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2. Atrial fibrillation in cancer: thromboembolism and bleeding in daily practice

Author

Chu, G., Seelig, J., Cannegieter, S.C., Gelderblom, H., Hovens, M.M.C., Huisman, M.V., Hulle, T. van der, Trines, S.A., Vlot, A.J., Versteeg, H.H., Hemels, M.E.W., Klok, F.A., Chu, G., Seelig, J., Cannegieter, S.C., Gelderblom, H., Hovens, M.M.C., Huisman, M.V., Hulle, T. van der, Trines, S.A., Vlot, A.J., Versteeg, H.H., Hemels, M.E.W., and Klok, F.A.

Abstract

Contains fulltext : 294501.pdf (Publisher’s version ) (Open Access), BACKGROUND: Cancer is suggested to confer thromboembolic and bleeding risk in patients with atrial fibrillation (AF). OBJECTIVES: We aimed to describe current anticoagulant practice in patients with AF and active cancer, present incidences of thromboembolic and bleeding complications, and evaluate the association between cancer type or anticoagulant management strategy with AF-related complications. METHODS: This retrospective study identified patients with AF and active cancer in 2 hospitals between January 1, 2012, and December 31, 2017. Follow-up lasted for 2 years. Data on cancer and anticoagulant treatment were collected. The outcomes of interest included ischemic stroke or transient ischemic attack (TIA) and clinically relevant nonmajor bleeding (CRNMB/MB). Incidence rates (IRs) per 100 patient-years and subdistribution hazard ratios (SHRs) with corresponding 95% Cis were estimated. RESULTS: We identified 878 patients with AF who developed cancer (cohort 1) and 335 patients with cancer who developed AF (cohort 2). IRs for ischemic stroke/TIA and MB/CRNMB were 3.9 (2.8-5.3) and 15.7 (13.3-18.5) for cohort 1 and 4.0 (2.2-6.7) and 16.7 (12.6-21.7) for cohort 2. 14.2% (cohort 1) and 19.1% (cohort 2) of patients with a CHA(2)DS(2)-VASc score of ≥2 did not receive anticoagulant treatment. Withholding anticoagulants was associated with thromboembolic complications (SHR: 5.1 [3.20-8.0]). In nonanticoagulated patients with a CHA(2)DS(2)-VASc score of <2, IRs for stroke/TIA were 4.5 (0.75-15.0; cohort 1) and 16.0 (5.1-38.7; cohort 2). CONCLUSION: Patients with AF and active cancer experience high rates of thromboembolic and bleeding complications, underlying the complexity of anticoagulant management in these patients. Our data suggest that the presence of cancer is an important factor in determining the indication for anticoagulants in patients with a low CHA(2)DS(2)-VASc score.

Published
2023

3. Thromboembolic and bleeding complications during interruptions and after discontinuation of anticoagulant treatment in patients with atrial fibrillation and active cancer: A daily practice evaluation.

Author

Chu, G., Seelig, J., Cannegieter, S.C., Gelderblom, H., Hovens, M.M.C., Huisman, M.V., Hulle, T. van der, Trines, S.A., Vlot, A.J., Versteeg, H.H., Hemels, M.E.W., Klok, F.A., Chu, G., Seelig, J., Cannegieter, S.C., Gelderblom, H., Hovens, M.M.C., Huisman, M.V., Hulle, T. van der, Trines, S.A., Vlot, A.J., Versteeg, H.H., Hemels, M.E.W., and Klok, F.A.

