| 1. |
- Almroth, Henrik, 1970-, et al.
(författare)
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The safety of flecainide treatment of atrial fibrillation : long-term incidence of sudden cardiac death and proarrhythmic events
- 2011
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796. ; 270:3, s. 281-290
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To assess the safety of long-term treatment with flecainide in patients with atrial fibrillation (AF), particularly with regard to sudden cardiac death (SCD) andproarrhythmic events.Design: Retrospective,observational cohort study.Setting.Single-centre study at Örebro University Hospital, Sweden.Setting: Single-centre study at Orebro University Hospital, Sweden.Subjects: A total of 112 patients with paroxysmal (51%) or persistent (49%) AF (mean age 60 ± 11 years) were included after identifying all patients with AF who initiated oral flecainide treatment (mean dose 203 ± 43 mg per day) between 1998 and 2006. Standard exclusion⁄inclusion criteria for flecainide were used,andflecainidetreatmentwasusually combined withanatrioventricular-blocking agent (89%).Main outcome measure: Death was classified as sudden or nonsudden according to standard definitions. Proarrhythmia was defined as cardiac syncope or lifethreatening arrhythmia.Results: Eight deaths were reported during a mean follow- up of 3.4 ± .4 years. Compared to the general population, the standardized mortality ratios were 1.57 (95% confidence interval (CI) 0.68–3.09) for allcause mortality and 4.16 (95% CI 1.53–9.06) for death from cardiovascular disease. Three deaths were classified as SCDs. Proarrhythmic events occurred in six patients (two each with wide QRS tachycardia, 1 : 1 conducted atrial flutter and syncope during exercise).Conclusion: We found an increased incidence of SCD or proarrhythmic events in this real-world study of flecainide used for the treatment of AF. The findings suggest that further investigation into the safety of flecainide for the treatment of patients with AF is warranted.
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| 2. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality
- 2009
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Ingår i: Scandinavian cardiovascular journal : SCJ. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 43:5, s. 330-336
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the impact of postoperative AF on late mortality and cause of death in CABG patients.DESIGN: All CABG patients without preoperative AF surgically treated between January 1, 1997 and June 30, 2000 were included (N = 1419). Altogether, 419 patients (29.5%) developed postoperative AF. After a median follow-up of 8.0 years, survival data were obtained, causes of death were compared and Cox proportional hazard analysis was used to determine predictors of late mortality.RESULTS: The total mortality was 140 deaths/419 patients (33.4%) in postoperative AF patients and 191 deaths/1 000 patients (19.1%) in patients without AF. Death due to cerebral ischemia (2.6% vs. 0.5%), myocardial infarction (7.4% vs. 3.0%), sudden death (2.6% vs. 0.9%), and heart failure (6.7% vs. 2.7%) was more common among postoperative AF patients. Postoperative AF was an age-independent risk indicator for late mortality with a hazard ratio (HR) of 1.56 (95% confidence interval 1.23-1.98).CONCLUSIONS: Postoperative AF is an age-independent risk factor for late mortality in CABG patients, explained by an increased risk of cardiovascular death.
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| 3. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Positioning of the ablation catheter in total endoscopic ablation
- 2014
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press. - 1569-9293 .- 1569-9285. ; 18:1, s. 125-127
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Tidskriftsartikel (refereegranskat)abstract
- Minimally invasive ablation of atrial fibrillation is an option in patients not suitable for or refractory to catheter ablation. Total endoscopic ablation can be performed via a monolateral approach, whereby a left atrial box lesion is created. If the ablation is introduced from the right side, the positioning of the ablation catheter on the partly hidden left pulmonary veins is of vital importance. Using thoracoscopy in combination with multiplane transoesophageal echocardiography, the anatomical position of the ablation catheter can be established. Our experience in over 60 procedures has confirmed this to be a safe technique of total endoscopic ablation.
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| 4. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality
- 2010
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 37:6, s. 1353-1359
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This article presents a study of postoperative atrial fibrillation (AF) and its long-term effects on mortality and heart rhythm.METHODS: The study cohort consisted of 571 patients with no history of AF who underwent primary aortocoronary bypass surgery from 1999 to 2000. Postoperative AF occurred in 165/571 patients (28.9%). After a median follow-up of 6 years, questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.6% of all patients. Data from hospitalisations due to arrhythmia or stroke during follow-up were analysed. The causes of death were obtained for deceased patients.RESULTS: In postoperative AF patients, 25.4% had atrial fibrillation at follow-up compared with 3.6% of patients with no AF at surgery (p<0.001). An episode of postoperative AF was the strongest independent risk factor for development of late AF, with an adjusted risk ratio of 8.31 (95% confidence interval (CI) 4.20-16.43). Mortality was 29.7% (49 deaths/165 patients) in the AF group and 14.8% (60 deaths/406 patients) in the non-AF group (p<0.001). Death due to cerebral ischaemia was more common in the postoperative AF group (4.2% vs 0.2%, p<0.001), as was death due to myocardial infarction (6.7% vs 3.0%, p=0.041). Postoperative AF was an age-independent risk factor for late mortality, with an adjusted hazard ratio of 1.57 (95% CI 1.05-2.34).CONCLUSIONS: Postoperative AF patients have an eightfold increased risk of developing AF in the future, and a doubled long-term cardiovascular mortality.
