIONAL PERSPECTIVE: Using an unbiased approach, we identified and validated dysregulation of three amyloid-beta related pathways in patients who had heart failure (HF) with concomitant atrial fibrillation (AF). Amyloid-beta depositions are a hallmark of Alzheimer's disease, but might also play a role in pathophysiological processes outside the central nervous system. Biopsy studies are needed to confirm the pathophysiological role of amyloid-beta in patients with AF and HF. Diagnostic and therapeutic implications should be investigated in the light of potential pathophysiological overlap between the three aging-related epidemics: Alzheimer's disease, AF and HF.
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- 2021
15. Additional file 1 of Segment length in cine (SLICE) strain analysis: a practical approach to estimate potential benefit from cardiac resynchronization therapy
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Zweerink, Alwin, Nijveldt, Robin, Braams, Natalia J., Maass, Alexander H., Vernooy, Kevin, Lange, Frederik J. De, Meine, Mathias, Geelhoed, Bastiaan, Rienstra, Michiel, Gelder, Isabelle C. Van, Vos, Marc A., Rossum, Albert C. Van, and Allaart, Cornelis P.
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Additional file 1: Table S1. Comparison of strain parameters between CRT responders and non-responders. Table S2. Predictive value of strain parameters for CRT response (≥ 15% reduction in LVESV). Table S3. Septal strain patterns and CRT response. Figure S1. Localization of the anatomical landmarks. Figure S2. Modification of the SLICE technique by implementing radial taglines.
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- 2021
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16. Estimated incidence of previously undetected atrial fibrillation on a 14-day continuous electrocardiographic monitor and associated risk of stroke.
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McIntyre, William F, Wang, Jia, Benz, Alexander P, Johnson, Linda, Connolly, Stuart J, Gelder, Isabelle C Van, Lopes, Renato D, Gold, Michael R, Hohnloser, Stefan H, Lau, Chu Pak, Israel, Carsten W, Wong, Jorge A, Conen, David, Healey, Jeff S, and Van Gelder, Isabelle C
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STROKE diagnosis ,ATRIAL fibrillation diagnosis ,HYPERTENSION epidemiology ,HYPERTENSION ,STROKE ,ARTHRITIS Impact Measurement Scales ,ATRIAL fibrillation ,ANTICOAGULANTS ,DISEASE incidence ,RISK assessment ,RANDOMIZED controlled trials ,ELECTROCARDIOGRAPHY ,RESEARCH funding ,STATISTICAL sampling ,CEREBRAL ischemia ,DISEASE complications - Abstract
Aims: There is uncertainty about whether and how to perform screening for atrial fibrillation (AF). To estimate the incidence of previously undetected AF that would be captured using a continuous 14-day ECG monitor and the associated risk of stroke.Methods and Results: We analysed data from a cohort of patients >65 years old with hypertension and a pacemaker, but without known AF. For each participant, we simulated 1000 ECG monitors by randomly selecting 14-day windows in the 6 months following enrolment and calculated the average AF burden (total time in AF). We used Cox proportional hazards models adjusted for CHA2DS2-VASc score to estimate the risk of subsequent ischaemic stroke or systemic embolism (SSE) associated with burdens of AF > and <6 min. Among 2470 participants, the median CHA2DS2-VASc score was 4.0, and 44 patients experienced SSE after 6 months following enrolment. The proportion of participants with an AF burden >6 min was 3.10% (95% CI 2.53-3.72). This was consistent across strata of age and CHA2DS2-VASc scores. Over a mean follow-up of 2.4 years, the rate of SSE among patients with <6 min of AF was 0.70%/year, compared to 2.18%/year (adjusted HR 3.02; 95% CI 1.39-6.56) in those with >6 min of AF.Conclusions: Approximately 3% of individuals aged >65 years with hypertension may have more than 6 min of AF detected by a 14-day ECG monitor. This is associated with a stroke risk of over 2% per year. Whether oral anticoagulation will reduce stroke in these patients is unknown. [ABSTRACT FROM AUTHOR]- Published
- 2022
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17. Pathophysiological pathways in patients with heart failure and atrial fibrillation.
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Santema, Bernadet T, Arita, Vicente Artola, Sama, Iziah E, Kloosterman, Mariëlle, Berg, Maarten P van den, Nienhuis, Hans L A, Gelder, Isabelle C Van, van der Meer, Peter, Zannad, Faiez, Metra, Marco, Maaten, Jozine M Ter, Cleland, John G, Ng, Leong L, Anker, Stefan D, Lang, Chim C, Samani, Nilesh J, Dickstein, Kenneth, Filippatos, Gerasimos, Veldhuisen, Dirk J van, and Lam, Carolyn S P
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ATRIAL fibrillation ,HEART failure patients ,AMYLOID beta-protein precursor ,AMYLOID ,MYOCARDIAL depressants ,BIOTRANSFORMATION (Metabolism) ,CORONARY artery disease - Abstract
Aims Atrial fibrillation (AF) and heart failure (HF) are two growing epidemics that frequently co-exist. We aimed to gain insights into the underlying pathophysiological pathways in HF patients with AF by comparing circulating biomarkers using pathway overrepresentation analyses. Methods and results From a panel of 92 biomarkers from different pathophysiological domains available in 1620 patients with HF, we first tested which biomarkers were dysregulated in patients with HF and AF (n = 648) compared with patients in sinus rhythm (n = 972). Secondly, pathway overrepresentation analyses were performed to identify biological pathways linked to higher plasma concentrations of biomarkers in patients who had HF and AF. Findings were validated in an independent HF cohort (n = 1219, 38% with AF). Patient with AF and HF were older, less often women, and less often had a history of coronary artery disease compared with those in sinus rhythm. In the index cohort, 24 biomarkers were up-regulated in patients with AF and HF. In the validation cohort, eight biomarkers were up-regulated, which all overlapped with the 24 biomarkers found in the index cohort. The strongest up-regulated biomarkers in patients with AF were spondin-1 (fold change 1.18, P = 1.33 × 10
−12 ), insulin-like growth factor-binding protein-1 (fold change 1.32, P = 1.08 × 10−8 ), and insulin-like growth factor-binding protein-7 (fold change 1.33, P = 1.35 × 10−18 ). Pathway overrepresentation analyses revealed that the presence of AF was associated with activation amyloid-beta metabolic processes, amyloid-beta formation, and amyloid precursor protein catabolic processes with a remarkable consistency observed in the validation cohort. Conclusion In two independent cohorts of patients with HF, the presence of AF was associated with activation of three pathways related to amyloid-beta. These hypothesis-generating results warrant confirmation in future studies. [ABSTRACT FROM AUTHOR]- Published
- 2022
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18. An entirely subcutaneous implantable cardioverter-defibrillator
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Hardy, Gust H., Smith, Warren M., Hood, Margaret A., Crozier, Ian G., Melton, Iain C., Jordaens, Luc, Theuns, Dominic, Park, Robert E., Wright, David J., Connelly, Derek T., Fynn, Simon P., Murgatroyd, Francis D., Sperzel, Johannes, Neuzner, Jorg, Spitzer, Stefan G., Ardashev, Andrey V., Oduro, Amo, Boersma, Lucas, Maass, Alexander H., Gelder, Isabelle C. Van, Wilde, Arthur A., Dessel, Pascal F. van, Knops, Reinoud E., Barr, Craig S., Lupo, Pierpaolo, Cappato, Riccardo, and Grace, Andrew A.
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Electrophysiology -- Analysis ,Heart diseases -- Care and treatment ,Implantable cardioverter-defibrillators -- Innovations - Abstract
A newly designed subcutaneous implantable cardioverter-defibrillator (ICD) system was evaluated to determine its application for preventing sudden death from cardiac causes in selected patients. An entirely subcutaneous ICD system was observed to consistently detect and convert ventricular fibrillation induced during electrophysiological testing in small, nonrandomized studies.
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- 2010
19. Long-term outcome of targeted therapy of underlying conditions in patients with early persistent atrial fibrillation and heart failure: data of the RACE 3 trial.
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Nguyen, Bao Oanh, Crijns, Harry J G M, Tijssen, Jan G P, Geelhoed, Bastiaan, Hobbelt, Anne H, Hemels, Martin E W, Mol, W J Myke, Weijs, Bob, Alings, Marco, Smit, Marcelle D, Tieleman, Robert G, Tukkie, Raymond, Veldhuisen, Dirk J Van, Gelder, Isabelle C Van, Rienstra, Michiel, Investigators, for the RACE 3, Van Veldhuisen, Dirk J, Van Gelder, Isabelle C, and RACE 3 Investigators
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ATRIAL fibrillation diagnosis ,RESEARCH ,ANTILIPEMIC agents ,RESEARCH methodology ,ATRIAL fibrillation ,ACE inhibitors ,EVALUATION research ,TREATMENT effectiveness ,COMPARATIVE studies ,RANDOMIZED controlled trials ,ALDOSTERONE antagonists ,RESEARCH funding ,ANGIOTENSIN receptors ,HEART failure ,DISEASE complications - Abstract
Aims: The Routine vs. Aggressive risk factor driven upstream rhythm Control for prevention of Early persistent atrial fibrillation (AF) in heart failure (HF) (RACE 3) trial demonstrated that targeted therapy of underlying conditions improved sinus rhythm maintenance at 1 year. We now explored the effects of targeted therapy on the additional co-primary endpoints; sinus rhythm maintenance and cardiovascular outcome at 5 years.Methods and Results: Patients with early persistent AF and mild-to-moderate stable HF were randomized to targeted or conventional therapy. Both groups received rhythm control therapy according to guidelines. The targeted group additionally received four therapies: angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ARBs), statins, mineralocorticoid receptor antagonists (MRAs), and cardiac rehabilitation. The presence of sinus rhythm and cardiovascular morbidity and mortality at 5-year follow-up were assessed. Two hundred and sixteen patients consented for long-term follow-up, 107 were randomized to targeted and 109 to conventional therapy. At 5 years, MRAs [76 (74%) vs. 10 (9%) patients, P < 0.001] and statins [81 (79%) vs. 59 (55%), P < 0.001] were used more in the targeted than conventional group. Angiotensin-converting enzyme inhibitors/ARBs and physical activity were not different between groups. Sinus rhythm was present in 49 (46%) targeted vs. 43 (39%) conventional group patients at 5 years (odds ratio 1.297, lower limit of 95% confidence interval 0.756, P = 0.346). Cardiovascular mortality and morbidity occurred in 20 (19%) in the targeted and 15 (14%) conventional group patients, P = 0.353.Conclusion: In patients with early persistent AF and HF superiority of targeted therapy in sinus rhythm maintenance could not be preserved at 5-year follow-up. Cardiovascular outcome was not different between groups.Trial Registration Number: Clinicaltrials.gov NCT00877643. [ABSTRACT FROM AUTHOR]- Published
- 2022
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20. Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial.