Abstract

Item does not contain fulltext, BACKGROUND AND AIMS: Cancer provides challenges to the continuity of anticoagulant treatment in patients with atrial fibrillation (AF), e.g. through cancer-related surgery or complications. We aimed to provide data on the incidence and reasons for interrupting and discontinuing anticoagulant treatment in AF patients with cancer and to assess its contribution to the risk of thromboembolism (TE) and major bleeding (MB). METHODS: This retrospective study identified AF patients with cancer in two hospitals between 2012 and 2017. Data on anticoagulant treatment, TE and MB were collected during two-year follow-up. Incidence rates (IR) per 100 patient-years and adjusted hazard ratios (aHR) were obtained for TE and MB occurring during on- and off-anticoagulant treatment, during interruption and after resumption, and after permanent discontinuation. RESULTS: 1213 AF patients with cancer were identified, of which 140 patients permanently discontinued anticoagulants and 426 patients experienced one or more interruptions. Anticoagulation was most often interrupted or discontinued due to cancer-related treatment (n = 441, 62 %), bleeding (n = 129, 18 %) or end of life (n = 36, 5 %). The risk of TE was highest off-anticoagulation and during interruptions, with IRs of 19 (14-25)) and 105 (64-13), and aHRs of 3.1 (1.9-5.0) and 4.6 (2.4-9.0), respectively. Major bleeding risk were not only increased during an interruption, but also in the first 30 days after resumption, with IRs of 33 (12-72) and 30 (17-48), and aHRs of 3.3 (1.1-9.8) and 2.4 (1.2-4.6), respectively. CONCLUSIONS: Interruption of anticoagulation therapy harbors high TE and MB risk in AF patients with cancer. The high incidence rates call for better (periprocedural) anticoagulant management strategies tailored to the cancer setting.

Published
2023

4. Determinants of label non-adherence to non-vitamin K oral anticoagulants in patients with newly diagnosed atrial fibrillation

Author

Seelig, J., Trinks-Roerdink, Emmy M., Chu, G., Pisters, R., Theunissen, L., Trines, S.A., Pos, L., Kirchhof, C., Jong, S.F.A.M.S. de, Hartog, F.R. den, Alem, A.P. van, Polak, P.E., Tieleman, R.G., Voort, P.H. van der, Lenderink, T., Otten, A.M., Jong, J. de, Gu, Y.L., Luermans, J., Kruip, M., Timmer, S., Vries, T. de, Cate, H.T., Geersing, G.J., Rutten, F.H., Huisman, M.V., Hemels, M.E.W., Seelig, J., Trinks-Roerdink, Emmy M., Chu, G., Pisters, R., Theunissen, L., Trines, S.A., Pos, L., Kirchhof, C., Jong, S.F.A.M.S. de, Hartog, F.R. den, Alem, A.P. van, Polak, P.E., Tieleman, R.G., Voort, P.H. van der, Lenderink, T., Otten, A.M., Jong, J. de, Gu, Y.L., Luermans, J., Kruip, M., Timmer, S., Vries, T. de, Cate, H.T., Geersing, G.J., Rutten, F.H., Huisman, M.V., and Hemels, M.E.W.

Abstract

Contains fulltext : 283509.pdf (Publisher’s version ) (Open Access), AIMS: To evaluate the extent and determinants of off-label non-vitamin K oral anticoagulant (NOAC) dosing in newly diagnosed Dutch AF patients. METHODS AND RESULTS: In the DUTCH-AF registry, patients with newly diagnosed AF (<6 months) are prospectively enrolled. Label adherence to NOAC dosing was assessed using the European Medicines Agency labelling. Factors associated with off-label dosing were explored by multivariable logistic regression analyses. From July 2018 to November 2020, 4500 patients were registered. The mean age was 69.6 ± 10.5 years, and 41.5% were female. Of the 3252 patients in which NOAC label adherence could be assessed, underdosing and overdosing were observed in 4.2% and 2.4%, respectively. In 2916 (89.7%) patients with a full-dose NOAC recommendation, 4.6% were underdosed, with a similar distribution between NOACs. Independent determinants (with 95% confidence interval) were higher age [odds ratio (OR): 1.01 per year, 1.01-1.02], lower renal function (OR: 0.96 per ml/min/1.73 m(2), 0.92-0.98), lower weight (OR: 0.98 per kg, 0.97-1.00), active malignancy (OR: 2.46, 1.19-5.09), anaemia (OR: 1.73, 1.08-2.76), and concomitant use of antiplatelets (OR: 4.93, 2.57-9.46). In the 336 (10.3%) patients with a reduced dose NOAC recommendation, 22.9% were overdosed, most often with rivaroxaban. Independent determinants were lower age (OR: 0.92 per year, 0.88-0.96) and lower renal function (OR: 0.98 per ml/min/1.73 m(2), 0.96-1.00). CONCLUSION: In newly diagnosed Dutch AF patients, off-label dosing of NOACs was seen in only 6.6% of patients, most often underdosing. In this study, determinants of off-label dosing were age, renal function, weight, anaemia, active malignancy, and concomitant use of antiplatelets.

