| 1. |
- Aronsson, Mattias, et al.
(författare)
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The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation : results from a MANTRA-PAF substudy.
- 2015
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Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 17:1, s. 48-55
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment.METHODS AND RESULTS: A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients.CONCLUSION: Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211).
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| 2. |
- Carlson, Jonas, et al.
(författare)
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Left Atrial Conduction along the Coronary Sinus during Ectopic Atrial Tachycardia and Atrial Fibrillation: A Study Using Correlation Function Analysis
- 2003
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Ingår i: Journal of Cardiovascular Electrophysiology. - : Wiley. - 1540-8167 .- 1045-3873. ; 14:10 Suppl, s. 148-153
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Tidskriftsartikel (refereegranskat)abstract
- ntroduction: Correlation function analysis was applied to endocardial electrograms to investigate conduction patterns along the coronary sinus (CS) during sinus rhythm (SR) and atrial tachycardias. Methods and Results: Eighteen recordings were obtained from 14 patients suffering from supraventricular tachycardias. Five atrial fibrillation(AF) recordings were compared to 10 SR recordings and 3 ectopic atrial tachycardia (EAT) recordings. The maximum correlation coefficient was used to assess similarity between signals, i.e., if they originate from the samewavefront. The cumulative time delay, calculated as pairwise summation of interelectrode time delays was used as an indicator of activation sequence along CS. Method validation using SR showed right to left conduction with high correlations in 8 of 10 recordings indicating one single wavefront. EAT recordings showed consistent left to right conduction with left atrial foci and right to left with right atrial focus and lower correlations than SR. All 5 AFrecordings showed predominantly left to right conduction direction, also with correlations lower than SR.Conclusion: 1) Correlation function analysis can be used to assess agreement between signals and direction of activation spread. 2) Due to the position of CS, the results can be used to derive mechanisms of interatrial conduction. 3) Consistency in electrical activity propagation along CS iscommon in AF.
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| 3. |
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| 4. |
- Cosedis Nielsen, Jens, et al.
(författare)
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Radiofrequency Ablation as Initial Therapy in Paroxysm Atrial Fibrillation
- 2012
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Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 367:17, s. 1587-1595
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation.MethodsWe randomly assigned 294 patients with paroxysmal atrial fibrillation and no history of antiarrhythmic drug use to an initial treatment strategy of either radiofrequency catheter ablation (146 patients) or therapy with class IC or class III antiarrhythmic agents (148 patients). Follow-up included 7-day Holter-monitor recording at 3, 6, 12, 18, and 24 months. Primary end points were the cumulative and per-visit burden of atrial fibrillation (i.e., percentage of time in atrial fibrillation on Holter-monitor recordings). Analyses were performed on an intention-to-treat basis.ResultsThere was no significant difference between the ablation and drug-therapy groups in the cumulative burden of atrial fibrillation (90th percentile of arrhythmia burden, 13% and 19%, respectively; P=0.10) or the burden at 3, 6, 12, or 18 months. At 24 months, the burden of atrial fibrillation was significantly lower in the ablation group than in the drug-therapy group (90th percentile, 9% vs. 18%; P=0.007), and more patients in the ablation group were free from any atrial fibrillation (85% vs. 71%, P=0.004) and from symptomatic atrial fibrillation (93% vs. 84%, P=0.01). One death in the ablation group was due to a procedure-related stroke; there were three cases of cardiac tamponade in the ablation group. In the drug-therapy group, 54 patients (36%) underwent supplementary ablation.ConclusionsIn comparing radiofrequency ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation, we found no significant difference between the treatment groups in the cumulative burden of atrial fibrillation over a period of 2 years.
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| 5. |
- Fernlund, Eva, et al.
(författare)
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Novel Mutation in the KCNJ2 Gene Is Associated with a Malignant Arrhythmic Phenotype of Andersen-Tawil Syndrome.
- 2013
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Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 18:5, s. 471-478
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Tidskriftsartikel (refereegranskat)abstract
- Andersen-Tawil syndrome (ATS) is a rare inherited multisystem disorder associated with mutations in KCNJ2 and low prevalence of life-threatening ventricular arrhythmias. Our aim was to describe the clinical course of ATS in a family, in which the proband survived aborted cardiac arrest (ACA) and genetic screening revealed a previously unknown mutation (c.271_282del12[p.Ala91_Leu94del]) in the KCNJ2 gene.
