| 1. |
- Akerstrom, Finn, et al.
(författare)
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Association between catheter ablation of atrial fibrillation and mortality or stroke
- 2024
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Ingår i: Heart. - : BMJ PUBLISHING GROUP. - 1355-6037 .- 1468-201X. ; 110, s. 163-169
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Tidskriftsartikel (refereegranskat)abstract
- Objective Catheter ablation of atrial fibrillation effectively reduces symptomatic burden. However, its long-term effect on mortality and stroke is unclear. We investigated if patients with atrial fibrillation who undergo catheter ablation have lower risk for all-cause mortality or stroke than patients who are managed medically. Methods We retrospectively included 5628 consecutive patients who underwent first-time catheter ablation for atrial fibrillation between 2008 and 2018 at three major Swedish electrophysiology units. Control individuals with an atrial fibrillation diagnosis but without previous stroke were selected from the Swedish National Patient Register, resulting in a control group of 48 676 patients. Propensity score matching was performed to produce two cohorts of equal size (n=3955) with similar baseline characteristics. The primary endpoint was a composite of all-cause mortality or stroke. Results Patients who underwent catheter ablation were healthier (mean CHA(2)DS(2)-VASc score 1.4 +/- 1.4 vs 1.6 +/- 1.5, p<0.001), had a higher median income (288 vs 212 1000 Swedish krona [KSEK]/year, p<0.001) and had more frequently received university education (45.1% vs 28.9%, p<0.001). Mean follow-up was 4.5 +/- 2.8 years. After propensity score matching, catheter ablation was associated with lower risk for the combined primary endpoint (HR 0.58, 95% CI 0.48 to 0.69). The result was mainly driven by a decrease in all-cause mortality (HR 0.51, 95% CI 0.41 to 0.63), with stroke reduction showing a trend in favour of catheter ablation (HR 0.75, 95% CI 0.53 to 1.07). Conclusions Catheter ablation of atrial fibrillation was associated with a reduction in the primary endpoint of all-cause mortality or stroke. This result was driven by a marked reduction in all-cause mortality.
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| 2. |
- Carnlöf, Carina, et al.
(författare)
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Health-related quality of life in patients with atrial fibrillation undergoing pulmonary vein isolation, before and after treatment
- 2010
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 9:1, s. 45-49
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) is the most common arrhythmia and many AF patients experience a significantly impaired health-related quality of life (HRQOL). AF is also associated with a high risk of stroke and death. Many pharmacologic treatments for AF are ineffective and may have adverse effects. New methods, such as pulmonary vein isolation (PVI), have been developed to treat AF.Aims: The aim of this study was to investigate the HRQOL issues in severe symptomatic AF patients before and after pulmonary vein isolation.Methods: Forty patients treated with PVI were included of which 36 concluded the study with the self-reported HRQOL questionnaires before and once after PVI. A standardized control group was used.Results: Compared to the control group the HRQOL before PVI was significantly lower in all domains except for bodily pain. The preoperative scores were compared with the scores obtained at the follow-up. All subscales of the SF-36 significantly improved after the PVI except for bodily pain, which remained unaltered.Conclusion: HRQOL is improved in AF patients with severe symptoms after PVI intervention.
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| 3. |
- Holmqvist, Fredrik, et al.
(författare)
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A decade of catheter ablation of cardiac arrhythmias in Sweden : ablation practices and outcomes
- 2019
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 40:10, s. 820-830
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing 'real-world' data on efficacy and safety are lacking. Using Swedish national registry data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported.Methods and Results: Consecutive patients (≥18 years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26 642 patients (57 ± 15 years, 62% men), undergoing a total of 34 428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff-Parkinson-White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11 916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7 years (interquartile range 2.7-7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P < 0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3 years). The rate of reported adverse events was low (n = 595, 1.7%). Death in the immediate period following ablation was rare (n = 116, 0.34%).Conclusion: Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF.
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| 4. |
- Holmqvist, Fredrik, et al.