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Willems, Stephan, Borof, Katrin, Brandes, Axel, Breithardt, Günter, Camm, A John, Crijns, Harry J G M, Eckardt, Lars, Gessler, Nele, Goette, Andreas, Haegeli, Laurent M, Heidbuchel, Hein, Kautzner, Josef, Ng, G André, Schnabel, Renate B, Suling, Anna, Szumowski, Lukasz, Themistoclakis, Sakis, Vardas, Panos, Gelder, Isabelle C van, and Wegscheider, Karl
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ATRIAL fibrillation ,SYMPTOMS ,ABLATION techniques ,MYOCARDIAL depressants ,CLINICAL trials - Abstract
Aims Clinical practice guidelines restrict rhythm control therapy to patients with symptomatic atrial fibrillation (AF). The EAST-AFNET 4 trial demonstrated that early, systematic rhythm control improves clinical outcomes compared to symptom-directed rhythm control. Methods and results This prespecified EAST-AFNET 4 analysis compared the effect of early rhythm control therapy in asymptomatic patients (EHRA score I) to symptomatic patients. Primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome, analyzed in a time-to-event analysis. At baseline, 801/2633 (30.4%) patients were asymptomatic [mean age 71.3 years, 37.5% women, mean CHA
2 DS2 -VASc score 3.4, 169/801 (21.1%) heart failure]. Asymptomatic patients randomized to early rhythm control (395/801) received similar rhythm control therapies compared to symptomatic patients [e.g. AF ablation at 24 months: 75/395 (19.0%) in asymptomatic; 176/910 (19.3%) symptomatic patients, P = 0.672]. Anticoagulation and treatment of concomitant cardiovascular conditions was not different between symptomatic and asymptomatic patients. The primary outcome occurred in 79/395 asymptomatic patients randomized to early rhythm control and in 97/406 patients randomized to usual care (hazard ratio 0.76, 95% confidence interval [0.6; 1.03]), almost identical to symptomatic patients. At 24 months follow-up, change in symptom status was not different between randomized groups (P = 0.19). Conclusion The clinical benefit of early, systematic rhythm control was not different between asymptomatic and symptomatic patients in EAST-AFNET 4. These results call for a shared decision discussing the benefits of rhythm control therapy in all patients with recently diagnosed AF and concomitant cardiovascular conditions (EAST-AFNET 4; ISRCTN04708680; NCT01288352; EudraCT2010-021258-20). [ABSTRACT FROM AUTHOR]- Published
- 2022
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21. Rate control drugs differ in the prevention of progression of atrial fibrillation.
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Koldenhof, Tim, Wijtvliet, Petra E P J, Pluymaekers, Nikki A H A, Rienstra, Michiel, Folkeringa, Richard J, Bronzwaer, Patrick, Elvan, Arif, Elders, Jan, Tukkie, Raymond, Luermans, Justin G L M, Kuijk, Sander M J van, Tijssen, Jan G P, Gelder, Isabelle C van, Crijns, Harry J G M, Tieleman, Robert G, van Kuijk, Sander M J, and van Gelder, Isabelle C
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ATRIAL fibrillation diagnosis ,MYOCARDIAL depressants ,RESEARCH ,RESEARCH methodology ,CATHETER ablation ,ATRIAL fibrillation ,EVALUATION research ,TREATMENT effectiveness ,COMPARATIVE studies ,RANDOMIZED controlled trials ,RESEARCH funding ,ELECTRIC countershock - Abstract
Aims: We hypothesize that in patients with paroxysmal atrial fibrillation (AF), verapamil is associated with lower AF progression compared to beta blockers or no rate control.Methods and Results: In this pre-specified post hoc analysis of the RACE 4 randomized trial, the effect of rate control medication on AF progression in paroxysmal AF was analysed. Patients using Vaughan-Williams Class I or III antiarrhythmic drugs were excluded. The primary outcome was a composite of first electrical cardioversion (ECV), chemical cardioversion (CCV), or atrial ablation. Event rates are displayed using Kaplan-Meier curves and multivariable Cox regression analyses are used to adjust for baseline differences. Out of 666 patients with paroxysmal AF, 47 used verapamil, 383 used beta blockers, and 236 did not use rate control drugs. The verapamil group was significantly younger than the beta blocker group and contained more men than the no rate control group. Over a mean follow-up of 37 months, the primary outcome occurred in 17% in the verapamil group, 33% in the beta blocker group, and 33% in the no rate control group (P = 0.038). After adjusting for baseline characteristics, patients using verapamil have a significantly lower chance of receiving ECV, CCV, or atrial ablation compared to patients using beta blockers [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.19-0.83] and no rate control (HR 0.64, 95% CI 0.44-0.93).Conclusion: In patients with newly diagnosed paroxysmal AF, verapamil was associated with less AF progression, as compared to beta blockers and no rate control. [ABSTRACT FROM AUTHOR]- Published
- 2022
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22. Atrial disease and heart failure: the common soil hypothesis proposed by the Heart Failure Association of the European Society of Cardiology.
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Coats, Andrew J S, Heymans, Stephane, Farmakis, Dimitrios, Anker, Stefan D, Backs, Johannes, Bauersachs, Johann, Boer, Rudolf A de, Čelutkienė, Jelena, Cleland, John G F, Dobrev, Dobromir, Gelder, Isabelle C van, Haehling, Stephan von, Hindricks, Gerhard, Jankowska, Ewa, Kotecha, Dipak, Laake, Linda W van, Lainscak, Mitja, Lund, Lars H, Lunde, Ida Gjervold, and Lyon, Alexander R
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HEART failure ,FIBROSIS ,COLLAGEN ,BLOOD platelets ,BLOOD coagulation - Abstract
The article presents the discussion on abnormal atrial structure and function termed as atrial myopathy or atrial disease being common in patients with heart failure (HF). Topics include atrial dilatation, fibrosis, and functional impairment being common if not universal accompaniments of both HF and AF; and containing collagen synthesis and degradation, autonomic innervation, activated platelets, and coagulation factors, and inflammatory pathways.
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- 2022
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23. Different circulating biomarkers in women and men with paroxysmal atrial fibrillation: results from the AF-RISK and RACE V studies.
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With, Ruben R De, Arita, Vicente Artola, Nguyen, Bao-Oanh, Linz, Dominik, Cate, Hugo Ten, Spronk, Henri, Schotten, Ulrich, Zonneveld, Anton Jan van, Erküner, Ömer, Bayón, M Agustina, Schmidt, Anders S, Luermans, Justin G L M, Crijns, Harry J G M, Gelder, Isabelle C Van, Rienstra, Michiel, De With, Ruben R, Artola Arita, Vicente, Ten Cate, Hugo, Jan van Zonneveld, Anton, and Van Gelder, Isabelle C
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ATRIAL fibrillation ,RISK assessment ,RESEARCH funding ,HEART failure ,LONGITUDINAL method - Abstract
Aims: The clinical risk profile of atrial fibrillation (AF) patients is different in men and women. Our aim was to identify sex differences in blood biomarkers in patients with paroxysmal AF.Methods and Results: Sex differences in 92 blood biomarkers were measured in 364 patients included in our discovery cohort, the identification of a risk profile to guide atrial fibrillation therapy (AF-RISK) study, assessed by multivariable logistic regression and enrichment pathway analysis. Findings were subsequently confirmed in 213 patients included in our validation cohort, the Reappraisal of Atrial Fibrillation: Interaction between HyperCoagulability, Electrical remodelling, and Vascular Destabilisation in the Progression of AF (RACE V) study. In the discovery cohort, mean age was 59 ± 12 years, 41% were women. CHA2DS2-VASc-score was 1.6 ± 1.4. A total of 46% had hypertension, 10% diabetes, and 50% had heart failure, predominantly with preserved ejection fraction (47%). In women, activated leucocyte cell adhesion molecule (ALCAM) and fatty acid binding protein-4 (FABP-4) were higher. In men, matrix metalloproteinase-3 (MMP-3), C-C motif chemokine-16 (CCL-16), and myoglobin were higher. In the validation cohort, four out of five biomarkers could be confirmed: levels of ALCAM (P = 1.73 × 10-4) and FABP-4 (P = 2.46 × 10-7) and adhesion biological pathways [false discovery rate (FDR) = 1.23 × 10-8] were higher in women. In men, levels of MMP-3 (P = 4.31 × 10-8) and myoglobin (P = 2.10 × 10-4) and markers for extracellular matrix degradation biological pathways (FDR = 3.59 × 10-9) were higher.Conclusion: In women with paroxysmal AF, inflammatory biomarkers were more often higher, while in men with paroxysmal AF, biomarkers for vascular remodelling were higher. Our data support the clinical notion that pathophysiological mechanisms in women and men with AF may differ.Trial Registration: Clinicaltrials.gov identifier NCT01510210 for AF-RISK; Clinicaltrials.gov NCT02726698 for RACE V. [ABSTRACT FROM AUTHOR]- Published
- 2022
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24. AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial.