Published
2022

5. 2019 ESC Guidelines for themanagement of patients with supraventricular tachycardia

Author

Brugada, J. Katritsis, D.G. Arbelo, E. Arribas, F. Bax, J.J. Blomstrom-Lundqvist, C. Calkins, H. Corrado, D. Deftereos, S.G. Diller, G.-P. Gomez-Doblas, J.J. Gorenek, B. Grace, A. Ho, S.Y. Kaski, J.-C. Kuck, K.-H. Lambiase, P.D. Sacher, F. Sarquella-Brugada, G. Suwalski, P. Zaza, A. De Potter, T. Sticherling, C. Aboyans, V. Basso, C. Bocchiardo, M. Budts, W. Delgado, V. Dobrev, D. Fitzsimons, D. Gevaert, S. Heidbuchel, H. Hindricks, G. Hlivak, P. Kanagaratnam, P. Katus, H. Kautzner, J. Kriebel, T. Lancellotti, P. Landmesser, U. Leclercq, C. Lewis, B. Lopatin, Y. Merkely, B. Paul, T. Pavlović, N. Petersen, S. Petronio, A.S. Potpara, T. Roffi, M. Scherr, D. Shlyakhto, E. Simpson, I.A. Zeppenfeld, K. Windecker, S. Baigent, C. Collet, J.-P. Dean, V. Gale, C.P. Grobbee, D.E. Halvorsen, S. Iung, B. Jüni, P. Lettino, M. Mueller, C. Richter, D.J. Sousa-Uva, M. Touyz, R.M. Amara, W. Grigoryan, S. Podczeck-Schweighofer, A. Chasnoits, A. Vandekerckhove, Y. Sokolovich, S. Traykov, V. Skoric, B. Papasavvas, E. Riahi, S. Kampus, P. Parikka, H. Piot, O. Etsadashvili, K. Stellbrink, C. Manolis, A.S. Csanádi, Z. Gudmundsson, K. Erwin, J. Barsheshet, A. De Ponti, R. Abdrakhmanov, A. Jashari, H. Lunegova, O. Jubele, K. Refaat, M.M. Puodziukynas, A. Groben, L. Grosu, A. Ibtissam, F. Trines, S.A. Poposka, L. Haugaa, K.H. Kowalski, O. Cavaco, D. Dobreanu, D. Mikhaylov, E.N. Zavatta, M. Nebojša, M. Ferreira-Gonzalez, I. Juhlin, T. Reichlin, T. Haouala, H. Akgun, T. Gupta, D. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC), Association for European Paediatric Congenital Cardiology (AEPC)

Published
2020

7. Risk factors and time delay associated with cardiac device infections: Leiden device registry

Author

Lekkerkerker, J.C., van Nieuwkoop, C., Trines, S.A., Van der Bom, J.G., Bernards, A., van de Velde, E.T., Bootsma, M., Zeppenfeld, K., Jukema, J.W., Borleffs, J.-W., Schalij, M.J., and van Erven, L.