(författare)
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Increasing Ablation Volumes And A Shift Towards More Complex Arrhythmias : Data From The Swedish National Catheter Ablation Registry
- 2018
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Konferensbidrag (refereegranskat)abstract
- Background: Catheter ablation has become the treatment of choice for many tachyarrhythmias. The ablation techniques are continuously refined and the indications expanded, enabling treatment of more complex substrates. Hence, the spectrum of treated arrhythmias is likely to have changed over time, but compelling data on this are lacking.Objective: The present study set out to explore the changing pattern of ablations performed in the setting of a universal, single-payer healthcare system, using data from the Swedish national catheter ablation registry.Methods: The Swedish National Catheter Ablation Registry covers virtually all (>97%) catheter ablations performed in Sweden since 2005 and comprises 42,192 ablations on 32,237 individual patients. In the present analysis, all ablations performed between 2005 and 2016 were included.Results: In 2005, there were 7 ablation centers in Sweden performing a total of 1,584 ablations (226/center; 175/million). In 2016, 11 ablation centers performed 5,022 ablations (457/center; 502/million). Ablation of atrial fibrillation increased from 326 ablations (21% of all) in 2005 to 2,063 (41%) in 2016. Although, the number of ablation procedures for ventricular tachycardia and premature ventricular contractions is increasing, it is still on a relatively modest level (Figure). In contrast to other reports, there is no apparent decline in the number of accessory pathway ablations.Conclusion: In the setting of a universal, single-payer healthcare system, the number of ablations more than tripled over a 10-year period. Ablation of atrial fibrillation is the main driver behind this increase and accounted for 41% of all ablations in Sweden in 2016.
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| 5. |
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| 6. |
- Insulander, Per
(författare)
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Cardiac electrophysiologic effects of mental stress
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Mental stress may trigger serious arrhythmias. Mental stress tests cause significant increases in heart rate, blood pressure and cardiac output. When beta-adrenergic inhibition is considered for secondary antiarrhythmic prophylaxis beta1 selective agents are often preferred because of less adverse reactions. The importance of the different beta-adrenoceptors on the electrophysiologic function is incompletely known. Methods: In all studies, healthy volunteers were investigated by means of standard electrophysiologic catheterization procedures. Electrophysiologic and hemodynamic variables were measured under different settings of autonomic modulation with the primary goal to characterize the effects of mental stress on cardiac conductive tissues and the importance of :1 and :2 adrenergic receptors in cardiac tissues. To this mean infusion of adrenergic agonists (using epinephrine, dobutamine and salbutamol), a mental stress test (Stroop s Colour Word Conflict Test, CWT) and selective and unselective autonomic tone inhibition, ATI, (using atenolol, propranolol and atropine) were used. Study I investigated the electrophysiologic effects on the cardiac conduction system elicited by CWT and compared them with the effects of epinephrine. Mental stress produced significant electrophysiologic effects with shortening of all measured electrophysiologic variables except atrial, most markedly those of the sinus and the atrioventricular nodes. During infusion of epinephrine, corresponding effects could only be reproduced at a much higher plasma level than during CWT. Study II investigated gender differences in the cardiac electrophysiologic effects elicited by CWT and by ATI. During CWT men had shorter QT and JT durations. Women had shorter refractoriness in the atrial tissue and in the AV node. After ATI no gender differences in sinus nodal properties were noted, whereas AV nodal refractoriness and conduction time were shorter in women. QT and JT duration, and the refractory period of the right ventricle, became shorter in men. Study III assessed the overall electrophysiologic effects of infusion with the beta2-agonist salbutamol. To distinguish beta2-agonist effects a comparison was made with the beta1 selective agonist dobutamine. Salbutamol produced significant changes in electrophysiologic properties both in myocardial and nodal tissues, the effects being greater on nodal properties. The proportional decreases in the AV node parameters were more pronounced than in the sinus node. There was an increase in the duration of the QS interval, indicating slower depolarization of the ventricle. QT dispersion increased. Study IV evaluated if the type of beta-blocker, beta1-selective or unselective, is of importance in inhibition of the electrophysiologic effects of CWT, which was also assessed with each beta-blocker combined with atropine. With propranolol as the beta-blocker in ATI the electrophysiologic effects of CWT were completely eliminated. ATI with atenolol, though, gives an incomplete inhibition of the effects of mental stress on sinus cycle length, sinus node recovery time, AV nodal and the ventricular refractoriness, and on QT-duration. Conclusions: Mental stress produces pronounced electrophysiologic effects, most markedly in the sinus and AV nodes and less in the ventricle. Circulating epinephrine plays only a minor direct role as a mediator of mental stress effects on the heart. During mental stress, women exhibit a more pronounced effect on the AV node and on the sinus node, and men react with a more pronounced effect on ventricular EP properties. After ATI, women have higher heart rate, longer QT and JT intervals, faster AH conduction, shorter AV nodal effective refractory period, and longer ventricular effective refractory period. Beta2-stimulation with salbutamol results in significant effects on cardiac electrophysiology, most pronounced in sinus and AV nodes and less on atrial and ventricular parameters. A discordant effect on ventricular conduction, which slowed, and refractoriness of the ventricular myocardium, which shortened, was seen. QT dispersion increased. Inhibition with atenolol does not eliminate the effects of mental stress on the ventricular myocardium, effects that at least partly appears mediated through stimulation of :2 adrenoceptors. Vagal withdrawal is part of the reaction to mental stress also in the ventricular myocardium.