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Brignole, Michele, Pentimalli, Francesco, Palmisano, Pietro, Landolina, Maurizio, Quartieri, Fabio, Occhetta, Eraldo, Calò, Leonardo, Mascia, Giuseppe, Mont, Lluis, Vernooy, Kevin, Dijk, Vincent van, Allaart, Cor, Fauchier, Laurent, Gasparini, Maurizio, Parati, Gianfranco, Soranna, Davide, Rienstra, Michiel, Gelder, Isabelle C Van, and Investigators, for the APAF-CRT Trial
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ATRIAL fibrillation ,HEART failure ,CARDIAC pacing ,CATHETER ablation ,PATIENTS - Abstract
Aims In patients with atrial fibrillation (AF) and heart failure (HF), strict and regular rate control with atrioventricular junction ablation and biventricular pacemaker (Ablation + CRT) has been shown to be superior to pharmacological rate control in reducing HF hospitalizations. However, whether it also improves survival is unknown. Methods and results In this international, open-label, blinded outcome trial, we randomly assigned patients with severely symptomatic permanent AF >6 months, narrow QRS (≤110 ms) and at least one HF hospitalization in the previous year to Ablation + CRT or to pharmacological rate control. We hypothesized that Ablation + CRT is superior in reducing the primary endpoint of all-cause mortality. A total of 133 patients were randomized. The mean age was 73 ± 10 years, and 62 (47%) were females. The trial was stopped for efficacy at interim analysis after a median of 29 months of follow-up per patient. The primary endpoint occurred in 7 patients (11%) in the Ablation + CRT arm and in 20 patients (29%) in the Drug arm [hazard ratio (HR) 0.26, 95% confidence interval (CI) 0.10–0.65; P = 0.004]. The estimated death rates at 2 years were 5% and 21%, respectively; at 4 years, 14% and 41%. The benefit of Ablation + CRT of all-cause mortality was similar in patients with ejection fraction (EF) ≤35% and in those with >35%. The secondary endpoint combining all-cause mortality or HF hospitalization was significantly lower in the Ablation + CRT arm [18 (29%) vs. 36 (51%); HR 0.40, 95% CI 0.22–0.73; P = 0.002]. Conclusions Ablation + CRT was superior to pharmacological therapy in reducing mortality in patients with permanent AF and narrow QRS who were hospitalized for HF, irrespective of their baseline EF. Study registration ClinicalTrials.gov Identifier: NCT02137187. [ABSTRACT FROM AUTHOR]
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- 2021
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25. First-line treatment of persistent and long-standing persistent atrial fibrillation with single-stage hybrid ablation: a 2-year follow-up study.
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Magni, Federico T, Al-Jazairi, Meelad I H, Mulder, Bart A, Klinkenberg, Theo, Gelder, Isabelle C Van, Rienstra, Michiel, Mariani, Massimo A, Blaauw, Yuri, and Van Gelder, Isabelle C
- Abstract
Aims: This study evaluates the efficacy and safety of first-line single-stage hybrid ablation of (long-standing) persistent atrial fibrillation (AF), over a follow-up period of 2 years, and provides additional information on arrhythmia recurrences and electrophysiological findings at repeat ablation.Methods and Results: This is a prospective cohort study that included 49 patients (65% persistent AF; 35% long-standing persistent AF) who underwent hybrid ablation as first-line ablation treatment (no previous endocardial ablation). Patients were relatively young (57.0 ± 8.5 years) and predominantly male (89.8%). Median CHA2DS2-VASc score was 1.0 (0.5; 2.0) and mean left atrium volume index was 43.7 ± 10.9 mL/m2. Efficacy was assessed by 12-lead electrocardiography and 72-h Holter monitoring after 3, 6, 12, and 24 months. Recurrence was defined as AF/atrial flutter (AFL)/tachycardia (AT) recorded by electrocardiography or Holter monitoring lasting >30 s during 2-year follow-up. At 2-year follow-up, single and multiple procedure success rates were 67% and 82%, respectively. Two (4%) patients experienced a major complication (bleeding) requiring intervention following hybrid ablation. Among the 16 (33%) patients who experienced an AF/AFL/AT recurrence, 13 (81%) were ATs/AFLs and only 3 (19%) were AF. Repeat ablation was performed in 10 (20%) patients and resulted in sinus rhythm in 7 (70%) at 2-year follow-up.Conclusion: First-line single-stage hybrid AF ablation is an effective treatment strategy for patients with persistent and long-standing persistent AF with an acceptable rate of major complications. Recurrences are predominantly AFL/AT that can be successfully ablated percutaneously. Hybrid ablation seems a feasible approach for first-line ablation of (long-standing) persistent AF. [ABSTRACT FROM AUTHOR]- Published
- 2021
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26. Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study
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With, Ruben R. De, Rienstra, Michiel, Smit, M.D., Weijs, Bob, Zwartkruis, Victor W., Hobbelt, Anne H., Hemels, M.E., Crijns, Harry J.G.M., Gelder, Isabelle C. Van, With, Ruben R. De, Rienstra, Michiel, Smit, M.D., Weijs, Bob, Zwartkruis, Victor W., Hobbelt, Anne H., Hemels, M.E., Crijns, Harry J.G.M., and Gelder, Isabelle C. Van
- Abstract
Contains fulltext : 203713.pdf (Publisher’s version ) (Closed access)
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- 2019
27. Antiarrhythmic drugs in patients with early persistent atrial fibrillation and heart failure: results of the RACE 3 study.
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Al-Jazairi, Meelad I H, Nguyen, Bao-Oanh, With, Ruben R De, Smit, Marcelle D, Weijs, Bob, Hobbelt, Anne H, Alings, Marco, Tijssen, Jan G P, Geelhoed, Bastiaan, Hillege, Hans L, Tieleman, Robert G, Veldhuisen, Dirk J Van, Crijns, Harry J G M, Gelder, Isabelle C Van, Blaauw, Yuri, Rienstra, Michiel, Investigators, for the RACE 3, De With, Ruben R, Van Veldhuisen, Dirk J, and Van Gelder, Isabelle C
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ATRIAL fibrillation diagnosis ,MYOCARDIAL depressants ,LEFT heart ventricle ,ATRIAL fibrillation ,RANDOMIZED controlled trials ,HEART physiology ,STROKE volume (Cardiac output) ,STATISTICAL sampling ,HEART failure - Abstract
Aims: Maintaining sinus rhythm in patients with persistent atrial fibrillation (AF) is challenging. We explored the efficacy of class I and III antiarrhythmic drugs (AADs) in patients with persistent AF and mild to moderate heart failure (HF).Methods and Results: In the RACE 3 trial, patients with early persistent symptomatic AF and short history of mild to moderate HF with preserved or reduced left ventricular ejection fraction (LVEF) were randomized to targeted or conventional therapy. Both groups received AF and HF guideline-driven treatment. Additionally, the targeted-group received mineralocorticoid receptor antagonists, statins, angiotensin-converting enzyme inhibitors and/or receptor blockers, and cardiac rehabilitation. Class I and III AADs could be instituted in case of symptomatic recurrent AF. Eventually, pulmonary vein isolation could be performed. Primary endpoint was sinus rhythm on 7-day Holter after 1-year. Included were 245 patients, age 65 ± 9 years, 193 (79%) men, AF history was 3 (2-6) months, HF history 2 (1-4) months, 72 (29.4%) had HF with reduced LVEF. After baseline electrical cardioversion (ECV), 190 (77.6%) had AF recurrences; 108 (56.8%) received class I/III AADs; 19 (17.6%) flecainide, 36 (33.3%) sotalol, 3 (2.8%) dronedarone, 50 (46.3%) amiodarone. At 1-year 73 of 108 (68.0%) patients were in sinus rhythm, 44 (40.7%) without new AF recurrences. Maintenance of sinus rhythm was significantly better with amiodarone [n = 29/50 (58%)] compared with flecainide [n = 6/19 (32%)] and sotalol/dronedarone [n = 9/39 (23%)], P = 0.0064. Adverse events occurred in 27 (25.0%) patients, were all minor and reversible.Conclusion: In stable HF patients with early persistent AF, AAD treatment was effective in nearly half of patients, with no serious adverse effects reported. [ABSTRACT FROM AUTHOR]- Published
- 2021
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28. Adaptations Processes in Human Atrial Fibrillation
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Brundel, Bianca J.J.M., Gelder, Isabelle C. Van, Crijns, Harry J.G.M., and Henning, Rob H.
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- 2001
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29. Atrial Fibrillation - Rate versus Rhythm Control
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Gelder, Isabelle C. Van and Crijns, Harry J.G.M.
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- 2003
30. Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter
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Gosselink, A.T. Marcel, Crijns, Harry J.G.M., Gelder, Isabelle C. van, Hillige, Hans, Wiesfeld, Ans C.P., and Lie, Kong I.