Subjects
Infective endocarditis -- Risk factors, Infective endocarditis -- Distribution, Infective endocarditis -- Research, Pacemaker, Artificial (Heart) -- Complications and side effects, Implantable cardioverter-defibrillators -- Complications and side effects, Company distribution practices, Health
Published
2009

8. Influence of risk factors in the ESC-EHRA EORP atrial fibrillation ablation long-term registry

Author

Trines, S.A., Stabile, G., Arbelo, E., Dagres, N., Brugada, J., Kautzner, J., Pokushalov, E., Maggioni, A.P., Laroche, C., Anselmino, M., Beinart, R., Traykov, V., Blomstrom-Lundqvist, C., and ESC-EHRA Atrial Fibrillation Ablat

Subjects
Male, medicine.medical_specialty, recurrence, complications, medicine.medical_treatment, Cardiomyopathy, Catheter ablation, Comorbidity, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, atrial fibrillation, catheter ablation, repeat ablation, risk factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Registries, Risk factor, Aged, business.industry, Hazard ratio, Atrial fibrillation, General Medicine, Middle Aged, medicine.disease, Europe, Heart failure, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract

Background The influence of risk factors on atrial fibrillation (AF) ablation recurrence is increasingly recognized. We present a sub-analysis of the European Society of Cardiology-European Heart Rhythm Association-European Society of Cardiology AF ablation long-term registry on the effect of traditional risk factors for AF on postablation recurrence, reablation, and complications using real-world data. Methods Risk factors for AF were defined as body mass index >= 27 kg/m(2), hypertension, chronic obstructive pulmonary disease, diabetes, alcohol >= 2 units/day, sleep apnea, smoking, no/occasional sports activity, moderate/severe mitral or aortic valve disease, any cardiomyopathy, peripheral vascular disease, chronic kidney disease, heart failure, coronary artery disease/infarction, and previous pacemaker/defibrillator implant. Patients were divided in two groups with >= 1 or without risk factors. Primary outcomes were arrhythmia recurrence after blanking period, reablation, and adverse events or death. Differences between the groups and the influence of individual risk factors were analyzed using multivariate Cox regression. Results Three thousand sixty nine patients were included; 217 patients were without risk factors. Risk factor patients were older (58.4 vs 54.1 years), more often female (32% vs 19.8%) and had more often persistent AF (27.2% vs 23.5%). In a multivariate analysis, patients without risk factors had a hazard ratio of 0.70 (95% CI 0.49-0.99) for recurrence compared to risk factor patients. The multivariate hazard ratios for reablation or adverse events/death were not different between the two groups. Hypertension and body mass index were univariate predictors of recurrence. Conclusions Patients with >= 1 risk factor had a 30% higher risk for arrhythmia recurrence after ablation, but no differences in risk for repeat ablations and adverse events or death.

Published
2019

9. Atrial fibrillation history impact on catheter ablation outcome

Author

Stabile, G., Trines, S.A., Lundqvist, C.B., and ESC-EHRA Atrial Fibrillation

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Atrial fibrillation, Catheter ablation, General Medicine, medicine.disease, Outcome (game theory), Internal medicine, Atrial Fibrillation, Cardiology, medicine, Catheter Ablation, Humans, Heart Atria, Registries, Cardiology and Cardiovascular Medicine, business
Published
2019

10. Cryoballoon vs. radiofrequency ablation for atrial fibrillation: a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish catheter ablation registry

Author

Mortsell, D., Arbelo, E., Dagres, N., Brugada, J., Laroche, C., Trines, S.A., Malmborg, H., Hoglund, N., Tavazzi, L., Pokushalov, E., Stabile, G., Blomstrom-Lundqvist, C., and ESC-EHRA Atrial Fibrillation Ablat

