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6. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation:the 8th AFNET/EHRA consensus conference

Author

Schnabel, Renate B., Marinelli, Elena Andreassi, Arbelo, Elena, Boriani, Giuseppe, Boveda, Serge, Buckley, Claire M., Camm, A. John, Casadei, Barbara, Chua, Winnie, Dagres, Nikolaos, de Melis, Mirko, Desteghe, Lien, Diederichsen, Soren Zoga, Duncker, David, Eckardt, Lars, Eisert, Christoph, Engler, Daniel, Fabritz, Larissa, Freedman, Ben, Gillet, Ludovic, Goette, Andreas, Guasch, Eduard, Svendsen, Jesper Hastrup, Hatem, Stephane N., Haeusler, Karl Georg, Healey, Jeff S., Heidbuchel, Hein, Hindricks, Gerhard, Hobbs, F. D. Richard, Huebner, Thomas, Kotecha, Dipak, Krekler, Michael, Leclercq, Christophe, Lewalter, Thorsten, Lin, Honghuang, Linz, Dominik, Lip, Gregory Y. H., Lochen, Maja Lisa, Lucassen, Wim, Malaczynska-Rajpold, Katarzyna, Massberg, Steffen, Merino, Jose L., Meyer, Ralf, Mont, Lluis, Myers, Michael C., Neubeck, Lis, Niiranen, Teemu, Oeff, Michael, Oldgren, Jonas, Potpara, Tatjana S., Psaroudakis, George, Purerfellner, Helmut, Ravens, Ursula, Rienstra, Michiel, Rivard, Lena, Scherr, Daniel, Schotten, Ulrich, Shah, Dipen, Sinner, Moritz F., Smolnik, Rudiger, Steinbeck, Gerhard, Steven, Daniel, Svennberg, Emma, Thomas, Dierk, Hills, Mellanie True, van Gelder, Isabelle C., Vardar, Burcu, Pala, Elena, Wakili, Reza, Wegscheider, Karl, Wieloch, Mattias, Willems, Stephan, Witt, Henning, Ziegler, Andre, Zink, Matthias Daniel, Kirchhof, Paulus, Schnabel, Renate B., Marinelli, Elena Andreassi, Arbelo, Elena, Boriani, Giuseppe, Boveda, Serge, Buckley, Claire M., Camm, A. John, Casadei, Barbara, Chua, Winnie, Dagres, Nikolaos, de Melis, Mirko, Desteghe, Lien, Diederichsen, Soren Zoga, Duncker, David, Eckardt, Lars, Eisert, Christoph, Engler, Daniel, Fabritz, Larissa, Freedman, Ben, Gillet, Ludovic, Goette, Andreas, Guasch, Eduard, Svendsen, Jesper Hastrup, Hatem, Stephane N., Haeusler, Karl Georg, Healey, Jeff S., Heidbuchel, Hein, Hindricks, Gerhard, Hobbs, F. D. Richard, Huebner, Thomas, Kotecha, Dipak, Krekler, Michael, Leclercq, Christophe, Lewalter, Thorsten, Lin, Honghuang, Linz, Dominik, Lip, Gregory Y. H., Lochen, Maja Lisa, Lucassen, Wim, Malaczynska-Rajpold, Katarzyna, Massberg, Steffen, Merino, Jose L., Meyer, Ralf, Mont, Lluis, Myers, Michael C., Neubeck, Lis, Niiranen, Teemu, Oeff, Michael, Oldgren, Jonas, Potpara, Tatjana S., Psaroudakis, George, Purerfellner, Helmut, Ravens, Ursula, Rienstra, Michiel, Rivard, Lena, Scherr, Daniel, Schotten, Ulrich, Shah, Dipen, Sinner, Moritz F., Smolnik, Rudiger, Steinbeck, Gerhard, Steven, Daniel, Svennberg, Emma, Thomas, Dierk, Hills, Mellanie True, van Gelder, Isabelle C., Vardar, Burcu, Pala, Elena, Wakili, Reza, Wegscheider, Karl, Wieloch, Mattias, Willems, Stephan, Witt, Henning, Ziegler, Andre, Zink, Matthias Daniel, and Kirchhof, Paulus

Abstract

Aims Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. Methods and results This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Conclusions Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.