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Amiodarone -- Health aspects ,Atrial fibrillation -- Drug therapy - Abstract
The anti-arrhythmic drug amiodarone may be effective in maintaining a normal heartbeat in patients with atrial fibrillation who do not respond to other anti-arrhythmic drugs. Eighty-nine patients with persistent atrial fibrillation took 600 milligrams (mg) of amiodarone for four weeks. Those who did not convert to a normal rhythm were defibrillated, and switched to approximately 200 mg of amiodarone a day. Fifteen patients converted to a normal rhythm on the drug alone and 74 had to be defibrillated. Normal rhythm was restored in 90% of the patients. Only three patients had a severe reaction to the drug and none developed a secondary arrhythmia. One patient died of end-stage heart failure, but this was not attributed to the drug. More than half the patients still had a normal rhythm three years later., Objective.--To study efficacy and safety of low-dose amiodarone for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation or flutter. Design.--Nonramdomized trial; mean duration of follow-up, 20.7 months. Setting.--Referral center; institutional practice; both hospitalized and ambulatory care. Patients.--Eighty-nine consecutive patients having chronic atrial fibrillation or flutter and eligible for cardioversion. Patients had failed previous treatment aimed at maintaining sinus rhythm. During follow-up one patient was withdrawn because of side effects; all patients were available for follow-up. Intervention.--Before cardioversion, patients received 600 mg of amiodarone daily during a 4-week loading period. After conversion, the daily maintenance dose was 204[+ or -]66 mg (mean[+ or -]SD). Main Outcome Measures.--Arrhythmia recurrence and adverse effects causing drug discontinuation. Results.--During loading, 15 patients (16%) converted, and after electrical cardioconversion, 90% of all patients had sinus rhythm. Actuarially, 53% of these patients were still in sinus rhythm after 3 years. In patients with compromised left ventricular function, 93% maintained sinus rhythm after 6 months. One patient died due to congestive heart failure. Intolerable side effects occurred in one patient. No proarrhythmia was observed. Logistic regression analysis revealed that amiodarone was ineffective in patients with mitral stenosis or chronic arrhythmia. Conclusions.--Low-dose amiodarone is effective for maintaining sinus rhythm in patients with difficult to treat chronic atrial fibrillation or flutter and is associated with a low incidence of serious side effects.
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- 1992
31. The RACE to the EAST. In pursuit of rhythm control therapy for atrial fibrillation-a dedication to Harry Crijns.
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Reissmann, Bruno, Breithardt, Günter, Camm, A John, Gelder, Isabelle C Van, Metzner, Andreas, Kirchhof, Paulus, and Van Gelder, Isabelle C
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ATRIAL fibrillation diagnosis ,STROKE diagnosis ,STROKE prevention ,DISEASE relapse prevention ,MYOCARDIAL depressants ,ATRIAL fibrillation ,SPECIAL days - Abstract
The RACE trial was one of the first landmark trials to establish whether restoring and maintaining sinus rhythm could reduce morbidity and mortality in patients with atrial fibrillation (AF). Its neutral outcome shaped clinical decision-making for almost 20 years. However, there were two important treatment-related factors associated with mortality of rhythm control therapy at that time: One was safety of antiarrhythmic drug therapy, and the other one withdrawal of anticoagulation after restoration of sinus rhythm. Both concerns have been overcome, and, moreover, important knowledge considering the importance of time for the treatment of AF has been gained. These insights led to the concept of the EAST-AFNET 4 trial, and after more than two decades in the pursuit of ongoing therapeutic improvement, early rhythm control therapy has demonstrated to reduce a composite of cardiovascular death, stroke, and hospitalization for worsening of HF or acute coronary syndrome, by 21% (first primary outcome, absolute reduction 1.1 per 100 patient-years). For this entire period, Harry Crijns characterized the treatment of AF patients, and contributed decisively to realizing the benefit of rhythm control therapy. It is almost easier to list the clinical trials without Harry's involvement than to list those which he co-designed and led. [ABSTRACT FROM AUTHOR]
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- 2021
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32. ESC and EHRA lead a path towards integrated care for multimorbid atrial fibrillation patients: the Horizon 2020 EHRA-PATHS project.
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Heidbuchel, Hein, Gelder, Isabelle C Van, Desteghe, Lien, and Investigators, for the EHRA-PATHS
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ATRIAL fibrillation ,INTEGRATIVE medicine - Abstract
Finally, a Patient Advisory Board will ensure representation of AF patients as stakeholders and a Worldwide Scientific Advisory Board guarantees worldwide validity of the findings. The EHRA-PATHS project, which unites 14 partners throughout Europe and which is led by EHRA/ESC as coordinator ( I Figure 1 i ) wants to 'address multimorbidity in elderly atrial fibrillation patients through interdisciplinary, patient-centred, systematic care pathways'. [Extracted from the article]
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- 2022
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33. The interpretation of CHA2DS2-VASc score components in clinical practice: a joint survey by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, the EHRA Young Electrophysiologists, the Association of Cardiovascular Nursing and Allied Professionals, and the European Society of Cardiology Council on Stroke.
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Zhang, Juqian, Lenarczyk, Radoslaw, Marin, Francisco, Malaczynska-Rajpold, Katarzyna, Kosiuk, Jedrzej, Doehner, Wolfram, Gelder, Isabelle C Van, Lee, Geraldine, Hendriks, Jeroen M, Lip, Gregory Y H, Potpara, Tatjana S, and Van Gelder, Isabelle C
- Abstract
This European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, EHRA Young Electrophysiologists, Association of Cardiovascular Nursing and Allied Professionals, and European Society of Cardiology (ESC) Council on Stroke joint survey aimed to assess the interpretation of the CHA2DS2-VASc score components and preferred resources for calculating the score. Of 439 respondents, most were general cardiologists (46.7%) or electrophysiologists (EPs) (42.1%). The overall adherence to the ESC-defined scoring criteria was good. Most variation was observed in the interpretation of the significance of left ventricular ejection fraction and brain natriuretic peptide in the scoring for the 'C' component, as well as the 'one-off high reading of blood pressure' to score on the 'H' component. Greater confidence was expressed in scoring the 'H' component (72.3%) compared with the 'C' (46.2%) and 'V' (45.9%) components. Respondents mainly relied on their recall for the scoring of CHA2DS2-VASc score (64.2%). The three most favoured referencing resources varied among different professionals, with pharmacists and physicians relying mainly on memory or web/mobile app, whereas nurses favoured using a web/mobile app followed by memory or guidelines/protocol. In conclusion, this survey revealed overall good adherence to the correct definition of each component in scoring of the 'C', 'H', and 'V' elements of the CHA2DS2-VASc score, although the variation in their interpretations warrants further clarifications. The preferred referencing resources to calculate the score varied among different healthcare professionals. Guideline education to healthcare professionals and updated and unified online/mobile scoring tools are suggested to improve the accuracy in scoring the CHA2DS2-VASc score. [ABSTRACT FROM AUTHOR]
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- 2021
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34. Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective.
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Simons, Sami O, Elliott, Adrian, Sastry, Manuel, Hendriks, Jeroen M, Arzt, Michael, Rienstra, Michiel, Kalman, Jonathan M, Heidbuchel, Hein, Nattel, Stanley, Wesseling, Geertjan, Schotten, Ulrich, Gelder, Isabelle C van, Franssen, Frits M E, Sanders, Prashanthan, Crijns, Harry J G M, and Linz, Dominik
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ATRIAL fibrillation ,OBSTRUCTIVE lung disease treatment ,LUNG diseases ,SPIROMETRY ,PULMONARY function tests - Abstract
Chronic obstructive pulmonary disease (COPD) is highly prevalent among patients with atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of COPD in AF patients is high and is estimated to be ∼25%. Diagnosis and treatment of COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and fatigue. Routine evaluation of lung function and determination of natriuretic peptides and echocardiography may be reasonable to detect COPD and heart failure as contributing causes of dyspnoea. Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy. However, it remains unclear whether treatment of COPD improves AF outcomes and which metric should be used to determine COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, the benefits of treatment of either COPD or AF in this population, and to clarify the need and cost-effectiveness of routine COPD screening. Open in new tab Download slide Open in new tab Download slide [ABSTRACT FROM AUTHOR]
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- 2021
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35. Chronic atrial fibrillation: success of serial cardioversion therapy and safety of oral anticoagulation
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Gelder, Isabelle C. Van, Crijns, Harry J.G.M., Tielman, Robert G., Brugemann, Johan, Kam, Pieter J. De, Gosselink, A.T. Marcel, Veheugt, Freek W.A., and Lie, Kong I.
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Atrial fibrillation -- Care and treatment ,Electric countershock -- Health aspects ,Anticoagulants (Medicine) -- Evaluation ,Health - Abstract
Background: Serial electrical cardioversion is often used for treatment of atrial fibrillation, but its long-term efficacy has not been determined prospectively. Objectives: To determine the long-term success rate of the serial electrical cardioversion approach in patients with chronic atrial fibrillation, to identify factors that predict its success, and to assess the efficacy and safety of oral anticoagulation in these patients. Methods: Patients with chronic (>24 hours) atrial fibrillation received anticoagulant therapy for at least 4 weeks prior to electrical cardioversion. No prophylactic antiarrhythmic agent was given after the first shock. Relapses were managed by using repeated cardioversions, after which serial antiarrhythmic drug therapy was started. Treatment with anticoagulants was withdrawn after 4 weeks of sinus rhythm. Results: Two hundred thirty-six patients were followed up for a mean [+ or -]SD of 3.7[+ or -]1.6 years. The actuarial cumulative percentages of patients who maintained sinus rhythm after serial cardioversion treatment was 42% and 27% after 1 and 4 years, respectively. Multivariate analysis showed that factors that were associated with failure of this approach included duration of atrial fibrillation that exceeded 36 months (risk ratio, 5.0; P
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- 1996
36. Sex-related differences in risk factors, outcome, and quality of life in patients with permanent atrial fibrillation: results from the RACE II study.