Subjects
Male, Reoperation, medicine.medical_specialty, Registry, Radiofrequency ablation, medicine.medical_treatment, Operative Time, Catheter ablation, macromolecular substances, 030204 cardiovascular system & hematology, Ablation, Cryoballoon, Cryosurgery, law.invention, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Recurrence, law, Physiology (medical), Internal medicine, medicine, Humans, Registries, 030212 general & internal medicine, Aged, Proportional Hazards Models, Sweden, business.industry, Atrial fibrillation, Middle Aged, Cardiac Ablation, medicine.disease, Pulmonary Veins, Radiofrequency, Catheter Ablation, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Aims Pulmonary vein isolation (PVI), the standard for atrial fibrillation (AF) ablation, is most commonly applied with radiofrequency (RF) energy, although cryoballoon technology (CRYO) has gained widespread use. The aim was to compare the second-generation cryoballoon and the irrigated RF energy regarding outcomes and safety.Methods and results Of 4657 patients undergoing their first AF ablation, 982 with CRYO and 3675 with RF energy were included from the Swedish catheter ablation registry and the Atrial Fibrillation Ablation Long-Term registry of the European Heart Rhythm Association of the European Society of Cardiology. The primary endpoint was repeat AF ablation. The major secondary endpoints included procedural duration, tachyarrhythmia recurrence, and complication rate. The re-ablation rate after 12 months was significantly lower in the CRYO vs. the RF group, 7.8% vs. 11%, P=0.005, while freedom from arrhythmia recurrence (30 s duration) did not differ between the groups, 70.2 % vs. 68.2%, P=0.44. The result was not influenced by AF type and lesion sets applied. In the Cox regression analysis, paroxysmal AF had significantly lower risk for re-ablation with CRYO, hazard ratio 0.56 (P=0.041). Procedural duration was significantly shorter with CRYO than RF, (meanSD) 133.6 +/- 45.2 min vs. 174.6 +/- 58.2 min, P

Published
2019

11. Incidence and clinical significance of cerebral embolism during atrial fibrillation ablation with duty-cycled phased-radiofrequency versus cooled-radiofrequency

Author

Kece, F., Bruggemans, E.F., Riva, M. de, Dehnavi, R.A., Wijnmaalen, A.P., Meulman, T.J., Brugman, J.A., Rooijmans, A.M., Buchem, M.A. van, Middelkoop, H.A., Eikenboom, J., Schalij, M.J., Zeppenfeld, K., and Trines, S.A.

Subjects
catheter ablation, PVAC Gold, asymptomatic cerebral embolism, atrial fibrillation, pulmonary vein isolation, cooled radiofrequency ablation
Abstract

OBJECTIVES The purpose of this study was to randomly compare the incidence of asymptomatic cerebral embolism (ACE) between the second-generation pulmonary vein ablation catheter (PVAC Gold) and the irrigated Thermocool catheter.BACKGROUND Pulmonary vein isolation (PVI) with the PVAC is associated with ACE. The PVAC Gold was designed to avoid this complication.METHODS Patients with paroxysmal atrial fibrillation were randomized 1:1 to PVI with the PVAC Gold or Thermocool catheter. Cerebral magnetic resonance imaging was performed in the days before and after ablation and repeated after 3 months in case of a new lesion. Monitoring for microembolic signals (MES) was performed by using transcranial Doppler ultrasonography. Parameters of coagulation were determined before, during, and after ablation. Neuropsychological tests and questionnaires were applied 10 days before and 3 months after ablation.RESULTS Seventy patients were included in the study (mean age 61 +/- 9 years; 43 male subjects; CHA(2)DS(2)-VASc [congestive heart failure, hypertension, age >= 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category] score 1.6 +/- 1.2; international normalized ratio 2.7 +/- 0.5; activated clotting time 374 +/- 24 s; p > 0.05 for all parameters). Procedural duration was shorter in the PVAC Gold group (140 +/- 34 vs. 207 +/- 44 min; p < 0.001). Eight (23%; 7 infarcts) patients in the PVAC Gold group exhibited a new ACE, compared with 2 (6%; no infarcts) patients in the Thermocool group (p = 0.042). Median number of MES was higher in the PVAC Gold group (1,111 [interquartile range, 715-2,234] vs. 787 [interquartile range, 532-1,053]; p < 0.001). There were no differences between groups regarding coagulation and neuropsychological outcomes.CONCLUSIONS PVI with the new PVAC Gold was associated with a higher incidence of ACE/cerebral infarcts and number of MES. Both catheters induced a comparable procoagulant state. Because there were no measurable differences in neuropsychological status, the clinical significance of ACE remains unclear. (Cerebral Embolism [CE] in Catheter Ablation of Atrial Fibrillation [AF] [CE-AF]; NCT01361295) (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Published
2019