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| 6. |
- Hertervig, Eva, et al.
(författare)
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Electroanatomic mapping of transseptal conduction during coronary sinus pacing in patients with paroxysmal atrial fibrillation
- 2003
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 37:6, s. 340-343
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To delineate the electrophysiological properties of transseptal conduction from the left to the right atrium in patients with paroxysmal atrial fibrillation ( AF). Design and results - Right atrial mapping using the electroanatomic mapping technique was performed at 111 +/- 16 sites in 16 patients with paroxysmal AF during pacing from distal coronary sinus ( CS). A single transseptal breakthrough near the CS ostium was observed in all patients. The activation time from the pacing site to the earliest septal activation site was 47 +/- 13 ms. The total septal activation time ( 68 +/- 16 ms) was markedly longer but the total right atrial activation time ( 118 +/- 17 ms) was similar to that in patients without AF in a previous observation. Conclusion - During distal CS pacing, a preferential site of transseptal conduction near the CS ostium was demonstrated in patients with paroxysmal AF. This has clinical implications when surgical dissection or catheter ablation is considered to eliminate interatrial connection in patients with AF.
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| 7. |
- Hertervig, Eva, et al.
(författare)
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Evidence for electrical remodelling of the atrial myocardium in patients with atrial fibrillation. A study using the monophasic action potential recording technique.
- 2002
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961. ; 22:1, s. 8-12
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Tidskriftsartikel (refereegranskat)abstract
- Experimental studies have shown that remodelling of the atrial myocardium is linked to the occurrence and perpetuation of atrial fibrillation (AF). Clinical evidence, however, is insufficient. We recorded monophasic action potentials (MAP) during AF from one to three sites in the right atrium in seven patients with chronic AF (CAF) and in 11 patients with paroxysmal AF (PAF). The fibrillatory (FF) interval between two consecutive upstrokes of the MAP was measured using a computer-assisted manual method. The mean, median, 15th, 10th, 5th percentile and shortest FF intervals were calculated in each patient and used as estimates of the local atrial effective refractory period (AERP) during AF. In three patients burst pacing at 400 and 500 beats min(-1) was delivered during the MAP recording. In nine patients, the AERP was also tested using the extra stimulus technique during sinus rhythm. RESULTS: Thirty-eight recordings were obtained. The shortest FF interval was significantly shorter in patients with CAF as compared with that in patients with PAF (50+/-13 vs. 72+/-31 ms, P<005). Similar differences were seen in the mean, median, 15th, 10th, and 5th percentile FF interval. The AERP during sinusrhythm was significantly longer than the estimated AERPs (P<0 05 to P<0.01) in the nine patients. There was no significant difference in FF interval before and after the burst pacing in the three patients. CONCLUSION: The AERP was significantly shortened during AF, as compared with that during sinus rhythm, and the AERP shortening was more marked in patients with CAF than in patients with PAF. These clinical findings support the connection between the electrical remodelling and the occurrence and/ or perpetuation of the AF.
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| 8. |
- Hertervig, Eva, et al.
(författare)
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Global dispersion of right atrial repolarization in healthy pigs and patients
- 2003
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 37:6, s. 329-333
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To investigate the feasibility of monophasic action potential ( MAP) mapping using an electro-anatomical mapping system ( CARTO) in obtaining information on global dispersion of atrial repolarization and to evaluate the role of dispersion of repolarization in the genesis of paroxysmal atrial fibrillation ( PAF). Methods and results - Right atrial MAPs were recorded from 53 +/- 18 sites in 10 healthy pigs and 33 +/- 21 sites in 6 patients with and 4 patients without history of PAF. In pigs, the global dispersions of activation time ( AT), MAP duration and end of repolarization time ( EOR), 70 +/- 8, 95 +/- 18 and 121 +/- 28 ms, respectively, were significantly greater than those among 10, 20 and 30 sites. In patients with PAF, the global dispersions of MAP duration and EOR ( 128 +/- 10 and 149 +/- 31 ms) were significantly greater than those in patients without PAF ( 84 +/- 10 and 91 +/- 17 ms). Conclusion - MAP mapping using the CARTO system was feasible in experimental and clinical settings in obtaining information on global dispersion of atrial repolarization. The number of recording sites could significantly affect repolarization parameters. The dispersions of atrial repolarization were significantly greater in patients with PAF than those without, suggesting the involvement of an increased dispersion of repolarization in the genesis of PAF.