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Kloosterman, Mariëlle, Crijns, Harry J G M, Mulder, Bart A, Groenveld, Hessel F, Veldhuisen, Dirk J Van, Rienstra, Michiel, Gelder, Isabelle C Van, Van Veldhuisen, Dirk J, and Van Gelder, Isabelle C
- Abstract
Aims: Atrial fibrillation (AF) risk factors translate into disease progression. Whether this affects women and men differently is unclear. We aimed to investigate sex differences in risk factors, outcome, and quality of life (QoL) in permanent AF patients.Methods and Results: The Rate Control Efficacy in Permanent Atrial Fibrillation (RACE II) randomized 614 patients, 211 women and 403 men, to lenient or strict rate control. In this post hoc analysis risk factors, cardiovascular events during 3-year follow-up (cardiovascular death, heart failure hospitalization, stroke, systemic embolism, bleeding, and life-threatening arrhythmic events), outcome parameters, and QoL were compared between the sexes. Women were older (71 ± 7 vs. 66 ± 8 years, P < 0.001), had more hypertension (70 vs. 57%, P = 0.002), and heart failure with preserved ejection fraction (36 vs. 17%, P < 0.001), but less coronary artery disease (13 vs. 21%, P = 0.02). Women had more risk factors (3.7 ± 1.2 vs. 2.9 ± 1.4, P < 0.001) Cardiovascular events occurred in 46 (22%) women and 59 (15%) men (P = 0.03). Women had a 1.52 times [95% confidence interval (CI) 1.03-2.24] higher yearly cardiovascular event-rate [8.2% (6.0-10.9) vs. 5.4% (4.1-6.9), P = 0.03], but this was no longer significant after adjusting for the number of underlying risk factors. Women had reduced QoL, irrespective of age and heart rate but negatively influenced by their risk factors.Conclusion: In this permanent AF population, women had more accumulation of AF risk factors than men. The observed higher cardiovascular event rate in women was no longer significant after adjusting for the number of risk factors. Further, QoL was negatively influenced by the higher number of risk factors in women. This suggests that sex differences may be driven by the greater risk factor burden in women. [ABSTRACT FROM AUTHOR]- Published
- 2020
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37. Time course of hemodynamic changes and improvement of exercise tolerance after cardioversion of chronic atrial fibrillation unassociated with cardiac valve disease
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Gelder, Isabelle C. Van, Crijns, Harry J.G.M., Blanksma, Paul K., Landsman, Martin L.J., Posma, Jan L., Berg, Maarten P. Van Den, Meijler, Frits L., and Lie, Kong I.
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Electric countershock -- Usage ,Atrial fibrillation -- Care and treatment ,Hemodynamics -- Physiological aspects ,Health - Abstract
This study prospectively assessed the time course, magnitude and mechanism of the hemodynamic changes after restoration of sinus rhythm in patients with chronic atrial fibrillation (AF) unassociated with valvular disease. Severe cardiac dysfunction may occur after chronic supraventricular tachycardia in patients with and without underlying cardiac disease. Improvement may follow abolishment of the arrhythmia or adequate slowing of the ventricular rate. Eight patients were studied with a mean previous duration of AF of 10 [+ or -] 9 months. Ejection fraction, exercise capacity and the atrial contribution to the left ventricular filling (only during sinus rhythm) were studied before cardioversion, after cardioversion and 1 week, 1 month and 6 months thereafter. A significant improvement in ejection fraction from 36 [+ or -] 13 to 53 [+ or -] 8% (p The hemodynamic consequences of chronic atrial fibrillation (AF) include an impairment of left ventricular function at rest and during exercise.[1,2] This may be caused by a loss of atrial [systole[1-6] and an inadequate ventricular rate response, especially during exercise.[3,4,6-8] Finally, this may result in a tachycardia-induced cardiomyopathy.[9-18] To reverse this process the general goal in these patients is to restore sinus rhythm. Recent studies, focusing primarily on improvement in exercise capacity, demonstrated an increase of maximal oxygen consumption at 1 month.[5,6] Other investigators studied the hemodynamic changes before and after cardioversion both at rest and during exercise, but follow-up was limited to 1 day.[2,3,8] Acute changes in postcardioversion exercise capacity were reported sporadically and there are only limited data concerning long-term changes in hemodynamic parameters. Therefore. this study evaluates the time-dependence of changes in hemodynamics and exercise tolerance after restoration of sinus rhythm in patients with chronic AF unassociated with cardiac valve disease over a time course of 6 months and tries to find evidence for a tachycardia-induced cardiomyopathy. METHODS Study patients: Between January 1988 and January 1989, 120 patients with chronic AF underwent cardioversion in our institution. Sixteen initially entered the present study. Exclusion criteria were AF of 24 months duration, valvular heart disease and New York Heart Association classification for exercise tolerance >II. The total follow-up was 6 months. Eight patients did not complete the study because of recurrence of AF in 5 days and verapamil for >1 day before the cardioversion. After the shock, chronic antiarrhythmic drug treatment was instituted in 5 of the 8 patients completing the study, depending on the patient's arrhythmia history. The only drug used was flecainide. During follow-up therapy was left unchanged. Patients were followed in the outpatient department 1 week, 1 month and 6 months after the shock. All patients gave written informed consent and the study was approved by the Medical Ethics Committee of the University Hospital Groningen. Measurement of ejection fraction and atrial contribution to ventricular filling with the nuclear stethoscope: The nuclear stethoscope is a computerized nonimaging probe (Nuclear Stethoscope, Bios Inc., Valhalla, New York). It consists of a single crystal detector, mounted on a flexible arm. The output of the nuclear stethoscope is fed into a computer system together with the electrocardiogram. The electrocardiogram and the radiocardiogram are displayed in real-time. During the display of the electrocardiogram and the radiocardiogram the RR interval and the ejection fraction are calculated and stored in a buffer[21,22] (Figure 1). Measurements were performed before cardioversion and Figure 3 shows the method of assessment of the atrial contribution to the ventricular filling (% atrial systole) using the same equipment. Exercise capacity assessment: The exercise studies were performed on the same day as the measurements with the nuclear stethoscope, except for the investigations after the shock. Postshock exercise testing was performed on the day after the cardioversion ( Exercise testing with respiratory gas exchange measurements was performed while patients exercised on a treadmill according to a modified Naughton protocol.[23] Oxygen consumption, carbon dioxide production and respiratory exchange ratios were measured continuously during exercise using an automated gas exchange measuring system (Sensormedics system 2900, Sensor Medics Corporation, Anaheim, California). Values were recorded at 20-second intervals through an on-line computer assembly (IBM computer systems, IBM Corporation, Austin, Texas). The electrocardiogram was monitored continuously with a computer-assisted system (Marquette Electronics Inc., Milwaukee, Wisconsin). Patients were familiar with exercise testing and they were encouraged to exercise until symptoms forced them to stop. All patients terminated the test because of dyspnea or fatigue, and in all patients the gas exchange anaerobic threshold (the point at which carbon dioxide production increased disproportionately in relation to oxygen consumption) and a respiratory exchange ratio >1 were reached. Peak oxygen consumption rate ([VO.sub.2]) was defined as oxygen consumption (ml/min/kg) at peak exercise calculated as the mean of values during the last minute of exercise. Efficiency of exercise was expressed as the ratio of peak [VO.sub.2] divided by the heart rate at peak [VO.sub.2]. Statistical analysis: Values are expressed as mean SD. A p value RESULTS Ejection fraction: Figure 4 shows the changes in ejection fraction in the course of time. Before cardioversion it was 36 [+ or -] 13%. The ejection fraction showed a small and not significant improvement 1 week after the cardioversion, but only after 1 month there was a significant increase to 53 [+ or -] 8% (p Peak oxygen consumption: Figure 5 shows the assessments of the peak oxygen consumption. It was unchanged at 1 day and 1 week after cardioversion but increased significantly from 20.1 [+ or -] 7 ml/min/kg before cardioversion to 25.2 [+ or -] 6 ml/min/kg I month after cardioversion (p Percent atrial systole: Figure 6 shows the changes in percent atrial systole from 4 hours after the cardioversion until 6 months thereafter as measured with the nuclear stethoscope. The mean atrial systole for all patients was 3 [+ or -] 5% on day 1 and increased significantly 1 week after the cardioversion to 16 [+ or -] 11%. Thereafter no further significant improvement occurred. Only 2 patients showed a detectable atrial systole (13 and 7%, respectively) immediately after the shock. At the end of follow-up, 1 patient did not have a return of the atrial contraction. This patient had a considerably enlarged left atrium (51 mm, long-axis view). Heart rate responses during exercise: At rest and during exercise, heart rates were significantly higher during AF than at different times after restoration of sinus rhythm (Table I). This table also presents the values for the peak [VO.sub.2]/heart rate at peak [VO.sub.2] ratio. This ratio shows a significant improvement after restoration of sinus rhythm. To illustrate the change in the efficiency of exercise the heart rate was plotted against the [VO.sub/2] at 1 day and 6 months after cardioversion (Figure 7). Resting heart rate was unchanged in 3 and lower in 4 patients at 6 months after cardioversion. Peak heart rate was higher in 4 patients at 6 months. In 5 patients the [VO.sub.2]/heart rate ratio was higher at all stages of exercise 6 months after the cardioversion. DISCUSSION Severe cardiac dysfunction can develop in association with a chronic supraventricular tachycardia. Many studies have shown a significant improvement after abolishment of the arrhythmia or after adequate slowing of the ventricular rate.