12. Atrial fibrillation history impact on catheter ablation outcome. Findings from the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry

Author

Stabile, G., Trines, S.A., Arbelo, E., Dagres, N., Brugada, J., Kautzner, J., Pokushalov, E., Maggioni, A.P., Laroche, C., Anselmino, M., Beinart, R., Traykov, V., Lundqvist, C.B., Steinwender, C., Chasnoits, A., Mairesse, G., Balabanski, T., Riahi, S., Nawar, M., Maaty, M.A. el, Raatikainen, P., Anselme, F., Lewalter, T., Brodherr, T., Efremidis, M., Geller, L., Glover, ben, Glikson, M., Gaita, F., Rekvava, R., Kalejs, O., Trines, S., Kalarus, Z., Oliveira, M.M., Adra-Gao, P., Ciudin, R., Mikhaylov, E., Sinkovec, M., Villacastin, J.P., Blomstrom-Lundqvist, C., Sychov, O., Roberts, P., Scherr, G.D.D., Manninger, M., Mastnak, B., Pachinger, O., Hintringer, F., Stuhlinger, M., Steinwender, L.C., Xhaet, Y.O., Shalganov, S.T., Stoyanov, M., Protich, M., Traykov, S.V., Marchov, D., Kaninski, G., Chasnoits, M.A., Cihak, R., Haman, K.L., Schmidt, B., Chun, K.R.J., Perrotta, L., Bordignon, S., Tilz, R., Willems, S., Hindricks, G., Koutsouraki, I.S., Sorensen, B.G., Galal, C.W., AbdelWahab, A., Mokhtar, C.S.S., Ortega, I.G., Martinez, J.G.M., Calatrava, M.D., Sabate, R.V., Girbau, L.M., Arcocha, M.F., Gaztanaga, L., Zamarreno, E., Alvarez, M., Macias, R., Villalobos, F.S., Perez, J.C.R., Castellano, N.P., Canadas, V., Ferrer, J.J.G., Filgueiras, D., Campal, J.M.R., Sanchez-Borque, P., Benezet-Mazuecos, J., Ramos, J.T., Lozano, F., Urda, V.C., Cordero, A.B., Palomo, C.M., Ruiz-Salas, A., Alzueta, J., Peinado, R., Filqueiras-Rama, D., Gallanti, A.G., Garofalo, D., Calvo, N., Antolin, J.J.O., Pedrote, A., Arana-Rueda, E., Garcia-Riesco, L., Lund, J., Defaye, P., Jacon, P., Venier, S., Dugenet, F., Piot, O., Copie, X., Paziaud, O., Lepillier, A., Costa, A. da, Romeyer-Bouchard, C., Boveda, S., Albenque, J.P., Combes, N., Combes, S., Ferracci, A., Pisapia, A., Katritsis, D., Letsas, K., Vlachos, K., Lioni, L., Vassilikos, V.P., Szegedi, N., Szeplaki, G., Tahin, T., Csanadi, Z., Sandorfi, G., Kiss, A., Nagy-Balo, E., Saghy, L., Glover, B.M., Galvin, J., Keelan, E., Nof, E., Grimaldi, M., Quadrini, F., Monaco, A. di, Troisi, F., Tritto, M., Renzullo, E., Sanzo, A., Zagari, D., Pappone, C., Agricola, P.M.G., Bella, P. della, Iuliano, A., Bongiorni, M.G., Calo, L., Ruvo, E. de, Sciarra, L., Ferraris, F., Ponti, R. de, Marazzi, R., Doni, L.A., Kim, A., Molhoek, S., Gelder, I. van, Rienstra, M., Compier, M.G., Pison, L., Crijns, H.J., Vernooy, K., Luermans, J., Jordaens, L., Groot, N. de, Szili-Torok, T., Bhagwandien, R., Elvan, Z.A., Buist, T., Gal, P., Lubinski, A., Krolak, T., Nowak, S., Mizia-Stec, K., Wnuk-Wojnar, A.M., Lelakowski, J., Kazmierczak, J., Kulakowski, P., Baran, J., Opolski, G., Kiliszek, M., Lodzinski, P., Borodzicz, S., Balsam, P., Blaszyk, K., Pytkowski, M., Kuteszko, R., Ciszewski, J., Fuglewicz, A., Wozniak, A., Adamczyk, K., Adragao, P., Cunha, P., Grecu, I.M., Tinica, G., Muresan, L., Rosu, R., Khomenko, E., Romanov, A., Bayramova, S., Mikhaylov, E.N., Lebedev, D.S., Patsouk, A.V., Yashin, S., Kryzhanovskiy, D., Bazayev, S.V., Morgunov, D., Silin, I., Popov, S., Kuznetsov, V., Jonsson, A., Platonov, P., Holmqvist, F., Kongstad, O., Yuan, S., Hoglund, N., Malmborg, H., Mortsell, D., Pernat, A., Morgan, J., Greenwood, E.F., Fletcher, L.L., Kravchenko, D.T., Doronin, A., Meshkova, M., Karpenko, I., Goryatchiy, A., Abramova, A., and ESC-EHRA Atrial Fibrillation Abla