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| 5. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Catheter ablation of symptomatic atrial fibrillation : Sex, ethnicity, and socioeconomic disparities
- 2022
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Ingår i: Heart rhythm O2. - : Elsevier. - 2666-5018. ; 3:6 Part B, s. 766-770
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Forskningsöversikt (refereegranskat)abstract
- Catheter ablation for treatment of atrial fibrillation (AF), AF ablation, is more effective than antiarrhythmic drugs in reducing AF burden, reducing symptoms and increasing health-related quality of life. Although females more often experience AF-related symptoms, and have more severe symptoms, have lower quality of life, and experience more serious adverse effects of antiarrhythmic drugs than males, they are less likely to undergo AF ablation. Potential explanations for the disparity include older age at diagnosis, longer AF duration, a greater number of comorbidities, more extensive atrial fibrosis, and presumed lower success rate and more complications after AF ablation in women. Studies have failed to show sex-related differences in AF recurrence or serious complications following AF ablation but show more nuisance bleeds in women. Ethnic minorities, such as African Americans and Latin Americans, and individuals of low socioeconomic status are also less likely to undergo AF ablation, possibly associated with greater numbers of comorbidities, lack of patient advocacy, healthcare costs, and inadequate insurance coverage. Inclusion of marginalized patient groups in clinical trials of AF treatment and a personalized, patient-centered approach may expand equality in utilization of AF ablation.
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| 6. |
- Djekic, Demir, et al.
(författare)
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Body Mass Index in Adolescence and Long-Term Risk of Early Incident Atrial Fibrillation and Subsequent Mortality, Heart Failure, and Ischemic Stroke
- 2022
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Ingår i: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980 .- 2047-9980. ; 11:21
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Tidskriftsartikel (refereegranskat)abstract
- Background: We sought to determine the role of obesity in adolescent men on development of atrial fibrillation (AF) and subsequent associated clinical outcomes in subjects diagnosed with AF.Methods and Results: We conducted a nationwide, register-based, cohort study of 1 704 467 men (mean age, 18.3±0.75 years) enrolled in compulsory military service in Sweden from 1969 through 2005. Height and weight, blood pressure, fitness, muscle strength, intelligence quotient, and medical disorders were recorded at baseline. Records obtained from the National Inpatient Registry and the Cause of Death Register were used to determine incidence and clinical outcomes of AF. During a median follow-up of 32 years (interquartile range, 24-41 years), 36 693 cases (mean age at diagnosis, 52.4±10.6 years) of AF were recorded. The multivariable-adjusted hazard ratio (HR) for AF increased from 1.06 (95% CI, 1.03-1.10) in individuals with body mass index (BMI) of 20.0 to <22.5 kg/m2 to 3.72 (95% CI, 2.44-5.66) among men with BMI of 40.0 to 50.0 kg/m2, compared with those with BMI of 18.5 to <20.0 kg/m2. During a median follow-up of ≈6 years in patients diagnosed with AF, we identified 3767 deaths, 3251 cases of incident heart failure, and 921 cases of ischemic stroke. The multivariable-adjusted HRs for all-cause mortality, incident heart failure, and ischemic stroke in AF-diagnosed men with baseline BMI >30 kg/m2 compared with those with BMI <20 kg/m2 were 2.86 (95% CI, 2.30-3.56), 3.42 (95% CI, 2.50-4.68), and 2.34 (95% CI, 1.52-3.61), respectively.Conclusions: Increasing BMI in adolescent men is strongly associated with early AF, and with subsequent worse clinical outcomes in those diagnosed with AF with respect to all-cause mortality, incident heart failure, and ischemic stroke.