[5,6,9-18] Most investigations concerned arrhythmias other than AF. In addition, those studying AF after cardioversion had a limited follow-up. This study presents the exact time course of systolic and diastolic hemodynamic changes in relation to changes in exercise tolerance in patients with AF after cardioversion. It shows maximal improvement in ventricular systolic function at 1 month, preceded by restoration of atrial systolic function (and hence normalization of diastolic filling) at 1 week after restoration of sinus rhythm, and obviously also by an acute slowing of the heart rate. Furthermore, it shows that the increase in exercise tolerance assessed from the peak [VO.sub.2] follows the same time course as the improvement in left ventricular ejection fraction. Delayed improvement in left ventricular function: Improvement in ejection fraction and peak [VO.sub.2] occurred during the first month after restoration of sinus rhythm. After 1 month both parameters remained unaltered. The late amelioration is in accordance with previous studies on changes in exercise capacity.[1,6] Because of the frequency of repeated investigations we could show that improvement in cardiac function stabilizes after 1 month. Whether a complete restoration of cardiac function has been attained at that time remains difficult to establish, since a comparison with the clinical situation before AF is impossible. However, one animal study suggests incomplete restoration after recovery from a tachycardiomyopathy induced by pacing.[18] Evidence for tachycardia-induced cardiomyopathy in the present study and possible underlying mechanisms: The dissociation between (sub)acute normalization of the ventricular rate and the atrial kick on the one hand, and the late improvement in left ventricular function and exercise tolerance on the other, suggests that an intrinsic cardiomyopathy plays an important role in AF. This is also suggested by typical changes in heart rate response with exercise early versus late after cardioversion (Figure 7). Compared with normal subjects, patients with heart failure have a reduced efficiency in exercise at any given [VO.sub.2] (i.e., a high heart rate in relation to the corresponding [VO.sub.2]), a reduced peak [VO.sub.2] and a lower peak heart rate.[25] Figure 7 shows that I day after cardioversion most of our patients exhibited a pattern similar to that found in patients with heart failure, with a significant improvement in [VO.sub.2]/heart rate ratio at 6 months. The same holds for the peak [VO.sub.2]/heart rate ratios presented in Table I. Although our patients did not have overt heart failure, these findings still support the notion that an intrinsic left ventricular cardiomyopathy may be present in the majority of patients with chronic AF. Tachycardia itself seems to be the most likely trigger leading to this cardiomyopathy. Chronically maintained high ventricular rates (as are intermittently present in patients with AF despite treatment with digoxin and verapamil) may lead to intracellular energy depletion and cell dysfunction that is not necessarily due to ischemia.[11,26] One alternative arrhythmia-related mechanism may be the presence of mitral regurgitation due to the irregular ventricular rate, which may cause ventricular dilatation. However, during AF its hemodynamic importance is supposed to be minimal, in particular if there is no primary mitral valve disease,[27] which was not the case in our patients. Another possible mechanism relates to ischemia, which may be caused by an increased rate-pressure product or by attenuation of myocardial blood flow, both due to tachycardia. Attenuation of blood flow has been suggested in an experimental tachycardia model.[18] However, ischemia may be a pathophysiologic mechanism on its own, especially in patients with significant coronary artery disease. Only 1 of our patients had coronary artery disease; therefore ischemia should be considered a secondary mechanism, at least in this study. Because of the above-mentioned findings, we believe that a high ventricular rate plays a key role in the development of a cardiomyopathy in patients with AF, and that its abolishment may lead to its reversal. The elucidation of specific mechanisms leading to this intrinsic tachycardiomyopathy deserves further attention, since these may become important therapeutic targets in the management of AF. Our results cannot be translated to the general population with chronic AF, especially to patients with significant coronary artery or mitral valve disease, who may have a more marked cardiomyopathy because their underlying disease adds to the negative effects of the chronic tachycardia. Study limitations: Five patients received flecainide after cardioversion. This drug may cause negative inotropic effects, which may have masked further improvement in cardiac function. Nevertheless, all patients showed improvement in cardiac function without an apparent difference between treated and untreated patients. These data cannot determine to what extent withdrawal of the negative inotropic verapamil influenced the course of hemodynamic changes. However, it appears extremely unlikely that the withdrawal of verapamil played a role in the improvement late (at 1 month) after cardioversion. Withdrawal of the positive inotropic digitalis before shock could not have significantly influenced the outcome of the present study; if it had any effect, it would have been in worsening of the hemodynamic situation. Clinical implications: Our data suggest that chronic AF unassociated with cardiac valve disease may lead to a slowly progressive intrinsic cardiomyopathy. Left ventricular dysfunction and a decreased exercise capacity may develop independent of the loss of the atrial kick and may be related to the chronic tachycardia present during AF. Early cardioversion after establishment of AF seems mandatory to prevent reversible or irreversible myocardial damage. Alternatively, abolishment of the tachycardia by adequate rate control of the AV conduction with drugs or His bundle ablation seems important. How far these treatment modalities are comparable with respect to reversion of tachycardiomyopathy needs further investigation. [1.] Braunwald E. Symposium on cardiac arrhythmias: introduction with comments on the hemodynamic significance of atrial systole. Am J Med 1964;37:665-669. [2.] Morris JJ Jr, Entman M, North WC, Kong Y, McIntosh H. The changes in cardiac put with reversion of atrial fibrillation to sinus rhythm. Circulation 1965; 31:670-678. [3.] Resnekov L. Haemodynamic studies before and after electrical conversion of atrial fibrillation and flutter to sinus rhythm. Br Heart J 1967;29:700-708. [4.] Khaja F, Parker JO. Hemodynamic effects of cardioversion in chronic atrial fibrillation. Arch Intern Med 1972;129:433-440. [5.] Lipkin DP, Frenneaux M, Stewart R, Joshi J, Lowe T, McKenna WJ. Delayed improvement in exercise capacity after cardioversion of atrial fibrillation to sinus rhythm. Br Heart J 1988;59:572-577. [6.] Atwood JE, Myers J, Sullivan M, Forbes S, Sandhu S, Callaham P, Froelicher V. The effect of cardioversion on maximal exercise capacity in patients with chronic atrial fibrillation. Am Heart J 1989;118:913-918. [7.] Cramer G. Early and late results of conversion of atrial fibrillation with quinidine. Acta Med Scand 1968;490:1-102. [8.] Killip T, Baer RA. Hemodynamic effects after reversion from atrial fibrillation to sinus rhythm by precardial shock. J Clin Invest 1966;45:658-671. [9.] Grogan M, Smith HC, Gersh BJ, Wood DL. Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol 1992;69:1570-1573. [10.] Heinz G, Siostrzonek P, Kreiner G, Gossinger H. Improvement in left ventricular systolic function after successful radiofrequency His bundle ablation for drug refractory, chronic atrial fibrillation and recurrent atrial flutter. Am J Cardiol 1992; 69:489-492. [11.] Packer DL, Bardy GH, Worley SJ, Smith MS, Cobb FR, Coleman RE, Gallagher JJ, German LD. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol 1986;57:563-570. [12.] Lemery R, Brugada P, Cheriex E, Wellens HJJ. Reversibility of tachycardia-induced left ventricular dysfunction after closed-chest catheter ablation of the atrioventricular junction for intractable atrial fibrillation. Am J Cardiol 1987;60: 1406-1408. [13] Peters KG, Kienzle MG. Severe cardiomyopathy due to chronic rapidly conducted atrial fibrillation: complete recovery after restoration of sinus rhythm. Am J Med 1988;85:242-244. [14.] Gillette PC, Wampler DG, Garson A, Zinner A, Ott D, Cooley D. Treatment of atrial automatic tachycardia by ablation procedures. J Am Coll Cardiol 1985;6: 405-409. [15.] McLaran CJ, Gersh BJ, Sugrue DD, Hammill SC, Seward JB, Holmes DR. Tachycardia induced myocardial dysfunction. A reversible problem? Br Heart J 1985;53:323-327. [16.] Cruz FES, Cheriex EC, Smeets JLRM, Atie J, Peres AK, Penn OCKM, Brugada P, Wellens HJJ. Reversibility of tachycardia-induced cardiomyopathy after cure of incessant supraventricular tachycardia. J Am Coll Cardiol 1990; 16:739-744. [17.] Tomita M, Spinale FG, Crawford FA, Zile MR. Changes in left ventricular volume, mass and function during the development and regression of supraventricular tachycardia-induced cardiomyopathy. Circulation 1991;83:635-644. [18.] Spinale FG, Tanaka R, Crawford FA, Zile MR. Changes in myocardial blood flow during development of and recovery from tachycardia-induced cardiomyopathy. Circulation 1992;85:717-729. [19.] Evans W, Swann P. Lone auricular fibrillation. Br Heart J 1954;16:189-194. [20.] Van Gelder IC, Crijns HJ, Van Gilst WH, Verwer R, Lie KI. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol 1991;68: 41-46. [21.] Wagner HN, Wake R, Nickoloff E, Natarajan TK. The nuclear stethoscope: a simple device for generation of left ventricular volume curves. Am J Cardiol 1977;38: 79-82. [22.] Berger HJ, Davies RA, Batsford WP, Hoffer PB, Gottschalk A, Zaret BL. Beat-to-beat left ventricular performance assessed from equilibrium cardiac blood pool using a computerized nuclear probe. Circulation 1981;63:133-142. [23.] Patterson JA, Naughton J, Pietras RJ, Gunnar RM. Treadmill exercise in assessment of functional capacity of patients with cardiac disease. Am J Cardiol 1972;30:757-762. [24.] Wallenstein S, Zucker CL, Fleiss JL. Some statistical methods useful in circulation research. Circ Res 1980;47:1-9. [25.] Francis GS. Hemodynamic and neurohumoral responses to dynamic exercise: normal subjects versus patients with heart disease. Circulation 1987;76(suppl VI): VI-11-VI-17. [26.] Armstrong PW, Stopps TP, Ford SE, De Bold AJ. Rapid ventricular pacing in the dog: pathophysiologic studies of heart failure. Circulation 1986;74:1075-1084. [27.] Naito M, Dreifus LS, Mardelli TJ, Chen CC, David D, Michelson EL, Marcy V, Morganroth J. Echocardiographic features of atrioventricular and ventriculoatrial conduction. Am J Cardiol 1980;46:625-633. From the Department of Cardiology, Thoraxcenter, University Hospital Groningen, Groningen, and the Interuniversity Cardiology Institute, Utrecht, the Netherlands. Manuscript received February 4, 1993; revised manuscript received April 27, 1993, and accepted April 28. Address for reprints: Isabelle C. Van Gelder, MD, Department of Cardiology. Thoraxcenter, Oostersingel 59, 9713 EZ Groningen, the Netherlands.