Published
2023

13. Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves

Author

Zink, Matthias Daniel, Laureanti, Rita, Hermans, Ben J.M., Pison, Laurent, Verheule, Sander, Philippens, Suzanne, Vernooy, Kevin, Zeemering, Stef, Schotten, Ulrich, Zink, Matthias Daniel, Laureanti, Rita, Hermans, Ben J.M., Pison, Laurent, Verheule, Sander, Philippens, Suzanne, Vernooy, Kevin, Zeemering, Stef, and Schotten, Ulrich

Abstract

Contains fulltext : 249094.pdf (Publisher’s version ) (Open Access)

Published
2022

14. Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves

Author

Zink, Matthias Daniel, primary, Laureanti, Rita, additional, Hermans, Ben J. M., additional, Pison, Laurent, additional, Verheule, Sander, additional, Philippens, Suzanne, additional, Pluymaekers, Nikki, additional, Vroomen, Mindy, additional, Hermans, Astrid, additional, van Hunnik, Arne, additional, Crijns, Harry J. G. M., additional, Vernooy, Kevin, additional, Linz, Dominik, additional, Mainardi, Luca, additional, Auricchio, Angelo, additional, Zeemering, Stef, additional, and Schotten, Ulrich, additional

Published
2022
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15. A Longer T peak -T end Interval Is Associated with a Higher Risk of Death: A Meta-Analysis.

Author

Braun, Cathrin Caroline, Zink, Matthias Daniel, Gozdowsky, Sophie, Hoffmann, Julie Martha, Hochhausen, Nadine, Röhl, Anna Bettina, Beckers, Stefan Kurt, and Kork, Felix

Subjects
*DEATH rate, *HEART beat, *MORTALITY, *PROGNOSIS, *ODDS ratio
Abstract

A noninvasive tool for cardiovascular risk stratification has not yet been established in the clinical routine analysis. Previous studies suggest a prolonged Tpeak-Tend interval (the interval from the peak to the end of the T-wave) to be predictive of death. This meta-analysis was designed to systematically evaluate the association of the Tpeak-Tend interval with mortality outcomes. Medline (via PubMed), Embase and the Cochrane Library were searched from 1 January 2008 to 21 July 2020 for articles reporting the ascertainment of the Tpeak-Tend interval and observation of all-cause-mortality. The search yielded 1920 citations, of which 133 full-texts were retrieved and 29 observational studies involving 23,114 patients met the final criteria. All-cause deaths had longer Tpeak-Tend intervals compared to survivors by a standardized mean difference of 0.41 (95% CI 0.23–0.58) and patients with a long Tpeak-Tend interval had a higher risk of all-cause death compared to patients with a short Tpeak-Tend interval by an overall odds ratio of 2.33 (95% CI 1.57–3.45). Heart rate correction, electrocardiographic (ECG) measurement methods and the selection of ECG leads were major sources of heterogeneity. Subgroup analyses revealed that heart rate correction did not affect the association of the Tpeak-Tend interval with mortality outcomes, whereas this finding was not evident in all measurement methods. The Tpeak-Tend interval was found to be significantly associated with all-cause mortality. Further studies are warranted to confirm the prognostic value of the Tpeak-Tend interval. [ABSTRACT FROM AUTHOR]

Published
2023
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17. Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