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| 7. |
- Fengsrud, Espen, 1970-
(författare)
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Atrial fibrillation : endoscopic ablation and postoperative studies
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke, heart failure and cardiovascular death. Initial treatment focuses on rhythm or rate control and anticoagulation after risk assessment. Catheter abla-tion (CA) is an option in highly symptomatic patients but is less effective in long-standing persistent AF(LSPAF). Total endoscopic ablation is an alternative, but its clinical role needs further evaluation. In patients undergoing aortocoronary bypass graft (CABG) surgery, up to 9 % present with preoperative AF. One-third experience postoperative AF, which is associated with increased hospital stay, risk of stroke and decreased long-term survival. The long-term effects on heart rhythm have not been studied.Methods and Results: 571 patients undergoing CABG from 1999 to 2000 were followed for six years. Postoperative AF was the strongest independent risk factor for late AF and an age-independent risk factor for late mortality. 615 pa-tients from the same cohort, including patients with preoperative AF, were fol-lowed up at 15 years. Death due to cerebral ischaemia, heart failure and sudden death were most common in the pre- and postoperative AF groups. The presence of pre- or postoperative AF was an independent risk factor for late mortality.In our first ten patients, total endoscopic ablation of AF using a right-sided unilateral approach was feasible and safe with acceptable results. 36 patients with symptomatic LSPAF were then randomized to total endoscopic ablation or rate control. Loop recorders were implanted in all patients. In the control group, all patients were in permanent AF for 12 months. In the ablation group, 12/15 patients (80%) were in SR without antiarrhythmic drugs at 12 months. Median freedom of AF at 3–12 months was 95%, and 8/15 (53%) had an AF burden of < 5%. Myocardial function, physical working capacity(PWC) and subjective physical and mental health improved.Conclusions: Postoperative AF patients have an eightfold increased risk of future AF and a doubled long-term cardiovascular mortality. Both pre- or post-operative AF in CABG patients is a major risk factor for late cardiovascular morbidity and mortality. Total endoscopic ablation of AF is feasible and safe. In patients with LSPAF, it significantly reduced AF burden at 12 months compared with controls. Myocardial function, PWC and subjective physical and mental health improved.
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| 8. |
- Fengsrud, Espen, 1970-, et al.
(författare)
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Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact
- 2017
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Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 51:1, s. 21-27
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients.Design: Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained.Results: Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = 0.038), as were death due to heart failure (18% and 14%, v. 7%, p = 0.007) and sudden death (9% and 5%, v. 2%, p = 0.029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively).Conclusions: Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.
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| 9. |
- Fengsrud, Espen, 1970-, et al.
(författare)
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Total endoscopic ablation of atrial fibrillation
- 2015
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Ingår i: Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery. - : Oxford University Press. - 1813-9175.
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Tidskriftsartikel (refereegranskat)abstract
- Total endoscopic ablation of atrial fibrillation is a treatment option in symptomatic patients after unsuccessful catheter ablation or when catheter ablation is considered inappropriate. We describe a technique of endoscopic ablation of the left atrium using temperature-controlled unipolar or bipolar radiofrequency. A left atrial box lesion encircling the pulmonary veins is created using three ports in the right hemithorax. The technical aspects and preliminary results of the procedure are discussed.
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| 10. |
- Fengsrud, Espen, 1970-, et al.
(författare)
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Total endoscopic ablation of patients with long-standing persistent atrial fibrillation : a randomized controlled study
- 2016
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - Oxford, United Kingdom : Oxford University Press. - 1569-9293 .- 1569-9285. ; 23:2, s. 292-298
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Total endoscopic ablation of atrial fibrillation is an alternative to catheter ablation, but its clinical role needs further evaluation. The aim of this study was to compare total endoscopic ablation with rate control in patients with long-standing persistent atrial fibrillation and to examine the effect of endoscopic ablation on heart rhythm, symptoms, physical working capacity and myocardial function during 1 year of follow-up.Methods: In a prospective controlled study, 36 patients aged >50 years with symptomatic long-standing persistent atrial fibrillation were randomized to either total endoscopic ablation (n = 17, after two drop-outs before ablation n = 15) or rate control therapy (n = 19). In the ablation group, a box lesion encircling the pulmonary veins was performed, using temperature-controlled radiofrequency energy. Loop recorders were implanted in all patients. Echocardiography and quality-of-life assessment were performed at 6 and 12 months, and physical working capacity assessment at 6 months.Results: There was no mortality or thromboembolic event. In the control group, all patients were in permanent atrial fibrillation during 12 months of follow-up. In the ablation group, the proportion of patients in sinus rhythm without antiarrhythmic drugs was 12/15 (80%) at 12 months. The median freedom of atrial fibrillation at 3-12 months was 95% in the ablation group and the proportion of patients with an atrial fibrillation burden of <5% at 3-12 months was 8/15 (53%). The left ventricular ejection fraction increased during follow-up in the ablation group compared with the control group (from 53.7 ± 8.6 to 58.8 ± 6.5%, P = 0.003), combined with a reduction in the left atrial area (from 29.2 ± 5.5 to 27.2 ± 6.3 cm(2), P = 0.002). The physical working capacity increased in the ablation group compared with the control group (from 94 ± 21.4 to 102.9 ± 14.4%, P = 0.011). The subjective physical and mental capacity scale also improved during follow-up in the ablation group, but not in the control group (P =0.003 and 0.018, respectively).Conclusions: Total endoscopic ablation in patients with long-standing persistent atrial fibrillation significantly reduced atrial fibrillation burden 12 months after intervention compared with controls. The left ventricular function, physical working capacity and subjective physical and mental health were improved. These results need to be confirmed in larger randomized trials.
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