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| 9. |
- Hertervig, Eva, et al.
(författare)
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Pulmonary vein potentials in patients with and without atrial fibrillation.
- 2008
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Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 10, s. 692-697
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Tidskriftsartikel (refereegranskat)abstract
- Background Pulmonary vein (PV) potentials are invariably recordable at the PV ostia in patients with atrial fibrillation (AF) and delayed conduction around the PV ostia may play a role in the initiation and maintenance of AF. Aims To investigate the presence and extent of PV potentials in patients with and without AF. Methods and results Circumferential catheter recordings at the PV ostia were obtained from 10 patients with paroxysmal AF and 9 with concealed Wolff-Parkinson-White (WPW) syndrome without history of AF. Typical PV potential was defined as either rapid deflections that separated from atrial deflection with a time delay in-between, or multiphasic, continuous or fractionated potentials. The presence of PV potentials was verified during sinus rhythm and during atrial pacing at the distal coronary sinus for the left PVs or at the right atrial appendage for the right PVs. To quantify the extent in which the PV potentials were recordable, the number of PVs with typical PV potentials recordable was counted. The time interval from the onset to the end of the electrograms recordable at the PV ostium (A-PV interval) was measured, and the maximal and mean of this interval were obtained. Typical PV potentials were recorded in 31 of 34 PVs (91%) in patients with AF, but in 4 of 36 PVs (11%) in patients with concealed WPW. A narrow, biphsic or triphasic, potential was recorded in 3 of 34 PVs (9%) in patients with AF, but in 29 of 36 (81%) PVs in patients with concealed WPW. The maximal and mean A-PV intervals were significantly longer in patients with AF (71 +/- 24 and 49 +/- 13 ms) than in patients with concealed WPW syndrome (33 +/- 14 and 25 +/- 6 ms). Conclusion In patients with AF, typical PV potentials with marked conduction time delay were almost invariably recordable at the PV ostium, but in patients without a history of AF, merely simple, narrow potentials were found. These findings support the involvement of conduction delay and re-entrant activities around the PV ostia in the genesis and/or perpetuation of AF.
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| 10. |
- Holmqvist, Fredrik, et al.
(författare)
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Interatrial conduction can be accurately determined using standard 12-lead electrocardiography: validation of P-wave morphology using electroanatomic mapping in man.
- 2008
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1547-5271. ; 5:3, s. 413-418
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Different P-wave morphologies during sinus rhythm as displayed on standard ECGs have been postulated to correspond to differences in interatrial conduction. OBJECTIVE: The purpose of this study was to evaluate the hypothesis by comparing P-wave morphologies using left atrial activation maps. METHODS: Twenty-eight patients (mean age 49 +/- 9 years) admitted for ablation of paroxysmal atrial fibrillation were studied. Electroanatomic mapping of left atrial activation was performed at baseline during sinus rhythm with simultaneous recording of standard 12-lead ECG. Unfiltered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology. The morphology was subsequently classified into one of three predefined types. All analyses were blinded. RESULTS: The primary left atrial breakthrough site was the fossa ovalis in 8 patients, Bachmann bundle in 18, and coronary sinus in 2. Type 1 P-wave morphology was observed in 9 patients, type 2 in 17, and type 3 in 2. Seven of eight patients with fossa ovalis breakthrough had type 1 P-wave morphology, 16 of 18 patients with Bachmann bundle breakthrough had type 2 morphology, and both patients with coronary sinus breakthrough had type 3 P-wave morphology. Overall, P-wave morphology criteria correctly identified the site of left atrial breakthrough in 25 (89%) of 28 patients. CONCLUSION: In the vast majority of patients, P-wave morphology derived from standard 12-lead ECG can be used to correctly identify the left atrial breakthrough site and the corresponding route of interatrial conduction.
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