Author

Zink, Matthias Daniel, Chua, Winnie, Zeemering, Stef, di Biase, Luigi, 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, de Bono, Joseph, Van Gelder, Isabelle C., de Potter, Tom, Scherr, Daniel, Themistoclakis, Sakis, Todd, Derick, Kirchhof, Paulus, Schotten, Ulrich, Universitat Autònoma de Barcelona, Cardiovascular Centre (CVC), Fysiologie, and RS: Carim - H08 Experimental atrial fibrillation

Subjects
medicine.medical_specialty, Radiofrequency ablation, medicine.medical_treatment, Catheter ablation, Ablation, Cardioversion, law.invention, advanced interatrial block, cryoballoon ablation, TACHYARRHYTHMIAS, Clinical Research, Recurrence, Risk Factors, law, Early recurrence, Physiology (medical), Internal medicine, medicine, AXAFA, Humans, AcademicSubjects/MED00200, delayed cure, Apixaban, RADIOFREQUENCY ABLATION, CLINICAL-SIGNIFICANCE, PULMONARY VEIN ISOLATION, Stroke, Aged, Retrospective Studies, business.industry, Vascular disease, Blanking period, Hazard ratio, Atrial fibrillation, catheter, medicine.disease, Ablation for Atrial Fibrillation, Treatment Outcome, Catheter Ablation, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
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

Published
2020
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18. Unobtrusive Nocturnal Heartbeat Monitoring by a Ballistocardiographic Sensor in Patients with Sleep Disordered Breathing

Author

Zink, Matthias Daniel, Brüser, Christoph, Stüben, Björn-Ole, Napp, Andreas, Stöhr, Robert, Leonhardt, Steffen, Marx, Nikolaus, Mischke, Karl, Schulz, Jörg B., and Schiefer, Johannes

Subjects
Adult, Male, Science, Middle Aged, Article, Ballistocardiography, Electrocardiography, Sleep Apnea Syndromes, Heart Rate, ddc:000, cardiovascular system, Humans, Medicine, Female, cardiovascular diseases, ddc:600, Algorithms
Abstract

Scientific reports 7(1), 13175 (2017). doi:10.1038/s41598-017-13138-0, Published by Nature Publishing Group, London

Published
2017
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23. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Author

