| 1. |
- De Groot, Natasja M.S., et al.
(författare)
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Critical appraisal of technologies to assess electrical activity during atrial fibrillation : a position paper from the European Heart Rhythm Association and European Society of Cardiology Working Group on eCardiology in collaboration with the Heart Rhythm Society, Asia Pacific Heart Rhythm Society, Latin American Heart Rhythm Society and Computing in Cardiology
- 2022
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Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129. ; 24:2, s. 313-330
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Forskningsöversikt (refereegranskat)abstract
- We aim to provide a critical appraisal of basic concepts underlying signal recording and processing technologies applied for (i) atrial fibrillation (AF) mapping to unravel AF mechanisms and/or identifying target sites for AF therapy and (ii) AF detection, to optimize usage of technologies, stimulate research aimed at closing knowledge gaps, and developing ideal AF recording and processing technologies. Recording and processing techniques for assessment of electrical activity during AF essential for diagnosis and guiding ablative therapy including body surface electrocardiograms (ECG) and endo- or epicardial electrograms (EGM) are evaluated. Discussion of (i) differences in uni-, bi-, and multi-polar (omnipolar/Laplacian) recording modes, (ii) impact of recording technologies on EGM morphology, (iii) global or local mapping using various types of EGM involving signal processing techniques including isochronal-, voltage- fractionation-, dipole density-, and rotor mapping, enabling derivation of parameters like atrial rate, entropy, conduction velocity/direction, (iv) value of epicardial and optical mapping, (v) AF detection by cardiac implantable electronic devices containing various detection algorithms applicable to stored EGMs, (vi) contribution of machine learning (ML) to further improvement of signals processing technologies. Recording and processing of EGM (or ECG) are the cornerstones of (body surface) mapping of AF. Currently available AF recording and processing technologies are mainly restricted to specific applications or have technological limitations. Improvements in AF mapping by obtaining highest fidelity source signals (e.g. catheter-electrode combinations) for signal processing (e.g. filtering, digitization, and noise elimination) is of utmost importance. Novel acquisition instruments (multi-polar catheters combined with improved physical modelling and ML techniques) will enable enhanced and automated interpretation of EGM recordings in the near future.
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| 2. |
- Haïssaguerre, Michel, et al.
(författare)
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Sudden cardiac arrest associated with early repolarization
- 2008
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 358:19, s. 2016-2023
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Early repolarization is a common electrocardiographic finding that is generally considered to be benign. Its potential to cause cardiac arrhythmias has been hypothesized from experimental studies, but it is not known whether there is a clinical association with sudden cardiac arrest.METHODS: We reviewed data from 206 case subjects at 22 centers who were resuscitated after cardiac arrest due to idiopathic ventricular fibrillation and assessed the prevalence of electrocardiographic early repolarization. The latter was defined as an elevation of the QRS-ST junction of at least 0.1 mV from baseline in the inferior or lateral lead, manifested as QRS slurring or notching. The control group comprised 412 subjects without heart disease who were matched for age, sex, race, and level of physical activity. Follow-up data that included the results of monitoring with an implantable defibrillator were obtained for all case subjects.RESULTS: Early repolarization was more frequent in case subjects with idiopathic ventricular fibrillation than in control subjects (31% vs. 5%, P<0.001). Among case subjects, those with early repolarization were more likely to be male and to have a history of syncope or sudden cardiac arrest during sleep than those without early repolarization. In eight subjects, the origin of ectopy that initiated ventricular arrhythmias was mapped to sites concordant with the localization of repolarization abnormalities. During a mean (+/-SD) follow-up of 61+/-50 months, defibrillator monitoring showed a higher incidence of recurrent ventricular fibrillation in case subjects with a repolarization abnormality than in those without such an abnormality (hazard ratio, 2.1; 95% confidence interval, 1.2 to 3.5; P=0.008).CONCLUSIONS: Among patients with a history of idiopathic ventricular fibrillation, there is an increased prevalence of early repolarization.
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| 3. |
- Mörtsell, David, 1973-
(författare)
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Outcomes and safety of new techniques for pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation : A study based on randomised trials and registries
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Atrial fibrillation (AF) is a common disease with a high prevalence in the adult population. Treatment of AF encompasses antiarrhythmic drugs and catheter ablation to reduce symptoms. The aim of this thesis was to study how to best alleviate symptoms of AF in a safe and efficient way comparing pharmacological treatment and the two dominating catheter ablation techniques, cryoballoon (CRYO) ablation and point-by-point radiofrequency (RF) ablation.Quality of life improved more for those AF patients randomised to treatment with catheter ablation compared to those treated with antiarrhythmic medication after 12 months of follow up (n=155).We evaluated a proposed optimised CRYO ablation protocol and randomised 140 patients to a single cryoballoon application per vein guided by a mapping catheter (Single cryo) or two cryoballoon applications (Routine). Acute pulmonary vein isolation rate did not differ. Procedure time decreased by 19 minutes with a lower complication rate in the Single cryo-arm. Freedom from AF after one procedure at 12 months did not differ; 73.9.0% (Single cryo) versus 71.4% (Routine).CRYO ablation was also assessed in persistent AF and paroxysmal AF. Freedom from arrhythmia recurrence was lower after a single ablation in persistent AF (64.9%) compared with paroxysmal AF (82.2%) after 12 months. However, the reduction of AF symptoms and quality of life was excellent in both groups and did not differ after 12 months.Patients undergoing their first AF ablation with CRYO or RF were included in a registry study. After 12 months, freedom from AF was equal irrespective of AF type, but there was a lower re-ablation rate and need for continued antiarrhythmic drug treatment after CRYO ablation. Procedure duration was reduced by 40 minutes with CRYO and complication rates did not differ,In conclusion, catheter ablation reduces AF symptoms more than antiarrhythmic drugs and cryoballoon ablation can be further optimised with reduced procedure times and improved safety. Cryoballoon ablation is as efficacious as RF ablation as a first-line therapy in both paroxysmal and persistent AF and the lower re-ablation rates and shorter procedure times may have important clinical implications when choosing AF ablation technique.
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