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, recurrence predictors, Coronary artery disease, 03 medical and health sciences, mid-term outcome, 0302 clinical medicine, Recurrence, Internal medicine, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Registries, atrial fibrillation duration, business.industry, Hypertrophic cardiomyopathy, atrial fibrillation, catheter ablation, Cardiology and Cardiovascular Medicine, Atrial fibrillation, General Medicine, Middle Aged, medicine.disease, Ablation, Log-rank test, Outcome and Process Assessment, Health Care, Cohort, Cardiology, Catheter Ablation, Female, business, Kidney disease
Abstract

Background Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1-year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry. Methods We described the real-life clinical epidemiology, therapeutic strategies, and the short- and mid-term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (= 2 years). Results The mean AF history duration was 46.2 +/- 57.4 months, 592 patients had an AF history duration = 2 years (mean 75.5 +/- 63.5 months) (P < 0.001). Patients with AF history duration = 2 years (34.0%) (P = 0.037). AF history duration >= 2 years, overall ablation procedure duration, hypertension, and chronic kidney disease were all predictors of recurrences after the blanking period. Conclusions In this multicenter registry, performing catheter ablation in patients with an AF history >= 2 years was associated with higher rates of AF recurrences at 1 year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified.

Published
2018

13. Atrial fibrillation and cancer - An unexplored field in cardiovascular oncology

Author

Chu, G., Versteeg, H.H., Verschoor, A.J., Trines, S.A., Hemels, M.E., Ay, C., Huisman, M.V., Klok, F.A., Chu, G., Versteeg, H.H., Verschoor, A.J., Trines, S.A., Hemels, M.E., Ay, C., Huisman, M.V., and Klok, F.A.

Abstract

Item does not contain fulltext, An increasing body of evidence suggests an association between cancer and atrial fibrillation (AF). The exact magnitude and underlying mechanism of this association are however unclear. Cancer-related inflammation, anti-cancer treatment and other cancer-related comorbidities are proposed to affect atrial remodelling, increasing the susceptibility of cancer patients for developing AF. Moreover, cancer is assumed to modify the risk of thromboembolisms and bleeding. A thorough and adequate understanding of these risks is however lacking, as current literature is scarce and show ambiguous results in AF patients. The standardized risk-models that normally aid the clinician in the decision of initiating anticoagulant therapy do not take the presence of malignancy into account. Other factors that complicate risk assessment in AF patients with cancer include drug-drug interactions and other cancer-related comorbidities such as renal impairment. In this review, we highlight the available literature regarding epidemiological association, risk assessment and anticoagulation therapy in AF patients with cancer.

Published
2019

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