Schnabel, Renate B., Marinelli, Elena Andreassi, Arbelo, Elena, Boriani, Giuseppe, Boveda, Serge, Buckley, Claire M., Camm, A. John, Casadei, Barbara, Chua, Winnie, Dagres, Nikolaos, de Melis, Mirko, Desteghe, Lien, Diederichsen, Soren Zoga, Duncker, David, Eckardt, Lars, Eisert, Christoph, Engler, Daniel, Fabritz, Larissa, Freedman, Ben, Gillet, Ludovic, Goette, Andreas, Guasch, Eduard, Svendsen, Jesper Hastrup, Hatem, Stephane N., Haeusler, Karl Georg, Healey, Jeff S., Heidbuchel, Hein, Hindricks, Gerhard, Hobbs, F. D. Richard, Huebner, Thomas, Kotecha, Dipak, Krekler, Michael, Leclercq, Christophe, Lewalter, Thorsten, Lin, Honghuang, Linz, Dominik, Lip, Gregory Y. H., Lochen, Maja Lisa, Lucassen, Wim, Malaczynska-Rajpold, Katarzyna, Massberg, Steffen, Merino, Jose L., Meyer, Ralf, Mont, Lluis, Myers, Michael C., Neubeck, Lis, Niiranen, Teemu, Oeff, Michael, Oldgren, Jonas, Potpara, Tatjana S., Psaroudakis, George, Purerfellner, Helmut, Ravens, Ursula, Rienstra, Michiel, Rivard, Lena, Scherr, Daniel, Schotten, Ulrich, Shah, Dipen, Sinner, Moritz F., Smolnik, Rudiger, Steinbeck, Gerhard, Steven, Daniel, Svennberg, Emma, Thomas, Dierk, Hills, Mellanie True, van Gelder, Isabelle C., Vardar, Burcu, Pala, Elena, Wakili, Reza, Wegscheider, Karl, Wieloch, Mattias, Willems, Stephan, Witt, Henning, Ziegler, Andre, Zink, Matthias Daniel, Kirchhof, Paulus, Schnabel, Renate B., Marinelli, Elena Andreassi, Arbelo, Elena, Boriani, Giuseppe, Boveda, Serge, Buckley, Claire M., Camm, A. John, Casadei, Barbara, Chua, Winnie, Dagres, Nikolaos, de Melis, Mirko, Desteghe, Lien, Diederichsen, Soren Zoga, Duncker, David, Eckardt, Lars, Eisert, Christoph, Engler, Daniel, Fabritz, Larissa, Freedman, Ben, Gillet, Ludovic, Goette, Andreas, Guasch, Eduard, Svendsen, Jesper Hastrup, Hatem, Stephane N., Haeusler, Karl Georg, Healey, Jeff S., Heidbuchel, Hein, Hindricks, Gerhard, Hobbs, F. D. Richard, Huebner, Thomas, Kotecha, Dipak, Krekler, Michael, Leclercq, Christophe, Lewalter, Thorsten, Lin, Honghuang, Linz, Dominik, Lip, Gregory Y. H., Lochen, Maja Lisa, Lucassen, Wim, Malaczynska-Rajpold, Katarzyna, Massberg, Steffen, Merino, Jose L., Meyer, Ralf, Mont, Lluis, Myers, Michael C., Neubeck, Lis, Niiranen, Teemu, Oeff, Michael, Oldgren, Jonas, Potpara, Tatjana S., Psaroudakis, George, Purerfellner, Helmut, Ravens, Ursula, Rienstra, Michiel, Rivard, Lena, Scherr, Daniel, Schotten, Ulrich, Shah, Dipen, Sinner, Moritz F., Smolnik, Rudiger, Steinbeck, Gerhard, Steven, Daniel, Svennberg, Emma, Thomas, Dierk, Hills, Mellanie True, van Gelder, Isabelle C., Vardar, Burcu, Pala, Elena, Wakili, Reza, Wegscheider, Karl, Wieloch, Mattias, Willems, Stephan, Witt, Henning, Ziegler, Andre, Zink, Matthias Daniel, and Kirchhof, Paulus

Abstract

Aims Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. Methods and results This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Conclusions Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.

24. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Author

Renate B Schnabel, Elena Andreassi Marinelli, Elena Arbelo, Giuseppe Boriani, Serge Boveda, Claire M Buckley, A John Camm, Barbara Casadei, Winnie Chua, Nikolaos Dagres, Mirko de Melis, Lien Desteghe, Søren Zöga Diederichsen, David Duncker, Lars Eckardt, Christoph Eisert, Daniel Engler, Larissa Fabritz, Ben Freedman, Ludovic Gillet, Andreas Goette, Eduard Guasch, Jesper Hastrup Svendsen, Stéphane N Hatem, Karl Georg Haeusler, Jeff S Healey, Hein Heidbuchel, Gerhard Hindricks, F D Richard Hobbs, Thomas Hübner, Dipak Kotecha, Michael Krekler, Christophe Leclercq, Thorsten Lewalter, Honghuang Lin, Dominik Linz, Gregory Y H Lip, Maja Lisa Løchen, Wim Lucassen, Katarzyna Malaczynska-Rajpold, Steffen Massberg, Jose L Merino, Ralf Meyer, Lluıs Mont, Michael C Myers, Lis Neubeck, Teemu Niiranen, Michael Oeff, Jonas Oldgren, Tatjana S Potpara, George Psaroudakis, Helmut Pürerfellner, Ursula Ravens, Michiel Rienstra, Lena Rivard, Daniel Scherr, Ulrich Schotten, Dipen Shah, Moritz F Sinner, Rüdiger Smolnik, Gerhard Steinbeck, Daniel Steven, Emma Svennberg, Dierk Thomas, Mellanie True Hills, Isabelle C van Gelder, Burcu Vardar, Elena Palà, Reza Wakili, Karl Wegscheider, Mattias Wieloch, Stephan Willems, Henning Witt, André Ziegler, Matthias Daniel Zink, Paulus Kirchhof, General practice, ACS - Heart failure & arrhythmias, APH - Personalized Medicine, APH - Quality of Care, Schnabel, Renate B/0000-0001-7170-9509, Rienstra, Michiel/0000-0002-2581-070X, Pala, Elena/0000-0002-1074-990X, Schnabel, Renate B., Marinelli, Elena Andreassi, Arbelo, Elena, Boriani, Giuseppe, Boveda, Serge, Buckley, Claire M., Camm, A. John, Casadei, Barbara, Chua, Winnie, Dagres, Nikolaos, de Melis, Mirko, DESTEGHE, Lien, Diederichsen, Soren Zoga, Duncker, David, Eckardt, Lars, Eisert, Christoph, Engler, Daniel, Fabritz, Larissa, Freedman, Ben, Gillet, Ludovic, Goette, Andreas, Guasch, Eduard, Svendsen, Jesper Hastrup, Hatem, Stephane N., Haeusler, Karl Georg, Healey, Jeff S., HEIDBUCHEL, Hein, Hindricks, Gerhard, Hobbs, F. D. Richard, Huebner, Thomas, Kotecha, Dipak, Krekler, Michael, Leclercq, Christophe, Lewalter, Thorsten, Lin, Honghuang, Linz, Dominik, Lip, Gregory Y. H., Lochen, Maja Lisa, Lucassen, Wim, Malaczynska-Rajpold, Katarzyna, Massberg, Steffen, Merino, Jose L., Meyer , Ralf, Mont, Lluis, Myers, Michael C., Neubeck, Lis, Niiranen, Teemu, Oeff, Michael, Oldgren, Jonas, Potpara, Tatjana S., Psaroudakis, George, Purerfellner, Helmut, Ravens, Ursula, Rienstra, Michiel, Rivard, Lena, Scherr, Daniel, Schotten, Ulrich, Shah , Dipen, Sinner, Moritz F., Smolnik, Rudiger, Steinbeck, Gerhard, Steven, Daniel, Svennberg, Emma, Thomas, Dierk, Hills, Mellanie True, van Gelder, Isabelle C., Vardar, Burcu, Pala, Elena, Wakili, Reza, Wegscheider, Karl, Wieloch, Mattias, Willems , Stephan, Witt, Henning, Ziegler, Andre, Zink, Matthias Daniel, Kirchhof, Paulus, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and RS: Carim - H08 Experimental atrial fibrillation

Subjects
Artificial intelligence, Technology, Consensus, Cost, Medizin, Heart failure, Outcomes, Guidelines, EHRA/HRS/APHRS/SOLAECE EXPERT CONSENSUS, Anticoagulation, Cognition, QUALITY-OF-LIFE, Physiology (medical), MAGNETIC-RESONANCE, Humans, PULMONARY VEIN ISOLATION, CARDIOVASCULAR EVENTS, Stroke/prevention & control, AFNET, Atrial cardiomyopathy, Atrial fibrillation, Bleeding, Catheter ablation, Cognitive function, Consensus statement, Dementia, EHRA, Integrated care, Quality of care, Research, Research priorities, Rhythm management, Screening, Stroke, ORAL ANTICOAGULANTS, CARDIOMYOPATHIES DEFINITION, RISK PREDICTION, Early Diagnosis, Human medicine, Cardiology and Cardiovascular Medicine, FOLLOW-UP, Atrial Fibrillation/complications
Abstract

Europace : the European journal of pacing, arrhythmias and cardiac electrophysiology euac062 (2022). doi:10.1093/europace/euac062, Published by Oxford Univ. Press, Oxford

Published
2022
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