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38. Predictors of recurrence of atrial fibrillation within the first 3 months after ablation.
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Zink, Matthias Daniel, Chua, Winnie, Zeemering, Stef, Biase, Luigi di, Antoni, Bayes de Luna, David, Callans, Hindricks, Gerhard, Haeusler, Karl Georg, Al-Khalidi, Hussein R, Piccini, Jonathan P, Mont, Lluís, Nielsen, Jens Cosedis, Escobar, Luis Alberto, Bono, Joseph de, Gelder, Isabelle C Van, Potter, Tom de, Scherr, Daniel, Themistoclakis, Sakis, Todd, Derick, and Kirchhof, Paulus
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ATRIAL fibrillation diagnosis ,RESEARCH ,RESEARCH methodology ,CATHETER ablation ,ATRIAL fibrillation ,RETROSPECTIVE studies ,MEDICAL cooperation ,EVALUATION research ,TREATMENT effectiveness ,DISEASE relapse ,COMPARATIVE studies ,RESEARCH funding - Abstract
Aims: Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50-70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation.Methods and Results: We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA-AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93-2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20-2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26-2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00-1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03).Conclusion: Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF.Trial Registration: Clinicaltrials.gov identifier NCT02227550. [ABSTRACT FROM AUTHOR]- Published
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39. Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure.
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Brandes, Axel, Crijns, Harry J G M, Rienstra, Michiel, Kirchhof, Paulus, Grove, Erik L, Pedersen, Kenneth Bruun, Gelder, Isabelle C Van, and Van Gelder, Isabelle C
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Cardioversion is widely used in patients with atrial fibrillation (AF) and atrial flutter when a rhythm control strategy is pursued. We sought to summarize the current evidence on this important area of clinical management of patients with AF including electrical and pharmacological cardioversion, peri-procedural anticoagulation and thromboembolic complications, success rate, and risk factors for recurrence to give practical guidance. [ABSTRACT FROM AUTHOR]
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40. Sex differences in catheter ablation of atrial fibrillation: results from AXAFA-AFNET 5.
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Kloosterman, Mariëlle, Chua, Winnie, Fabritz, Larissa, Al-Khalidi, Hussein R, Schotten, Ulrich, Nielsen, Jens C, Piccini, Jonathan P, Biase, Luigi Di, Häusler, Karl Georg, Todd, Derick, Mont, Lluis, Gelder, Isabelle C Van, Kirchhof, Paulus, investigators, for the AXAFA-AFNET 5, Di Biase, Luigi, Van Gelder, Isabelle C, and AXAFA-AFNET 5 investigators
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Aims: Study sex-differences in efficacy and safety of atrial fibrillation (AF) ablation.Methods and Results: We assessed first AF ablation outcomes on continuous anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the primary outcome (death, stroke or transient ischaemic attack, or major bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive function] 3 months after ablation. Women were older (66 vs. 63 years, P < 0.001), more often symptomatic, had lower QoL and a longer history of AF. No sex differences in ablation procedure were found. Women stayed in hospital longer than men (2.1 ± 2.3 vs. 1.6 ± 1.3 days, P = 0.004). The primary outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P = 0.19. Women experienced more bleeding events requiring medical attention (5.7% vs. 2.1%, P = 0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage (0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and 5.9%, P = 0.26; and SF-12 mental 3.7% and 1.6%, P = 0.17]. At baseline, mild cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes at end of follow-up.Conclusion: Women and men experience similar improvement in QoL and MoCA score after AF ablation on continuous anticoagulation. Longer hospital stay, a trend towards more nuisance bleeds, and a lower overall QoL in women were the main differences observed. [ABSTRACT FROM AUTHOR]- Published
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41. Subclinical atherosclerosis is associated with incident atrial fibrillation: a systematic review and meta-analysis.
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Kristensen, Kit Engedal, Knage, Cille Cederholm, Nyhegn, Liv Havgaard, Mulder, Bart A, Rienstra, Michiel, Gelder, Isabelle C Van, Brandes, Axel, and Van Gelder, Isabelle C
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Aims: Coronary artery disease is an established risk factor for incident atrial fibrillation (AF), but it is unclear whether subclinical atherosclerosis also increases the risk of incident AF. Therefore, the aim was to assess the association between subclinical atherosclerosis, defined by increased carotid intima-media thickness (cIMT) or coronary artery calcium score (CACS), and incident AF.Methods and Results: A systematic review of MEDLINE, EMBASE, and Cochrane was done to find all cohort studies investigating the association between subclinical atherosclerosis, defined by increased cIMT or CACS, and incident AF. Eligible articles had to be available in an English full-text version; include adults over the age of 18 years; include ≥100 participants; and have a follow-up period ≥12 months. Data on cIMT were pooled using a fixed-effects model, while data on CACS (I2 >25) were pooled using a random-effects model. Five studies on cIMT including 36 333 patients and two studies on CACS including 34 603 patients were identified. All studies investigating the association between increased cIMT and incident AF showed a significant association, with an overall hazard ratio (HR) of 1.43 [95% confidence interval (CI) 1.27-1.59]. The two studies investigating the association between increased CACS and AF also showed a significant association with an overall HR of 1.07 (95% CI 1.02-1.12).Conclusion: Data from seven observational studies suggest that subclinical atherosclerosis defined by increased cIMT or CACS is associated with an increased risk of incident AF. These findings emphasize the need for further research investigating whether treatment of subclinical atherosclerosis should be a part of the initiatives to prevent AF. [ABSTRACT FROM AUTHOR]- Published
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42. Characteristics and outcomes of atrial fibrillation in patients without traditional risk factors: an RE-LY AF registry analysis.
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Kloosterman, Mariëlle, Oldgren, Jonas, Conen, David, Wong, Jorge A, Connolly, Stuart J, Avezum, Alvaro, Yusuf, Salim, Ezekowitz, Michael D, Wallentin, Lars, Ntep-Gweth, Marie, Joseph, Philip, Barrett, Tyler W, Tanosmsup, Supachai, McIntyre, William F, Lee, Shun Fu, Parkash, Ratika, Amit, Guy, Grinvalds, Alex, Gelder, Isabelle C Van, and Healey, Jeff S
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ATRIAL fibrillation diagnosis ,RESEARCH ,STROKE ,RESEARCH methodology ,ATRIAL fibrillation ,ACQUISITION of data ,MEDICAL cooperation ,EVALUATION research ,COMPARATIVE studies ,RESEARCH funding ,HEART failure - Abstract
Aims: Data on patient characteristics, prevalence, and outcomes of atrial fibrillation (AF) patients without traditional risk factors, often labelled 'lone AF', are sparse.Methods and Results: The RE-LY AF registry included 15 400 individuals who presented to emergency departments with AF in 47 countries. This analysis focused on patients without traditional risk factors, including age ≥60 years, hypertension, coronary artery disease, heart failure, left ventricular hypertrophy, congenital heart disease, pulmonary disease, valve heart disease, hyperthyroidism, and prior cardiac surgery. Patients without traditional risk factors were compared with age- and region-matched controls with traditional risk factors (1:3 fashion). In 796 (5%) patients, no traditional risk factors were present. However, 98% (779/796) had less-established or borderline risk factors, including borderline hypertension (130-140/80-90 mmHg; 47%), chronic kidney disease (eGFR < 60 mL/min; 57%), obesity (body mass index > 30; 19%), diabetes (5%), excessive alcohol intake (>14 units/week; 4%), and smoking (25%). Compared with patients with traditional risk factors (n = 2388), patients without traditional risk factors were more often men (74% vs. 59%, P < 0.001) had paroxysmal AF (55% vs. 37%, P < 0.001) and less AF persistence after 1 year (21% vs. 49%, P < 0.001). Furthermore, 1-year stroke occurrence rate (0.6% vs. 2.0%, P = 0.013) and heart failure hospitalizations (0.9% vs. 12.5%, P < 0.001) were lower. However, risk of AF-related re-hospitalization was similar (18% vs. 21%, P = 0.09).Conclusion: Almost all patients without traditionally defined AF risk factors have less-established or borderline risk factors. These patients have a favourable 1-year prognosis, but risk of AF-related re-hospitalization remains high. Greater emphasis should be placed on recognition and management of less-established or borderline risk factors. [ABSTRACT FROM AUTHOR]- Published
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43. Development of an international standard set of outcome measures for patients with atrial fibrillation: a report of the International Consortium for Health Outcomes Measurement (ICHOM) atrial fibrillation working group.
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Seligman, William H, Das-Gupta, Zofia, Jobi-Odeneye, Adedayo O, Arbelo, Elena, Banerjee, Amitava, Bollmann, Andreas, Caffrey-Armstrong, Bridget, Cehic, Daniel A, Corbalan, Ramon, Collins, Michael, Dandamudi, Gopi, Dorairaj, Prabhakaran, Fay, Matthew, Gelder, Isabelle C Van, Goto, Shinya, Granger, Christopher B, Gyorgy, Bathory, Healey, Jeff S, Hendriks, Jeroen M, and Hills, Mellanie True
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Aims As health systems around the world increasingly look to measure and improve the value of care that they provide to patients, being able to measure the outcomes that matter most to patients is vital. To support the shift towards value-based health care in atrial fibrillation (AF), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international Working Group (WG) of 30 volunteers, including health professionals and patient representatives to develop a standardized minimum set of outcomes for benchmarking care delivery in clinical settings. Methods and results Using an online-modified Delphi process, outcomes important to patients and health professionals were selected and categorized into (i) long-term consequences of disease outcomes, (ii) complications of treatment outcomes, and (iii) patient-reported outcomes. The WG identified demographic and clinical variables for use as case-mix risk adjusters. These included baseline demographics, comorbidities, cognitive function, date of diagnosis, disease duration, medications prescribed and AF procedures, as well as smoking, body mass index (BMI), alcohol intake, and physical activity. Where appropriate, and for ease of implementation, standardization of outcomes and case-mix variables was achieved using ICD codes. The standard set underwent an open review process in which over 80% of patients surveyed agreed with the outcomes captured by the standard set. Conclusion Implementation of these consensus recommendations could help institutions to monitor, compare and improve the quality and delivery of chronic AF care. Their consistent definition and collection, using ICD codes where applicable, could also broaden the implementation of more patient-centric clinical outcomes research in AF. [ABSTRACT FROM AUTHOR]
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44. Nurse-led vs. usual-care for atrial fibrillation.