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| 7. |
- Jemtrén, Anette, et al.
(författare)
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Accessory pathway properties are similar in symptomatic and asymptomatic preexcitation.
- 2022
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Ingår i: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. - : Springer Science and Business Media LLC. - 1572-8595. ; 65:1, s. 193-199
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Tidskriftsartikel (refereegranskat)abstract
- Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation.This retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36±17years with a range of 3-89years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization.A total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤250ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (P=0.40) as was the mean APERP (303±68ms vs. 307±75) (P=0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (P<0.001).The results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.
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| 8. |
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| 9. |
- Stroth, U., et al.
(författare)
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Progress from ASDEX Upgrade experiments in preparing the physics basis of ITER operation and DEMO scenario development
- 2022
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 62:4
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Tidskriftsartikel (refereegranskat)abstract
- An overview of recent results obtained at the tokamak ASDEX Upgrade (AUG) is given. A work flow for predictive profile modelling of AUG discharges was established which is able to reproduce experimental H-mode plasma profiles based on engineering parameters only. In the plasma center, theoretical predictions on plasma current redistribution by a dynamo effect were confirmed experimentally. For core transport, the stabilizing effect of fast ion distributions on turbulent transport is shown to be important to explain the core isotope effect and improves the description of hollow low-Z impurity profiles. The L-H power threshold of hydrogen plasmas is not affected by small helium admixtures and it increases continuously from the deuterium to the hydrogen level when the hydrogen concentration is raised from 0 to 100%. One focus of recent campaigns was the search for a fusion relevant integrated plasma scenario without large edge localised modes (ELMs). Results from six different ELM-free confinement regimes are compared with respect to reactor relevance: ELM suppression by magnetic perturbation coils could be attributed to toroidally asymmetric turbulent fluctuations in the vicinity of the separatrix. Stable improved confinement mode plasma phases with a detached inner divertor were obtained using a feedback control of the plasma β. The enhanced D α H-mode regime was extended to higher heating power by feedback controlled radiative cooling with argon. The quasi-coherent exhaust regime was developed into an integrated scenario at high heating power and energy confinement, with a detached divertor and without large ELMs. Small ELMs close to the separatrix lead to peeling-ballooning stability and quasi continuous power exhaust. Helium beam density fluctuation measurements confirm that transport close to the separatrix is important to achieve the different ELM-free regimes. Based on separatrix plasma parameters and interchange-drift-Alfvén turbulence, an analytic model was derived that reproduces the experimentally found important operational boundaries of the density limit and between L- and H-mode confinement. Feedback control for the X-point radiator (XPR) position was established as an important element for divertor detachment control. Stable and detached ELM-free phases with H-mode confinement quality were obtained when the XPR was moved 10 cm above the X-point. Investigations of the plasma in the future flexible snow-flake divertor of AUG by means of first SOLPS-ITER simulations with drifts activated predict beneficial detachment properties and the activation of an additional strike point by the drifts.
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