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Wijtvliet, E P J Petra, Tieleman, Robert G, Gelder, Isabelle C van, Pluymaekers, Nikki A H A, Rienstra, Michiel, Folkeringa, Richard J, Bronzwaer, Patrick, Elvan, Arif, Elders, Jan, Tukkie, Raymond, Luermans, Justin G L M, Asselt, A D I Thea Van, Kuijk, Sander M J Van, Tijssen, Jan G, Crijns, Harry J G M, and Investigators, RACE 4
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Background Nurse-led integrated care is expected to improve outcome of patients with atrial fibrillation compared with usual-care provided by a medical specialist. Methods and results We randomized 1375 patients with atrial fibrillation (64 ± 10 years, 44% women, 57% had CHA
2 DS2 -VASc ≥ 2) to receive nurse-led care or usual-care. Nurse-led care was provided by specialized nurses using a decision-support tool, in consultation with the cardiologist. The primary endpoint was a composite of cardiovascular death and cardiovascular hospital admissions. Of 671 nurse-led care patients, 543 (81%) received anticoagulation in full accordance with the guidelines against 559 of 683 (82%) usual-care patients. The cumulative adherence to guidelines-based recommendations was 61% under nurse-led care and 26% under usual-care. Over 37 months of follow-up, the primary endpoint occurred in 164 of 671 patients (9.7% per year) under nurse-led care and in 192 of 683 patients (11.6% per year) under usual-care [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.69 to 1.04, P = 0.12]. There were 124 vs. 161 hospitalizations for arrhythmia events (7.0% and 9.4% per year), and 14 vs. 22 for heart failure (0.7% and 1.1% per year), respectively. Results were not consistent in a pre-specified subgroup analysis by centre experience, with a HR of 0.52 (95% CI 0.37–to 0.71) in four experienced centres and of 1.24 (95% CI 0.94–1.63) in four less experienced centres (P for interaction <0.001). Conclusion Our trial failed to show that nurse-led care was superior to usual-care. The data suggest that nurse-led care by an experienced team could be clinically beneficial (ClinicalTrials.gov NCT01740037). Trial Registration number ClinicalTrials.gov (NCT01740037). Open in new tab Download slide Open in new tab Download slide [ABSTRACT FROM AUTHOR]- Published
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45. In-hospital and 12-month follow-up outcome from the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term registry: sex differences.
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Grecu, Mihaela, Blomström-Lundqvist, Carina, Kautzner, Josef, Laroche, Cecile, Gelder, Isabelle C Van, Jordaens, Luc, Tavazzi, Luigi, Cihak, Robert, Campal, Jose Manuel Rubio, Kalarus, Zbigniew, Pokushalov, Evgeny, Brugada, Josep, Dagres, Nikolaos, Arbelo, Elena, investigators, ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term Registry, Van Gelder, Isabelle C, Rubio Campal, Jose Manuel, and ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term Registry investigators
- Abstract
Aim: The purpose of this study was to compare sex differences of atrial fibrillation (AF) catheter ablation (CA) and to analyse the opportunities for improved outcomes.Methods and Results: All data were collected from the Atrial Fibrillation Ablation Long-Term registry, a prospective, multinational study conducted by the ESC-EORP European Heart Rhythm Association (EHRA) under the EURObservational Research Programme (ESC-EORP). A total of 104 centres in 27 European countries participated. Of 3593 included patients, 1146 (31.9%) were female. Female patients were older (61.0 vs. 56.4 years; P < 0.001), had more comorbidities (hypertension, diabetes, and obesity), more episodes of arrhythmias per month (6.9 vs. 6.2; P < 0.001), and a higher average EHRA score (2.6 vs. 2.4; P < 0.001). The duration of the procedure was shorter in females (160.1 min vs. 167.9 min; P < 0.001), irrespective of additional ablation lesions added to pulmonary vein isolation. Overall cardiovascular complications were more frequent in women than in men (5.7% vs. 3.4%; P < 0.001). Furthermore, cardiac perforations (3.8% vs. 1.3%; P = 0.011) and neurological complications (2.2% vs. 0.3%; P = 0.004) were found in females in less experienced centres than in experienced ones. On a final note, at 12 months, AF recurrence rate was similar in females and males (34.4% vs. 34.2%; P = 0.897), but more females were still on antiarrhythmic drugs (50.6% vs. 44.1%; P < 0.001) when compared with men.Conclusion: Females underwent CA procedures for AF less frequently than males throughout Europe, despite more recurrent symptoms. With the same success rate, severe acute complications remained considerable in females, especially in less experienced centres. [ABSTRACT FROM AUTHOR]- Published
- 2020
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46. ETA Poster: The Clinical Value of Regular Thyroid Function Tests During Amiodarone Treatment
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Benjamens, Stan, Dullaart, Robin P.F., Sluiter, Wim J., Rienstra, Michiel, Gelder, Isabelle C Van, and Links, Thera P
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- 2016
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47. The road goes ever on: innovations and paradigm shifts in atrial fibrillation management.
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Heijman, Jordi, Vernooy, Kevin, Gelder, Isabelle C van, and C van Gelder, Isabelle
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ATRIAL fibrillation treatment ,ATRIAL fibrillation ,CATHETER ablation ,ANTICOAGULANTS - Published
- 2021
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48. Atrial fibrillation and heart failure temporality: does it matter?
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Deutekom, Colinda Van, Gelder, Isabelle C Van, and Rienstra, Michiel
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- 2023
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49. Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study.
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With, Ruben R De, Rienstra, Michiel, Smit, Marcelle D, Weijs, Bob, Zwartkruis, Victor W, Hobbelt, Anne H, Alings, Marco, Tijssen, Jan G P, Brügemann, Johan, Geelhoed, Bastiaan, Hillege, Hans L, Tukkie, Raymond, Hemels, Martin E, Tieleman, Robert G, Ranchor, Adelita V, Veldhuisen, Dirk J Van, Crijns, Harry J G M, Gelder, Isabelle C Van, De With, Ruben R, and Van Veldhuisen, Dirk J
- Abstract
Aims: Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF).Methods and Results: The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (Δ12 ± 19 vs. Δ6 ± 22, P = 0.007), physical role limitations (Δ32 ± 41 vs. Δ17 ± 45, P = 0.018), and general health (Δ8 ± 16 vs. Δ0 ± 17, P < 0.001). Dyspnoea at rest improved more (Δ-0.8 ± 1.3 vs. Δ-0.4 ± 1.2, P = 0.018) and EHRA class was lower at 1-year follow-up in the targeted group. Patients with AF at 1 year, improvement in physical functioning (Δ9 ± 9 vs. Δ-3 ± 16, P = 0.001), general health (Δ7 ± 16 vs. Δ-7 ± 19, P = 0.004), and social functioning (Δ6 ± 23 vs. Δ-4 ± 16, P = 0.041) were larger in the targeted group.Conclusion: A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year.Trial Registration Number: Clinicaltrials.gov NCT00877643. [ABSTRACT FROM AUTHOR]- Published
- 2019
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50. Comparing biomarker profiles of patients with heart failure: atrial fibrillation vs. sinus rhythm and reduced vs. preserved ejection fraction.
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Santema, Bernadet T, Kloosterman, Mariëlle, Gelder, Isabelle C Van, Mordi, Ify, Lang, Chim C, Lam, Carolyn S P, Anker, Stefan D, Cleland, John G, Dickstein, Kenneth, and Filippatos, Gerasimos
- Abstract
Aims The clinical correlates and consequences of atrial fibrillation (AF) might be different between heart failure with reduced vs. preserved ejection fraction (HFrEF vs. HFpEF). Biomarkers may provide insights into underlying pathophysiological mechanisms of AF in these different heart failure (HF) phenotypes. Methods and results We performed a retrospective analysis of the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), which was an observational cohort. We studied 2152 patients with HFrEF [ejection fraction (EF < 40%)], of which 1419 were in sinus rhythm (SR) and 733 had AF. Another 524 patients with HFpEF (EF ≥50%) were studied, of which 286 in SR and 238 with AF. For the comparison of biomarker profiles, 92 cardiovascular risk markers were measured (Proseek
® Olink Cardiovascular III panel). The circulating risk marker pattern observed in HFrEF was different than the pattern in HFpEF: in HFrEF, AF was associated with higher levels of 77 of 92 (84%) risk markers compared to SR; whereas in HFpEF, many more markers were higher in SR than in AF. Over a median follow-up of 21 months, AF was associated with increased mortality risk [multivariable hazard ratio (HR) of 1.27; 95% confidence interval (CI) 1.09–1.48, P = 0.002]; there was no significant interaction between heart rhythm and EF group on outcome. Conclusion In patients with HFrEF, the presence of AF was associated with a homogeneously elevated cardiovascular risk marker profile. In contrast, in patients with HFpEF, the presence of AF was associated with a more scattered risk marker profile, suggesting differences in underlying pathophysiological mechanisms of AF in these HF phenotypes. View large Download slide View large Download slide [ABSTRACT FROM AUTHOR]- Published
- 2018
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